CT of the Airways (eBook)

Series Editor’s Introduction 6
Preface 8
Contributors 11
Part I: Introductory 13
Airway Anatomy and Physiology 14
Kathryn Chmura, Stella Hines, and Edward D. Chan 14
INTRODUCTION 14
DEVELOPMENT OF THE LUNGS 14
GROSS ANATOMY 14
Supraglottic Airway 14
Larynx 17
Infraglottic Airway 18
HISTOLOGY 22
Conducting Portion of the Airways 22
Respiratory Portion of the Airways 23
PHYSIOLOGY 24
General Considerations 24
Pulmonary Function Tests 24
Physiologic, Imaging, and Histopathologic Correlations 30
Radiologic Anatomy of the Airways 35
Phillip M. Boiselle and David A. Lynch 35
UPPER AIRWAY 35
TRACHEA 35
MAIN BRONCHI 47
SEGMENTAL AND SUBSEGMENTAL BRONCHI 48
SMALL BRONCHI AND BRONCHIOLES 56
NORMAL FINDINGS ON EXPIRATORY CT 56
Pathology of the Airways 59
Chih-Wei Wang and Thomas V. Colby 59
LARGE AIRWAYS 59
Introduction 59
Tracheomalacia and Tracheobronchomalacia 59
Tracheobronchopathia Osteochondroplastica 59
Tracheobronchomegaly 59
Infectious Bronchitis 60
Bronchiectasis 61
Cystic Fibrosis 63
Mucoid Impaction of Bronchi 63
Bronchocentric Granulomatosis 65
Allergic Bronchopulmonary Fungal Disease 67
Middle Lobe Syndrome 67
Relapsing Polychondritis 67
Broncholithiasis 69
SMALL AIRWAYS 69
PATHOLOGIC PATTERNS OF BRONCHIOLITIS 69
Cellular Bronchiolitis 69
Follicular Bronchiolitis 72
Respiratory Bronchiolitis 72
Bronchiolitis Obliterans with Intraluminal Polyps (BOOP or OP pattern) 73
Constrictive Bronchiolitis 75
Peribronchiolar Metaplasia (Bronchiolarization) 75
Bronchiolocentric Nodules 76
AIRWAY PATHOLOGY IN SELECTED CLINICOPATHOLOGIC ENTITIES 78
Asthma 78
Diffuse Panbronchiolitis 80
Fume-Related Bronchiolar Injury 81
Anatomical Airway Imaging Methods 84
Phillip M. Boiselle and David A. Lynch 84
HELICAL AND MULTIDETECTOR-ROW CT TECHNOLOGY 84
AXIAL CT IMAGES 84
ALTERNATIVE CT DISPLAY METHODS: MULTIPLANAR AND 3-D RECONSTRUCTIONS 86
IMAGING TECHNIQUE: OPTIMIZING IMAGE QUALITY 87
CT RECONSTRUCTION AND REFORMATION METHODS 92
3-D Reconstruction Methods 92
2-D Multiplanar Reformation Methods 94
TECHNIQUES FOR DETECTION OF SMALL AIRWAY ABNORMALITY 95
Expiratory CT 98
DUAL ENERGY CT 98
CONCLUSION 100
Functional Airway Imaging Methods 104
Jonathan G. Goldin 104
INTRODUCTION 104
IMAGING PROTOCOLS 105
TECHNIQUES FOR CT QUANTITATIVE MEASURE OF AIRWAY STRUCTURE AND FUNCTION 110
Airway Measurements 113
Lung Attenuation 116
Lung Volume Analysis 118
NOVEL CT VENTILATION TECHNIQUES 118
CLINICAL CT MEASURES OF THE AIRWAYS AND AIRWAY FUNCTION 119
Trachea 119
Proximal Airways 120
Peripheral Airways 120
CONCLUSION 121
Part II: Large Airways 127
Tracheobronchial Stenoses 128
Phillip M. Boiselle, Jay Catena, Armin Ernst, and David A. Lynch 128
IMAGING TECHNIQUE 128
FRAMEWORK FOR APPROACHING TRACHEOBRONCHIAL STENOSES 131
POST-INTUBATION STENOSIS 131
AMYLOIDOSIS 135
IDIOPATHIC LARYNGOTRACHEAL STENOSIS 137
INFLAMMATORY BOWEL DISEASE 138
RELAPSING POLYCHONDRITIS 140
RHINOSCLEROMA 142
SABER-SHEATH TRACHEA 142
SARCOIDOSIS 144
TRACHEOBRONCHOPATHIA OSTEOCHONDROPLASTICA 146
TRANSPLANTATION 148
TUBERCULOSIS 149
WEGENER GRANULOMATOSIS 151
Tracheal and Bronchial Neoplasms 157
Karen S. Lee and Phillip M. Boiselle 157
INTRODUCTION 157
IMAGING ASSESSMENT 157
CT CHARACTERIZATION OF AIRWAY NEOPLASMS 162
BENIGN LESIONS 168
Squamous Cell Papilloma 169
Papillomatosis 169
Lipomas 170
Hamartoma 171
Peripheral Nerve Sheath Tumors 171
Chondroma 171
MALIGNANT LESIONS 174
Squamous Cell Carcinoma 174
Adenoid Cystic Carcinoma 177
Carcinoid 178
Mucoepidermoid Carcinoma 183
SECONDARY AIRWAY MALIGNANCIES 185
NON-NEOPLASTIC MIMICKERS 186
Tracheobronchopathia Osteochondroplastica 186
Amyloidosis 188
Miscellaneous 193
Tracheobronchomalacia 197
Ronaldo Hueb Baroni, Rodrigo Caruso Chate, Daniel Nobrega da Costa, and Phillip M. Boiselle 197
Introduction 197
Classification 198
Congenital or Primary Form 198
Acquired or Secondary Form 199
Epidemiology 200
Histopathology 200
Clinical Presentation 201
Natural History 201
Traditional Diagnostic Approach 201
Historical Review of Non-Invasive Imaging Methods 203
Provocative Maneuvers for Non-Invasive Functional Airway Imaging 203
Diagnostic Criterion for TBM 205
How to Perform a Functional MDCT Study 206
Dose-Reduction for MDCT 207
Multiplanar Reformations and 3-D ct Reconstructions 207
Diagnostic Interpretation of Functional MDCT Studies 207
Treatment 213
Conclusions 215
Bronchiectasis 219
John D. Newell 219
INTRODUCTION 219
DEFINITION OF BRONCHIECTASIS 219
CLINICAL SIGNIFICANCE AND PRESENTATION OF BRONCHIECTASIS 221
ETIOLOGIES OF BRONCHIECTASIS 222
CT TECHNIQUE FOR THE DIAGNOSIS OF BRONCHIECTASIS 223
CT CRITERIA FOR THE DIAGNOSES OF BRONCHIECTASIS 225
CT OF BRONCHIECTASIS IN SPECIFIC DISEASE STATES 227
CYSTIC FIBROSIS 227
NON-TUBERCULOUS MYCOBACTERIAL DISEASE INFECTION 230
ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS 234
ALPHA-1 ANTITRYPSIN DEFICIENCY 236
IMMUNODEFICIENCIES 237
PRIMARY CILIARY DYSKINESIA 239
Part III: Small Airways 242
Asthma 243
Philippe A. Grenier, Catherine Beigelman-Aubry, and Pierre-Yves Brillet 243
INTRODUCTION 243
CT FINDINGS 244
Bronchial Wall Thickening 244
Bronchial Dilatation 244
Mucoid Impaction 247
Decreased Lung Attenuation 247
Expiratory Air Trapping 248
AIRWAY HYPERRESPONSIVENESS AND SMALL AIRWAY INFLAMMATION 249
Bronchial Hyperresponsiveness 249
Small Airway Hyperresponsiveness 249
Small Airway Inflammation 253
AIRWAY WALL REMODELING AND AIRFLOW OBSTRUCTION 253
Pathologic and Functional Findings 253
CT Assessment 253
Effect of Treatment 256
Infectious Small Airways Diseasesand Aspiration Bronchiolitis 259
Kyung S. Lee 259
INTRODUCTION 259
INFECTIOUS BRONCHIOLITIS 259
Causes of Noninfectious Bronchiolitis 260
Respiratory Syncytial Virus Pneumonia 260
Mycoplasma pneumoniae Pneumonia 261
Chlamydia pneumoniae Pneumonia 262
Bacterial Bronchiolitis 264
Bronchiolitis Due to Granulomatous Disease 266
Bronchiolitis Due to Aspergillus Infection 269
ASPIRATION BRONCHIOLITIS 271
CONCLUSION 273
Noninfectious Inflammatory Small Airways Diseases 275
David A. Lynch 275
CLASSIFICATION OF NONINFECTIOUS SMALL AIRWAYS DISEASE 275
DIFFUSE PANBRONCHIOLITIS 275
Imaging Features 278
Differential Diagnosis 278
FOLLICULAR BRONCHIOLITIS 280
INHALATIONAL LUNG DISEASE 281
Toxic Inhalation 281
Anthracosis Related to Biomass Fuels 282
Flock Lung 284
Pneumoconioses 287
BRONCHIOLITIS ASSOCIATED WITH DIFFUSE LUNG DISEASES 287
Hypersensitivity Pneumonitis 287
Sarcoidosis 287
Langerhans Cell Histiocytosis 287
BRONCHIOLITIS ASSOCIATED WITH SYSTEMIC DISEASES 287
Collagen Vascular Disease 287
Inflammatory Bowel Disease 287
BRONCHOCENTRIC GRANULOMATOSIS 289
Obliterative Bronchiolitis 296
C. Isabela S. Silva and Nestor L. Müller 296
INTRODUCTION 296
DEFINITION AND TERMINOLOGY 296
CLINICAL FEATURES 298
PULMONARY FUNCTION TESTS 298
HISTOLOGIC FINDINGS 298
IMAGING FINDINGS 298
Chest Radiography 301
Computed Tomography Findings 301
SPECIFIC CAUSES AND UNDERLYING DISEASES ASSOCIATED WITH OBLITERATIVE BRONCHIOLITIS 312
Postinfectious Obliterative Bronchiolitis 312
Obliterative Bronchiolitis Associated with Transplantation 314
Postinhalational Obliterative Bronchiolitis 317
Obliterative Bronchiolitis Associated with Connective Tissue Disorders 317
Sauropous androgynus-Related Obliterative Bronchiolitis 317
Obliterative Bronchiolitis Associated with Diffuse Neuroendocrine Cell Hyperplasia, Carcinoid Tumorlets, and Carcinoid Tumors 319
Cryptogenic Obliterative Bronchiolitis 319
Obliterative Bronchiolitis Associated with Inflammatory Bowel Disease 319
Smoking-Related Small Airwaysand Interstitial Lung Disease 327
David M. Hansell and Athol U. Wells 327
INTRODUCTION 327
RESPIRATORY BRONCHIOLITIS/RESPIRATORY BRONCHIOLITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE 328
Pathology 328
Clinical Aspects 329
Imaging 330
DESQUAMATIVE INTERSTITIAL PNEUMONIA 333
Pathology 335
Clinical Aspects 335
Imaging 336
LANGERHANS CELL HISTIOCYTOSIS 338
Pathology 338
Clinical Aspects 340
Imaging 340
MIXED SMOKING-RELATED DISORDERS 343
LARGE AIRWAYS ABNORMALITIES IN CIGARETTE SMOKERS 345
PartIV: Pediatric Airways Disorders 351
Large Airways 352
Edward Y. Lee and Marilyn J. Siegel 352
INTRODUCTION 352
PATIENT PREPARATION/TECHNIQUE 352
Sedation 352
Intravenous Contrast Material 353
IMAGING TECHNIQUE 353
Technical Considerations of Multislice CT 353
POST-PROCESSING TECHNIQUES 354
Multiplanar Reformation Methods 354
Maximum and Minimum Intensity Projection Images 354
Three-Dimensional Volume Rendering 357
IMAGE INTERPRETATION 359
CLINCIAL APPLICATIONS FOR CT 359
CONGENITAL MALFORMATIONS OF THE TRACHEA AND BRONCHI 359
Congenital Tracheobronchial Anomalies 359
Congenital Vascular Anomalies 362
ACQUIRED TRACHEAL NARROWING 367
Tracheal Stricture 368
Bronchial Stricture 369
Primary Airway Neoplasms 369
Secondary Airway Tumors 373
Infection 373
TRACHEOMALACIA AND BRONCHOMALACIA 376
CONCLUSIONS 377
Computed Tomography of Pediatric Small Airways Disease 381
Alan S. Brody 381
ANATOMY AND DEVELOPMENT 381
IMAGING OVERVIEW 382
Technique 382
INHALATIONAL DISEASE 389
ASTHMA 389
ACUTE BRONCHIOLITIS 389
BRONCHIOLITIS OBLITERANS 391
FOLLICULAR BRONCHIOLITIS 395
NEUROENDOCRINE CELL HYPERPLASIA OF INFANCY 396
BRONCHIOLITIS OBLITERANS ORGANIZING PNEUMONIA OR CRYPTOGENIC ORGANIZING PNEUMONIA 399
HYPERSENSITIVITY PNEUMONITIS 400
OTHER CAUSES OF BRONCHIOLITIS 401
Index 405