CTICasesDiscrete Centrilobular Emphysema Mimicking Cystic Lung Disease
Imaging findings
A patient referred for workup of a presumed unknown cystic lung disease (including abdominal CT screening for angiomyolipomas) has lucent lung spaces that mostly lack definable walls, with vessels coursing directly through their centers, in an atypically diffuse distribution rather than upper-lobe predominant. A few of the larger spaces contain residual tissue strands.
Key takeaways
Lucencies without walls that have vessels passing straight through their centers represent discrete centrilobular emphysema rather than true cysts, an important distinction because invoking cystic lung disease triggers an extensive (million-dollar) workup. The unusually diffuse distribution argues against ordinary smoking-related emphysema, and while cysts of protein (light-chain or amyloid) deposition can rarely contain tissue strands too, the absence of definable walls favors emphysema; pathology can be misleading if the reader lacks clinical context.
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