The size of the lung (i.e., lung volumes) may be a clue to the differential diagnosis (Box 7-7). Development of high-resolution computed tomography (HRCT) has resulted in markedly improved accuracy in diagnosing interstitial lung disease. 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. Some are primarily lung disorders, and some others are manifestations of diseases arising elsewhere. More often, however, nodular and reticular patterns are combined in the same patient, resulting in a reticulonodular appearance of the interstitial disease. Commonly, interstitial lung disease (ILD) presents with dyspnea on exertion, diffuse bilateral infiltrates on chest imaging, and restriction with diffusion impairment on physiologic testing. Thick-walled cystic spaces can be seen subpleurally in the bases. Often less evident in apices and bases. It consists of an amorphous opacification or increase in attenuation, which is mildly severe and is not sufficient to obliterate the pulmonary vessels. These structures typically have a central dot that represents the pulmonary artery. 7-10) tend to be well defined and can be seen in numerous interstitial lung diseases. Honeycombing is the only dependable radiographic sign of interstitial fibrosis. This appearance is virtually diagnostic, although under very rare circumstances both pulmonary papillomatosis and paragonimiasis may mimic cystic bronchiectases. 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. Ill-defined nodules up to 1 cm in diameter are identified in both lungs. (B) Axial CT in another patient with NSIP caused by nitrofurantoin at the level of the main bronchi shows bilateral ground-glass opacities and reticulation mainly in the peripheral lung. Numerous fairly well defined miliary nodules are seen bilaterally besides diffuse reticular changes and early honeycombing, but are only shown for the right side. 7-6) occurs in many diseases, such as lymphangitic spread of carcinoma, pulmonary fibrosis, and sarcoidosis. There is also thickening of the axial interstitium along the bronchi (arrow) and nodules along the fissures (thick arrows). 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. ILDs may occur in isolation or in association with systemic diseases. 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. Peripheral septal lines lie perpendicular to the pleural surface (open arrow). 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. Ground-glass attenuation is a term used almost exclusively with CT. Notice the subpleural sparing at the fissures. Figure 7-3 Thin-walled cysts are seen in the lungs of a patient with lymphangioleiomyomatosis. Pneumoconiosis (inorganic dust) (e.g., silicosis, coal miner’s lung, berylliosis) (Figs. 7-3) and honeycombing. 6.17). The chest radiograph, however, is often nonspecific. 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. Publicationdate 2007-12-20. Linear opacities of nonspecific interstitial pneumonia. Fig. Oily contrast material embolism (e.g., secondary to lymphography) (Fig. Radiology Key; Thoracic Key; Veterinary Medicine; Gold Membership; Contact; Menu. Fig. 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. Fig. 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. Pattern recognition in diffuse interstitial lung disease has been the subject of controversy for many years. Table 6.3 summarizes all disorders that demonstrate radiographically a diffuse reticular or reticulonodular pattern characteristic of interstitial lung disease. (e.g., carcinomas from thyroid, lung, breast or gastrointestinal tract, or melanomas, sarcomas and lymphomas) (Fig. Crossref, Medline, Google Scholar; 49 Myers JL, Veal CF Jr, Shin MS, Katzenstein AL. congestive heart failure). Fairly well defined in silicosis and poorly in berylliosis. Fig. In patients with isolated bronchiectasis, there are no other signs of lung disease. Kerley lines refer to septal lines that are thickened either by fluid accumulation, cellular infiltration, or connective tissue proliferation within the interlobular septa. Finally, fibrosis of the interlobular septa can be associated with any form of pulmonary fibrosis, but is most frequently observed with pneumoconiosis. Box 7-8 High-Resolution Computed Tomography Findings for Linear Opacities, Thickening of bronchovascular bundles (axial), Interlobular septal thickening (septal lines). c Nodular pattern (silicosis). Predominantly in the mid- and lower-lung fields. Hemosiderosis and pulmonary ossification secondary to mitral stenosis (Fig. Reduced lung volumes may result in a restrictive pattern identified on pulmonary function tests. There are two types of cystic patterns: thin-walled cysts (Fig. (C) … Langerhans cell histiocytosis (eosinophilicgranuloma) (Fig. 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 … * Pattern that is predominant or usually associated with a specific disorder. ILD is also termed diffuse parenchymal lung disease (DPLD). 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. Varicella (chickenpox) pneumonia (Fig. 7-13). e Honeycomb pattern (idiopathic interstitial fibrosis). 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). It is often accompanied by other signs of interstitial lung disease, especially the patterns associated with reticular opacities and architectural distortion. 6.6 Histoplasmosis (2 cases). 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. 6.2 Bronchiectases. Fig. Interstitial (in-tur-STISH-ul) lung disease describes a large group of disorders, most of which cause progressive scarring of lung tissue. Figure 7-6 Axial interstitial thickening in a patient with sarcoidosis. Patients usually present (Box 7-2) with dyspnea as the predominant symptom. Some are primarily lung disorders, and some others are manifestations of diseases arising elsewhere. In interstitial disease it is produced when the fine reticulogranular pattern has progressed to such an extent that the overall density of the involved lung is increased, but the individual interstitial lesion is no longer recognizable. The intralobular bronchiole often becomes visible when there is centrilobular thickening. Honeycomb spaces usually are 1 cm or less in diameter with relatively thick walls (>2 mm), and they are a pathologic correlate of end-stage lung disease with fibrosis (Fig. These disorders are grouped together because of similarities in their clinical presentations, plain chest radiographic appearance, and… Patients invariably present with dyspnea of varying time course and severity. 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. 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. Pleural disease may take one of several forms (. 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. Interstitial lung disease (ILD) consists of a large and heterogeneous group of rare pulmonary disorders, characterized by abnormalities involving the alveoli and airway. Thin-walled cysts are seen in the lungs of a patient with lymphangioleiomyomatosis. The fibrotic disorders are characterized by marked restriction, and small lungs invariably are seen in idiopathic pulmonary fibrosis and related disorders. Interstitial Pulmonary Fibrosis. Centrilobular nodules in respiratory bronchiolitis. Notice the dilated esophagus (e). 4 to 10 mm, poorly defined (early acute stage of disease). 6.11 Berylliosis. Web Chapter 56. The ILD consist of disorders of known cause (e.g., collagen vascular diseases, drug-related diseases) as well as … Miliary, discrete (DD: tuberculomas that are larger than 5 mm and can calcify). Many diseases demonstrate more than one pattern (see, Patterns of Opacities in Interstitial Lung Disease, NODULAR OR RETICULAR NODULAR PATTERN (SMALL, ROUNDED OPACITIES), LINEAR PATTERN (SMALL, IRREGULAR, RETICULAR OPACITIES), PARENCHYMAL CONSOLIDATION (AIRSPACE OR ALVEOLAR DISEASE). More often, however, nodular and reticular patterns are combined in the same patient, resulting in a reticulonodular appearance of the interstitial disease. 6.14 Farmer’s lung. Both congenital and acquired bronchiectases can be mistaken radiographically for localized interstitial lung disease (Fig. The lung interstitium is that part of the lung that does not include the airspaces, the capillary endothelial cells, and the alveolar lining epithelium. 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. Calcification extremely rare. 6.1a). Honeycombing represents an end-stage lung that is destroyed by fibrosis. Miliary and larger with mid and upper lung fields predominance. The patterns are described as nodular, irregular or linear, cystic, ground-glass, and parenchymal consolidation. It is found, besides in interstitial diseases, also with air-space disease (e.g. Often poorly defined, confluent nodules of varying size. Innumerable, extremely sharply defined, tiny densities measuring less than 1 mm in diameter are seen bilaterally. 7-7) is common in many interstitial lung diseases. 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. 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