High-Resolution CT of the Lung #152201 Cust: LWW Au: Webb Pg. No. i CMYK S4DcESIGaN SrERVlICiESS OlF e Title: High-Resolution CT of the Lung 5ed Server: Short / Normal/Long Publishing Services #152201 Cust: LWW Au: Webb Pg. No. ii CMYK S4DcESIGaN SrERVlICiESS OlF e Title: High-Resolution CT of the Lung 5ed Server: Short / Normal/Long Publishing Services High-Resolution CT of the Lung F I F T H E D I T I O N W. Richard Webb, MD Professor Emeritus of Radiology and Biomedical Imaging Emeritus Member, Haile Debas Academy of Medical Educators University of California San Francisco San Francisco, California Nestor L. Müller, MD, PhD Professor Emeritus of Radiology Department of Radiology, University of British Columbia Vancouver, British Columbia, Canada David P. Naidich, MD, FACR, FAACP Professor of Radiology and Medicine New York University Langone Medical Center New York, New York #152201 Cust: LWW Au: Webb Pg. No. iii CMYK S4DcESIGaN SrERVlICiESS OlF e Title: High-Resolution CT of the Lung 5ed Server: Short / Normal/Long Publishing Services Senior Executive Editor: Jonathan W. Pine, Jr. Acquisitions Editor: Ryan Shaw Product Development Editor: Amy G. Dinkel Production Project Manager: David Orzechowski Senior Manufacturing Coordinator: Beth Welsh Marketing Manager: Dan Dressler Senior Designer: Joan Wendt Production Service: S4Carlisle Publishing Services Copyright © 2015 Wolters Kluwer Health Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com 4th edition © 2009 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval sys- tem without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data Webb, W. Richard (Wayne Richard), 1945- author. High-resolution CT of the lung / W. Richard Webb, Nestor L. Müller, David P. Naidich. — Fifth edition. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4511-7601-8 (alk. paper) I. Müller, Nestor Luiz, 1948- , author. II. Naidich, David P., author. III. Title. [DNLM: 1. Lung—radiography. 2. Tomography, X-Ray Computed. 3. Lung Diseases—pathology. WF 600] RC734.T64 616.2’407572—dc23 2014003388 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. 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No. iv CMYK S4DcESIGaN SrERVlICiESS OlF e Title: High-Resolution CT of the Lung 5ed Server: Short / Normal/Long Publishing Services DEDICATION To my father, who encouraged my curiosity and taught me to figure things out ––WRW To my wife, Isabela, and my children—Alison, Phillip, and Noah Müller ––NLM To Jocelyn, whose constant love and support has always been my greatest inspiration ––DPN #152201 Cust: LWW Au: Webb Pg. No. v CMYK S4DcESIGaN SrERVlICiESS OlF e Title: High-Resolution CT of the Lung 5ed Server: Short / Normal/Long Publishing Services #152201 Cust: LWW Au: Webb Pg. No. vi CMYK S4DcESIGaN SrERVlICiESS OlF e Title: High-Resolution CT of the Lung 5ed Server: Short / Normal/Long Publishing Services Contributing Authors Brett M. Elicker, MD Associate Professor of Clinical Radiology and Biomedical Imaging Chief, Cardiac and Pulmonary Imaging University of California San Francisco San Francisco, California Myrna C. B. Godoy, MD, PhD Assistant Professor of Radiology University of Texas MD Anderson Cancer Center Houston, Texas C. Isabela S. Müller, MD, PhD Department of Radiology Delfin Clinic Salvador, Bahia, Brazil vii #152201 Cust: LWW Au: Webb Pg. No. vii CMYK S4cDESaIGNr SERlVICiESS OlF e Title: High-Resolution CT of the Lung 5ed Server: Short / Normal/Long Publishing Services #152201 Cust: LWW Au: Webb Pg. No. viii CMYK S4DcESIGaN SrERVlICiESS OlF e Title: High-Resolution CT of the Lung 5ed Server: Short / Normal/Long Publishing Services Preface During the past 25 years, high-resolution CT (HRCT) has of an inch thick, and, to our knowledge, referenced every become established as an indispensable tool in the evalu- known paper on HRCT. From our perspective, it was the ation of patients with diffuse lung disease. HRCT is now most important thing we had ever done. commonly used in clinical practice to detect and char- That is how things start. Maybe that is the best way acterize a variety of lung abnormalities. In the approxi- things should start. It was certainly fun and rewarding mately 5 years since our fourth edition was published, for each of us. And we three have stuck together over the considerable progress has taken place in the understand- years, out of our combined respect, admiration, friend- ing of diffuse lung diseases and the recognition of new ship, and good humor. Each one of us believes that we entities and their nature, causes, and characteristics. learned more from our collaboration than we taught. Without doubt, HRCT has played a fundamental role in In this edition, we have incorporated an update and contributing to this progress and has become essential to review of numerous recent advances in the classifica- the diagnosis of a number of diffuse diseases. tion and understanding of diffuse lung diseases and their This fifth edition continues what the three of us, in- HRCT features. Recent technical modifications in obtain- dependently, in conjunction, and with each other’s en- ing HRCT have also been reviewed, most notably the use couragement and support, began some 30 years ago. The of helical HRCT and dose-reduction techniques. We hope photograph of the three of us below was taken by a local the reader will find these changes and updates helpful. resident at the 1989 Diagnostic Course in Davos, on a walk As is our wont, we have reorganized our discussions into we took on the promenade above the Sweitzerhof on the new sections and chapters, which we feel best presents the day of our arrival, when as junior faculty, we were more most important topics in HRCT diagnosis for reference than a little anxious about teaching along with such im- and learning. portant and impressive chest radiologists as Fraser, Felson, A new section has been added at the end of the book Greenspan, Milne, Flowers, Heitzman, and many others. to provide a general review of HRCT, including an illus- trated glossary of HRCT terms and a chapter providing a compilation of the common and typical appearances of the most common diffuse lung diseases encountered in clinical practice. These sections are intended to provide an illustrated index to the detailed descriptions of dis- eases found elsewhere in the book. It is with a great deal of pride that we complete our fifth edition of this book, which has occupied so much of our thoughts, efforts, and time over the years. This task is accomplished in the hope that this book will encour- age future generations of thoracic imagers to develop mutually productive relationships with friends and col- leagues, in order to explore important questions in our At this meeting, we each spoke about the use of HRCT, understanding of the role of imaging in the assessment of which, at the time, was a little-known technique that thoracic disease. was regarded with skepticism by many radiologists. We To this end, we acknowledge the contributions of three learned from each other as we spoke, compared slides esteemed colleagues, our former fellows, who have au- in the speaker-ready room, and gained confidence from thored parts of this book. Their efforts have greatly in- our shared opinions. At this meeting, we began thinking spired our own enthusiasm for the considerable task of about a collaboration that would combine our experience bringing this edition to fruition. and thoughts about this new modality and its potential uses. Our first edition of this book was published in late W. RichaRd Webb NestoR L. MüLLeR 1991, with a grand total of 159 pages. It was a quarter david P. Naidich ix #152201 Cust: LWW Au: Webb Pg. No. ix CMYK S4cDESaIGNr SERlVICiESS OlF e Title: High-Resolution CT of the Lung 5ed Server: Short / Normal/Long Publishing Services
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