Back in 2007, I met this girl at a swing dance bar in Denver, Colorado and we chatted a little bit. I got her number and then we started messaging each other the next day. And while we were messaging each other, I ended up going to and taking a shower and when I got back out of the shower I looked at my phone and she had messaged me something like seven or ten times since I went into the shower and the conversation was like her having a conversation with herself. She like asked a question and then she commented on it and then she said a few things and then she was like, why aren't you responding to me?  And this happened in a matter of 15 minutes and she didn't realize but she was lowering her value in my eyes by doing this. She was making herself less attractive by the things that she was saying. And now you may be thinking, that's great, Matt, but this guy that I've been talking to hasn't messaged me. It's been a lot longer than 15 minutes since he messaged me. What should I do? Well, I'm going to tell you exactly what you should do if a guy hasn't messaged you back or if he's ignoring you or something like that over text message. But first let's talk about some of the reasons why guys don't message back. First one is that he's busy with something. Second is he doesn't really like texting. Third is he thinks that you're acting needy and so he's feeling less attracted to you. Fourth is that he really isn't all that into you in the first place. Number five is that he's not near his phone. Number six is that he's with another girl. And ultimately what all of these boil down to is that you're just not a priority to him at this moment. And so although it might you might be a priority to him at other moments, but at this moment, you're just not a priority to him. So before we talk about exactly what you should do, let's talk about what doesn't work when messaging men when when he hasn't responded to your text message. What doesn't work. Number one is chasing him. Don't chase men never chase a guy right men value things that they work for best case scenario here if you start chasing him and messaging him all the time and what are you doing and trying to contact him and setting things up and start doing everything best case scenario is that he'll run away. Why is that the best case scenario? Because the worst case scenario is that you'll start doing everything in the relationship and he'll start taking you for granted which is what happens in most scenarios when women do this with men.  He'll feel like you're amazing and interesting and different. And he won't take you he won't end up taking you for granted. And if something does end up going wrong, you'll know about it immediately. If you don't, if you're the one chasing him, a lot of guys, even if they lose interest or lose attraction for you, they in your pursuing them, they'll just let you do it. And so you don't want to be in that situation. Number two is games and manipulation. So games and manipulation don't work. They only work temporarily if they do it all. And when you do that, when you start playing games, usually the guy starts playing games as well. And then you're just playing games with each other forever. And you have to play a game in order for him to stay interested. And so you don't want to play games and you don't want to use manipulation. The third one that doesn't work is shaming or condemning him. And the reason that you don't want to do this is because if he's really a high value man, what he'll end up doing is walking away from you. And if he's not a really high value man, and he decides that he wants to stay and deal with your shaming and condemning, what he'll end up doing is feeling a lot of resentment for you a lot of anger towards you and you don't want to do that. And then the fourth thing that you don't want to do is attacking or getting any kind of revenge on him. This is really just creating a cycle of hurting each other because you're going to hurt him.  And then he's going to try to hurt you. And it's just going to be this cycle that spirals downward into an oblivion of something that you absolutely do not want to experience. So what does work? What should you do if a man is ignoring you? He doesn't text back to you. You sent him a message. And he doesn't text back. What should you do? Number one is you should give him some space.  And what it is, is it's like, imagine that you and the guy are in a rubber band together and you push him away from you and he snaps back towards you, right? And so that's kind of what you want to do is you want to give him that space, give him that space, because he can't miss you if you're around him all the time. And so if he's not doing what you want him to do, if he's pulling back a little bit, if he's ignoring you or whatever, you want to give him some space, just give him some space for at least a day or two or three, depending on what the situation is. And usually most guys will end up coming back in that period of time. If he hasn't done that, then we'll talk about what to do after that. But don't make him the center of your universe. What you want to do is have your own life outside of this man, you want to create your own identity, your own life, have your own passions, have things going on, have friends, have connections, have everything going on outside of your life so that the man isn't the center of your universe. You want him to be an addition to your life, not the center of it. And so the second thing that you want to do is praise him when he comes back. And a lot of women get really angry at me when I say this, because they're like, Oh, no, you know, you have to punish him and you got to tell him what he did wrong and all that kind of stuff. Well, anybody, any kind of animal trainer out there, whether it's dog trainers or cat trainers or anyone, they know that if an animal runs off, he runs away, you do not punish that animal when it comes back, because you're punishing the good behavior, the bad behaviors running away, the good behaviors coming back. So you don't punish the good behavior, or the person, the animal, the whatever will stop doing the good behavior. And you might be thinking, Well, he's not an animal. Well, we're all animals, right? And so we all behave in a similar way, and we go towards things that we are rewarded for going towards, and we stay away from things that were punished for going towards.   So we're talking about that a little bit earlier. And basically what you want to do is you want to test him. And so some women think that a man has ghosted them, right? So a guy like stops contacting them for a day or two, or three or four, and they're like, Oh my God, he ghosted me. Well, it's really interesting because I have women come to me with this challenge all the time. And they're like, man, this guy ghosted me. And you know, what should I do in the future? And I'm like, are you sure? Are you sure he ghosted you?  And they're like, Well, what do you mean? And I have them send a text message to that guy. And what happens a lot of the time is the guy ends up responding and thinking that she actually ghosted him. And so it's it's not always the case that or or a lot of times he'll think that she's not interested because she's like leaning back too far and and trying to get him to pursue her. But she's she hasn't shown any interest or any of that kind of stuff because there's other dating coaches out there that teach that kind of nonsense. And you don't want to do that, right? Instead, if the guy has kind of disappeared for a little bit, you send a message and he hasn't responded for a while. And it's been a couple of days. You want to send him a message just to test what's going on and see what's going on. You don't want to start pursuing him at that point. You don't want to start chasing him and doing everything. But you can test the waters and find out what's going on with him just to make sure that he's okay, just to see if he wants to start connecting with you again, just to make sure that he doesn't think that you ended up ghosting him. And so I actually have a forward text message that's designed when a man pulls away or ghosts or disappears on you that you can send to him that gets his attention and makes him realize that pulling away from you was a mistake. A lot of women that have sent this message to guys, the guys actually responded and apologized for pulling away and taking these women out for dinner or drinks or all kinds of different things in order to make up for pulling away in the first place. If you want to know what that forward text message is, click the button on the right hand side of this screen to watch a video about it right now.


All right, we'll go ahead and get started. It is now 1201. Just want to say hello and welcome to the sixth of many live stream noon conferences hosted by MRI online. In response to the changes happening around the world right now and the shutting down of in-person events, we have decided to provide free daily noon conferences to all radiologists worldwide. Today we are joined by Dr. Jeanette Collins. She is a thoracic radiologist, an editor of seminars in a rent genealogy and MRI online. She is a prior program director, prior dean of graduate medical education and prior radiology chair. She is the author of Essentials in Test Radiology and over 225 papers. She is a past president of Society of Thoracic Radiology, Association of University Radiologist, Association of Program Directors in Radiology, Alliance of Clinician Educators in Radiology, Radiological Society of North America, the recipient of the RSNA Outstanding Educator Award, the AUR Gold Medal. Just a reminder that there will be time at the end of this hour for a Q&A session. Please use the Q&A feature and we will get to as many of those as we can before our time is up. That being said, thank you so much for joining us, Dr. Collins. I will let you take it from here. Thank you, Ashley. I'm honored to be a part of MRI online's initiative to provide free live streaming and on-demand education to trainees and practicing radiologists worldwide. Thank you all for attending. I also want to thank all of you who are making personal and professional sacrifices during the COVID-19 pandemic. The topic today is CT Patterns of Lung Disease. I have the following disclosures. I get paid by Walters-Clure Publishing. I get paid by Elsevier as Editor of Seminars in Rancology. And I get paid by MRI online as the Director of Medical Content. None of these entities influence the content of this presentation. These are three objectives for you. So this is what I want you to be able to do at the end of this presentation. To describe seven patterns of disease seen on CT. To recognize each of those seven patterns when you see them on CT. And lastly, to give a differential diagnosis for each of those patterns. This is a list of the seven patterns I will discuss. But I want you to look at the thumbnail images on the right because I think you can appreciate that the appearance of each is very different from all the rest. And that's why it's important to recognize patterns because doing so can help you narrow the differential diagnosis. And in some cases, suggest a specific diagnosis. I'll start with the honeycomb pattern. This is cystic air spaces that have thick, clearly defined walls. Typically layered along the pleural surface. Honeycombing represents pulmonary fibrosis. The most common cause of pulmonary fibrosis is idiopathic pulmonary fibrosis or IPF. This is the imaging equivalent of the pathologic diagnosis of usual interstitial pneumonia. Other causes of pulmonary fibrosis are collagen vascular diseases, asbestosis. And if you see a predominantly upper lung distribution of honeycombing, you want to think about end stage sarcoidosis and chronic hypersensitivity pneumonitis. This is a macroscopic specimen of a lung of a patient with pulmonary fibrosis. You can appreciate multiple holes in the lung representing the honeycomb pattern. This is a case of a 62 year old woman with chauvin disease. I'm showing you four images of the lungs spanning the upper lungs to the lower lungs so that you can appreciate that in most cases of pulmonary fibrosis with honeycombing, the disease is worse in the basis than it is in the upper lungs. If you look closely, you can see the cysts with clearly defined walls layered along the pleural surface. And if you get really close, you may even hear the bees buzzing in this honeycombing. There are two other features of pulmonary fibrosis that are also featured on this image. One is traction bronchiectasis. We can see that in the posterior right lung where we see dilated airways that are being pulled toward this area of fibrotic lung. And in the more anterior right lung, we can see a pulmonary vessel with a very arcuate contour because it too is being pulled toward this area of fibrosis. This is architectural distortion. So three main features of pulmonary fibrosis are honeycombing, traction bronchiectasis and architectural distortion. The next pattern is a cystic pattern which is thin walled circumscribed air filled structures in the lung. There are unlimited number of diagnoses to consider when you see this pattern. The two most common are Langerhans cell histiocytosis and lymph angioliomyomatosis. That's kind of a tongue twister, so we often call it LAM. Other diagnoses to consider are lymphocytic interstitial pneumonitis which commonly occurs with chogren syndrome, collagen vascular diseases and pneumocystis pneumonia. Now there's another item on this list, emphysema. I put that item here even though emphysema is not a true cystic lung disease, but it can look like cystic lung disease. This is what central lobular emphysema looks like typically. You can see numerous loosened areas throughout the lungs. Some people have called this the Swiss cheese appearance. As with any smoking related disease and central lobular emphysema is a smoking related disease, the findings are more prominent in the upper lungs. So how can you differentiate central lobular emphysema from true cystic lung disease? There are two ways. One, if you look at these loosencies throughout the lung, you can see that they don't all have circumferential walls. So I'm showing you one of these loosen areas in the left lung where you can see the posterior margin is not walled off. It does not have a true circumferential wall like true cystic lung disease will have. A second feature of central lobular emphysema is seeing an opaque dot or linear opacity or arcuate opacity within the center of the loosency. This represents the central lobular artery. You will not see this in true cystic lung disease. So let's look at some cases of true cystic lung disease starting with this case of a 50 year old woman with progressive shortness of breath and a history of spontaneous pneumothorax. This is a case of lymph angiomyomatosis. This is a pretty typical appearance of lamb where there are multiple round circumscribed nice looking cysts throughout the lung with absolutely normal intervening lung parenchyma. Lamb is a disease where the cysts occur throughout the lungs upper, mid and lower. You can suggest the diagnosis of lamb if it's a female pre menopausal patient. Lamb occurs in females. I actually did read a report of a male blue nose dolphin who had lamb, but I think it's safe to say that if it's a male patient unless he has tuberous sclerosis complex which is along the same spectrum of diseases lamb that it's going to be a female that has lamb not male. Now there are other features of lamb that can help distinguish it from other cystic lung diseases. One is that they often have pleural effusions, specifically chylous pleural effusions. And another feature associated with lamb are renal angiomyopomas. Here's another case of lamb where you can see multiple cysts in both lungs and this patient developed a common complication of lamb and that is spontaneous pneumothorax. There is a large pneumothorax on the left with partial collapse of the left lung. The pneumothorax is smaller on the right seen at the right apex and at the right base. Here's a third case of lamb. This is a very severe case. This patient had end stage lung disease secondary to lamb. Developed a spontaneous pneumothorax as shown by the letter P on the right. And when the case of lamb is so severe as it is here it can be sometimes hard to appreciate the cystic pattern because it almost looks just like diffuse honeycomb lung. This next case is of a 40 year old man with a history of cigarette smoking and an abnormal chest radiograph. He had no respiratory symptoms. This is a case of lamb's cell histiocytosis. This is another smoking related lung disease and therefore you would expect the findings to be most prominent in the upper lungs. So I'm showing you four images of the lungs from top to bottom so that you can see that the bases of the lungs are normal except for minimal ground glass opacity in the posterior lungs, which represents dependent adolectasis. But the findings of lamb's cell histiocytosis are in the upper lungs. And what are those findings? Cysts and nodules. Now, lamb's cell histiocytosis starts out as nodules which become cysts. So you may only see nodules or you may see both nodules and cysts or you may only see cysts. Typically the cysts of lamb's cell histiocytosis tend to be a little more thick wall than those seen with lamb and more irregular or more nasty looking. Not like the nice happy cysts that I showed you in the case of lamb. Lamb's cell histiocytosis is seen in the upper lungs. Lamb is seen, the cysts of lamb are seen throughout the lungs. Here's another case of longer Han's cell histiocytosis where you can see nodules and cysts. If you see nodules and cysts in the upper lungs of a cigarette smoker, you can make the diagnosis of longer Han's cell histiocytosis with about 99% degree of confidence. This is a case of lymphocytic interstitial pneumonitis, a patient with chauvin syndrome. Now this is a cystic lung disease that tends to occur predominantly in the lower lungs. You can see nice round cysts with circumferential walls. And there is a feature of LIP that can help distinguish it from other causes of cystic lung disease. And that is that patients with LIP have a greater incidence of maltomas and other types of lymphoma, as did this patient, which we can see by the presence of this nodule in the periphery of the left lung. This is a case of pneumocystis pneumonia, the most common feature on CT of pneumocystis pneumonia is ground glass opacity, which I will be discussing in just a minute. This patient does have a lot of ground glass opacity in both lungs, but another feature is this cyst. In this case, this is an irregular cyst. And in fact, in pneumocystis pneumonia, the cysts are actually expanding pneumata seals. That's what the P stands for. You can see cysts with pneumocystis pneumonia that are very small and very thin wall, or you can see cysts that are quite large and have thick walls. You may see one or two cysts or there may be multiple cysts. Here's a different case of pneumocystis pneumonia, presenting predominantly with ground glass opacity, especially in the left lung, but also this multi-loculated cystic structure. And that's been a defining feature of pneumocystis pneumonia, is cysts that are multi-loculated. If you see this pattern of ground glass opacity and multi-loculated cysts in a patient with AIDS or who is otherwise immunocompromised, you must suggest the diagnosis of pneumocystis pneumonia. I'm going to talk next about four nodular patterns. One is the perilimphatic pattern. Another, when there is no discrete pattern, I call random. Third is a central lobular pattern. And then fourth, bronchovascular. I'll start with the perilimphatic pattern. Note that my differential diagnosis includes only one thing because the most common cause of the perilimphatic pattern is sarcoidosis. To understand what I mean by perilimphatic, it's helpful to look at an illustration of the lymphatic distribution in the lung. The lymph starts in the subplural lymphatics and courses more centrally along the bronchovascular bundles to drain into the higher lymph nodes. So now hopefully you can see how a perilimphatic distribution will be subplural and bronchovascular. A perilimphatic distribution is subplural and bronchovascular. The classic appearance of parenchymal sarcoidosis is nodules in a perilimphatic distribution. Note the nodules in a subplural location. Remember that the fissures are also plural line. So expect to see nodules along the fissures as well. The bronchovascular bundle on the left shows that it is very beaded in appearance, very irregular. You can see how it differs from the bronchovascular bundle in the right lung. So this is peribronchovascular nodules. These are subplural nodules. This represents a perilimphatic distribution of nodules. The classic parenchymal findings of sarcoidosis. Here's another case of sarcoidosis with subplural nodules and nodules along the bronchovascular bundle. Note that some of these nodules are a little bit larger than the nodules I showed you in the last case. The nodules in sarcoidosis tend to be one to five millimeters in size but can sometimes be a sonometer or even larger. And yet another case of sarcoidosis with perilimphatic distribution of nodules, subplural and bronchovascular. Now, when there is no dominant pattern, we can think of it as a random pattern. And the diagnoses to consider in this case would be silicosis and co-workers pneumoconiosis, tuberculosis and fungal infection. And by the way, whenever I say tuberculosis, fungal rolls right off my tongue because all of the features of tuberculosis can also be present with fungal disease. And metastases also will have a random pattern of nodules. In this case, we can see multiple small one to three millimeter nodules profusely throughout both lungs. Now, you may be seeing that there are some nodules in a subplural location, but the dominant pattern is not subplural. The dominant pattern is random. This is a typical appearance of simple silicosis. And with this appearance, with this profusion of nodules, these patients are often asymptomatic. But over time, these nodules coalesce, they become mass like, progressive massive fibrosis is the term we use for that. And those patients are symptomatic. This is a case of biliary tuberculosis. Looks very much like silicosis. And this is a case of colon cancer metastases. There are a couple typical features of metastases to the lung, whether it's from a primary bronchogenic carcinoma or an extra pulmonary tumor. And that is that the nodules tend to be well circumscribed and they tend to be varying in size with some very small and some very large. The next nodular pattern I'll talk about is the central lobular pattern. And to understand this, I'm showing you an illustration on the left of the secondary pulmonary lobular architecture. The secondary pulmonary lobules are the smallest unit of lung that may be seen on CT. They are seen best in the periphery of the lung. The hexagonal shape of the secondary pulmonary lobule is formed by the inter lobular septae. And in the middle of the secondary pulmonary lobule is the core pulmonary artery and bronchiol. Now, if you take away the septae and just leave the core structures behind, as I'm showing you on the right, you can see that the central pulmonary arteries or whatever may be affecting the central lobular structures are fairly equidistant apart. So a central lobular pattern of nodules will be nodules that appear fairly equidistant from each other. And here are two diagnoses to consider when you see this pattern. Subacute hypersensitivity pneumonitis, also called extrinsic allergic alveolitis and respiratory bronchiolitis. Now, respiratory bronchiolitis is a disease of exclusion. It occurs in the upper lungs of cigarette smokers. Remember that all smoking related lung disease tends to occur predominantly in the upper lungs. This is a pretty typical appearance of hypersensitivity pneumonitis. Note when the main features of the central lobular pattern, at least how I define it, is that the nodules are not dense like they are in the cases I showed you of silicosis or miliary tuberculosis. These nodules are hazy ground glass opacities. And I think you can imagine that they're fairly equidistant apart because they're so hazy, they're a little bit hard to recognize as discrete nodules. But that's part of the typical appearance of hypersensitivity pneumonitis. This CT scan is of a patient who had multiple symptoms, cough, dyspnea, shortness of breath, et cetera. And she went to the hospital, she was admitted, she was treated with antibiotics and got better. And then she went home and all of her symptoms reappeared until it was discovered that she was allergic to her parrot. This is a typical scenario of people with hypersensitivity pneumonitis. They'll get better in the hospital, not because of the antibiotic treatment, but because they're away from the offending substance that they're allergic to. Here's another case of hypersensitivity pneumonitis, numerous hazy ground glass nodules. Perhaps you can imagine that they're about equidistant apart from each other. This next case is of a 43-year-old man with shortness of breath and a history of cigarette smoking. This patient had no respiratory symptoms, but I saw all of these ground glass nodules. The arrows point to a couple larger nodules, but if you look closely, you can see that there are multiple tiny ground glass nodules all over in the lungs. Now you wanna be careful in situations like this that you don't automatically start thinking about cancers and infections and numerous other diagnoses that this could represent in a patient who's asymptomatic. If it's a cigarette smoker, at least be thinking about the diagnosis of respiratory bronchiolitis, particularly if they have this appearance and they have an upper lung predominant distribution. Now the last nodular pattern I will discuss is the bronchovascular pattern. And here are some things to consider. Lymphoproliferative disorders, lymphengetic carcinomatosis, capacy sarcoma, sarcoidosis, organizing pneumonia and infectious pneumonia. This is a patient who had undergone bone marrow transplant and developed post-transplant lymphoproliferative disease. This is a very typical appearance of post-transplant lymphoproliferative disease. Ill-defined nodules along the bronchovascular bundles. If you know this patient has had a bone marrow or solid organ transplant and you see these findings, you can be very confident in suggesting the diagnosis of post-transplant lymphoproliferative disease. Now you can't exclude infection, but the treatment for post-transplant lymphoproliferative disease is a decrease in immunosuppressive therapy, which is very different from the treatment of pneumonia, which is some kind of antibiotic. And if you don't decrease the immunosuppressive therapy, this disease can progress and become malignant lymphoma that isn't well treated. This is a case of capacy sarcoma, which is still occurring in patients with AIDS. Nodules along the bronchovascular bundles tend to be in the lower lungs. They may be small nodules, causing a beaded appearance to the bronchovascular bundle. Or the nodules may become a little bit larger, creating what people have referred to as flame-shaped nodules. Or the nodules can coalesce, as we're starting to see in the left lower lung, creating more mass-like appearance. It's hard to distinguish individual nodules when the disease progresses to this state. There are a couple other features of capacy sarcoma that help differentiate it from other causes of bronchovascular nodules. One is septal thickening. In the left anterior lung, we can see this opaque linear opacity representing thickening of the interlobular septa. This is equivalent to the curly B lines that you see on chest radiographs. This patient also has small pleural effusions. If you see these findings of bronchovascular nodules, septal thickening and pleural effusions in a patient with AIDS, you should suggest the diagnosis of capacy sarcoma. I show you again this case of sarcoidosis just to remind you that bronchovascular nodules are a subset of the perilympathic distribution. Remember the perilympathic distribution is subplural and bronchovascular nodules. The next pattern is ground glass. If you've never seen it before, well, here's an image. And what it is, is glass that you can see through. You can see the person's hand through the glass. On chest CT, ground glass is hazy opacity that does not obscure the underlying airways or vasculature. It's a very nonspecific finding and the differential diagnosis is very long. But here are some of the most common findings when you see most common causes of ground glass pattern or at least when you see ground glass, it's very typical for the particular diagnosis. Infectious pneumonia commonly presents as ground glass opacity with or without consolidated areas of lung, pulmonary hemorrhage, particularly in a patient who say a month out from bone marrow transplant. If you see diffused ground glass opacity, you want to be thinking about pulmonary hemorrhage. Organizing pneumonia, pulmonary alveolar prodenosis, and even one type of cancer, adenocarcinoma in situ. Less common causes of the ground glass pattern, but very typical for those diagnoses, is deschromative interstitial pneumonitis and nonspecific interstitial pneumonitis. I put the very last item in capital letters, emphasized with an exclamation point, so that you always will remember to think about pulmonary edema when you see ground glass opacities. Although it's very nonspecific, edema is very common. Well, here's a case of diffused ground glass opacity. Note that you can still see the pulmonary vessels and the airways. This is a case of mycoplasma pneumonia, but this could just as easily be any other infectious etiology, especially any viral disease. This could be a severe case of COVID-19 pneumonia. This could be diffused pulmonary hemorrhage. This patient does have small pleural effusion, however, which is not a typical feature of COVID-19 pneumonia. Here's a case of a patient who has scattered ground glass opacities and also small cysts in the right posterior lung and the left anterior lung, as well as a few areas of more consolidated lung. Now you might already know what the diagnosis is because I showed you a similar case earlier, a patient who had ground glass opacity and cysts. This is a case of pneumocystis pneumonia. This is a typical case of organizing pneumonia, peripheral ground glass opacities. In about 50% of cases of organizing pneumonia, you will see a peripheral distribution of ground glass opacities and also in some cases, consolidation. You may be familiar with this appearance of peripheral ground glass opacities if you've been seeing some of the cases of COVID-19 pneumonia that have appeared because this is a typical finding in the early stages of COVID-19 pneumonia. As well as in addition to peripheral ground glass opacities, you may also see rounded nodular areas of ground glass opacity. And after about 10 to 12 days, COVID-19 pneumonia can progress to more profuse ground glass opacity and even areas of consolidation. Now it's not surprising that COVID-19 pneumonia presents in a similar fashion to organizing pneumonia because pathologically we know that what we're seeing on the CT scan in cases of COVID-19 pneumonia is organizing pneumonia. This is a case of pulmonary alveolar proteinosis. In addition to ground glass opacity and even some areas of consolidation, we see amidst the areas of ground glass opacity, these thickened intralobular lines and intralobular septi, creating what is called crazy paving. Crazy paving is a buzzword. It was coined, the term was coined for pulmonary alveolar proteinosis. But since then, we've identified multiple other causes of crazy paving. So it's really a non-specific finding. This is another case of pulmonary alveolar proteinosis where you can see the few areas of ground glass opacity and intralobular lines and thickened intralobular septa, crazy paving. There's also an incidental finding on this coronal CT scan. Did you notice this arcuate opacity in the right apex? And do you know what that is? Well, if you said that's an accessory asagis fissure, you are correct. Now, what is this rounded opacity abutting the inferior edge of this fissure? Well, if you said that's the asagis vein, then you are correct a second time. Normally, the asagis vein is positioned at the right tracheobronchial angle, but the asagis vein is always abnormally superior in position when there is an accessory asagis fissure. As I said earlier, you can even have cancerous causes for ground glass opacity in the lung. Most typically, that will be adenocarcinoma in situ. These two images are from two separate patients with adenocarcinoma in situ, showing the typical appearance of a rather ill-defined but rounded area of ground glass opacity. You have to be vigilant to look for these areas and you can't determine that if they've been stable on a CT scan for a year that they are okay, benign, and you can forget about them because adenocarcinoma in situ can be a very indolent type of cancer. And I've seen numerous cases where these ground glass nodules do not change perceptively in a year or two years. And I have a couple cases where they did not change significantly in five years and then they can start to enlarge and become more aggressive. Here's a case of numerous areas of ground glass opacity and septal thickening. This is a case of pulmonary edema. Remember that pulmonary edema is such a common diagnosis that you need to think of it often. The next pattern is the mosaic pattern. Now mosaic just refers to heterogeneity. And I've already showed you infiltrated disease that can cause a mosaic pattern of lung attenuation such as multifocal pneumonia. So I'm gonna focus on two of the other main causes of a mosaic pattern of lung attenuation, small airways disease and pulmonary vascular disease. This is a patient who had a bone marrow transplant and developed chronic rejection which pathologically is seen as obliterative bronchiolitis. This is a disease where there is closure of the small airways in the lung. I'm showing you two images. One is taken during inspiration. The second image was after the patient was instructed to take in a big breath, blow it all out and hold it. So that's an expiratory image. If you haven't seen expiratory images before, you should become familiar with the features that define them as expiratory. One is that on expiration, the posterior membranous trachea will be bowed anteriorly. Note that on the expiratory image, the trachea is either nice and round or ovoid in shape. On expiration, the trachea is bowed and takes on an arcuate shape. The second feature of expiratory images is decreased lung volume. You would expect that because when you blow the air out of your lung, the lungs have less volume. In addition, with less air in the lung, the overall Houndsville attenuation of the lung will increase. So you expect to see more opacity in the lungs on expiration compared with inspiration. Now, this inspiratory image looks normal. If you look really closely, you may be able to see a little bit of heterogeneity in the lung attenuation, but most days I call that normal. But it's wildly abnormal on the expiratory image. These images were taken one minute apart. What's happening is the air is getting into the small airways, but it can't get out on expiration. So the air is trapped and that's what these loosen areas represent is trapped air. The more highly attenuating lung is the normal lung where the air gets out on expiration. This is a mosaic pattern of lung attenuation due to obliterative bronchiolitis. In some cases of obliterative bronchiolitis, the disease is so severe that most of the lung traps air and even on inspiratory images, you may not be able to appreciate the mosaic pattern of lung attenuation. I think you can still see it a little bit in this case where there are areas of lung that are more loosen next to areas of lung that are more opaque, but it's not as dramatic as I showed you on the last image. This patient has more severe small airways disease and also has other features of small airways disease. If you look at this bronchovascular bundle on the left lung, this is in the lingula, what you see is the airway is dilated and thick wall. The pulmonary artery next to it is of smaller diameter than the adjacent airway. Normally they are the same diameter, but this airway is abnormally dilated. This is referred to as the signet ring sign. Now those were cases of mosaic lung attenuation secondary to small airways disease, but vascular disease can also cause mosaic lung attenuation. We often refer to that as mosaic perfusion. This is a case of sickle cell disease. Now what happens in sickle cell disease is that the red blood cells take on a sickle shape which clogs the pulmonary vessels. That leads to decreased perfusion to the subtended lung. And since the lung is not being normally perfused, it is more lucent appearing. The normally perfused lung will be of higher attenuation than the lung that is not being normally perfused. Another clue that can sometimes help to determine a mosaic pattern of perfusion is that the vascular structures in the abnormally perfused lung are diminutive compared with the vascular structures in the adjacent normally perfused lung. Another vascular disease that can result in mosaic perfusion is chronic thromboembolic disease. Here's another case of mosaic perfusion on coronal CT. You can appreciate the heterogeneous appearance in lung attenuation. The next pattern I'll talk about is the tree and bud pattern. This is centralobular dots and linear branching opacities seen best in the periphery of the lung. Remember the secondary pulmonary lobules I showed you? The centralobular arteries and airways run in the center of the secondary pulmonary lobules. When those small airways become impacted by mucus, or other type of debris, they are seen as these dots or linear branching opacities on CT dependent upon whether they're seen in profile or cross-section. What they are is dilatation and impaction of the small bronchioles. You may be seeing this outside your window today. I took this image outside my office window. It's a tree in bud. A tree is analogous to the airways of the lung because they both branch and taper as they go from the center to the periphery. But what's happening here is that at the very end of the limbs, it's not tapered. There are multiple rounded Y-shaped densities that represent the budding. Well, on a CT scan of a patient who has infection or something that is filling the small airways and dilating them, you will see these small irregular opacities. This is the differential diagnosis from a tree in bud pattern that I'm gonna start with because if you don't remember anything else from this presentation, I hope you'll remember that the most common cause of the tree in bud pattern is infection. The most common cause of the tree in bud pattern is infection, any type of infection. This is a case of bacterial bronchiolitis. And what we see is predominantly in the periphery of the lungs where the small airways are located. You see these linear and branching opacities. In some cases, you see dots as in the posterior right lung here, another dot here, another dot here. When you see the dot, you're seeing the impacted small airway that's not in profile. It's seen in cross-section. And when you see the linear opacities, you're seeing the impacted airways in profile. This is a case of mycobacterium avium complex showing the same tree in bud pattern. And this is a case of methicillin resistant staphylococcus aureus pneumonia showing you the tree in bud pattern. Now, this patient's pneumonia also caused occlusion of the left lower lobe airways leading to left lower lobe collapse. And that's why you see this straight edge representing the posteriorly displaced left major fissure. Well, there are other ideologies of the tree in bud pattern including allergic bronchopulmonary aspergillosis, cystic fibrosis, aspiration and diffuse pan bronchiolitis. I won't be talking about this latter entity. We don't see it often in North America, but some of you listening to me now may be from Asia, where there is a greater prevalence of this disease and it can have the same appearance as the other diagnoses that I'm going to be discussing. Allergic bronchopulmonary aspergillosis is a type of aspergillus lung disease that is not infectious. It is an immunologic response to the aspergillus hypha that accumulate in the airways caused damage to the airway walls leading to bronchiectasis. The seniquanon of allergic bronchopulmonary aspergillosis is central bronchiectasis as we see here in the right upper low, a very dilated airway. Now sometimes the airways are patent in ABPA and sometimes they are impacted with aspergillus hyphae, mucus, and other debris. When they are impacted, they will appear opaque on chest radiographs and on CT scans and they may take on the appearance of a finger in glove or a Mickey Mouse ears or other such descriptions. But ABPA not only can involve the central airways, but the aspergillus hyphae and other debris can extend into the small airways creating the tree and bud pattern that we can see in the right lower low posteriorly. ABPA is not treated with antibiotics. It's usually treated with corticosteroids because it's an immunologic process. Cystic fibrosis is a disease where patients make too much mucus that collects in the airways that also damages the airway walls and leads to bronchiectasis. Typically early on in cystic fibrosis, you will start to see dilatation of the central airways. And later on, as the disease progresses, it will involve the more distal small airways. Just as an ABPA, you may see the airways as patent or you may see them impacted. This patient has both central bronchiectasis as well as bronchiolectasis and tree and bud opacities from impacted small bronchioles. Uncommonly, cystic fibrosis may predominantly involve the small airways. This is unusual, but I have seen more than one case of this. I practice in a hospital where we do cystic fibrosis research and I have read numerous chest radiographs and CT scans, thousands actually, of patients with cystic fibrosis. So I have come across this where you see these tree and bud opacities representing involvement of the small airways but the central airways don't really look that bad. This is a case of a patient who aspirated which caused impaction of the small airways creating the tree and bud pattern. And you'll notice that this area of tree and bud opacity in the posterior right lung has the appearance of a jack in that ball and jacks game that you may be played when you were younger. I used to love that game myself. And that's why this is sometimes referred to as the jacks sign. Dr. Collins. Yes. I hate to cut you off here but we've got just a few minutes left and you have some excellent questions happening in the question and answer section. Thank you, Paul. So let me wind this up by saying that the last pattern is septal thickening and it can be smooth or irregular but smooth septal thickening is usually due to pulmonary edema. Look for ground glass opacities and pleural effusions to suggest that diagnosis.  And lymphogedic carcinomatosis which tends to cause beaded septal thickening. And I wanna say this because it's important when you see beaded septal thickening and nodules throughout the lung and it involves only one lung it's almost always lymphedic carcinomatosis due to primary bronchogenic carcinoma. So let's look at some cases. Ready to see if you learned those three things that I wanted you to have as your objectives. What's the pattern? And your options are honeycomb, cysts, nodules or cysts and nodules. Let's see what you think. And 85% of you said cysts and nodules and you are correct. Excellent. This patient has numerous cysts and nodules throughout the lung but we're not done yet. So now that you have the pattern you probably have a differential diagnosis and to narrow that differential diagnosis you need to ask the question. What question do you need to ask? What is the person's occupation? Are they a cigarette smoker? Do they have fever, chills and night sweats? Or do they have a history of a college and vascular disease? Let's see what you think. Well, there's quite a spectrum of answers here. The majority of you want to know whether the patient is a cigarette smoker. And that is exactly the question that you should ask because this is a 32 year old man with a history of cigarette smoking who had nodules and cysts in the upper lungs. The typical presentation and CT appearance of Longerham's cell histiocytosis. Next case, what is the pattern? And these are your options, honeycomb, cysts, nodules and cysts and nodules. Let's see what you think. And 97% of you are correct. This is a pattern of nodules. Specifically, hazy ground glass centralogular nodules. And this is the patient's history. Worsening dyspnea on exertion, cough, fever, chills, anorexia. She is not a smoker, but she does have a pyrrhic at home. So what's the most likely diagnosis? Asbestosis, Longerham's cell histiocytosis, respiratory bronchiolitis, or hypersensitivity pneumonitis. And what did you say? 97% of you got this right, hypersensitivity pneumonitis. Now you could have thought of respiratory bronchiolitis which can appear as centralogular ground glass nodules although it's not usually as diffuse as in the case I showed you and it's a diagnosis of exclusion. Patients with respiratory bronchiolitis are typically asymptomatic. So this was a case of hypersensitivity pneumonitis. Next case. Now I want you to figure out the pattern and tell me what the most likely history is. Is this a foundry worker, a cigarette smoker, a patient with a lung transplant, or asthma? What did you think? And 82% of you said lung transplant and you were right. What we see here are numerous nodules that are predominantly in a bronchovascular distribution. In a patient with a transplant, this is very suggestive of post-transplant lymphoproliferative disease. Case four, what is the most likely diagnosis? And these are your options, asthma, aspiration, diffuse pan bronchiolitis, or obliterative bronchiolitis. Let's see what you think. And quite a smattering of answers, which I thought might be the case. But the answer here is aspiration. Now, you may be looking at this image and say, well there's tree and bud opacities and that can occur with asthma, aspiration, diffuse pan bronchiolitis, or obliterative bronchiolitis. So why is it aspiration? Well, you also had to notice another feature, an air fluid level in the esophagus, in this patient with ecolasia associated with aspiration. Ready for one more final case? What pattern is shown? Tree and bud, nodules, mosaic pattern of lung attenuation, or honeycomb? Well, what did you think? 95% of you said honeycomb. Great. Pat yourself on the back. This is a honeycomb pattern, multiple cysts layered along the pleural surface. What diagnosis should be considered? Diffuse pan bronchiolitis, bronchogenic carcinoma, lymphin genetic carcinomatosis, or silicosis. And we need the poll, Paul. Thank you. Okay, please select your option now. And what did you think? Well, I'm also not surprised that there's a smattering of answers here. A lot of people thought diffuse pan bronchiolitis or silicosis. This was a tricky one. I have to tell you that this is a honeycomb pattern, which is not a typical pattern for any of these diagnoses. So to know what the diagnosis is, you had to be able to find this bronchogenic carcinoma in the periphery of the left upper low. It's harder to appreciate nodules in patients with diffuse lung disease. So you have to be very vigilant to look for nodules that may represent cancer in patients with diffuse pulmonary fibrosis. In patients with diffuse lung disease, including pulmonary fibrosis, have a greater incidence of bronchogenic carcinoma than does the general population. So that ends my formal presentation. And I don't know if we have any time for any questions, but I can answer them if you email them to me or ask them online. Dr. Valentin, take a few minutes and answer just a couple of questions if you would like. Okay, let me go to questions and answers. How do you distinguish GGO ground glass opacity from mosaic? And that would refer to mosaic lung attenuation. Well, ground glass opacity can really be considered a component of mosaic lung attenuation because mosaic lung attenuation just means heterogeneity of the lung attenuation. Some areas appear ground glass in appearance. Some areas appear loosened. But if you want to determine whether the heterogeneity is due to an infiltrative process or due to an airway process, you should do expiratory images because the heterogeneity and lung attenuation will be accentuated when it is due to an airway process like obliterative bronchiolitis. It will not be accentuated if it's due to an infiltrative process like pneumonia. Another question is, for honeycomb, do you use specific numbers of layers to call honeycomb? Some have told me there should be three tiers to call it honeycomb. Well, to me, a layer is more than one. So if I see at least two rows of cysts, to me, that's layered. And it really doesn't matter though. I mean, sometimes in pulmonary fibrosis, you may only see one row, but it can be helpful to distinguish honeycombing from centri-logular emphysema sometimes because centri-logular emphysema won't be layered whereas honeycomb very often is. But you don't have to have layers to be able to diagnose pulmonary fibrosis. Can COVID-19 have crazy paving secondary to bacterial consolidation and pleural effusion? Yes, COVID-19 pneumonia can present with crazy paving. That's usually one of the later findings seen after 10 to 12 days, but it is one of the noted features in the cases of COVID-19 pneumonia that have been reported. And consolidation is also seen in later stages of COVID-19 pneumonia. Pleural effusion, however, has not been described as a typical feature of COVID-19 pneumonia. And if you see pleural effusion or cavatary lesions in the lung or evidence of empyema, you should be thinking of something either unrelated to COVID-19 or as a super infection in patients with COVID-19 pneumonia. And those are the patients for which CT scanning is recommended. Cystic fibrosis versus allergic bronchopulmonary aspergillosis. Well, they can look similar because they can both involve the small and the large airways. Patients with cystic fibrosis usually have a much different presentation. The diagnosis is usually made when they're young and it's a progressive disease that gets worse as they age, whereas allergic bronchopulmonary aspergillosis generally develops later in age and is not something that progresses over time the same way as does cystic fibrosis. Cystic fibrosis also affects other organs like the pancreas and the GI tract. So that can help make the differential between the two as well. On CT scanning, if you're just looking at the findings, however, of one point in time, they can look very similar. So I talked about how to differentiate paracental emphysema from honey combing. Why do you get tree and bud and anterior segment in aspiration? Well, sometimes it depends upon how the patient is positioned because aspiration is a gravity-dependent phenomena. So the aspirated material will go into the airways that are within the most gravity-dependent portion of the lung. I've seen numerous cases where patients have been prone in position while they're on the operating table and they aspirated or they may be prone for some reason while they're in the intensive care unit. And so you will see areas of tree and bud opacity in the anterior, non-dependent, what is typically the non-dependent area of lung if they have aspirated while they're in the prone position. Dr. Collins, thank you so much for your time today and thanks to all of you for participating in our noon conference. Reminder that this conference will be made available on demand within the next 24 hours on MRIonline.com. Please join us tomorrow, March 31st at 12 p.m., as Dr. Pomerance will be with us for a noon conference on critical concepts and spinal imaging. Please visit us on our website and follow us on social media to be notified of reminders and updates. Thanks so much and have a great day. Thank you.


Hello everyone. This is a GSOC Jenkins Docker base quick start weekly meeting We're almost done with GSOC project. It's almost the end of it. And today we have BeaViento, Jean-Marc, Ashutosh, of course and myself So the last two weeks have been pretty calm, I would say But nonetheless the project is progressing We had a few work items that have been done last week and the week before and before going to the Current pull requests and the work items that we should focus on this week I'd like to talk about which we discussed about the presentation That should happen end of August or beginning of September. Maybe Jean-Marc knows better than I do and About a possible extension of the date If ever we would need a few weeks more to finish the project So I'd like to hear you about that. First of all, the presentation Jean-Marc, would you have any dates to communicate? They're Sorry for the noise in the background Come here Dates we initially plan to do the presentation the 21st but The consensus was that we'll do it one week before Which is if my memory is good The 14th so on Thursday 14th If this matters so one week before Okay, I can check exactly the date But I need to juggle here No, that's okay. So it's just before the middle of September Yeah So we still have 14th Okay, 14th 14th for the presentation It's only Ashutosh and us clapping hands or it's something we have to do together Is that question for me or oh, yes, sorry Jean-Marc Because you happen to be an admin also, that's why I'm asking So what do you mean with clapping hands? Just us as mentors being part of the audience and cheering When Ashutosh does the presentation or do we have to do the presentation together the four of us? I prefer Ashutosh does it he did a good job last time Yes, indeed. It's the mentee that will present If necessary if he wishes he can call in the mentor Just be So keep in mind that it will be 15 minutes per presentation So questions with questions. Yes So 10-minute presentation solid if you run into troubles you can grab a couple of minutes But no one will be allowed over 15 minutes, of course Got it Fine Any question about that Ashutosh No, no questions Okay now for the possible extension we got a message on Gitter earlier today by Chris turn asking should we Extend the deadline for this project or are you good with the existing deadline to which I answer I Will ask other people from the project, but I think we're good. We've done what we've done We're happy with what we have and That would be fine But I want to get your feedback Jean-Marie Keshutosh and Viviente. Who's first? You're the first You started yeah here Yeah, so first thing it's a general question to the whole group. It was asked by Chris and I asked him to steer These opportunities because there's some administrative Magic that needs to be done From what I've seen especially if we if the PRs for integrating the work from Ashutosh Into Jenkins IO are created and that we started a discussion there I Don't see a need for extending now The the other part of that question or that answer is now if Ashutosh is going to disappear Somewhere between the moon and Mars and and we we don't see him anymore It would really be a pity to leave the work as it is unfinished, so but here This work I see Ashutosh smiling, but I think he got the message but We can arrange the the finishing of it At a different pace more respect respectful of Ashutosh College time and and so on but it would be a waste To have something half baked and that we need to throw away because nobody's is following it anymore Got got a message so to summarize because I gave too many words There I think it's a very good decision to stop the G-soc type of Interaction, but I would love to have a G-soc like or open source like collaboration continuing on on this project that that would be really a Great thing, so this is my point of view Bruno back. Yeah, thanks a lot John Mark I'm on the same line in fact and I didn't know if we should add as a Final target, you know integrating to jenkin.io. So I asked the question to Damian on the portal this morning And he told me we don't have the bandwidth to integrate the image creation and so on into Jenkins infra for the next two weeks and I can't promise that we will have the bandwidth at the beginning of September so I'm okay with adding as a final target integration into the jenkin.io official documentation, but we won't be able to integrate the whole docker thing into the Jenkins Organization, that's a pity, but that's what it is there. We have a small amount of time And so it wouldn't make sense to extend for me in order to get some more time for the Jenkins Infra team to integrate. I should just work. So no need to extend from my point of view either And also, yes, I would love to continue work on this project with all of you And maybe do something around Aktoberfest We'll see what you can do later on Berbjanto, what's your feedback by that? Yeah, we can hear you Okay, yeah, I think it's okay We don't need to extend because I think most of our work already did it Got it Thank you. I'm reading because because of the noise here. I had a hard time to understand. Yeah Yeah, okay. Oh Yes, I was saying we're mostly happy with what we have now. It's not finished, polished, but it's kind of working and yes, the cherry on the cake would be to have our documentation Integrated into Jenkins.io and that will be it. Unfortunately, no Technical items would be integrated into the Jenkins organization yet because of time constraints. Cool Anything else you would like to say Ashutosh or maybe into our remark before we go to the pull request and work items Yeah, so You mentioned it won't be available like I don't know what what exactly is the problem like will the bandwidth Will be expanded expanded later or something? We can hope so Bruno explain what you meant with yeah, it's it's not the bandwidth of the network if the bandwidth of the team it was a metaphor an image because We have a huge work item in Jenkins. Yeah regarding to network bandwidth funny you know, yeah and people from The infra team are working on reducing the consumption of the bandwidths that we have thanks to J For for example, and that takes a lot of time we also have another work item regarding the latest LTS and Then they have been some bugs lately with the image a Docker image creation and Also, we have to migrate some of the work into arm 64 for Money because of the money it costs less to use arm 64 for example so lots of things that are really Pre-eritory and we can't use that time to integrate your work into the Jenkins in Organization so that the team that does not have enough time in the coming weeks to integrate your work So not really related to network bandwidth. Sorry for that Just a hint for a shoot us There this will be something interesting for you to observe and eventually participate in Infra team is looking for contribution more on the infrastructure part So you could Eventually with their their help Contribute help because you know what you have built and Learn how they work and in in that manner Increase your knowledge In more infrastructure part, which I know is one of your your interest and they're looking for help and they can give you also a tickets or things to solve where You can definitely help the Jenkins community So That's a good idea Yeah, just remember. Just remember. Sorry to cut There's a huge pile of work Prior to work that's that's I will even say life-threatening for the Jenkins project They they absolutely need to to do for in Bruno just mentioned it Jay frog is giving us Important infrastructure to for the continuous integration of Jenkins But we're consuming by the popularity of the product. We're consuming a huge huge network bandwidth And we absolutely need and we've been requested by them. You need to decrease that because this is Rocket high and and we cannot support that anymore. So actions are taken Taken there a good way to enter that and then I conclude on that and Bruno can guide you With that too is they have a regular meetings of the infrastructure work and so that would be a good thing to start attending To do to those meetings. So you hear and so you know what's going on Is something for after bullsummer code back to you Bruno? Thank you, Jean-Marc, and yes, that was a very good idea now that you know darker and Jenkins There are lots of things you could do to help Jenkins and the infra team for example this morning I made a PR for the darker SSH agent that you're using for our GSOC project Because I saw that we needed to upgrade to bookworm, you know gets rid of bullsize and go to bookworm It was just a few lines of code and it already got integrated Merge and released today and frankly you can do that You could do that if you ever feel like you like that, you know, it's pretty rewarding Just to enter a few lines of code and bam your name is part of a Jenkins agents release So yes, maybe after GSOC But the same is also valid for Bevianto. Sorry to cut. Yeah. Yeah. He's also invited in where he is more skills In that domain, so have a look Yes, please do so and if you ever feel intimidated or something please reach out to me I could help be some kind of proxy to introduce you to those repos for example Thanks a lot for this inside your mark. That was a great idea. Anything else I should touch before we go to the work items and PRs Yeah Yeah, I was thinking the same that we won't need extinction if I was thinking if not the Infra team we can at least Get all the PRs to the Jenkins.io for all the tutorials By the end of the project Cool, thank you Perfect and another thing I forgot to forgot like in the last meeting When you said to attend the Docs office hours, but this week's Docs office hours was not supposed to kill life. Oh, yeah Yeah, so I wasn't able to ask Mark about if it will be there. I I tried to attend the EU timing but Mark was not attending that one either He was in yes, I think he was on holiday or something In this Google calendar said that he was attending DevOps days or something. Oh Okay, so maybe this week we'll see yes Thanks a lot Anything else? No, nothing else Cool, let's go to let's go to pull request now. So I've seen I Wrote three, but I think I saw five plug-in update PRs last week So this warms beautifully Congrats on this work. I'm super happy to see that kind of PRs boom boom boom, you know, just review looks Okay approved merge and we're ready to go Then we have variable for doc a hub repository so It was because you were you still using your own repo and maybe one day we will be part of Jenkins repo So never know so in you introduced Just a change of a variable If I'm not mistaken so that yeah Whenever ooh, let's bet that bigger whenever we'll migrate to somewhere else We will be able to use a different Docker hub username fine Then this one is adding an updating a read me What was that about? What to date the title for this one? Okay This one is for separately building the If someone is not trusting the images he can he or she can build the images so oh Yes, I remember now yes Yes, because You know, it's a chicken and egg problem like John Mark always says Because if we make it to the Jenkins IO official documentation we will have to reference your repo or your Docker images and Not that many people know you yet So they can feel some kind of insecurity using your images and that's why we are proposing to rebuild Locally the images just in case people would be afraid to use yours Then you fix something that was Bummer we couldn't use the automatic opening of the browser when using git pod and You change just a little thing that made a huge difference you went from open browser to open preview And this has worked in then for me at least each and every time because it was kind of randomly Working and now it's working each and every time which is fine and then You clear this one the removing reverse proxy warning, but only for git pod I think I remember there's some kind of IQ or JQ in order to change the jcask value when using git pod, am I right? Yes, I added it to the git pod.yms file Like yes, and then with YQ Okay, fine And it has proved to work because locally I have Warning when I'm not using the right URL and in git, but I don't have the warning anymore. So that's cool And Now let's go to the open PRs There's only one if I'm not mistaken. So let's get rid of the S. It's the end-to-end Multi-branch. So this one was the last tutorial we had spotted It used to be with a docker-in-docker and it was pretty obscure and Complicated and you change it. Oh, you change quite a lot of files in order to get this tutorial to work and You don't have to use docker-in-docker anymore I think you told us last week that you started with the same agent as the node Tutorial and that this does work for you. I've reviewed that and it also worked For me, but you asked us for a review So would you have anything to share with us? Would you like to share your screen and tell us more about this PR? Yeah, so for this PR, it's a Extinction of the node tutorial kind of so it uses the same it works on the same agent, but We need to add the blue ocean plugin for this So we need to use different controller and all the other tutorials. We are using the same controller But for this one will use the same agent, but different controllers. So I Have to edit the Docker-compose file itself because in the tutorial we were using the same controller and it was kind of dependent on the controller because That's yeah, so I Have created the updated the docker-compose file for Different controller, but it was giving it giving some errors to me because I am not sure why it was giving but the it was giving errors while updating the plugins not updating the plugins while creating the images the Importing the plug-in dot txt file. It was giving some errors during that time I think because the plugins are not updated in that file Right now, but I'm not sure yet Mm-hmm. Okay, so we should review it, but it's not ready to merge Yes Okay, and another thing for this. I'll have to edit all the GitHub actions too for this to integrate this into them, too. Yes. Yes, that's I've updated I Have only one GitHub action is left that is the testing of the main one the which tested all the containers So I'll have to upgrade that one Yeah, that's tough one But that will work. Okay. I'm sure Okay. Thank you So we still have 10 items to this day I guess you haven't been able to progress because it's none of your fault about Dependable is not configured yet Dependable, but I don't understand why it's not working. I looked into it There are not many tutorials on the YouTube and other places either, but I Checked I checked everything. I think but it's still not working Be avianto, I think I remember I read this week a comment of yours saying that it was not working on your fork either Yeah Sorry, sorry, it's working or not working not working. Oh, okay Mm-hmm, and you don't have any more error message or whatever that could help us knowing why Okay So why does it work on mine? I Don't get it Jean-Marc, have you tried? Dependable on your fork or not? No Okay, honestly, I've I had no consumed my other course No problem about that. It was just in case because I don't know I'm the one who started Dependable on my fork and then made a push request to Pro request to the main repo So I don't know if I did something that blocks other force or even the upstream to work with Dependable Maybe it's my fault and I don't know what I did Maybe not I enable Dependable on another repository And now did I check if it worked or not? I have several repos which on fork and That work with Dependable But and I also have some other repos which are forks of official Jenkins on which Dependable works But I'm not the one who started Dependable on those forks, you know They were already part of the main repo when I cloned them So, I don't know Okay, I Would try this week to find something Bruno, I will have to drop in about two minutes Go Jean-Marc, you're free to go. Thanks for coming. Thank you. Yeah, okay. Yeah, sorry. Okay, and don't get lost between the moon and Mars, right? Yes, yes, I Want to merge my quote to the Jenkins Yeah, okay Thank you later then. Bye. Bye you buddy. Thank you Then the next one was the end to end multi-brand pipeline project creation we already talked about this one. It's a work in progress The next one is use github tools to configure jk I don't think this one is mandatory, but that would be a nice things to have if it's still Didn't you solve that already? Yeah, I don't remember this one Yeah, the thing is we wanted to retrieve The exposed URL things to GH port, but I think we don't need that anymore in fact Because it's already done maybe not with GH port, but I think in jk ask you already changed the Jenkins URL in some way yet. It's already available This one is old one. Yeah, that's right. Yeah, yeah close issue Done Right, that's cool. I don't think I can try that but that's okay Now then Use depend about if ever if wants to work and update CLI to keep the samples up to date. So for depend about you Just say which kind of ecosystem you're using for example, we are using Docker ecosystem because we have Docker files So just say we are using the Docker ecosystem here are the links to our Docker files and it will do its best to Update the versions you're using in the variables Docker files. So this one should work Whenever depend about It's okay with working on your repo Maybe that would be just a little work to do. I don't know if you've done that Because you added some Docker files Lately for the multi-bronze pipeline for example, and I'm not sure it's part yet of the update CLI Depend of a configuration. I think it's not part of that But as it doesn't work yet well You get the idea then I was thinking of update CLI because dependable is somehow Limited update CLI is also limited on some other parts But the combination of the two makes for a very robust update system So if you find the time to experiment with update CLI Please do so. So we have a working sample With continuous update and as dependable doesn't work that well Well, maybe we should Switch to update CLI. I think we'll have another LTS tomorrow for example Jenkins LTS and It would be nice if we could have a bit CLI to update our various Docker images Of the controls thanks to them, you know having the latest Jenkins LTS version for example and It's the same for the Debian version. We are based on And so on and so on and so on there are lots of things to update if you really want to and we could even Go up to the samples, you know, you have several samples for Maven node and so on Various repos you could put update CLI or depend about in these repos also So they also get updated So we don't have to let people experiment with some things which are outdated or vulnerable for example Okay Then we have build and push the Docker image even only if the Docker files have changed I'm almost sure you've already implemented this one, right? Yeah, I think I saw your GitHub action only fired if the Docker file change. So Let's close this one. Oh, that will be a light week and let until you experiment with a video which could take the whole week Close issue That's cool and then open the first PR on Jenkins.io. So I don't know how this one will look like because The format you're using for the documentation which lies within our repo Isn't quite the same as the official documentation of Jenkins so I guess you would have to fork and clone the Jenkins.io repo and then make the Modification directly in another branch and propose them to Jenkins.io not using directly The documentation you wrote, you know, I don't want just to copy your file into the Jenkins.io repo But just make the modification until it looks almost the same than the first Existing documentation on Jenkins.io, but with the latest information you entered into your repo. Okay Yeah I have used the Jenkins.io documentation while writing the blog Yeah, of course. You already know that And you already know how to Build the Jenkins.io website on your local machine also Yes, you're not using Windows, of course So that does work on your machine on Windows. It's a mess even with WSL2 Anyhow The last one is optional. It's a proposal set of other examples to implement We've done, you've done most of the tutorials we were thinking of so Maven, Python node and multi-branch And maybe there would be some other ones to implement. The goal there is not to Solve them, you know to make them but just to create some work items some Issues into the repo so that anybody later on could try to tackle this. Okay But this one is not mandatory just if you have time to and of course you should think of the final Presentation the demo So you should you could take some time Because we still have more than two weeks But yes, you should definitely start to think about that You did a great job for the mid-term presentation And I'm sure if you invest time enough into the next one. It will be great also and of course don't hesitate to share or to do Rehearsal with audience, be it friends, family, mentors, whatever if you feel like it, okay Great Whoa, time is running Anything else you'd like to share Ashutosh? Cool Okay So if you don't have anything to add, let's call it done and See you next week on the same meeting and before that, of course, we have the Gitter element Matrix you name it if you want to discuss emails and That's all the video should be available for everyone 24 to 48 hours from now And if we don't get in touch by next week, have a nice week. Bye. Bye Thank you Welcome