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Organizing pneumonia (OP) is a nonspecific lung parenchymal response to any form of injury, with its idiopathic variant coined as cryptogenic organizing pneumonia (COP). The hallmark pathological features are presence of polypoid granulation tissue, or Masson bodies, in the alveolar spaces, with lung architecture preserved in most patients with good clinical outcomes poststeroid treatment. Clinically, patients exhibit signs and symptoms of subclinical or subacute infection that do not respond to antibiotics. Computed Tomography (CT) plays a vital role in establishing the diagnosis, monitoring of OP, and for better understanding of its imaging phenotypes which are crucial for clinical decision making. This article highlights the 3 main imaging patterns of OP on CT, the classic, nodular and fibrotic forms. Identifying these diverse imaging features holds the key for precise diagnosis of OP.
Aortopulmonary shared sheath hematoma is a rare complication of acute aortic syndromes and can occur in the setting of focal rupture of the ascending aortic wall into the common aortopulmonary adventitia. It has been described in the setting of ascending aortic dissection, intramural hematoma, or ruptured aortic aneurysm. Aortic wall rupture into this shared space leads to a hematoma that can extend along the pulmonary arteries and result in extraluminal compression and narrowing of the pulmonary arteries. It is essential for radiologists to recognize the imaging features of aortopulmonary shared sheath hematoma to promptly alert the clinical team, to ensure accurate diagnosis, and to guide urgent management.
Hydrocephalus is defined by abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles, resulting in ventriculomegaly with variable effects on intracranial pressure. Historically classified as obstructive or communicating, contemporary frameworks further categorize hydrocephalus by chronicity, age of onset, and etiology, particularly distinguishing idiopathic from secondary causes in adults. Hydrocephalus most commonly arises from impaired CSF circulation or absorption, with less frequent contribution from altered CSF production. Increasing attention has been directed toward alternative CSF clearance mechanisms, including the glymphatic system, which remain incompletely defined. Radiologic evaluation is central to the diagnosis and management of hydrocephalus, enabling accurate assessment of ventricular morphology, associated parenchymal changes, and potential underlying etiologies. Normal pressure hydrocephalus, a chronic communicating hydrocephalus of older adults, is characterized by a clinical triad of gait disturbance, cognitive decline, and urinary dysfunction. Conventional structural and advanced imaging markers may assist in diagnosis, prognostication, and selection of patients for CSF diversion, in conjunction with clinical assessment. This review summarizes fundamental physiologic concepts of CSF dynamics and imaging features of hydrocephalus, with particular emphasis on imaging in normal pressure hydrocephalus.
Cystic lung diseases represent a heterogeneous group of conditions characterized by the presence of multiple pulmonary cysts. Accurate recognition and differentiation of true cysts from their mimics (such as cavities, emphysema, bullae, blebs, and honeycombing) are essential, as management strategies and prognoses vary significantly. This review provides a systematic approach to the radiologic evaluation of cystic lung diseases, beginning with the definition and pathogenesis of pulmonary cysts and progressing through a structured diagnostic algorithm. We detail the characteristic imaging findings and clinical associations for major cystic lung diseases, including lymphangioleiomyomatosis (LAM), Birt-Hogg-Dubé syndrome (BHD), light-chain deposition disease (LCDD), lymphocytic interstitial pneumonia (LIP), desquamative interstitial pneumonia (DIP), pulmonary Langerhans cell histiocytosis (PLCH), and amyloidosis. Additionally, we discuss uncommon etiologies, such as cystic metastases, hypersensitivity pneumonitis, and cystic changes associated with genetic syndromes like neurofibromatosis type 1 (NF-1) and trisomy 21. The review emphasizes key imaging clues, such as cyst distribution, wall characteristics, associated nodules, and parenchymal abnormalities, that aid in narrowing the differential diagnosis. With the growing use of CT imaging, cystic lung diseases are increasingly identified in both symptomatic and asymptomatic patients. Familiarity with their imaging patterns, clinical contexts, and distinguishing features is essential for radiologists and clinicians alike. By following a stepwise, pattern-based approach, early and accurate diagnosis can be achieved, potentially improving patient outcomes through timely surveillance and targeted management.
Rapid MRI protocols are increasingly used in pediatric emergency imaging, providing fast, high-quality images without ionizing radiation, intravenous contrast, or sedation. These focused exams, using limited, optimized sequences, maintain diagnostic accuracy and can enhance patient flow in emergency settings. It is essential for radiologists to be familiar with key MR imaging findings of both common and rare pediatric emergency conditions, such as appendicitis, ovarian torsion, osteomyelitis, and childhood stroke. This article reviews the clinical indications and protocols for various rapid MRI exams and includes a case-based review of high-yield diagnoses.
Computed tomography (CT) perfusion has become a cornerstone of acute ischemic stroke imaging, extending treatment eligibility beyond conventional time windows and enabling individualized, tissue-based decision-making. Despite its widespread adoption, CT perfusion interpretation remains susceptible to technical, physiologic, and workflow-related pitfalls, which can significantly impact clinical management. Awareness of these pitfalls is essential to guide subsequent management decisions and to avoid inappropriate inclusion or exclusion of patients from endovascular therapy.
Despite overwhelming data detailing the harm of cigarette use, nearly 1.25 billion people worldwide continue to smoke. Amongst the myriad afflictions associated with cigarette use, smoking related interstitial lung disease is a common and likely underrecognized entity given the overlap and lack of consensus in clinical, pathological, and radiological diagnosis. Many characteristic patterns of disease have been identified on diagnostic chest imaging, and using a pattern-based approach to radiologic diagnosis can improve diagnostic accuracy. Several discrete disease processes are categorized as smoking related interstitial lung disease and range from a potentially reversible desquamative interstitial pneumonia/alveolar macrophage pneumonia, to chronic and insidious onset idiopathic pulmonary fibrosis with high morbidity and mortality. This article reviews the common clinical findings and demographics associated with patient presentation, histopathological findings for each of the smoking related interstitial lung diseases upon tissue sampling or biopsy and suggests a pattern-based approach to radiologic diagnosis.
Lymphatic disease results from abnormal perfusion of lymph to various compartments such as the peritoneum, duodenum and the pleural space. However, this often occurs concurrently with congenital heart disease, especially single ventricle congenital heart disease. By understating the physiologic principles of the lymphatic and circulatory system and how this can be impacted by congenital heart disease, one can appreciate the pathophysiology of lymphatic disease in the setting of congenital heart disease.
The lymphatic system is a crucial component of human physiology, maintaining fluid homeostasis, supporting immune surveillance, and transporting macronutrients from the gastrointestinal tract. Disorders of lymphatic conduction-whether congenital or acquired-can result in debilitating complications including chylothorax, protein-losing enteropathy, plastic bronchitis, and generalized anasarca. Advances in imaging and percutaneous interventions have brought great progress in management of these conditions, offering less invasive, targeted approaches with improved outcomes. This review provides a discussion of lymphatic anatomy and physiology, classification of flow disorders, imaging modalities, and the technical execution of percutaneous lymphatic interventions. It then highlights disease-specific approaches, with attention to recent innovations in embolization techniques.
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Acquired pulmonary venous disease is predominantly detected on postablation imaging for atrial fibrillation, but may also be encountered incidentally or during evaluation for acute cardiopulmonary events. These entities require a high index of suspicion, as they involve subtle findings in an often-overlooked region. Moreover, recognition of associated findings may be particularly difficult on nongated imaging, which is prone to artifacts. Cardiac-gated CT and magnetic resonance imaging remain the primary imaging modalities, though echocardiography and diagnostic catheterization may contribute to the diagnosis in select cases. This review outlines key acquired pulmonary venous abnormalities, including pulmonary vein stenosis, pulmonary vein thrombosis, tumor invasion of the pulmonary vein, and intrapulmonary venous collateralization ("meandering pulmonary vein"). For each, we review relevant pathophysiology, imaging features, and clinical implications. The objective is to highlight key imaging features and potential challenges to avoid misdiagnosis and guide appropriate management across clinical scenarios.
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Pulmonary alveolar proteinosis (PAP) is a rare airspace disease classically associated with the crazy-paving pattern on high-resolution computed tomography (HRCT). While highly suggestive, this imaging pattern is not pathognomonic and appears across a wide spectrum of pulmonary pathologies. In this review, we adopt a phenotype-first approach, using representative imaging cases to walk the reader through the differential diagnosis of crazy-paving, with attention to radiologic distribution, clinical context, and disease acuity. We emphasize distinguishing features between PAP and its mimics-including pulmonary edema, diffuse alveolar hemorrhage, organizing pneumonia, mucinous adenocarcinoma, exogenous lipoid pneumonia, acute fulminant PAP, and COVID-19 pneumonia-using side-by-side imaging and contextual pearls. Special attention is given to the radiologic clues favoring autoimmune versus secondary PAP, including geographic distribution of ground-glass opacities, subpleural sparing, and lower lobe predominance. The review concludes with a summary of diagnostic strategies, pathologic correlation, and treatment options, including insights from post-pandemic diagnostic pitfalls. This pattern-based framework is designed for the radiologist and serves as a practical guide for recognizing PAP within the broader spectrum of airspace diseases.
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Interstitial lung abnormalities (ILA) refer to incidental changes seen on chest CT, usually in people without a formal diagnosis of interstitial lung disease (ILD). Interest in ILA has grown in recent years, partly because they may signal early fibrotic lung changes and partly because CT scans are being used more often for screening. Defined by the Fleischner Society and updated by the ATS, ILA encompasses 3 patterns: nonsubpleural, subpleural nonfibrotic, and subpleural fibrotic. Subpleural fibrotic ILA, marked by traction bronchiectasis and honeycombing, carries the greatest likelihood of progression and the poorest prognosis. Older age, smoking history, and certain genetic traits such as the MUC5B promoter variant increase the likelihood of finding ILA. The presence of ILA also appears to raise the risk of lung cancer. For management, current guidelines recommend tailoring follow-up based on individual risk, with closer surveillance for patients more likely to progress. Newer tools, including quantitative imaging and artificial intelligence, may help detect subtle disease earlier and refine risk assessment. Despite advances, challenges remain in defining progression thresholds and treatment strategies, highlighting the need for further research.
Recognizing characteristic traits, or phenotypes, of Autoimmune-Associated Interstitial Lung Disease (AA-ILD) on HRCT imaging assists in diagnosis, prognosis, treatment decisions and imaging surveillance. The primary AA-ILD imaging phenotypes considered include pulmonary parenchymal patterns, extrapulmonary associated findings, clinical context and change over time. Focusing on the imaging appearance of the major interstitial pneumonia patterns by histopathologic categories, the localized imaging features defined by the secondary pulmonary lobule, and the growing list of sub-patterns or imaging signs, we begin to bridge the gap between the strictly defined categories studied in the literature with the often vague "feel" of AA-ILD imaging in clinical practice. Furthermore, this review explores the current and future applications of automated CT assessment in AA-ILD imaging phenotypes.
Neurodegenerative disorders have traditionally been classified according to clinical syndromes or patterns of anatomical involvement on neuroimaging. However, growing evidence demonstrates that similar clinical phenotypes may arise from distinct molecular pathologies, while a single pathogenic protein may manifest with diverse clinical and imaging presentations. This has led to the emergence of the proteinopathy paradigm, which conceptualizes neurodegeneration as a disorder of protein misfolding, aggregation, and consequent pathologic changes. This review provides an imaging-focused overview of the major central nervous system proteinopathies, including prion diseases, amyloid-β-related disorders, tauopathies, synucleinopathies, and TAR DNA-binding protein 43-associated diseases. We discuss the presence of distinct and often predictable radiological phenotypes in these conditions, which can help in diagnosis, predict clinical progression, and explain clinical phenotype. Conventional magnetic resonance imaging remains central to structural pattern recognition, while advanced techniques such as diffusion-weighted imaging, susceptibility-weighted imaging, perfusion imaging, and quantitative volumetry may enhance diagnostic confidence. Molecular imaging with fluorodeoxyglucose positron emission tomography and emerging amyloid and tau tracers further enables in vivo characterization of disease-specific metabolic and molecular signatures. By integrating molecular mechanisms with imaging findings, this review highlights the role of neuroimaging as a bridge between microscopic protein pathology and macroscopic disease expression. Understanding proteinopathy-specific imaging patterns allows a shift from symptom-led diagnosis toward a biology-driven framework, improving diagnostic accuracy, prognostication, and the potential for targeted therapeutic monitoring in neurodegenerative disease.
Within the overarching diagnosis of lymphatic anomalies, the subgroup of complex lymphatic anomalies (CLAs) has classically been comprised of 4 entities which are characterized by multisystem involvement, structural complexity, and functional impairment of the lymphatic system. The 4 subtypes generalized lymphatic anomaly, kaposiform lymphangiomatosis, Gorham-Stout disease, and central conducting lymphatic anomaly, share overlapping characteristics which can make differentiating between them a challenge. Recently, a fifth subtype, generalized lymphatic dysplasia, has been defined as a separate classification. CLAs may contribute to significant morbidity for affected patients, and a multidisciplinary approach is critical to optimize treatment approaches. From a diagnostic perspective, it is imperative that readers interpreting those images for patients with CLAs are aware of various manifestations of the different subtypes, and that the readers have a strong understanding of follow-up imaging recommendations when needed. In conjunction, the utility of images to guide intervention continues to grow, and maintaining an updated perspective on the diagnostician's role is critical to facilitating excellent patient care. We aim to provide an overview of current practices and approaches to further the readers' knowledge base on CLAs.