2001;18 (1): 196-208. Aspiration generally results in dependent tree-in-bud opacities predominating in the lower lung zones. The miliary pattern consists of multiple small (< 3 mm) pulmonary nodules of similar size that are randomly distributed throughout both lungs . 15), but may also occur as an imaging manifestation of endobronchial tumor (Fig. In a patient with pneumonia, detection of an air-fluid level on chest radiographs or CT images suggests the presence of a lung abscess or empyema with bronchopleural fistula. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.Pneumonia can range in seriousness from mild to life-threatening. Other diseases that can manifest the silhouette sign include atelectasis (segmental or lobar), aspiration, pleural effusion, and tumor . Pneumonia is a general term in widespread use, defined as infection within the lung. Eur. Fungus ball develops within preexisting cavity, usually in association with tuberculosis or sarcoidosis. Pneumonia is in contrast to pneumonitis, which is inflammation of the pulmonary interstitium. Imaging features that favor mucormycosis over Aspergillus infection in a neutropenic patient are detection of the reverse halo or bird's nest sign, multiplicity of pulmonary nodules (> 10), and development of infection despite voriconazole prophylaxis [66–68]. 2. [Updated 2020 Mar 6]. Noninfectious causes of the miliary pattern include metastatic disease, IV injected foreign material, and rarely sarcoidosis [62, 63]. Fig. Fig. A, Axial CT images in soft-tissue (left) and lung (right) windows shows linear burrow track (arrows) extending from thickened pleura to pulmonary nodule. Fig. This sign was originally thought to indicate hematogenous dissemination of disease [20, 21], but when it was studied on multiplanar reformatted images, most of the so-called feeding vessels were actually pulmonary veins coursing from the nodule, and the pulmonary arteries usually coursed around the nodule . The lung is the second most common organ involved, after the liver, and is infected by either hematogenous or direct transdiaphragmatic spread from the liver [74–76]. Similar findings involved all aspects of both lungs. 23 —49-year-old man with pulmonary hydatid disease. Example of air crescent or Monad sign. Fig. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. 16 —63-year-old man with squamous cell lung cancer. Perilymphatic nodules are distributed along peribronchovascular structures, the subpleural lung, and along interlobular septa. Ancillary clinical or radiographic features suggestive of Pneumocystis pneumonia include a history of immunosuppression, imaging findings of pulmonary cysts, and the occurrence of secondary spontaneous pneumothorax  (Fig. c Consolidations were the dominant CT nding on day 14 Pneumonia is an infection that inflames the air sacs in one or both lungs. 2 —4-year-old girl with lingular pneumonia. The burrow sign is a linear track extending from the pleural surface or hemidiaphragm to a cavitary or cystic pulmonary nodule. 9,10 Specific radiologic signs had variable sensitivity and specificity, but the likelihood ratios of any sign were > 1.5 only in autopsy studies. Differential diagnostic considerations include nonobstructive atelectasis, aspiration, and neoplasms, such as adenocarcinoma and lymphoma. Coronal CT image (inset) from earlier examination shows unruptured cyst. Pneumocystis pneumonia. Air-fluid level in endocyst (arrowhead) in combination with meniscus sign forms Cumbo sign. Example of finger-in-glove sign. • Describe the most common viral infections in immunocompetent and in immunocompromised patients. 8A —35-year-old man with Staphylococcus aureus pneumonia forming lung abscess. Pulmonary necrosis may become evident as hypoenhancing geographic areas of low lung attenuation that may be difficult to differentiate from adjacent pleural fluid  (Fig. The finger-in-glove sign is the chest radiographic finding of tubular and branching tubular opacities that appear to emanate from the hila, said to resemble gloved fingers [45, 46]. Humans serve as a definitive host when they ingest raw or improperly cooked crab or crayfish . 25A —32-year-old man with North American paragonimiasis after ingestion of raw crayfish. Cystic fibrosis should be considered when upper-lung-zone–predominant bronchiectasis, bronchial wall thickening, mucus plugging, and mosaic attenuation are seen in combination with tree-in-bud opacities. The small airways or terminal bronchioles are invisible on CT images because of their small size (< 2 mm) and thin walls (< 0.1 mm). Several weeks later, the organism migrates through the diaphragm to enter the pleural space. 24 —27-year-old woman with pulmonary hydatid disease. under- ve hypokalemic diarrheal children admi ed to an . Fig. Imaging Pulmonary Infection: Classic Signs and Patterns, Bronchiolitis Obliterans with Organizing Pneumonia Versus Chronic Eosinophilic Pneumonia, Sonographic Diagnosis of Biliary Atresia in Pediatric Patients Using the “Triangular Cord” Sign Versus Gallbladder Length and Contraction. Common radiological features of pneumonia 1. Example of feeding vessel sign. 4 —40-year-old man after IV injection of crushed morphine sulfate tablets. This study aimed to compare the clinical and radiological characteristics of SARS-CoV-2 and endemic HCoVs infection in adult hospitalized patients with community-acquired pneumonia (CAP). A lung abscess usually forms an acute angle when it intersects with an adjacent pleural surface, and its wall is often thick and irregular. 1. Example of burrow sign. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. b On day 8, the number and size of GGOs increased. (Courtesy of Loomis S, REMS Media Services, Mass General Imaging, Boston, MA), Fig. Septic emboli should be considered when the feeding vessel sign is seen with cavitating and noncavitating nodules and subpleural wedge-shaped consolidation. Split-pleura sign is not specific for empyema but rather indicates presence of exudative effusion. The ground-glass opacity represents hemorrhage surrounding infarcted lung and is caused by vascular invasion by the fungus . The split-pleura sign may be seen in combination with the air-fluid level sign when a bronchopleural fistula occurs within empyema. Keywords: abscess, fungus, infection, signs. Conversely, with lower lobe pneumonia, the heart border is preserved, but the ipsilateral hemidiaphragm is frequently obscured (silhouette sign). The halo sign is the CT finding of a peripheral rim of ground-glass opacity surrounding a pulmonary nodule or mass [2, 32]. Fig. Example of miliary pattern. Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. 2. Sattar SBA, Sharma S. Bacterial Pneumonia. (Courtesy of Henry T, Emory University, Atlanta, GA). 22 —Drawings show normal hydatid cyst and meniscus, Cumbo, and water lily signs. 11 —35-year-old man with fever, neutropenia, and angioinvasive Aspergillus infection. Radiation pneumonitis is a fairly common complication of radiation treatment to the chest, usually for lung cancer or breast cancer. In patients with acute symptoms, crazy-paving sign may represent pulmonary edema, pulmonary hemorrhage, or infection. In a patient with pneumonia, the CT detection of inhomogeneous enhancement and cavitation suggests the presence of necrotizing infection [25, 26]. The crazy-paving sign is the CT finding of a combination of ground-glass opacity and smooth interlobular septal thickening that resembles a masonry pattern used in walkways . Posteroanterior radiograph shows large right lower lobe thick-walled cavity with lobulated air–soft-tissue interface representing floating endocyst (arrow). Coronal CT image shows septic pulmonary emboli manifesting themselves as peripheral solid and cavitary pulmonary nodules of varying sizes. Fig. Fig. 5), any form of pneumonia can manifest the bulging fissure sign. The fungal ball or mycetoma develops within a preexisting lung cavity and may exhibit gravity dependence (Fig. 7 —55-year-old man with necrotizing aspiration pneumonia. The chest CT findings reflect the life cycle of the parasite. 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