Faces of Upper Lung Field Diseases

Infection

TB

ABPA

Tree in Bud Sign Bronchopulmonary Aspergillosis (ABPA)
CT scan through the chest shows medium sized bronchi, bronchioles and small airways impacted with fluid. This collage is presented to reveal tree in bud changes resulting from impaction in the smaller terminal bronchioles and respiratory units. The tree-in-bud pattern also results in small centrilobular nodules connected to multiple branching linear structures of similar caliber from a single stalk. Originally it was felt to result from endobronchial spread of Mycobacterium tuberculosis, but is is now recognized in diverse entities including peripheral airway diseases caused by infection (bacterial, fungal, viral, or parasitic), congenital disorders, idiopathic disorders (obliterative bronchiolitis, pan bronchiolitis), aspiration or inhalation of foreign substances, immunologic disorders, connective tissue disorders and peripheral pulmonary vascular diseases such as neoplastic pulmonary emboli.
In this case there are also dilated medium sized airways, impacted with soft tissue characteristic of the finger in glove sign and most likely due to allergic bronchopulmonary aspergillosis (ABPA)
Ashley Davidoff MD Ashley Davidoff MD TheCommonVein.net
47113c01

Inflammation

Emphysema

69 year old male with neurofibromatosis and emphysema

Sarcoidosis

Silicosis

CT chest without contrast in the coronal projection at the level of the hilum shows eggshell calcifications in the hilar and mediastinal lymph nodes (red arrow) consistent with a diagnosis of silicosis, complicated by progressive massive fibrosis. Bullous disease (blue arrow) is also seen bilaterally, right greater than left. Differential diagnosis includes coal-worker’s pneumoconiosis, sarcoidosis, and blastomycosis.
Courtesy Maegan Lu, Jonathan Scalera, MD
CT chest without contrast in the axial projection at the level of the ascending aorta shows eggshell calcifications in the hilar and mediastinal lymph nodes (red arrow) consistent with a diagnosis of silicosis, complicated by progressive massive fibrosis. Bullous disease (blue arrow) is also seen bilaterally, right greater than left. Differential diagnosis includes coal-worker’s pneumoconiosis, sarcoidosis, and blastomycosis.
Courtesy Maegan Lu, Jonathan Scalera, MD

Hypersensitivity Pneumonitis

Hypersensitivity Pneumonitis 2013

Langerhans Cell Histiocytosis

CT shows extensive disease that appears to be centered around the bronchioles and small airways associated with centrilobular nodules, bronchiolectasis and thick walled cysts, more prominent in the upper lobes and mid lung fields but also involving the bases
Ashley Davidoff MD TheCommonVein.net 50F 01a

Crack Lung

CXR 1month Later Prominent Upper Lobe Ground Glass Parenchymal Changes
55 year old male with substance use disorder presents with progressive and now more severe dyspnea. Frontal CXR shows extensive upper lobe ground glass changes in the upper lobes. Inhalational pneumonitis was suspected with multifocal regions of consolidation.
Progressive inhalational pneumonitis from smoking or cocaine inhalation was suspected
Ashley Davidoff MD TheCommonVein.net 251Lu 135918
CT 1month Later Prominent Upper Lobe and Superior Aspects of the Lower Lobe Ground Glass Parenchymal Changes
55-year-old male with substance use disorder presents with progressive and now more severe dyspnea. Coronal CT through the mid lung fields shows upper lobe predominant ground glass changes with thickening of the interlobular septa and a “crazy paving” appearance is suggested. The superior segments of the lower lobes are also involved. Subpleural sparing is suggested. Thickening and irregularity of the right and left major fissures and the transverse fissure are noted.
Progressive inhalational pneumonitis from smoking or cocaine inhalation was suspected. DIP and hypersensitivity pneumonitis remained in the differential diagnosis
Ashley Davidoff MD TheCommonVein.net 251Lu 135935
CT 1month Later Prominent Upper Lobe and Superior Aspects of the Lower Lobe Ground Glass Parenchymal Changes
55-year-old male with substance use disorder presents with progressive and now more severe dyspnea. Sagittal CT through the right lung field shows ground glass changes in the upper mid and superior segment of the lower lobe. The fissures of the areas of involved lung are focally thickened. There is subpleural sparing
Progressive inhalational pneumonitis from smoking or cocaine inhalation was suspected. DIP and hypersensitivity pneumonitis remained in the differential diagnosis
Ashley Davidoff MD TheCommonVein.net 251Lu 135940
CT 1month Later Prominent Left Upper Lobe and Superior Segment of the Lower Lobe Ground Glass Parenchymal Changes
55-year-old male with substance use disorder presents with progressive and now more severe dyspnea. Sagittal CT through the left lung field shows ground glass changes in the upper mid and superior segment of the lower lobe. The fissures of the areas of involved lung are focally thickened. There is subpleural sparing and “crazy paving” pattern suggested with thickened interlobular septa.
Progressive inhalational pneumonitis from smoking or cocaine inhalation was suspected. DIP and hypersensitivity pneumonitis remained in the differential diagnosis
Ashley Davidoff MD TheCommonVein.net 251Lu 135943

Chronic Eosinophilic Pneumonia

Upper Lobe Peripheral Infiltrates Centrilobular Nodules, and Interlobular Septal Thickening
CT scan in the coronal performed 6 months ago at the time of clinical presentation shows upper lobe predominant peripheral infiltrates more prominent in the left upper lobe. Subsequent diagnosis by BAL of chronic eosinophilic pneumonia (CEP) was made
Ashley Davidoff TheCommonVein.net

DIP

Malignancy Mechanical/Atelectasis Trauma Metabolic Circulatory- Hemorrhage Immune Infiltrative Idiopathic Iatrogenic Idiopathic