Focal lung pneumatosis: Difference between revisions
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*A '''cavity''' has a wall thickness omore than 4 mm |
*A '''cavity''' has a wall thickness omore than 4 mm |
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The terms above, when referring to other sites than the lungs, often imply fluid content. |
The terms above, when referring to other sites than the lungs, often imply fluid content. |
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Lung blebs or cysts are seen in about 8% of the general population, with an increased prevalence in older people.<ref name="ArakiNishino2015"/> They may be part of the aging changes of the lungs, and cause a slight decrease in their [[Diffusing capacity for carbon monoxide|diffusing capacity]].<ref name="ArakiNishino2015"/> |
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==Bleb or bulla== |
==Bleb or bulla== |
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[[File:Alpha 1-antitrypsine deficiency lung CT scan.JPEG|thumb|[[CT scan]] of the lung showing bullae in the lower lung lobes of a subject with type [[alpha-1-antitrypsin deficiency]]. There is also increased lung density in areas with compression of lung tissue by the bullae.]] |
[[File:Alpha 1-antitrypsine deficiency lung CT scan.JPEG|thumb|[[CT scan]] of the lung showing bullae in the lower lung lobes of a subject with type [[alpha-1-antitrypsin deficiency]]. There is also increased lung density in areas with compression of lung tissue by the bullae.]] |
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The most common |
The most common disease causing blebs or bullae is [[chronic obstructive pulmonary disease]] (COPD).<ref name=Medscape>{{cite web|url=https://emedicine.medscape.com/article/1894169-overview|title=Bullectomy|website=[[Medscape]]|author=Neerja Gulati}} Updated: Feb 21, 2019</ref> The pathophysiologic process in this case is ''emphysema'', which is the breakdown of the walls of the [[pulmonary alveolus|alveoli]]. |
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Other conditions associated with lung bullae are: |
Other conditions associated with lung bullae are: |
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[[File:CT of lymphocytic interstitial pneumonia.jpg|thumb|[[CT scan]] of [[lymphocytic interstitial pneumonia]].]] |
[[File:CT of lymphocytic interstitial pneumonia.jpg|thumb|[[CT scan]] of [[lymphocytic interstitial pneumonia]].]] |
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[[File:HRCT of cysts of pneumocystis pneumonia.jpg|thumb|[[CT scan]] of multiple lung cysts in [[pneumocystis pneumonia]].]] |
[[File:HRCT of cysts of pneumocystis pneumonia.jpg|thumb|[[CT scan]] of multiple lung cysts in [[pneumocystis pneumonia]].]] |
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The presence of multiple pulmonary cysts may indicate a need to evaluate the possibility of cystic lung diseases.<ref name="ArakiNishino2015"/> Cystic lung diseases include: |
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*[[Langerhans cell histiocytosis]] (LCH)<ref name="ArakiNishino2015"/> |
*[[Langerhans cell histiocytosis]] (LCH)<ref name="ArakiNishino2015"/> |
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*[[Lymphangioleiomyomatosis]] (LAM)<ref name="ArakiNishino2015"/> |
*[[Lymphangioleiomyomatosis]] (LAM)<ref name="ArakiNishino2015"/> |
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*[[Light chain deposition disease]]<ref name="Ferreira FranciscoSoares Souza2015"/> |
*[[Light chain deposition disease]]<ref name="Ferreira FranciscoSoares Souza2015"/> |
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*[[Lung metastases]] rarely cause multiple cystic lung lesions. This form of presentation has been described in metastatic [[sarcoma]]s.<ref name="Ferreira FranciscoSoares Souza2015"/> |
*[[Lung metastases]] rarely cause multiple cystic lung lesions. This form of presentation has been described in metastatic [[sarcoma]]s.<ref name="Ferreira FranciscoSoares Souza2015"/> |
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==Incidental blebs and cysts== |
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A focal lung pneumatosis that is an [[incidental imaging finding]] such as on a [[CT scan]], without suspicious findings (such as findings indicating any of the diseases listed above), generally does not indicate further follow-up.<ref name="BeddyBabar2010">{{cite journal|last1=Beddy|first1=Peter|last2=Babar|first2=Judith|last3=Devaraj|first3=Anand|title=A practical approach to cystic lung disease on HRCT|journal=Insights into Imaging|volume=2|issue=1|year=2010|pages=1–7|issn=1869-4101|doi=10.1007/s13244-010-0050-7}}</ref> |
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==Cavity== |
==Cavity== |
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Revision as of 13:21, 1 May 2019
A focal lung pneumatosis is a pocket of air (pneumatosis) in the parenchyma of the lungs.
A focal volume of air in the lung parenchyma that is larger than alveoli can be classified by its wall thickness:
- A bleb or bulla has a wall thickness of less than 1 mm[1]
- A cyst has a wall thickness of up to 4 mm.[1] A minimum wall thickness of 1 mm has been suggested,[1] but thin-walled pockets may be included in the definition as well.[2]
- A cavity has a wall thickness omore than 4 mm
The terms above, when referring to other sites than the lungs, often imply fluid content.
Lung blebs or cysts are seen in about 8% of the general population, with an increased prevalence in older people.[2] They may be part of the aging changes of the lungs, and cause a slight decrease in their diffusing capacity.[2]
Bleb or bulla
The most common disease causing blebs or bullae is chronic obstructive pulmonary disease (COPD).[3] The pathophysiologic process in this case is emphysema, which is the breakdown of the walls of the alveoli.
Other conditions associated with lung bullae are:
- Alpha 1-antitrypsin deficiency[3]
- Marfan syndrome[3]
- Ehlers–Danlos syndromes[3]
- Cocaine smoking[3]
- Sarcoidosis[3]
- HIV/AIDS[3]
- Intravenous substance abuse[3]
Cyst
The presence of multiple pulmonary cysts may indicate a need to evaluate the possibility of cystic lung diseases.[2] Cystic lung diseases include:
- Langerhans cell histiocytosis (LCH)[2]
- Lymphangioleiomyomatosis (LAM)[2]
- Lymphocytic interstitial pneumonia (LIP)[2]
- Birt–Hogg–Dubé syndrome[4]
- Pneumocystis pneumonia[4]
- Amyloidosis[4]
- Light chain deposition disease[4]
- Lung metastases rarely cause multiple cystic lung lesions. This form of presentation has been described in metastatic sarcomas.[4]
Incidental blebs and cysts
A focal lung pneumatosis that is an incidental imaging finding such as on a CT scan, without suspicious findings (such as findings indicating any of the diseases listed above), generally does not indicate further follow-up.[5]
Cavity
Two diseases that are commonly associated with cavities of lung tissue are Mycobacterium tuberculosis and Klebsiella pneumoniae. The formation of cavities is due to tissue necrosis and creates an environment that allows the pathogen to expand in numbers and spread further.[6]
References
- ^ a b c Dr Daniel J Bell and Dr Yuranga Weerakkody. "Pulmonary cyst". Radiopaedia. Retrieved 2019-05-01.
- ^ a b c d e f g Araki, Tetsuro; Nishino, Mizuki; Gao, Wei; Dupuis, Josée; Putman, Rachel K; Washko, George R; Hunninghake, Gary M; O'Connor, George T; Hatabu, Hiroto (2015). "Pulmonary cysts identified on chest CT: are they part of aging change or of clinical significance?". Thorax. 70 (12): 1156–1162. doi:10.1136/thoraxjnl-2015-207653. ISSN 0040-6376.
- ^ a b c d e f g h Neerja Gulati. "Bullectomy". Medscape. Updated: Feb 21, 2019
- ^ a b c d e Ferreira Francisco, Flavia Angélica; Soares Souza, Arthur; Zanetti, Gláucia; Marchiori, Edson (2015). "Multiple cystic lung disease". European Respiratory Review. 24 (138): 552–564. doi:10.1183/16000617.0046-2015. ISSN 0905-9180.
- ^ Beddy, Peter; Babar, Judith; Devaraj, Anand (2010). "A practical approach to cystic lung disease on HRCT". Insights into Imaging. 2 (1): 1–7. doi:10.1007/s13244-010-0050-7. ISSN 1869-4101.
- ^ Gadkowski, L. Beth; Stout, Jason E. (9 April 2008). "Cavitary pulmonary disease". Clinical Microbiology Reviews. 21 (2): 305–333. doi:10.1128/CMR.00060-07. PMC 2292573. PMID 18400799.