An Algorithmic Approach to Lung Disease


Steps for initial review

  1. initial review of CXR, including scout film
  2. review of data acquisition and reconstruction
  3. initial scrolling of CT to establish quality and overview of disease
  4. determine category of disease
    • reticular
    • nodular
    • diffuse alteration in density

2. Data Acquisition and Reconstruction

  • standard technique includes 1-2.5 mm edge enhanced, sharp reconstruction
  • expiratory imaging evaluates air trapping
  • prone image differentiates dependent atelectasis vs early interstitial disease
  • MIP (maximum intensity projection) image for detecting small nodules

3. Scrolling to Establish Overview

  • assess overall lung volumes, motion artifact, inspiratory efforts
  • figure out major abnormal pattern

5. Reticulation

  • criteria for diagnosis of UIP includes lower lobe honeycombing and bronchiectasis
    • peripheral reticulation with distortion and angulation of secondary lobule
    • subpleural and costophrenic angle predominance with component of upper lobe
    • nonsegmental distribution (crosses fissures)
    • traction bronchiectasis or honeycombing
    • heterogenous appearance
  • Probable UIP
  • Interlobular septal thickening
    • dendriform pulmonary ossification can occur more in the posterior and lateral basilar segments of lower lobe, associated with recurrent gastric aspiration in elderly men

6. Nodular Diseases

7. Diffuse Alteration in Density