It has been broadly divided into smooth regular, irregular or nodular. It was possibly related to contact with a local fish and wild animal market (Huanan Seafood Wholesale Market), where there was also sale of live animals. The chest CT images and clinical data of them were reviewed and compared. Superior rib erosions may be present and are indistinguishable from similar findings in rheumatoid arthritis or scleroderma. Samples were viewed under a Nikon Eclipse E600 light microscope equipped with a digital camera and morphometric analysis was performed using the morphometric software nis elements by Nikon.. These patients have pathologic changes that are indistinguishable from those seen in ARDS, with diffuse alveolar damage producing an exudative intra-alveolar edema with hyaline membrane formation. GGO associated with centrilobular nodules may be seen with hypersensitivity pneumonitis (Fig. oedema . Interlobular Septal Thickening Interlobular Septal Thickening SmallSmall Intralobular Interstitial Thickening Intralobular Interstitial Thickening IntermediateIntermediate HoneycombingHoneycombing. c. Smooth Interlobular septal thickening is seen in pulmonary . A septal pattern results from thickening of the interlobular septa (i.e., the tissue that separates the secondary pulmonary lobules) ( Fig. Posted by DR Nagendra kumar sinha at 22:33. Additional chest radiographic findings in SLE include elevation of the hemidiaphragms with decreased lung volumes and resultant bibasilar areas of linear atelectasis. Exudative pleural effusions occur when pleural membranes or vasculature are damaged or disrupted therefore leading to increased capillary permeability or decreased lymphatic drainage. It was initially described as a pathognomonic sign of pulmonary alveolar proteinosis. Nonspecific interstitial pneumonia (NSIP) with a peripheral distribution of ground glass opacity (GGO) and subpleural sparing. Interlobular septal thickening, thickening of fissures and thickening of the peribronchovascular interstitium (bronchial cuffing). The differential diagnosis of GGO is broad. This finding has a variety of causes, including infectious, neop … Interstitial thickening is pathological thickening of the pulmonary interstitium and can be divided into: interlobular septal thickening intralobular septal thickening See also interlobular septa secondary pulmonary lobules HRCT terminology It is often seen as fine linear or reticular thickening. Functional or anatomic esophageal obstruction may result in aspiration with the development of lower lobe pneumonia. This patient is a smoker with DIP. On HRCT, GGO is characterized by hazy regions of increased lung opacity or attenuation in which vessels remain visible (Fig. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases.In some cases, it is the predominant radiological finding. Increased tissue within the volume scanned results in GGO. In these patients, thickening and obliteration of small muscular pulmonary arteries and arterioles are responsible for the development of pulmonary arterial hypertension. Intralobular septal thickening is a form of interstitial thickening and should be distinguished from interlobular septal thickening. Expiratory image (B) shows patchy air trapping (arrows). FIGURE 23-25 Pulmonary hemorrhage with intralobular interstitial thickening and intralobular lines. The intralobular lines indicate that the process is not acute allowing distinction from more acute causes of diffuse or multifocal GGA. They are composed of connective tissue and contain lymphatics and pulmonary venules. Possibility of Pneumocystis Carnii. 1 Department of Radiology, Haihe Clinical College of Tianjin Medical University, Tianjin 300350, China. Redistribution of blood flow to the upper lobes, a manifestation of pulmonary venous hypertension, and prominence of the fissures caused by subpleural edema and fibrosis are concomitant findings. In a patient with acute symptoms, the distribution of GGO is of limited value in helping distinguish among the various possible causes. Acute drug reaction with pulmonary edema and diffuse ground glass opacity (GGO). Interlobular septal thickening at HRCT can be smooth, nodular, or irregular in contour. Other findings included intralobular or interlobular septal thickening, and a crazy-paving pattern. Interlobular septal thickening is commonly seen in patients with interstitial lung disease. Focal or unilateral abnormalities in 50% of patients. In the chronic setting, GGO with a peripheral distribution (arrows) is suggestive of an interstitial pneumonia or more specifically nonspecific interstitial pneumonia, DIP, or usual interstitial pneumonia. She was in mild respiratory distress. Visible intralobular bronchioles (62/80), bronchiolectasis within fibrotic consolidations (47/80), and honeycombing (61/80) were more common in patients with idiopathic pulmonary fibrosis (p < 0.0001). 58 ordinary cases were enrolled. 4.7). In a patient with chronic symptoms, the list of diagnostic possibilities is the same as for GGO, but alveolar proteinosis, which is otherwise quite rare, should be considered a distinct possibility (Fig. Hilar lymphadenopathy in 50% of patients. 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), on Increased Lung Attenuation: Ground Glass Opacity and Consolidation, Pulmonary Edema, Diffuse Alveolar Damage, the Acute Respiratory Distress Syndrome, and Pulmonary Hemorrhage, fundamentals of high resolution lung ct common findings common pattern. Even processes that are classically diffuse or symmetric, such as pulmonary edema, may occasionally present with focal or patchy abnormalities. In general, the symptoms should be considered acute when they have been present for less than a few weeks and chronic if they have been present for 6 weeks or more. Hazy regions of opacity are noted in the parahilar lung in this patient with acute pulmonary hemorrhage due to Wegener’s granulomatosis. There are no parenchymal abnormalities associated with rheumatoid pulmonary arteritis. The septa are usually perpendicular to the pleura in the lung periphery. An air–fluid level within a dilated esophagus suggests secondary distal esophageal stricture formation from chronic reflux esophagitis. Features of organization such as architectural distortion, intralobular lines, lobular distortion, and traction bronchiectasis were noted present and con - This distribution is typical of NSIP. Interlobular septal thickening, thickening of fissures and thickening of the peribronchovascular interstitium (bronchial cuffing). The areas occupied by pleural tissue and by interlobular septa were measured with the help of a graphic tablet. Diffuse interlobular septal thickening (DIST) is an abnormality seen on high-resolution CT (HRCT) scanning of the thorax. Clinical information, particularly the duration of symptoms, can limit the diagnosis when either of these findings is present. Results Compared with the ordinary patients, the severe/critical patients had older ages, higher incidence of comorbidities, cough, expectoration, chest pain, and dyspnea. Normally, no septal lines can be identified on the radiograph, and only a few can be seen on high-resolution CT, mostly in the anterior and lower aspects of … When this finding is conspicuous and associated with GGO, pulmonary edema is the most likely diagnosis (Fig. The differential diagnosis of GGO is broad and includes a variety of diseases in different disease categories. . global health emergency. In the acute setting, the various causes of GGO are difficult to distinguish from one another based on their appearance. 1, 3). interlobular septum: the connective tissue between secondary pulmonary lobules, usually containing a vein and lymphatics; seen radiographically when thickened as a Kerley B or septal line. These lines are best visualized in the subpleural and juxtadiaphragmatic regions of the lung, where they outline the anterior and posterior margins of secondary lobules. Pleural effusions are significantly less common in scleroderma than in rheumatoid disease or SLE and may be a. Septal thickening is most often seen as thin, short, 1- to 2-cm lines oriented perpendicular to and intersecting the costal pleura. The presence of lung cysts associated with GGO suggests Pneumocystis jiroveci infection. It is characterized by noncaseous epithelioid cell granulomas and changes in tissue architecture, which may affect almost any organ. Detailed view of the left upper lobe. Abnormalities characterized by increased lung opacity can be divided into two categories based upon their attenuation: ground glass opacity (GGO) and consolidation. Acute pulmonary edema with patchy GGO. Depending on filling with fluid or with tumor cells, septal thickening is irregular or smooth. Abnormalities characterized by increased lung opacity can be divided into two categories based upon their attenuation: ground glass opacity (GGO) and consolidation. A peripheral distribution of findings with sparing of the immediate subpleural lung is highly suggestive of NSIP (Fig. pulmonary oedema. The interlobular septa (singular: interlobular septum) are located between the secondary pulmonary lobules and are continuous with both the subpleural interstitium (peripheral connective tissue) and the peribronchovascular interstitium (axial connective tissue) as well as the more delicate intralobular septa.. Septal pattern is defined as thickening of the interlobular septae (i.e. The frequencies of interlobular septal thickening, ground-glass opacities, fibrotic consolidation, and emphysema were similar in both groups. This begins as an alveolitis (inflammation of the alveolar interstitium) that is seen radiographically as fine reticular or ground glass opacities with a lower zone predominance. CRAZY PAVING Ashley Davidoff MD CRAZY PAVING Ashley Davidoff MD Ashley Davidoff MD CRAZY PAVING Ashley Davidoff MD CRAZY PAVING Additionally, although interlobular and intralobular septal thickening was a typical characteristic of COVID-19 in recent published studies [7, 8, 11, 24], it was rarely found in this study. Pulmonary edema with a combination of ground glass opacity (GGO) and interlobular septal thickening. Most of the first reported patients visited the market about 1 month before onset. Interlobular septal thickening infers disease infiltration. If GGO is associated with significant mosaic perfusion and/or air trapping (involvement of multiple lobules in three or more lobes), the diagnosis of hypersensitivity pneumonitis is strongly favored (Fig. When GGO is associated with chronic symptoms, the differential diagnosis is different and very broad. The findings could be gravitationally dependent. The combination of GGO and smooth interlobular septal thickening in the same lung regions is termed “crazy paving.” This name refers to the appearance of irregularly shaped paving stones in an English garden. It may be due to fluid, cellular infiltration, or fibrosis. Interlobular septal thickening at HRCT can be smooth, nodular, or irregular in contour. Transudative pleural effusions are formed when normal hydrostatic and oncotic pressures are disrupted. Septal thickening is most often seen as thin, short, 1- to 2-cm lines oriented perpendicular to and intersecting the costal pleura. Thickening of the interlobular septa is a common and easily recognizable finding at high-resolution computed tomography (HRCT; 1-2 mm collimation high-spatial-frequency reconstruction algorithm). Morphometric analysis. While originally described as a typical HRCT finding in pulmonary alveolar proteinosis (Fig. Case 1. Thickening of the interlobular septa is a common and easily recognizable finding at high-resolution computed tomography (HRCT; 1–2 mm collimation high-spatial-frequency reconstruction algorithm). GGO may also result from atelectasis. High Resolution CT > Findings > Pleural Effusion PLEURAL EFFUSION. Several additional chest radiographic findings may be seen in patients with scleroderma. 5.1 ). and thickening of the mesorectal fascia were also seen (Figure2). Radiographically, rapidly coalescent bilateral airspace opacities are seen, whereas the typical thin-section CT finding is one of ground glass opacity (. Axial CT of the chest shows thickening of the intralobular and interlobular septa with a superimposed background of ground-glass opacity in a patient with pulmonary alveolar proteinosis. A. Intralobular interstitial thickening, which was superimposed on GGO, was also frequently observed with 28 identified cases (65%) (Figs. The mean area examined for each of these compartment was 3.9 ± 0.5 mm 2 (M ± SE) in the random fields, 2.4 ± 1.6 mm 2 in intralobular septa, and 2.2 ± 0.8 mm 2 in pleural tissue. Enlargement of the central pulmonary arteries and right heart dilatation may be seen on chest radiographs in patients with pulmonary arterial hypertension. Abnormalities that may be seen in the chest wall of individuals with rheumatoid arthritis include tapered erosion of the distal clavicles, rotator cuff atrophy with a high-riding humeral head, bilateral symmetric glenohumeral joint space narrowing with or without superimposed degenerative joint disease, and superior rib notching or erosion. 4.8). Table 17.5 Manifestations of Rheumatoid Lung Disease, Pulmonary involvement may take the form of acute lupus pneumonitis or chronic interstitial disease. There were also areas of ground-glass opacity. Normally very few interlobular septae are seen in the ante-rior and lower aspects of the lower lobes on HRCT. 1, 3). Because patients with scleroderma are at a greater risk for developing lung cancer, particularly bronchioloalveolar cell carcinoma, the appearance of a mass or persistent airspace opacity should raise this possibility. Septal ThickeningSeptal Thickening Large PatternLarge Pattern There is a geographical distribution . Sarcoidosis is a multisystem chronic inflammatory condition of unknown etiology. 4.11). A patchy and geographic distribution of GGO, with significant involvement of the central lung, is not typical of an interstitial pneumonia (i.e., NSIP, DIP, LIP, and OP), but is occasionally seen with NSIP in patients with connective tissue disease or LIP. The diagnosis is often determined by the clinical history, as in this patient with drug toxicity resulting from treatment of lymphoma. These lines are best visualized in the subpleural and juxtadiaphragmatic regions of the lung, where they outline the anterior and posterior margins of secondary lobules. Diffuse interlobular septal thickening (DIST) is an abnormality seen on high-resolution CT (HRCT) scanning of the thorax. The risk factors associated with disease severity were analyzed. When the distribution of GGO is strongly peripheral, an interstitial pneumonia is favored, most specifically NSIP or DIP, but eosinophilic pneumonia and OP may also show this appearance (Fig. There is presence of ground glass haziness with interstitial interlobular and intralobular septal thickening noted in both lungs with symmetrical and perihilar distribution, sparing the lung peripheries. Interlobular (Septal) Lines. HRCT (A) shows nonspecific patchy GGO in a patient with chronic symptoms. January 2006; Radiology 237(3):1091-6; DOI: Radiographic evidence of UIP is distinctly uncommon in SLE, but fibrosis is said to be present pathologically in one-third of patients. On CT scans, diseases affecting one of the components of the septa are responsible for thickening and thus cause the septa visible [1] (Figs. e. Intralobular septal thickening seen in all ILDs . A crazy-paving pattern is a non-specific radiological sign which is characterized by the presence of diffuse ground-glass attenuation associated with interlobular septal thickening and intralobular lines. Clinical information, particularly the duration of symptoms, can limit the diagnosis when either of these findings is present. There is also reticulation with thickening of the intralobular lines and interlobular septae associated with mild traction bronchiolectasis in the subpleural areas of both basal lungs. Crazy-paving sign. Interlobular septal thickening centrilobular nodules, bronchial wall thickening, interlobular (n=19, 9.6%) (Figs. 4.4), suggesting a specific diagnosis in a patient with acute symptoms and GGO aided by history (e.g., immunosuppression or AIDS, exposures, and known cardiac disease) and the specific presenting symptoms (e.g., fever, sputum production, and hemoptysis). Even processes such as pulmonary edema, which are commonly symmetric or diffuse, can produce patchy, focal, or nodular opacities in some patients (Fig. Keywords Pulmonary Sarcoidosis Interlobular Septum Lipid Pneumonia Dependent Lung Region Pulmonary Interstitial Edema Each of these findings tends to be nonspecific and has a long differential diagnosis. Abnormalities of soft tissues and bony thorax, Pulmonary fibrosis (basilar predominance), Pulmonary arterial hypertension and right heart enlargement, Detection of clinically suspected parenchymal abnormality when the chest radiograph is normal or shows questionable abnormality, Characterization of parenchymal abnormalities, Monitoring of response to therapy or progression of disease. Interlobular Septal Thickening in Idiopathic Bronchiectasis: A Thin-Section CT Study of 94 Patients 1. Fig.1: Chest radiograph of a 44-year-old immunocompetent woman with subacute dyspnea, short of breath and no fever shows diffuse, bilateral opacities predominantly in the perihilar and mid-to-lower lungs.Note normal-sized heart. Patients with the CREST syndrome (subcutaneous calcification, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia), a variant of scleroderma, may have radiographically visible calcifications within the subcutaneous tissues of the chest wall. On presentation she was tachycardic and tachypneic, with oxygen saturation of 81% on 2 L/min of oxygen. It consists of scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines. Simulated alveolar wall thickening in interstitial disease. This finding is helpful in distinguishing PLC from other causes of interlobular septal thickening like Sarcoidosis or cardiogenic pulmonary edema. Conclusions: Smooth interlobular septal thickening, with or without associated ground-glass opacities, in patients with hepatosplenomegaly is the most common finding in NPD type B. The risk factors associated with disease severity were analyzed. 16.1 and 16.2). This is an uncommon manifestation of rheumatoid disease that usually develops secondary to diffuse interstitial fibrosis. Pulmonary arterial hypertension with enlarged central pulmonary arteries and RV dilatation is seen in up to 50% of patients with scleroderma and may be seen in the absence of interstitial fibrosis. Therefore, the presence of severe interstitial fibrosis in a patient with clinical features of SLE should prompt consideration of the diagnosis of an overlap syndrome (mixed connective tissue disease). This case illustrates a patient with laboratory confirmed SARS-CoV-2 … While DIST may be present to variable extents in a number of lung conditions, it is uncommon as a predominant finding except in a few entities. It may reflect the presence of alveolar disease, interstitial disease, or a combination of both, and it may be a manifestation of lung infiltration, active inflammation, or fibrosis (Fig. This distribution is more suggestive of other causes of GGO such as hypersensitivity pneumonitis (Fig. Smooth septal thickening: is commonly secondary to the accumulation of intersitial fluid i.e. The duration of symptoms (i.e., acute or chronic) is important in limiting the initial differential diagnosis (Table 4.1). Each of these findings tends to be nonspecific and has a long differential diagnosis. Several findings may be helpful in limiting the differential diagnosis (Table 4.2). d. irregular interlobular septal thickening is seen in alveolar. The interlobular septal thickening outlined lobules 1–2.5 cm in diameter and appeared polygonal in shape.
2020 interlobular vs intralobular septal thickening radiology