The Lung Parenchyma

  • Mary M. Salvatore
  • Ronaldo Collo Go
  • Monica A. Pernia M.


The lung parenchyma should be evaluated on axial images using lung window settings (window 1500, level −500) which are recorded on the computer image. Scroll using the mouse through the right lung beginning at the apex and moving toward the lung bases evaluating the lung parenchyma in front of the right major fissure which will include the right upper and middle lobes of the lung. Next scroll from the bases of the lung to the apex reviewing the lung posterior to the right major fissure, the right lower lobe. Repeat this process reviewing the left lung parenchyma. In front of the left major fissure is the left upper lobe which includes the lingual and posterior is the left lower lobe.


Secondary pulmonary lobule Hounsfield unit Ground glass opacity Organizing pneumonia Usual interstitial pneumonitis (UIP) Nonspecific interstitial pneumonitis (NSIP) Chronic hypersensitivity pneumonitis (CHP) 


  1. 1.
    Mata J, Cáceres J, Alegret X, Coscojuela P, De Marcos JA. Imaging of the azygos lobe: normal anatomy and variations. AJR Am J Roentgenol. 1991;156(5):931–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Seiber W, Karcara N, Pant P. Pulmonary azygos lobe—an anatomical variant. Kathmandu Univ Med J. 2014;46(2):151–2.CrossRefGoogle Scholar
  3. 3.
    Miller WS. The lung. Springfield, IL: Thomas; 1947. p. 39–42.Google Scholar
  4. 4.
    Richard Webb W. Thin-section CT of the secondary pulmonary lobule: anatomy and the image—the 2004 Fleischner lecture. Radiology. 2006;239(2):322–38.CrossRefPubMedGoogle Scholar
  5. 5.
    Weibel ER. Looking into the lung: what can it tell us? AJR Am J Roentgenol. 1979;133:1021–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Heitzman ER, Markarian B, Berger I, Dailey E. The secondary pulmonary lobule: a practical concept for interpretation of chest radiographs. I. Roentgen anatomy of the normal secondary pulmonary lobule. Radiology. 1969;93:507–12.CrossRefPubMedGoogle Scholar
  7. 7.
    Osborne DR, Effmann EL, Hedlund LW. Postnatal growth and size of the pulmonary acinus and secondary lobule in man. AJR Am J Roentgenol. 1983;140:449–54.CrossRefPubMedGoogle Scholar
  8. 8.
    Reid L, Simon G. The peripheral pattern in the normal bronchogram and its relation to peripheral pulmonary anatomy. Thorax. 1958;13:103–9.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ochs M, Nyengaard JR, Jung A, Knudsen L, Voigt M, Wahlers T, Richter J, Gundersen HJG. The number of alveoli in the human lung. Am J Respir Crit Care Med. 2004;169(1):120–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Itoh H, Murata K, Konishi J, Nishimura K, Kitaichi M, Izumi T. Diffuse lung disease: pathologic basis for the high-resolution computed tomography findings. J Thorac Imaging. 1993;8:176–88.CrossRefPubMedGoogle Scholar
  11. 11.
    Hounsfield GN. Computed medical imaging. Nobel lecture, December 8, 1979. J Comput Assist Tomogr. 1980;4(5):665–74.CrossRefPubMedGoogle Scholar
  12. 12.
    Zach J, Newell J, Schroeder J, et al. Quantitative CT of the lungs and airways in healthy non-smoking adults. Invest Radiol. 2012;47(10):596–602.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Friedman PJ. Imaging studies in emphysema. Proc Am Thorac Soc. 2008;5(4):494–500.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Shin KE, Chung MJ, Jung MP, Choe BK, Lee KS. Quantitative computed tomographic indexes in diffuse interstitial lung disease: correlation with physiologic tests and computed tomography visual scores. J Comput Assist Tomogr. 2011;35(2):266–71.CrossRefPubMedGoogle Scholar
  15. 15.
    Austin JH, Müller NL, Friedman PJ, et al. Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology. 1996;200:37–1.CrossRefGoogle Scholar
  16. 16.
    Marten K, Schnyder P, Schirg E, et al. Pattern-based differential diagnosis in pulmonary vasculitis using volumetric CT. AJR Am J Roentgenol. 2005;184(3):720–33.CrossRefPubMedGoogle Scholar
  17. 17.
    Ficker JH, Brückl WM, Suc J, Geise A. Haemoptysis: Intensive care management of pulmonary hemorrhage. Internist (Berl). 2017;58(3):218–25.CrossRefGoogle Scholar
  18. 18.
    Gluecker T, Capasso P, Schnyder P, Gudinchet F, Schaller M-D, Revelly J-P, Chiolero R, Vock P, Wicky S. Clinical and radiologic features of pulmonary edema. Radiographics. 1999;19(6):1507–31.CrossRefPubMedGoogle Scholar
  19. 19.
    Baik JH, Ahn MI, Park YA, Park SH. High resolution CT findings of re-expansion pulmonary edema. Korean J Radiol. 2010;11:164–8.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Beigelman-Aubry C, Godet C, Caumes E. Lung infections: the radiologist’s perspective. Diagn Interv Imaging. 2012;93(6):431–40.CrossRefPubMedGoogle Scholar
  21. 21.
    Algin O, Gökalp G, Topal U. Signs in chest imaging. Diagn Interv Radiol. 2011;17(1):18–29.PubMedGoogle Scholar
  22. 22.
    Gharib AM, Stern EJ. Radiology of pneumonia. Med Clin North Am. 2001;85(6):1461–91.CrossRefPubMedGoogle Scholar
  23. 23.
    Patsios D, Roberts HC, Paul NS, Chung T, Herman SJ, Pereira A, Weisbrod G. Pictorial review of the many faces of bronchioloalveolar cell carcinoma. Br J Radiol. 2007;80(960):1015–23.CrossRefPubMedGoogle Scholar
  24. 24.
    Walter JM, Stanley M, Singer BD. Metastatic pulmonary calcification and end-stage renal disease. Cleve Clin J Med. 2017;84(9):668–9.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Gietema HA, Muller NL, Fauerbach PV, Sharma S, Edwards LD, Camp PG, Coxson HO. Quantifying the extent of emphysema: factors associated with radiologists’ estimations and quantitative indices of emphysema severity using the eclipse cohort. Acad Radiol. 2011;18:661–71.CrossRefPubMedGoogle Scholar
  26. 26.
    Smith BM, Austin JH, Newell JD Jr, D’Souza BM, Rozenshtein A, Hoffman EA, Ahmed F, Barr RG. Pulmonary emphysema subtypes on computed tomography: the MESA COPD study. Am J Med. 2014;127(1):94.e7–23.CrossRefGoogle Scholar
  27. 27.
    Hogg JC. Pathophysiology of airflow limitation in chronic obstructive pulmonary disease. Lancet. 2004;364:709–21.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Tunsupon P, Dhillon SS, Harris K, Alraiyes AH. Saber-sheath trachea in a patient with severe COPD. BMJ Case Rep. 2016;2016.
  29. 29.
    Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner society: glossary of terms for thoracic imaging. Radiology. 2008;246(3):697–722.CrossRefPubMedGoogle Scholar
  30. 30.
    Baskin HJ Jr. The pathogenesis and imaging of the tuberous sclerosis complex. Pediatr Radiol. 2008;38:936.CrossRefPubMedGoogle Scholar
  31. 31.
    Ferrans VJ, Yu ZX, Nelson WK, Valencia JC, Tatsuguchi A, Avila NA, et al. Lymphangioleiomyomatosis (LAM): a review of clinical and morphological features. J Nihon Med Sch. 2000;67(5):311–29.CrossRefGoogle Scholar
  32. 32.
    Zar HJ. Chronic lung disease in human immunodeficiency virus (HIV) infected children. Pediatr Pulmonol. 2008;43(1):1–10.CrossRefPubMedGoogle Scholar
  33. 33.
    Tokuyasu H, Watanabe E, Okazaki R, Kawasaki Y, Kikuchi R, Isowa N, et al. Sjögren’s syndrome with multiple bullae caused by lymphocytic interstitial pneumonia. Lung. 2007;185(3):187–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Girschikofsky M, Arico M, Castillo D, et al. Management of adult patients with Langerhans cell histiocytosis: recommendations from an expert panel on behalf of Euro-Histio-Net. Orphanet J Rare Dis. 2013;8:72.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Sekar T, Swan KG, Vietrogoski RA. A beeline through Sir Peter James Kerley’s life. AJR Am J Roentgenol. 2011;196(4):W375–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Morgan-Parkers JH. Metastases: mechanisms, pathways, and cascades. Am J Radiol. 1995;164:1075–82.Google Scholar
  37. 37.
    Prakash P, Kaira MK, Sharma A, Shepard JA, Digumarthy SR. FDG PET/CT in assessment of pulmonary lymphangitic carcinomatosis. AJR Am J Roentgenol. 2010;194(1):231–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Herold CJ, Bankier AA, Fleishmann D. Lung metastases. Eur Radiol. 1996;6:596.CrossRefPubMedGoogle Scholar
  39. 39.
    Kebbe J, Abdo T. Interstitial lung disease: the diagnostic role of bronchoscopy. J Thorac Dis. 2017;9(Suppl 10):S996–S1010.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch DA, Nicholson AG, et al. An Official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013;188(6):733–48.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Bagnato G, Harari S. Cellular interactions in the pathogenesis of interstitial lung diseases. Eur Respir Soc. 2015;24(135):102–14.CrossRefGoogle Scholar
  42. 42.
    Urushiyama H, Terasaki Y, Nagasaka S, Terasaki M, Kunugi S, Nagase T, Fukuda Y, Shimizu A. Role of α1 and α2 chains of type IV collagen in early fibrotic lesions of idiopathic interstitial pneumonias and migration of lung fibroblasts. Lab Invest. 2015;95(8):872–85.CrossRefPubMedGoogle Scholar
  43. 43.
    Todd NW, Atamas SP, Luzina IG, Galvin JR. Permanent alveolar collapse is the predominant mechanism in idiopathic pulmonary fibrosis. Expert Rev Respir Med. 2015;9(4):411–8. Scholar
  44. 44.
    Salvatore M, Henschke CI, Yip R, Jacobi A, Eber C, Padilla M, Knoll A, Yankelevitz D. JOURNAL CLUB: evidence of interstitial lung disease on low-dose chest CT images: prevalence, patterns, and progression. AJR Am J Roentgenol. 2016;2016(3):487–94.CrossRefGoogle Scholar
  45. 45.
    Miller WT, Shah RM. Isolated diffuse ground-glass opacity in thoracic CT: causes and clinical presentations. Chest Imaging. 2005;184(2):613–22.Google Scholar
  46. 46.
    Piciucchi S, Tomassetti S, Ravaglia C, Gurioli C, Gurioli C, Dubini A, Carloni A, Chilosi M, Colby TV, Poletti V. From “traction bronchiectasis” to honeycombing in idiopathic pulmonary fibrosis: a spectrum of bronchiolar remodeling also in radiology? BMC Pulm Med. 2016;16(1):87.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Arakawa H, Honma K. Honeycomb lung: history and current concepts. AJR Am J Roentgenol. 2011;196:773–82.CrossRefPubMedGoogle Scholar
  48. 48.
    Raghu G, Collard HR, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183(6):788–824.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Lynch DA, Sverzellati N, Travis WD, Brown KK, Colby TV, Galvin JR, Goldin JG, Hansell DM, Inoue Y, Johkoh T, Nicholson AG, Knight SL, Raoof S, Richeldi L, Ryerson CJ, Ryu JH, Wells AU. Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. Lancet Respir Med. 2018;6:138–53.CrossRefPubMedGoogle Scholar
  50. 50.
    Montesinos JJ, Laguna MA. Case 1: cryptogenic organizing pneumonia. AJR Am J Roentgenol. 1998;171(3):835. 838–9.CrossRefPubMedGoogle Scholar
  51. 51.
    Pereira CA, Gimenez A, Kuranishi L, Storrer K. Chronic hypersensitivity pneumonitis. J Asthma Allergy. 2016;9:171–81.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Sherrick AD, Swensen SJ, Hartman TE. Mosaic pattern of lung attenuation on CT scans: frequency among patients with pulmonary artery hypertension of different causes. AJR Am J Roentgenol. 1997;169(1):79–82.CrossRefPubMedGoogle Scholar
  53. 53.
    Alhamad EH, Al-boukai AA, Al-kassimi FA, et al. Prediction of pulmonary hypertension in patients with or without interstitial lung disease: reliability of CT findings. Radiology. 2011;260(3):875–83.CrossRefPubMedGoogle Scholar
  54. 54.
    Sreenivasan S, Bennett S, Parfitt VJ. Images in cardiovascular medicine. Westermark’s and Palla’s signs in acute pulmonary embolism. Circulation. 2007;115:e211.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Mary M. Salvatore
    • 1
  • Ronaldo Collo Go
    • 2
  • Monica A. Pernia M.
    • 3
  1. 1.RadiologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Division of Pulmonary, Critical Care, and Sleep MedicineCrystal Run Health CareMiddletownUSA
  3. 3.Internal MedicineNew York Medical College - Metropolitan Hospital ProgramNew YorkUSA

Personalised recommendations