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Vermehrte Transparenz in der Dünnschicht-CT des Lungenparenchyms

Increased transparency in thin-slice computed tomography of lung parenchyma

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Zusammenfassung

Dichteminderungen sind ein häufiger Befund in der Dünnschicht-Computertomographie des Lungenparenchyms. Es lassen sich diffuse und fokale Dichteminderungen beschreiben. Als häufigste Ursache für eine diffuse Dichteminderung ist das Emphysem zu nennen. Aufgrund der anatomischen Anordnung kann man das zentrilobuläre, panlobuläre und paraseptale Emphysem klassifizieren. Ein Mosaikmuster (Moasikperfusion und Air-Trapping) zeigt sich ebenfalls in einer diffusen Dichteminderung. Von Emphysem und Mosaikmuster, bei denen die Dichteminderungen keine Wandstrukturen zeigen, sind die fokalen, zystischen Veränderungen abzugrenzen. Die Langerhanszell-Histiozystose und die Lymphangioleiomyomatose sind die häufigsten zystischen Erkrankungen des Lungenparenchyms, die sich aufgrund der Geometrie und anatomischen Verteilung der Zysten meistens differenzieren lassen. Zu den selteneren Erkrankungen gehören das Birt-Hogg-Dubé Syndrom, die lymphoide interstitielle Pneumonie sowie die kongenitalen oder frühkindlichen Veränderungen wie die zystische adenomatoide Malformation oder das Swyer-James Syndrom.

Abstract

Areas with reduced density are a common finding with thin-slice computed tomography (CT) examinations of lung parenchyma. Diffuse and localized patterns can be differentiated. The most frequent cause for a diffuse decrease in density is pulmonary emphysema which can be classified into centrilobular, panlobular and paraseptal emphysema based on the distinct anatomical features. A mosaic pattern (due to mosaic perfusion or air trapping) is also characterized by a diffuse decrease in density. Focal cystic changes can be differentiated from emphysematous changes and mosaic patterns which do not reveal wall structures. Langerhans cell histiocytosis and lymphangioleiomyomatosis are the most frequent cystic diseases of the lung parenchyma. Based on the geometry and anatomical distribution of the cysts a differentiation is mostly possible. Rare diseases leading to a reduced lung density include the Birt-Hogg-Dubé syndrome, lymphoid interstitial pneumonia as well as congenital diseases or diseases which are acquired during early childhood, such as cystic adenomatoid malformation or Swyer-James syndrome.

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Literatur

  1. Hansell DM, Bankier AA, MacMahon H et al (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246:697–722

    Article  PubMed  Google Scholar 

  2. Pipavath SN, Schmidt RA, Takasugi JE et al (2009) Chronic obstructive pulmonary disease: radiology-pathology correlation. J Thorac Imaging 24:171–180

    Article  PubMed  Google Scholar 

  3. Grosse C, Bankier A (2007) Bildgebung des Lungenemphysems. Radiologe 47:401–406

    Article  PubMed  CAS  Google Scholar 

  4. Ley-Zaporozhan J, Ley S, Kauczor HU (2008) Morphological and functional imaging in COPD with CT and MRI: present and future. Eur Radiol 18:510–521

    Article  PubMed  Google Scholar 

  5. Berrocal T, Madrid C, Novo S et al (2004) Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology. Radiographics 24:e17

    Article  PubMed  Google Scholar 

  6. Martinez S, Heyneman LE, McAdams HP et al (2008) Mucoid impactions: finger-in-glove sign and other CT and radiographic features. Radiographics 28:1369–1382

    Article  PubMed  Google Scholar 

  7. Kawamoto S, Yuasa M, Tsukuda S et al (2001) Bronchial atresia: three-dimensional CT bronchography using volume rendering technique. Radiat Med 19:107–110

    PubMed  CAS  Google Scholar 

  8. Diederich S (2010) Hochauflösende Computertomographie der Lunge: Milchglas und seine Differenzialdiagnosen. Radiologe 50:1141–1152

    Article  PubMed  CAS  Google Scholar 

  9. Mastora I, Remy-Jardin M, Sobaszek A et al (2001) Thin-section CT finding in 250 volunteers: assessment of the relationship of CT findings with smoking history and pulmonary function test results. Radiology 218:695–702

    PubMed  CAS  Google Scholar 

  10. Hansell DM (2001) Small airways diseases: detection and insights with computed tomography. Eur Respir J 17:1294–1313

    Article  PubMed  CAS  Google Scholar 

  11. Pipavath SJ, Lynch DA, Cool C et al (2005) Radiologic and pathologic features of bronchiolitis. AJR Am J Roentgenol 185:354–363

    PubMed  Google Scholar 

  12. Dillman JR, Sanchez R, Ladino-Torres MF et al (2011) Expanding upon the unilateral hyperlucent hemithorax in children. Radiographics 31:723–741

    Article  PubMed  Google Scholar 

  13. Müller AM, Mayer E, Schumacher R et al (2008) Postnatal erworbene Lungenzyste. Differenzialdiagnosen zystischer Lungenläsionen im Kindesalter. Pathologe 29:264–268

    Article  PubMed  Google Scholar 

  14. Jacobi V, Schick C, Thalhammer A (2003) Blickdiagnosen im HR-CT der Lunge. Radiologie up2date 1:17–30

    Article  Google Scholar 

  15. Juvet S, Hwang D, Downey G (2006) Rare lung diseases I – Lymphangioleiomyomatosis. Can Respir J 13:375–380

    PubMed  Google Scholar 

  16. Avila N, Kelly J, Chu S et al (2000) Lymphangioleiomyomatosis: abdominopelvic CT and US findings. Radiology 216:147–153

    PubMed  CAS  Google Scholar 

  17. Bernstein S, Newell JJ, Adamczyk D et al (1995) How common are renal angiomyolipomas in patients with pulmonary lymphangiomyomatosis? Am J Respir Crit Care Med 152:2138–2143

    PubMed  CAS  Google Scholar 

  18. Hansell DM, Armstrong P, Lynch DA et al (Hrsg) (2005) Imaging of Disease of the Chest. Elsevier Mosby, London

  19. Lenoir S, Grenier P, Brauner M et al (1990) Pulmonary lymphangiomyomatosis and tuberous sclerosis: comparison of radiographic and thin-section CT findings. Radiology 175:329–334

    PubMed  CAS  Google Scholar 

  20. Moss J, Avila NA, Barnes PM et al (2001) Prevalence and clinical characteristics of lymphangioleiomyomatosis (LAM) in patients with tuberous sclerosis complex. Am J Respir Crit Care Med 164:669–671

    PubMed  CAS  Google Scholar 

  21. Costello LC, Hartman TE, Ryu JH (2000) High frequency of pulmonary lymphangioleiomyomatosis in women with tuberous sclerosis complex. Mayo Clin Proc 75:591–594

    Article  PubMed  CAS  Google Scholar 

  22. Franz DN, Brody A, Meyer C et al (2001) Mutational and radiographic analysis of pulmonary disease consistent with lymphangioleiomyomatosis and micronodular pneumocyte hyperplasia in women with tuberous sclerosis. Am J Respir Crit Care Med 164:661–668

    PubMed  CAS  Google Scholar 

  23. Adriaensen M, Schaefer-Prokop C, Duyndam D et al (2011) Radiological evidence of lymphangioleiomyomatosis in female and male patients with tuberous sclerosis complex. Clin Radiol 66:625–628

    Article  PubMed  CAS  Google Scholar 

  24. Avila NA, Dwyer AJ, Rabel A et al (2007) Sporadic lymphangioleiomyomatosis and tuberous sclerosis complex with lymphangioleiomyomatosis: comparison of CT features. Radiology 242:277–285

    Article  PubMed  Google Scholar 

  25. Juvet S, Hwang D, Downey G (2010) Rare lung diseases III: pulmonary Langerhans‘ cell histiocytosis. Can Respir J 17:e55–e62

    PubMed  Google Scholar 

  26. Hidalgo A, Franquet T, Gimenez A et al (2006) Smoking-related interstitial lung diseases: radiologic-pathologic correlation. Eur Radiol 16:2463–2470

    Article  PubMed  Google Scholar 

  27. Brauner MW, Grenier P, Tijani K et al (1997) Pulmonary Langerhans cell histiocytosis: evolution of lesions on CT scans. Radiology 204:497–502

    PubMed  CAS  Google Scholar 

  28. Brauner MW, Grenier P, Mouelhi MM et al (1989) Pulmonary histiocytosis X: evaluation with high-resolution CT. Radiology 172:255–258

    PubMed  CAS  Google Scholar 

  29. Grant LA, Babar J, Griffin N (2009) Cysts, cavities, and honeycombing in multisystem disorders: differential diagnosis and findings on thin-section CT. Clin Radiol 64:439–448

    Article  PubMed  CAS  Google Scholar 

  30. American Thoracic Society; European Respiratory Society (2002) American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias (2002) This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med 165:277–304

    Google Scholar 

  31. Mueller-Mang C, Grosse C, Schmid K et al (2007) What every radiologist should know about idiopathic interstitial pneumonias. Radiographics 27:595–615

    Article  PubMed  Google Scholar 

  32. Menko FH, Steensel MA van, Giraud S et al (2009) Birt-Hogg-Dubé syndrome: diagnosis and management. Lancet Oncol 10:1199–1206

    Article  PubMed  CAS  Google Scholar 

  33. Toro JR, Wei MH, Glenn GM et al (2008) BHD mutations, clinical and molecular genetic investigations of Birt-Hogg-Dubé syndrome: a new series of 50 families and a review of published reports. J Med Genet 45:321–331

    Article  PubMed  CAS  Google Scholar 

  34. Toro JR, Pautler SE, Stewart L et al (2007) Lung cysts, spontaneous pneumothorax, and genetic associations in 89 families with Birt-Hogg-Dubé syndrome. Am J Respir Crit Care Med 175:1044–1053

    Article  PubMed  CAS  Google Scholar 

  35. Agarwal PP, Gross BH, Holloway BJ et al (2011) Thoracic CT findings in Birt-Hogg-Dubé syndrome. AJR Am J Roentgenol 196:349–352

    Article  PubMed  Google Scholar 

  36. Zamora AC, Collard HR, Wolters PJ et al (2007) Neurofibromatosis-associated lung disease: a case series and literature review. Eur Respir J 29:210–214

    Article  PubMed  CAS  Google Scholar 

  37. Stocker JT, Madewell JE, Drake RM (1977) Congenital cystic adenomatoid malformation of the lung. Classification and morphologic spectrum. Hum Pathol 8:155–171

    Article  PubMed  CAS  Google Scholar 

  38. Rosado-de-Christenson ML, Stocker JT (1991) Congenital cystic adenomatoid malformation. Radiographics 11:865–886

    PubMed  CAS  Google Scholar 

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  1. Division of Cardiothoracic Imaging, Department of Medical Imaging, University of Toronto, NCSB-IC560, 585 University Avenue, M5G2N2, Toronto, ON, Kanada

    J. Ley-Zaporozhan

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Ley-Zaporozhan, J. Vermehrte Transparenz in der Dünnschicht-CT des Lungenparenchyms. Radiologe 51, 881–896 (2011). https://doi.org/10.1007/s00117-011-2238-3

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