High-Resolution CT of the Chest: Comprehensive Atlas [3 ed.] 0781791901, 9780781791908

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INCLUDE ONLINE ACCESS TO HILLY bLJlilCHAIILL

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High-Resolution CT

of the QlOSt C o m p r e h e n s i v e

THTRD EDITION

Walters KtuwerLippincoit ***** Williams & Wilkins

A t l a s

EHC J. StEfll Stephen J. Swensen Jeffrey P. Kanne

High-Resolution CT of the Chest Comprehensive Atlas THIRD EDITION

— ERIC J. STERN, M.D. Professor of Radiology Adjunct Professor of Medicine Adjunct Professor of Medical Education and Bioinformatics Vice-Chair for Academic Affairs University of Washington Seattle, Washington

— STEPHEN J. SWENSEN, M.D., Professor of Radiology Mayo Clinic Rochester, Minnesota

— JEFFREY P. KANNE, M.D. Associate Professor Vice Chairman of Quality and Safety Department of Radiology University of Wisconsin - Madison Madison, Wisconsin

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Lippincott Williams & Wilkins

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All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. g vemment employees are not covered by the abovementioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data Stem, Eric J. High-resolution CT of the chest: comprehensive atlas / Eric J. Stem, Stephen J. Sw ensen, Jeffrey P. Kanne. - 3rd ed. p.; cm. Includes bibliographical references and index. ISBN 978-0-7817-9190-8 (alk. paper) 1. Chest—Tomography—Atlases. I. Swensen, Stephen J. II. Kanne, Jeffrey P. III. Title. [DNLM: 1. Respiratory Tract Diseases—radiography—Atlases. 2. Radiography, Thoracic— Atlases. 3. Respiratory System—pathology—Atlases. 4. Tomography, X-Ray Computed—Atlases. WE 17 S839h 2009] RC941.S85 2009 617.5'40757—dc22 2009023437 Care has been taken to confirm the accuracy of the information presented and to describ generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accu­ racy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant fl w of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for an y change in indications and dosage and for added warnings and precautions. This is particularly important when the recom­ mended agent is a new or infrequently employed dmg. Some dmgs and medical devices presented in the publication have Food and Dmg Admin­ istration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care providers to ascertain the FDA status of each dmg or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 6383030 or fax orders to (301) 223-2320. International customers should call (3 01) 223-2300. Visit Lippincott Williams & Wilkins on the Internet at: LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST.

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Contents 1

INTRODUCTION TO HIGH-RESOLUTION COMPUTED TOMOGRAPHY 1

2

AIRWAY AND LUNG ANATOMY 6

3

LARGE AIRWAYS DISEASES 30

4

BRONCHIECTASIS 69

5

SMALL AIRWAYS DISEASES 98

6

CYSTIC LUNG DISEASES 119

7

OBSTRUCTIVE LUNG DISEASES 143

8

LUNG TRANSPLANTATION AND LUNG VOLUME REDUCTION SURGERY 168

9

DIFFUSE LUNG DISEASES 193

10

ASBESTOS-RELATED DISEASES 256

11

MASSES 275

12

INFECTIOUS PNEUMONIA 302

13

ACQUIRED IMMUNODEFICIENCY SYNDROME - RELATED DISEASES 328

INDEX 353

vii

1

Introduction to High-Resolution Computed Tomography High-resolution computed tomography (HRCT) has contributed significantly to the radio logic assessment of intrathoracic and pulmonary diseases since its refinement in the mid 1980s. The foremost reason is that HRCT scans detect and allow characterization of maty dis­ ease processes, which with conv entional chest radiograph y are occult, nonspecific, or equivocal. Computed tomography (CT) scanning is still the most common cross-sectional imaging examination for evaluation of the chest. In our practices, dedicated HRCT scans are performed in a minority of cases; ho wever, it should be readily appreciated that most mod­ em multidetector-row CT scanners, and their capability for volumetric scanning, quickly pro­ duce many thin sections, essentially equivalent to the HRCT techniques of the past, but now with easy generation of reformations in coronal or sagittal imaging planes expanding our ap­ preciation for the extent and distribution of v arious conditions and abnormalities. In many ways, all state-of-the-art thin section chest imaging, with or without contrast enhancement, is high-resolution chest imaging, making an understanding of the carious presentations of lung abnormalities all the more important.

Technique Dedicated HRCT is a technique that can be performed on an y late-generation CT scanner. It differs from conventional CT only by optimizing technical parameters for spatial resolution by using the narrowest beam collimation possible