4 Holes in the lung Cyst - thin walled ( 1-3 mm) - alone or in groups Cavity- represents areas of tissue necrosis & clearing within areas of parenchymal opacification.- thick walled ( > 3 mm )- suggests a more aggressive pathologythan a cyst.
5 Holes in the lung Focal * cyst * cavity Diffuse LymphangioleiomyomatosisTuberous sclerosisL.C.HisteocytosisHoneycombing diseaseEmphysema
12 Congenital cystic adenomatoid malformation ( CCAM ) * air , fluid , or air-fluid containing cysts of varying sizes* 3 types are recognized based on cyst size & number- type or more large cysts(2-10cm)- type 2---neumerous small cysts- type 3 – solid with microcysts
16 Bleb* usually located in the apex of lung within the pleura
17 Pneumatoceletypically associated with infection, particularly staph. Pneumonia in childrencharacteristically increase in size over time.probably due to Ball-valve air-trapping.resolves eventually.May reach a large size to fill the hemi- thorax
24 Hydatid disease* endemic in sheep-raising areas of Mediterranean basin* solitary in 75%, multiple in 25%* water density* rare calcify* complications:rupture between layers of cyst—meniscus or halo signruptue into bronchus—water lilly signrupture into pleura---hydropneumothorax
42 Bronchiectasis Cystic structures continuous with broncheal tree. Signet ring sign
43 Cavity We have to look at: * wall thickness * contents ------- air air-fluid levelair with soft tissue mass.* relation to broncheal tree
44 Wall thickness : more than 4 mm Contents* only air : regularity of the inner margin- if regular……chronic lung abscess- if irregular ….cavitating tumor* air-fluid level:- if fluid level is straight…acute lung abscess- if fluid level is wavy ….ruptured hydatid cyst* contents of the cavity-if inner wall is smooth with soft tissueinside….mycetoma-if inner wall is irregular with soft tissuemass..necrotic tumor
45 Cavity containing only air * regularity of inner margin- if regular ---ch. Lung abscess- if irregular---cavitating tumor
46 Cavity with air-fluid level - if fluid level is straight-------- acute lung abscess- if fluid level is wavy ----------ruptured hydatid cyst
47 Cavity with mass inside - if inner wall is smooth---mycetoma- if inner wall is nodular –necrotic tumor
54 Diffuse holes in the lung LymphangioleiomyomatosisTuberous sclerosisL.C.HistiocytosisHoneycombing diseaseEmphysema
55 Lymphangioleiomyomatosis (LAM ) Proliferation of smooth muscles in lung interstitiumHyperinflated lungWidespread thin wall cystsNo nodulesDiffuse lung involvementComplicated by pneumothorax (40%) & chylothothorax (60%)Only in femalesAll patients die within 10 years.
59 Tuberous sclerosis * autosomal dominant * pulmonary changes seen almost exclusively only in females in 3rd-4th decades* changes similar to LAM except chylous effusion
60 L.C.Histeocytosis Histeocytes proliferation Widespread cyts & nodules Cysts are irregular in shapes (bizzare, bilobed, leaf like ),more numerous in apices, sparing costo-pherenic anglesLung volume is preserved>90% Smokers, middle age , menSpontaneous pneumothorax in 15%
62 Honeycombing diseaseIndicates “end stage “ lung and can be seen in any process leading to severe pulmonary fibrosisAdjacent small cysts , 1-3 mm, typically share wallsPredominate in lower lobes, peripheral & subpleural lung regionsTypically occur in several contiguous layers
63 60% due IPFOther causes:- autoimmune diseaselike scleroderma & RA- hypersensitivitypneumonitis- drug reactions- asbestosis
65 EmphysemaPerminant, abnormal,enlargement of airspaces distal to the terminal bronchioles, accompanied by destruction of walls of the involved airspaces3 types:- centrilobular emphysema- panlobular emphysema- paraseptal emphysema
66 Centrilobular emphysema The more commonerUsually results from cigarette smokingMainly involves upper lobesMultiple, small, lucencies, lack visible wallscentrilobular distributd (grouped near the center of 2ry pulmonary lobules), surrounding the centrilobular artery
69 Panlolobular ( panacinar) emphysema Uniform destruction of pulmonary lobulediffuse or more severe in lower lungPulmonary vessels in affected lung appear smaller and fewer than normalNo focal lucincies can be seen
70 Paraseptal emphysemaMore stricking in subpleural location, arranged in single layerOften have visible very thin wallsCan be an isolated phenomenonCan be associated with centrilobular emphysemaWhen larger than 1cm , are termed as bulla
71 Paraseptal emphysema, Centrilobular emphysema and bulla can coexist together while panlobular emphysema is usually not associated with paraseptal emphysema or bulla .
77 In cystic lesions, benign nature is often be assumed, while cavitary lesions usually suggest more aggressive pathology.Other forms of focal pulmonary cysts may be seen in adults outside these clinical sittings, and are of obscure origin but are thaught to be related to smoking.