Imaging Pearls ❯ Chest ❯ Pulmonary Hemorrhage
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- Pulmonary Hemorrhage CT Findings
Ground-Glass Opacities (GGOs): * This is the most common and earliest finding.
It represents partial filling of the alveoli with blood. On CT, it appears as a hazy increase in lung attenuation where the underlying bronchovascular margins are still visible.
Consolidation: * As alveoli become completely filled with blood, the GGOs progress to dense consolidation.
Unlike GGOs, consolidation completely obscures the underlying pulmonary vessels. Air bronchograms are frequently seen within these areas - Pulmonary Hemorrhage CT Findings
"Crazy-Paving" Pattern: * This occurs when there is a combination of ground-glass opacity with thickened interlobular and intralobular septa.
In acute hemorrhage, this thickening is typically due to fluid or blood filling the interstitium alongside the alveoli.
Centrilobular Nodules: * Ill-defined, small centrilobular nodules may appear if blood pools primarily within the smaller bronchioles and adjacent alveoli. - Pulmonary Hemorrhage Distribution
Diffuse & Bilateral
Widespread involvement, often sparing the extreme lung bases or apices.Diffuse Alveolar Hemorrhage (DAH) due to vasculitis (e.g., Granulomatosis with Polyangiitis, Goodpasture syndrome), systemic lupus erythematosus (SLE), or drug toxicities. - Pulmonary Hemorrhage Distribution
Because the CT features of pulmonary hemorrhage overlap significantly with hydrostatic pulmonary edema, atypical infections (e.g., PCP or viral pneumonias), and alveolar proteinosis, clinical correlation is critical. The rapid clearing of opacities on follow-up imaging (often within days) is highly characteristic of hemorrhage compared to infectious or inflammatory processes.
- Pulmonary Hemorrhage: CT Findings
- Bilateral patchy perihilar infiltrates
- Ground glass centrilobular nodules
- Filling defect in major airways (clot) - Pulmonary Hemorrhage: Causes in Patients with Renal Disease
- Polyarteritis nodosa
- Churg-Strauss syndrome
- Goodpasture syndrome SLE (lupus)
- Henoch Schonlein purpura
- Rheumatoid artritis - Pulmonary Hemorrhage: Causes
- Bleeding diathesis (leukemia, hemophilia)
- Trauma
- Wegeners granulomatosis
- Drugs like amphotericin B and mitomycin
- Infectious disease
- Idiopathic pulmonary hemosiderosis - Wegener Granulomatosis: Facts
- Necrotizing vasculitis that involves small to medium vessels
- May involve ear, nose, throat, lung or kidneys
- Clinical presentation ranges from sinusitis to cough, fever, wheezing to hematuria - Wegener Granulomatosis: Facts
- Upper airways involved in up to 92% of cases, renal in 80% and joints in 67%
- Age at dx usually 40-55 yrs
- M=F but females have airway problems more commonly
- Treatment with steroids and cyclophosphamide - Wegener Granulomatosis: Chest
- Cavitary nodules
- Large airway stenosis
- Nodules 1-10 cm in size
- Consolidation with or w/o hemorrhage
- Subglottic stenosis
- Adenopathy uncommon