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Semin Respir Crit Care Med 2022; 43(06): 780-791
DOI: 10.1055/s-0042-1755564
Review Article

High-Resolution Computed Tomography of Nonfibrotic Interstitial Lung Disease

Cristina Marrocchio
1   Department of Radiology, University of Trieste, Trieste, Italy
,
David A. Lynch
2   Department of Radiology, National Jewish Health, Denver, Colorado
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Abstract

Nonfibrotic interstitial lung diseases include a heterogeneous group of conditions that can result in various patterns of lung involvement. When approaching the computed tomographic (CT) scan of a patient with a suspected or known interstitial lung disease, the use of the appropriate radiological terms and a systematic, structured approach to the interpretation of the imaging findings are essential to reach a confident diagnosis or to limit the list of differentials to few possibilities. The large number of conditions that cause nonfibrotic interstitial lung diseases prevents a thorough discussion of all these entities. Therefore, this article will focus on the most common chronic lung diseases that can cause these CT findings. A pattern-based approach is used, with a discussion of nodular pattern, consolidation, crazy paving, ground-glass opacities, septal thickening, and calcifications. The different clinical conditions will be described based on their predominant pattern, with particular attention to findings that can help in the differential diagnosis.

Keywords

CT - interstitial lung diseases - sarcoidosis - pulmonary eosinophilia - aspiration - pneumonia - pulmonary alveolar proteinosis


Publication History

Article published online:
28 November 2022

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  • References

  • 1 Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008; 246 (03) 697-722
    CrossrefPubMedGoogle Scholar
  • 2 Kim J, Dabiri B, Hammer MM. Micronodular lung disease on high-resolution CT: patterns and differential diagnosis. Clin Radiol 2021; 76 (06) 399-406
    CrossrefPubMedGoogle Scholar
  • 3 Gruden JF, Webb WR, Naidich DP, McGuinness G. Multinodular disease: anatomic localization at thin-section CT–multireader evaluation of a simple algorithm. Radiology 1999; 210 (03) 711-720
    CrossrefPubMedGoogle Scholar
  • 4 Lee KS, Kim TS, Han J. et al. Diffuse micronodular lung disease: HRCT and pathologic findings. J Comput Assist Tomogr 1999; 23 (01) 99-106
    CrossrefPubMedGoogle Scholar
  • 5 Webb WR, Stein MG, Finkbeiner WE, Im JG, Lynch D, Gamsu G. Normal and diseased isolated lungs: high-resolution CT. Radiology 1988; 166 (1, Pt 1): 81-87
    CrossrefPubMedGoogle Scholar
  • 6 Webb WR. Thin-section CT of the secondary pulmonary lobule: anatomy and the image–the 2004 Fleischner lecture. Radiology 2006; 239 (02) 322-338
    CrossrefPubMedGoogle Scholar
  • 7 Criado E, Sánchez M, Ramírez J. et al. Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics 2010; 30 (06) 1567-1586
    CrossrefPubMedGoogle Scholar
  • 8 Lynch DA, Webb WR, Gamsu G, Stulbarg M, Golden J. Computed tomography in pulmonary sarcoidosis. J Comput Assist Tomogr 1989; 13 (03) 405-410
    CrossrefPubMedGoogle Scholar
  • 9 Nakatsu M, Hatabu H, Morikawa K. et al. Large coalescent parenchymal nodules in pulmonary sarcoidosis: “sarcoid galaxy” sign. AJR Am J Roentgenol 2002; 178 (06) 1389-1393
    CrossrefPubMedGoogle Scholar
  • 10 Heo JN, Choi YW, Jeon SC, Park CK. Pulmonary tuberculosis: another disease showing clusters of small nodules. AJR Am J Roentgenol 2005; 184 (02) 639-642
    CrossrefPubMedGoogle Scholar
  • 11 Bartz RR, Stern EJ. Airways obstruction in patients with sarcoidosis: expiratory CT scan findings. J Thorac Imaging 2000; 15 (04) 285-289
    CrossrefPubMedGoogle Scholar
  • 12 Davies CW, Tasker AD, Padley SP, Davies RJ, Gleeson FV. Air trapping in sarcoidosis on computed tomography: correlation with lung function. Clin Radiol 2000; 55 (03) 217-221
    CrossrefPubMedGoogle Scholar
  • 13 Magkanas E, Voloudaki A, Bouros D. et al. Pulmonary sarcoidosis. Correlation of expiratory high-resolution CT findings with inspiratory patterns and pulmonary function tests. Acta Radiol 2001; 42 (05) 494-501
    PubMedGoogle Scholar
  • 14 Terasaki H, Fujimoto K, Müller NL. et al. Pulmonary sarcoidosis: comparison of findings of inspiratory and expiratory high-resolution CT and pulmonary function tests between smokers and nonsmokers. AJR Am J Roentgenol 2005; 185 (02) 333-338
    CrossrefPubMedGoogle Scholar
  • 15 Nunes H, Humbert M, Capron F. et al. Pulmonary hypertension associated with sarcoidosis: mechanisms, haemodynamics and prognosis. Thorax 2006; 61 (01) 68-74
    CrossrefPubMedGoogle Scholar
  • 16 Murdoch J, Müller NL. Pulmonary sarcoidosis: changes on follow-up CT examination. AJR Am J Roentgenol 1992; 159 (03) 473-477
    CrossrefPubMedGoogle Scholar
  • 17 Brauner MW, Lenoir S, Grenier P, Cluzel P, Battesti J-P, Valeyre D. Pulmonary sarcoidosis: CT assessment of lesion reversibility. Radiology 1992; 182 (02) 349-354
    CrossrefPubMedGoogle Scholar
  • 18 Aquino SL, Gamsu G, Webb WR, Kee ST. Tree-in-bud pattern: frequency and significance on thin section CT. J Comput Assist Tomogr 1996; 20 (04) 594-599
    CrossrefPubMedGoogle Scholar
  • 19 Rossi SE, Franquet T, Volpacchio M, Giménez A, Aguilar G. Tree-in-bud pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics 2005; 25 (03) 789-801
    CrossrefPubMedGoogle Scholar
  • 20 Romero S, Barroso E, Gil J, Aranda I, Alonso S, Garcia-Pachon E. Follicular bronchiolitis: clinical and pathologic findings in six patients. Lung 2003; 181 (06) 309-319
    CrossrefPubMedGoogle Scholar
  • 21 Howling SJ, Hansell DM, Wells AU, Nicholson AG, Flint JD, Müller NL. Follicular bronchiolitis: thin-section CT and histologic findings. Radiology 1999; 212 (03) 637-642
    CrossrefPubMedGoogle Scholar
  • 22 Fitzgerald JE, King Jr TE, Lynch DA, Tuder RM, Schwarz MI. Diffuse panbronchiolitis in the United States. Am J Respir Crit Care Med 1996; 154 (2, Pt 1): 497-503
    CrossrefPubMedGoogle Scholar
  • 23 Hirakata K, Nakata H, Nakagawa T. CT of pulmonary metastases with pathological correlation. Semin Ultrasound CT MR 1995; 16 (05) 379-394
    CrossrefPubMedGoogle Scholar
  • 24 Churg A, Müller NL, Wright JL. Respiratory bronchiolitis/interstitial lung disease: fibrosis, pulmonary function, and evolving concepts. Arch Pathol Lab Med 2010; 134 (01) 27-32
    CrossrefPubMedGoogle Scholar
  • 25 Gruden JF, Webb WR, Warnock M. Centrilobular opacities in the lung on high-resolution CT: diagnostic considerations and pathologic correlation. AJR Am J Roentgenol 1994; 162 (03) 569-574
    CrossrefPubMedGoogle Scholar
  • 26 Hanak V, Kalra S, Aksamit TR, Hartman TE, Tazelaar HD, Ryu JH. Hot tub lung: presenting features and clinical course of 21 patients. Respir Med 2006; 100 (04) 610-615
    CrossrefPubMedGoogle Scholar
  • 27 Hartman TE, Tazelaar HD, Swensen SJ, Müller NL. Cigarette smoking: CT and pathologic findings of associated pulmonary diseases. Radiographics 1997; 17 (02) 377-390
    CrossrefPubMedGoogle Scholar
  • 28 Heyneman LE, Ward S, Lynch DA, Remy-Jardin M, Johkoh T, Müller NL. Respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia: different entities or part of the spectrum of the same disease process?. AJR Am J Roentgenol 1999; 173 (06) 1617-1622
    CrossrefPubMedGoogle Scholar
  • 29 Moon J, du Bois RM, Colby TV, Hansell DM, Nicholson AG. Clinical significance of respiratory bronchiolitis on open lung biopsy and its relationship to smoking related interstitial lung disease. Thorax 1999; 54 (11) 1009-1014
    CrossrefPubMedGoogle Scholar
  • 30 Cheah FK, Sheppard MN, Hansell DM. Computed tomography of diffuse pulmonary haemorrhage with pathological correlation. Clin Radiol 1993; 48 (02) 89-93
    CrossrefPubMedGoogle Scholar
  • 31 Johkoh T, Ikezoe J, Nagareda T, Kohno N, Takeuchi N, Kozuka T. Metastatic pulmonary calcification: early detection by high-resolution CT. J Comput Assist Tomogr 1993; 17 (03) 471-473
    CrossrefPubMedGoogle Scholar
  • 32 Roberton BJ, Hansell DM. Organizing pneumonia: a kaleidoscope of concepts and morphologies. Eur Radiol 2011; 21 (11) 2244-2254
    CrossrefPubMedGoogle Scholar
  • 33 Cho YH, Chae EJ, Song JW, Do KH, Jang SJ. Chest CT imaging features for prediction of treatment response in cryptogenic and connective tissue disease-related organizing pneumonia. Eur Radiol 2020; 30 (05) 2722-2730
    CrossrefPubMedGoogle Scholar
  • 34 Ujita M, Renzoni EA, Veeraraghavan S, Wells AU, Hansell DM. Organizing pneumonia: perilobular pattern at thin-section CT. Radiology 2004; 232 (03) 757-761
    CrossrefPubMedGoogle Scholar
  • 35 Polverosi R, Maffesanti M, Dalpiaz G. Organizing pneumonia: typical and atypical HRCT patterns. Radiol Med (Torino) 2006; 111 (02) 202-212
    CrossrefPubMedGoogle Scholar
  • 36 Oikonomou A, Hansell DM. Organizing pneumonia: the many morphological faces. Eur Radiol 2002; 12 (06) 1486-1496
    CrossrefPubMedGoogle Scholar
  • 37 Lee JS, Lynch DA, Sharma S, Brown KK, Müller NL. Organizing pneumonia: prognostic implication of high-resolution computed tomography features. J Comput Assist Tomogr 2003; 27 (02) 260-265
    CrossrefPubMedGoogle Scholar
  • 38 Lee JW, Lee KS, Lee HY. et al. Cryptogenic organizing pneumonia: serial high-resolution CT findings in 22 patients. AJR Am J Roentgenol 2010; 195 (04) 916-922
    CrossrefPubMedGoogle Scholar
  • 39 Chung MP, Nam BD, Lee KS. et al. Serial chest CT in cryptogenic organizing pneumonia: Evolutional changes and prognostic determinants. Respirology 2018; 23 (03) 325-330
    CrossrefPubMedGoogle Scholar
  • 40 Price M, Gilman MD, Carter BW, Sabloff BS, Truong MT, Wu CC. Imaging of eosinophilic lung diseases. Radiol Clin North Am 2016; 54 (06) 1151-1164
    CrossrefPubMedGoogle Scholar
  • 41 Johkoh T, Müller NL, Akira M. et al. Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients. Radiology 2000; 216 (03) 773-780
    CrossrefPubMedGoogle Scholar
  • 42 Daimon T, Johkoh T, Sumikawa H. et al. Acute eosinophilic pneumonia: thin-section CT findings in 29 patients. Eur J Radiol 2008; 65 (03) 462-467
    CrossrefPubMedGoogle Scholar
  • 43 Cheon JE, Lee KS, Jung GS, Chung MH, Cho YD. Acute eosinophilic pneumonia: radiographic and CT findings in six patients. AJR Am J Roentgenol 1996; 167 (05) 1195-1199
    CrossrefPubMedGoogle Scholar
  • 44 Mitchell TA, Hamilos DL, Lynch DA, Newell JD. Distribution and severity of bronchiectasis in allergic bronchopulmonary aspergillosis (ABPA). J Asthma 2000; 37 (01) 65-72
    CrossrefPubMedGoogle Scholar
  • 45 Ward S, Heyneman L, Lee MJ, Leung AN, Hansell DM, Müller NL. Accuracy of CT in the diagnosis of allergic bronchopulmonary aspergillosis in asthmatic patients. AJR Am J Roentgenol 1999; 173 (04) 937-942
    CrossrefPubMedGoogle Scholar
  • 46 Agarwal R, Gupta D, Aggarwal AN, Saxena AK, Chakrabarti A, Jindal SK. Clinical significance of hyperattenuating mucoid impaction in allergic bronchopulmonary aspergillosis: an analysis of 155 patients. Chest 2007; 132 (04) 1183-1190
    CrossrefPubMedGoogle Scholar
  • 47 Logan PM, Müller NL. High-attenuation mucous plugging in allergic bronchopulmonary aspergillosis. Can Assoc Radiol J 1996; 47 (05) 374-377
    PubMedGoogle Scholar
  • 48 Silva CI, Müller NL, Fujimoto K, Johkoh T, Ajzen SA, Churg A. Churg-Strauss syndrome: high resolution CT and pathologic findings. J Thorac Imaging 2005; 20 (02) 74-80
    CrossrefPubMedGoogle Scholar
  • 49 Kim YK, Lee KS, Chung MP. et al. Pulmonary involvement in Churg-Strauss syndrome: an analysis of CT, clinical, and pathologic findings. Eur Radiol 2007; 17 (12) 3157-3165
    CrossrefPubMedGoogle Scholar
  • 50 Pereira-Silva JL, Silva CI, Araújo Neto CA, Andrade TL, Müller NL. Chronic pulmonary microaspiration: high-resolution computed tomographic findings in 13 patients. J Thorac Imaging 2014; 29 (05) 298-303
    CrossrefPubMedGoogle Scholar
  • 51 Scheeren B, Marchiori E, Pereira J, Meirelles G, Alves G, Hochhegger B. Pulmonary computed tomography findings in patients with chronic aspiration detected by videofluoroscopic swallowing study. Br J Radiol 2016; 89 (1063): 20160004
    CrossrefPubMedGoogle Scholar
  • 52 Samhouri BF, Tandon YK, Hartman TE. et al. Presenting clinicoradiologic features, causes, and clinical course of exogenous lipoid pneumonia in adults. Chest 2021; 160 (02) 624-632
    CrossrefPubMedGoogle Scholar
  • 53 Im JG, Han MC, Yu EJ. et al. Lobar bronchioloalveolar carcinoma: “angiogram sign” on CT scans. Radiology 1990; 176 (03) 749-753
    CrossrefPubMedGoogle Scholar
  • 54 Wang T, Yang Y, Liu X. et al. Primary invasive mucinous adenocarcinoma of the lung: prognostic value of CT imaging features combined with clinical factors. Korean J Radiol 2021; 22 (04) 652-662
    CrossrefPubMedGoogle Scholar
  • 55 Chen Y, Chen A, Jiang H. et al. HRCT in primary pulmonary lymphoma: can CT imaging phenotypes differentiate histological subtypes between mucosa-associated lymphoid tissue (MALT) lymphoma and non-MALT lymphoma?. J Thorac Dis 2018; 10 (11) 6040-6049
    CrossrefPubMedGoogle Scholar
  • 56 Murayama S, Murakami J, Yabuuchi H, Soeda H, Masuda K. “Crazy paving appearance” on high resolution CT in various diseases. J Comput Assist Tomogr 1999; 23 (05) 749-752
    CrossrefPubMedGoogle Scholar
  • 57 Johkoh T, Itoh H, Müller NL. et al. Crazy-paving appearance at thin-section CT: spectrum of disease and pathologic findings. Radiology 1999; 211 (01) 155-160
    CrossrefPubMedGoogle Scholar
  • 58 Rossi SE, Erasmus JJ, Volpacchio M, Franquet T, Castiglioni T, McAdams HP. “Crazy-paving” pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics 2003; 23 (06) 1509-1519
    CrossrefPubMedGoogle Scholar
  • 59 McCarthy C, Carey BC, Trapnell BC. Autoimmune pulmonary alveolar proteinosis. Am J Respir Crit Care Med 2022; 205 (09) 1016-1035
    CrossrefPubMedGoogle Scholar
  • 60 Jouneau S, Ménard C, Lederlin M. Pulmonary alveolar proteinosis. Respirology 2020; 25 (08) 816-826
    CrossrefPubMedGoogle Scholar
  • 61 Chong WH, Saha BK, Austin A, Chopra A. The significance of subpleural sparing in CT chest: a state-of-the-art review. Am J Med Sci 2021; 361 (04) 427-435
    CrossrefPubMedGoogle Scholar
  • 62 Xiao L, Zhu H, Zhang W, Li L. A case of progressive pulmonary alveolar proteinosis with lymphadenopathy revealed on 18F-FDG PET/CT. Hell J Nucl Med 2021; 24 (01) 94-95
    PubMedGoogle Scholar
  • 63 Hawkins P, Chawke L, Cormican L. et al. Autoimmune pulmonary alveolar proteinosis: a discrepancy between symptoms and CT findings. Lancet 2021; 398 (10296): e7
    CrossrefPubMedGoogle Scholar
  • 64 Hida T, Nishino M, Hino T. et al. Traction bronchiectasis/bronchiolectasis is associated with interstitial lung abnormality mortality. Eur J Radiol 2020; 129: 109073
    CrossrefPubMedGoogle Scholar
  • 65 Akira M, Yamamoto S, Hara H, Sakatani M, Ueda E. Serial computed tomographic evaluation in desquamative interstitial pneumonia. Thorax 1997; 52 (04) 333-337
    CrossrefPubMedGoogle Scholar
  • 66 Hartman TE, Primack SL, Kang EY. et al. Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia. Assessment with serial CT. Chest 1996; 110 (02) 378-382
    CrossrefPubMedGoogle Scholar
  • 67 Kawabata Y, Takemura T, Hebisawa A. et al; Desquamative Interstitial Pneumonia Study Group. Desquamative interstitial pneumonia may progress to lung fibrosis as characterized radiologically. Respirology 2012; 17 (08) 1214-1221
    CrossrefPubMedGoogle Scholar
  • 68 Lichtenberger III JP, Digumarthy SR, Abbott GF, Shepard JA, Sharma A. Diffuse pulmonary hemorrhage: clues to the diagnosis. Curr Probl Diagn Radiol 2014; 43 (03) 128-139
    CrossrefPubMedGoogle Scholar
  • 69 Zamora MR, Warner ML, Tuder R, Schwarz MI. Diffuse alveolar hemorrhage and systemic lupus erythematosus. Clinical presentation, histology, survival, and outcome. Medicine (Baltimore) 1997; 76 (03) 192-202
    CrossrefPubMedGoogle Scholar
  • 70 Reisman S, Chung M, Bernheim A. A review of clinical and imaging features of diffuse pulmonary hemorrhage. AJR Am J Roentgenol 2021; 216 (06) 1500-1509
    CrossrefPubMedGoogle Scholar
  • 71 Lee KS, Kim TS, Fujimoto K. et al. Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients. Eur Radiol 2003; 13 (01) 43-51
    CrossrefPubMedGoogle Scholar
  • 72 Aberle DR, Gamsu G, Lynch D. Thoracic manifestations of Wegener granulomatosis: diagnosis and course. Radiology 1990; 174 (3, Pt 1): 703-709
    CrossrefPubMedGoogle Scholar
  • 73 Primack SL, Hartman TE, Lee KS, Müller NL. Pulmonary nodules and the CT halo sign. Radiology 1994; 190 (02) 513-515
    CrossrefPubMedGoogle Scholar
  • 74 Suzuki A, Sakamoto S, Kurosaki A. et al; for Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis and Research Committee of Intractable Renal Disease of the Ministry of Health, Labour, and Welfare of Japan. Chest high-resolution CT findings of microscopic polyangiitis: a Japanese first nationwide prospective cohort study. AJR Am J Roentgenol 2019; 213 (01) 104-114
    CrossrefPubMedGoogle Scholar
  • 75 Stein MG, Mayo J, Müller N, Aberle DR, Webb WR, Gamsu G. Pulmonary lymphangitic spread of carcinoma: appearance on CT scans. Radiology 1987; 162 (02) 371-375
    CrossrefPubMedGoogle Scholar
  • 76 Munk PL, Müller NL, Miller RR, Ostrow DN. Pulmonary lymphangitic carcinomatosis: CT and pathologic findings. Radiology 1988; 166 (03) 705-709
    CrossrefPubMedGoogle Scholar
  • 77 Harrison NK, Glanville AR, Strickland B. et al. Pulmonary involvement in systemic sclerosis: the detection of early changes by thin section CT scan, bronchoalveolar lavage and 99mTc-DTPA clearance. Respir Med 1989; 83 (05) 403-414
    CrossrefPubMedGoogle Scholar
  • 78 Chan ED, Morales DV, Welsh CH, McDermott MT, Schwarz MI. Calcium deposition with or without bone formation in the lung. Am J Respir Crit Care Med 2002; 165 (12) 1654-1669
    CrossrefPubMedGoogle Scholar
  • 79 Belém LC, Zanetti G, Souza Jr AS. et al. Metastatic pulmonary calcification: state-of-the-art review focused on imaging findings. Respir Med 2014; 108 (05) 668-676
    CrossrefPubMedGoogle Scholar
  • 80 Egashira R, Jacob J, Kokosi MA. et al. Diffuse pulmonary ossification in fibrosing interstitial lung diseases: prevalence and associations. Radiology 2017; 284 (01) 255-263
    CrossrefPubMedGoogle Scholar
  • 81 Shaw BM, Shaw SD, McCormack FX. Pulmonary alveolar microlithiasis. Semin Respir Crit Care Med 2020; 41 (02) 280-287
    Article in Thieme ConnectPubMedGoogle Scholar
  • 82 Bendstrup E, Jönsson ÅLM. Pulmonary alveolar microlithiasis: no longer in the stone age. ERJ Open Res 2020; 6 (03) 6
    CrossrefPubMedGoogle Scholar
  • 83 Sumikawa H, Johkoh T, Tomiyama N. et al. Pulmonary alveolar microlithiasis: CT and pathologic findings in 10 patients. Monaldi Arch Chest Dis 2005; 63 (01) 59-64
    CrossrefPubMedGoogle Scholar