Imaging Features of the Normal Aging Chest

  • Carol C. Wu
  • Jo-Anne O. Shepard


As a part of the normal aging process, many changes occur in the lungs, mediastinum, pleura, and thoracic skeleton. Age-related mild pulmonary fibrosis, air trapping, and apical scarring can be seen in the lungs. Tortuous and atherosclerotic vessels and mediastinal lipomatosis are not infrequently seen in elderly patients. With increasing age, diaphragmatic hernia and eventration may become more prominent. Additionally, degenerative changes of the osseous structures can sometimes mimic pulmonary nodules. Familiarity with the imaging appearance of these changes is important to help avoid mistaking these changes as pathologic processes.


Subpleural reticulation Tracheal calcification Apical cap Airtrapping (f) Focal fibrosis (f) Osteophyte (f) Intraparenchymal lymph node (f) Lung nodule (f) Thymus (f) Mediastinal lipomatosis (f) Unfolded aorta (f) Atherosclerosis (f) Aberrant right subclavian artery (f) Kommerell diverticulum (f) Eventration (f) Diaphragmatic hernia (f) Costal cartilage calcification (f) 


  1. 1.
    Janssens JP, Pache JC, Nicod LP. Physiological changes in respiratory function associated with ageing. Eur Respir J. 1999;13:197–205.PubMedCrossRefGoogle Scholar
  2. 2.
    Gibson GJ, Pride NB, O’Caine C, Quagliato R. Sex and age differences in pulmonary mechanics in normal nonsmoking subjects. J Appl Physiol. 1976;41:20–5.PubMedGoogle Scholar
  3. 3.
    Calabresi C, Arosio B, Galimberti L, Scanziani E, Bergottini R, Annoni G, et al. Natural aging, expression of fibrosis-related genes and collagen deposition in a rat lung. Exp Gerontol. 2007;42:1003–11.PubMedCrossRefGoogle Scholar
  4. 4.
    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;251:566–73.PubMedCrossRefGoogle Scholar
  5. 5.
    McLoud TC, Isler RJ, Novelline RA, Putman CE, Simeone J, Stark P, et al. The apical cap. AJR Am J Roentgenol. 1981;137:299–306.PubMedGoogle Scholar
  6. 6.
    Yousem SA. Pulmonary apicl cap: a distinctive but poorly recognized lesion in pulmonary surgical pathology. Am J Surg Pathol. 2001;25:679–83.PubMedCrossRefGoogle Scholar
  7. 7.
    Resnick D, Niwayama G. Degenerative disease of the spine. In: Resnick D, editor. Diagnosis of bone and joint disorders. 3rd ed. Philadelphia: Saunders; 1995. p. 1372–462.Google Scholar
  8. 8.
    Otake S, Takahashi M, Ishigaki T. Focal pulmonary interstitial opacities adjacent to thoracic spine osteophytes. AJR Am J Roentgenol. 2002;179:893–6.PubMedGoogle Scholar
  9. 9.
    Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner society: glossary of terms for thoracic imaging. Radiology. 2008;246:697–722.PubMedCrossRefGoogle Scholar
  10. 10.
    Webb WR, Stern EJ, Kanth N, Gamsu G. Dynamic pulmonary CT: findings in healthy adult men. Radiology. 1993;186:117–24.PubMedGoogle Scholar
  11. 11.
    Stern EJ, Frank MS. Small-airway disease of the lungs: findings at expiratory CT. AJR Am J Roentgenol. 1994;163:37–41.PubMedGoogle Scholar
  12. 12.
    Lee KW, Chung SY, Yang I, Lee Y, Ko EY, Park MJ. Correlation of aging and smoking with air trapping at thin-section CT of the lung in asymptomatic subjects. Radiology. 2000;214:831–6.PubMedGoogle Scholar
  13. 13.
    Bankoff MS, McEniff NJ, Bhadelia RA, Garcia-Moliner M, Daly BD. Prevalence of pathologically proven intrapulmonary lymph nodes and their appearance on CT. AJR Am J Roentgenol. 1996;167:629–30.PubMedGoogle Scholar
  14. 14.
    Trapnell DH. Recognition and incidence of intrapulmonary lymph nodes. Thorax. 1964;19:44–50.PubMedCrossRefGoogle Scholar
  15. 15.
    Kradin RL, Spirn PW, Mark EJ. Intrapulmonary lymph nodes: clinical, radiologic, and pathologic features. Chest. 1985;87:662–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Miyake H, Yamada Y, Kawagoe T, Hori Y, Mori H, Yokoyama S, et al. Intrapulmonary lymph nodes: CT and pathologic features. Clin Radiol. 1999;54:640–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Awai K, Nishioka Y, Tachiyama Y. Intrapulmonary lymph node: findings on high-resolution CT scans. AJR Am J Roentgenol. 1993;161:208–9.PubMedGoogle Scholar
  18. 18.
    Sykes AM, Swensen SJ, Tazelaar HD, Jung SH. Computed tomography of benign intrapulmonary lymph nodes: Retrospective comparison with sarcoma metastases. Mayo Clin Proc. 2002;77:329–33.PubMedCrossRefGoogle Scholar
  19. 19.
    Ahn MI, Gleeson TG, Chan IH, McWilliams AM, Macdonald SL, Lam S, et al. Perifissural nodules seen at CT screening for lung cancer. Radiology. 2010;254:949–56.PubMedCrossRefGoogle Scholar
  20. 20.
    Naidich DP, Webb WR, Muller NL, Vlahos I, Krinsky GA. Mediastinum. In: Naidich DP, Webb WR, Muller NL, Vlahos I, Krinsky GA, editors. Computed tomography and magnetic resonance of the thorax. 4th ed. Philadelphia: Wolters, Kluwer, Lippincott, Williams & Wilkins; 2007. p. 308–12.Google Scholar
  21. 21.
    Perlo VP, Arnason B, Castleman B. The thymus gland in elderly patients with myasthenia gravis. Neurology. 1975;25:294–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Dixon AK, Hilton CJ, Williams GT. Computed tomography and histologic correlation of the thymic remnant. Clin Radiol. 1981;32:255–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Homer JM, Wechsler RJ, Carter BL. Mediastinal lipomatosis. Radiology. 1978;128:657–61.PubMedGoogle Scholar
  24. 24.
    Price JE, Rigler LG. Widening of the mediastinum resulting from fat accumulation. Radiology. 1970;96:497–500.PubMedGoogle Scholar
  25. 25.
    Bein ME, Mancuso AA, Mink JH, Hansen GC. Computed tomography in the evaluation of mediastinal lipomatosis. J Comput Assist Tomogr. 1978;2:379–83.PubMedCrossRefGoogle Scholar
  26. 26.
    Glickstein MF, Miller WT, Dalinka MK, Lally JF. Paraspinal ­lipomatosis: a benign mass. Radiology. 1987;163:79–80.PubMedGoogle Scholar
  27. 27.
    Aronberg DJ, Glazer HS, Madsen K, Sagel SS. Normal thoracic aortic diameters by computed tomography. J Comput Assit Tomogr. 1984;8:247–50.Google Scholar
  28. 28.
    Naidich DP, Webb WR, Muller NL, Vlahos I, Krinsky GA. Aorta, arch vessels, and great veins. In: Naidich DP, Webb WR, Muller NL, Vlahos I, Krinsky GA, editors. Computed tomography and magnetic resonance of the thorax. 4th ed. Philadelphia: Wolters, Kluwer, Lippincott, Williams & Wilkins; 2007. p. 87–216.Google Scholar
  29. 29.
    Tenenbaum A, Garniek A, Shemesh J, Fisman EZ, Stroh CI, Itzchak Y, et al. Dual-helical CT for detecting aortic atheromas as a source of stroke: comparison with transesophageal echocardiography. Radiology. 1998;208:153–8.PubMedGoogle Scholar
  30. 30.
    Rudd JH, Warbuton EA, Fryer TD, Jones HA, Clark JC, Antoun N, et al. Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation. 2002;105:2708.PubMedCrossRefGoogle Scholar
  31. 31.
    Edwards J. Anomalies of derivatives of the aortic arch system. Med Clin North Am. 1948;32:925–49.PubMedGoogle Scholar
  32. 32.
    Akers DL, Fowl RJ, Plettner JJ, Kempczinski RF. Complications of anomalous ­origin of the right subclavian artery: case report and review of the literature. Ann Vasc Surg. 1991;5:385–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Caskey CI, Zerhouni EA, Fishman EK, Rahmouni AD. Aging of the diaphragm: a CT study. Radiology. 1989;171:385–9.PubMedGoogle Scholar
  34. 34.
    Naidich DP, Webb WR, Muller NL, Vlahos I, Krinsky GA. Pleura, chest wall, and diaphragm. In: Naidich DP, Webb WR, Muller NL, Vlahos I, Krinsky GA, editors. Computed tomography and magnetic resonance of the thorax. 4th ed. Philadelphia: Wolters, Kluwer, Lippincott, Williams & Wilkins; 2007. p. 769–883.Google Scholar
  35. 35.
    Estenne M, Yernault JC, DeTroyer A. Rib cage and diaphragm-abdomen compliance in humans: effects of age and posture. J Appl Physiol. 1985;59:1842–8.PubMedGoogle Scholar
  36. 36.
    Teale C, Romaniuk C, Mulley G. Calcification on chest radiographs: the association with age. Age Aging. 1989;18:333–6.CrossRefGoogle Scholar
  37. 37.
    Edge JR, Millard FJ, Reid L, Simon G. The radiographric appearances of the chest in persons of advanced age. Br J Radiol. 1964;37:769–74.PubMedCrossRefGoogle Scholar
  38. 38.
    Austin JH, Romney BM, Goldsmith LS. Missed bronchogenic ­carcinoma: radiographic findings in 27 patients with a potentially resectable lesion evident in retrospect. Radiology. 1992;182:115–22.PubMedGoogle Scholar
  39. 39.
    Shah PK, Austin JH, White CS, Patel P, Haramati LB, Pearson GD, et al. Missed non-small cell lung cancer: radiographic findings of potentially resectable lesions ­evident only in retrospect. Radiology. 2003;226:235–41.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Radiology, Division of Thoracic Imaging and InterventionMassachusetts General HospitalBostonUSA

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