54 Upper Zone-Predominant Disease

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig C 54-1 Postprimary tuberculosis. Large cavitary lesion with surrounding consolidation involves the apical posterior segment of the right upper lobe. (Courtesy of Diana Litmanovich, M.D., Boston)

• Fig C 54-2 Sarcoidosis. Coronal projection shows that the interstitial abnormalities in a bronchovascular distribution primarily involve the upper lung zones. (Courtesy of Diana Litmanovich, M.D., Boston)

• Fig C 54-3 Pulmonary Langerhans cell histiocytosis. Irregular nodules and thick-walled cysts in the upper lung. Lower sections (not shown) showed relative sparing of the lung bases.104

• Fig C 54-4 Silicosis. Scan obtained at the level of the aortic arch shows large symmetric bilateral opacities with irregular margins (arrows) indicative of progressive massive fibrosis, as well as numerous small nodules and septal thickening (arrowheads).105

• Fig C 54-5 Centrilobular emphysema. Section through the upper lobes shows subtle areas of lung destruction limited to individual secondary pulmonary lobules. The structure of these lobules, including the central core structures, is intact. Such subtle emphysema will often remain undetected on chest radiography. (Courtesy of Diana Litmanovich, MD, Boston)

• Fig C 54-6 Chronic eosinophilic pneumonia. Air-space consolidation primarily involves the peripheral lung.106

• Fig C 54-7 Cystic fibrosis. Scan obtained at the level of the upper lobes demonstrates severe signs of bronchiectasis partly filled with mucus, moderate signs of bronchial wall thickening, multiple areas of consolidation (arrows) with air bronchograms, and emphysema (arrowheads).107

• Fig C 54-8 Allergic bronchopulmonary aspergillosis. (A) Initial scan shows multiple tubular areas of increased attenuation in the left upper lobe. (B) Repeat study 2 months later shows cystic bronchiectasis in the region.46

• Fig C 54-9 Neurogenic pulmonary edema. Confluent alveolar consolidations in the central portions of the upper lungs. A few thickened interlobular septa are also seen (arrows).108

• Fig C 54-10 Ankylosing spondylitis. Severe volume loss of the lung apices with traction cystic bronchiectasis.109