0:01

So here's a nice case where the pulmonary fibrosis is

0:03

really not that floored.

0:04

So clearly peripheral and basal predominant.

0:08

There wasn't much in the upper lobes,

0:11

especially in the A lung AEs.

0:12

But here we start to see some mild reticulation

0:16

and some mild traction bronchiectasis as well.

0:19

Maybe a little hard to see.

0:21

They pointed out there's, there's always,

0:22

sometimes there's motion

0:23

here, but you just gotta read through it.

0:25

But these, so these small cysts here, like for example,

0:27

right in there, really in the outer, say two centimeters of,

0:31

of lung, you really shouldn't see any airways.

0:33

So this is a small little cystic thing

0:35

superimposed reticulation.

0:36

That's an area of traction bronchiectasis.

0:39

And so that tells us that clearly there is some mild

0:42

fibrosis in this patient with this reticular abnormality.

0:46

But why am I showing this, this very boring case?

0:49

Um, I'm showing to you

0:50

because as a radiologist you gotta look at everything.

0:54

And so one of the things

0:55

that we gonna look at are gonna be the soft tissue windows.

0:58

And so if we look carefully, we're gonna see a lot

1:01

of these plural plaques.

1:04

And so if I was just looking at the CT in terms

1:06

of lung parenchyma, I might've called this an

1:08

indeterminant for UIP pattern.

1:10

It's just, it's just not that severe enough for me

1:12

to be confident what's going on.

1:14

But now that we see clearly these asbestos related pleural

1:18

plaques bilaterally, which, so just to remember, just

1:21

as a reminder, uh, these

1:23

almost always will spare the lung AEs.

1:25

How there, see how there are no plaques up here.

1:27

And if we go down the Coran angle,

1:29

they all always will spare the claran angle as well

1:32

to go down the Coran engles here.

1:33

There's none down here, no plaques.

1:35

There are no plaques in the Coran angles.

1:37

I don't know why that happens. But yeah,

1:38

the pleural plaques, they don't involve those areas.

1:40

So if you see pleural abnormality,

1:43

even if it's calcified extending into the cos, Frank Angles

1:45

or lung AEs, you start

1:47

to think about other alternative diagnosis too.

1:49

Asbestos related pleural disease.

1:51

But in this case we have classic asbestos related pleural

1:53

disease, these beautiful calcified plaques bilaterally

1:56

symmetric with mild fibrosis, this case of asbestosis.

2:00

The tiny wrinkle here is

2:01

that this patient also has some mild

2:04

dendri formm pulmonary ossification.

2:06

I don't know if you guys noticed that

2:07

initially, but it's bilateral.

2:09

So these areas, so these are not plaques, right?

2:11

These are actually within the lung parenchyma.

2:13

So how that hyperdense

2:15

and they are branching in terms of the morphology,

2:18

if we put it into our lung window here.

2:22

Harder to see the hyper density,

2:25

but I think it's easier to see the branching morphology

2:28

of these areas of dendri formm pulmonary ossification.

2:32

And so what is dendri formm pulmonary ossification?

2:35

So it's probably, so no one really knows for sure,

2:38

but it's probably a response to chronic lung inflammation.

2:43

We see it very commonly in pulmonary fibrosis.

2:45

So we see it in UIP idiopathic pulmonary fibrosis.

2:48

We can even see in a connective tissue disease.

2:50

It's I think most strongly described the setting

2:53

of systemic sclerosis.

2:54

We tend not to see in a fibrotic hp,

2:56

there's some sparse data on that, but classic

2:58

Fibrotic HP cases, I don't know why,

3:00

but we don't see it as much.

3:02

And then the other thing that sometimes we'll see is even

3:04

outside of patients with pulmonary fibrosis,

3:06

just sometimes you'll see isolated

3:08

and driven form pulmonary ossification in patients

3:11

who have chronic recurrent aspiration.

3:13

And there's some modest data which supports that

3:15

as a theory.