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The fourth pattern includes abnormalities that result in decreased lung attenuation or air-filled lesions.
These include:
- Emphysema
-
The fourth pattern ... on the basis of HRCT ... Radiology #Pulmonary #CTChest ... #LowAttenuation ... #Differential #
Low Attenuation pattern 
1. Lymphangiomyomatosis (LAM): uniform cysts in woman of child-bearing age; no history of
Low Attenuation pattern ... Centrilobular emphysema ... Clinical #Radiology #HRCT ... #CTChest #LowAttenuation ... #Comparison #Table
Low Attenuation pattern (2) 
1. Centrilobular emphysema: low attenuation areas without walls. Notice the centrilobular artery
Low Attenuation pattern ... Centrilobular emphysema ... Clinical #Radiology #HRCT ... #CTChest #LowAttenuation ... #Comparison #Table
Differential diagnosis on HRCT
Most of our knowledge about imaging findings in interstitial lung disease comes from
Differential diagnosis ... on HRCT Most of ... disease comes from HRCT ... On HRCT there are ... low attenuation (table
Basic Interpretation
A structured approach to interpretation of HRCT involves the following questions:
What is the dominant HR-pattern:
reticular
nodular
high
interpretation of HRCT ... the dominant HR-pattern ... low attenuation (emphysema ... Radiology #Pulmonary #HRCT ... #Algorithm #ILD
UIP with honeycombing (left) and chronic HP (right)
Differential diagnosis of Hypersensitivity Pneumonitis.
Subacute stage:
- RB-ILD: seen in
chronic HP (right) Differential ... Subacute stage: - RB-ILD ... centrilobular emphysema ... show very similar HRCT ... Diagnosis #Radiology #CTChest
The idiopathic interstitial pneumonias (IIPs) comprise a heterogenous group of disorders. 
They represent fundamental responses of
combinations of fibrosis ... listed in the table ... morphologic findings on HRCT ... Radiology #Pulmonary #CTChest ... IdiopathicInterstitialPneumonia #ILD
On the left a smoker with RB-ILD with subtle HRCT-findings.
The dominant pattern is ground glass opacification.
Additional
with subtle HRCT-findings ... The dominant pattern ... are paraseptal emphysema ... there is a broad differential ... interpretion of the HRCT
Septal thickening
Thickening of the lung interstitium by fluid, fibrous tissue, or infiltration by cells results in
interstitium by fluid, fibrous ... cells results in a pattern ... diagnosis (Table ... Radiology #Pulmonary #HRCT ... #CTChest #Reticular