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369
TUESDAY
Patterns of Lung
Disease on CTJannette Collins, MD, MEd, FCCP
University of Wisconsin, Madison
CT “Pattern”
“Nonspecific finding or
collection of findings on CT
suggesting one or more
specific disease processes”
Objectives1. Describe 7 patterns of
disease seen on CT
2. State the differentialdiagnosis associated witheach pattern
3. Recognize each pattern
Honeycomb
Cystic
Nodular
Ground Glass
Mosaic
Tree-in-bud
Septal thickening
Honeycomb pattern
•Cystic airspaces
•Thick, clearly definable walls
•Layered along pleural
surface
•Pulmonary fibrosis
Honeycomb pattern
• IPF
•Collagen vascular diseases
•Asbestosis
*Upper lung – sarcoidosis, HP
Patterns of Lung Disease on CTJannette Collins, MD, MEd
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TUESDAY
62 year-old-woman
with Sjogren
disease
Cystic Pattern
•Thin-walled
•Circumscribed
•Air-filled
Cystic Pattern
•Langerhan cell histiocytosis
•Lymphangioleiomyomatosis
•LIP
•Collagen vascular diseases
•PCP
•Emphysema (look-alike)
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Centrilobular Emphysema Centrilobular artery
50- year-old-woman with
progressive SOB and
history of spontaneous
PTX
Lymphangioleiomyomatosis
40 year-old-man with
history of cigarette
smoking and an
abnormal CXR
Langerhan Cell Histiocytosis
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nodule cyst
LIP
Pneumocystis PneumoniaNodules
•Perilymphatic
•Random
•Centrilobular
•Bronchovascular
Nodular Pattern -
Perilymphatic
•Sarcoidosis
Sarcoidosis
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Nodular Pattern - Random
•Silicosis/Coal worker’s
pneumoconiosis
•TB/fungal
•Metastases
Silicosis
Miliary Tuberculosis Colon cancer metastases
Nodular Pattern -
Centrilobular
Nodular Pattern -
Centrilobular
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Hypersensitivity Pneumonitis43 year-old-man with
SOB and history of
cigarette smoking
Respiratory Bronchiolitis Nodular Pattern -
Bronchovascular•Lymphoproliferative disorders
•Lymphangitic carcinomatosis
•Kaposi sarcoma
•Sarcoidosis
•COP
• Infectious pneumonia
Post-transplant Lymphoproliferative
Disease
LIP and Sjogren Disease
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Kaposi Sarcoma Sarcoidosis
Ground Glass Pattern•Hazy opacity
•Preserved
bronchi/vessels
•Nonspecific
Ground Glass Pattern• Infectious pneumonia
• Pulmonary hemorrhage
• COP
• Pulmonary alveolar proteinosis
• BAC
• DIP/NSIP
• EDEMA!
Mycoplasma Pneumonia Diffuse Alveolar Hemorrhage
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Cryptogenic Organizing Pneumonia Pulmonary Alveolar Proteinosis
Bronchoalveolar cell carcinoma DIP
NSIP Edema
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Mosaic Pattern•Infiltrative
disease
•Small airwaysdisease
•Pulmonaryvasculardisease
Obliterative Bronchiolitis
Inspiration Expiration
Tree-in-Bud Pattern
•Centrilobular dots and linear
branching opacities
•Bronchiolar dilatation
•Bronchiolar impaction
Tree-in-Bud Pattern
•Infection
Bacterial bronchiolitis
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MAC Tree-in-Bud Pattern
•ABPA
•Cystic fibrosis
•Aspiration
•Diffuse panbronchiolitis
ABPA Cystic Fibrosis
Aspiration Diffuse Panbronchiolitis
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Interlobular septal
thickening
•Marginates secondary
pulmonary lobule
•Contains pulmonary veins
and lymphatics
•“Kerley” lines
Interlobular Septa
Smooth ILS thickening
•Pulmonary edema
•Infectious pneumonia
Pulmonary Edema
Nodular ILS thickening
•Lymphangitic carcinomatosis
•Sarcoidosis
Lymphangitic Carcinomatosis
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TUESDAY