Radiology at Harvard Medical School

Contributors and Affiliations

• Lopez, MD, MBA: Assistant Professor of Radiology, Harvard Medical School, Brigham and Women’s Hospital
• Cory Robinson-Weiss, MD: Clinical Fellow in Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School
• Yuntong Ma, MD: Resident in Radiology, Brigham and Women’s Hospital, Harvard Medical School
• Christopher G. Sakellis, MD: Staff Radiologist, Division of Nuclear Medicine, Harvard Medical School
• Fiona E. Malone, MD: Resident in Radiology, Brigham and Women’s Hospital, Harvard Medical School
• Junzi Shi, MD: Clinical Fellow in Musculoskeletal Radiology, Brigham and Women’s Hospital, Harvard Medical School
• Michael L. Steigner: Staff Radiologist, Division of Cardiovascular Imaging, Brigham and Women’s Hospital, Associate Professor of Radiology, Harvard Medical School
• Daniel Souza, MD, MSc: Fellowship Program Director, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women’s Hospital
• Ngoc-Anh T. Tran, MD: Resident in Radiology, Brigham and Women’s Hospital, Harvard Medical School
• Ellen X. Sun, MD: Staff Radiologist, Division of Emergency Radiology, Brigham and Women’s Hospital

Medical Imaging Findings

• Random Nodules on CT:

  • Metastatic colon cancer case presented with multiple random nodules abutting the pleural surface.
  • Differential diagnosis includes hematogenous metastases and disseminated infections.

• Miliary Nodules:

  • Case of miliary tuberculosis displayed innumerable tiny random nodules distributed throughout both lungs.
  • Miliary pattern reflects extensive disease caused by hematogenous spread.

Specific Nodule Patterns

• Tree-in-Bud Nodules:

  • Appears as small nodules "budding" from linear branching structures, indicative of mucus-impacted bronchioles.
  • Associated with small airway infections such as atypical mycobacteria or tuberculosis.

• Cysts in Lungs:

  • Differential for multiple lung cysts includes:
    • Lymphangioleiomyomatosis (LAM), characterized by diffuse, thin-walled cysts.
    • Pulmonary Langerhans cell histiocytosis showing irregular upper lung cysts.
    • Birt-Hogg-Dube syndrome associated with renal and pulmonary cysts.

Pneumonia Complications

• Pulmonary Abscess:

  • Result of necrosis due to bacteria such as Staphylococcus aureus, commonly presenting with an air-fluid level.

• Empyema:

  • Infection in pleural cavity developing through three stages, often requiring surgical intervention in advanced cases.

Types of Pneumonia

• Lobar Pneumonia:

  • Consolidation of a single lobe, commonly bacterial in nature.

• Bronchopneumonia:

  • Patchy consolidation across multiple lobes, caused by various pathogens.

• Interstitial Pneumonia:

  • Misnomer for ground-glass opacities typically induced by atypical pathogens.

• Round Pneumonia:

  • Infectious opacity commonly observed in children, often due to Streptococcus pneumoniae.

Emphysema and Lung Pathology

• Emphysema Characteristics:

  • Involves destruction of alveolar walls leading to abnormal enlargement of airspaces, linked to macrophage activity and excess elastase.

• Centrilobular Emphysema:

  • Predominantly affects upper lobes, largely related to smoking.
  • Emphasizes the role of macrophage-mediated inflammation in lung diseases.

Key Points to Note

• Accurate diagnosis relies on understanding imaging patterns and context of symptoms.
• Differential diagnoses are vital to differentiate conditions with similar radiological appearances.
• The interplay between infections, inflammation, and lung structure (like presence of nodules or cysts) is crucial for clinical evaluation and management.

Explore the training and expertise of Harvard Medical School's radiology professionals. This quiz covers various aspects of radiology education, including the roles of residents and clinical fellows. Test your knowledge on the faculty and the institutions associated with advanced imaging practices.