Cxrchest Ct

Distribution, morphology. & clinical correlation help narrow Ddx

Pattern

Pathophysiology

Ddx

Consolidation

Radiopaque material in air space & interstitium patent airway -» "air bronchograms"

Acute: water (pulm edema), pus (PNA). blood Chronic: neoplasm (BAC. lymphoma), aspiration, inflammatory (BOOP, eosinophilic PNA). PAP. granuloma (TB/fungal. alveolar sarcoid)

Ground glass (CT easier than CXR)

Interstitial thickening or partial filling of alveoli (but vessels visible)

Acute: pulm edema, infxn (PCP, viral, resolving bact. PNA) Chronic: ILD

w/o fibrosis: acute hypersens.. DIP/RB. PAP w / fibrosis: IPF

Septal lines Kerley A & B

Radiopaque material in septae

Cardiogenic pulm edema, interstitial PNA (viral, mycoplasma), lymphangitic tumor

Reticular

Lace-like net (ILD)

ILD (espec. IPF. CVD. bleomycin, asbestos)

Granulomas

Abscess

Peripheral infarct

Cavitary: Primary or metastatic cancer.

TB (react, or miliary), fungus. Wegener's. RA septic emboli. PNA Noncavhary: any of above • sarcoid, hypersens. pneum.. HIV. Kaposi's sarcoma PE. cocaine, angioinv. aspergillus. Wegener's

Tree-in-bud (best on CT)

Inflammation of small airways

Bronchopneumonia, endobronchial TB/MAI. viral PNA. aspiration.ABPA, CF, asthma. BOOP

Hilar fullness Upper lobe

T LN or pulm arteries n/a

Neoplasm (lung. mets. lymphoma)

Infxn (AIDS); Granuloma (sarcoid/TB/ fungal)

Pulmonary hypertension

TB. fungal, sarcoid, hypersens. pneum., CF, XRT

Lower lobe Peripheral

n/a n/a

Aspiration, bronchiect.. IPF. RA. SLE. asbestos BOOP. IPF & DIP. eos PNA. asbestosis

CXR in heart failure

• I cardiac silhouette (in systolic dysfxn. not in diastolic)

• Pulmonary venous hypertension: cephalization of vessels (vessels size > bronchi in upper lobes), peribronchial cuffing (fluid around bronchi seen on end -» small circles), Kerley B lines (horizontal 1-2 cm lines at bases), t vascular pedicle width, loss of sharp vascular margins, pleural effusions ( 75% bilateral)

• Pulmonary edema: ranges from ground glass to consolidation; often dependent and central, sparing outer third ("bat wing" appearance)

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