Upper Lung Zones

Position of Disease
Upper lung field distribution
Ashley Davidoff MD TheCommonvein.net lungs-0774
Chronic Eosinophilic Pneumonia Affects the Alveoli and Alveolar Septal Interstitium 
Chronic eosinophilia is characterised by alveolar filling with eosinophils and inflammatory exudates(a) and interalveolar interstitial thickening, (overlaid in red in b). The infiltrates are classically peripherally positioned, usually upper lobes, more commonly bilateral but can be unilateral, and manifest as consolidation and or ground glass opacities.  The CT shows bilateral peripheral consolidations in the upper lobes
Ashley Davidoff MD The CommonVein.net  lungs-0775e

Lower Lung Fields

Position of Disease
Lower Lobe distribution
Ashley Davidoff MD TheCommonvein.net lungs-0771
Smoking Chronic Bronchitis – Lower Lobes
Caption:
CT coronal chest image at the level of the carina shows inflamed segmental and subsegmental airways in the lower lobes (overlaid in red) caused by cigarette smoking, with foci of mucus impaction (yellow).
The distribution of lung injury in smoking-related diseases is influenced by gravity. In chronic bronchitis, heavier solid particulates from smoke settle in the lower lobes, where mucus trapping and impaired clearance lead to persistent inflammation. In emphysema, lighter gaseous toxins rise to the upper lobes, causing oxidative damage and alveolar destruction.
Ashley Davidoff, TheCommonvein.net (lungs-0788 – lo res bronchitis)
Position of Disease
Basilar and peripheral distribution
Ashley Davidoff MD TheCommonvein.net lungs-0769b
Position of Disease
Broncho vascular distribution
Ashley Davidoff MD TheCommonvein.net lungs-0769

Central Perihilar

Position of Disease
Perihilar distribution
Ashley Davidoff MD TheCommonvein.net lungs-0770
Position of Disease
Mid lung field distribution
Ashley Davidoff MD TheCommonvein.net lungs-0773
Position of Disease
Diffuse Lung Disease
Ashley Davidoff MD TheCommonvein.net lungs-0775

Peripheral Subpleural Sparing

Position of Disease
Subpleural Sparing
Ashley Davidoff MD TheCommonvein.net lungs-0775 0775-lo res subpleural sparing
Most Common Appearance of Acute Eosinophillic Pneumonia
Acute Eosinophilic pneumonia is characterised by ground glass opacities (100%)  and sometimes consolidation (55%) most commonly with a random distribution 60%.  Septal lines (90%) and thickening of the bronchovascular bundles (66%) and bilateral pleural effusions (75%) were common.
Ashley Davidoff MD TheCommonvein.net lungs-0775-b (Reference De Giacomi F et al)

 

CT WITH SUBPLEURAL AND LYMPHOVASCULAR NODULES IN THE RIGHT UPPER LOBE – INTERLOBULAR SEPTA AND CENTRILOBULAR
SARCOIDOSIS, ACTIVE – ALVEOLAR FORM
48-year-old previously well presented with dyspnea and initial CXR showed an infiltrate at the right base, and clinically resolved. He presented a year later with right chest pain and low grade ever and the CXR showed patchy opacities in the LUL and in the RLL
A subsequent CT showed LUL nodular opacities and subpleural rim of consolidation in the LUL and more prominently at both lung bases, associated with significant mediastinal adenopathy. Lymphovacscular nodularity was noted in the bronchovascular bundles as well as in the interlobular septa, consistent with sarcoidosis
CXR and CT 4 years later showed almost complete resolution of the parenchymal findings and the CT findings except for minimal reticulation and scarring in the subpleural regions
Ashley Davidoff MD

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