Brett M. Elicker - Fundamentals of High-Resolution Lung CT: Common Findings, Common Patters, Common Diseases and Differential Diagnosis: Common Findings, Common Patterns, Common Diseases, and Differential Diagnosis

Fundamentals of High-Resolution Lung CT

Common Findings, Common Patterns, Common Diseases, and Differential Diagnosis

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Library of Congress Cataloging-in-Publication Data

Elicker, Brett M.

Fundamentals of high-resolution lung CT : common findings, common patterns, common diseases, and differential diagnosis / Brett M. Elicker, W. Richard Webb.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-4511-8408-2 (alk. paper)

I. Webb, W. Richard (Wayne Richard), 1945- II. Title.

[DNLM: 1. Lungradiography. 2. Tomography, X-Ray Computed. 3. Diagnosis, Differential. 4. Lung Diseasesradiography. WF 600]

616.2407572dc23

2012032695

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To Emma, Cole, Jack, and

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from

B.M.E.

To E, C, and J

from

W.R.W. (i.e. The Old Salt)

T he accurate interpretation of high-resolution CT in patients with diffuse lung disease is fundamentally based on 1) the recognition of specific HRCT findings; 2) an understanding of what they mean and their relationship to differential diagnosis; 3) a basic knowledge of the lung diseases that most commonly result in diffuse lung disease; and 4) the typical constellation of findings associated with each of these diseases.

Although interpreting HRCT can seem to be a complicated task, an understanding of these four basic principles often leads to the recognition of a typical or classic pattern of lung disease and the correct diagnosis or a list of diagnostic possibilities. On the other hand, it is important to understand that some HRCT patterns are necessarily nonspecific and should lead to further evaluation and correlation with clinical findings or lung biopsy.

In some sense, this book is HRCT Lite. It is intended to provide a simple and easily understandable approach to diagnosis and differential diagnosis. However, it is also important to emphasize that we do not consider this book to be an oversimplification of the HRCT principles and diagnosis of diffuse lung disease. The chapters and illustrations in this book are based upon, and demonstrate, the fundamental observations, rules, shortcuts, thought patterns, and differential diagnoses we use in everyday clinical practice and have built up over a period of years of HRCTpathologic correlation. It also is intended to review our basic and practical understanding of the lung diseases commonly assessed using HRCT.

It is our intention that this book provides the fundamental insights and facts necessary to interpret HRCT in most clinical settings, in an easily understood and digestible format. Although it is not comprehensive, it is our hope that it provides a practical and useful understanding of HRCT and its use in the diagnosis of diffuse lung disease.

Brett M. Elicker

W. Richard Webb

San Francisco, California

Fundamentals of High-Resolution Lung CT

Common Findings, Common Patterns, Common Diseases, and Differential Diagnosis

High-resolution computed tomography (HRCT) is widely used in the evaluation of a variety of diffuse lung diseases. The goal of this introductory chapter is to discuss the basics of HRCT, including indications, technique, and normal lung anatomy, as displayed using this modality.

INDICATIONS FOR HRCT

HRCT has several indications and uses in patients with, or suspected of having, diffuse lung disease ().

Detection of Diffuse Lung Disease

HRCT can be more sensitive and specific in the diagnosis of diffuse lung disease than other diagnostic tests (), including plain radiographs and pulmonary function tests. For instance, HRCT may detect abnormalities in asymptomatic patients with connective tissue disease or other conditions, or with various exposures, before pulmonary function tests become abnormal. Detecting abnormalities at an early stage may allow for appropriate treatment, preventing progression of lung disease.