Cystic fibrosis: a comparison of computed tomography and plain chest radiographs.

In patients with cystic fibrosis, plain chest radiographs may suggest the presence of bronchiectasis, bronchoceles, hilar adenopathy, or pulmonary arterial hypertension. We compared computed tomography (CT) with conventional chest radiography in 12 patients. CT clearly reveals the cause of increased linear markings, nodular lesions, and enlarged hila as seen on plain chest radiographs. It showed that nine patients had hilar adenopathy, five had enlarged pulmonary arteries, and 11 had bronchiectasis. Bronchoceles, a finding that may influence therapy, were seen on seven CT scans but on only four of the plain films.

Conventional tomographic hilar anatomy emphasizing the pulmonary veins.

The pulmonary hili are a frequent site of interpretive uncertainty because of their complex anatomy. The right hilar shadow relates primarily to the ascending and descending pulmonary arteries and the right superior pulmonary vein, whereas the left hilar density accrues from the left pulmonary artery, left descending pulmonary artery, and left superior pulmonary vein. The right and left superior pulmonary veins are intimately associated with and inseparable from the arteries. Knowledge of the course of these veins facilitates their identification on conventional tomograms. The right and left inferior pulmonary veins lie behind the lower hili and contribute only a small increment to the normal hilar density; the horizontal course of these vessels readily distinguishes them from the vertically oriented lower lobe arteries. Prominence of both the right and left superior and inferior veins may cause hilar pseudotumors. Conventional tomograms are most helpful in understanding plain radiographs. A multiview approach in anteroposterior, 55 degrees posterior oblique, and lateral projections is recommended for a complete assessment. Computed tomography in transaxial sections adds further understanding of spatial relations in the hili, including the contributions of the pulmonary veins.

The end-stage lung: pathogenesis, pathology, and radiology.

The morphological concept of an end-stage lung implies a pathologically and radiologically nonspecific appearance of diffuse lung disease which can be caused by many different disease processes. The lung can respond to injury in only a limited and stereotyped fashion; with persistent injury, these pathological changes telescope toward a common appearance, the end-stage lung, which is characterized by cystic spaces of variable size and extent throughout both lungs caused by alveolar septal dissolution, bronchiolectasia, and obstructive emphysema. The most important radiological manifestation is cystic spaces, a sign of severe, irreversible damage to that portion of the lung. Pleural thickening, cor pulmonale, spontaneous pneumothorax, calcific nodules, or scar carcinoma may also be seen.