TABLE 12-1 DISORDERS FREQUENTLY MANIFESTING AS PERIPHERAL OPACITIES ON CHEST RADIOGRAPHY OR COMPUTED TOMOGRAPHY
FIGURE 12-1. Usual interstitial pneumonitis. A: Posteroanterior (PA) chest radiograph of a 72-year-old woman with scleroderma shows low lung volumes and bilateral reticular interstitial lung disease. B: CT shows that the reticular opacities have a subpleural, peripheral distribution (arrows).
FIGURE 12-2. Eosinophilic pneumonia. A: PA chest radiograph of a 21-year-old woman shows bilateral airspace opacities that extend to the lung periphery. B: CT better shows the peripheral distribution of disease. Note prominent air bronchograms.
FIGURE 12-3. Alveolar sarcoidosis. A: PA chest radiograph of a 28-year-old asymptomatic man shows nonsegmental peripheral airspace disease and bilateral hilar and mediastinal lymphadenopathy. B: CT shows bilateral peripheral airspace disease. Note air bronchograms (arrows), a common feature of alveolar sarcoidosis.
FIGURE 12-4. Alveolar sarcoidosis. A: PA chest radiograph of a 29-year-old man shows ill-defined opacities in the upper lungs (circles). B: CT image shows a peripheral distribution of airspace disease. Note nodular beading of a left lower lobe bronchovascular bundle (arrow), a characteristic feature of sarcoidosis. C: CT with mediastinal windowing shows bilateral hilar (arrows) and subcarinal (asterisk) lymphadenopathy. Most patients with alveolar sarcoidosis have accompanying lymphadenopathy.
TABLE 12-2 CLASSIFICATION OF EOSINOPHILIC LUNG DISEASE
FIGURE 12-5. Chronic eosinophilic pneumonia. A: PA chest radiograph of a 62-year-old woman shows bilateral interstitial and airspace opacities, which are worse in the peripheral lungs, and elevation of the right hemidiaphragm related to right upper lobe volume loss. Based on the findings on this single exam, with no prior chest radiograph for comparison, both acute and chronic processes must be considered. B: CT of the right lung better shows the peripheral distribution of airspace disease. Note air bronchograms (arrows), which are a common feature of EP. No honeycombing is seen. C: PA chest radiograph obtained 2 months later, after treatment with steroids, shows complete clearing of bilateral peripheral lung disease.
FIGURE 12-6. Chronic eosinophilic pneumonia, recurrent. A: PA chest radiograph of an 85-year-old woman shows bilateral, ill-defined parenchymal opacities in a predominantly peripheral distribution. The right lung is more involved than the left. B: PA chest radiograph taken 5 months later shows clearing of much of the right lung and worsening disease in the periphery of the left lung (arrows). C: PA chest radiograph obtained 1 month after (B) shows partial clearing of the left upper lung, worsening disease in the left mid peripheral lung (straight arrows), and worsening disease in the right middle lung (curved arrows). Migratory lung disease is a characteristic feature of EP.
FIGURE 12-7. Chronic eosinophilic pneumonia. A: PA chest radiograph of a 30-year-old woman with several months' history of productive cough, fever, fatigue, chills, and dyspnea on exertion, treated unsuccessfully with several courses of antibiotics, shows bilateral ill-defined opacities, predominantly in the mid lungs. B: CT shows peripheral and central airspace disease. C: CT coronal reformatted image clearly shows the subpleural, peripheral distribution of disease (arrows). The patient improved rapidly with steroid treatment.
FIGURE 12-8. Pulmonary infarct. A: PA chest radiograph of a 52-year-old woman with acute pulmonary embolism shows focal airspace disease at the left costophrenic angle (circle). B: CT shows bilateral subpleural airspace opacities, which are largest in the left lower lobe (arrow), and bilateral pleural effusions. C: CT with mediastinal windowing confirms the presence of a central filling defect (arrows) within otherwise opacified lingular and left lower lobe pulmonary arteries, characteristic features of acute pulmonary emboli.
FIGURE 12-9. Pulmonary infarcts. CT of a 69-year-old man 10 weeks after a confirmed acute pulmonary embolic event shows residual subpleural scarring related to bilateral pulmonary infarcts (arrows).
FIGURE 12-10. Cryptogenic organizing pneumonitis. A: PA chest radiograph of a 53-year-old man with rheumatoid arthritis shows bilateral peripheral airspace disease involving predominantly the upper and middle lungs. B: CT confirms the peripheral distribution of disease and shows prominent air bronchograms.
FIGURE 12-11. Cryptogenic organizing pneumonitis. CT shows bilateral dense airspace and ground-glass opacities in a peripheral distribution. The patient had COP related to amiodarone lung toxicity.
FIGURE 12-12. Cryptogenic organizing pneumonitis. A: PA chest radiograph of a 52-year-old man after bone marrow transplant for leukemia shows bilateral ill-defined parenchymal opacities. B: CT shows that the opacities are peripheral and nonsegmental. Note air bronchograms (arrows).
FIGURE 12-13. Cryptogenic organizing pneumonia. CT of a 66-year-old man with rheumatoid arthritis shows peripheral airspace disease involving only the left lung.