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The fourth pattern includes abnormalities that result in decreased lung attenuation or air-filled lesions.
These include:
- Emphysema
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- Lung cysts (LAM ... #Diagnosis #Radiology ... #Pulmonary #CTChest ... Differential #Diagram #Comparison ... #SignetRing #RadiologyAssistant
Upper lung zone preference is seen in:
- Inhaled particles: pneumoconiosis (silica or coal)
- Smoking related diseases
Upper lung zone ... (centrilobular emphysema ... bronchiolitis (RB-ILD ... edema #Diagnosis #Radiology ... #Upper #Lower #RadiologyAssistant
On the left three different patients with lung cysts.
From left to right: Lymphangiomyomatosis, LIP and Langerhans
patients with lung ... Clinical #Diagnosis #Radiology ... #CTChest #Cystic ... #Comparison #LAM ... Histiocytosis #RadiologyAssistant
Low Attenuation pattern 
1. Lymphangiomyomatosis (LAM): uniform cysts in woman of child-bearing age; no history of
Centrilobular emphysema ... #Clinical #Radiology ... #HRCT #CTChest ... Cystic #Pattern #Comparison ... #Table #RadiologyAssistant
Differential diagnosis of Langerhans cell histiocytosis.
Nodular LCH:
- Sarcoidosis: perilymphatic distribution.
- Metastases: random distribution.
Cystic LCH:
- LAM: round
Centrilobular emphysema ... Clinical #Diagnosis #Radiology ... #CTChest #Cystic ... #Differential #Comparison ... #Table #RadiologyAssistant
Low Attenuation pattern (2) 
1. Centrilobular emphysema: low attenuation areas without walls. Notice the centrilobular artery
Centrilobular emphysema ... #Clinical #Radiology ... #HRCT #CTChest ... Cystic #Pattern #Comparison ... #Table #RadiologyAssistant
Nodular pattern
1. Hypersensitivity pneumonitis: ill defined centrilobular nodules.
2. Miliary TB: random nodules
3. Sarcoidosis: nodules with perilymphatic
Hypersensitivity pneumonitis: ill ... #Clinical #Radiology ... #HRCT #CTChest ... Nodular #Pattern #Comparison ... #Table #RadiologyAssistant
Centrilobular emphysema due to smoking. The periphery of the lung is spared (blue arrows). Centrilobular artery
Centrilobular emphysema ... periphery of the lung ... #Clinical #Radiology ... #CTChest #Centrilobular ... #RadiologyAssistant
UIP with honeycombing (left) and chronic HP (right)
Differential diagnosis of Hypersensitivity Pneumonitis.
Subacute stage:
- RB-ILD: seen in
centrilobular emphysema ... Clinical #Diagnosis #Radiology ... #CTChest #UIP # ... Comparison #Chronic ... #RadiologyAssistant
On the left a patient with RB-ILD.
The dominant feature is ground glass opacification and there are
patient with RB-ILD ... centrilobular emphysema ... #Clinical #Radiology ... #CTChest #RBILD ... #RadiologyAssistant