Crazy Lady Radiology Lecture 2

Lined by ciliated columnar epithelium
Very pliable in children (may b e deviated to right at almost 90 degrees in a normal expiratory film
Only deviated to the left if aortic arch is on the right side

On expiration, post. wall collapses

Diseases of lung fibrosis: sarcoidosis, chronic hypersensitivity pneumonitis, ankylosing spondylitis
COPD/emphysema

Mounier-Kuhn syndrome
Ehlers-Dalos syndrome

95% of COPD
Acquired, due to increased intrathoracic pressures

Diffuse airway dilatation
Congenital abnormality or atrophy of CT of trachea and central bronchi
Corrugated tracheal walls (mucosal protrusions), central bronchi normal or dilated, distal bronchi normal or dilated/ectatic, with or without fibrosis
Tracheomalacia possible

Extrinsic compression
Post-traumatic stenosis
Tracheobronchomalacia
Saber-sheath trachea

Tracheobronchopathia osteochondroplastica
Wegener’s granulomatosis
Relapsing polychondritis
Amyloidosis
Descending laryngeal papillomatosis
IBD
Sarcoidosis

Neoplasms
Rhinoscleroma
Complete cartilaginous rings

Goiter
Thyroid neoplasms
Lymphoma
Leukemia
Bronchogenic carcinoma
Esophageal carcinoma
Aberrant vessels

*Prolonged intubation*
Female, smoking status, history of DM
MC 3-6cm above carina
Short segment
*3-8wks post-extubation or stomy*

Excessive collapsibility, at least 50% luminal collapse; *Seen in up to 78% of healthy people.*
So, better PPV if collapse is 70% or greater. Wall thickness is preserved

Primary or acquired: long term intubation or other trauma, congenital abnormalities, chronic extensive compression (vascular ring or sling), COPD, chronic inflammation, and infection
Forced expiration or coughing are better to Ds than tidal breathing

Airway involvement is uncommon
Upper airways > small airways
Non-caseating mucosal and submucosal granulomas

Should be considered w/ asthma-like symptoms and a hx of inflammatory bowel disease or w/ chronic GI complaints

Confirmation w/ a biopsy *is a must*
CT underestimates longitudinal submucosal spread in malignant entities
2/3 of tracheal neoplasms are either squamous or adenoid cystic carcinoma
Most likely to have extraluminal extension and mediastinal adenopathy

Small well-defined intraluminal nodule(s)
Hemangioma, hamartoma, chondroma, inflammatory myofibroblastic tumor, papillomatosis

Usually at carina
Squamous, adenoid cystic, adenocarcinoma, mucoepidermoid carcinoma

Longitudinal extent > transaxial extent, and tumor usually >180 degrees or airway circumference

Concentric calcified or ossified nodular or concentric wall thickening without posterior wall thickening. *Could be focal*
May involve larynx and upper trachea
Could be isolated or systemic
Congo red stain: “apple green” birefringence under polarized light
DDX: rhinoscleroma (Klebsiella type infection)

HPV 6 and 11, vertical and sexual transmission, can recur
Degeneration into squamous cell carcinoma in 3-5%
Younger patients
Descends from initial laryngeal seeding
Recurs if disseminated
Lung nodules could be solid or cavitary

Should be size of adjacent small artery
If bigger than artery, suspect bronchiectasis (signet ring sign)
If bronchus fails to taper down towards peripheral lung or extends all the way to sub pleural region, think cylindrical bronchiectasis

Often does not show abnormalities radiographically

Bronchiectasis-specific sign

Bronchiectasis-specific sign

Peribronchial cuffing (thickened bronchial walls)
Finger-in-glove opacities (airways filled w/ material)
Multiple air-fluid levels

Mucus in mainstem bronchus

Hypersensitivity reactions (type I and III) to aspergillum fumigatus
Hx of asthma or CF. Fever, cough, dyspnea, wheezing, hemoptysis
Serology: increased IgE, IgG against A. fumigatus, eosinophilia

Due to air trapping from small airway diseases
Failure of some lung parts to deflate producing overinflated (more black) areas interspersed between normal (more white) deflated lungs on expiration
*Some air trapping can be seen in up to 52% of healthy individuals w/ normal PFTs*

Groundglass opacities + lines
Due to edema in emphysema

Constrictive bronchiolitis
Asthma
Smokers
Hypersensitivity pneumonitis
Sarcoidosis

Smallest visible unit on CT
Has centrilobular core (arteriole, bronchiole) and septa (with venues, alveolar walls, lymphatics)
Best assessed w/ high resolution CT

Inflammatory cells filling bronchioles or peribronchiolar fibrosis
-viral bronchiolitis
-respiratory bronchiolitis due to smoking
-hypersensitivity pneumonitis

V or Y shaped nodules
MC due to infection or small volume aspiration
Other causes: CF, panbronchiolitis, etc.
Vascular mimickers: talcosis, intravascular mets.

Dense opacities
Groundglass opacities
Cystic/cavitary

Linear opacities
Nodular or ill-defined opacities
Honeycombing

Usual interstitial pneumonia (UIP)
Nonspecific Interstitial Pneumonia (NSIP) – potentially targeted w/ steroids and cytostatics

Stack of cyst-like changes
Feature of advanced fibrosis and poor prognosis
Indicates irreversible end-damage
Seen in UIP, NSIP in fibrotic stage, asbestosis, sarcoidosis

In chronic interstitial lung diseases, suggests acute inflammation and potentially treatable w/ immunosuppression

Interstitial edema or atypical infection (pneumocystis and mycoplasma are most common ones)

UIP with no cause
Poor prognosis with only treatment being lung transplant
No biopsy needed with classic imaging presentation: honeycombing most predominant in sub pleural lung at the bases and dorsal lungs

Not always idiopathic and can be seen w/ CT diseases (scleroderma, CREST syndrome, etc.)
Treatment of main underlying disease often stabilizes or improves lung findings
Classic imaging features: sub pleural reticulations, honeycombing, apicobasal gradient and posterior predominance (biopsy not needed if you have these)

Could be acute or chronic; clinical scenario should be incorporated
Can be groundglass, more dense consolidation, or combo of both
Can have interstitial component

Could be neoplastic (lung cancer or lymphoma) – tissue diagnosis should be performed. Lung cancer presenting as pneumonia-looking consolidation especially should be considered in smokers over 40-50yo and should be followed up by imaging to assure resolution

Pulmonary fine details are not visible w/i opacity
Ddx: infection, inflammation, cancer, edema

Most commonly assoc. w/ neoplasms: lung cancer (esp. if unilateral), breast cancer, lymphoma
Ddx: infection (PCP, CMV, mycoplasma)

Can present w/ ill-defined dense consolidation(s), nodules, groundless opacities
Causes: prior infection, extrinsic allergens, drugs, radiation therapy, inflammatory myotherapy
Imaging: nonspecific and confirmation is on biopsy

Always a cause: CT disease, drug reaction, hypersensitivity pneumonitis
Peripheral opacities some extending into central lungs and bronchiectasis are main features
Biopsy provides definitive dx
Tx w/ steroids and cystostatics

Best assessed w/ *HRCT (high-resolution CT)*

-Usually in dependent distribution
-Frequently with peribronchial nodularity (plugged distal small airways)

Sudden onset of acute dyspnea and cough.

Bilateral diffuse airspace opacities w/ gradually increasing density towards dependent portions
Aerated non-dilated bronchi, normal heart size
Small B/L pleural effusions

Resembles infection or neoplasm clinically and radiologically
Non-caseating granulomatous inflammation
Mediastinal lymphadenopathy > lung involvement (nodules, opacities, sometimes cavitary)
Large nodular or confluent lung opacities are due to confluence of granulomas and/or progressive massive fibrosis