CONTENTS
- Pulmonary lymphoid neoplasms
- PTLD (posttransplant lymphoproliferative disorder)
- IgG4-related lung disease
- Benign hyperplastic disorders
- Questions & discussion
abbreviations used in the pulmonary section: 4
- ABPA: Allergic bronchopulmonary aspergillosis 📖
- AE-ILD: Acute exacerbation of ILD 📖
- AEP: Acute eosinophilic pneumonia 📖
- AFB: Acid Fast Bacilli
- AIP: Acute interstitial pneumonia (Hamman-Rich syndrome) 📖
- ANA: Antinuclear antibody 📖
- ANCA: Antineutrophil cytoplasmic antibodies 📖
- ARDS: Acute respiratory distress syndrome 📖
- ASS: Antisynthetase Syndrome 📖
- BAL: Bronchoalveolar lavage 📖
- BiPAP: Bilevel positive airway pressure 📖
- CEP: Chronic eosinophilic pneumonia 📖
- CF: Cystic fibrosis 📖
- COP: Cryptogenic organizing pneumonia 📖
- CPAP: Continuous positive airway pressure 📖
- CPFE: Combined pulmonary fibrosis and emphysema 📖
- CTD-ILD: Connective tissue disease associated interstitial lung disease 📖
- CTEPH: Chronic thromboembolic pulmonary hypertension 📖
- DAD: Diffuse alveolar damage 📖
- DAH: Diffuse alveolar hemorrhage 📖
- DIP: Desquamative interstitial pneumonia 📖
- DLCO: Diffusing capacity for carbon monoxide 📖
- DRESS: Drug reaction with eosinophilia and systemic symptoms 📖
- EGPA: Eosinophilic granulomatosis with polyangiitis 📖
- FEV1: Forced expiratory volume in 1 second 📖
- FVC: Forced vital capacity 📖
- GGO: Ground glass opacity 📖
- GLILD: Granulomatous and lymphocytic interstitial lung disease 📖
- HFNC: High flow nasal cannula 📖
- HP: Hypersensitivity pneumonitis 📖
- IPAF: Interstitial pneumonia with autoimmune features 📖
- IPF: Idiopathic pulmonary fibrosis 📖
- IVIG: Intravenous immunoglobulin 📖
- LAM: Lymphangioleiomyomatosis 📖
- LIP: Lymphocytic interstitial pneumonia 📖
- MAC: Mycobacterium Avium complex 📖
- MCTD: Mixed connective tissue disease 📖
- NIV: Noninvasive ventilation (including CPAP or BiPAP) 📖
- NSIP: Nonspecific interstitial pneumonia 📖
- NTM: Non-tuberculous mycobacteria 📖
- OHS: Obesity hypoventilation syndrome 📖
- OP: Organizing pneumonia 📖
- OSA: Obstructive sleep apnea 📖
- PAP: Pulmonary alveolar proteinosis 📖
- PE: Pulmonary embolism 📖
- PFT: Pulmonary function test 📖
- PLCH: Pulmonary Langerhans Cell Histiocytosis 📖
- PPFE: Pleuroparenchymal fibroelastosis 📖
- PPF: Progressive pulmonary fibrosis 📖
- PVOD/PCH Pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis 📖
- RB-ILD: Respiratory bronchiolitis-associated interstitial lung disease 📖
- RP-ILD: Rapidly progressive interstitial lung disease 📖
- TNF: tumor necrosis factor
- UIP: Usual Interstitial Pneumonia 📖
basics
- Various names for this entity:
- Extranodal marginal zone lymphoma (EMZL).
- Mucosa-associated lymphoid tissue (MALT) lymphoma.
- MALToma.
- BALT (Bronchus-associated lymphoid tissue) lymphoma. (30382779)
epidemiology
- MALT lymphoma is the most common primary pulmonary lymphoma (~80% of all cases). However, this remains rare overall (comprising <0.3% of all primary lung malignancies). (34022027)
- Median age at diagnosis is 60 years, but younger patients may be involved in the context of immunosuppression. (Shepard 2019)
- Chronic immunological stimulation promotes the development of MALT lymphoma:
- Autoimmune disorders (~25%):
- Lupus.
- Sjogren syndrome.
- Rheumatoid arthritis.
- MCTD (mixed connective tissue disease).
- Hashimoto thyroiditis.
- Immunodeficiency:
- HIV infection.
- CVID (common variable immunodeficiency disorder).
- Autoimmune disorders (~25%):
- MALT lymphomas may coexist with LIP (lymphocytic interstitial pneumonia) and/or pulmonary amyloidosis. (26761531)
symptoms
- Half of patients are asymptomatic (diagnosed incidentally via radiology).
- Symptoms may include cough, dyspnea, or chest pain.
- Constitutional symptoms are uncommon (e.g., weight loss, fever).
- Paraneoplastic syndromes may rarely occur (e.g., transverse myelitis, cerebellar ataxia, or peripheral neuropathy). (26761531)
radiology
- Findings vary greatly, but three general patterns may be seen. Either consolidation or nodular patterns are most common (#1-2).
- (1) Alveolar consolidation with air bronchograms:
- Typically involves the middle lobe.
- Cavitation is rarely reported. (30382779)
- (2) Tumor-like appearance, with a solitary circumscribed nodular opacity:
- May contain an air bronchogram.
- Nodular opacity with a halo sign may be present.
- (3) Infiltrative pattern with diffuse, poorly defined ground-glass opacities.
- Patchy, large areas of ground-glass opacity may occur throughout the lungs. (26761531)
- Pleural effusion is uncommon.
- Hilar or mediastinal lymphadenopathy may occur in ~30%. (34022027)
laboratory studies
- IgM or IgG monoclonal gammopathy may be seen in about a third of cases. (Murray 2022)
diagnosis
- Diagnosis typically requires a biopsy. If there is a solitary lesion, resection may be diagnostic and therapeutic.
- CT-guided percutaneous biopsy has a sensitivity of 80%. (28609772)
- Bronchoscopic biopsy often yields insufficient tissue to secure a diagnosis. Bronchoalveolar lavage may demonstrate >20% lymphocytosis, with >10% B-cell clonality. (29697079)
staging
- Limited stage: Involvement of a single extralymphatic site, or extension of a lymph node into a contiguous extralymphatic organ.
- Advanced stage:
- Multiple sites of extranodal disease. (34022027)
- About half of patients have multiorgan involvement.
management
- Excision or radiotherapy may be adequate for isolated lesions.
- Surveillance may be reasonable for some patients with limited stage disease. (34022027)
- Extensive stage disease may be treated with systemic therapy (e.g., rituximab, with or without chemotherapy). (34022027)
epidemiology
- This is the second most common type of primary pulmonary lymphoma (~10%).
- Half of diffuse large B-cell lymphomas arise de novo, whereas half arise from transformation of MALT lymphoma. (29697079)
- Affected patients often fall into one of two groups:
- (1) Immunocompetent patients in their ~60s-70s.
- (2) Younger patients in the context of immunodeficiency:
- Solid organ transplantation.
- HIV infection.
symptoms
- Patients are usually symptomatic.
- Respiratory symptoms may include cough and dyspnea. (29697079)
- Systemic “B-symptoms” are often marked (e.g., fever, night sweats, weight loss).
radiology
- Pulmonary nodules and masses are reported in half of patients. (Shepard 2019)
- Distribution tends to be peribronchial or subpleural, with a lower lobe predominance.
- Cavitation is more commonly seen in PP-DLBCL as compared to MALT lymphoma. (29697079)
- Pleural effusions and hilar lymphadenopathy may be seen.
treatment
- If immunodeficiency is treatable (e.g., HIV), this alone can be successful.
- Otherwise, treatment may be similar to other high-grade B-cell lymphomas (e.g., combination chemotherapy).
basics
- This is an angiocentric, EBV-associated large B-cell lymphoproliferative disorder involving infiltration of the blood vessels (previously called “angiocentric lymphoma”).
- The lungs are primarily involved. However, the skin, brain, and kidneys may also be affected. The spleen, lymph nodes, and bone marrow are usually uninvolved.
epidemiology
- Usually occurs in an age range of ~30-60 years old. (35000715, 29697079)
- 2:1 male predominance.
- Risk factors are related to immunological dysfunction:
symptoms
- Overview:
- The lungs, skin, and nervous system are most often involved.
- Symptoms are often present for months prior to diagnosis.
- Lung is involved in ~85%. (29697079)
- Symptoms may include cough, dyspnea, hemoptysis, chest pain, and constitutional symptoms.
- Skin (50%):
- Nervous system (~30%):
- Other features may include:
radiology
- Multiple pulmonary nodules and masses usually occur: (Shepard 2019)
- Size ranges from ~1-10 cm.
- Initially lesions may appear similar to airspace disease, but over time they may become more nodular. This may produce a halo sign (nodule surrounded by ground-glass opacity). Lesions can coalesce, to produce a consolidative appearance. (Shepard 2019)
- Central low attenuation or cavitation may occur in ~25% of patients (corresponding to central necrosis and higher grade disease). Peripheral enhancement can occur.
- Distribution:
- Lower lung predominance.
- Subpleural and peribronchovascular distribution. (30955581)
- Lesions may migrate over time, or wax and wane.
- Large airway ulceration may occur. (37031988)
- Hilar or mediastinal lymphadenopathy is rare. (35000715) If lymphadenopathy is seen, this makes the diagnosis questionable. (37031988)
laboratory studies
- Complete blood count:
- May be normal.
- Hyperleukocytosis or lymphopenia may occur. (Fishman 2023, 28609772)
- Inflammatory markers are usually normal. (30955581)
- Eosinophilia may be observed in the blood and/or bronchoalveolar lavage. (Murray 2022)
differential diagnosis may include:
- GPA (granulomatosis with polyangiitis).
- Necrotizing sarcoid granulomatosis. 📖
- Malignancy, including:
- Metastatic disease.
- Various lymphomas (including primary pulmonary lymphoma).
- Fungal infections.
- Tuberculosis.
tissue diagnosis
- Tissue biopsy is required for diagnosis.
- Site: If possible, a skin lesion should be biopsied (punch biopsy may be inadequate, so excisional biopsy may be required). (37031988) Otherwise, a lung biopsy may be needed. Due to varying tumoral infiltration and EBV staining, if the first biopsy doesn't yield a diagnosis then other sites should be sampled. (29697079)
- Findings may include angioinvasion and angio-infiltration. The term “granuloma” is a misnomer, because granulomas are not typically observed. (29697079)
pathological grading
- Grade 1 (minimal atypia, scant necrosis, rare EBV-positive cells): 1/3 progress to lymphoma.
- This is the rarest grade encountered. (26761531)
- Grade 2 (increased atypia, readily detected EBV-positive cells): 2/3 progress to lymphoma.
- This is the most commonly encountered grade. (26761531)
- Grade 3 (extensive necrosis, monomorphic atypical cells): this represents a lymphoma.
treatment
- If possible, any immunosuppression should be reversed or treated.
- Some patients with isolated pulmonary disease and lower grade can be observed, if symptoms are minimal. Spontaneous remission may occur.
- More aggressive disease can be treated with combination chemotherapy (e.g., R-CHOP: rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). (30955581) Monotherapy with steroid or rituximab doesn't produce durable remission and should be avoided. (34246385)
- Primary pulmonary lymphomas constitute only 0.4% of all lymphomas. Thus, pulmonary involvement from systemic lymphoma is more common than primary pulmonary lymphoma.
- Involvement may involve hematogenous dissemination or contiguous spread to lymph nodes.
- Imaging findings may include:
- Lung nodule(s) and mass(es).
- Consolidation and/or ground-glass opacities.
basics
- Posttransplantation lymphoproliferative disorder (PTLD) involves uncontrolled replication of lymphocytes that are typically infected with Epstein Barr Virus (EBV). The disorder results from immunosuppression, since normally the immune system would detect and destroy these cells. However, EBV is not always present, with the proportion of EBV-negative PTLD appearing to increase over time. (33229389)
epidemiology
- Rates of PTLD vary across different transplants:
- Lung transplantation: 2-9%
- Heart transplantation: 3-5%
- Liver transplantation: 2-4%
- Kidney transplantation: <1%
- Hematopoietic stem cell transplantation: is much less common. (33229389)
- Timing: Following solid organ transplantation, PTLD can occur at any point in time. Risk may be greatest during the first post-transplantation year.
- Risk factors:
- EBV(-) recipient (especially receiving an organ from an EBV(+) donor, leading to acquisition of EBV infection at the time of transplantation).
- Rejection requiring increased immunosuppression.
three distinct clinical syndromes
- (1) Polyclonal B-cell proliferation with malignant transformation, widespread disease, and multiorgan involvement.
- Constitutes up to 30% of PTLD.
- Occurs within weeks of transplantation
- (2) Benign polyclonal proliferation of B-cells presenting similarly to infectious mononucleosis.
- Constitutes ~50% of PTLD.
- Usually occurs within a year of transplantation.
- (3) Monoclonal B-cell proliferation with extranodal disease and visceral involvement:
- Constitutes up to ~15% of PTLD.
- Occurs later after transplantation (>6-12 months).
- Less likely to occur in the allograft; more likely to be disseminated.
- May be more aggressive.
clinical findings: PTLD following lung transplantation
- Lungs are most commonly affected.
- Symptoms may include cough and/or dyspnea.
- Constitutional symptoms may be present (e.g., fever, fatigue, weight loss).
- Extrapulmonary locations are also commonly involved (e.g., skin, CNS, and GI tract).
thoracic radiology
- One or more nodules/masses is usually the primary finding:
- Additional features can include: (Shepard 2019)
- Hilar and mediastinal lymphadenopathy.
- Small pleural effusions.
- Interlobular septal thickening.
differential diagnosis may include
- Fungal pneumonia (e.g., aspergillosis).
diagnostics
- EBV serologies and PCR.
- Histological diagnosis (surgical excisional biopsy is typically required, although core needle biopsies may be diagnostic). (29697079)
management
- Reduction of immunosuppression (as able) may allow for partial restoration of immunity to EBV. However, among transplant patients this may carry a risk of precipitating allograft rejection.
- Anti-CD20 monoclonal antibody (e.g., Rituximab) may be effective in many patients. However, in patients with more aggressive forms of PTLD, combined chemotherapy may be necessary (e.g., R-CHOP regimen, as used in other forms of lymphoma).
- (Antiviral therapy: there might be a role for antiviral agents in prophylaxis against PTLD, but there is no evidence to support the use of antiviral therapy for established PTLD.) (29697079)
basics
- IgG4-related disease is a fibroinflammatory condition that involves tissue infiltration by IgG4-positive plasma cells that stimulate fibrosis. It follows a biphasic progression, with an initial inflammatory phase that eventually leads to fibrosis with obliterative arteritis. (Fishman 2023)
- IgG4-related disease may occur as a diffuse systemic process, or it may be localized to one or two organs.
epidemiology
- Usually affects middle-aged or elderly patients (median age at presentation is ~60-70 years old).
- ~75% of patients are men. (33422239)
clinical manifestations of IgG4 disease
multiorgan system involvement in IgG4-related disease
- Virtually any organ system can be involved. (33422239) The most commonly affected sites are as follows:
- Pulmonary symptoms (occur in ~10% of patients).
- Cough, dyspnea.
- Chest pain.
- Constitutional symptoms are uncommon (fever, weight loss, fatigue).
- Pancreatitis (~50% of autoimmune pancreatitis may actually represent IgG4-related disease). (33422239)
- Cholangitis (which may mimic sclerosing cholangitis).
- Sclerosing sialadenitis.
- Mediastinal or retroperitoneal fibrosis; aortitis or aortic aneurysm.
- About half of patients with idiopathic retroperitoneal fibrosis have IgG4-related disease. (26510025)
- Kidney (cortical mass may mimic metastatic tumor).
- Hypertrophic pachymeningitis. (Fishman 2023)
pulmonary involvement: four clinical pulmonary syndromes
- (1) Inflammatory lung pseudotumor.
- (2) Central airway disease.
- Imaging may demonstrate tracheobronchial stenosis.
- Fibrosing mediastinitis may also occur, with involvement of the central airways.
- (3) Interstitial pneumonia.
- (4) Pleuritis.
- Discussed further here: 📖
thoracic radiology
five major radiological subtypes:
- Nodule/mass-like lesions:
- May be multiple.
- Rounded, ground-glass opacities.
- Alveolar interstitial subtype:
- Diffuse ground-glass opacities, honeycombing, and traction bronchiectasis.
- Can mimic NSIP (nonspecific interstitial pneumonitis).
- Bronchovascular subtype:
- Mediastinal and hilar lymphadenopathy is often seen.
- Nodular thickening of the interlobular septa and bronchovascular bundles.
- May mimic sarcoidosis (mediastinal and hilar lymphadenopathy is often seen).
other potential findings:
- Mediastinal or hilar lymphadenopathy.
- Most frequent form of thoracic involvement.
- Present in up to 80% of patients. (28797400)
- Fibrosing mediastinitis.
- Pancreatic abnormalities are seen in about a third of patients with pulmonary IgG4-related disease.
laboratory studies
elevated IgG4 level
- Normal serum IgG4 level is ~4-86 mg/dL. (28797400)
- IgG4 level >140 mg/dL:
- IgG4 >10% of the total IgG may improve specificity. (Fishman 2023)
other laboratory findings
- Peripheral blood eosinophilia and elevated IgE occur in ~25% of patients. (Fishman 2023)
- Low levels of C3, C4.
- Increased circulating plasmablasts. (31227290)
management
- Optimal therapy remains unclear, given the rarity of this disease.
- IgG4-related disease is often a progressive, fibrotic process (although spontaneous remission can occur). Therefore, systemic therapy should arguably be offered for symptomatic patients and some asymptomatic patients as well. (33422239)
- Most patients will respond to steroid (e.g., prednisone 0.5-1 mg/kg daily, often ~20-50 mg/day). (31227290) A common regimen is to continue this dose for 2-4 weeks, then reduce by 5 mg every 2 weeks over a period of 4-6 weeks. (Fishman 2023) For patients unresponsive to steroid, other options may include cyclosporine, azathioprine, methotrexate, mycophenolate, or rituximab.
- Ongoing follow-up is advisable, given that the disease may relapse. (33422239)
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References
- 24394830 Hadid W, Rifai D, David O, Sadikot RT. A woman in her 40s with AIDS and lung mass. Chest. 2014 Jan;145(1):173-177. doi: 10.1378/chest.13-1312 [PubMed]
- 24889441 Madan K, Purkait S, Arava S, Bhalla AS, Kumar R, Guleria R. A 79-year-old woman with bilateral cavitating lung nodules. Chest. 2014 Jun;145(6):1419-1424. doi: 10.1378/chest.13-2081 [PubMed]
- 25180750 Catteeuw J, Koegelenberg CFN, Bruwer JW, Sissolak G, Schroeter L, Mohamed N, Irusen EM. A 54-year-old man referred with nonresolving pneumonia. Chest. 2014 Sep;146(3):e92-e96. doi: 10.1378/chest.13-2790 [PubMed]
- 26510025 Khosroshahi A, Digumarthy SR, Gibbons FK, Deshpande V. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 34-2015. A 36-Year-Old Woman with a Lung Mass, Pleural Effusion, and Hip Pain. N Engl J Med. 2015 Oct 29;373(18):1762-72. doi: 10.1056/NEJMcpc1502151 [PubMed]
- 26761531 Sirajuddin A, Raparia K, Lewis VA, Franks TJ, Dhand S, Galvin JR, White CS. Primary Pulmonary Lymphoid Lesions: Radiologic and Pathologic Findings. Radiographics. 2016 Jan-Feb;36(1):53-70. doi: 10.1148/rg.2016140339 [PubMed]
- 28609772 Borie R, Wislez M, Antoine M, Cadranel J. Lymphoproliferative Disorders of the Lung. Respiration. 2017;94(2):157-175. doi: 10.1159/000477740 [PubMed]
- 28797400 Fakih HAM, Samra Y, Ataya A, Prasad A, Papierniak E, Wakefield D, Urbine D. An 84-Year-Old Man With Progressive Dyspnea and an Abnormal Chest CT Scan. Chest. 2017 Aug;152(2):e45-e49. doi: 10.1016/j.chest.2017.03.013 [PubMed]
- 29697079 Tang VK, Vijhani P, Cherian SV, Ambelil M, Estrada-Y-Martin RM. Primary pulmonary lymphoproliferative neoplasms. Lung India. 2018 May-Jun;35(3):220-230. doi: 10.4103/lungindia.lungindia_381_17 [PubMed]
- 29928458 De Vega Sanchez B, Disdier Vicente C, Lopez Pedreira MR. An asymptomatic man with pathological chest radiography. Breathe (Sheff). 2017 Dec;13(4):e103-e108. doi: 10.1183/20734735.008717 [PubMed]
- 30382779 Maley JH, Dannheim K, Kooistra T, Hallowell RW. A Man with a Decade of Persistent Pulmonary Opacities. Ann Am Thorac Soc. 2018 Nov;15(11):1344-1348. doi: 10.1513/AnnalsATS.201803-222CC [PubMed]
- 30955581 Goh KJ, Takano A, Koh MS, Tiew PY, Chong CS, Tay CK. A 53-Year-Old Man Presenting With Diplopia and Cavitary Lung Nodules. Chest. 2019 Apr;155(4):e107-e112. doi: 10.1016/j.chest.2018.10.021 [PubMed]
- 31200868 Ko JP, Girvin F, Moore W, Naidich DP. Approach to Peribronchovascular Disease on CT. Semin Ultrasound CT MR. 2019 Jun;40(3):187-199. doi: 10.1053/j.sult.2018.12.002 [PubMed]
- 31227290 Morales AT, Cignarella AG, Jabeen IS, Barkin JS, Mirsaeidi M. An update on IgG4-related lung disease. Eur J Intern Med. 2019 Aug;66:18-24. doi: 10.1016/j.ejim.2019.06.010 [PubMed]
- 33229389 Walter G, Lyubetska H, Sharma A. Fever in a lung transplant recipient. Cleve Clin J Med. 2020 Nov 23;87(12):735-741. doi: 10.3949/ccjm.87a.19132 [PubMed]
- 33422239 Hawkins P, Doyle A, Gavin L, Fabre A, Murphy DJ, Dunican E, McCarthy C. A 33-Year-Old Man With Dyspnea, Chest Pain, and a Massive Pleural Effusion. Chest. 2021 Jan;159(1):e39-e43. doi: 10.1016/j.chest.2020.08.2102 [PubMed]
- 34022027 Roy AM, Venkata AN, Yadala S. A 44-Year-Old Woman With a 10-Year History of Dyspnea and Pulmonary Nodules. Chest. 2021 Apr;159(4):e247-e250. doi: 10.1016/j.chest.2020.10.051 [PubMed]
- 34099156 Kinoshita Y, Ikeda T, Ueda Y, Sasaki T, Kushima H, Ishii H. A 63-Year-Old Woman With an Acute Exacerbation of Interstitial Pneumonia. Chest. 2021 Jun;159(6):e389-e394. doi: 10.1016/j.chest.2021.01.018 [PubMed]
- 34246385 Hyde R, Wynne J, Sriram P, Lu L, Hadigal S. A 67-Year-Old Woman With Abdominal Pain, Paresthesia, and Rapidly Expanding Lung Nodule. Chest. 2021 Jul;160(1):e29-e34. doi: 10.1016/j.chest.2021.01.037 [PubMed]
- 35000715 Morin JA, Gooch CR, Stowell JT, Mallea JM, Jiang L, Thomas M. A 71-Year-Old Man With Diffuse Waxing and Waning Multifocal Lung Lesions, Empyema, and Episodic Fevers Reveals a Rare Diagnosis. Chest. 2022 Jan;161(1):e35-e41. doi: 10.1016/j.chest.2021.08.065 [PubMed]
- 35131079 Walker A, Rupal A, Jani C, Al Omari O, Singh H, Patel D, Perrino C, McCannon J. Longstanding Phenytoin Use as a Cause of Progressive Dyspnea. Chest. 2022 Feb;161(2):e91-e96. doi: 10.1016/j.chest.2021.08.079 [PubMed]
- 37031988 Tehzeeb J, Divilov V, Htoo A, Sajjadi F, Chopra A. A 21-Year-Old Hispanic Woman Presenting With Cutaneous and Pulmonary Nodules. Chest. 2023 Apr;163(4):e167-e171. doi: 10.1016/j.chest.2022.10.035 [PubMed]
Books:
- Shah, P. L., Herth, F. J., Lee, G., & Criner, G. J. (2018). Essentials of Clinical pulmonology. In CRC Press eBooks. https://doi.org/10.1201/9781315113807
- Shepard, JO. (2019). Thoracic Imaging The Requisites (Requisites in Radiology) (3rd ed.). Elsevier.
- Walker C & Chung JH (2019). Muller’s Imaging of the Chest: Expert Radiology Series. Elsevier.
- Palange, P., & Rohde, G. (2019). ERS Handbook of Respiratory Medicine. European Respiratory Society.
- Rosado-De-Christenson, M. L., Facr, M. L. R. M., & Martínez-Jiménez, S. (2021). Diagnostic imaging: chest. Elsevier.
- Murray & Nadel: Broaddus, V. C., Ernst, J. D., MD, King, T. E., Jr, Lazarus, S. C., Sarmiento, K. F., Schnapp, L. M., Stapleton, R. D., & Gotway, M. B. (2021). Murray & Nadel’s Textbook of Respiratory Medicine, 2-Volume set. Elsevier.
- Fishman's: Grippi, M., Antin-Ozerkis, D. E., Cruz, C. D. S., Kotloff, R., Kotton, C. N., & Pack, A. (2023). Fishman’s Pulmonary Diseases and Disorders, Sixth Edition (6th ed.). McGraw Hill / Medical.
