Image first Work cases

chest integrated “lp5”

image number	image 2	Title
CT Emphysema, Paraseptal Emphysematous Changes Bilateral Lower Lobes 65-year-old male with emphysema of the lungs presents with a cough, fever and leukocytosis. CT in the axial plane shows bibasilar paraseptal emphysematous changes and centrilobular changes in the lingula and RUL. Hyperinflation with resultant small heart is noted. Ashley Davidoff MD TheCommonVein.net 259Lu 117504		bleb
Axial CT – Lady Windermere Syndrome 61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough. Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndrome Ashley Davidoff MD TheCommonVein.net 250Lu 135876	Axial CT – Lady Windermere Syndrome 61-year-old male with a history of treated mycobacterial infections including MAC and chronic cough. Axial CT at the level of the mid to lower chest shows mildly ectatic segmental airways to the lower, and middle lobe bronchi but significant bronchiectasis to the middle lobe and lingula involving the subsegmental airways. There is a relative paucity of mucus in the ectatic airways. The history of MAC and the distribution of the bronchiectasis in the middle lobe and lingula are reminiscent of the diagnosis of Lady Windermere syndrome Ashley Davidoff MD TheCommonVein.net 250Lu 135876	bronchiectasis
136598c Fibrotic NSIP 59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD Upper Image Axial CT shows bibasilar ground glass, bronchiectasis, and bronchiolectasis with volume loss and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing. Note air-fluid level in the distended esophagus. The lower image focuses on the peripheral sparing. The spared secondary lobules have also undergone enlargement secondary to the fibrotic process Ashley Davidoff MD TheCommonVein.net 110Lu 136598c01	136598c Fibrotic NSIP 59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD Upper Image Axial CT shows bibasilar peripheral reticular changes, ground glass, bronchiectasis, and bronchiolectasis with volume and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing posteriorly. Note air-fluid level in the distended esophagus. Lower Image The lower image focuses on the traction bronchiectasis caused by the fibrotic process Ashley Davidoff MD TheCommonVein.net 110Lu 136598c	bronchiolectasis

Chest CT above shows bronchiolitis which is characterized by peribronchial thickening which is thickening of the small airways of lung (yellow arrows)Ashley Davidoff MD TheCommonVein.net 81F-bronchiolitis-infection-inflammation-004

bronchiolitis

bronchiolitis (CXR)

Finger in Glove Sign
19 year old female with cystic fibrosis and bronchiectasis
CT scan through the upper lung fields shows mucin filled subsegmental bronchi of the right upper lobe with morphology reminiscent of the “finger in glove” sign (point to by yellow arrows)
Courtesy Priscilla Slanetz MD MPH TheCommonVein.net31966cl B.A

bronchocelebronchocentric bronchocentric

CT in the axial plane shows a bilobed calcified broncholith in the lateral segment of the middle lobe (c, d white arrowheads) with post obstructive atelectasis (c, blue arrowhead)
Ashley Davidoff MD TheCommonVein.net 136585cL B.A

broncholith

CT Scan Bilateral Apical Builla Centrilobular Emphysema
CT scan in the axial plane shows bilateral apical bullous lung disease, most commonly seen in emphysema
Ashley Davidoff MD TheCommonVein.Net 136440 B.A

bulla

CT scan in the coronal plane of shows bilateral apical bullous lung disease, magnified in the lower image
Ashley Davidoff MD TheCommonVein.Net 136439c B.A

bullous emphysema

Coronal and sagittal CT reconstructions show a cavitating mass in the superior segment of the right lower lobe (upper images) correlated with axial images (lower panel)
Ashley Davidoff MD TheCommonVein.net 176Lu 136737 B.A

cavity (lungs)

132575.8bL

CT above shows a secondary lobule which is the smallest identifiable unit of the lung (made up of around 30 a0cni supplied by a common distal bronchiole and pulmonary artery)and its boundaries can be visualized by assessing the interlobular speta (red arrows)Ashley Davidoff MD TheCommonVein.net B.A

centrilobular emphysema

Lingular Pneumonia
52 year old male presents with a cough and fever
CT scan in the axial plane shows a lingular consolidation with air bronchograms and a positive silhouette sign. Both the superior and inferior lingular segments are involved
Ashley Davidoff MD TheCommonVein.net135190 B.A

consolidation in the lungs

**CT shows alveolar proteinosis-** **central distribution which is characterized by diffuse bilateral ground-glass opacities involving both the upper and lower lobes**
**Ashley Davidoff**
**TheCommonVein.net117513 B.A**

consolidation in the lungs

cryptogenic organizing pneumonia (COP)

A 62-year-old female patient with Sjögren’s syndrome. Axial high-resolution computed tomography scan of the chest (A) and coronal reformatting (B). In A, diffuse thickening of the bronchial walls (closed arrows), some ground-glass opacities and thin-walled cysts of varying sizes, with a diffuse, bilateral distribution (open arrows). In B, distribution predominantly in the lower fields.
Daniel Simões Oliveira et al
Radiologia Brasileira 51 (5): 321–327. web-lungs-0013.jpg B.A

cyst in the lungs

Axial CT through the lower lung fields at the level of the left atrium shows desquamative interstitial pneumonia (DIP) which is characterized by diffuse ground glass changes with more prominent heterogeneity (b and c). Some of secondary lobules are expanded, with some with slightly thickened septa and prominent centrilobular nodules likely indicating small airway involvement (c, white ring).
Ashley Davidoff MD TheCommonVein.net 253Lu 136008 B.A
desquamative interstitial pneumonia (DIP)

CHF – Alveolar Edema
CT scan shows Diffuse ground glass pattern with thickening of the interlobular septa and manifesting as crazy paving pattern
Ashley Davidoff MD TheCommonVein.net 131742cL B.Adiffuse alveolar damage (DAD)

Position of Disease
Subpleural Sparing
Ashley Davidoff MD TheCommonvein.net lungs-0775 0775-lo res subpleural sparing

diffuse lung changes

emphysema

Axial CT scan with contrast shows bilateral complex and loculated effusions with thickened enhancing pleura.
Ashley Davidoff MD TheCommonVein.net 135684cL B.Aempyema

CT in the axial plane shows an obstructing lesion in the left mainstem bronchus of the lung (green arrowhead) with post obstructive atelectasis of the lingula (black arrowhead) and a small portion of left upper lobe anteriorly (white arrowhead). The major fissure is displaced anteriorly.
Ashley Davidoff MD TheCommonVein.net 257Lu 136110cL B.A

endobronchial finding

CT Extra-Pleural Fat Sign
CT shows extra fat sign which is characterized by focal subsegmental area of atelectasis in the right lower lobe abutting the diaphragm associated with extra pleural fat proliferation secondary to the parenchymal infiltrate.
Ashley Davidoff MD TheCommonVein.net 136036c B.A

extrapleural finding (fat sign)

CT Miliary Tuberculosis
60-year-old female presents with a cough and weight loss. Axial CT shows miliary nodules throughout both lung fields. Some of these nodules are are centrilobular or distributed along the bronchovascular bundles (b, maroon arrowheads) and others are fissural based (b, pink arrowheads). She responded well to treatment and final diagnosis was mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 265Lu 136201cL

This CT shows fissural nodules which are usually benign round nodules with well-defined margins that usually appear within fissural lines (yellow arrowheads)
Ashley Davidoff MD TheCommonVein.net136201cL01 B.A

Ashley Davidoff MD TheCommonVein.net136201cL01 B.A

fissural (nodules)fissuresfissuresLfissures focal lung finding

Axial CT of the chest at the level of the aortic arch shows follicular bronchiolitis (BALT) which is characterized by centrilobular nodules, ground-glass opacities and bronchial wall thickening.
Ashley Davidoff MD TheCommonVein.net 132Lu 136652 B.A

follicular bronchiolitis (BALT) geographic changes (lungs)

This CT shows a ground glass nodule in the lung which is characterized by a small round hazy opacity that are usually less than 3cm in size (yellow arrows)Ashley Davidoff MD TheCommonVein.net29787L B.A

ground glass nodule in the lungs

This CT shows diffuse ground glass opacities involving the upper lobes and lower lobes. A finding commonly seen in patients with sarcoidosis Ashley Davidoff MD TheCommonVein.net 029Lu 29064a002.8 B.A.

CT shows diffuse ground glass opacities involving the upper lobes and lower lobes. A finding commonly seen in patients with sarcoidosis Ashley Davidoff MD TheCommonVein.net 029Lu 29064a002.8 B.A

ground glass opacity (GGO)
“This X-ray depicts what a normal CXR should look like. Ashley Davidoff MD TheCommonVein.net 028-M-Normal-CXR-001L B.Ahilum

This CT shows a dominant pattern of extensive honeycombing in the lower lobes. Honeycombing is described as small well-defined clustered cystic spaces that look like a honeycomb with thickened walls. Also present above are reticular patterns which signal the fibrosis that often accompanies honeycombing
Ashley Davidoff MD thecommonvein.net 134902-lungs UIP B.A

1Ashley Davidoff MD thecommonvein.net 34902-lungs-UIPL B.A

honeycomb lung
idiopathic pulmonary fibrosis IPF (UIP radiologic equivalent?) incomplete fissure

CT scan of a 74 year old febrile female above shows a wedge shaped right upper lobe infiltrate consisting of a combination of consolidation and ground glass components along a bronchovascular distribution consistent with bronchopneumonia. An enlarged right hilar lymph node is present
Ashley Davidoff TheCommonVein.net RnD Image First program 135180.bronchopneumoniacB.A

infiltrate lungs (see opacity)

CT scan of the chest shows mosaic attenuation peripheral pulmonary lobules best exemplified in the posterior aspects of the superior segments of the lower lobes bilaterally
A lobular bronchiole is overlaid in teal in c, while the accompanying lobular arteriole is seen in royal blue entering the lobule and then branching. The peripheral venules (red) in the interlobular septa join to form the lobular vein. The accompanying lymphatics (yellow) accompany the venules in the interlobular septa. These are not visualized but are implied
In this remarkable CT we were able to identify a few secondary lobules at the periphery of the lung that have a rectangular shape in this instance. The branching structure that enters the lobule (blue in c), is characterised as an arteriole for two reasons. Firstly, it is paired with a tubular airway seen in (b) in its most proximal portion as a lucent tubule, and subsequently interpolated in light blue in c. Secondly it branches in the center of the lobule. It is distinct from the border forming interlobular septum which surrounds it. A second relatively large vessel colored in red receives a branch from the interlobular septum and by virtue of its size and position it has to be a pulmonary venule. We know that the lymphatic vessel accompanies the venule, and so the yellow lymphatic has been implied but not visualised. We also know that connective tissue surrounds these two structures. In this instance the matrix of the lobule that consists of the alveoli is less dense than it should be and is surrounded by normal lung parenchyma. Lucency, or mosaic attenuation implies either small vessel disease or small airway disease. In the latter instance air trapping from small airway disease is implied.
Ashley Davidoff MD TheCommonVein.net 47152c02 RnD

interlobular septum interstitial fibrosis (combined with UIP, ILD)

interstitial lung disease interstitium

left paratracheal stripe

CT chest above shows poorly-diffentiated adenocarincoma. Poorly-diffentiated adenocarincomas on CT are characterizedr by irregular or spiculated masses that are lobulated in shape as seen above. Usually they are located in the periphery
Ashley Davidoff MD TheCommonVein.net B.A

lobulation

CT above shows reveals bulky conglomerate lymphadenopathy with central hypodensity in right levels IV, VI, supraclavicular region and partially visualized within the upper mediastinum. Ashley Davidoff MD TheCommonVein.net Lymphsadenopathy-low-demsity-TB-04-CT-5-years-agoL B.Alow density lymphadenopathy (LAD)
lymph nodes of the chest: superior mediastinal nodes
lymph nodes of the chest: aortic nodes
lymph nodes of the chest: inferior mediastinal nodes

lymphadenopathy in the chest (LAD)

53 year old male with history of smoking presents with a cough CXR shows a large mass in the left apex
Diagnosis adenocarcinoma of the lung with extensive necrosis of the tumor (yellow arrow)
Ashley Davidoff MD The CommonVein.net lungs-large-adenocarcinoma-necrosis-001-53m-CXRcL B.Amass in the lungAshley Davidoff MD The CommonVein.netheart-membranous-VSD-000b-37F-CXR-normal_L BA

Ashley Davidoff MD The CommonVein.netheart-membranousheart-membranous-VSD-000b-37F-CXR-normal_L02 B.A

mediastinal compartments

The ski slopes of Mount Mediastinum
Start with the left slope at the apex of the left lung. After you get off the ski-lift, follow the signs to the “Subclavian Steel” which is painted in dark maroon – just like blood. You will gain speed very quickly off this slope which starts with the subclavian artery. This is the most dangerous of the slopes since you are almost upside down as you start. As you gather speed come across the bump of the aorta. This trail is called the “Aortic Notch” and its sign is colored in bright red. – This trail holds the biggest mogul. A shallow mogul of the MPA (“Lung Artree” dark blue) comes next, and then a concave in pink for the left atrial appendage. “Pretty Pendage” (short lived) After that it is a great mild and long slope of the orange LV (“Smooth Elvee”) until you pass alongside the triangular fat pad of the LV.
The second slope on the right starts near the apex of the right lung and is marked with a bright green sign called “vein cave” As you step off the lift – there is a ninety degree drop, and if you look to your left you will see the red cells in the superior vena cava traveling much slower than you. After the “vein cave” route, the gentle curve around the right atrium (purple) takes over and you are brought to an almost negligible slope of the right ventricle. (teal) The right and left slope meet at the bottom by the ski house.
Ashley Davidoff MD TheCommonVein.net 42260bb01 BA

mediastinumAshley Davidoff MD TheCommonVein.net131745.8LB.A
Ashley Davidoff MD TheCommonVein.net 131745.8L02 B.Amicronodules lungs

Frontal CXR – Miliary TB
60-year-old immunocompromise female presents with a cough and weight loss CXR shows a diffuse miliary pattern. Final diagnosis was mycobacterium tuberculosis. Associated findings include healed right sided rib fractures and surgical clips in the left axilla
Ashley Davidoff MD TheCommonVein.net 265Lu 136197 B.A

Mosaic attenuation pattern. CT scan through lower lobes shows the indirect sign of constrictive obliterative bronchiolitis, in this case the sequel to a severe viral lower respiratory tract infection.
https://pubs.rsna.org/doi/full/10.1148/radiol.13120908 B.A

mosaic attenuation patternheart-SLE-congestive-cardiomyopathy-mitral-regurgitation-002-CT-mucoid-impaction-40F_L mucoid impaction lungs multifocal lung finding

40 year old female with SLE and congestive-cardiomyopathy. Axial CT (top row) shows a focal nodule that was connected to a bronchiole. Bronchiectasis with mucoid impaction and ABPA were radiological considerations. T2 weighted MRI (bottom row) shows T2 brightness confirming the fluid or proteinaceous nature of the nodule likely from mucoid impaction. Note surrounding mosaic attenuation suggesting associated small airway obstruction.
Ashley Davidoff MD TheCommonVein.net 002-CT-mucoid-impaction

CT scan at the level of the aortic arch shows a mass in the anterior segment of the right upper lobe of the lung characterised by a c shaped or crescent shaped anterior rim of air with ball of soft tissue, reminiscent of the crescent sign most characteristic of an aspergillus infection of a cavity and resulting in an aspergilloma.
Ashley Davidoff TheCommonVein.net20760cB.A

20760cmycetoma fungal mass

NODULAR PATTERN ON CXR IN ILD
Frontal view exemplifies a diffuse nodular pattern of ILD such as is seen in silicosis and sarcoidosis
Courtesy You Tube on ILD. web-lungs-0161b

web-lungs-0161b_cnodular pattern in the lungs

72-m-lung-screen-ca-02-currentc 72-m-lung-screen-ca-02-currentcLnodule lung nodules interlobular septum lungs (CT)

NSIP
71-year-old female presents with a history of scleroderma, ILD, hypothyroidism and dcSSc
CT in the coronal plane shows bibasilar ground glass changes, with bronchovascular thickening traction bronchiectasis, and bronciolectasis
Ashley Davidoff MD TheCommonVein.net 196Lu 136607 B.A

136607Lnonspecific interstitial pneumonia (NSIP)

Scleroderma with predominant cellular NSIP pattern characterised by predominant ground glass pattern and peripheral distribution. Bronchiectasis is not a prominent feature. Peripheral sparing is noted
Ashley Davidoff MD TheCommonVein.net scleroderma NSIP 006 B.A

60-M-scleroderma-NSIP-006Lnonspecific interstitial pneumonia (NSIP) cellular form

obliterative bronchiolitis

Westermark sign. Frontal radiograph (A) and an enhanced CT of the chest (B) demonstrate lucency within the right upper lobe representing oligemia secondary to pulmonary embolus.
Source
Signs in Thoracic Imaging
Journal of Thoracic Imaging 21(1):76-90, March 2006.web-lungs-0074

oligemia lungs opacity lungslung-COVID-Organizing-pneumonia-53M-013_OP
organizing pneumonia (OP)

Panlobular Emphysema
CT scan of a 78 year old male with history of alpha-1 antitrypsin deficiency with extensive and severe emphysematous change uncharacteristically more prominent in the upper and midlung regions. Associated complex right pleural effusion with compressive atelectasis
Ashley Davidoff TheCommonVein.net RnD116533.panlobular-emphysema-alpha-1-antitrypsinB.A

panlobular emphysema parenchyma of lung

peribronchovascular finding peribronchovascular interstitium

136202cl_03

136202cL_02perilymphatic33679c04.8c
pleura (anatomy)

132135

PLEURAL BASED NODULE (red arrow) and FISSURAL NODULES (green arrow) –
SARCOIDOSIS – CHARACTERISTIC NODULES
51-year-old male with history of sarcoidosis
The frontal CXR shows subtle nodular changes in the right upper peripheral lung field (red circles) and the lateral examination shows 3 regions of nodular changes (red arrowheads)
The CT examination scout film confirms 3 major regions of nodular change in the posterior and superior segment of the RUL along the confluence of the right major and minor fissure and in the posterior segment of the left upper lobe peripherally.
The axial images show a variety of characteristic changes including;
Ground glass opacity
Stellate or flame shaped nodules
Semisolid nodules
Fissural based nodules
Subpleural nodules
Micronodules along the
lymphovascular and
bronchovascular bundles of the secondary lobule
Calcified nodule some of which are surrounded by soft tissue of the granuloma
There are small calcified nodes in the mediastinum, but no significant pathological adenopathy
No obvious cardiac nor splenic involvement is noted
Ashley Davidoff MD132135.8L. B.A

pleura-based finding

136550c_effusion

pleural effusion

Chest X-ray Asbestos Related Disease
76-year-old former pipe fitter, presents with a cough.
CXR in the frontal and lateral projections show evidence of asbestos related disease characterized by pleural thickening and calcified pleural plaques.
Ashley Davidoff MD TheCommonVein.net 42016c01B.A

pleural plaque

pleural tag (CT)

chest-lungs-pneumomedistinum-001-CXR-trauma_c

chest-lungs-pneumomedistinum-001-CXR-trauma_cL

pneumomediastinum

pneumonia

Fibrotic Hypersensitivity Pneumonitis
Ashley Davidoff TheCommonVein.netb11431-004B.A

b11431-004Lpneumonitis

pulmonary blood flow redistribution

pulmonary fibrosis

REVERSED HALO SIGN CAUSED BY PE AND PROBABLE HEMORRHAGIC INFARCTION
32 year old male presents with acute PE and reversed halo sign indicative most likely of a hemorrhagic pulmonary infarction
Ashley Davidoff MD131475.8

pulmonary infarct

neo_interstitial_emphysema

neo_interstitial_emphysemapulmonary interstitial emphysema

Langerhans Cell Histiocytosis
Lower Lobe Nodules
Ashley Davidoff MD TheCommonVein.net66M-Langerhans-017-CT-micronodules

random micronodules lungs

High-resolution CT in respiratory bronchiolitis-associated interstitial lung disease. Bronchiolocentric interstitial ground-glass opacifications, accentuated in the upper part of the lung (in blue square)
Ashley Davidoff MD TheCommonVein.netSmoking-Related Interstitial Lung Diseaseweb-lungs-298cL B.A

respiratory bronchiolitis ILD