The mean CFAE area (5.6 ± 6.9 mm2 vs. 18.5 ± 20.3 mm2 vs. 24.3 ± 26.6 mm2, P = 0.005) and CFAE area index (3.1 ± 4.2 vs. 9.2 ± 10.7 vs. 11.8 ± 15.3, P = 0.025) in the LA were significantly different among groups. Additional findings in this patient are paraseptal emphysema in the upper lobes and some subtle septal thickening in the basal parts. Notice the distribution of the conglomerate masses of fibrosis in the posterior part of the lungs. The HRCT shows a mosaic pattern with hyperaerated secondary nodules and secondry nodules of increased attenuation. Fibrosis results in obliteration of pulmonary vessels, which can lead to pulmonary hypertension. If the UIP pattern is of unknown cause (i.e. Anti-arrhythmic agents were discontinued at the 3 months visit if there was no evidence of recurrence. This is the typical perilymphatic distribution of the noduless. These diseases have specific patterns of morphologic findings on HRCT and histology. On the left two different patients with similarl HRCT findings. Langerhans cell histiocytosis: > 90% are smokers, cysts have irregular shapes and the basal costophrenic angles are spared. In the dependent parts of the lung there is also some consolidation, so there is a gradient from front to back. Multivariable analysis incorporating LA size and volume, CFAE area, CFAE area index, the presence of CFAEs in LA septal area, and IAST group was performed to evaluate the predictors of acute procedural failure during catheter ablation. Ventricular tachycardia catheter ablation after repaired tetralogy of Fallot: how to overcome an electrical short circuit. On the left a patient who was involved in a traffic accident and within hours developed ARDS. The images on the left suggest the diagnosis hypersensitivity pneumonitis. Complex fractionated atrial electrogram area (surrounded by black line) was 13.7 mm2 in this patient. Scherr D Dalal D Cheema A Cheng A Henrikson CA Spragg Det al. In addition there are multiple small well-defined nodules. Extra-pulmonary ARDS Interatrial septal thickness was measured at a single site 1 cm inferior to the fossa ovalis. Note: edema can have a very unusual appearance and be distributed very patchy: some areas are filled with fluid as opposed to other areas in immediate vicinity which appear normal. Sarcoidosis: nodules with perilymphatic distribution, along fissures, adenopathy. Additional findings are pleural thickening, small pleural effusions and parenchymal bands. This case nicely demonstrates that sarcoidosis truely is 'the great mimicker'. Opacifications range from ground glass to consolidation. Only third IAST tertile group was a borderline significant independent predictor of acute procedural failure (hazard ratio 4.701, 95% confidence interval: 0.903–24.468, P = 0.060). Pleural effusion due to pleuritic carcinomatosis ( > 50% of patients). Ground-glass opacity and interlobular septal thickening are also visible. There is a cavitating lesion and typical tree-in-bud appearance. Consolidation anywhere, lymphadenopathy and pleural effusion. NSIP (4) NSIP was characterized by temporally homogenous septal inflammatory thickening and minimal organizing fibrosis (score 3), N = 20 cases (Figure 1E). Interstitial thickening is pathological thickening of the pulmonary interstitium and can be divided into: interlobular septal thickening intralobular septal thickening See also interlobular septa secondary pulmonary lobules HRCT terminology Scroll through the images. HP is an allergic lung disease caused by the inhalation of a variety of antigens (farmer's lung, bird fancier's lung, 'hot tub' lung, humidifier lung). Cystic airspaces This is late stage Langerhans cell histiocytosis. In a patient with a known malignancy lymphangitic carcinomatosis would be high in the differential diagnostic list. CFAE, complex fractionated atrial electrogram; IAST, interatrial septal thickness; LA, left atrial. A variety of underlying conditions, from infections to major trauma, can cause ARDS.Primary pulmonary risk factors include aspiration, pneumonia, toxic inhalation and pulmonary contusion. Based on these non-specific CT findings there is a broad differential diagnosis and additional clinical information is mandatory for the interpretion of the HRCT. There are multiple areas of consolidation. Lymphangitic carcinomatosis: irregular septal thickening, usually focal or unilateral, in 50% adenopathy, known carcinoma. In all patients with a NSIP pattern, the clinician should be advised to look for connective tissue diseases, hypersensitivity pneumonitis or drugs . The blue arrow indicates the biopsy needle. Additional pleural fluid and lung metastases. Special Thanks NSIP is histologically characterized by a homogeneous, uniform pattern of cellular interstitial inflammation associated with variable degrees of fibrosis. There are multiple small bilateral peripheral consolidations. On the left a patient with rheumatoid arthritis and bilateral peripheral consolidations as a result of organizing pneumonia. This location was used because the fossa ovalis is easily recognized as a focal area of soft tissue density traversing the interatrial septum. NSIP (3) Depending on filling with fluid or with tumor cells, septal thickening is irregular or smooth. Previously, the degree of IAST correlated with total epicardial adipose tissue amount, but whether IAST reflects real interatrial septal fat infiltration is unknown. Note the patchy distribution of lung disease and the almost complete distorsion more basal. Patient is ventilated with PEEP (positive end expiratory pressure ) leading to a barotrauma of the lung parenchyma: there are multiple subpleural cysts and a bilateral pneumothorax. This HRCT-image also demonstrates subtle centrilobular opacity in a patient with subacute HP. The mean left ventricular ejection fraction was 53.2 ± 7.1%. 4. Interlobular septal thickening, thickening of fissures and thickening of the peribronchovascular interstitium (bronchial cuffing). This finding is helpful in distinguishing Lymphangitic Carcinomatosis from other causes of interlobular septal thickening like pulmonary edema or sarcoid. Is pursuit of termination of atrial fibrillation during catheter ablation of great value in patients with longstanding persistent atrial fibrillation? At a lobar level, 69% (514 of 748) of lobes with bronchiectasis had septal thickening. Nademanee K McKenzie J Kosar E Schwab M Sunsaneewitayakul B Vasavakul Tet al. The differentiation between NSIP and UIP has tremendous prognostic implication for the patient. The first chest film shows bilateral consolidations in the lower lobes (arrow), initially interpreted as infection. There is smooth septal thickening and some ground glass opacity in the dependent part of the lungs. Radiol Clin North Am 2001:39: 1115-35, by Zampatori M, Sverzellati N, Poletti V et al. 2000;20:1245-1259, Appendicitis - Pitfalls in US and CT diagnosis, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, Esophagus: anatomy, rings and inflammation, Multiple Sclerosis - Diagnosis and differential diagnosis, Developmental Dysplasia of the Hip - Ultrasound, High Resolution Lung CT, UCSF Interactive Radiology Series on CD-ROM, American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias, What Every Radiologist Should Know about Idiopathic Interstitial Pneumonias. This is not a 100% specific criterium but is quite helpful for differential diagnosis. Pulmonary interstitial high-resolution computed tomography abnormality. Chronic hypersensitivity pneumonitis (2) However, in most patients, interstitial thickening is not extensive. American Journal of Roentgenology, Vol 173, 1617-1622, by Santiago E. Rossi, MD, Jeremy J. Erasmus, MD, H. Page McAdams, MD, Thomas A. Sporn, MD and Philip C. Goodman, MD. The CFAE area in LA was not significantly correlated with LA size or volume (r = −0.073, P = 0.5453 and r = −0.140, P = 0.247, respectively). One third have continuing disease leading to clinically significant organ impairment. This can happen from inflammation, scarring, or a buildup of fluid. In the presence of a surgical biopsy showing a UIP pattern the diagnosis of IPF requires exclusion of other known causes of UIP including drug toxicities, environmental exposures (asbest), and collagen vascular diseases like RA, SLE, polyarteritis nodosa and sclerodermia. Mosaic pattern with areas of ground-glass atenuation and areas of low attenuation. ARDS, Acute Interstitial Pneumonia.