Imaging of unusual diffuse lung diseases.
OBJECTIVE
Computed tomography scans are commonly used in imaging lung diseases. As more information accumulates, patterns of rare or new diseases on CT scans are being increasingly reported. Several pulmonary diseases have distinguishing features, which are better delineated on high resolution CT scans than plain chest radiographs. The radiographic features of unusual diffuse lung diseases published in the past two years are described.


RESULTS
Severe acute respiratory syndrome generally manifests as focal or diffuse bilateral areas of consolidation on chest radiography and reticulation with ground-glass attenuation commonly seen on CT scans. A normal HRCT rules out the diagnosis of Pneumocystis carinii pneumonia while a normal chest radiograph does not. Immunocompromised patients without AIDS, who have CMV pneumonia, generally demonstrate a combination of ground-glass attenuation, air-space consolidation, and small nodules on HRCT. Nodules less than 10 mm in size in immunocompromised patients are highly suggestive of viral infections. Bronchial wall thickening on HRCT associated with cavitating nodules is suggestive of Wegner granulomatosis in the appropriate clinical setting. Small cysts may be seen in a minority of patients with subacute hypersensitivity pneumonitis and centrilobular emphysema in chronic farmer's lung. Reversed halo sign has a high specificity for cryptogenic organizing pneumonia. The triad of ground-glass opacities, ill-defined centrilobular nodules and cysts and focal areas of air trapping is highly suggestive of subacute hypersensitivity pneumonitis.


CONCLUSIONS
Familiarizing with radiographic and CT scan patterns may help the clinician to exclude certain diagnoses and narrow the differential diagnosis for others.
Jamaica Hospital Medical Center and Flushing Hospital, New York, New York, USA.
Sabiha
S
Raoof
Suhail
S
Raoof
David P
DP
Naidich
D003586:Cytomegalovirus Infections / Q000000981:diagnostic imaging*; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging*; D011020:Pneumonia, Pneumocystis / Q000000981:diagnostic imaging*; D011024:Pneumonia, Viral / Q000000981:diagnostic imaging*; D045169:Severe Acute Respiratory Syndrome / Q000000981:diagnostic imaging*; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed