chronic bronchitis (chronic obstructive pulmonary disease) · diffuse pulmonary and alveolar...

Definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pulmonary disorder characterized by increased resistance to airflow · FEV1/FVC< 70%." Epidemiology

Among smokers 15–20% develop COPD." Etiology, pathophysiology, pathogenesis

Inflammatory reaction of the large and small airways caused by inhaled noxiousagents and involving bronchial obstruction, mucociliary dysfunction, and struc-tural changes (destruction) · Disruption of the physiologic balance between pro-teases and protease inhibitors · Oxidative stress.

Imaging Signs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

" Modality of choiceCT.

" Radiographic findingsOften normal · Bronchial walls may appear more pronounced (“tramline” shad-ows) · Signs of right heart strain.

" CT findingsThickened bronchial walls ·Mucus retention · Centrilobular emphysemamay bepresent · Enlarged central pulmonary arteries.

" Pathognomonic findingsChronic bronchitis and COPD are not radiologic diagnoses ·Morphologic findingson the radiograph essentially depend on the severity of the disorder.

Clinical Aspects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

" Typical presentationProductive cough · Dyspnea · Hemoptysis · Clubbed fingers.Reduced FEV1, abnormal blood gases, elevated C‑reactive protein.Functional grading FEV1 (GOLD): Stages 0–IV (I: mild, ≥ 80%; II: moderate, 50–79%; III: severe, 30–49%; IV: very severe, < 30%).Systemic components of COPD: weight loss, cachexia (“pink puffer” · pulmonarycachexia in COPD with emphysema) · osteoporosis, muscle atrophy · heart fail-ure, atherosclerosis.

" Therapeutic optionsTobacco abstinence · Bronchodilators · Inhalational corticosteroids · Oxygentherapy.

" Course and prognosisChronic progressive disorder ·Mortality depends on the stage.

" What does the clinician want to know?The diagnosis is based on clinical and especially functional parameters · Radiolo-gy plays a supporting role by determining the extent of emphysema and identify-ing complications.

..... 31

2Disorders

ofthe

Airw

aysChronic Bronchitis (Chronic Obstructive Pulmonary Disease)

Galanski, Direct Diagnosis in Radiology. Thoracic Imaging(ISBN 9783131451316), © 2010 Georg Thieme Verlag KG

Differential Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Asthma – Hyperinflation without parenchymal destruction

Emphysema – Centrilobular emphysema is often a component ofCOPD

Bronchiectasis – Frequent complication of chronic bronchitis

Selected References

Takasugi JE, Godwin JD. Radiology of chronic obstructive pulmonary disease. Radiol ClinNorth Am 1998; 36: 29–55

Vogelmeier C et al. [Pathogenese der COPD.] Internist 2006; 47: 885–894 [In German]

.....32

Fig. 2.5 COPD in a48-year-old womansmoker. Morphologicfindings on the radio-graph are hardly impres-sive except in advancedcases with recurrent in-fection. The plain chestradiograph shows alow-lying, flattened dia-phragm consistent withhyperinflation and aslightly increased bron-chovascular shadowingin the basal lung seg-ments. Vascularity isminimal in the upperfields due to emphysem-atous changes.

2

Disorders

ofthe

Airw

ays

Chronic Bronchitis (Chronic Obstructive Pulmonary Disease)


Definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diffuse pulmonary and alveolar hemorrhages from various causes." Epidemiology

The most common cause is Goodpasture syndrome (affects young adults, morecommon in men than women by a ratio of 9 :1) · Less common causes includecollagen vascular diseases (more common in women than men), idiopathic dis-ease (pulmonary hemosiderosis), hemorrhagic diathesis, and diffuse coagulationdisorder.

" Etiology, pathophysiology, pathogenesisBleeding into the alveoli due to immune-mediated capillary damage (antibodiesto glomerular and alveolar basement membranes in Goodpasture syndrome) ordue to nonimmune-mediated capillary damage · Leads successively to recurrenthemorrhage, hemosiderin deposits, and fibrosis.

Imaging Signs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

" Modality of choiceCT is preferable to plain radiography.

" Radiographic findingsNodular, confluent to patchy, edemalike shadows · Predominantly basal and cen-tral · In the acute stage there is alveolar shadowing · In the subacute stage thereis an interstitial reticulonodular pattern · Resolves within 1–2 weeks · Chronicstage (recurrent hemorrhages) leads to fibrosis.

" CT findingsFindings in the acute stage include ill-defined acinar nodules, circumscribedground-glass opacities, or diffuse bilateral consolidation that spares the pulmo-nary periphery · The subacute stage includes micronodules and septal thicken-ing · In the chronic stage there are signs of fibrosis.

" Pathognomonic findings on CTAcute nodular or interstitial shadowing that rapidly resolves spontaneously.


" Typical presentationHemoptysis (in 80% of cases but not invariably), dyspnea, cough, and iron-defi-ciency anemia · Goodpasture syndrome also includes hematuria, renal insuffi-ciency, hypertension · Bronchoalveolar lavage shows hemosiderin-laden macro-phages.

" Therapeutic optionsTreatment of the underlying disorder · Immunosuppressives · Glucocorticoids ·Plasmapheresis.

" Course and prognosisVariable · Depend on the underlying disorder.

" What does the clinician want to know?Diagnosis and differential diagnosis · Stage · Follow-up.

..... 161

7Im

mune

Disorders

andDisorders

ofUncertain

EtiologyPulmonary Hemorrhage and Goodpasture Syndrome


.....162

Fig. 7.6 Goodpasturesyndrome in a 35-year-old man. The CT scansshow bilateral, homoge-neously dense, ground-glass opacification thathas spared only the sub-pleural parenchyma.

7

Immune

Disorders

andDisorders

ofUncertain

Etiology

Pulmonary Hemorrhage and Goodpasture Syndrome



Pulmonary hemorrhage – Goodpasture syndrome: antibodies to basementmembrane

– Wegener granulomatosis: ANCA‑positive involve-ment of the paranasal sinuses

– Churg–Strauss syndrome: asthma, blood eosinophilia– Systemic lupus erythematosus: ANCA‑positive– Polyangiitis: pulmonary and renal syndrome,fever, myalgia, joint pain, 80% of patients areANCA‑positive

– Idiopathic hemosiderosis: occurs in children,no renal involvement, no antibodies

Pulmonary edema(cardiac, not cardiac)

– Hemoptysis rare– Associated pleural effusion

Interstitial pneumonia – Fever, inflammation parameters– No hemoptysis– No renal involvement

Tips and Pitfalls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Can be misinterpreted as pulmonary edema or atypical pneumonia.

..... 163

Fig. 7.7 Acute pulmo-nary hemorrhage in a70-year-old woman withdyspnea and hemopty-sis. Moderately dense,homogeneous, bilateralperihilar and basal shad-ows resembling a butter-fly edema.

7Im

mune

Disorders

andDisorders

ofUncertain

EtiologyPulmonary Hemorrhage and Goodpasture Syndrome


Definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lymphoma limited to the chest and lungs, with or without mediastinal lymphade-nopathy · No extrathoracic manifestation for at least 3 months." Epidemiology

Rare compared with secondary lymphoma arising via hematogenous dissemina-tion or by direct extension from hilar or mediastinal lymphomas.

" Etiology, pathophysiology, pathogenesisForms:– In combination with intrathoracic lymphadenopathy · 10–15% of lympho-

mas ·More common in Hodgkin disease than in non-Hodgkin lymphoma.– Primary pulmonary lymphoma (at most with minimal lymph node involve-

ment) · Rare, < 1% of all malignant lymphomas · Either Hodgkin or non-Hodg-kin lymphoma · In primary pulmonary non-Hodgkin lymphoma, a distinctionis made between low-grade MALT B‑cell lymphoma, high-grade non-Hodgkinlymphoma of B‑cell type (about two-thirds of cases, usually associated withEpstein–Barr virus; risk groups—HIV‑infected patients and organ transplantrecipients), and the angioimmunoblastic lymphomas of T‑cell type.

Imaging Signs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

" Modality of choiceCT is preferable to plain radiography.

" Radiographic findingsBroad spectrum of findings ranging from miliary foci to nodules, pneumonia-likeinfiltrates (with or without air bronchogram), and interstitial and even ground-glass changes.

" CT findingsBroad spectrum of findings (in two-thirds of cases there are bilateral and/or mul-tiple foci)—one or more nodules with or without cavitation · Round or segmentalinfiltrates (with or without an air bronchogram) · Up to 50% of high-grade lym-phomas include liquefaction that may be rapidly progressive · Reticulonodularchanges.

" Pathognomonic findingsRapidly progressive consolidations with an air bronchogram and elongated bron-chovascular structures (CT angiogram sign).


" Typical presentationLow-grade lymphoma: Asymptomatic in > 50% of cases, otherwise mild nonspe-cific symptoms (cough, slight dyspnea, chest pain) · High-grade lymphoma: Gen-erally symptomatic (symptoms of hepatitis B infection).

" Confirmation of the diagnosisBiopsy.

..... 197

8Bronchopulm

onaryNeoplasm

sPulmonary Lymphoma


.....198

Fig. 8.9 Highly malig-nant Epstein–Barr virus-associated B‑cell non-Hodgkin lymphoma in a39-year-old man withHIV infection. Two-weekhistory of fever, nonpro-ductive cough, and rapiddeterioration of generalhealth.a The plain chest radio-

graph shows an ex-tensive, relatively ho-mogeneous infiltra-tion of the right lowerlobe, enclosing a smallradiolucency consis-tent with liquefaction.

b On CT (coronal MIPslices) the finding alsoappears relatively ho-mogeneous. The ma-jor vessels and bron-chi are intact (CT an-giogram sign and airbronchogram).

8

Bronchopulmonary

Neoplasm

s

Pulmonary Lymphoma


..... 199

Fig. 8.10 MALT lympho-ma in a 40-year-old manwith HIV infection andweight loss and limitedexercise tolerance. Bothlungs show large infil-trates resembling roundfocal lesions that are par-tially confluent in thebasal segments, formingpneumonia-like areas ofconsolidation. The bron-chovascular structurescoursing through theseareas appear intact; theyare not significantlyshifted, compressed, orobstructed. These find-ings suggest lymphomainfiltrates. There may behilar lymphadenopathyon the right side.

8Bronchopulm

onaryNeoplasm

sPulmonary Lymphoma


" Therapeutic optionsLow-grade lymphoma: Watch and wait, resection, or single-modality therapy ·High-grade lymphoma: Treatment depends on the underlying disorder, chemo-therapy, modulation of immunosuppression.

" Course and prognosisLow-grade lymphoma has a good prognosis (5-year survival rate is over 80%) ·High-grade lymphoma has a poor prognosis, depending on the initial situation(HIV infection, organ transplantation).

" What does the clinician want to know?Staging after diagnosis by biopsy.


Nodular lesions – Bronchial neoplasm– Metastases

Areas of consolidation – Pneumonia– Distinguished by history, clinical findings, and course

Interstitial changes – Pulmonary interstitial disorder

Kaposi sarcoma – Radiographically indistinguishable

Tips and Pitfalls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Because pulmonary lymphomas are rare, radiographic findings may variously bemisinterpreted as pneumonia, malignancy (lung carcinoma, metastases), or pulmo-nary interstitial disease.

Selected References

Cadranel J, Wislez M. Antoine M. Primary pulmonary lymphoma. Eur Respir J 2002; 20:750–762

Gimenez A et al. Unusual primary lung tumors: a radiologic-pathologic overview. Radio-graphics 2002; 22: 609–619

Lee DK et al. B‑cell lymphoma of bronchus-associated lymphoid tissue (BALT): CT featuresin 10 patients. J Comput Assist Tomogr 2000; 24: 30–34

.....200

8

Bronchopulmonary

Neoplasm

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Pulmonary Lymphoma


.....346

A

abdomen, blunt trauma 317abscessmediastinal 283paraspinal 248pulmonary 294

acceleration/deceleration forces307, 311, 313

achalasiaesophageal 268, 269–270secondary 270

Actinomyces israelii 298actinomycosis 298–300acute coronary syndrome 217acute myeloid leukemia 106, 334adenocarcinoma 48, 49, 180, 182, 187,194, 196

adenoma, bronchial 192adenoviruses 64, 70adult respiratory distress syndrome(ARDS) 69, 72, 228, 320–322

air bronchogram 187, 197, 198air crescent sign 105, 107, 108,109, 214

air trapping 25, 28, 29, 30, 33, 51alveolar cell carcinoma 187–190alveolar proteinosis 99, 113, 128,170–172, 228

alveolitisextrinsic allergic 153–156associated with aspergillosis 105differential diagnosis 113, 116,122, 125, 128, 131

not associated with smoking25, 30, 122, 125

fibrosing 132, 140toxic 156

amiodarone, drug reactions 323, 326anemia, hemolytic 259aneurysmaortic 265–268, 271subclavian artery 206

angiographytraditional 6see also CT angiogram sign; digitalsubtraction angiography (DSA)

anorexia 87anthracosilicosis 57, 58–59antiarrhythmic agents, drug reactions323

antibodies see anticytoplasmic anti-bodies; antinuclear antibodies

anticytoplasmic antibodies 138, 144antiinflammatory agents, drugreactions 323

antinuclear antibodies 135, 138, 140,144, 166

antiseptic agents, drug reactions 323antitopoisomerase I antibodies 140α1-antitrypsin deficiency 37aortaaneurysm 265–268, 271coarctation 12, 268, 274–276dissection 271–273ectasia 273pseudocoarctation 274rupture 311–312

aortic arch, anomalies 12, 13,277–278, 279

aortic valvebicuspid 274disease 227stenosis 268

arteriovenous malformation1–2, 214

artificial respiration, barotrauma98, 313

asbestos exposure 44, 45, 180, 292asbestos-associated changes 62, 296asbestosis 61–63, 133, 143aspergilloma 105, 107, 109–111aspergillosisallergic 36, 50, 105, 151–152associated phenomena 105differential diagnosis 93imaging signs 102invasive 105noninvasive 109–111

Page locators in italics indicateillustrations.

Index


..... 347

Aspergillus 70, 102, 105, 109hypersensitivity reactionsee aspergillosis, allergic

aspiration, sequelae 81–83, 310aspiration pneumonia 69aspiration pneumonitis 81asthmaatopic 151, 157bronchial 24, 40, 105, 151differential diagnosis 32, 81, 152

atelectasis 41–43, 69, 310platelike 8round (folded lung) 41, 44–46, 214

atopic disorders 157autoimmune disorders 129, 135, 140azygos vein, dilation 279–281

B

bare area sign 289barotrauma, due to artificialrespiration 98, 313

bat wing sign 99, 170, 226blast injuries 307blastomycosis 102bleomycin, drug reactions 323“blue bloater” 38Bochdalek hernia 262, 264, 317Boerhaave syndrome 282, 315bone marrow transplantation334, 336

breast carcinoma, metastases207, 211, 252, 256, 303, 304

bridging symptoms 61, 62bronchial atresia 15–17, 151bronchial carcinomacentral 14, 18, 19differential diagnosis 150lymphangitis carcinomatosa 210metastases 215, 252, 256, 257,303, 304

peripheral 181, 182, 190with poststenotic pneumonia 75radiation pneumonitis 329and smoking 296, 300

bronchial rupture 313–314

bronchiectasis 20, 22–24in allergic bronchopulmonaryaspergillosis 151, 152

asbestos-related 61aspiration-related 81in bronchial carcinoid 191in chronic pneumonia 86in chronically ill patients 94in common variable immunodefi-ciency (CVID) 54

complication of chronic bronchitis32

in cystic fibrosis 33, 34, 35, 54, 203imaging 6, 22in immotile cilia syndrome/Kartagener syndrome 51, 52

and mycobacterial infection 94in nonobstructive middle lobesyndrome 47

in nonspecific interstitialpneumonitis 126, 127

postinfectious 36, 91reversible 24in rheumatoid arthritis 132in scimitar syndrome 6in Sjögren syndrome 138“string of pearls” appearance 115traction 114, 153, 167, 328in viral pneumonia 97

bronchioalveolar carcinoma 119, 172,187–190

bronchiolectasis 126, 127bronchiolitis 25–27, 120, 122allergic 25, 153postinfectious 28respiratory 25, 120, 122, 123–125,156

in rheumatoid arthritis 132bronchiolitis obliterans 25, 28–30, 40differential diagnosis 119in MacLeod/Swyer-Jamessyndrome 8

with organizing pneumonia 25, 30,323, 325

result of drug reaction 323, 324syndrome 28, 333–335

Index


.....348

bronchiolitis obliteranssee also cryptogenic organizingpneumonia

bronchitis, chronic 24, 31–32bronchoceles 151bronchopneumonia 76–77bronchopneumonic infiltrate 11bronchopulmonary infections 6, 9,70, 156, 298recurrent 6, 33, 38, 54, 193

bronchoscopy, indicated 55, 56Broviak catheter 339bulging fissure sign 73

C

calcificationseggshell 58–59goiter 234, 235, 236lymph nodes 256parenchymal 344–345popcorn 183, 195, 214tuberculoma 214

calcified foci 91, 92Candida 70, 102candidiasis, imaging signs 102capillary hemangiomatosis 219capillary leak syndrome 336, 338carcinoidbronchial 191–194differential diagnosis 183, 215metastases 256thymic 237, 239

cardiac anomalies 12cardiac pacemaker 342–343cardiomegaly 223, 226cardiomyopathy 221, 222carmustine, drug reactions 323Castleman disease 235, 252, 253–255catheters 339–341Ceelen–Gellerstedt syndrome165–166

central venous catheters 339–341Chagas disease 270chemotherapy agents, drug reactions323

chest painacute 216in esophageal rupture 315in Langerhans cell histiocytosis177

localized 298in mediastinitis 282neoplastic 181, 184, 197,239, 242

in pleural empyema 294in pneumonia 64, 73, 86, 103in pneumothorax 286in pulmonary embolism 216radiating into the back 271in systemic lupus erythematosus135

unilateral 301chest trauma 307, 311, 313Chlamydia pneumoniae 64chlamydial infection 64, 78, 90chloride transport, defective 33chondrohamartoma 214choriocarcinoma 240, 256chronic obstructive pulmonary disease(COPD) 31–32

Churg–Strauss syndrome 160chylothorax 291coagulation disorder 280coccidiomycosis 102collagen diseasesand aortic aneurysm 265differential diagnosis 129, 137, 143,144, 166

nonspecific interstitial pneumonitis126

pleural effusion 289, 291and pneumothorax 286pulmonary involvement 116, 117,119, 122, 128

see also rheumatoid arthritis;systemic lupus erythematosus

comet tail 44, 45, 46common variable immunodeficiency(CVID) 54

connective tissue disorderssee collagen disease

Index


..... 349

consolidationsin collagen diseases 135, 137, 144,147, 149

intrapulmonary 10in middle lobe syndrome 47, 52in pneumonia 64, 80, 83, 97, 100,101, 112, 113

subpleural or peribronchial117, 128

in tuberculosis 91, 93contusions 307–310coronary heart disease 221coughchronic 47, 94productive 25, 31, 64, 76, 79, 171smokerʼs 123

crazy paving pattern 112, 113, 128,170, 171, 187

Crispin–Norman score 33cryptococci, opportunistic pneumonia70

cryptococcosis, imaging signs 102Cryptococcus neoformans 102cryptogenic organizing pneumonia117–119, 323, 325differential diagnosis116, 128, 190

CT angiogram sign 188, 189, 197, 198Cushing syndrome 239cyclophosphamide, drug reactions323

cystic changes 80, 114, 138, 142, 153,155, 174, 201, 202, 203in Langerhans cell histiocytosis60, 177, 178

cystic fibrosis 33–36, 50, 54, 151,152, 203

cysts 229–233bronchogenic 229, 231developmental anomalies 229differential diagnosis 40esophageal duplication 229isolated lesions 229neuroenteric 229pericardial 230, 231pulmonary 138

thin-walled 131, 173, 174, 178thymic 231, 232, 233, 237, 239

cytomegalovirus 70, 100cytomegalovirus pneumonia 80, 97,100–101, 104, 112

D

dependent viscera sign 317dermatomyositis 144–146desquamative interstitial pneumonia120–122, 125, 128

developmental anomaly 274dextrocardia 51dialysis catheter 339diaphragmrelaxation 317rupture 317–319

digital subtraction angiography(DSA) 7

displaced crus sign 289drug abusers, septic embolism 84, 85drug reactions 122, 323–327, 338dust inhalation, chronic 57dystelectasis 136

E

edemaat high altitude 12atypical 69, 75butterfly 163, 166, 226differential diagnosis 72in engraftment syndrome 336, 338imaging 330reperfusion 330–332see also pulmonary edema

eggshell calcification 58–59Ehlers–Danlos syndrome265, 271, 286

Eisenmenger reaction 3emphysemabullous 23, 179, 288centrilobular 32, 37local 15, 16mediastinal 313, 314

Index


.....350

emphysema, panlobular 30, 37, 176paraseptal 37pulmonary 37–40quantification and classification 39and smoking 37

empyema 73, 84, 291, 294, 300,303, 306

endobronchial tumor 19endocarditis 227endometriosis 303engraftment syndrome 336–338Enterobacteriaceae 67eosinophilic lung disease 157–160eosinophilic pneumonia119, 157–160, 323

Epstein–Barr virus 70, 129,197, 198

Escherichia coli 67esophagusdilatation 140, 212fistula 316rupture, usually iatrogenic282, 315–316

stenosis 270varices 260

extralobar sequestration 9, 11extrapulmonary infections 72

F

fallen lung sign 313falls 307farmerʼs lung 153feeding vessel sign 207fertility/sterility 51fibrosing alveolitis 132, 140fibrosing mediastinitis 282fibrosishoneycomb 153often not recognized as sarcoidosis169

pleural 292–293radiation-induced 206see also idiopathic pulmonaryfibrosis

fibrothorax 292, 306

filling defects 216, 218finger in glove shadows 151focal lesionsin anthracosilicosis 58aspergilloma 109in cryptogenic organizingpneumonia 117, 118

extrapulmonary 292in Langerhans cell histiocytosis177, 178

in nonsmall cell lung cancer180, 186

pulmonary 147, 148in rhematoid arthritis 133, 134in sarcoidosis 167traumatic 309in Wegener granulomatosis147, 148

folded lung 41, 44–46, 214foreign body aspiration 14, 19,55–56, 81

fungal infectionschronic 93differential diagnosis 150, 169,209, 300

endemic to North America 102radiographic findings 72, 102septic embolisms 84see also aspergillosis

fungal pneumonia 70, 78, 80, 86,102–104secondary to sigmoid colonperforation 68

G

ganglioneuroblastomas 244, 248ganglioneuromas 244gastric juice, aspirated 81germ cell tumors 239, 240–243, 256goiter, retrosternal 234–236,239, 243

Goldenʼs sign 41Goodpasture syndrome 161–164graft-versus-host disease 29, 30,334, 336

Index


..... 351

granulomasdifferential diagnosis 183noncaseating 167postinfectious 215

granulomatosisbronchocentric 152see also Wegener granulomatosis

gunshot wounds 307

H

Haemophilus influenzae 51, 64, 70, 76halo sign 105, 108, 147, 189, 190hamartoma 183, 194, 214pulmonary 195–196

Hampton hump 46Hashimoto disease 129heart failure 226chronic 224

hemangioendothelioma 303hematoma, paraspinal 248hemithorax 12, 13hypertransradiant 18–21, 55

hemopoiesis, extramedullary 248,259–261

hemoptysis 12, 161, 163, 165, 166hemothorax 292traumatic 310, 311

hepatitis B 84hepatization, red, yellow, gray 73hereditary hemorrhagic telangiectasiasee Osler–Weber–Rendu disease

herniadiaphragmatic 262–264, 317hiatal 262–264, 316paraesophageal 316

herpesviruses 70in viral pneumonia 97

Hickman catheter 339histoplasmosis 102HIV/AIDSand Castleman disease 253opportunistic infections 70, 71pneumocystis pneumonia 112see also immunocompromised pa-tients; pneumocyctis pneumonia

Hodgkin disease 197, 250–252honeycomb lung 153, 177honeycombingin asbestosis 61in idiopathic pulmonary fibrosis114, 115, 122, 143

in Jo-1 syndrome 145in rheumatoid arthritis 132in systemic sclerosis 140, 142

Horner syndrome 204hot tub lung 94hypercalcemia 344hypereosinophilia syndrome157, 160

hyperhydration 223, 226hyperinflation 55hyperparathyroidism 344, 345hypersensitivity pneumonia 179hypersensitivity pneumonitis153–156see also alveolitis, extrinsic allergic

hypertension 271hypertensive crisis 224hypervolemia 279hypogammaglobulinemia 237

I

iceberg tumor 191immotile cilia syndrome36, 51–54, 53

immunocompromised patientscytomegalovirus pneumonia100, 101

fungal pneumonia 102lymphocytic interstitial pneumonitis129

pneumocystis pneumonia 101, 112pneumonia 70pulmonary lymphoma 197, 199tuberculosis 91viral pneumonia 97

immunodeficiency 23, 78immunosuppressants, drug reactions324

infarct pneumonia 217

Index


.....352

influenza viruses 70in viral pneumonia 97

inhalationchronic, of dust 57of noxious/toxic substances122, 153

interface sign 289International Labour Organizationclassification 61, 296

interstitial pneumonia 225idiopathic 137secondary 122, 128

interstitial shadowing 89, 97, 99,113, 224perihilar 171

invasive pulmonary aspergillosis105–108

inverse ε sign 274iodine deficiency 234

J

Jo-1 syndrome 145

K

Kaposi sarcoma 200, 254Kartagener syndrome 22, 36,51–54, 52

Kerley B lines 223, 224Klebsiella 64, 67, 70, 73

L

lacerations 307–310Lady Windermere syndrome 94Langerhans cell histiocytosis 177–179cystic changes 60, 125, 131,169, 176

nodular changes 40predilection for upper and middlelung fields 203

large cell carcinoma 180, 181laryngeal papillomatosis 201–203left heart failure 221, 222, 223,224, 227

left-to-right shunt 3, 6, 219Legionella 64, 67, 73leukocytosis with left shift 64, 73lipoma, thymic 237, 239Listeria 70lobar pneumonia 65, 73–75, 77Loeffler infiltrate 157lungaccessory 9congenital hypoplasia 6

lung cancer see nonsmall cell lungcancer; small cell lung cancer

lung transplantation 295bronchiolitis obliterans syndrome28, 29

rejection or other complications101, 295

sequela 330–332lupus pneumonitis 135lymph nodesbenign hyperplasia 253–255calcifications 256central necrosis 256metastases 169, 186, 252, 256–258

lymphadenopathyasymmetric 169benign 186hilar 220inflammatory infectious 252, 258mediastinal 173, 188normal venous anatomy 279in sarcoidosis 167, 168, 169, 279

lymphangioleiomyomatosis40, 173–176, 179

lymphangioma 231lymphangitis carcinomatosa207, 210–212, 225

lymphocytic interstitial pneumonitis122, 129–131, 138, 176

lymphomas 250–252angioimmunoblastic 197differential diagnosis 119, 169, 186,235, 243

generalized 239MALT 129, 197, 199mediastinal involvement 250, 251

Index


..... 353

non-Hodgkin 197, 198, 250–252pleural metastases 304primary malignant 258pulmonary 190, 197–200, 209

M

Mach effect 288MacLeod/Swyer-James syndrome8, 14, 18, 19, 20–21, 37

malignancysigns of 301, 304suspected 213

MALT lymphoma 129, 197, 199Marfan syndrome 265, 271, 286measles virus, in viral pneumonia 97meconium ileus 33mediastinal massgoiter 234, 236thymic tumor 237, 238

mediastinitis 282–283mediastinumcysts 229–233germ cell tumors 240infiltration 205, 244, 251, 298,299, 301

involvement in lymphoma 250, 251involvement in neurogenic tu-mors 245

involvement in small cell lungcancer 184, 185

widening 41, 43, 242, 246, 271, 273,311, 312

melanoma 256meningocele 206, 231, 248meniscus sign 289, 290mesothelioma 61, 260, 301–303, 304metastasesbrain 184differential diagnosis 150hematogenous spread207, 211, 304

lymphatic spread 304miliary 207, 208mucinous adenocarcinoma 256osteochondral tumors 256

pleural 304–306pulmonary 207–209solitary 207, 209spinal 185thyroid carcinoma 208, 305of unknown primary 256

methotrexate, drug reactions 323microabscesses, pleural 86microlithiasis, alveolar 345middle lobe syndrome 47–50mitral valvedefect 221, 222prolapse 284stenosis 219

Monday morning fever 153Morgagni hernia 262, 264, 317mosaic pattern 25, 28, 30, 33, 40, 335motor vehicle accidents 307, 311, 314mucinous adenocarcinoma, metastases256

mucociliary dysfunction 22mucoepidermoid carcinoma 194Mucoraceae 70multiple endocrine neoplasia (MEN) 1syndrome 239

myasthenia gravis 129, 237, 239mycetoma 214see also aspergilloma

mycobacterial infections 33, 70atypical 50, 70, 104nontuberculous 80, 94–96

Mycobacterium abscessus 94Mycobacterium avium-intracellulare94

Mycobacterium bovis 91Mycobacterium kansasii 94Mycobacterium malmoense 95Mycobacterium tuberculosis 91mycoplasma pneumonia 64, 75, 77,79, 80, 88

mycoplasmas 73, 76mycoses see actinomycosis; aspergillo-sis; fungal infections

myelofibrosis 259myeloproliferative syndrome 259myocardial infarction 221

Index


.....354

N

necrotizing granulomatous vasculitissee Wegener granulomatosis

Neisseria 70nerve sheath tumors 244neurilemomas 244, 245, 260neurinomas 206neuroblastomas 244, 248neuroendocrine tumors 184neurofibromas 206, 244, 246–247,260

neurofibromatosis 244neurogenic tumors 244–249, 254nicotine 25nipple shadow 215nitrofurantoin, drug reactions323, 324

nocardiosis 103nodule, solitary 213–215non-Hodgkin lymphoma 197, 198,250–252

nonsmall cell lung cancer111, 180–183

nonspecific interstitial pneumonitis122, 126–128, 131, 143, 156

O

occupational exposures 60, 296occupational safety regulations 57organic dust toxic syndrome 153Osler–Weber–Rendu disease 1, 2osteochondral tumors, metastases256

osteosarcoma, metastases 286

P

Pancoast tumor 204–206pancreatic exocrine insufficiency 33pancreatic pseudocyst 231papillomatosis 201–203papillomaviruses 201paraaminosalicylic acid, drugreactions 323

paragangliomas 254, 260parainfluenza virus, in viralpneumonia 97

paraneoplasia 144paraneoplastic syndrome 239parasitic infections 157, 160paravertebral abscess 260parenchymal bleeding 338patent ductus arteriosus 3, 12pectus excavatum 50, 284–285penicillamine, drug reactions 323pentamidine prophylaxis 80, 112perfusion defect 14, 18, 19, 216, 217peribronchial cuffing 223peripheral blood stem celltransplantation 336

peripheral bronchial carcinoma 190phrenic palsy 317pigeon breederʼs lung 153, 155“pink puffer” 31, 38pleural effusion 43, 289–291, 294,301, 303

pleural peel 292–293pleural plaques 61, 62, 296–297pleural thickeningand effusion 289, 304in endometriosis 303and interstitial edema 223in mesothelioma 301nodular 291, 304in pleural fibrosis 292and pleural plaques 296, 297postinfectious or posttraumatic62, 296

in rheumatoid arthritis 132pleuritis 132, 135pneumatoceles 86, 87, 201, 203, 307,317, 321

pneumococci 70, 73pneumoconiosis 57–60, 169see also asbestosis

Pneumocystis jirovecii 70, 78, 112, 129pneumocystis pneumonia 68, 80, 101,104, 112–113, 122

pneumomediastinum 313, 315, 316pneumonectomy 43

Index


..... 355

pneumoniaage group susceptibility75, 77, 79, 90

aspiration 81–83atypical 78–80, 163, 321bacterial 75, 77, 79chlamydial 78, 80chronic 190community-acquired 64–66, 73,76, 88

cryptogenic organizing 116,117–119, 128, 190, 323, 325

fungal 102–104hospital-acquired (nosocomial)67–69, 73, 76, 83

idiopathic interstitial 114–131, 327interstitial 77, 78–80lobar 93mixed infection 112mycoplasma 75, 88–90opportunistic 70–72organizing 25, 30poststenotic 75staphylococcal 86–87viral 75, 77, 79, 97–99

pneumonitisnonspecific interstitial323, 324, 326

radiation reaction 327, 328pneumothorax 74, 174, 177,286–288, 310

polycythemia 259polymyositis 144–146popcorn calcifications 183, 195, 214positive end-expiratory pressure(PEEP) respiration 320, 321

postirradiation aspiration 82primary sclerosing cholangitis 129protein S deficiency 217, 280Proteus spp. 67, 73pseudolesions 215Pseudomonas 33, 51, 67, 70, 76pulmonary abscess 73, 111pulmonary agenesis 43pulmonary arterial hypertension 178,219–220

pulmonary arteryatresia 12–14catheter 339dilated 219hypoplasia 12–14, 18, 19idiopathic ectasia 220

pulmonary calcinosis 344–345pulmonary carcinoma, primary 209pulmonary congestion 221–222pulmonary contusion and lacera-tion 307–310

pulmonary cyst 40pulmonary edemaalveolar 78, 226–228in ARDS 320differential diagnosis 99, 112,163, 172

in eosinophilic lung disease 157hydrostatic 223, 226, 322interstitial 78, 212, 223–225pathogenetic mechanisms 223, 226

pulmonary embolism 69, 75,216–218

pulmonary fibrosis, idiopathic 62,114–116, 122, 128, 133, 143, 169,212

pulmonary hemorrhage 99, 113,161–164, 166, 172, 228

pulmonary hemosiderosis, idiopathic165–166

pulmonary hypertension 6pulmonary hypoplasia 6pulmonary infarct 46, 69, 75pulmonary infectionssee bronchopulmonary infections

pulmonary interstitial disease 200pulmonary laceration 111, 317pulmonary lymphoma 190, 209pulmonary parenchymableeding 338calcifications 344–345cystic destruction 173, 175

pulmonary sequestration 6, 8, 9–11pulmonary syndrome, idiopathic328, 336

pulmonary valve stenosis 220

Index


.....356

pulmonary venolobar syndrome 6pulmonary venous anomalies6, 7, 8, 219

pulmonary venous pressure, elevated221–222

pulsation artifacts 311

R

radiation reaction 328–329railroad track sign 22, 24Raynaud phenomenon 140red cell aplasia 237Reid classification 22renal cell carcinoma 256reperfusion edema 330–332respiratory distress, recurrent 192respiratory syncytial virus 64, 97reticulonodular shadowing 130rheumatic disorders 62, 138rheumatoid arthritis, pleuropulmonarymanifestations 132–134

rheumatoid nodules 132, 134, 150,190, 209

ribsdestruction by Pancoast tumor204

notching 274, 275rickettsia pneumonia 80rickettsiae 78right aortic arch 12, 13right heart failure 219, 222RNA viruses 70

S

sarcoidosis 167–169, 190differential diagnosis 60, 93, 179,190, 212, 254, 258

and lymphadenopathy 144, 190peribronchovascular distribu-tion 156

predilection 119, 122, 167staging 167, 168

schwannomas 244scimitar syndrome 6–8

scleroderma 62, 133, 140–143,156, 212

Seldinger catheterization 339seminoma 240septal defects 3, 4, 6, 274septic embolism 73, 84–85, 150Serratia marcescens 67shock wave trauma 307shrinking lung syndrome 135, 137shunt 3–5sickle cell anemia 259signet ring sign 22, 24silhouette sign 41, 43, 47, 230, 232silicate dust 57silicosis 156sirolimus, drug reaction 324situs inversus 51Sjögren syndrome 138–139small cell lung cancer 184–186, 258smokingchronic 120and chronic bronchitis 31and emphysema 37and Langerhans cell histiocytosis177

lung cancer, associated withsmoking 194

and nonsmall cell lung cancer 180and small cell lung cancer 184

spinal anomalies 229splenosis 303, 306split pleura sign 294, 306sputumanalysis 64asbestos bodies 61blood-tinged 86, 226brown 79fungal hyphae 151mucopurulent 76rusty brown 73viscous 151

squamous cell carcinoma180, 182, 256

stab wounds 307Stanford classification of aorticdissection 271

Index


..... 357

staphylococcal infection 76, 295Staphylococcus aureus 64, 67streptococci 76Streptococcus pneumoniae 64, 67string of pearls pattern 22, 115, 210subclavian artery, aneurysm 206subglottic stenosis 147, 150superior vena cavalocation of central venouscatheter 339

occlusion 281superior vena cava syndrome250, 251, 279

Swan–Ganz catheter 339systemic lupus erythematosuspleural effusion 289, 291pleuropulmonary involvement135–137

systemic sclerosis 140–143

T

teratocarcinoma 240teratoma 235, 239, 240, 241testicular tumor 240thalassemia 259, 260, 261thromboembolic disease 84thymic tumors 235, 237–239,243, 254

thymoma 237–239, 243, 306thyroid carcinoma 208, 256, 305thyroid insufficiency 234TNM classification, nonsmall cell lungcancer 181–183

toothpaste shadows 151toxic substances, inhalation 122, 153tracheal stenosis 147tracheobronchial system, injury313–314

traction bronchiectasis 114, 153, 155,167, 328

traction bronchiolectasis 140tramline shadows 31trauma 307, 311, 313, 317tree-in-bud signin aspiration pneumonia 81

in cystic fibrosis 33in immotile cilia syndrome 51, 53in mycobacterial infections 94nonspecific 22, 25in tuberculosis 91in viral pneumonia 97

tuberculoma 183, 195calcification 214

tuberculosis 91–93, 104, 150,169, 256

tuberous sclerosis 173tumor cysts 231, 233tumorsbenign 303, 304often cause atelectasis 43solitary 180, 182, 187, 191,195, 306

Turner syndrome 274

U

urothelial carcinoma, pulmonarymetastases 208

V

vanillylmandelic acid 11varicella zoster virus 70vascular anomalies 341vascular permeability, increased223, 226

venous occlusive disease 219venous thromboses 280ventilator pneumonitis 153viruses 78

W

wasting diseases, chronic 78Wegener granulomatosis 79, 86, 102,111, 147–150, 190

Westermark sign 216

Y

yellow nail syndrome 54

Index


chronic bronchitis (chronic obstructive pulmonary disease) · diffuse pulmonary and alveolar...

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