Index and Table of Contents

Technical and Practice Issues

• Case 11: 62-years old misdiagnosed to have interstitial lung disease - mid-inspiratory and expiratory scans
• Snippet 03: Radiation risk and CT chest
• Case 23: 60-years old - 40-pack years smoker - right upper lobe nodule - resolved using "mean" reconstructions to simulate a chest radiograph
• Snippet 11: ACR appropriateness criteria for diffuse lung disease imaging and ACR-STR guidelines
• Dual energy CT (DECT)
  • Case 14: 70-years old man with COVID-19 - DECT showing perfusion defects
  • Case 19: 55-years old with COVID-19 vasculopathy / angiopathy - 10 1/2 months follow-up
  • Case 24: 55-years old - perfusion defects in chronic thromboembolic pulmonary hypertension (CTEPH)
  • Case 38: 40-years old man with COVID-19 - 15 months follow-up of COVID changes and vasculopathy

Principles of Interpretation

(Principles / Approach / Signs / Indications)

• Signs and Differentials

  • Snippet 01: Differentiating traction bronchiectasis from honeycombing
  • Snippet 02: Centrilobular / bronchocentric nodules
  • Snippet 04: Fibrotic NSIP vs probable UIP
  • Case 16: 56-years old - Approach to interpretation of diffuse ground glass
  • Case 17: 17-years old with hemoptysis - tuberculosis - differentiating dense centrilobular nodules of infectious bronchiolitis from soft nodules due to blood
  • Snippet 06: Six fibrosing ILD questions answered
  • Snippet 07: CT signs suggesting connective tissue disease (CTD) ILD
  • Snippet 08: Mosaic attenuation - differentiating CTEPH, small airways disease and interstitial lung disease
  • Snippet 09: Variant fibrosis in connective tissue disease (CTD) ILD
  • Snippet 10: Diagnosis of bronchiectastis
  • Snippet 12: Visual classification of centrilobular and paraseptal emphysema
  • Snippet 13: Spectrum of smoking related changes in a single patient
  • Case 66: Importance of the inspiratory-expiratory pair
  • Case 68: Looking at the Lungs Carefully When There is Lymphadenopathy
  • Snippet 15: CT Scan Findings in Sarcoidosis
  • Lecture: Signs of Fibrosing ILDs - Reticular opacities, traction bronchiectasis and honeycombing
  • Lecture: Approach to diffuse small lung nodules
  • Lecture: Overview of diffuse lung diseases
  • Lecture: Centrilobular nodule, proliferative bronchiolitis, etc
  • Snippet 16: Differentiating inflammatory from fibrotic ILDs
  • Snippet 17: How to diagnose subtle progression of interstitial lung disease at the secondary pulmonary lobule level

• First Principles of Interpretation

  • Do not ignore the non-contrast (plain) scan - 3 cases
  • Case 33: 70-years old - looking at the plain scan to resolve active nodes on PET/CT - old healed granulomatous infection
  • Case 50: First princples - look at the noncontrast (plain) scan subcarinal bronchogenic cyst
  • Case 55: First principles - trace the bronchus - non-resolving consolidation - foreign body - clove in left lower lobe bronchial segment
  • Case 69 - What ails chest imaging training? 60-years old with a left upper lobe lesion for biopsy

• Indications

  • Snippet 14: A history of the irrelevance of the cardiothoracic ratio
  • Case 61: Uses of prone imaging
  • Case 62: Indications of chest MRI
  • Case 66: Importance of the inspiratory-expiratory pair
  • Case 85: The Power of Old Scans

Guidelines and White Papers

• 2020 ATS/JRS/ALAT - Hypersensitivity pneumonitis - new classification
• Snippet 11: ACR appropriateness criteria for diffuse lung disease imaging and ACR-STR guidelines
• 2022 ATS/ERS/JRS/ALAT - Progressive pulmonaryfibrosis - fibrotic hypersensitivity pneumonitis
• 2022 ATS/ERS/JRS/ALAT - Progressive pulmonaryfibrosis - scleroderma ILD
• 2022 ATS/ERS/JRS/ALAT - CPFE - Official statement

Lung

• Interstitial Lung Diseases

  • Fibrotic

  • Lecture 01 - 2023 06 15 - Fibrosing ILDs

  • Snippet 17: How to diagnose subtle progression of interstitial lung disease at the secondary pulmonary lobule level

    • UIP/IPF
      • Case 5: 70-years old male smoker - usual interstitial pneumonia (UIP) / idiopathic pulmonary fibrosis (IPF)
      • Case 6: 63-years old man - probable usual interstitial pneumonia (probable UIP) / idiopathic pulmonary fibrosis (IPF)
      • Case 7: 75-years old man - UIP/IPF with a complication - lung nodule - squamous cell carcinoma
      • Snippet 01: Differentiating traction bronchiectasis from honeycombing
      • Snippet 04: Fibrotic NSIP vs probable UIP
      • Snippet 06: Six fibrosing ILD questions answered
    • Combined Pulmonary Fibrosis and Emphysema (CPFE)
      • Snippet 13: Spectrum of smoking related changes in a single patient
      • Case 48: 78-years old - combined pulmonary fibrosis and emphysema (CPFE)
      • Case 67: 69-years old - combined pulmonary fibrosis and emphysema (CPFE) and the official statement from ATS/ERS/JRS/ALAT
    • Fibrotic NSIP / Connective Tissue Disease - ILD
      • Snippet 04: Fibrotic NSIP vs probable UIP
      • Case 10: 67-years old woman - fibrotic organizing pneumonia (OP) - Sjogren's
      • Snippet 07: CT signs suggesting connective tissue disease (CTD) ILD
      • Snippet 09: Variant fibrosis in connective tissue disease (CTD) ILD
      • Case 39: 27-years old - scleroderma ILD - secondary pleuroparenchymal fibroelastosis (PPFE)
      • Case 58: 27-years old - scleroderma ILD - progressive pulmonary fibrosis
    • Non-UIP/Non-IPF
      • Fibrotic Hypersensitivity Pneumonitis
        • Case 49: 65-years old - fibrotic hypersensitivity pneumonitis - hexagonal pattern
        • Case 57: 55-years old man - fibrotic hypersensitivity pneumonitis - progressive pulmonary fibrosis
        • Case 85: 65-years old non-smoker - fibrotic hypersensitivity pneumonitis
      • Chronic Pulmonary Sarcoidosis
        • Case 29: 58-years old - sarcoidosis over 18 years
    • Indeterminate
    • Miscellaneous
      • Case 56: 66-years old - COVID-19 fibrosis - UIP-like
      • Case 77: 55-years old - primary PPFE - pleuroparenchymal fibrosis

  • Nonfibrotic

    • Case 16: 56-years old - PCP / PJP presenting as diffuse ground glass
    • Case 26: 16-years old - pulmonary alveolar proteinosis (PAP)
    • Case 44: 33-years old - ANCA-associated vasculitis and diffuse alveolar hemorrhage
    • Case 46: 70-years old - nitrofurantoin lung injury with organizing pneumonia (OP) pattern
    • Case 59: 73-years old - nivolumab lung injury - pre-existing ILA
    • Case 64: 70-years old - H1N1 lung involvement - organizing pneumonia (OP) pattern
    • Case 85: 65-years old non-smoker - non-fibrotic hypersensitivity pneumonitis progressing to fibrotic
    • Lecture: REF-Cafe Roentgen Lecture 03 - Non-fibrosing ILDs

  • Interstitial Lung Abnormality (ILA)

    • Case 36: 76-years old - interstitial lung abnormality (ILA) to fibrotic interstitial lung disease (ILD)
    • Case 59: 73-years old - nivolumab lung injury - pre-existing ILA

  • Nodular

    • Case 12: 38-years old - nodules and septal thickening - acute onset - tropical pulmonary eosinophilia
    • Snippet 02: Centrilobular / bronchocentric nodules
    • Case 29: 58-years old - sarcoidosis over 18 years
    • Case 30: 51-years old - classic silicosis
    • Case 68: 47-years old - Stage II sarcoidosis
    • Lecture: Approach to diffuse small lung nodules
    • Case 84: 30-years old - classic miliary tuberculosis
    • Case 88: 48-years old - flour mill worker silicosis

  • Miscellaneous

    • Case 3: 19-years old man with lungs of stone - alveolar microlithiasis
    • Case 4: 70-years old with carcinoma breast - lymphangitis carcinomatosis
    • Case 60: 69-years old - radiation pneumonitis and fibrosis
    • Case 70: 51-years old - idiopathic diffuse pulmonary ossification (DPO)
    • Case 79: 74-years old man - radiation recall pneumonitis

• Cystic Lung Diseases

  • Case 35: 46-years old - cysts and nodules - amyloidosis
  • Case 65 - 46-years old - Birt-Hogg-Dube (BHD) syndrome
  • Lecture: REF-Cafe Roentgen Lecture 07 - Diffuse cystic lung diseases

• Emphysema and COPD

  • Snippet 12: Visual classification of centrilobular and paraseptal emphysema
  • Snippet 13: Spectrum of smoking related changes in a single patient
  • Case 48: 78-years old - combined pulmonary fibrosis and emphysema (CPFE)
  • Case 54: 56-years old - never-smoker - COPD - severe small airways disease
  • Case 67: 69-years old - combined pulmonary fibrosis and emphysema (CPFE) and the official statement from ATS/ERS/JRS/ALAT

• Focal Lung Diseases

  • Solitary Nodule

    • Case 1C: 67-years old with a calcified lung nodule - old granuloma - part of the "do not ignore the plain scan" series
    • High risk CT imaging features in lung cancer screening - lecture
    • Case 7: 75-years old man - UIP/IPF with a complication - lung nodule - squamous cell carcinoma
    • Case 23: 60-years old - 40-pack years smoker - right upper lobe nodule - old granuloma
    • Case 31: 54-years old - incidental lung nodule - pulmonary sclerosing pneumocytoma
    • Case 52: 54-years old - solitary nodule with cyst - neuroendocrine tumor - carcinoid
    • Case 76: 57-years old - solitary perifissural nodule (PFN)
    • Case 86: 55-years old - growing cavitated lung nodule - adenocarcinoma metastasis
    • Lecture: REF-Cafe Roentgen Lecture 08 - Solitary lung nodule > 8 mm
    • Lecture: REF-Cafe Roentgen Lecture 09 - Solitary lung nodule - PFN, juxtrapleural nodule, nodules in smokers, Lung-RADs, etc.

  • Multiple Nodules

    • Case 21: 61-years old - cryptococcus lung nodules
    • Case 34: Young patient - mercury poisoning
    • Case 35: 46-years old - cysts and nodules - amyloidosis

  • Subsolid Nodule

    • Case 22: 64-years old - growing subsolid nodule - adenocarcinoma
    • Lecture: REF-Cafe Roentgen Lecture 10 - Subsolid nodule

  • Masses

    • Case 27: 18-years old - lung mass - sequestration
    • Case 28: 70-years old - multiple lung masses - lipoid pneumonia
    • Case 41: 78-years old - non-resolving opacity - invasive mucinous adenocarcinoma
    • Case 53: 18-years old - lung mass with calcification - inflammatory myofibroblastic tumor
    • Case 78 - 24-years old - slow growing lung mass with mediastinal component - classic Hodgkin lymphoma

  • Consolidation

    • Case 9: 64-years old - non-resolving consolidation - invasive mucinous adenocarcinoma
    • Case 55: 65-years old - non-resolving consolidation - foreign body - clove in left lower lobe bronchial segment
    • Case 83: 51-years old - non-resolving consolidation / opacities - vasculitis - GPA

  • Cavities

    • Case 20: 61-years old - chronic cavitary aspergillosis - scab sign

  • Miscellaneous / Others

    • Case 73: 44-years old - acute hemoptysis - pancreatic pseudocyst extending into mediastinum, eroding into lung

Airways

• Bronchiectasis

  • Snippet 10: Diagnosis of bronchiectasis
  • Case 75: 51-years old - asthma - allergic bronchopulmonary aspergillosis (ABPA)

• Small airways

  • Snippet 08: Mosaic attenuation - differentiating CTEPH, small airways disease and interstitial lung disease
  • Case 47: 64-years old smoker - respiratory bronchiolitis (RB)
  • Snippet 13: Spectrum of smoking related changes in a single patient
  • Case 54: 56-years old - never-smoker - COPD - severe small airways disease
  • Case 71: 35-years old - episodic breathlessness - Sywer-James-MacLeod's syndrome

• Large airways

  • Case 13: 3-years old - congenital lobar emphysema
  • Case 37: 20-years old - stalactite trachea - tracheobronchopathia osteochondroplastica
  • Case 40: 49-years old - primary tracheal chondrosarcoma
  • Case 43: 21-years old - endobronchial and tracheal tuberculosis
  • Case 55: 65-years old - non-resolving consolidation - foreign body - clove in left lower lobe bronchial segment
  • Case 66: 53-years old - foreign body - betelnut / supari - left main bronchus

Mediastinum and Hilum

• Masses

  • Case 1A: 22-years old with with mediastinal extension of thyroid nodule - part of the "do not ignore the plain scan" series
  • Case 1B: 19-years old with left mediastinal / hilar fibrosis - part of the "do not ignore the plain scan" series
  • Case 15: 36-years old - mediastinal fibrosis
  • Case 42: 15-years old - prevascular space mass - lymphoma
  • Case 50: 43-years old - subcarinal bronchogenic cyst
  • Case 51: 63-years old - large left ventricular cardiac aneurysm with egg-shell calcification
  • Case 80: 55-years old - upper thoracic paravertebral posterior mediastinal mass - schwannoma
  • Case 81: 57-years old - medial cardiophrenic angle mass - foramen of Morgagni hernia
  • Case 87: 51-years old - prevascular space mediastinal mass - thymic cyst

• Lymphadenopathy

  • Case 8: 14-years old - rupture of a large necrotic paratracheal mediastinal node into the lung - tuberculosis
  • Case 33: 70-years old - active nodes on PET/CT - calcified on plain scan - old healed granulomatous infection
  • Case 45: 51-years old - eggshell calcification due to silicosis
  • Case 88:48-years old - eggshell calcification - silicosis

• Non-Mass Pathology

Vascular

• Pulmonary

  • Pulmonary Thromboembolism

    • Case 24: 55-years old - chronic thromboembolic pulmonary hypertension (CTEPH)
    • Snippet 08: Mosaic attenuation - differentiating CTEPH, small airways disease and interstitial lung disease

  • Pulmonary Hypertension

    • Case 24: 55-years old - chronic thromboembolic pulmonary hypertension (CTEPH)

  • Arteriovenous Fistula

  • Venous Lesions

    • Case 61: 68-years old - venous aneurysms in lung collapsing on prone imaging
    • Case 62: 41-years old - venous brachiocephalic aneurysm - prevascular space mediastinum

  • Miscellaneous

    • Case 63: 48-years old - unilateral absence pulmonary artery (UAPA)

• Aorta and Others

  • Case 51: 63-years old - large left ventricular cardiac aneurysm with egg-shell calcification

Pleura and Extrapleural

• Case 25: 45-years old - extrapleural masses - thoracic splenosis
• Case 74: 76-years old - multifocal pleural masses - metastases from thymic carcinoma

Chest Wall and Diaphragm

• Case 25: 45-years old - extrapleural masses - thoracic splenosis due to old diaphragmatic rupture
• Case 81: 57-years old - medial cardiophrenic angle mass - foramen of Morgagni hernia
• Case 82: 60-years old - type I sliding hiatus hernia

Congenital and Developmental

• Case 13: 3-years old - congenital lobar emphysema
• Case 27: 18-years old - lung mass - sequestration
• Case 50: 43-years old - subcarinal bronchogenic cyst
• Case 61: 68-years old - venous aneurysms in lung
• Case 62: 41-years old - venous brachiocephalic aneurysm
• Case 63: 48-years old - unilateral absence pulmonary artery (UAPA)
• Case 65 - 46-years old - Birt-Hogg-Dube (BHD) syndrome

Infection

• Tuberculosis

  • Case 8: 14-years old - rupture of a large necrotic paratracheal mediastinal node into the lung - tuberculosis
  • Case 17: 17-years old with hemoptysis - tuberculosis and both dense and soft centrilobular nodules
  • Case 23: 60-years old - 40-pack years smoker - right upper lobe old granuloma
  • Case 43: 21-years old - endobronchial and tracheal tuberculosis
  • Case 69: 60-years old with mass-like calcific lesions
  • Lecture: Tuberculosis vs sarcoidosis
  • Case 84: 30-years old - classic miliary tuberculosis

• Fungal

  • Case 16: 56-years old - Pneumocystic pneumonia (PCP) due to Pneumocystic jirovecii
  • Case 20: 61-years old - chronic cavitary aspergillosis - scab sign
  • Case 21: 61-years old - cryptococcus lung nodules

• Bacterial

• Parasitic

  • Case 12: 38-years old - nodules and septal thickening - acute onset - tropical pulmonary eosinophilia

• Viral

  • Case 2: 69-years old man with COVID-19 - resolution of so-called "fibrosis" at 9 months follow-up
  • Case 14: 70-years old man with COVID-19 - perfusion defects due to COVID angiopathy at 3 1/2 weeks
  • Case 18: 51-years man with COVID-19 - 11 months follow-up
  • Case 19: 55-years old with COVID-19 vasculopathy / angiopathy - 10 1/2 months follow-up
  • Case 32: 69-years old man with COVID-19 - 16 1/2 months follow-up
  • Case 38: 40-years old man with COVID-19 - 15 months follow-up of COVID changes and vasculopathy
  • Case 56: 66-years old - COVID-19 fibrosis - UIP-like
  • Case 64: 70-years old - H1N1 lung involvement

Neoplasms

• Malignant

  • Case 4: 70-years old with carcinoma breast - lymphangitis carcinomatosis
  • Case 7: 75-years old man - UIP/IPF with a complication - lung nodule - squamous cell carcinoma
  • Case 9: 64-years old - non-resolving consolidation - invasive mucinous adenocarcinoma
  • Case 22: 64-years old - growing subsolid nodule - adenocarcinoma
  • Case 40: 49-years old - primary tracheal chondrosarcoma
  • Case 41: 78-years old - non-resolving opacity - invasive mucinous adenocarcinoma
  • Case 42: 15-years old - prevascular space mass - lymphoma
  • Case 86: 55-years old - growing cavitated lung nodule - adenocarcinoma metastasis

• Benign

  • Case 31: 54-years old - incidental lung nodule - pulmonary sclerosing pneumocytoma
  • Case 52: 54-years old - solitary nodule with cyst - neuroendocrine tumor - carcinoid
  • Case 53: 18-years old - lung mass with calcification - inflammatory myofibroblastic tumor

• Lung Cancer Screening

  • High risk CT imaging features in lung cancer screening - lecture
  • Case 23: 60-years old - 40-pack years smoker - right upper lobe nodule - resolved using "mean" reconstructions to simulate a chest radiograph

Connective Tissue Diseases and Vasculitides and Sarcoidosis

• General

  • Snippet 07: CT signs suggesting connective tissue disease (CTD) ILD
  • Snippet 09: Variant fibrosis in connective tissue disease (CTD) ILD

• Sarcoidosis

  • Case 29: 58-years old - sarcoidosis over 18 years
  • Case 68: 47-years old - Stage II sarcoidosis - nodules and nodes
  • Snippet 15: CT scan findings in sarcoidosis
  • Lecture: Tuberculosis vs sarcoidosis

• Scleroderma

  • Case 39: 27-years old - scleroderma ILD - secondary pleuroparenchymal fibroelastosis (PPFE)
  • Case 58: 27-years old - scleroderma ILD - progressive pulmonary fibrosis

• Sjogren's

  • Case 10: 67-years old woman - fibrotic organizing pneumonia (OP) - Sjogren's

• Vasculitis

  • Case 44: 33-years old - ANCA-associated vasculitis and diffuse alveolar hemorrhage
  • Case 83: 51-years old - progressive masses and nodules - GPA (granulomatosis with polyangitis)

Exposure

(Smoking, Occupational, Biomass Gas) / Poisonings / Radiation & Medication Induced Injury)

• Smoking

  • Case 23: 60-years old - 40-pack years smoker - right upper lobe nodule - resolved using "mean" reconstructions to simulate a chest radiograph
  • Snippet 12: Visual classification of centrilobular and paraseptal emphysema
  • Case 47: 64-years old smoker - respiratory bronchiolitis (RB) and discussion of smoking related changes
  • Snippet 13: Spectrum of smoking related changes in a single patient
  • Case 48: 78-years old - combined pulmonary fibrosis and emphysema (CPFE)
  • Case 67: 69-years old - combined pulmonary fibrosis and emphysema (CPFE) and the official statement from ATS/ERS/JRS/ALAT
  • Lecture: REF-Cafe Roentgen - smoking related lung diseases

• Air Pollution / Biomass Gas

  • Case 54: 56-years old - never-smoker - COPD - severe small airways disease

• Occupational

  • Case 30: 51-years old - classic silicosis
  • Case 45: 51-years old - eggshell calcification due to silicosis
  • Case 88: 48-years old - flour mill worker silicosis

• Poisoning

  • Case 34: Young patient - mercury poisoning

• Medication Induced Lung Injury (MIPI)

  • Case 46: 70-years old - nitrofurantoin lung injury
  • Case 59: 73-years old - nivolumab lung injury

• Radiation Lung Injury

  • Case 60: 69-years old - radiation pneumonitis and fibrosis
  • Case 79: 74-years old man - radiation recall pneumonitis

REF-Cafe Roentgen Thoracic Thursday Lecture Series

• Lecture 01 - 2023 06 15 - Fibrosing ILDs
• Lecture 02 - 2023 06 22 - Fibrosing ILDs - contd, Technique & Introduction to Non-Fibrosing ILDs
• Lecture 03 - 2023 06 29 - Non-fibrosing ILDs
• Lecture 04 - 2023 07 13 - Non-ILD Diffuse Lung Diseases - Bronchiectasis, Emphysema, Constrictive Bronchiolitis
• Lecture 05 - 2023 07 20 - Centrilobular Nodule, Proliferative Bronchiolitis, etc
• Lecture 06 - 2023 08 03 - Smoking Related Lung Diseases