0:01

All right.

0:01

Now let's talk about diffuse nodular lung disease.

0:05

So if

0:06

after this talk you are better able

0:08

to recognize different patterns

0:09

of diffuse nodular lung disease,

0:11

you can put together differential diagnosis based

0:14

on specific patterns.

0:16

And you'll recall imaging

0:18

or clinical findings, which allow you

0:19

to make a specific diagnosis.

0:21

I feel like it would've been successful.

0:25

So where are we going? We're gonna be talking about

0:26

what the heck is diffuse nodule lung disease?

0:28

What are we really talking about here?

0:30

And then we're gonna be talking about the subcategories.

0:33

The subcategories are very helpful if you can get a case

0:35

of diffuse nodule lung disease

0:37

and then subcategorize based on one of these three patterns,

0:40

you can really narrow the differential diagnosis.

0:43

And sometimes you come down to one specific diagnosis

0:46

and then we'll just wrap up.

0:47

So this is pretty cut and dry.

0:49

We're not talking about indeterminate pulmonary nodule.

0:51

We're not talking about flechner,

0:52

lung rads, any of this kind of stuff.

0:54

Uh, that is not the, in the scope here.

0:57

What we're gonna be talking about are these

0:59

innumerable pulmonary nodules.

1:01

People have stopped me and said, you know,

1:03

innumerable, what does that really mean?

1:05

Because if you really want to

1:06

count them, you could count them.

1:07

Well, for me, I would think so.

1:09

If you would have to count more than 30

1:11

or 40 nodules, to me, that's innumerable.

1:13

You don't want to count them, right?

1:15

And you kind of like know when you see it,

1:17

like there's just too many nodules that count.

1:20

Then you're dealing with a case

1:21

of diffuse nodule lung disease.

1:23

And usually these nodules

1:25

and diffuse nodule lung disease are gonna be smaller,

1:28

usually on a scale of four to five millimeters.

1:30

They can be a little larger sometimes,

1:31

but these are the predominant size of nodules.

1:34

Sometimes can be smaller as well.

1:36

And then not always,

1:38

but the vast majority

1:40

of time diffuse nodular lung disease will be bilateral

1:43

and generally symmetric.

1:44

But sometimes they could be a little bit asymmetric in

1:46

setting of perilymphatic nodularity

1:48

and sub cases of central lobular nodularity

1:52

before actually go into the subtypes

1:54

of diffuse nodule lung disease.

1:56

Let's talk about mips.

1:57

And so I think MIPS

1:58

or maximum intensity projection images,

2:02

these are now standard of care, right?

2:04

If your hospital

2:06

or medical center is not routinely doing mips,

2:08

or if you don't have the ability to create MIPS on the fly,

2:12

you probably should reconsider that.

2:14

MIPS are quite helpful. They can be a variable thickness

2:17

variable overlap, but bottom line, you need to do it

2:19

because it'll help you for diffuse nodule lung disease

2:23

if you don't have an AI

2:24

or a vessel subtraction tool

2:26

to help you identify isolated pulmonary nodules.

2:28

I told, I said I wasn't gonna talk about that,

2:29

but I think I, these,

2:30

these mips are helpful for that as well.

2:33

And given the high number of isolated pulmonary nodules

2:36

that we see on chest ET, if you're not doing mips,

2:39

you're doing yourself a disservice.

2:40

You're just slowing yourself down

2:41

and you're making yourself less accurate.

2:43

So, um, I'll get, get off my high horse, uh, bottom line,

2:47

if you're not doing them, do them again.

2:48

I think that, I'm sure 99%

2:50

of places out there are doing these routinely.

2:54

Example of a regular axo image on the left

2:56

and m image on the right is just so much

2:58

Easier. We see more

2:59

nodules per axial slice

3:02

because there are thick slabs of data in there.

3:05

And then it's easier to define where these nodules are

3:09

relative to the underlying secondary pulmonary lobular

3:11

anatomy and the general anatomy

3:13

of the lung parenchyma in terms of subpleural lung

3:16

and bronchovascular tree.

3:18

So, so much better.

3:19

Just if you're dealing with nodules, look at the mips.

3:22

Obviously these regular actually images are valuable

3:24

as well, but you gotta do both.