CT features of normal lung change in asymptomatic elderly patients

Abstract

Background: Not all morphological lung changes in the elderly contribute to respiratory disease and may be a consequence of normal aging. Objectives: To describe the changes in asymptomatic elderly patients compared with those in younger patients in a Thai population. Methods: The study cohort comprised 60 participants without respiratory symptoms in three groups of 20 by age: 20−40 years, 41−60 years, and >60 years. Participants were prospectively selected from patients referred for computed tomography (CT) of the abdomen, or head and neck, and underwent sequential CT during deep breathing at four lung levels. Two observers scored images by consensus. We compared groups using Pearson chi-square and Fisher exact tests, and used receiver operating characteristic curves to categorize bronchiectasis and bronchial wall thickening by age. Results: Air trapping was related to age (5/20 group 1, 7/20 group 2, and 18/20 group 3 (P <0.01)) and was most prevalent in lower lobes (78%, P < 0.01). Reticulation was found in only one middle aged patient (P = 0.36). Bronchiectasis was more common in patients <56 years (7/23) than <56 years (3/37), P = 0.035. Bronchial wall thickening (7/23 in patients >56 years and 2/37 in patients <56 years, P = 0.02) and extensive air trapping were related to age (0/6 group 1, 1/6 group 2, and 5/6 group 3, P = 0.02). Findings were independent of smoking history. Conclusions: Asymptomatic older patients had higher prevalence of bronchiectasis, bronchial wall thickening, and air trapping, independent of smoking history.

Does the computed tomographic appearance of the lung differ between young and old dogs?

“…In this study, examination of the CT images included quantitative measurements and search for multiple possible lesions based on previous studies of CT signs in aged humans; however, few examples were found of ground glass pattern, bronchial thickening, or bronchial dilation, and no signs of reticular pattern, emphysema, pleural thickening, or septal thickening were identified in any dog. Hence, finding any of these features in CT images of a dog with respiratory signs suggests the presence of nonage‐related lung pathology that is clinically relevant.…”

“…The number of dogs available for study was limited by the need to avoid including dogs likely to have had pathologic lung lesions. Use of a single observer to review the CT is also a limitation, but this is not considered to be a major problem because of the relatively homogenous nature of the study sample and use of comprehensive, preconsidered assessment criteria based on previous studies of humans …”

“…Changes associated with normal aging in the lungs of humans have been studied extensively, one aim being to avoid overdiagnosis of age‐related changes as signs of clinically significant disease. Age‐related changes seen in pulmonary CT images of humans include decreased lung attenuation as a result of dilatation of alveoli and/or emphysema, air‐trapping, cysts, a subpleural reticular pattern, bronchial dilation, bronchial thickening, and thickening of interlobular septa without inflammation . Computed tomographic signs usually associated with interstitial lung disease may also be seen in healthy elderly humans, and radiologists have been cautioned not to overinterpret such findings in asymptomatic patients .…”

Frequency of Incidental Ageing-Related Lung Findings in an Elderly Population: A Saudi Teleradiology CT Study

“…In symptomatic patients, thickening of the walls of the small airways is associated with various reactive and inflammatory conditions [11,12]. On the other hand, such finding is commonly seen in elderly asymptomatic cases, typically win the thickening is of mild or moderate degree [1,3]. Mosaic attenuation due to air trapping has a known association with small airway disease, including bronchial wall thickening [4,11].…”

“…Several ageing-related morphological lung changes can be detected by computed tomography (CT), many of which are incidentally seen in asymptomatic populations [1][2][3][4][5]. Such findings include bronchial wall thickening, bronchial dilatation, mosaic attenuation from air trapping, pneumatocoeles, linear opacities and reticulations [1,2,4,6,7].…”