Subjective pitfalls in HRCT interpretation

High-resolution computed tomography (HRCT) allows a detailed assessment of the anatomy and pathology of the pulmonary parenchyma. However, numerous potential pitfalls exist that can hinder or preclude accurate interpretation of HRCT images. These sources of potential diagnostic error can be systematically evaluated with respect to the major categories of HRCT abnormalities: (1) increased parenchymal attenuation, (2) linear opacities and interstitial disease, (3) nodular lung disease, and (4) holes in the lung. Accurate HRCT interpretation depends on the correct recognition and characterization of imaging abnormalities. Technical factors that enhance or limit scan interpretation, HRCT features of subtle disease, and imaging mimics of commonly observed pathology are addressed in detail with regard to each of the above categories of disease. Common pitfalls are illustrated and explained in an effort to increase general awareness of these sources of real and potential diagnostic confusion.