Dr Ahmed Refaey , FRCR

Differential diagnosis of chest diseases

Micronodular(miliary)disease

TB Histoplasmosis Chicken box Sarcoidosis LCH Pneumoconiosis Alveolar microlithiasis Metastasis

Septal thickening

Beaded / nodular * lymphangitic carcinomatosa * sarcoidosis * silicosis

Smooth * lymphangitisc carcinomatosis * pulmonary edema * alveolar proteinosis

Bilateral perihilar air-space disease

Pulmonary edema Pulmonary hemorrhage Alveolar proteinosis PCP

Acute alveolar infiltrate

Pulmonary edema Pneumonia Pulmonary hemorrhage Aspiration

Chronic alveolar disease

Alveolar cell carcinoma Alveolar sarcoidosis Lymphoma Alveolar proteinosis

Unilateral hyperlucent lung Obstructive emphysema Mcleoid syndrome ( Swyer James

syndrome) Pneumothorax Pulmonary embolism Bullous disease Air trapping e.g. FB , mass Poland syndrome

Multiple lung nodules (macronodules)

Metastasis Wegner’s granulomatosis Rheumatoid n nodules AVMs Septic emboli

Small cavitating lung lesions Septic emboli Rheumatoid nodules Wegner’s granulomatosis Sq. or transitional cell ca metastasis

Upper lober disease( CASSET P )

Cystic fibrosis Ankylosing spondylitis Sarcoidosis Silicosis Esinophilic granuloma PCP

Basilar interstitial lung disease ( BADASS )

Bronchiectasis Aspiration Drugs / DIP-UIP Asbestosis Sickle cell disease Scleroderma

Masses with air bronchogram Lymphoma Alveolar cell carcinoma Pseudolymphoma ( maltoma )

Anterior mediastinal mass

Thymic tumors Substernal Thyroid LNs Germ cell tumor

Middle mediastinal mass

LNs Aneurysm Esophageal duplication Bronchogenic cyst

Posterior mediastinal mass Neurogenic tumors Paraspinal hematoma Paraspinal abscess Extraskeletal hematopoiesis LNs enlargement Lateral meningeocele

Opacified hemithorax

Atelectasis Pneumonia Pleural effusion Post pneumonectomy

Pneumomediastinum

Ruptured esophagus Ruptured trachea / bronchus Iatrogenic Broncheal asthma pneumoperitoneum

Pleural calcification

Old TB empyema Asbestos exposure Hemithorax

Cardiopherenic angle mass

Pericardial cyst Diaphragmatic hernia ( Morgagni ) Lung sequestration Pericardial fat bad

Unilateral pulmonary edema Aspiration Disease in other lung e.g. COPD Postural Rapid expansion pulmonary edema “ Look for ICT”

Long segment tracheal narrowing

Tracheopathia osteoplastica Tracheo-broncheal amyloidosis Wegner’s granulomatosis Intubation injury Tracheobronchomalacia Relapsing polychondritis Papillomatosis ( extensive )

Peripheral distributed lung disease

Esinophilic pneumonia --- upper lobes

BOOP ----- lower lobes Hypersensitivity pneumonitis Multiple infarcts DIP Alveolar cell carcinoma

Bronchiectasis

CT criteria of bronchiectasis

1- lack of tapering of bronchi2-internal diameter of bronchus larger

than the adjacent artery3- bronchi are visible within 1 cm of

pleura4- mucus-filled , dilated bronchi

Bronchiectasis

Chronic airway infection Pulmonary fibrosis –traction bronchiectasis ABPA ------- central

bronchiectasis Cystic fibrosis ------- apical bronchiectasis Mounier-Kuhn syndrome –

tracheobronchomegally Kartagner syndrome --- situs inversus +

sinusitis

Mounier-Kuhn syndrome

ABPA

Cystic fibrosis

Kartagener’s syndrome

Dilated esophagus

Scleroderma Achalasia Obstructing tumor Drugs ( atropine) Surgury ( gastric pull-up)