Answer

Fibrosing alveolitis

There is a fine linear and nodular pattern of increased density in both lungs predominantly in the lower zones. The heart outline is shaggy - the appearances are of an interstial lung pattern and given the clinical history would fit with fibrosing alveolitis.

Interstitial diseases

Interstitial pattern shadowing is caused by thickening of the tissue surrounding the alveoli and capillaries in the lung. Probably the most well-recognised appearance is Kerly's B lines. These are short, horizontal lines in the lung bases which reach the pleura. These not only occur in heart failure but also in lymphangitis carcinomatosa.

Various types of interstitial pattern shadowing are described and these can occur in isolation or in combination such as reticular-nodular:

■ Fine netting: reticular

■ Coarse mesh: honeycomb pattern

■ Innumerable tiny nodules: nodular

Interstitial pulmonary fibrosis or fibrosing alveolitis is an idiopathic disease which causes inflammation and later lung fibrosis. Chest X-rays show an interstitial pattern which predominantly affects the bases. The lung volumes are reduced unless there is co-existing chronic obstructive pulmonary disease when lung volumes can look normal. CT or HRCT (high resolution CT) demonstrates the interstitial shadowing (Fig. 1.56) is in a peripheral distribution. Ground glass shadowing (which does not obscure pulmonary vasculature) may also be present. This can sometimes correlate with active inflammation and increased likelihood of steroid response (Table 1.8).

Fig. 1.56 CT fibrosing alveolitis. Peripherally distributed fibrosis and honeycombing. The patient is positioned prone as dependent fluid can cause diagnosic dilemma (particularly if the changes are less marked than this example).

Table 1.8 Causes of interstitial pattern shadowing

■ Chronic obstructive pulmonary disease (COPD)

■ Interstitial pulmonary oedema

■ Dust exposure

■ Asbestosis

■ Connective tissue diseases

■ Infection (mycoplasma, Pneumocystis)

■ Lymphangitis carcinomatosa

Paediatric

■ Oxygen toxicity

■ Acute bronchiolitis (also overinflation and small patches of consolidation)

Fig. 1.57 Fibrosing alveolitis. There is peripheral fibrotic change and a mass in the right lung. The incidence of bronchial neoplasm is increased in fibrosing alveolitis.

Fig. 1.57 Fibrosing alveolitis. There is peripheral fibrotic change and a mass in the right lung. The incidence of bronchial neoplasm is increased in fibrosing alveolitis.

Fig. 1.58 Cystic fibrosis (CF). The widespread interstitial pattern shadowing is typical of CF. Note the right-sided portacath and a right-sided apical pneumothorax.

46-year-old smoker.

On surgical waiting list for hernia surgery (Fig. 1.59).

Fig. 1.59 Quiz case.

46-year-old smoker.

On surgical waiting list for hernia surgery (Fig. 1.59).

Fig. 1.59 Quiz case.

Answer Emphysema

There is hyperexpansion of both lungs with flattening of the diaphragms. At the level of the diaphragm there are eight anterior ribs (normal is six to seven). There are decreased lung markings throughout the lungs particularly affecting the lung bases, a pattern found in alpha-1-antitrypsin deficiency. Radiological changes of chronic bronchitis and emphysema chronic obstructive pulmonary disease (COPD) include:

■ hyperinflation (increased retrosternal clear space on lateral film),

■ flattening of diaphragms,

■ reduced lung markings (emphysema),

■ peribronchial thickening,

■ bullae (increased risk of pneumothorax),

■ cardiac enlargement,

■ enlarged pulmonary arteries (pulmonary hypertension).

Was this article helpful?

0 0
Reducing Blood Pressure Naturally

Reducing Blood Pressure Naturally

Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.

Get My Free Ebook


Post a comment