The 1578th Chest Conference/ 3rd Biennial Clinical-

Radiologic-Pathologic Correlation

Radiologic-pathologic correlation of pulmonary

diseases

Harumi Itoh, M.D.

University of Fukui, Japan

2014/8/28

1

Interlobular septum

Bｒ

PA

PV

PV

Centriacinar emphysema ①

PV

Br

PA

ILS

Centrilobular normal lung

Paraseptal normal lung

Centriacinar emphysema ② Centriacinar emphysema

Paraseptal normal lung with polygonal shape

③

Bronchopneumonia

Cavity

Multiple nodules

④ Bronchopneumonia (centrilobular nodule)

MB

1 mm

Respiratory bronchiole

⑤ R

Pulmonary tuberculosis

Small nodules

⑥

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2

Ｂｒ

ＰＶ

ＩＬＳ 3 ｍｍ

Centrilobular cavity

Bronchiole

Pulmonary tuberculosis (centrilobular loose nodules) ⑦ Pulmonary tuberculosis ⑧

２ ｍｍ

Br

Br

Pulmonary tuberculosis (centrilobular compact nodules) ⑨

10

10 mm

PV

Pulmonary tuberculosis (centrilobular nodules) ⑩ Pulmonary tuberculosis (centrilobular nodules) ⑪

slice3 . . . . 3 mm

Pulmonary tuberculosis (tree in bud) ⑫

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3

Pulmonary tuberculosis (tree in bud) ⑬

5mm

Silicosis (centrilobular nodules) Interlobular septum ⑭

3ｍｍ

Silicosis (centrilobular compact nodule)

Br

PA

⑮

１ｍｍ

Br PA

PA

Silicosis (centrilobular small nodule) ⑯ Silicosis (paraseptal nodule)

5mm PV

Centrilobular nodule

⑰

１ｍｍ

Silicosis (paraseptal nodule) ⑱

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Silicosis

Left upper lobe

⑲

5mm

Centrilobular

Paraseptal

Interlobular septum

Pleura

Silicosis Calcified nodules

⑳

1mm

Silicosis (centrilobular nodule)

Interlobular septum

Centrilobular nodule

PV

Bronchiole Focal emphysema

21

Silicosis (centrilobular + paraseptal nodules) 22

5 ｍｍ

Langerhans cell histiocytosis 23 Langerhans cell histiocytosis

Centrilobular nodules

Centrilobular cysts

24

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5

PV

RB

PV

PV

PV

MB PA

Perilobular, periacinar fibrosis (fibrosis of alveoli along pulmonary venules)

IPF/UIP Courtesy of Dr. T. Takemura, Japan 25

485

IPF/UIP

Subpleural small opacities

Courtesy of Dr. T. Ogura, Japan

26

PA

RB ＰＶ

ILS PA

PA

ＰＶ

ＰＶ

ＰＶ

0.5mm

Courtesy by Dr. T. Takemura, Japan 1 mm

＊

f-NSIP 27

N

⑧ ⑨ ⑩

R SSc Polygonal opacities

Traction bronchiectasis

Courtesy by Dr. T. Ogura, Japan

28 IPF/UIP (honeycomb lung)

２ cm ２ cm

29

10mm

Courtesy by Dr. T. Takemura, Japan

Honeycomb lung (IPF/UIP)

10mm

PV

PV

PV

PV

PV

MB

ILS

2mm PA

PA

30

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Honeycomb lung（IPF/UIP） 31

160 182

＊ ＊

Pulmonary fibrosis combined with emphysema Courtesy of Dr. T. Ogura, Japan 32

4 years later 0

Cystic change with destruction of respiratory bronchioles and alveoli

V

A

* *

V

A

A

PA in emphysematous

space

Perilobular fibrosis along

PV and pleura

MB

Courtesy of Dr. T. Takemura

Pulmonary fibrosis combined

with emphysema 33

Pulmonary edema (left heart failure)

Short septal lines

34

3cm

Pulmonary edema

Short s

epta

l lines in

lung b

ase

35

1cm

thickened interlobular septum

and pleura

Pulmonary edema 36

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Centilobular nodules Pulmonary ossification

3mm 3mm

ILS

ILS

37 Thickened long septa

Left upper lobe

Coronal CT

Normal long septa 38

Thickened bronchoarterial bundle

PV

Thickened pleura

Thickened interlobular septum

Lymphangiosis carcinomatosa 39

Thickened bronchovascular

bundles (central and periphery)

Lymphangiosis

carcinomatosa 40 Lymphangiosis carcinomatosa 41 Lymphangiosis carcinomatosa

2mm

Thickened bronchoarterial bundle

Thickened interlobular septum

42

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Lymphoproliferative disorder

Bronchovascular bundle

Bronchovascular bundle

43

Y.S

Lymphoproliferative disorder

Thickening of centrilobular

bronchovascular bundles

48

44

③ ④

Pulmonary sarcoidosis 45

Pulmonary sarcoidosis

PV

Br・PA

Br・PA

46 Pulmonary sarcoidosis

Br

PA

47 Pulmonary sarcoidosis

2mm

48

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RB

Pulmonary sarcoidosis 49 Pulmonary sarcoidosis 50

K.N

Pulmonary thromboembolism 51

②

Pulmonary thromboembolism

Pulmonary arteries

52 Metastasis of hepatic cancer 53

5 mm Pulmonary vein

Bronchiole

Metastasis of hepatic cancer

Pulmonary artery

54

2014/8/28

10

1 mm

Bronchiole

Pulmonary artery: dilated with tumors

Metastasis of hepatic cancer 55

① ②

Cystic metastasis of bladder cancer

Courtesy of Dr. S. Imokawa Thickened blood vessels

56

1mm

Pulmonary artery: filled by tumor and thrombus

Perivascular tumor

Metastasis of bladder cancer

Courtesy of Dr. S. Imokawa 66

57

Org. DAD

Ground glass shadow

Traction bronchiectsis

58

1 mm

Org. DAD

AD

AD

Thickened back to back alveoli

59

K.T

Adenocarcinoma

Thickened back to back alveoli intervened by contrasted air space

60

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Thickened back-to-back alveoli

Normal back-to-back alveoli

GGA

Adenocarcinoma with lepidic growth Adenocarcinoma 61