Radiographic Lung Patterns

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1 Radiographic Lung Patterns

2 Systematic approach heart mediastinum vessels lungs pleural space thoracic wall diaphragm/abdomen

3 Lung pathology Most cause INCREASED OPACITY patterns INTERSTITIAL ALVEOLAR BRONCHIAL Some cause DECREASED OPACITY emphysema, air trapping hypoperfusion PTE VASCULAR NODULAR

4 Approach Is there increased opacity? What is the pattern(s)? What is the distribution?

5 DISTRIBUTION PATTERN FOCAL/MULTIFOCAL NODULAR ALVEOLAR INTERSTITIAL DIFFUSE INTERSTITIAL BRONCHIAL VASCULAR

6 VASCULAR

7 Vascular pattern What you will see... DIFFUSE increased opacity Due to: Multiple enlarged pulmonary vessels Veins Arteries BOTH

8 Vascular pattern Remember compare: cranial vessels to: caudal vessels to: 4th rib 9th rib Artery and vein should be: same size or smaller than rib similar size to each other

9 Vascular BIG ARTERIES normal VEINS BIG VEINS normal ARTERIES BIG VEINS BIG ARTERIES Pulmonary hypertension Left heart failure Overcirculation

10 BRONCHIAL

11 Bronchial pattern What you will see... DIFFUSE increased opacity Due to... Prominent bronchial walls RAILROAD TRACKS DONUTS out to PERIPHERY

12 Bronchial pattern DIFFERENTIALS Chronic bronchitis allergic, irritant Feline asthma Infectious bronchitis Lungworms Heartworm disease

13 INTERSTITIAL

14 Interstitial pattern What you will see... DIFFUSE or FOCAL UNSTRUCTURED haziness BLURRING of vessel margins Due to: interstitial fluid or cells ARTIFACT

15 Interstitial pattern

16 Interstitial Differentials Artifact - expiratory, obesity old-dog lungs Pneumonitis viral, parasitic, metabolic, toxic Alveolar disease in transition Pulmonary fibrosis ARDS Neoplasia - RARE (LSA, mets)

17 Bronchial vs. Interstitial

18 Bronchial vs. Interstitial

19 DIFFUSE increased opacity Is opacity made up of STRUCTURES or MARKINGS? YES NO hazy blurred vessels vessels donuts RR tracks VASCULAR BRONCHIAL INTERSTITIAL

20 ALVEOLAR

21 Alveolar pattern What you will see... FOCAL or MULTIFOCAL distribution Uniform fluid opacity - fluffy to solid Due to: cells/fluid filling alveoli

22 Alveolar pattern continuum with INTERSTITIAL AIR BRONCHOGRAMS LOBAR SIGN SILHOUETTE SIGN

23 Air Bronchogram Branching BLACK airway WHITE background CAN T see vessels no yes yes no

24 Lobar sign Periphery of lobe affected Abrupt demarcation between diseased and normal lung DON T confuse with PLEURAL FISSURES

25 Silhouette sign Adjacent to ST structure Effacement of margins cardiac silhouette pulmonary vessels diaphragm

26 Alveolar pattern BIG 3 Differentials: hemorrhage, contusions pneumonia edema BLOOD PUS WATER Other Differentials: Atelectasis Neoplasia Lung lobe torsion

27 Alveolar Location? CRANIOVENTRAL HILAR CAUDODORSAL Pneumonia Cardiogenic pulmonary edema Non-cardiogenic pulmonary edema Hemorrhage Hemorrhage Hemorrhage

28 NODULAR

29 Nodular Pattern AKA = structured interstitial What you will see... FOCAL or MULTIFOCAL opacities Due to: nodules or masses MUST define characteristics of nodule(s)!!

30 Differentials for nodules H ematoma - trauma A bscess - foreign body N eoplasia - primary and metastatic G ranuloma - fungal, parasitic B ulla - air or fluid filled

31 Nodule characteristics NUMBER - Single vs. Multiple SIZE - overall and relative nodule vs. mass (>3 cm) similar vs. variable MARGINATION well defined vs. ill defined

32 Single Nodule/Mass WELL-DEFINED margins NEOPLASIA!! Primary vs. single metastatic nodule ILL-DEFINED margins ABSCESS GRANULOMA > 3 cm more likely PRIMARY tumor BULLA, HEMATOMA

33 Multiple Nodules/Masses Fungal Pneumonia Metastatic Neoplasia ILL-DEFINED MARGINS WELL-DEFINED SIMILARLY small, miliary SIZE VARIABLY LYMPHADENOPATHY SYMPTOMATIC OTHER

34 Margination If you see both ILL and WELL DEFINED? ILL DEFINED won t look WELL DEFINED WELL DEFINED can look ILL DEFINED Due to: respiratory motion silhouetting BUT.. associated hemorrhage or inflammation

35 Cavitated Nodules Soft tissue and AIR WALL THICKNESS!! Differentials H A N G with necrosis thick irregular wall Bulla thin wall

36 Nodular pattern BEWARE OF IMPOSTORS... End on vessels Surface structures Pulmonary osteomas REMEMBER REAL NODULES! size > 5mm on BOTH views ST opacity

37 SUMMARY

38 PATTERN SIGNS f o c a l d i f f u s e NODULAR ALVEOLAR INTERSTITIAL BRONCHIAL VASCULAR focal/multifocal nodules air bronchogram silhouette sign lobar sign blurring of vessels railroad tracks, donuts enlarged pulm vessels

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