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Miscellaneous Diffuse Pulmonary Diseases

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What Radiology Residents Need to Know: Chest Radiology

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Abstract

This chapter describes a broad spectrum of diffuse pulmonary disease, including sarcoidosis, lymphangioleiomyomatosis (LAM), pulmonary alveolar proteinosis, ANCA-associated granulomatous vasculitis, scleroderma, cystic fibrosis, drug toxicity, radiation-induced lung disease, lymphoid interstitial pneumonia (LIP), and amyloidosis.

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References

  1. Eisenberg RL. Clinical Imaging: An Atlas of Differential Diagnosis. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2010.

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Authors and Affiliations

  1. Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Ronald L. Eisenberg MD, JD

Authors
  1. Ronald L. Eisenberg MD, JD
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Electronic Supplementary Material

Fig. e15.1

Sarcoidosis. Adenopathy circumferentially encircles the trachea, producing the donut sign (arrows) (TIF 1658 kb)

Fig. e15.1

Sarcoidosis. Adenopathy circumferentially encircles the trachea, producing the donut sign (arrows) (TIF 2583 kb)

Fig. e15.2

Sarcoidosis. (a) Lateral radiograph. (Courtesy of Jeffrey Klein, MD, Burlington, VT) (TIF 850 kb)

Fig. e15.2.

Sarcoidosis. (b) coronal CT image (same patient as Figure 2) show extensive eggshell calcifications in hilar and mediastinal lymph nodes bilaterally. (Courtesy of Jeffrey Klein, MD, Burlington, VT) (TIF 756 kb)

Fig. e15.3

Sarcoidosis. (a) Diffuse reticulonodular pattern widely distributed throughout both lungs (TIF 619 kb)

Fig. e15.3

Sarcoidosis. (b) Diffuse reticulonodular and alveolar infiltrates [1] (TIF 683 kb)

Fig. e15.4

Sarcoidosis. Diffuse bilateral mediastinal and hilar adenopathy. Calcification in the affected hilar nodes suggests a prolonged clinical course. Note the simultaneous presence of huge subcarinal nodes (arrowheads), an unusual finding in other granulomatous diseases such as tuberculosis [1] (TIF 1244 kb)

Fig. e15.5

Sarcoidosis. Interstitial abnormalities with a bronchovascular distribution primarily involve the upper lungs. (Courtesy of Diana Litmanovich, MD, Boston) (TIF 1872 kb)

Fig. e15.6

Sarcoidosis. Galaxy sign. (a) Coalescence of perilymphatic nodules produces a mass surrounded peripheral small nodules (TIF 109 kb)

Fig. e15.6

Sarcoidosis. Galaxy sign. (b) In another patient, a similar process produces multiple masses bilaterally (TIF 180 kb)

Fig. e15.7

Sarcoidosis. Perilymphatic distribution of numerous small nodules in relation to the parahilar bronchovascular interstitium. The bronchial walls appear irregularly thickened. Subpleural nodules (small arrows) border the costal pleural surfaces and right major fissure, an appearance virtually diagnostic of sarcoidosis. Clusters of subpleural granulomas (large arrows) have been termed “pseudoplaques” [1] (TIF 626 kb)

Fig. e15.8

Sarcoidosis. Characteristic pattern of bullae associated with central scarring and bronchiectasis. Note the scattered, poorly marginated nodules, some of which appear to have a perivascular distribution [1] (TIF 541 kb)

Fig. e15.9

Sarcoidosis. Distortion of pulmonary architecture. (a) Bilateral ground-glass opacities and parenchymal distortion (arrows) with moderate traction bronchiectasis, all predominantly involving the upper lobes [2] (TIF 1408 kb)

Fig. e15.9

Sarcoidosis. Distortion of pulmonary architecture. (b) Bilateral ground-glass opacities and parenchymal distortion (arrows) with moderate traction bronchiectasis, all predominantly involving the upper lobes [2] (TIF 1816 kb)

Fig. e15.10

Sarcoidosis. Scattered bilateral areas of ground-glass attenuation associated with inter- and intralobular lines in a young asymptomatic man [1] (TIF 1595 kb)

Fig. e15.11

Sarcoidosis. (a) Large central masses with partially well-defined and partially ill-defined margins (“alveolar” sarcoid) (TIF 501 kb)

Fig. e15.11

Sarcoidosis. (b) More peripheral lesions with air bronchograms [1] (TIF 506 kb)

Fig. e15.12

Sarcoidosis. (a) Parenchymal nodules in both lungs mimic metastatic disease (TIF 1048 kb)

Fig. e15.12

Sarcoidosis. (b) Parenchymal nodules in both lungs mimic metastatic disease [1] (TIF 1023 kb)

Fig. e15.13

Sarcoidosis. Various manifestations. (a) Hilar enlargement (small arrows) and diffuse reticulonodular opacities (large arrows), predominantly in the upper lungs (TIF 1917 kb)

Fig. e15.13

Sarcoidosis. Various manifestations. (b) Bilateral hilar lymphadenopathy (arrows), virtually without calcification (TIF 1308 kb)

Fig. e15.13

Sarcoidosis. Various manifestations. (c) Innumerable micronodules in a centrilobular and peribronchovascular distribution (arrows) (TIF 1284 kb)

Fig. e15.13

Sarcoidosis. Various manifestations. (d) In a different patient, multiple calcified mediastinal and hilar lymph nodes (large arrow), as well as pulmonary opacities that have a mass-like appearance (small white arrows) [2] (TIF 1753 kb)

Fig. e15.14

Sarcoidosis. Effect of treatment. (a) Initial view shows Grade IV disease with extensive reticulonodular changes in the mid and upper lungs bilaterally (TIF 1633 kb)

Fig. e15.14

Sarcoidosis. Effect of treatment. (b) After several months of intensive steroid therapy, there has been remarkable improvement, with only relatively mild fibrotic residual (TIF 3345 kb)

Fig. e15.15

Lymphangioleiomyomatosis. Numerous thin-walled cystic air spaces of various sizes [1] (TIF 1113 kb)

Fig. e15.16

Lymphangioleiomyomatosis. Multiple ringlike lucencies (arrows) [3] (TIF 1493 kb)

Fig. e15.17

Pulmonary alveolar proteinosis. Diffuse geographic ground-glass attenuation with superimposed intra- and interlobular septal thickening (arrowhead). Note the polygonal appearance, which represents the secondary pulmonary lobule [1] (TIF 1437 kb)

Fig. e15.18

Pulmonary alveolar proteinosis. (a) Widespread air-space disease and superimposed reticular interstitial thickening. Note the nocardial abscess in the left lower lobe [1] (TIF 552 kb)

Fig. e15.18

Pulmonary alveolar proteinosis. (b) After bronchoalveolar lavage, the air-space and interstitial components have diminished (TIF 555 kb)

Fig. e15.19

ANCA-associated granulomatous vasculitis. Multiple irregular nodules in a peribronchovascular distribution [1] (TIF 1558 kb)

Fig. e15.20

Scleroderma. (a) Interstitial changes. (Courtesy of Gillian Lieberman, MD, Boston) (TIF 553 kb)

Fig. e15.20

Scleroderma. (b) Acro-osteolysis of the fingers. (Courtesy of Gillian Lieberman, MD, Boston) (TIF 987 kb)

Fig. e15.21

Scleroderma. Scan obtained at the level of the liver dome shows patchy areas of ground-glass attenuation, irregular linear hyperattenuating areas, and traction bronchiectasis [1] (TIF 1387 kb)

Fig. e15.22

Scleroderma. Patulous esophagus with air-fluid level (white arrow), recurrent aspiration with subsequent bibasilar bronchiectasis, and chronic ground-glass opacities. The black arrow points to a bronchus visible in the peripheral 1 cm of the lung [4] (TIF 1403 kb)

Fig. e15.23

Cystic fibrosis. Multiple small cysts superimposed on a diffuse, coarse, reticular pattern [1] (TIF 904 kb)

Fig. e15.24

Cystic fibrosis. (a) Dilated, thick-walled bronchi (large arrow), as well as collapse of the right middle lobe (small arrows), which contains dilated airways (TIF 582 kb)

Fig. e15.24

Cystic fibrosis. (b) More inferior image shows the “tree-in-bud” pattern (arrows) [1] (TIF 585 kb)

Fig. e15.25

Cystic fibrosis. (a) Distinct bronchial wall thickening and bronchiectasis (arrows) surrounded by ground-glass opacities in the apex of the right lung (TIF 1244 kb)

Fig. e15.25

Cystic fibrosis. (b) Bilateral bronchiectasis and mucous impaction (arrows) primarily involve the upper lungs (TIF 1762 kb)

Fig. e15.25

Cystic fibrosis. (c) Bilateral bronchiectasis and mucous impaction (arrows) primarily involve the upper lungs (TIF 1489 kb)

Fig. e15.25

Cystic fibrosis. (d) In another patient, an expiratory image shows distinct mosaic attenuation due to air trapping in small airways disease. There is also typical bronchiectasis with mucous plugging (arrows) [2] (TIF 1401 kb)

Fig. e15.26

Drug toxicity (cocaine abuse). Diffuse bilateral reticular opacities with superimposed thickening of inter- and intralobular interstitium [1] (TIF 601 kb)

Fig. e15.27

Drug toxicity (bleomycin). Scattered areas of ground-glass opacity and thickening of interlobular septa in the lower lungs with a right pleural effusion. There is architectural distortion and traction bronchiectasis secondary to fibrosis [1] (TIF 1530 kb)

Fig. e15.28

Amiodarone toxicity. (a) Heterogeneous multifocal areas of parenchymal opacification in the right lower lung (TIF 1900 kb)

Fig. e15.28

Amiodarone toxicity. (b) The attenuation of the liver is much higher than that of the spleen, a characteristic finding of amiodarone use but not an indicator of toxicity (TIF 568 kb)

Fig. e15.29

Radiation-induced lung disease. Two months after radiation therapy for tracheal carcinoma, localized air-space consolidation has developed in the right lower lobe. There is also interstitial disease that produces thickened intralobular septa centrally. Later scans showed the development of dense scaring [1] (TIF 884 kb)

Fig. e15.30

Radiation fibrosis. One year after radiation therapy for lung carcinoma, there is a reticular pattern and ground-glass opacity in the medial aspect of the right upper lobe. Note the traction bronchiectasis due to fibrosis and the sharp demarcation between the normal and irradiated lung [1] (TIF 684 kb)

Fig. e15.31

Radiation fibrosis. Extensive traction bronchiectasis (arrows) in the irradiated field [4] (TIF 2195 kb)

Fig. e15.32

Radiation fibrosis. (a) Geographic configuration of interstitial opacities in the right middle and lower lung (arrows), with elevation of the right hemidiaphragm. (Courtesy of Gillian Lieberman, MD, Boston) (TIF 704 kb)

Fig. e15.32

Radiation fibrosis. (b) In another patient, there is a parenchymal opacity in the left lung with a linear lateral margin (arrows) from a radiation port and traction bronchiectasis consistent with fibrosis of the irradiated area. (Courtesy of Gillian Lieberman, MD, Boston) (TIF 592 kb)

Fig. e15.33

Lymphocytic interstitial pneumonia. (a) Scattered cysts (arrows) in a patient with Sjogren syndrome and LIP [3] (TIF 1484 kb)

Fig. e15.33

Lymphocytic interstitial pneumonia. (b) In another patient with AIDS and LIP, there are numerous lung cysts (arrows) [3] (TIF 1326 kb)

Fig. e15.34

Amyloidosis of the airways. Diffuse circumferential thickening of the bronchial walls bilaterally (arrows). Note the high-attenuation regions in the bronchial walls, which likely represent calcification [1] (TIF 1954 kb)

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Eisenberg, R.L. (2020). Miscellaneous Diffuse Pulmonary Diseases. In: What Radiology Residents Need to Know: Chest Radiology . Springer, Cham. https://doi.org/10.1007/978-3-030-16826-1_15

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  • DOI: https://doi.org/10.1007/978-3-030-16826-1_15

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