Faces of Central Lung Fields

Perihilar Distribution
Ashley Davidoff MD TheCommonvein.net lungs-0770

Infection
TB

1 Month Later Active TB with Transbronchial Spread
Ashley Davidoff MD TheCommonVein.net

PCP

Inflammation
Sarcoidosis

59 year old female with sarcoidosis. CT shows segmental and subsegmental airway thickening, bronchiectasis, and pleuro-parenchymal nodules
Ashley Davidoff TheCommonVein.net
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

Hypersensitivity Pneumonitis 

Hypersensitivity Pneumonitis 2019Courtesy Ashley Davidoff The CommonVein.net


Crack Lung

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. Thickening and irregularity of the right and left major fissures and the transverse fissure are noted. LVH is suggested.
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 135934


Malignancy Mechanical/Atelectasis Trauma

Metabolic

Alveolar Proteinosis

48 year old male with alveolar proteinosis
Follow up Ashley Davidoff TheCommonVein.net 117528.8
48 year old male with alveolar proteinosis-
central distribution
Ashley Davidoff TheCommonVein.net

Circulatory- CHF

Perihilar Alveolar Edema
70 year old female s/p cardiac arrest and ROSC. CXR shows centralized alveolar edema as a result of intra- alveolar accumulation of transudate. The centralized distribution of the infiltrates is characteristic of severe heart failure – batwing distribution
Ashley Davidoff MD TheCommonVein.net

Mild early Severe CHF

CXR Frontal Batwing Pattern
50 year-old male presents with severe dyspnea and orthopnea.  CXR in the frontal projection shows perihilar congestion with batwing distribution, left atrial enlargement and left ventricular configuration of the heart.  These findings are consistent with severe heart failure with a projected LVEDP of greater than 30mmHg
Ashley Davidoff MD TheCommonVein.net 285Lu 135759
CT  Batwing Pattern Severe CHF
50 year-old male presents with severe dyspnea and orthopnea.  CT in the coronal plain shows early severe CHF, with perihilar ground glass changes (magnified in c) and Kerley B lines (b, black arrowheads)  These findings are consistent with early severe heart failure with a projected LVEDP of greater than 30mmHg
Ashley Davidoff MD TheCommonVein.net 285Lu 135761cL

Hemorrhage Immune Infiltrative Idiopathic Iatrogenic Idiopathic