y

y y y o

= =

, <2 mm =

  o y o o Kohn: Lambert: :

(lobular):

2 ,

y o o , y o o 2 , ,

y o o , y o y o o   o   , , , , 2 , ,

1 o o o o 2 acinus o o o 2

: , , = 30 50 1 ,

= 3 12 acinus

2 o o o o o o o

: HRCT

, , 2  

= = , = ,

o   

2 : ( : ( : , 3 12 acini ( + ) , ), . . 2 , . . , ( , ) + , )

+ o

o o o CT depended , , o HRCT o o . o   o o  : , <2 mm ,

o o o o

2 3 2 3 , ,

: window centre: 300 and 950 HU window widths: 1,000 and 1,500 HU

 o  mm o (air trapping): . 1 ( . ) , , . 5 10

How to Approach CT of the Lung? o o o o

o o o o o o ,  y y : , , , 2 ) y y , y . . . y  y y y y o ) o y y y ( ) : , ) = , , , ( . . depended , = , , , 2 ( . . / ( ) 2

, (

, .

 y y y o

o o o o o o o : :

(cystic like): , , ,

Fig. 3.5. CT of the lung coronal reconstruction. Mosaic perfusion in both lungs secondary to recurrent pulmonary embolism and refl ecting decreased perfusion in some lung areas and fl ow redistribution to the normal surrounding areas. Note the difference in vessel 5onspec when areas of increased and decreased attenuation are compared (arrows). This difference in 5onspec is absent when inhomogeneous lung attenuation is caused by a patchy distribution of ground-glass opacity (Fig. 3.2)

o o o o o

<3 1 3 = 7 mm 10 mm= < 7 mm = o o

o o

o o o o o o ( o

. .

/ , , , septal lines), , , (

. .

y y y

Crazy paving ( Honey combing (

): ): ,

Upper lung versus lower lung versus diffuse distribution y Upper: Langerhans cell histiocytosis, sarcoidosis, silicosis and coal workers pneumoconiosis, tuberculosis, histoplasmosis respiratory bronchiolitis, cystic fibrosis, chronic eosinophilic pneumonia, centrilobular emphysema, paraseptal emphysema, y Lower: oedema, usual interstitial pneumonia (UIP) (idiopathic pulmonary fi brosis (IPF) and disease-associated UIP), asbestosis, 6onspecific c interstitial pneumonia (NSIP), desquamative interstitial pneumonia (DIP), lipoid pneumonia, 6onspecifi pneumonia, haematogenous metastases, alveolar haemorrhage, panlobular emphysema y Diffuse: hypersensitivity pneumonitis, lymphangioleiomyomatosis, diffuse pneumonia, lymphangitic spread of tumour, haematogenous metastases, sarcoidosis Central lung versus peripheral lung y Central(surrounding the large bronchovascular structures): sarcoidosis, silicosis and coal workers pneumoconiosis, lymphangitic spread of tumour, alveolar proteinosis, large airways disease y Peripheral: usual interstitial pneumonia (UIP) (idiopathic pulmonary fi brosis (IPF) and disease-associated UIP), asbestosis, 6onspecific c interstitial pneumonia (NSIP), chronic eosinophilic pneumonia, 6onspecifi pneumonia, acute interstitial pneumonia (AIP), desquamative interstitial pneumonia (DIP), hypersensitivity pneumonitis, haematogenous metastases, septic emboli, pulmonary embolism, small airways disease

Posterior versus anterior lung (depended vs non depended) y Posterior: pulmonary oedema, adult respiratory distress syndrome (ARDS) usual interstitial pneumonia (UIP) (idiopathic pulmonary fi brosis (IPF) and disease-associated UIP), asbestosis, 7onspecific c interstitial pneumonia (NSIP), silicosis and coal workers pneumoconiosis, sarcoidosis, hypersensitivity pneumonitis, lipoid pneumonia y Anterior: post-adult respiratory distress (ARDS) fi brosis Can be unilateral or asymmetric Pneumonia, lymphangitic spread of tumor, sarcoidosis 2 y y y y y y : 2

in or surrounding the blood vessels [(peri-)vascular] in or surrounding the large airways [(peri-)bronchial] immediately under the pleura (subpleural) in the interlobular septa in the central part of the secondary pulmonary lobule somewhere in between

y o o depended ( , . ) o y o o o     interstitial lung disease) o y o . 2 o y o , . . ( , )  Crazy paving ( ): ( . ) ( , , , , ) . , , CT depended , ( : )

(RBILD) (respiratory bronchiolitis

y o

vs Acute course of disease y Pulmonary infection (bacterial, viral, pneumocystis jiroveci pneumonia, mycoplasma pneumonia) y Pulmonary oedema y Pulmonary haemorrhage y Adult (acute) respiratory distress syndrome [ARDS] y Acute interstitial pneumonia [AIP] y Eosinophilic pneumonia (acute) y Radiation pneumonitis (acute)  Subacute/chronic course of disease y Hypersensitivity pneumonitis y Smoking related parenchymal lung disease, y respiratory bronchiolitis (Respiratory bronchiolitis - interstitial lung disease [RBILD], Desquamative interstitial pneumonia [DIP]) y Usual interstitial pneumonia [UIP]: idiopathic pulmonary fi brosis [IPF] and disease associated UIP y Nonspecifi c interstitial pneumonia (NSIP) y Alveolar proteinosis y Lymphocytic interstitial pneumonia [LIP] (Sj gren syndrome, AIDS) y Asbestosis y Vasculitis (Churg-Strauss syndrome) y Eosinophylic pneumonia (chronic) y Organising pneumonia y Bronchioloalveolar carcinoma y Lipoid pneumonia y Sarcoidosis o = o = ( ) Crazy paving ( ): o o  ( Intralobular, interlobular, perilobular, interstisium)   o : o Acute course of disease  Pulmonary oedema  Pulmonary infection (bacterial, viral, Pneumocystis  jiroveci pneumonia, mycoplasma pneumonia)  Pulmonary haemorrhage  Acute interstitial pneumonia [AIP]  Adult (acute) respiratory distress syndrome [ARDS]  Radiation pneumonitis (acute)  Eosinophilic pneumonia (acute) o Subacute/chronic course of disease  Usual interstitial pneumonia [UIP]: idiopathic pulmonary  fi brosis [IPF] and disease associated UIP  Nonspecifi c interstitial pneumonia [NSIP]  Alveolar proteinosis  Organising pneumonia  Vasculitis (Churg-Strauss syndrome)  Eosinophylic pneumonia (chronic)  Bronchioloalveolar carcinoma (mucinous) 

   y o o

Lymphangitic spread of tumour Sarcoidosis Lipid pneumonia , . ( . . , UIP)

: 

Acute course of disease y Pulmonary infection (bacterial, Pneumocystis jiroveci pneumonia, aspergillus and mycoplasma y pneumonia) y Pulmonary oedema y Pulmonary haemorrhage y Adult (acute) respiratory distress syndrome [ARDS] y Acute interstitial pneumonia [AIP] y Eosinophilic pneumonia (acute) y Radiation pneumonitis (acute) Subacute/chronic course of disease y Organising pneumonia y Bronchioloalveolar carcinoma y Lymphoma y Eosinophilic pneumonia (chronic) y Vasculitis (Churg-Strauss syndrome) y Lipoid pneumonia y Usual interstitial pneumonia [UIP]: idiopathic pulmonary fi brosis [IPF] and disease associated UIP y Nonspecifi c interstitial pneumonia [NSIP] y Hypersensitivity pneumonitis y Sarcoidosis y Lymphocytic interstitial pneumonia [LIP] (Sj gren syndrome, AIDS)