Pictorial Essay: Multinodular Disease

doi:10.1378/chest.129.3.805

Chest

Volume 129, Issue 3, March 2006, Pages 805-815

https://doi.org/10.1378/chest.129.3.805 Get rights and content

The evaluation of patients presenting with multinodular pulmonary disease provides an important clinical challenge for physicians. The differential diagnosis includes an extensive list of benign and malignant processes making the management of these cases frequently problematic. With the introduction of high-resolution CT (HRCT) scanning, the ability to assess various patterns of diffuse multinodular disease has evolved into an essential part of the diagnostic process. The purpose of this article is to develop an approach to the diagnosis of multinodular parenchymal disease using HRCT scan pattern recognition as a point of departure.

Section snippets

Algorithm Overview

Due to its ability to evaluate the lung parenchyma in cross-section, eliminating the superimposition of densities, CT scanning offers a unique opportunity to evaluate lung nodules in exquisite detail.² This includes first the ability to assess lesions by anatomic distribution, and second by morphology.3, 4, 5

Multinodular HRCT Algorithm: A Step-Wise Approach

The use of this algorithm begins by dividing CT scans into two broad arms based on the presence (group 1) or absence (group 2) of pleural or perifissural involvement (Table 1).

Conclusion

The finding of multiple lung nodules is a characteristic that encompasses a number of disparate parenchymal diseases. Although inexact, the use of anatomic and morphologic features to characterize nodules based on HRCT scan findings may help to simplify the differential diagnosis. Most importantly, the use of this imaging algorithm can prove to be an aid in standardizing the clinical approach to differential diagnosis. In a study reported by Gruden et al,⁴ four experienced chest radiologists

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No financial or other potential conflicts of interest exist for any of the authors.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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Chest

Chest Imaging for CliniciansPictorial Essay: Multinodular Disease

Section snippets

Algorithm Overview

Multinodular HRCT Algorithm: A Step-Wise Approach

Conclusion

Radiol Clin North Am

Chest

Clin Chest Med

Mayo Clin Proc

Anatomic distribution and histopathologic patterns in diffuse lung disease: correlation with HRCT

J Thorac Imaging

Secondary pulmonary lobule: normal and abnormal CT appearance

AJR Am J Roentgenol

Centrilobular opacities on HRCT: diagnosis and differential diagnosis with pathologic correlation

AJR Am J Roentgenol

Centrilobular lesions of the lung: demonstration by high resolution CT and pathologic correlation

Radiology

The CT findings of pulmonary sarcoidosis: analysis of 25 patients

AJR Am J Roentgenol

Adult onset of pulmonary tuberculosis: findings on chest radiographs and CT scans

AJR Am J Roentgenol

Appearance of pulmonary metastases on high-resolution CT scans: comparison with histopathologic findings from autopsy specimens

AJR Am J Roentgenol

Tree-in-bud pattern: frequency and significance on thin-section CT

J Comput Assist Tomogr

Pulmonary histiocytosis X: comparison of radiographic and CT findings

Radiology

Pulmonary nodules: preliminary experience with three-dimensional evaluation

Radiology

Design and structure of the human lung

Pulmonary sarcoidosis: evaluation with high-resolution CT

Radiology

Pulmonary sarcoidosis: correlation of CT and histopathologic findings

Radiology

Computed tomographic evaluation of silicosis and coal worker’s pneumoconiosis

Radiol Clin North Am

Silicosis in 76 men: qualitative and quantitative CT evaluation- clinical-radiologic correlation study

Radiology

Imaging of occupational lung disease

Radiographics

CT findings in lymphangitic carcinomatosis of the lung: correlation with histologic findings and pulmonary function tests

AJR Am J Roentgenol

Appearance of pulmonary metastases on high-resolution CT scans: comparison with histopathologic findings from autopsy specimens

AJR Am J Roentgenol

Blood supply of pulmonary metastases

J Thorac Imaging

Computed tomography halo sign of pulmonary nodules: frequency and diagnostic value

J Thorac Imaging

Chest Imaging for Clinicians
Pictorial Essay: Multinodular Disease