Mosaic Attenuation: Etiology, Methods of Differentiation, and Pitfalls.
Mosaic attenuation is a commonly encountered pattern on computed tomography that is defined as heterogeneous areas of differing lung attenuation. This heterogeneous pattern of attenuation is the result of diverse causes that include diseases of the small airways, pulmonary vasculature, alveoli, and interstitium, alone or in combination. Small airways disease can be a primary disorder, such as respiratory bronchiolitis or constrictive bronchiolitis, or be part of parenchymal lung disease, such as hypersensitivity pneumonitis, or large airways disease, such as bronchiectasis and asthma. Vascular causes resulting in mosaic attenuation are typically chronic thromboembolic pulmonary hypertension, which is characterized by organizing thrombi in the elastic pulmonary arteries, or pulmonary arterial hypertension, a heterogeneous group of diseases affecting the distal pulmonary arterioles. Diffuse ground-glass opacity can result in a mosaic pattern related to a number of processes in acute (eg, infection, pulmonary edema), subacute (eg, organizing pneumonia), or chronic (eg, fibrotic diseases) settings. Imaging clues that can assist the radiologist in pinpointing a diagnosis include evidence of large airway involvement, cardiovascular abnormalities, septal thickening, signs of fibrosis, and demonstration of airtrapping at expiratory imaging.
From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.).
Seth J
SJ
Kligerman
From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.).
Travis
T
Henry
From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.).
Cheng T
CT
Lin
From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.).
Teri J
TJ
Franks
From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.).
Jeffrey R
JR
Galvin
D000388:Air; D001995:Bronchography / Q000379:methods; D045853:Exhalation; D018324:Hemangioma, Capillary / Q000000981:diagnostic imaging; D006801:Humans; D001239:Inhalation; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000000981:diagnostic imaging*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging; D011668:Pulmonary Veno-Occlusive Disease / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed