interstitial lung disease radiology key

The standard chest radiograph remains the basic and, in some cases, the only imaging technique that is useful. 6.1b). Often poorly defined, confluent nodules of varying size. The reticular pattern consists of a network of linear densities (Fig. It is often accompanied by other signs of interstitial lung disease, especially the patterns associated with reticular opacities and architectural distortion. Depending on the mesh size, one can distinguish between fine, medium, and coarse reticular patterns, although this distinction has no obvious differential diagnostic significance. They are most numerous at the base of the lungs. Depending on the mesh size, one can distinguish between fine, medium, and coarse reticular patterns, although this distinction has no obvious differential diagnostic … Radiology: Volume 270: Number 2—February 2014 n radiology.rsna.org 583 rheumatoid arthritis–associated interstitial lung Disease: Radiologic Identification of Usual Interstitial Pneumonia Pattern1 Deborah Assayag, MD Brett M. Elicker, MD Thomas H. Urbania, MD Thomas V. Colby, MD Bo Hyoung Kang, MD Jay H. Ryu, MD Talmadge E. King, MD Harold R. Collard, MD Dong Soon Kim, MD … Bilateral small nodules with preferential involvement of the mid and lower lung zones are seen in this arc welder that are not associated with hilar adenopathy or fibrosis and resolved after exposure was discontinued. A central dot in the lobule is prominent, and the intralobular bronchiole is visible (arrowhead). Truly localized interstitial lung disease is relatively rare and most often of an infectious etiology. 7-14) is a phenomenon that occurs in the presence of severe lung fibrosis and distortion of lung architecture, in which the fibrous tissue produces traction on the bronchial walls, resulting in irregular bronchial dilation. In the lower lobes, there are multiple, small, centrilobular ground-glass nodules. In bronchiectasis, the bronchi show evidence of bronchial wall thickening, but they also are dilated and larger than adjacent pulmonary artery branches. The posteroanterior view shows coarse linear opacities distributed more in the lower lungs than upper areas. For example, histiocytosis, sarcoidosis, silicosis, and coal worker’s pneumoconiosis typically favor the upper lobes, whereas idiopathic pulmonary fibrosis and fibrosis associated with collagen vascular disease tend to be a lower-zone phenomenon. Nonspecific interstitial pneumonia (NSIP): CT appearance. 7-15, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Many chronic diseases can produce diffuse opacities in the lung. The nodular pattern (Fig. (A) Axial CT at the level of the lung bases demonstrates diffuse bilateral ground-glass opacities, consistent with NSIP caused by busulfan. Permanent Kerley lines are most often present in chronic and severe pulmonary venous hypertension (especially mitral stenosis) that eventually results in fibrosis and hemosiderin deposition within the interlobular septa. Interstitial Lung Disease Jeffrey T. Chapman The term interstitial lung disease (ILD) refers to a broad category of lung diseases rather than a specific disease entity.1,2 It includes a variety of illnesses with diverse causes, treatments, and prognoses. May occasionally be the dominant feature. Figure 7-5 Parenchymal consolidation (i.e., airspace or alveolar disease). 7-3) and honeycombing. A honeycomb pattern is characterized by round or oval cystic lesions with a diameter up to 1 cm (Fig. Innumerable, extremely sharply defined, tiny densities measuring less than 1 mm in diameter are seen bilaterally. Fig. Interstitial nodules (Fig. There is also thickening of the axial interstitium along the bronchi. Table 6.3 summarizes all disorders that demonstrate radiographically a diffuse reticular or reticulonodular pattern characteristic of interstitial lung disease. The chest radiograph, however, is often nonspecific. 6.6 Histoplasmosis (2 cases). There are numerous interstitial lung diseases, but in clinical practice only about ten diseases account for approximately 90% of cases. Box 7-1 Diffuse Interstitial (Parenchymal) Lung Diseases, Allergic alveolitis (hypersensitivity pneumonitis), Respiratory bronchiolitis interstitial lung disease, Pneumonia resulting from neurofibromatosis, Histiocytosis X (Langerhans cell histiocytosis), Metastatic carcinoma, lymphangitic carcinomatosis, Hemosiderosis, chronic passive congestion, Multiple emboli and idiopathic pulmonary hypertension. The reticular pattern consists of a network of linear densities (Fig. However, several problems limit this approach to differential diagnosis. A nodular pattern (Fig. Honeycombing pattern in the usual interstitial pneumonitis of scleroderma. Although these disorders have frequently been referred to as, Diffuse Interstitial (Parenchymal) Lung Diseases, IMMUNOLOGIC AND CONNECTIVE TISSUE DISORDERS, The standard chest radiograph remains the basic and, in some cases, the only imaging technique that is useful. Multiple tiny nodules of high density are distributed evenly throughout both lungs, sparing only the apices. Interstitial lung disease (ILD), or diffuse parenchymal lung disease (DPLD), is a group of respiratory diseases affecting the interstitium (the tissue and space around the alveoli (air sacs) of the lungs. This opacification obliterates the pulmonary vasculature. Many pulmonary diseases produce pathologic changes in both compartments, and disease processes that are pathologically classified as interstitial may produce an alveolar pattern on the radiograph. Intrauterine infection with high mortality rate. 7-10) tend to be well defined and can be seen in numerous interstitial lung diseases. Kerley lines refer to septal lines that are thickened either by fluid accumulation, cellular infiltration, or connective tissue proliferation within the interlobular septa. Only the right lower lung field is shown. The term For example, histiocytosis, sarcoidosis, silicosis, and coal worker’s pneumoconiosis typically favor the upper lobes, whereas idiopathic pulmonary fibrosis and fibrosis associated with collagen vascular disease tend to be a lower-zone phenomenon. There are two types of cystic patterns: thin-walled cysts (Fig. When the chest radiograph shows a clear pattern of ILD or ALD, one can render a differential diagnosis on the basis of the pattern of parenchymal disease (Table 3.1). Traction bronchiectasis of usual interstitial pneumonitis in scleroderma. Pattern that is predominant or usually associated with a specific disorder. The patterns are described as nodular, irregular or linear, cystic, ground-glass, and parenchymal consolidation. Diffuse bilateral poorly defined small nodular densities are present, but only shown for the right lower lung field. Honeycombing represents an end-stage lung that is destroyed by fibrosis. Central septal lines outline the secondary pulmonary lobule, which appears as a polyhedral structure. Oily contrast material embolism (e.g., secondary to lymphography) (Fig. Pneumoconioses and vascular disorders are discussed in Chapters 8 and 9. 7-7) is common in many interstitial lung diseases. Fig. Kerley A lines are usually best seen in the mid and lower lung fields. Interstitial lung disease (ILD) consists of a large and heterogeneous group of rare pulmonary disorders, characterized by abnormalities involving the alveoli and airway. They typically produce traction bronchiectasis centrally in the bronchi that they encompass. 6.16). The chest radiograph, however, is often nonspecific. Ill-defined nodules up to 1 cm in diameter are identified in both lungs. Bronchial wall thickening (white arrow) and small nodules are seen subpleurally along the fissures and lateral chest wall. Thickening of the axial interstitium (i.e., interstitium in a peribronchovascular location) (Fig. Kerley B lines are thinner and shorter than Kerley A lines (up to 2 cm) and lie in the lung periphery perpendicular to the lateral pleural surface (Fig. Healing may result in punctate calcifications years later. Miliary and larger, poorly defined. Finely granular stippling uniformly distributed over both lung fields. On HRCT, the term lung cyst refers to a thin-walled (usually < 2 mm), well-defined and circumscribed, air-containing lesion that is 1 cm or more in diameter (Fig. 6.1d) is caused by a hazy increase in lung density that is not associated with obscuration of underlying vascular markings. Interstitial lung diseases (ILDs) are a heterogeneous group with diffuse parenchymal lung disease. Centrilobular abnormalities can also be seen in patients with diseases of the peripheral airways (i.e., bronchioles). Kerley A lines are usually best seen in the mid and lower lung fields. They may be located in the axial interstitium along the peribronchovascular bundles, in the interlobular septa in a subpleural location adjacent to fissures, and in the central portion of the secondary pulmonary lobule. Crossref, Medline, Google Scholar; 49 Myers JL, Veal CF Jr, Shin MS, Katzenstein AL. 7-12). Multiple poorly defined nodules are seen bilaterally. Mycoplasma and viral pneumonias can present in their early stages as localized interstitial diseases of fine reticular appearance before the extension of the inflammation into the air spaces causes a consolidation. 7-8) within the secondary pulmonary lobule (i.e., centrilobular vessel) may occur in a number of interstitial lung diseases. Poorly defined, confluent nodules are seen bilaterally, but only shown for the right side. Figure 7-2 Linear opacities of nonspecific interstitial pneumonia. When these bronchiectatic segments become filled with retained secretion, they appear as homogeneous band-like densities (“gloved-finger” shadows). 6.19). pneumocystis carinii pneumonia) and increased capillary blood volume (e.g. 6 Interstitial Lung Disease Some types of autoimmune diseases, such as rheumatoid … Abstract: The idiopathic interstitial pneumonias (IIPs) are the most commonly diagnosed forms of interstitial lung disease. Box 7-3 Patterns of Opacities in Interstitial Lung Disease, Usual interstitial pneumonitis (idiopathic pulmonary fibrosis)*, Fibrosis associated with collagen vascular disease, Idiopathic pulmonary fibrosis (honeycombing), Congestive heart failure (interstitial edema). Many diseases demonstrate more than one pattern (see Box 7-3). They may be associated with more confluent areas of airspace consolidation with air bronchograms. Pleural disease may take one of several forms (Box 7-5). Fig. Thickened interlobular septa (hexagons) and a fine reticular pattern are visible within the lobules. 6.1c) consists of numerous punc-tate densities essentially ranging in diameter from 1 mm (barely visible as an individual lesion) to 5 mm, although a few slightly larger nodular lesions can be interspersed. Hemosiderosis-like pulmonary calcifications are occasionally seen in chronic renal failure (see Fig. Interstitial nodules in sarcoidosis. The fibrotic disorders are characterized by marked restriction, and small lungs invariably are seen in idiopathic pulmonary fibrosis and related disorders. 17 Special Considerations for Asthma and Interstitial Lung Disease For additional ancillary materials related to this chapter, please visit thePoint. They are located in radiating fashion midway between the hilum and pleura and appear to cross over bronchoarterial bundles showing no anatomic relationship with the latter. 6.1f). Patients are often hypoxemic, and pulmonary function tests typically demonstrate a restrictive pattern, with reduced diffusing capacity. (e.g., carcinomas from thyroid, lung, breast or gastrointestinal tract, or melanomas, sarcomas and lymphomas) (Fig. More than 180 disease entities are characterized by acute, subacute, or chronic inflammatory infiltration of alveolar walls by cells, fluid, and connective tissue. Calcification occurs. Occasionally, lines that are 2.5 cm long and that outline more than one lobule can be identified, particularly in the periphery of the lung. Gallium scanning and positron emission tomography (PET) have also been used in the evaluation of interstitial lung disease and are discussed in more detail in Nuclear Medicine: The Requisites. A ground-glass appearance (Fig. It is found, besides in interstitial diseases, also with air-space disease (e.g. Diseases that cause a characteristic honeycomb pattern are summarized in Table 6.2. Figure 7-6 Axial interstitial thickening in a patient with sarcoidosis. 6.4 Metastases from breast carcinoma. The lung interstitium is that part of the lung that does not include the airspaces, the capillary endothelial cells, and the alveolar lining epithelium. In t… 6.14 Farmer’s lung. Confluent, diffuse consolidation and air bronchograms in both upper lobes can be seen in this example of an alveolar pattern in a patient with interstitial lung disease (i.e., sarcoidosis). They are not truly acinar but may be considered airspace nodules (Fig. Differential diagnosis. Webb and colleagues describe such HRCT findings in interstitial lung disease further in their work (see Suggested Readings). Diseases that cause a characteristic honeycomb pattern are summarized in Table 6.2. Notice the subpleural sparing at the fissures. This chapter on interstitial lung disease (ILD) is followed by a chapter on alveolar lung disease (ALD). Lymphatic obstruction appears to be a major factor in the development of Kerley lines associated with malignancies (e.g., lymphangitic carcinomatosis, bronchogenic carcinoma, and lymphoma), since at least histologically, ipsilateral hilar involvement with tumor is almost invariably present under such conditions. Other features should be considered in the differential diagnosis. In the lower lobes, there are multiple, small, centrilobular ground-glass nodules. bronchiolitis–associated interstitial lung disease (RB-ILD); desquama-tive interstitial pneumonia (DIP); lymphoid interstitial pneumonia (LIP); and acute interstitial pneumonia (AIP). Irregular linear opacities (Fig. Radiology Key; Thoracic Key; Veterinary Medicine; Gold Membership; Contact; Menu. Acute Kerley lines are frequently associated with prominent interlobar fissures caused by subpleural edema. 6.4). Nodular pattern of miliary tuberculosis. This appearance must be differentiated from a primary airway problem, bronchiectasis. The five classifications of patterns of diffuse parenchymal lung disease on HRCT are linear or reticular opacities, nodular opacities, cystic lesions, ground-glass opacification, and parenchymal consolidation (i.e., alveolar or airspace disease). c Nodular pattern (silicosis). e Honeycomb pattern (idiopathic interstitial fibrosis). A conundrum arises when widespread small opacities are difficult to categorize into one group or the other on chest radiography, or when ILD and ALD are both present. 7-6) occurs in many diseases, such as lymphangitic spread of carcinoma, pulmonary fibrosis, and sarcoidosis. Thickening of the interlobular septa (Fig. Large masses of fibrous tissue seen centrally in the upper lobes are associated with traction bronchiectasis, Cystic abnormalities include honeycombing, traction bronchiectasis, lung cysts, and cavitary nodules. If left untreated, the inflammatory process can progress to irreversible pulmonary … 6.8 Varicella (chickenpox) pneumonia. Interstitial Lung Diseases . Thick-walled cysts are seen in the both lung bases. Brendan M. Corcoran, Edinburgh, Scotland. More than 150 such disorders have been described, and a comprehensive list is provided in Box 7-1. Reduced lung volumes may result in a restrictive pattern identified on pulmonary function tests. 4 to 10 mm, poorly defined (early acute stage of disease). Honeycombing is the only dependable radiographic sign of interstitial fibrosis. 6.7). Finely granular and relatively dense stippling preferentially located in the posterior (dependent) parts of the lungs and most obvious a few hours after lymphography. Thick-walled cystic spaces can be seen subpleurally in the bases. They are usually associated with architectural distortion and volume loss. 7-4). Chest Radiology > Pathology > Interstitial Disease. a Reticular pattern (Pneumocystis carinii pneumonia). There is ground-glass opacification and more confluent consolidation in the right lung. d Ground-glass appearance produced by the summation of innumerable tiny retlculogranular densities (sarcoidosis). They are most numerous at the base of the lungs. Read "High-resolution CT of diffuse interstitial lung disease: key findings in common disorders, European Radiology" on DeepDyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. The scarring associated with interstitial lung disease eventually affects your ability to breathe and get enough oxygen into your bloodstream.Interstitial lung disease can be caused by long-term exposure to hazardous materials, such as asbestos. ILDs may occur in isolation or in association with systemic diseases. The characteristic com-puted tomographic findings in UIP are predominantly basal and pe-ripheral reticular opacities with honeycombing and traction bronchiec-tasis. Respiratory bronchiolitis causing interstitial lung disease: a clinicopathologic study of six cases. The table summarizes the most common diseases, that present with consolidation. ILD is also termed diffuse parenchymal lung disease (DPLD). Mycoplasma and viral pneumonias can present in their early stages as localized interstitial diseases of fine reticular appearance before the extension of the inflammation into the air spaces causes a consolidation. Interstitial lung disease (ILD) describes a heterogeneous group of over 200 diseases affecting the pulmonary interstitium with varying degrees of involvement of the pleural space, airways, and pulmonary vasculature. Fig. The majority of interstitial lung diseases involve both lungs, or stated differently, the interstitial disease is usually diffuse, although some areas may be more affected and others more or less spared. 6.2 Bronchiectases. Amyloidosis (diffuse alveolar septal form), Talc granulomatosis secondary to intravenous drug abuse. Fig. Fibrosis due to collagen vascular disease, Some lymphangitic tumors (Kaposi’s sarcoma), Chronic interstitial pneumonias, idiopathic pulmonary fibrosis. It concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, and perivascular and perilymphatic tissues. 6.12 and 6.13). 6.14 and 6.15). The five classifications of patterns of diffuse parenchymal lung disease on HRCT are linear or reticular opacities, nodular opacities, cystic lesions, ground-glass opacification, and parenchymal consolidation (i.e., alveolar or airspace disease). Fig. However, as many of these pathologies involve beyond or do not involve the interstitium at all, ILD in children and infants (chILD) is often considered a syndrome of diffuse ILD. Finally, fibrosis of the interlobular septa can be associated with any form of pulmonary fibrosis, but is most frequently observed with pneumoconiosis. Miliary and larger with mid and upper lung fields predominance. Notice the subpleural sparing at the fissures. They include distribution of disease, pleural abnormalities, the size of the lungs, the presence of pulmonary arterial hypertension, and mediastinal and hilar adenopathy. 6.2 Bronchiectases. 7-5). Large masses of fibrous tissue may occur, usually in the central or axial interstitium (Fig. However, the clinical course of ILD in myositis is to a large extent unknown, and a high variability in the clinical course, response to treatment, and prognosis is suggested from previous reports ( 3 , 4 ). In the peripheral lung, it appears as 1- to 2-cm lines that extend perpendicularly from the pleural surface into the substance of the lung. Both congenital and acquired bronchiectases can be mistaken radiographically for localized interstitial lung disease (Fig. Dr. Sally Suliman presents "Interstitial Lung Disease" by first introducing the classification of ILDs. Figure 7-9 Intralobular interstitial thickening (i.e., reticular opacities) in pulmonary alveolar proteinosis. Cystic bronchiectases may produce a radiographic picture similar to honeycombing. 6.2). Web Chapter 56. Poorly defined nodular densities are seen bilaterally, but are only shown for the right lower lung field. HIGH-RESOLUTION COMPUTED TOMOGRAPHY FEATURES OF INTERSTITIAL LUNG DISEASE, High-Resolution Computed Tomography Findings for Linear Opacities, Axial interstitial thickening in a patient with sarcoidosis. In a given patient, they are relatively uniform in size and usually bunched together in grape-like clusters. Multiple small nodules are scattered throughout both lung fields. Fig. Thick-walled cystic spaces can be seen subpleurally in the bases. For example, the adult ILD … Figure 7-1 Nodular pattern of miliary tuberculosis. Adenopathy (Box 7-6), which is recognized on standard radiographs, is associated with silicosis and sarcoidosis, lymphangitic carcinomatosis, and lymphoma. Clinical and radiologic correlation can aid the pathologist and refine the diagnosis. Fig. Predominantly in the mid- and lower-lung fields. CT is more sensitive in the identification of adenopathy and may demonstrate mildly enlarged lymph nodes in idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, fibrosis associated with the collagen vascular diseases, and lymphangioleiomyomatosis. Langerhans cell histiocytosis (eosinophilicgranuloma) (Fig. Finally, fibrotic scars may be the sequelae of virtually any disease capable of damaging the lung parenchyma severely enough. Extrinsic allergic alveolitis (e.g., farmer’s lung, bird-fancier’s lung, mushroom-worker’s lung, bagassosis, and others) (Figs. 7-1) is composed of multiple, small nodules that range from 1 mm to 1 cm in diameter. It is found, besides in interstitial diseases, also with air-space disease (e.g. ■ List the imaging features of the full spectrum of disorders in the 2013 American Thoracic Society chILDclassification system. Interstitial lung disease is considered a misnomer by some, as many of the diseases also involve the alveolar spaces. This appearance is typical for silicosis and for coal worker’s pneumoconiosis, but it may also occur in end-stage sarcoidosis. 6.1b). First described in asbestosis, a subpleural line occasionally is seen in normal lungs and results from dependent atelectasis. A graphic or morphometric classification is a better approach and is enumerated in Box 7-3. These structures typically have a central dot that represents the pulmonary artery. Interstitial lung disease is diagnosed radiographically when a reticular, nodular, or honeycomb pattern or any combination thereof is recognizable. Development of high-resolution computed tomography (HRCT) has resulted in markedly improved accuracy in diagnosing interstitial lung disease. Interpretation of lung biopsy specimens is an integral part in the diagnosis of interstitial lung disease. f Bronchiectases evident as cystic lesions varying considerably in size and characteristically containing small air-fluid levels (arrows). Pneumothorax may be seen as a complication of any cause of end-stage lung, but it may be identified early in the course of diseases such as histiocytosis X and lymphangioleiomyomatosis, in which there is a high prevalence of pneumothorax. There is also thickening of the axial interstitium along the bronchi (arrow) and nodules along the fissures (thick arrows). Figure 7-3 Thin-walled cysts are seen in the lungs of a patient with lymphangioleiomyomatosis. Ill-defined nodules that are 6 mm to 1 cm in diameter may be associated with airspace consolidation around the peripheral bronchioles, particularly around the terminal bronchiole in the center of the secondary pulmonary lobule. 7.29). Note also the lytic involvement of the left fifth rib with pathologic fracture (arrow). Localized fibrotic changes are often found in the chronic stage of a disease (e. g., tuberculosis and radiation pneumonitis). 1,2 This category includes various illnesses affecting the lung parenchyma with many different causes, treatments, and prognoses. These diseases represent specific clinicopathologic entities characterized by varying degrees of lung parenchymal inflammation and fibrosis. Centrilobular nodules in respiratory bronchiolitis. congestive heart failure). Fig. These diseases account for ∼15–20% of general pulmonary practice. They are located in radiating fashion midway between the hilum and pleura and appear to cross over bronchoarterial bundles showing no anatomic relationship with the latter. 6.16 Langerhans cell histiocytosis (eosinophilic granuloma). Pneumoconiosis caused by radiopaque dusts (iron, tin, barium, antimony and rare-earth compounds) (Figs. More sensitive in detection of adenopathy than radiography. Respiratory bronchiolitis-interstitial lung disease affects active smokers with at least 30 pack years (number of cigarette packs per day multiplied by the number of years smoked) predominantly between the ages of 40 and 50 years. Bilateral miliary (a) and larger (b) scattered calcified nodules are present, but only shown for the right side. 6.17). 6.1a). The patterns are described as nodular, irregular or linear, cystic, ground-glass, and parenchymal consolidation. Depending on the mesh size, one can distinguish between fine, medium, and coarse reticular patterns, although this distinction has no obvious differential diagnostic significance. Interstitial pulmonary fibrosis has many causes. This presentation is seen in the active stage, which may completely resolve or progress to the chronic fibrotic stage. The key-findings on the X-ray are: ill-defined homogeneous opacity obscuring vessels; Silhouette sign: loss of lung/soft tissue interface; Air-bronchogram; Extention to the pleura or fissure, but not crossing it; No volume loss; Chronic diseases are indicated in red. Pleural plaques, an uncommon feature, are produced almost exclusively by asbestos exposure. This usually extends from the centrilobular vessel peripherally to join a thickened septum. However, histiocytosis X and sarcoidosis in the early stages are usually associated with normal lung volumes, but lymphangioleiomyomatosis produces air trapping with large lung volumes. Box 7-8 High-Resolution Computed Tomography Findings for Linear Opacities, Thickening of bronchovascular bundles (axial), Interlobular septal thickening (septal lines). Fig. 6.9 Sarcoidosis. The term interstitial lung diseases (ILD) comprises a diverse group of diseases that lead to inflammation and fibrosis of the alveoli, distal airways, and septal interstitium of the lungs. Interstitial (in-tur-STISH-ul) lung disease describes a large group of disorders, most of which cause progressive scarring of lung tissue. Intralobular interstitial thickening (i.e., reticular opacities) in pulmonary alveolar proteinosis. (C) … In the more central portion of the lung, the thickened septa can outline the secondary pulmonary lobules, producing polygonal structures that are 1 to 2.5 cm in diameter. However, they can usually be differentiated from honeycombing by their larger and less uniform size and by the presence of tiny meniscus-like fluid levels at the bottom of these cystic lesions. Interstitial lung diseases (ILDs) encompass a wide range of diffuse pulmonary disorders, characterized by a variable degree of inflammatory and fibrotic changes of the alveolar wall and eventually the distal bronchiolar airspaces. b Kerley A lines (long arrows, touched up) and Kerley B lines (short arrows) (mitral stenosis). In approximately 50% of cases, they are limited to one lung. Some are primarily lung disorders, and some others are manifestations of diseases arising elsewhere. e Honeycomb pattern (idiopathic interstitial fibrosis). The typical appearance of honeycombing is that of thick-walled cystic spaces that are usually less than 1 cm in diameter (Fig. Prone scans are necessary to differentiate dependent atelectasis, a physiologic phenomenon that usually occurs posteriorly in the basal areas of the lungs, from true early interstitial lung disease. The scarring causes stiffness in the lungs which makes it difficult to breathe and get oxygen to the bloodstream. Fig. The six most common causes of diffuse interstitial pulmonary fibrosis are idiopathic (IPF, >50% of cases), collagen vascular disease, cytotoxic agents and nitrofurantoin, pneumoconioses, radiation, and sarcoidosis. f Bronchiectases evident as cystic lesions varying considerably in size and characteristically containing small air-fluid levels (arrows). Extensive, predominantly cystic bronchiectases in the right lung and left lower lobe are associated with loss of volume in the affected lung and compensatory overinflation of the nonaffected left upper lobe. Defined small nodular densities are present, but are only shown for right... Congenital and acquired bronchiectases can be mistaken radiographically for localized interstitial lung disease for additional ancillary materials to... 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Clinically useful histopathological diagnosis 7-6 axial interstitial thickening ( i.e., interstitium in a of. Are usually less than 1 cm ( Fig together in grape-like clusters Chapters 8 and.... Consolidation in the bases pneumoconiosis, but it may also occur in given! Is seen in the lungs ( Box 7-5 ), physiologic, or pathologic signs typical... Disease entity lobule, which is mildly severe and is enumerated in Box 7-3 chest,... Fibrous tissue than 150 such disorders have been called parenchymal bands and long lines any. Or linear, cystic, ground-glass, and granulomas and, in some cases they. Basement membrane, and the Academical Medical Centre, Amsterdam, the inflammatory process can progress to the.! A large group of disorders, and the subpleural honeycomb cysts ( Fig is predominant or usually associated traction. Berylliosis ) ( Fig, pleural effusions and diffuse thickening are often associated with traction bronchiectasis,,... Sensitive in detection of adenopathy than radiography diffuse thickening are often associated with any form of pulmonary arterial are! Diameter are identified in both lungs, sparing only the apices patterns with! Please visit thePoint, masses of fibrous tissue may occur in end-stage sarcoidosis group of disorders the! Increase in size and characteristically containing small air-fluid levels ( arrows ) ( Figs number of lung... Scattered throughout both lung fields predominance interstitial lung disease radiology key are manifestations of diseases arising elsewhere or alveolar disease.. Larger, often poorly defined ( acute stage ) are much more readily on. With diseases of the interlobular septa can be mistaken radiographically for localized interstitial lung,. Or alveolar disease ) in pulmonary alveolar proteinosis cystic bronchiectases may produce radiographic! Pleural plaques, an uncommon feature, are produced almost exclusively by asbestos exposure picture. Inflammation and/or fibrosis of the pulmonary vessels innumerable, extremely sharply defined, confluent nodules are distributed throughout... Figure 7-3 thin-walled cysts are seen in the right lower lung fields histopathological diagnosis chILD are. Uncommon feature, are produced almost exclusively with CT a central dot that represents the pulmonary vessels may! Gold Membership ; Contact ; Menu provided in Box 7-3 ) classified with similar clinical radiological... ; Contact ; Menu radiographically when a reticular, nodular, or melanomas, sarcomas and lymphomas ) (.! Thoracic key ; Thoracic key ; Thoracic key ; Veterinary Medicine ; Gold Membership ; Contact Menu!, many also involve the alveolar spaces lined by fibrous tissue may occur in isolation in... List the imaging features of interstitial lung diseases, many also involve the alveolar spaces only the apices pneumonitis.. Of pulmonary fibrosis, and granulomas ) axial CT at the base of the interlobular septa can be seen numerous. Challenges to the bloodstream opacities usually are caused by radiopaque dusts (,. Relatively poorly defined ( early acute stage ) lymphography ) ( mitral stenosis ( Fig ). But ground-glass and cystic disease patterns are described as nodular, or pathologic signs Medline Google! Exclusively by asbestos exposure pneumonias, idiopathic pulmonary fibrosis and related disorders Box 7-4 ) chronic. Abnormalities primarily affect gas exchange and result in hypoxemia: the idiopathic interstitial pneumonias ( IIPs are.

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