Chest CT Recognition Pattern

Systematic approach to interpreting chest CT scans using windowing and anatomical landmarks

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1. Essential Window Settings

A. Standard Windows

•

Lung window:
- Level: -600 to -700 HU
- Width: 1000-1500 HU
- Best for parenchyma, airways

•

Mediastinal window:
- Level: 30-50 HU
- Width: 350-400 HU
- Best for soft tissues, vessels

•

Bone window:
- Level: 300-500 HU
- Width: 1500-2000 HU
- Best for osseous structures

B. Special Reconstructions

•

MPR: Multiplanar reconstructions for lobar anatomy

•

MIP: Maximum intensity projection for vessels/nodules

•

MinIP: Minimum intensity projection for emphysema

2. VITAMINS Systematic Approach

Step

Assessment

Key Elements

V

Vessels

PE, dissection, aneurysms

I

Inflammation

Consolidation, GGO, tree-in-bud

T

Tracheobronchial

Airway stenosis, mucus plugs

A

Alveoli

Airspace disease, atelectasis

M

Mediastinum

Lymph nodes, masses

I

Infectious

Cavities, nodules, tree-in-bud

N

Nodules

Size, margins, calcification

S

Surroundings

Pleura, bones, soft tissues

3. Key CT Patterns

A. Parenchymal Patterns

Pattern

Features

Differential

Ground-glass

Hazy increased attenuation with visible vessels

Pneumonia, edema, fibrosis

Crazy paving

GGO + interlobular septal thickening

PJP, alveolar proteinosis

Mosaic attenuation

Geographic density variations

Air trapping, vascular disease

Tree-in-bud

Centrilobular branching nodules

Endobronchial infection

B. Nodule Characterization

•

Benign features:
- Smooth margins
- Complete calcification
- Fat density (hamartoma)
- Stable for 2+ years

•

Malignant features:
- Spiculated margins
- Growth on serial scans
- Upper lobe location
- Eccentric calcification

4. Vascular Evaluation

A. Pulmonary Embolism Signs

•

Direct signs:
- Intraluminal filling defect
- "Railway track" sign (partial)
- Complete vessel cutoff

•

Indirect signs:
- Mosaic perfusion
- Wedge-shaped infarct
- Right heart strain

B. Aortic Evaluation

•

Dissection:
- Intimal flap separating true/false lumen
- Differential enhancement

•

Aneurysm:
- Ascending ≥5cm
- Descending ≥4cm

5. Lymph Node Mapping

Station

Location

Significance

4R/L

Lower paratracheal

Lung cancer staging

7

Subcarinal

Common metastatic site

10-14

Hilar/lobar

Tumor vs inflammation

Normal size: <1cm short axis (except 7: <1.5cm)

6. CT Chest Reporting Template

1.

Technique: Contrast/non-contrast, slice thickness

2.

Lungs:
- Parenchymal abnormalities
- Nodules/masses (location, size)
- Airways

3.

Mediastinum:
- Lymph nodes (stations, size)
- Vascular findings

4.

Pleura:
- Effusions
- Thickening/nodules

5.

Bones/Soft tissue:
- Fractures
- Destructive lesions

Always review in multiple windows. Correlate findings with clinical history. For nodules, apply Fleischner Society guidelines. For PE studies, check right ventricle/left ventricle ratio. In oncology patients, compare with prior scans for interval changes.

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