Cavitating pulmonary nodules with Halo sign

The major differentials for 'cavitating pulmonary nodules with halo sign' ie., perilesional GGO are :

1. Angio-invasive infections like Invasive Aspergillosis.
2. Wegener's Granulomatosis.
3. Hemorrhagic Metastases.
4. Carcinomas (BAC and Squamous Cell Carcinoma) and Lymphoma.

These perilesional GGOs may represent hemorrhage or cellular infiltration.

Solitary Pulmonary Nodule : Probability being Malignant

Solitary Pulmonary Nodule : Probability being Malignant : in decreasing order (Ss)

Spiculated margins
Size >3cm (defnitionwise this would be a 'mass' !!)
Seventy or more (>70yrs)
Speedy growth rate (Rapid doubling time)
Smoker
Superior location (Upper Lobes)

AIR CRESCENT SIGN

Causes of AIR CRESCENT SIGN

    1. Aspergilloma -(Most Common).
    2. Angioinvasive.A.
    3. Echinococcal cyst.
    4. TB.
    5. Rasmussen aneusrysm
    6. Lung abscess
    7. Bronchogenic Ca.
    8. Hematoma.
    9. PCP.

Saprophytic aspergillosis (Aspergilloma) is commonly associated with thickening of the wall of the cavity and adjacent pleura (due to hypersensitivity reaction). The pleural thickening may be the earliest 'radiographic' sign before any visible changes in the cavity.

The 5 forms of PULMONARY ASPERGILLOSIS include:

1. SAPROPHYTIC

2. Allergic Broncho Pulmonary Aspergillosis (ABPA) / Hypersensitivity reaction.
- Long standing bronchial   asthma;
- Finger-in-Glove appearance,
- Segmental and Subsegmental bronchi of upper lobes
- fungal hyphal impaction of affected bronchi with distal mucoid impaction with 30% showing hyperdensity /   frank calcification in CT.

3. SEMI-INVASIVE / Nectrotizing Aspergillosis.
4. AIRWAY INVASIVE.
5. ANGIOINVASIVE ASPERGILLOSIS.

Ref : RG article, 2001.

Case Of Ca Lung

A Case of Carcinoma Lung

50year old male patient, smoker, admitted with fever & sepsis.

CT Chest lung window shows a spiculated mass lesion
 in right upper lobe with multiple pleural tails/tags.

Lesion shows heterogenous, peripheral enhancement, indicating a necrotic lesion. 

Enlarged rim enhancing (necrotic) 3cm mediastinal lymph node is also seen.

In same patient liver showed a well-defined, but irregularly marginated hypodense (20-30HU) lesion with minimal peripheral enhancement. ?Liver Abscess !.

Again, the left adrenal showed a macroscopic fat containing lesion. (Adrenal Adenoma)

Elevated Hemidiaphragm on Chest X-Ray

Causes of an elevated hemidiaphragm are:

 1) Above the diaphragm – decreased lung volume (atelectasis, collapse, lobectomy, pneumonectomy, pulmonary hypoplasia).

2) Diaphragm – phrenic nerve palsy, diaphragmatic eventration

3) Below the diaphragm – abdominal tumour, subphrenic abscess, distended stomach or colon.

Differential diagnoses which may mimic an elevated hemidiaphragm are subpulmonic effusion, diaphragmatic hernia, diaphragmatic rupture and a tumour of the pleura or diaphragm

White Out Lung on Chest X-Ray

Complete White Out’ on the CXR has a limited number of causes.


The differential diagnosis can be shortened further with one simple observation - the position of the trachea.


Is it central, pulled or pushed from the side of opacification?


Pulled 


-Pneumonectomy(usually associated with a segmental rib defect)
-Total Lung Collapse
-Pulmonary Agenesis


Central:


-Consolidation
-Mesothelioma


Pushed:


-Pleural effusion
-Diaphragmatic hernia

Causes of Smooth Interstitial Thickening in HRCT Lung

Causes of Smooth Interstitial Thickening in HRCT Lung 


          L - Lymphangitis Carcinomatosis
          A – Alveolar proteinosis
          L – Lymphoma
          I – Interstitial Pneumonia