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 MÜLLER’S
IMAGING OF THE
CHEST
This page intentionally left blank
 2nd
EDITION

MÜLLER’S
IMAGING OF THE
CHEST
EDITORS
CHRISTOPHER M. WALKER, MD
Associate Professor of Radiology
University of Kansas Medical Center
Kansas City, Kansas
JONATHAN H. CHUNG, MD
Associate Professor
Section Chief of Thoracic Radiology
Interim Vice Chair for Quality
Department of Radiology
The University of Chicago Medicine
Chicago, Illinois

ASSOCIATE EDITORS
STEPHEN B. HOBBS, MD
Assistant Professor
Department of Radiology and Medicine
University of Kentucky
Lexington, Kentucky

BRENT P. LITTLE, MD
Division of Thoracic Imaging
Department of Radiology
Massachusetts General Hospital
Boston, Massachusetts
CAROL C. WU, MD
Associate Professor
Department of Diagnostic Radiology
The University of Texas MD Anderson Cancer Center
Houston, Texas
1600 John F. Kennedy Blvd.
Ste 1600
Philadelphia, PA 19103-2899

MÜLLER’S IMAGING OF THE CHEST, SECOND EDITION ISBN: 978-0-323-46225-9

Copyright © 2019 by Elsevier, Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
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This book and the individual contributions contained in it are protected under copyright by the Publisher
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To Eunhee, thank you for your constant support and pushing me to take on this project.
You truly make me a better man.
To Elsie, thank you for always loving me and making me aware of the things
that matter most in life.
To Lillian, thank you for always making me laugh and giving the biggest
hugs a dad could ever ask for.
CMW

To my parents, Kyu Youl and Bok Hee: Thank you for endlessly encouraging my curiosity.
To my daughter, Alexandra: Thank you for always being so excited to see me
when I come home; it is the only time I have felt like a rock star.
And to my loving wife, Aimee-Sue: Thank you for being the backbone of our family.
Your unending support and love always inspire me.
JHC
 CONTRIBUTORS

Kiran Batra, MD Stephane L. Desouches, DO

Assistant Professor Assistant Professor of Radiology
Department of Radiology Medical College of Wisconsin
UT Southwestern Medical Center Milwaukee, Wisconsin
Dallas, Texas
Robert M. DeWitt, MD, Major, USAF MC
Matthew Bentz, MD Assistant Professor of Radiology
Assistant Professor Uniformed Services University of the Health Sciences
Department of Diagnostic Radiology Bethesda, Maryland
Oregon Health and Science University Landstuhl Regional Medical Center
Portland, Oregon Landstuhl, Germany

Marcelo F. Benveniste, MD Jeremy J. Erasmus, MD

Associate Professor Professor
Department of Diagnostic Radiology Department of Diagnostic Radiology
Thoracic Section The University of Texas MD Anderson Cancer Center
The University of Texas MD Anderson Cancer Center Houston, Texas
Houston, Texas
Stephen K. Frankel, MD
Anupama Brixey, MD Chief Medical Officer
Department of Diagnostic Radiology Professor of Medicine
Oregon Health and Science University Division of Pulmonary, Critical Care, and Sleep Medicine
Portland, Oregon Department of Medicine
National Jewish Health
Juliana Bueno, MD Denver, Colorado
Assistant Professor of Radiology
Department of Radiology and Medical Imaging Tomás Franquet, MD
University of Virginia Chief, Section of Thoracic Imaging
Charlottesville, Virginia Department of Radiology
Hospital de Sant Pau
Suzanne C. Byrne, MD, FRCPC Barcelona, Spain
Clinical Assistant Professor of Radiology
Department of Radiology Cristina S. Fuss, MD
Memorial University Associate Professor
St. John’s, Newfoundland, Canada Department of Diagnostic Radiology
Oregon Health and Science University
Brett W. Carter, MD Portland, Oregon
Associate Professor
Department of Diagnostic Radiology Sherief Garrana, MD
The University of Texas MD Anderson Cancer Center Resident Physician
Houston, Texas Department of Thoracic Radiology
University of Missouri–Kansas City/Saint Luke’s Hospital of
Jonathan H. Chung, MD Kansas City
Associate Professor Kansas City, Missouri
Section Chief of Thoracic Radiology
Interim Vice Chair for Quality Matthew D. Gilman, MD
Department of Radiology Division of Thoracic Imaging and Intervention
The University of Chicago Medicine Massachusetts General Hospital
Chicago, Illinois Boston, Massachusetts

Patricia M. de Groot, MD J. David Godwin, MD

Associate Professor Professor of Radiology
Department of Diagnostic Radiology Department of Radiology
The University of Texas MD Anderson Cancer Center University of Washington
Houston, Texas Seattle, Washington

vi
 Contributors vii

Daniel R. Gomez, MD John P. Lichtenberger, MD

Associate Professor Associate Professor of Radiology
Department of Radiation Oncology Uniformed Services University of the Health Sciences
The University of Texas MD Anderson Cancer Center Bethesda, Maryland
Houston, Texas
Rebecca M. Lindell, MD
Ashish Gupta, MD Assistant Professor
Assistant Professor Department of Radiology
Department of Medical Imaging Mayo Clinic
University of Ottawa Rochester, Minnesota
Ottawa, Ontario, Canada
Brent P. Little, MD
Vedant Gupta, MD Division of Thoracic Imaging
Assistant Professor of Medicine Department of Radiology
University of Kentucky College of Medicine Massachusetts General Hospital
Lexington, Kentucky Boston, Massachusetts

Thomas E. Hartman, MD Jaume Llauger, MD

Professor Chief, Section of Musculoskeletal Imaging
Department of Radiology Department of Radiology
Mayo Clinic Hospital de la Santa Creu i Sant Pau
Rochester, Minnesota Universitat Autònoma de Barcelona
Barcelona, Spain
Stephen B. Hobbs, MD
Assistant Professor Andrea L. Magee, MD
Department of Radiology and Medicine Resident Radiologist
University of Kentucky Department of Radiology
Lexington, Kentucky The University of Chicago
Chicago, Illinois
Yeon Joo Jeong, MD
Department of Radiology Victorine V. Muse, MD
Pusan National University Hospital Assistant Professor of Radiology
Pusan National University School of Medicine Harvard Medical School
Busan, South Korea Massachusetts General Hospital
Boston, Massachusetts
Michael A. Kadoch, MD
Assistant Professor of Clinical Radiology Justin M. Oldham, MD, MS
Department of Radiology Assistant Professor
University of California–Davis Department of Internal Medicine
Sacramento, California Division of Pulmonary, Critical Care, and Sleep Medicine
University of California–Davis
Jeffrey S. Klein, MD Sacramento, California
A. Bradley Soule and John P. Tampas Green and Gold
Professor of Radiology Melissa Price, MD
Department of Radiology Instructor in Radiology
University of Vermont College of Medicine Division of Thoracic Imaging and Intervention
Burlington, Vermont Massachusetts General Hospital
Boston, Massachusetts
Sarah T. Kurian, MD
Department of Radiology Steven L. Primack, MD
University of Missouri–Kansas City Professor and Vice Chair
Kansas City, Missouri Department of Diagnostic Radiology
Oregon Health and Science University
Kyung Soo Lee, MD Portland, Oregon
Department of Radiology
Samsung Medical Center
Sungkyunkwan University School of Medicine
Seoul, South Korea
viii Contributors

Bradley S. Sabloff, MD Mylene T. Truong, MD

Professor Professor
Department of Diagnostic Radiology Department of Diagnostic Radiology
The University of Texas MD Anderson Cancer Center The University of Texas MD Anderson Cancer Center
Houston, Texas Houston, Texas

Jean M. Seely, MDCM, FCRPC Emily B. Tsai, MD

Associate Professor Department of Radiology
University of Ottawa Stanford University
Head of Breast Imaging Section Stanford, California
Department of Medical Imaging
The Ottawa Hospital Chitra Viswanathan, MD
Clinician Investigator Professor
Ottawa Hospital Research Institute Department of Diagnostic Radiology
Ottawa, Ontario, Canada Division of Diagnostic Imaging
The University of Texas MD Anderson Cancer Center
Phillip A. Setran, MD Houston, Texas
Radiology Resident
Department of Diagnostic Radiology Christopher M. Walker, MD
Oregon Health and Science University Associate Professor of Radiology
Portland, Oregon University of Kansas Medical Center
Kansas City, Kansas
Girish S. Shroff, MD
Associate Professor Charles S. White, MD
Department of Diagnostic Radiology Professor
The University of Texas MD Anderson Cancer Center Department of Diagnostic Radiology
Houston, Texas University of Maryland
Baltimore, Maryland
Justin T. Stowell, MD
Resident Carol C. Wu, MD
Department of Radiology Associate Professor
University of Missouri–Kansas City Department of Diagnostic Radiology
Kansas City, Missouri The University of Texas MD Anderson Cancer Center
Houston, Texas
Nicola Sverzellati, MD, PhD
Professor of Radiology
Department of Medicine and Surgery
University of Parma
Parma, Italy

The aim of this second edition of Imaging of the Chest is to provide
a succinct, state-of-the art overview of imaging of the thorax. We
congratulate Drs. Christopher Walker and Jonathan Chung in
achieving this goal by combining their outstanding talents as editors
and their ability to obtain the collaboration of an exceptional
team of internationally renowned chest radiologists to write
chapters in their fields of expertise. The new edition includes a
truly up-to-date review of the clinical, radiologic, and pathologic
manifestations of lung diseases and several hundred new images
that provide excellent illustrations of the latest technologic advances.
The emphasis of this book, similar to daily practice, is on
chest radiography and computed tomography (CT). However,
as is also required in clinical practice, it includes the indications
and characteristic findings on magnetic resonance imaging and,
when applicable, scintigraphy, positron emission tomography
(PET), integrated PET-CT imaging, and ultrasound. The book
also provides a summary of the clinical manifestations and
pathologic findings. The clinical history is always helpful and
often essential for an accurate diagnosis or appropriate differential
FOREWORD
diagnosis, while knowledge of the pathologic findings allows a
better understanding of the patterns of abnormalities seen on
the radiologic images.
As the editors, we were delighted with the quality of the first
edition and very thankful to the numerous authors who were
responsible for its success. There have been, however, many major
changes and new developments since the publication of that
edition in 2008, which led to the need for a major revision and
update. We chose to pass on the new edition to a young team
of editors with the talent, energy, and dedication required in
planning, organizing, and completing this monumental endeavor.
We are very pleased to see that they managed to improve the
quality of the book and believe that it will be extremely useful
to radiology residents, chest radiology fellows, pulmonary physi-
cians, thoracic surgeons, and general radiologists with an interest
in chest imaging.
Nestor L. Müller
C. Isabela Silva Müller
ix

We are honored and humbled to be the editors of the second
edition of Müller’s Imaging of the Chest. We are indebted to the
previous editors, Drs. Nestor Müller and Isabela Silva, as well
as their Associate and Assistant Editors, Drs. David Hansell, Kyung
Soo Lee, and Martin Rémy-Jardin, for their extraordinary work
in directing and creating the first edition of this textbook and
organizing a team of some of the most esteemed chest radiologists.
The authoritative and comprehensive content in the first edition
of Imaging of the Chest made it the clear gold standard reference
in thoracic imaging. When we were first offered the opportunity
to edit this textbook, we were reluctant because the first edition
was a hard act to follow. However, the opportunity to have a
hand in the second iteration of the textbook, which we used as
our personal go-to reference, was too hard to turn down. Thank-
fully, our wives urged us to take on this project lest we
kick ourselves in the future. Given the daunting task of updating
and editing the authoritative content assembled by the previous
world-class team of chest radiologists, we knew we would
need help. Our associate editors, Drs. Stephen Hobbs, Brent
Little, and Carol Wu, were all obvious choices to help us
direct this endeavor given their superior clinical training, unique
clinical backgrounds, and complementary clinical and academic
interests.
Chest radiography continues to be the most commonly
obtained imaging study throughout the world. In many patients,
a high-quality chest radiograph, combined with appropriate
clinical information, allows for accurate diagnosis. However, in
many cases, it is helpful to obtain chest computed tomography
(CT) imaging given its higher contrast resolution. In recent years,
the line between high-resolution CT of the chest and standard
CT has blurred as volumetric helical CT acquisition becomes
the norm, allowing for reconstruction of images in any plane
and in virtually any slice thickness. Contrast-enhanced chest CT
and chest CT angiography are highly valuable tools in the assess-
ment of suspected malignancy, vascular abnormalities, and
thromboembolic disease. Magnetic resonance imaging (MRI)
and positron emission tomography (PET) imaging are useful
adjuncts in thoracic imaging, specifically in the setting of known
or suspected malignancy. Although specialized centers have used
MRI and PET imaging for evaluation of nonmalignant pulmonary
abnormalities, these are still mostly avenues for research rather
than accepted clinical standards.
In the second edition of this textbook, we aim to provide a
comprehensive review of thoracic imaging while simultaneously
compressing the size of the textbook from a two-volume set to
x
PREFACE
a single-volume reference. Needless to say, this was challenging,
but we are quite proud of the end product and hope you will
agree that essential content has not been excluded. The first part
of this book deals with normal imaging appearance of the thorax
on chest radiography and CT with detailed discussions of thoracic
anatomy. Truly, one does not know what abnormal is until one
knows what normal is. The second part of this book approaches
thoracic imaging from the “findings” aspect rather than from
the diagnosis side. This is likely most relevant to readers of this
textbook, given that this is how patients present: with an unknown
diagnosis but with abnormalities on chest imaging. Finally, the
third part is arranged in a diagnosis or diagnostic category
approach, as is typical of most textbooks.
Specific highlights include updates on lung cancer screening
and an updated review of pulmonary fibrosis and interstitial lung
disease management and diagnosis. In addition, four new chapters
were created to more fully include topics pertinent to chest imagers:
Leukemia, Idiopathic Pleuroparenchymal Fibroelastosis, Interstitial
Pneumonia with Autoimmune Features, and Noninfectious Lung
and Stem Cell Transplantation Complications.
This book would not have been possible without the support
of our colleagues and mentors. We thank, first, all our mentors
at the University of Washington and the Massachusetts General
Hospital for cultivating our passion for cardiopulmonary imaging
and guiding us in the gauntlet of academic radiology; second,
specific leaders in the field, including Drs. David A. Lynch and
J. David Godwin, whom we had the pleasure of working with
and who continually provided their support and advice on all
matters; and third, our trainees, who have always kept us honest
in regard to what we knew (or thought we knew). We hope you
enjoy reading this textbook (although based on your track record,
we assume you will get around to it next rotation). Finally, we
thank the wonderful staff at Elsevier who have made this endeavor
possible, including but not limited to Robin Carter, Ann Anderson,
Claire Kramer, and Margaret Nelson.
This book is aimed at clinical radiologists, pulmonologists,
trainees, and any other health care professionals interested in
thoracic imaging. It provides a concise but comprehensive
overview of imaging findings of thoracic diseases. We hope that
the second edition of Müller’s Imaging of the Chest will be a
valuable resource for the thoracic health care community and
will ultimately improve patient care.
Jonathan H. Chung, MD
Christopher M. Walker, MD
 CONTENTS

SECTION 1 Normal Chest SECTION 5 Pulmonary Neoplasms

1 Normal Chest Radiography and Computed 16 Screening for Lung Cancer 317
Tomography 1 SUZANNE C. BYRNE | THOMAS E. HARTMAN
JULIANA BUENO | CHRISTOPHER M. WALKER |
JONATHAN H. CHUNG 17 Lung Cancer: Radiologic Manifestations and
Diagnosis 324
SECTION 2 Radiologic Manifestations of Lung CAROL C. WU | JEFFREY S. KLEIN

Disease 18 Pulmonary Carcinoma Staging 341

2 Consolidation 57 KYUNG SOO LEE | YEON JOO JEONG

JONATHAN H. CHUNG | CHRISTOPHER M. WALKER 19 Neuroendocrine Hyperplasia, Pulmonary

3 Atelectasis 71 Tumorlets, and Carcinoid Tumors 365
BRENT P. LITTLE STEPHANE L. DESOUCHES | CHRISTOPHER M. WALKER |
JONATHAN H. CHUNG
4 Nodules and Masses 91 20 Pulmonary Hamartoma 376
SARAH T. KURIAN | CHRISTOPHER M. WALKER |
JONATHAN H. CHUNG CHRISTOPHER M. WALKER | JONATHAN H. CHUNG

5 Interstitial Patterns 109 21 Inflammatory Pseudotumor 381

JONATHAN H. CHUNG | CHRISTOPHER M. WALKER JONATHAN H. CHUNG | CHRISTOPHER M. WALKER

6 Decreased Lung Density 138 22 Pulmonary Metastases 384

CHRISTOPHER M. WALKER | JONATHAN H. CHUNG STEPHANE L. DESOUCHES | CHRISTOPHER M. WALKER |
JONATHAN H. CHUNG

SECTION 3 Developmental Lung Disease

7 Airway and Parenchymal Anomalies 147
JUSTIN T. STOWELL | CHRISTOPHER M. WALKER |
JONATHAN H. CHUNG
8 Congenital Malformations of the Pulmonary
Vessels in Adults 167
BRENT P. LITTLE
SECTION 4 Pulmonary Infection
9 Bacterial Pneumonia 193
STEPHANE L. DESOUCHES | CHRISTOPHER M. WALKER |
JONATHAN H. CHUNG
10 Pulmonary Tuberculosis 219
KYUNG SOO LEE | YEON JOO JEONG
11 Nontuberculous (Atypical) Mycobacterial
Infection 241
BRENT P. LITTLE
12 Fungal Infections 251
SUZANNE C. BYRNE | REBECCA M. LINDELL |
THOMAS E. HARTMAN
13 Viruses 273
CHRISTOPHER M. WALKER | JONATHAN H. CHUNG
14 Parasites 287
CHRISTOPHER M. WALKER | JONATHAN H. CHUNG
15 Human Immunodeficiency Virus Infection 300
CAROL C. WU | JOHN P. LICHTENBERGER |
SECTION 6 Lymphoproliferative Disorders
and Leukemia
23 Pulmonary Lymphoid Hyperplasia
and Lymphoid Interstitial Pneumonia
(Lymphocytic Interstitial Pneumonia) 393
JONATHAN H. CHUNG | CHRISTOPHER M. WALKER
24 Non-Hodgkin Lymphoma 401
PATRICIA M. DE GROOT | CAROL C. WU |
BRETT W. CARTER | KYUNG SOO LEE
25 Hodgkin Lymphoma 413
EMILY B. TSAI | CAROL C. WU | VICTORINE V. MUSE |
KYUNG SOO LEE
26 Leukemia 423
GIRISH S. SHROFF | CAROL C. WU |
CHITRA VISWANATHAN | MYLENE T. TRUONG
SECTION 7 Diffuse Lung Diseases
27 Usual Interstitial Pneumonia/Idiopathic
Pulmonary Fibrosis 429
JONATHAN H. CHUNG | CHRISTOPHER M. WALKER
28 Nonspecific Interstitial
Pneumonia 440
JONATHAN H. CHUNG | CHRISTOPHER M. WALKER
29 Cryptogenic Organizing Pneumonia/
Secondary Organizing Pneumonia 449
KIRAN BATRA JONATHAN H. CHUNG | CHRISTOPHER M. WALKER

xi
xii Contents

30 Acute Interstitial Pneumonia 456 48 Behçet Disease 611

JONATHAN H. CHUNG | CHRISTOPHER M. WALKER JONATHAN H. CHUNG | CHRISTOPHER M. WALKER

31 Sarcoidosis 461 49 Takayasu Arteritis 616

JONATHAN H. CHUNG | CHRISTOPHER M. WALKER CHRISTOPHER M. WALKER | JONATHAN H. CHUNG

32 Hypersensitivity Pneumonitis 478 SECTION 10 Pulmonary Embolism, Hypertension,

ANDREA L. MAGEE | CHRISTOPHER M. WALKER |
JONATHAN H. CHUNG and Edema

33 Pulmonary Langerhans Cell Histiocytosis 494 50 Acute Pulmonary Embolism 622

STEPHEN B. HOBBS CAROL C. WU | MATTHEW D. GILMAN

34 Smoking-Related Interstitial Lung 51 Chronic Pulmonary Thromboembolism 633

Disease 502 BRENT P. LITTLE

STEPHEN B. HOBBS 52 Nonthrombotic Pulmonary Embolism 642

35 Lymphangioleiomyomatosis and Tuberous CHRISTOPHER M. WALKER | JONATHAN H. CHUNG

Sclerosis 513 53 Pulmonary Arterial Hypertension 658

NICOLA SVERZELLATI VEDANT GUPTA | STEPHEN B. HOBBS

36 Idiopathic Pleuroparenchymal 54 Hydrostatic Pulmonary Edema 674

Fibroelastosis 524 CHRISTOPHER M. WALKER | JONATHAN H. CHUNG
ROBERT M. DEWITT | STEPHEN K. FRANKEL
55 Permeability Pulmonary Edema 685
37 Eosinophilic Lung Diseases 527 STEPHEN B. HOBBS
MELISSA PRICE | CAROL C. WU | MATTHEW D. GILMAN

38 Metabolic and Storage Lung Diseases 535 SECTION 11 Diseases of the Airways
CHRISTOPHER M. WALKER | JONATHAN H. CHUNG 56 Tracheal Diseases 694
BRENT P. LITTLE

SECTION 8 Connective Tissue Diseases 57 Bronchiectasis and Other Bronchial

39 Rheumatoid Arthritis 552 Abnormalities 713
STEPHEN B. HOBBS BRENT P. LITTLE

40 Systemic Sclerosis (Scleroderma) 561 58 Asthma 733

BRENT P. LITTLE JONATHAN H. CHUNG | CHRISTOPHER M. WALKER

41 Systemic Lupus Erythematosus 565 59 Bronchiolitis 745

BRENT P. LITTLE SHERIEF GARRANA | CHRISTOPHER M. WALKER |
JONATHAN H. CHUNG
42 Polymyositis/Dermatomyositis 571
STEPHEN B. HOBBS
60 Emphysema 765
STEPHEN B. HOBBS
43 Sjögren Syndrome 576
STEPHEN B. HOBBS SECTION 12 Inhalational Diseases and Aspiration
44 Mixed Connective Tissue Disease 581 61 Asbestos-Related Disease 775
BRENT P. LITTLE STEPHEN B. HOBBS

45 Interstitial Pneumonia With Autoimmune 62 Silicosis and Coal Workers’

Features 585 Pneumoconiosis 793
MICHAEL A. KADOCH | JUSTIN M. OLDHAM STEPHEN B. HOBBS

63 Uncommon Pneumoconioses 809

SECTION 9 Vasculitis and Granulomatosis STEPHEN B. HOBBS

46 Antineutrophil Cytoplasmic Antibody– 64 Aspiration 822

Associated Vasculitis 592 TOMÁS FRANQUET
STEPHANE L. DESOUCHES | CHRISTOPHER M. WALKER |
JONATHAN H. CHUNG SECTION 13 Iatrogenic Lung Disease and Trauma
47 Goodpasture Syndrome (Anti–Basement 65 Drug-Induced Lung Disease 836
Membrane Antibody Disease) 606 SARAH T. KURIAN | CHRISTOPHER M. WALKER |
JONATHAN H. CHUNG | CHRISTOPHER M. WALKER JONATHAN H. CHUNG
 Contents xiii

66 Therapeutic Radiation and Radiation-Induced 73 Benign Pleural Thickening 988

Lung Disease 847 CAROL C. WU | JEAN M. SEELY
MARCELO F. BENVENISTE | DANIEL R. GOMEZ |
BRADLEY S. SABLOFF | JEREMY J. ERASMUS 74 Pleural Neoplasms 1008
BRETT W. CARTER | PATRICIA M. DE GROOT | JEAN M. SEELY
67 Blunt Thoracic Trauma 863
PHILLIP A. SETRAN | STEVEN L. PRIMACK | CRISTINA S. FUSS
SECTION 15 Mediastinum
68 Postoperative Complications 885
MYLENE T. TRUONG | CAROL C. WU | CHARLES S. WHITE 75 Pneumomediastinum 1030
TOMÁS FRANQUET
69 Chest Radiography in the Intensive
Care Unit 907 76 Mediastinitis 1039
ANUPAMA BRIXEY | MATTHEW BENTZ | STEVEN L. PRIMACK TOMÁS FRANQUET

70 Noninfectious Lung and Stem Cell 77 Mediastinal Masses 1051

Transplantation Complications 929 BRETT W. CARTER

BRENT P. LITTLE

SECTION 16 Diaphragm and Chest Wall

SECTION 14 Pleural Disease
78 Diaphragm 1070
71 Pneumothorax 942 CHRISTOPHER M. WALKER | JONATHAN H. CHUNG |
ASHISH GUPTA | JEAN M. SEELY J. DAVID GODWIN

72 Pleural Effusion 963 79 Chest Wall 1088

ASHISH GUPTA | JEAN M. SEELY TOMÁS FRANQUET | JAUME LLAUGER
This page intentionally left blank
 MÜLLER’S
IMAGING OF THE
CHEST
 1 Normal Chest Radiography and Computed Tomography 11

Fig. 1.16 (A) Pulmonary lobes and segments: anterior

view. A schematic drawing superimposed on a three-
dimensional surface reformatted image obtained with a
multidetector CT scanner shows the location of the
S1 S1 + 2 pulmonary segments and lobes on the anterior surface
of the right and left lungs. The segments that form the
anterior surface of the right lung include the apical (S1)
and anterior (S3) segments of the right upper lobe, the
lateral (S4) and medial (S5) segments of the right middle
S3 lobe, and the anterior basal (S8) segment of the right
S3
lower lobe. The anterior view of the left lung shows the
location of the apicoposterior segment (S1 + 2), anterior
(S3) segment, and superior (S4) and inferior (S5) lingular
segments of the left upper lobe, as well as the antero-
medial basal (S7 + S8) segment. Because the heart was
removed from the original image, the lateral basal (S9)
and posterior basal (S10) segments of the left lower lobe
are also demonstrated on this image. (B) Pulmonary lobes
and segments: posterior view. The segments that form
S5 S4 the posterior surface of the right lung include the apical
(S1), posterior (S2), and anterior (S3) segments of the
right upper lobe and the superior (S6), lateral basal (S9),
posterior basal (S10), and (adjacent to the heart, which
S10 is not shown) medial (S7) basal segments of the right
lower lobe. The segments that form the posterior surface
S4 S9 of the left lung include the apicoposterior (S1 + S2)
S5 segments of the left upper lobe and the superior (S6),
anteromedial basal (S7 + S8), lateral basal (S9), and
posterior basal (S10) segments of the left lower lobe.

S8
+8
S7

Right Left

S1
S1 + 2

S3
S2

S6
S6

S7 + 8
S10
S7
S10

S9 S9

B Right Left
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