Abstract
Purpose of Review
Cystic lung disease is characterized by multiple air-filled spaces in the lung. Pulmonary cysts occur in a variety of diseases, including infectious, inhalational, genetic, and neoplastic conditions. The purpose of this report is to review the CT imaging patterns and appearances of the most common cystic lung diseases, and to highlight the differences between different cystic lung diseases and the unique qualities related to each condition.
Recent Findings
Common cystic lung diseases include lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, lymphocytic interstitial pneumonia, desquamative interstitial pneumonia, Birt-Hogg-Dubé syndrome, and light chain deposition disease/amyloidosis. Infections or age-related change may also result in cystic lung disease.
Summary
Cystic lung disease has multiple etiologies. CT imaging allows for characterization of lung cyst morphology, pattern, and distribution; familiarity with the imaging appearance of the most common cystic lung diseases allows for earlier identification, diagnosis, and disease management.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246(3):697–722. https://doi.org/10.1148/radiol.2462070712.
•• Baldi BG, Carvalho CRR, Dias OM, Marchiori E, Hochhegger B. Diffuse cystic lung diseases: differential diagnosis. J Bras Pneumol. 2017;43(2):140–9. https://doi.org/10.1590/S1806-37562016000000341 . Up to date, review of cystic lung disease with clinical, pathologic, and radiologic descriptions.
Park S, Lee EJ. Diagnosis and treatment of cystic lung disease. Korean J Intern Med. 2017;32(2):229–38. https://doi.org/10.3904/kjim.2016.242.
Ferreira Francisco FA, Soares Souza A Jr, Zanetti G, Marchiori E. Multiple cystic lung disease. Eur Respir Rev. 2015;24(138):552–64. https://doi.org/10.1183/16000617.0046-2015.
McCormack FX, Travis WD, Colby TV, Henske EP, Moss J. Lymphangioleiomyomatosis: calling it what it is: a low-grade, destructive, metastasizing neoplasm. Am J Respir Crit Care Med. 2012;186(12):1210–2. https://doi.org/10.1164/rccm.201205-0848OE.
Johnson SR, Taveira-DaSilva AM, Moss J. Lymphangioleiomyomatosis. Clin Chest Med. 2016;37(3):389–403. https://doi.org/10.1016/j.ccm.2016.04.002.
Xu KF, Feng R, Cui H, Tian X, Wang H, Zhao J, et al. Diffuse cystic lung diseases: diagnostic considerations. Semin Respir Crit Care Med. 2016;37(3):457–67. https://doi.org/10.1055/s-0036-1580690.
Jawad H, Walker CM, Wu CC, Chung JH. Cystic interstitial lung diseases: recognizing the common and uncommon entities. Curr Probl Diagn Radiol. 2014;43(3):115–27. https://doi.org/10.1067/j.cpradiol.2014.01.001.
Raoof S, Bondalapati P, Vydyula R, Ryu JH, Gupta N, Raoof S, et al. Cystic lung diseases: algorithmic approach. Chest. 2016;150(4):945–65. https://doi.org/10.1016/j.chest.2016.04.026.
Adriaensen ME, Schaefer-Prokop CM, Duyndam DA, Zonnenberg BA, Prokop M. Radiological evidence of lymphangioleiomyomatosis in female and male patients with tuberous sclerosis complex. Clin Radiol. 2011;66(7):625–8. https://doi.org/10.1016/j.crad.2011.02.009.
• Tobino K, Johkoh T, Fujimoto K, Sakai F, Arakawa H, Kurihara M, et al. Computed tomographic features of lymphangioleiomyomatosis: evaluation in 138 patients. Eur J Radiol. 2015;84(3):534–41. https://doi.org/10.1016/j.ejrad.2014.12.008 . Series of 138 Japanese patients describing intrathoracic and extrathoracic radiologic findings.
Taveira-DaSilva AM, Moss J. Management of lymphangioleiomyomatosis. F1000Prime Rep. 2014;6:116. https://doi.org/10.12703/P6-116.
Meraj R, Wikenheiser-Brokamp KA, Young LR, McCormack FX. Lymphangioleiomyomatosis: new concepts in pathogenesis, diagnosis, and treatment. Semin Respir Crit Care Med. 2012;33(5):486–97. https://doi.org/10.1055/s-0032-1325159.
Seaman DM, Meyer CA, Gilman MD, McCormack FX. Diffuse cystic lung disease at high-resolution CT. AJR Am J Roentgenol. 2011;196(6):1305–11. https://doi.org/10.2214/AJR.10.4420.
• Gupta N, Finlay GA, Kotloff RM, Strange C, Wilson KC, Young LR, et al. Lymphangioleiomyomatosis diagnosis and management: high-resolution chest computed tomography, transbronchial lung biopsy, and pleural disease management. An Official American Thoracic Society/Japanese Respiratory Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2017;196(10):1337–48. https://doi.org/10.1164/rccm.201709-1965ST Practice guidelines and consensus statement from American Thoracic Society and Japanese Respiratory Society regarding LAM.
Muzykewicz DA, Black ME, Muse V, Numis AL, Rajagopal J, Thiele EA, et al. Multifocal micronodular pneumocyte hyperplasia: computed tomographic appearance and follow-up in tuberous sclerosis complex. J Comput Assist Tomogr. 2012;36(5):518–22. https://doi.org/10.1097/RCT.0b013e318264e404.
Manoukian SB, Kowal DJ. Comprehensive imaging manifestations of tuberous sclerosis. AJR Am J Roentgenol. 2015;204(5):933–43. https://doi.org/10.2214/AJR.13.12235.
Tazi A, de Margerie C, Naccache JM, Fry S, Dominique S, Jouneau S, et al. The natural history of adult pulmonary Langerhans cell histiocytosis: a prospective multicentre study. Orphanet J Rare Dis. 2015;10:30. https://doi.org/10.1186/s13023-015-0249-2.
Mendez JL, Nadrous HF, Vassallo R, Decker PA, Ryu JH. Pneumothorax in pulmonary Langerhans cell histiocytosis. Chest. 2004;125(3):1028–32.
DeMartino E, Go RS, Vassallo R. Langerhans cell histiocytosis and other histiocytic diseases of the lung. Clin Chest Med. 2016;37(3):421–30. https://doi.org/10.1016/j.ccm.2016.04.005.
• Iwasawa T, Takemura T, Ogura T. Smoking-related lung abnormalities on computed tomography images: comparison with pathological findings. Jpn J Radiol. 2018;36(3):165–80. https://doi.org/10.1007/s11604-017-0713-0 Review of smoking-related lung disease with radiologic-pathologic correlation.
Gupta N, Vassallo R, Wikenheiser-Brokamp KA, McCormack FX. Diffuse cystic lung disease. Part I. Am J Respir Crit Care Med. 2015;191(12):1354–66. https://doi.org/10.1164/rccm.201411-2094CI.
Vargas D, Richards JC, Ocazionez D, Sirajuddin A, Browne L, Restrepo CS. Cardiothoracic manifestations of primary histiocytoses. Br J Radiol. 2016;89(1068):20160347. https://doi.org/10.1259/bjr.20160347.
Panchabhai TS, Farver C, Highland KB. Lymphocytic interstitial pneumonia. Clin Chest Med. 2016;37(3):463–74. https://doi.org/10.1016/j.ccm.2016.04.009.
Martinez-Balzano CD, Touray S, Kopec S. Cystic lung disease among patients with Sjogren syndrome: frequency, natural history, and associated risk factors. Chest. 2016;150(3):631–9. https://doi.org/10.1016/j.chest.2016.05.015.
Bak SH, Lee HY. Overlaps and uncertainties of smoking-related idiopathic interstitial pneumonias. Int J Chron Obstruct Pulmon Dis. 2017;12:3221–9. https://doi.org/10.2147/COPD.S146899.
Godbert B, Wissler MP, Vignaud JM. Desquamative interstitial pneumonia: an analytic review with an emphasis on aetiology. Eur Respir Rev. 2013;22(128):117–23. https://doi.org/10.1183/09059180.00005812.
Kligerman S, Franks TJ, Galvin JR. Clinical-radiologic-pathologic correlation of smoking-related diffuse parenchymal lung disease. Radiol Clin N Am. 2016;54(6):1047–63. https://doi.org/10.1016/j.rcl.2016.05.010.
Gupta N, Seyama K, McCormack FX. Pulmonary manifestations of Birt-Hogg-Dube syndrome. Familial Cancer. 2013;12(3):387–96. https://doi.org/10.1007/s10689-013-9660-9.
Dal Sasso AA, Belem LC, Zanetti G, Souza CA, Escuissato DL, Irion KL, et al. Birt-Hogg-Dube syndrome. State-of-the-art review with emphasis on pulmonary involvement. Respir Med. 2015;109(3):289–96. https://doi.org/10.1016/j.rmed.2014.11.008.
Gupta N, Sunwoo BY, Kotloff RM. Birt-Hogg-Dube syndrome. Clin Chest Med. 2016;37(3):475–86. https://doi.org/10.1016/j.ccm.2016.04.010.
Menko FH, van Steensel MA, Giraud S, Friis-Hansen L, Richard S, Ungari S, et al. Birt-Hogg-Dube syndrome: diagnosis and management. Lancet Oncol. 2009;10(12):1199–206. https://doi.org/10.1016/S1470-2045(09)70188-3.
Lee JE, Cha YK, Kim JS, Choi JH. Birt-Hogg-Dube syndrome: characteristic CT findings differentiating it from other diffuse cystic lung diseases. Diagn Interv Radiol. 2017;23(5):354–9. https://doi.org/10.5152/dir.2017.16606.
Kumasaka T, Hayashi T, Mitani K, Kataoka H, Kikkawa M, Tobino K, et al. Characterization of pulmonary cysts in Birt-Hogg-Dube syndrome: histopathological and morphometric analysis of 229 pulmonary cysts from 50 unrelated patients. Histopathology. 2014;65(1):100–10. https://doi.org/10.1111/his.12368.
• Park HJ, Chae EJ, Do KH, Lee SM, Song JW. Differentiation between lymphangioleiomyomatosis and Birt-Hogg-Dube syndrome: analysis of pulmonary cysts on CT images. AJR Am J Roentgenol. 2019;1–7. doi:https://doi.org/10.2214/AJR.18.20232. Small retrospective study of patients with BHD or LAM, with specific imaging findings that differentiate the two entities.
Colombat M, Stern M, Groussard O, Droz D, Brauner M, Valeyre D, et al. Pulmonary cystic disorder related to light chain deposition disease. Am J Respir Crit Care Med. 2006;173(7):777–80. https://doi.org/10.1164/rccm.200510-1620CR.
Zamora AC, White DB, Sykes AM, Hoskote SS, Moua T, Yi ES, et al. Amyloid-associated cystic lung disease. Chest. 2016;149(5):1223–33. https://doi.org/10.1378/chest.15-1539.
Sakai M, Yamaoka M, Kawaguchi M, Hizawa N, Sato Y. Multiple cystic pulmonary amyloidosis. Ann Thorac Surg. 2011;92(5):e109. https://doi.org/10.1016/j.athoracsur.2011.07.063.
Sheard S, Nicholson AG, Edmunds L, Wotherspoon AC, Hansell DM. Pulmonary light-chain deposition disease: CT and pathology findings in nine patients. Clin Radiol. 2015;70(5):515–22. https://doi.org/10.1016/j.crad.2015.01.002.
Piciucchi S, Dubini A, Tomassetti S, Sanna S, Ravaglia C, Carloni A, et al. Angiosarcoma in the chest: radiologic-pathologic correlation: case report. Medicine (Baltimore). 2016;95(48):e5348. https://doi.org/10.1097/MD.0000000000005348.
Molodtsova V, Ryabova M, Dvorakovskaya I, Vasilyeva M, Akopov A. Recurrent respiratory papillomatosis with lung involvement. Respir Med Case Rep. 2018;25:323–6. https://doi.org/10.1016/j.rmcr.2018.10.019.
Fortes HR, von Ranke FM, Escuissato DL, Araujo Neto CA, Zanetti G, Hochhegger B, et al. Recurrent respiratory papillomatosis: a state-of-the-art review. Respir Med. 2017;126:116–21. https://doi.org/10.1016/j.rmed.2017.03.030.
Fortes HR, Ranke FMV, Escuissato DL, Araujo Neto CA, Zanetti G, Hochhegger B, et al. Laryngotracheobronchial papillomatosis: chest CT findings. J Bras Pneumol. 2017;43(4):259–63. https://doi.org/10.1590/S1806-37562016000000351.
Copley SJ, Wells AU, Hawtin KE, Gibson DJ, Hodson JM, Jacques AE, et al. Lung morphology in the elderly: comparative CT study of subjects over 75 years old versus those under 55 years old. Radiology. 2009;251(2):566–73. https://doi.org/10.1148/radiol.2512081242.
Copley SJ. Morphology of the aging lung on computed tomography. J Thorac Imaging. 2016;31(3):140–50. https://doi.org/10.1097/RTI.0000000000000211.
Araki T, Nishino M, Gao W, Dupuis J, Putman RK, Washko GR, et al. Pulmonary cysts identified on chest CT: are they part of aging change or of clinical significance? Thorax. 2015;70(12):1156–62. https://doi.org/10.1136/thoraxjnl-2015-207653.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Tami J. Bang, Thomas D. Suby-Long, and Daniel Vargas declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Pulmonary Radiology
Rights and permissions
About this article
Cite this article
Bang, T.J., Suby-Long, T.D. & Vargas, D. Imaging Cystic Lung Disease. Curr Pulmonol Rep 8, 69–77 (2019). https://doi.org/10.1007/s13665-019-00227-w
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13665-019-00227-w