Thoracic

Reprinted with permission from the Fleischner Society and Radiology

John H. M. Austin,
David
P. Naidich,

MD
MD

#{149}
Nestor

L. Muller,
Remy-Jardin,

#{149}
Martine

Glossary
ofTerms
Recommendations
Committee
ofthe

the Nomenclature
tee of the Fleischner
sented
the Glossary
of
Thoracic
Radiology
(1).
covers
mainly
the terms

CommitSociety
preTerms
for
That glossary
used in the

N 1984,

interpretation

of chest

examinations.
In 1991,
Naidich

Drs

radiographic

Webb,

offered

an

Muller,

and

introductory

sary of the vocabulary

computed
tomography
book,
High-Resolution
(2), and updated
that

MD,

PhD
MD

#{149}
Paul
#{149}
W.

J.

Richard

Friedman,
Webb,

MD
MD

GLOSSARY
air crescent
Air in a crescentic
shape
in a nodule
or mass, in which
the air separates
the
outer
wall of the lesion from an inner
sequestrum,
which
most commonly
is
a fungus
ball of Aspergillus
species
(5-7).

contributions
as a base, now
a considerably
expanded
glossary.
Our intent
is to list, define,
and
provide
references
for the main terms
used in chest CT that are specific
to
the lungs.
HRCT
is used to indicate
high-resolution
computed
tomography

pulmonary

(3). The

present

committee,

in 1993
by

using

those
offers

Use

(2-4).
of words

is inherently

versial.
We are pleased
ers to offer improvements
nitions.
Index

terms:

Computed

contro-

to invite
readto our defi-

tomography

Lung,

parenchyma,

especially

manifest
as less than normal
increase
in attenuation
during
expiration
(810). To be differentiated
from the decreased
attenuation
of hypoperfusion
secondary
to locally
increased
pulmonary
arterial
resistance.

CT

architectural
Radiology

1996;

From

200:327-331

the Department

of Radiology,

Colum-

bia-Presbytenian
Medical
Center,
622 W 168th
St. New York, NY 10032-3784
(J.H.M.A.);
Department
of Radiology,
University
of British Co-

lumbia
ences

and Vancouver
Centre,

Radiology,
School

Hospital

Canada

(N.L.M.);

and Health

Sd-

Department

of

University

of California
San Diego,
Department
of RaRoyal Brompton
National Heart and

of Medicine

diology,

England
(D.M.H.);
New York University

De-

Medical Center, NY (D.P.N.); Department

of Radiology, H#{244}pita!
Calmette,
Lille, France (M.R.J.);
Department
of Radiology,
University
of California San

Francisco,

Department
University

School

of Radiology,
School

of Medicine

The Johns

of Medicine,

RSNA,

1996

(W.R.W.);

Hopkins

Baltimore,
Md
10, 1995; revision
revision
received

(E.AZ.). Received November

requested
February
12, 1996;
March 18; accepted
April 26. Address
requests
toJ.H.M.A.
C

distortion

A manifestation
of lung disease
in
which
bronchi,
pulmonary
vessels,
a
fissure
or fissures,
or septa of secondary pulmonary
lobules
are abnormally displaced
(11-15).
band
See parenchymal

reprint

bronchiolectasis
1

Pathology.-

septum

sign

Irregular
septa!
thickening
that
suggests
the appearance
of a row of
beads;
usually
a sign of lymphangitic
carcinomatosis
(16), but may also occur rarely
in sarcoidosis
(12,17). Because the thickening
usually
is more
irregular
than beaded,
the term irregular
septal
thickening
generally
is
preferred.

of a bron-

bulla
1. Pathology.-A
sharply
demarcated,
dilated
air space that measures
1 cm or more in diameter
and possesses
a thin epithelialized
wall, which
is usually
no greater
than 1 mm in
thickness.
See also bullous
emphysema,
emphysema,
and paraseptal emphysema.
2. CT.A round,
focal air space,
1
cm or more
in diameter,
demarcated
by a thin wall; usually
multiple
or associated
with other
signs of pulmonary emphysema.
bullous

beaded

Dilatation

chiole
or bronchioles,
often with thickening
of the bronchiolar
wall (23).
2. CT.Bronchiolar
dilatation
(13,14,23).
See also traction
bronchiolectasis.

band.

(P.J.F.);

Lung
Hospital,
London,
pantment
of Radiology,

1 Pathology.-Irreversible
dilatation of a bronchus
or bronchi,
often
with thickening
of the bronchial
wall
(18,19).
When
mild, the dilatation
is
cylindric
(ie, normal
bronchial
tapering is absent).
When
more severe,
the
dilatation
is saccular,
and irregular
constrictions
may be present.
When
very severe,
the bronchi
may be markedly dilated,
especially
distally
(10,18,20).
See also traction
bronchiectasis.
2. CT.-Bronchial
dilatation,
often
with thickening
of the wall (19-22).
.

1 Pathophysiology.-The
retention
of excess
gas (air)
in all or part of
the lung, especia!ly
during
expiration,
either
as a result
of complete
or partial airway
obstruction
or as a result
of
local abnormalities
in pulmonary
compliance.
Although
not in common
usage, the term gas trapping
is more
accurate.
2. CT.-Decreased
attenuation
of

glossary

MB
MD

bronchiectasis

air trapping

CT of the Lung

M. Hansell,
A. Zerhouni,

for CT ofthe
Lungs:
ofthe
Nomenclature
Fleischner
Society

glos-

of thin-section
(CT) in their

#{149}
David
#{149}
Elias

Radiology

emphysema

Emphysema
characterized
by the
presence
of bullae.
See emphysema.
centriacinar

emphysema

See centrilobular

emphysema.

centrilobular
Referring
chioloartenolar

to the region
of the broncore of a secondary
327

pulmonary
structures.

lobule.

centrilobular

See centrilobular

sis (31-33)
and sarcoidosis
(12,32),
also in Langerhans
cell histiocytosis
(32-34)
and lymphangiomyomatosis
(32,33,35).
See bulla,
cystic
air
space,
and honeycomb
cysts.

emphysema

I Pathology.-Emphysema
that is
characterized
by destroyed
centrilobular alveolar
septa and enlargement
of respiratory
bronchioles
(24-26).
Usually
in the upper
lung zones
of

and

cigarette

smokers.

2. CT.-Centrilobular
decreased
attenuation,
usually
without
visible
walls, of nonuniform
distribution,
and
predominantly
located
in upper
lung
zones
(25,26).
Synonym:
centriacinar
emphysema.
centrilobular

central

in a secondary

branches

artery
artery

and
and

in a secondary

consolidation
1
Pathology.-Transudate,
exudate,
or tissue replacing
alveolar
air (1).
2. CT-Homogeneous
increase
in
pulmonary
parenchymal
attenuation
that obscures
the margins
of vessels
and airway
walls (30). An air bronchogram may be present.
.

centrilobular

structures.

cyst
1. Pathology.-A
round,
circumscribed
space that is surrounded
by
an epithelial
or fibrous
wall of thickness,
which
may be uniform
or varied,
and that in the lung usually
contains
air but may contain
liquid,
semisolid,
or solid material
(31).
2. CT-A
round,
parenchymal
space with a well-defined
wall; usually air-containing
when
in the lung
but without
associated
pulmonary
emphysema;
commonly
used to describe enlarged
air spaces
in end-stage
fibrosis
of idiopathic
pulmonary
fibro-

328

#{149}
Radiology

(35),

or

may be thick as in idiopathic

pulmonary fibrosis
(31-33).
See bulla,
cyst,
and honeycomb
cysts.

A masslike
collection
of intertwined
hyphae,
usually
Aspergillus
species,
matted
together
by mucus,
fibrin, and
cellular
debris
and colonizing
a pulmonary
cavity
caused
by prior disease
(eg, sarcoidosis).
May move to a dependent
location
when
the patient
changes
position.
At CT, may show a
spongework
pattern,
including
foci
of high attenuation
(41). Synonym:
mycetoma.
gas

trapping
See air

dependent

increased

dependent

trapping.

attenuation
opacity.

ground-glass

attenuation

Subpleural
increased
attenuation
in
dependent
lung. The increased
attenuation
disappears
when
the region
of
lung is nondependent.
May also appear as a subpleural
line.
distal
I

acinar

emphysema

characby predominant
involvement
of alveolar
ducts and sacs, characteristically in subpleural
lung and adjacent to interlobular
septa
and vessels
.

opacity.

opacity

Pathology.-Emphysema

terized

ground-glass

opacity

Hazy increased
attenuation
of lung,
but with preservation
of bronchial
and vascular
margins;
caused
by partial filling of air spaces,
interstitial
thickening,
partial
collapse
of alveoli,
normal
expiration,
or increased
capillary blood
volume
(14,15,30,42,43).
Not

to be

confused

with

consolida-

tion,
in which
bronchovascular
margins are obscured.
May be associated
with an air bronchogram
(43).

(24,26).

2. CT-Emphysema
characterized
by subpleural
regions
of low attenuation or bullae
separated
by intact
interlobular
septa
(24,26).
Synonym:
paraseptal
emphysema.
distortion

See architectural

distortion.

emphysema

1 Pathology.-Permanently
enlarged
air spaces
distal to the terminal
bronchiole,
accompanied
by destroyed
alveolar
walls (24,26).
Absence
of obvious fibrosis
historically
has been
regarded
as an additional
criterion
(24), but the validity
of that criterion
recently
has been called
into question
(36,37).

2. CT-Focal
region
or regions
of
low attenuation,
usually
without
visible walls, resulting
from actual
or
perceived
enlarged
air spaces
and
destroyed
alveolar
walls (24,29,38,39).
May be associated
with air trapping
(40). See also bulla,
bullous
emphysema,
centrilobular
emphysema,
cyst,

cystic

air

space,

distal

halo

sign

Ground-glass
the circumference
(7,44).
May
pergillosis
ous causes

honeycomb

structures

See

as in lymphangiomyomatosis

dependent

lobule;
these arteries
measure
approximately
I mm and 0.5-0.7
mm in diameter,
respectively;
HRCT
depicts
these vessels
(29). However,
a normal
bronchiole
supplying
a secondary
lobule
has a wall thickness
of approximately
0.15 mm, which
is beyond
the
resolution
of HRCT.
Therefore,
norma! airways
in secondary
pulmonary
lobules
are not detected
at CT examination
(29).

core

Enlarged
unit of peripheral
air-contaming
lung, surrounded
by a wall of
variable
thickness,
which
may be thin

ball

See ground-glass

tubular
pulmonary

lobule
(ie, the centrilobular
bronchiole)
(27,28).
2. CT.-The
pulmonary
its immediate

air space

See

structures

1. Anatomy.-The
structures

cystic

fungus

aci-

nar emphysema,
panlobular
emphysema,
and paraseptal
emphysema.

opacity
surrounding
of a nodule
or mass

be a sign of invasive
as(7) or hemorrhage
of van(44).

cysts

Cystic
air spaces,
usually
of comparable diameter
and on the order
of
0.3-1.0
cm in diameter,
formed
by the
honeycombing
of interstitial
pulmonary fibrosis
(29,31,33).
honeycombing
I Pathology.-Destroyed,
fibrotic,
and cystic lung, representing
complete loss of acinar
and bronchiolar
architecture
as the end stage of fibresing lung disease
(31-33,45).
2. CT-Clustered
cystic air spaces,
usually
of comparable
diameters
on
the order
of 0.3-1.0
cm but as much
as
2.5 cm, usually
subpleural
and charactenized
by well-defined
walls, which
are often thick (29,31-33,45).
A CT
feature
of diffuse
pulmonary
fibrosis.
A diagnostic
pitfall is that, in the presence of underlying
pulmonary
em.

August

1996

physema,
air-space
consolidation
mimic
this appearance.

interlobular
See

septal

septal

can

thickening

lines

Fine linear
opacities
present
in a
lobule
when
the intralobular
interstitium is thickened.
When
numerous,
they

may

appear

as a fine

differences

(3). A more

inclusive

in perfusion
term

than

parenchymal
the

originally
described
mosaic
oligemia (48). Air trapping
secondary
to
bronchial
or bronchiolar
obstruction
may also produce
focal zones
of decreased
attenuation,
an appearance
that can be enhanced
by using expiratory
CT (8-10).

line.

intralobular

to regional

reticular

mycetoma
See fungus

ball.

nodule
irregular
Any
thickness

linear
linear

opacity
opacity

of 1-3

mm,

distinct

spherical,
from

interlobular
septa,
bronchovascular
bundles,
and nodular
opacities
(12).
May be intralobular
or extend
through
several
adjacent
secondary
lobules.
linear

opacity

An elongated,
thin line of soft-tissue attenuation.
Rarely,
calcification
or foreign
material
may increase
the
attenuation.
See also irregular
linear
opacity
and subpleural
line.

opacity

approximately
focus
of ab-

circumscribed

normal
tissue.
2. Radiology.-Round
opacity,
at
least moderately
well marginated
and
no greater
than 3 cm in maximum
diameter.
Some authors
use the modifier small
if the maximum
diameter
of the opacity
is less than 1 cm (46).
See also micronodule.

opacification
See parenchymal

Referring

within
surface.

core

structures

pleural

An irregular
band
of peripheral
pulmonary
opacity
adjacent
to visceral pleura
that simulates
the appearance
of a pleural
plaque
and is
formed
by the coalescence
of small
nodules
(eg, in coal-workers
pneumoconiosis)
(17).

opacification.
pattern

emphysema
See reticulation.

structures

See centrilobular

to pulmonary

1-2 cm of any visceral

See also subpleural.

pseudoplaque

reticular

panacinar
lobular

is preferred.

peripheral

1. Pathology.-Small,

of irregular

Increase
in pulmonary
attenuation
that may or may not obscure
the margins of vessels
and airway
walls. Consolidation
indicates
that definition
of
these margins
(excepting
air bronchograms)
is lost, whereas
ground-glass
opacity
indicates
a lesser increase
in
attenuation,
in which
definition
of the
margins
is preserved
(14,30,43).
Whenever possible,
use of the more specific
terms
consolidation
or groundglass

pattern.

opacification

See panlobular

emphysema.

structures.
reticulation

panlobular
lobule
1

See secondary

pulmonary

lobule.

micronodule
Discrete,
small, round,
focal opacity
of at least soft-tissue
attenuation
and
with a diameter
no greater
than 7 mm
(17,42).
Some authors
have limited
use
of this term to a diameter
of less than
5 mm (13) or less than 3 mm (8,11).
Other
authors
simply
use the term
small
nodule
(46). See nodule.

midlung

window

A midlung
region,
characterized
by
the absence
of large blood
vessels
and
by a paucity
of small blood
vessels,
that corresponds
to the minor
fissure
and adjacent
peripheral
lung (47).

mosaic

oligemia

See mosaic
mosaic

perfusion

A patchwork
attenuation,

Volume

perfusion.

200

of regions
interpreted
#{149}
Number

of varied
as secondary

emphysema
that

Pathology.-Emphysema

involves,

more

portions

of the

or less uniformly,
all
secondary
lobules
(24).
It tends
to predominate
in the lower
lobes and is the form of emphysema
associated
with hereditary
a1-protease
inhibitor
(a1-antitrypsin)
deficiency.
2. CT.-Emphysema
that tends
to
show rather
uniformly
decreased
parenchymal
attenuation
and a paucity
of vessels
(39). Severe
panlobular
emphysema
may be indistinguishable
from severe
centnlobular
emphysema,
except on the basis of zonal distribution.
Synonym:
panacinar
emphysema.

paraseptal
See distal

emphysema
acinar

parenchymal

band

Elongated
millimeters

opacity,
wide and

emphysema.

usually
several
up to about
5-cm long,
often
extending
to the
pleura,
which
may be thickened
and
retracted
at the site of contact
(49).
Originally
described
in asbestosis
(49)
but also a sign of focal fibrosis
of nonspecific
cause.

Innumerable,
interlacing
line shadows that suggest
a mesh.
A descniptive term usually
associated
with interstitial
lung diseases.
May be fine,
intermediate,
or coarse.
Synonym:
reticular
pattern.

secondary

pulmonary

1. Anatomy.-The
lung surrounded
septa,
according

Heitzman

lobule

smallest
unit of
by connective
tissue
to Miller
(27) and

et a! (28).

These

septa,

known
as interlobular
septa,
are best
developed
in the periphery
of the
anterior,
lateral,
and juxtamediastinal
regions
of the upper
and middle
lobes,
and in the periphery
of the anterior
and diaphragmatic
regions
of the
lower
lobes (28,29,50).
The septa
tend
to be incompletely
developed
or absent elsewhere
in the lungs.
Millers
lobule
ranges
in size from 0.5 to 3.0
cm and may contain
3-20 acini (51).
2. Anatomy.-The
unit of lung subtended
by any bronchiole
that gives
off three to five terminal
bronchioles,
according
to Reid (52). Connective
tissue septa
are not part of this definition. A small Millers
lobule
(0.5 cm)
corresponds
to a Reids lobule.
Radiology

#{149}
329

3. CT.-Millers
ondary

lobule

CT (51).

lobule
is the
is identified

that

See also

centrilobular

budding
tree and represents
tive bronchiolar
dilatation

secwith

bronchiolitis

stnuc-

[23]

spread

hires.

losis

pulmonary

structures.

septal

See

septal

to

thickening.

1.

2.

sign

A ring of opacity
(usually
representing
a dilated,
thick-walled
bronchus)
in association
with a smaller,
round,
soft-tissue
opacity
(the adjacent pulmonary
artery
or, rarely,
dilated bronchial
artery)
suggesting
a
signet
ring
(22). Usually
this finding
indicates
bronchiectasis,
but it may
also occur in multifocal
bronchioloalveolar
carcinoma
and metastatic
adenocarcinoma
(22).

4.

5.

18.

structures
visceral
pleura.

8.

10.

bronchiectasis

interpreted

as representing

pulmonary

fibrosis

12.

13.

retractile

AJR

Bronchiolar
dilatation
tion with peribronchiolar
tion that is interpreted
ing retractile
pulmonary

14.

in associaopacificaas representfibrosis
(14).

15.

of centrilobular
that resembles

21.

and

utility
of the
1985; 157:605-

JE, Fishman
EK, Siegelman
Invasive pulmonary
aspergil!osis
in acute
leukemia:
characteristic
findings on CT, the
CT halo sign, and the role of CT in early

Zerhouni

Radiology

EA, Naidich

Siegelman

55.

1985;

23.

24.

27.
28.

DP, Stitik FP, Khouri

tomogra-

II. In1985;
29.

30.

Hansell DM, Wells AU, Rubens MB, Cole

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31.

bird

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DM.
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1993;

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injury
score.

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34.

35.

McGuinness

G, Naidich

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by

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BS,

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