2 PULMONARY OPACITY Area that more opaque than the surrounding area “area that preferentially attenuates the x-ray beam”Area that more opaque than the surrounding areaCLASSIFIED INTOAirspace opacitiesAtelectasis (collapse)Nodules and massesLinear and band like opacitiesCysts and bullaeNodular and reticulonodular opacities and honeycombing
9 RadioGraphics,Infectious pneumonia in a 35-year-old patient with hypogammaglobulinemia.November 2009 RadioGraphics, 29,
10 Small focus of pulmonary consolidation caused by pulmonary infarction David Hansell et al, Imaging of diseases of the chest, 5th edition, 2010
11 Widespread, uniform airspace opacities in acute respiratory distress syndrome David Hansell, Imaging of diseases of the chest, 5th edition, 2010
12 ATELECTASIS Most frequent cause is bronchial obstruction Bronchial obstruction in adultUsually the result of a bronchial neoplasm or mucus plugOccasionally, FB aspiration, broncholiths, extrinsic compression e.g. enlarged LNs, aortic aneurysmPassive atelectasisDiscoid atelectasis ( Platelike or linear atlectasis)A form of adhesive atelectasisUsually abuts the pleura and is perpendicular to pleural surface
14 David Hansell, Imaging of diseases of the chest, 5th edition, 2010
15 Left upper lobe collapse due to bronchial carcinoma Left upper lobe collapse due to bronchial carcinoma. Note that the carcinoma has caused ‘rat tail’ narrowing of the left upper bronchus.David Hansell, Imaging of diseases of the chest, 5th edition, 2010
16 Fluid bronchogram at CT Fluid bronchogram at CT. Fluid-filled bronchi beyond a carcinoma in the atelectatic lower left lobe are clearly visible. David Hansell, Imaging of diseases of the chest, 5th edition, 2010
17 ROUND ATELECTASISA form of chronic atelectasis that resembles a massMain DDx is BCA“bronchi and vessels curving into the periphery and converging toward a mass and area of pleural thickening (Comet tail sign)”
18 David Hansell, Imaging of diseases of the chest, 5th edition, 2010
19 SOLITARY PULMONARY NODULE/MASS Pulmonary nodule : lesion up to 3 cm in diameter.DDx of SPN/massNeoplasmBCA, metastasis, lymphoma, carcinoid tumor, hamartoma, etcInflammatoryInfection: TB, fungus, round pneumonia, lung abscess, septic emboliNon infection: RA, Wegener granulomatosis
20 SOLITARY PULMONARY NODULE/MASS DDx of SPN/massCongenitalPulmonary AVM, sequestration, lung cyst, bronchial atresia with mucoid impactionMiscellaneousOrganizing pneumonia, pulmonary infarction, round atelectasis, etc.Mimics of SPNExternal objectBone island or rib, healing rib fracturePleural plaqueLoculated pleural fluid
21 Patient with a known extrathoracic malignant neoplasm Patients with CA of H&N, bladder, breast, cervix, bile ducts, esophagus, ovary, prostate, or stomach with SPN“primary lung CA were more likely than metastasis”Patients with known salivary glands, adrenals, colon, kidney, thyroid, thymus or uterus“fairly even odds”Patients with known melanoma, sarcoma, or testicular cancer“solitary metastasis is more likely than primary lung CA”
22 Features which can be diagnostically helpful CalcificationFat density within a noduleGround glass opacitySizeShapeCavitationAir bronchogram and bubblelike lucenciesEnhancment
23 BENIGN CALCIFICATION Concentric calcification Popcorn calcification Uniform calcificationDavid Hansell et al, Imaging of diseases of the chest, 5th edition, 2010
24 David Hansell et al, Imaging of diseases of the chest, 5th edition, 2010
25 Fat in hamartomaDavid Hansell et al, Imaging of diseases of the chest, 5th edition, 2010
26 Density of the noduleMarch 2007 RadioGraphics, 27,
27 Size and shapeDavid Hansell et al, Imaging of diseases of the chest, 5th edition, 2010
28 Fleischner society recommendations MacMahon et al. Radiology 237:395, Nov 2005
29 Contrast enhancementRate of growthAdjacent bone destruction
33 Miliary TB Metastasis thyroid CA SILICOSIS Silva et al, The teaching files chest , 2010.SILICOSIS
34 Centrilobular nodules in Subacute hypersensitivity pneumonitis Silva et al, The teaching files chest, 2010.
35 Tree-in-bud in infective bronchiolitis Silva et al, The teaching files chest, 46-47,2010.
36 Pulmonary metastasis Miliary TB RANDOM DIST NODULES Silva et al, The teaching files chest, 48-49, 2010.
37 ABNORMAL LUCENCY LESION Cyst, cavity, bleb, bulla, emphysemaCYST;any round circumscribed space that is surrounded by an epithelial or fibrous wall of variable thicknessCAVITY;a gas-filled space, seen as a lucency or low-attenuation area, within pulmonary consolidation, a mass, or a noduleusually produced by the expulsion or drainage of a necrotic part of the lesion via the bronchial treeCavity is not a synonym for abscess.
38 BLEB;a small gas-containing space within the visceral pleura or subpleural lung, not > 1 cm in diameterCT: a thin-walled cystic airspace contiguous with the pleuraBULLA;An airspace measuring > 1 cm – usually several centimeters – in diametersharply demarcated by a thin wall that is no greater than 1 mm in thickness.usually accompanied by emphysematous changes in the adjacent lung.Bullous emphysema is bullous destruction of the lung parenchymausually on a background of paraseptal or panacinar emphysema
39 EMPHYSEMA;permanently enlarged airspaces distal to the terminal bronchiole with destruction of alveolar wallsCT; focal areas or regions of low attenuation, usually without visible walls.[