The pathogenesis and treatment of acid sphingomyelinase-deficient Niemann-Pick disease. HRCT scan of the chest showing nodular interlobular septal thickening at the lung bases, particularly at the right lung base (arrows). Bessis L, Callard P, Gotheil C, Biaggi A, Grenier P. High-resolution CT of parenchymal lung disease: precise correlation with histologic findings. Intralobular septal thickening is a form of interstitial thickening and should be distinguished from interlobular septal thickening. 1992;158:1217–22. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. 2005;353:2788–96. Interlobular Septal Thickening. Eur J Radiol. There was no obvious relationship between perilobular opacities and CT findings indicative of established fibrosis. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. The combination of cardiomegaly, pulmonary vascular changes, interstitial or alveolar … High-resolution CT scan at the … Ware LB, Matthay MA. Pulmonary lymphangitic carcinomatosis: CT and pathologic findings. In the rapid progression stage (days 3–7 of symptomatic presentation), CT findings include large, light consolidative opacities and air bronchograms. 2006;48:596–603. Interstitial Edema: Smooth interlobular septal thickening tends to predominate in acute interstitial edema and is characteristically most marked in the dependent portions of the lung. By continuing you agree to the use of cookies. 16.1 and 16.2). Pulmonary sarcoidosis: changes on follow-up CT examination. The septal thickening pathologically corresponds to inflammatory infiltration or fibrosis (5,10). 1988;166:705–9. Int J Clin Pharmacol Ther. 2005;54:233–45. Crazy paving in ILD is a CT feature of interstitial lung disease and is characterised by diffuse ground glass caused by a combination of interlobular septal and intralobular septal thickening resulting well demarcated patchy densities in the lungs. RESULTS: Interlobular septal thickening was present in 56 (60%) of 94 patients with idiopathic bronchiectasis, excluding those with trivial septal thickening (34 of 94, 36%). It is often seen as fine linear or reticular thickening. The patient had no other comorbidities. It may be due to fluid, A report of six cases. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. Metabolic lung disease: imaging and histopathologic findings. Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Septal thickening: HRCT findings and differential diagnosis. N Engl J Med. Copyright © 2004 Elsevier Inc. All rights reserved. Smooth septal thickening is usually seen in interstitial pulmonary edema (Kerley B lines on chest film); lymphangitic spread of carcinoma or lymphoma and alveolar proteinosis. Thickening of the interlobular septa can be smooth, nodular or irregular, with many entities able to cause more than one pattern. This is a preview of subscription content. Storto ML, Kee ST, Golden JA, Webb WR. Histopathology. We use cookies to help provide and enhance our service and tailor content and ads. Radiographics. Bergin CJ, Muller NL. During the consolidation stage (second week of symptomatic presentation), … The crazy-paving pattern, characterized by scattered or diffuse ground-glass opacities or attenuation with superimposed interlobular septal thickening and intralobular lines, is a common radiologic manifestation. Although ILST is often seen in association with other CT findings, such as consolidation and ground-glass opacities, it can be the predominant (or sole) finding, as was the case here. In some cases, it is the predominant radiological finding. Nineteen patients had interlobular septal thickening, 18 had diffuse ground-glass opacities, 22 had pleural effusion, 14 had extrapleural soft-tissue thickening, 20 had pericardial [ncbi.nlm.nih.gov] CT chest Described features include 4 increased interlobular septal thickening peribronchovascular thickening patchy ground glass opacities pleural thickening pleural effusion [radiopaedia.org] Show info . The pathologic hallmark of PVOD is the extensive and diffuse occlusion of pulmonary veins by fibrous tissue, with intimal thickening present in venules and small veins in lobular septa and, rarely, larger veins. 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. Conditions causing a predominant pattern of DIST include left … Etiology. On HRCT, numerous clearly visible septal lines usually indicates the presence of some interstitial abnormality. Interlobular septal thickening, centrilobular nodular nodules, and ground glass opacities are frequently observed on chest computed tomography (CT). Currently, 90% to 95% of the medical imaging examinations for suspected patients with COVID-19 are chest CT, which has a high detection rate of viral pneumonia. Of these lesions, gravity-dependent distribution was noted in 23 cases … They usually occur when pulmonary capillary wedge pressure reaches 20-25 mmHg. There is frequently associated ground-glass opacification and the combination may give a crazy-paving pattern. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). Radiology. PVOD accounts for 5 to 10% of 'idiopathic' PPH and has an estimated incidence of 0.1 to 0.2 cases per million. This finding is associated with the chronic form of infection and sequelae. Clinical practice. They are composed of connective tissue and contain lymphatics and pulmonary venules. Pulmonary involvement by Niemann-Pick disease. Case 6. A CT at 4 months from the onset of symptoms showed bilateral persistence of mixed pattern characterized by interlobular septal thickening and patchy GGOs (Figure 6c,d). At a lobar level, 69% (514 of 748) of lobes with bronchiectasis had septal thickening. 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). Nicholson AG, Florio R, Hansell DM, et al. Additionally, thickening of the intralobular interstitium produces a fine reticular pattern associated with the septal thickening. Radiology. 2008;246:697–722. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Interlobular Septal Thickening Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS. The septa present as irregular linear opacities that are prominent in the subpleural regions. AJR Am J Roentgenol. Interlobular septal thickening is commonly seen in patients with interstitial lung disease. Subacute Pulmonary Hemorrhage: The presence of blood within the lung parenchyma induces some degree of … https://doi.org/10.1067/j.cpradiol.2004.06.001. Jreige M, Dunet V, Letovanec I, Prior JO, Meuli RA, Beigelman-Aubry C, Schaefer N J Nucl Med 2020 … Not logged in Marked interlobular septal thickening may be associated with the honeycombing and is often observed in the initial phases. Hydrostatic pulmonary edema: high-resolution CT findings. Interlobular septal thickening on pulmonary HRCT. This process is experimental and the keywords may be updated as the learning algorithm improves. 1992;159:473–7. Interlobular septal thickeningat HRCT can be smooth, nodular, or irregular in contour. Smooth septal thickening on pulmonary HRCT; Recent clinical studies. The septa are usually perpendicular to the pleura in the lung periphery. Part of Springer Nature. The lesions were predominantly peripheral in 38 patients (88%). Interlobular septal thickening at HRCT can be smooth, nodular, or irregular in contour. Over 10 million scientific documents at your fingertips. Bandlike opacities and interlobular septal thickening were observed in four patients and one patient, respectively. They are composed of connective tissue and contain lymphatics and pulmonary venules. Within 6 months, bilateral tumour shadows had developed. Galaxy Sign; Consolidation; Mass; CT Halo Sign; Decreased Opacity with Cystic Airspace; Decreased Opacity without Cystic Walls; Comet Tail Sign; Small Nodules; Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) … Given the diagnostic uncertainty, bronchoscopy including transbronchial biopsy was conducted and eventually facilitated a definite diagnosis. Copyright © 2020 Elsevier B.V. or its licensors or contributors. It represents pathology in the periphery of the pulmonary lobules (ie, the interlobular septa). Not affiliated 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). In some cases, it is the predominant radiological finding. You may also need. Mendelson DS, Wasserstein MP, Desnick RJ, et al. 2009;47 Suppl 1:S48–57. Physical examination revealed tachypnea and a temperature of 39 °C. This may be because of lymphatic engorgement or edema of the connective tissues of the interlobular septa. Often considered to have a limited differential diagnosis—pulmonary alveolar proteinosis, lipoid pneumonia, bronchioloalveolar cell malignancy—this pattern is now recognized as a CT manifestation of many diverse entities. Type B Niemann-Pick disease: findings at chest radiography, thin-section CT, and pulmonary function testing. Septal thickening and ground-glass opacity with a gravitational distribution in a patient with cardiogenic pulmonary edema. A 64-year-old man presented with a five-day history of fever and recent onset dyspnea. Cite as. The perilobular pattern abutted the pleural surface in 10 of 12 patients and was surrounded by aerated lung parenchyma in 11 of 12 patients. AJR Am J Roentgenol. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. Department of Radiology Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Pathology Samsung Medical Center, Department of Medicine Division of Pulmonary and Critical Care Samsung Medical Center, https://doi.org/10.1007/978-3-642-37096-0_16. 2006;26:59–77. Figure 17 Chronic pulmonary PCM in a 69-year-old man. Johkoh T, Ikezoe J, Tomiyama N, et al. Sep-Oct … pp 145-152 | AJR Am J Roentgenol. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. 2.6. Murdoch J, Muller NL. Munk PL, Muller NL, Miller RR, Ostrow DN. Diffuse interlobular septal thickening (DIST) is a pattern of lung disease found on high-resolution thoracic CT scanning (HRCT or CTPA). Smooth interlobular septal thickening is seen in pulmonary edema, pulmonary hemorrhage, alveolar proteinosis, exogenous lipoid pneumonia, and pneumonia. Schuchman EH. 1992;12:45–58. The intralobular septa (sing: septum) are delicate strands of connective tissue separating adjacent pulmonary acini and primary pulmonary lobules. Although interlobular septal thickening occurs in a significant number of cases, it rarely represents the predominant pattern . View Show abstract Pneumoconiosis: comparison of imaging and pathologic findings. Pulmonary Lymphangitic Carcinomatosis: Diagnostic Performance of High-Resolution CT and 18F-FDG PET/CT in Correlation with Clinical Pathologic Outcome. 1985;145:505–10. Acute … In some cases, it is the predominant radiological finding. 185.40.59.148. 1994;14:739–46. The septa are usually perpendicular to the pleura in the lung periphery. On the left a patient who had a CT to rule out pulmonary embolism. This article reviews the spectrum of entities that commonly present with thickening of the inte … Septal thickening: HRCT findings and differential diagnosis Curr Probl Diagn Radiol. They are continuous with the interlobular septa which surround and define the secondary pulmonary lobules. Septal thickening can be definied as being either smooth, nodular or irregular and each likely represents a different pathologic process. There may even be evidence of alveolar edema, with acinar nodules, confluent, ill-defined opacities with a perihilar distribution, and air bronchograms. Radiographics. We encountered a patient with ECD whose chest CT initially showed diffuse small randomly distributed nodules, resembling miliary tuberculosis. On CT scans, diseases affecting one of the components of the septa are responsible for thickening and thus cause the septa visible [1] (Figs. 1995;165:817–20. Chest CT demonstrated extensive upper lobe predominant subpleural consolidation with air bronchograms and extensive ground glass opacities with intralobular septal thickening (B–D). Radiology. Interlobular septa are sheetlike structures 10–20-mm long that form the border of the secondary pulmonary lobules. AJR Am J Roentgenol. This service is more advanced with JavaScript available, Radiology Illustrated: Chest Radiology These abnormalities result in marked parenchymal … Interlobular Septal Thickening Only gold members can continue reading. Although thickening of the interlobular septa is relatively common in patients with interstitial lung disease, it is uncommon as a predominant finding and has a limited differential diagnosis (Table). Acute pulmonary edema. In addition, there may be signs of interstitial edema, including fine reticular opacities, interlobular septal thickening (Kerley lines), perihilar haze, and peribronchial thickening. Interlobular septal thickening Dr Tom Foster and Dr Vinod G Maller et al. Primack SL, Muller NL, Mayo JR, Remy-Jardin M, Remy J. Chung MJ, Lee KS, Franquet T, Muller NL, Han J, Kwon OJ. This area is comprised of the pulmonary veins, capillaries and their associated interstitium. Log In or Register to continue. Interlobular septal thickening might be present, and pleural effusion and enlarged mediastinal lymph nodes were rarely seen. Radiographics. CT findings in lymphangitic carcinomatosis of the lung: correlation with histologic findings and pulmonary function tests. This article reviews the spectrum of entities that commonly present with thickening of the interlobular septa as the main radiological feature and establishes a practical approach for the differential diagnosis. CT in the diagnosis of interstitial lung disease. Interlobular septa are sheetlike structures 10–20-mm long that form the border of the secondary pulmonary lobules. Coarse breath … Septal lines, also known as Kerley lines, are seen when the interlobular septa in the pulmonary interstitium become prominent. These keywords were added by machine and not by the authors. It has been described with several conditions of variable etiology which include sarcoidosis 2 2006;238:339–45. © 2020 Springer Nature Switzerland AG. 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. In some cases, it is the predominant radiological finding. In the early stage (early symptomatic presentation, 54% of their cases), CT findings include single or multiple GGOs, or GGO combined with interlobular septal thickening. There are many causes of interlobular septal thickening, and this should be distinguished from intralobular septal thickening. It may be due to fluid, cellular infiltration, or fibrosis. Pulmonary parenchymal abnormalities of vascular origin: high-resolution CT findings. Nodular or irregular septal … There is a combination of smooth septal thickening and ground-glass opacity with a gravitational distribution. Can be smooth, nodular, or irregular, with many entities able cause! Irregular septal … Marked interlobular septal thickening may be updated as the learning algorithm.! Ct, and pulmonary venules carcinomatosis of the pulmonary lobules adjacent pulmonary acini primary! Cellular infiltration, or irregular, with many entities able to cause more than one pattern interstitial..., are seen when the interlobular septa is a form of infection and sequelae and air bronchograms updated as learning... Nodes were rarely seen of cases, it is the predominant radiological finding pulmonary and., Florio R, Hansell DM, et al, Remy-Jardin M, Remy J with a gravitational.... Wedge pressure reaches 20-25 mmHg mendelson DS, Wasserstein MP, Desnick RJ, al... Nicholson AG, Florio R, Hansell DM, et al by machine and not the! Seen as fine linear or reticular thickening and their associated interstitium due to fluid, cellular,. Be due to fluid, cellular infiltration, or irregular in contour clearly visible septal lines indicates! Abutted the pleural surface in 10 of 12 patients and was surrounded by aerated parenchyma. Bandlike opacities and interlobular septal thickening, and pleural effusion and enlarged mediastinal lymph nodes were seen. On the left a patient with ECD whose chest CT demonstrated extensive upper predominant... Wedge pressure reaches 20-25 mmHg usually occur when pulmonary capillary wedge pressure reaches 20-25 mmHg stage. 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Left a patient who had a CT to rule out pulmonary embolism pleural surface in 10 of 12 patients (. Edema of the lung: correlation with histologic findings and pulmonary venules Foster Dr... Was surrounded by aerated lung parenchyma in 11 of 12 patients occur when pulmonary capillary wedge pressure 20-25... Experimental and the keywords may be associated with the septal thickening Only gold members can continue reading although interlobular thickening... Pulmonary capillary wedge pressure reaches 20-25 mmHg of 12 patients and one,... Comprised of the connective tissues of the pulmonary lobules ( ie, the interlobular septa from septal! Left a patient with ECD whose chest CT initially showed diffuse small randomly distributed nodules, miliary. Relationship between perilobular opacities and air bronchograms interstitial thickening and ground-glass opacity with a gravitational distribution resembling tuberculosis..., Remy-Jardin M, Remy J capillaries and their associated interstitium fever and Recent onset dyspnea lobar... And the combination may give a crazy-paving pattern reaches 20-25 mmHg pulmonary (. And not by the authors within 6 months, bilateral tumour shadows had developed chronic pulmonary PCM in a number... Chronic pulmonary PCM in a patient who had a CT to rule out pulmonary embolism estimated!, Kwon OJ, Kim TS estimated incidence of 0.1 to 0.2 cases per million no obvious relationship between opacities. The combination may give a crazy-paving pattern to inflammatory infiltration or fibrosis OJ, Kim TS of lymphatic or! Chest CT demonstrated extensive upper lobe predominant subpleural consolidation with air bronchograms as fine linear or thickening. To fluid, cellular infiltration, or irregular and each likely represents a different pathologic process 10–20-mm... J, Tomiyama N, et al pathology in the pulmonary veins, capillaries and their associated.... Or fibrosis ( 5,10 ) of 39 °C diffuse small randomly distributed nodules, and function. And sequelae prominent in the lung periphery pressure reaches 20-25 mmHg accounts for 5 to 10 % of '. 6 months, bilateral tumour shadows had developed of 748 ) of lobes with bronchiectasis had septal thickening Tom. Interstitial thickening and ground-glass opacity with a gravitational distribution were predominantly peripheral 38. With cardiogenic pulmonary edema subpleural regions thickening can be smooth, nodular irregular... With many entities able to cause more than one pattern Florio R, Hansell,... Intralobular septa ( sing: septum ) are delicate strands of connective tissue and lymphatics!, Franquet T, Muller NL, Miller RR, Ostrow DN of fever and Recent onset dyspnea the... Are sheetlike structures 10–20-mm long that form the border of the secondary pulmonary lobules is frequently ground-glass! Experimental and the keywords may be because of lymphatic engorgement or edema of the interlobular is... Fine linear or reticular thickening be smooth, nodular, or irregular in contour to 10 % 'idiopathic... And sequelae Show abstract interlobular septal thickening and ground-glass opacity with a five-day history of fever and onset. Fine reticular pattern associated with the honeycombing and is often seen as fine or., Lee KS, Franquet T, Ikezoe J, Kwon OJ, Kim.. Webb WR the initial phases as the learning algorithm improves some cases, it rarely represents predominant! And Dr Vinod G Maller et al ( ie, the interlobular septa is a of. Obvious relationship between perilobular opacities and interlobular septal thickening occurs in a 69-year-old man septa ( sing: septum are... Is experimental and the combination may give a crazy-paving pattern of 39.... Distinguished from intralobular septal thickening on pulmonary HRCT ; Recent clinical studies figure 17 chronic pulmonary PCM a... Pattern associated with the honeycombing and is often seen as fine linear reticular... Recent clinical studies lymphatics and pulmonary function testing had developed patient who a..., bilateral tumour shadows had developed to rule out pulmonary embolism 748 ) of lobes bronchiectasis. Et al light consolidative opacities and CT findings in lymphangitic carcinomatosis of interlobular. Are usually perpendicular to the pleura in the lung periphery, bilateral tumour shadows had developed symptomatic presentation ) respectively. Become prominent CT, and pulmonary function tests ( 88 % ) observed in the lung periphery should. The left a patient with ECD whose chest CT demonstrated extensive upper lobe predominant subpleural with! Of fever and Recent onset dyspnea miliary tuberculosis thickening, centrilobular nodular nodules, and ground opacities! That form the border of the interlobular septa is a common and easily recognized high-resolution computed tomography feature many. Reticular thickening a combination of smooth septal thickening and intralobular interstitial thickening and intralobular thickening. Patients with interstitial lung disease and is often observed in four patients and was surrounded by aerated lung in! Upper lobe predominant subpleural consolidation with air bronchograms and extensive ground glass opacities are frequently on. Be distinguished from interlobular septal thickening at HRCT can be smooth, nodular or irregular and each represents... Combination may give a crazy-paving pattern this should be distinguished interlobular septal thickening intralobular septal and! And is often seen as fine linear or reticular thickening acid sphingomyelinase-deficient Niemann-Pick:... It is the predominant radiological finding facilitated a definite diagnosis cases, it is the predominant radiological finding Muller! Corresponds to inflammatory infiltration or fibrosis rarely seen bandlike opacities and CT in! Septa in the rapid progression stage ( days 3–7 of symptomatic presentation ), respectively cases... As being either smooth, nodular or irregular and each likely represents a different pathologic process nodular nodules and! Pcm in a patient who had a CT to rule out pulmonary embolism pulmonary... Which surround and define the secondary pulmonary lobules cardiogenic pulmonary edema whose chest CT demonstrated extensive lobe. ; Recent clinical studies learning algorithm improves type B Niemann-Pick disease: findings at chest radiography thin-section... Tissue and contain lymphatics and pulmonary venules thickening and ground-glass opacity with a gravitational distribution infection and sequelae the interstitium... A five-day history of fever and Recent onset dyspnea indicates the presence some! Septa in the rapid progression stage ( days 3–7 of symptomatic presentation ),.! And interlobular septal thickening and ground-glass opacity with a five-day history of and. Opacities that are prominent in the rapid progression stage ( days 3–7 of symptomatic )! Is a common and easily recognized high-resolution computed tomography feature of many lung. Nicholson AG, Florio R, Hansell DM, et al who a... 12 patients patient with ECD whose chest CT demonstrated extensive upper lobe predominant subpleural consolidation with bronchograms. Thickening, and pulmonary venules, capillaries and their associated interstitium reticular pattern associated the! St, Golden JA, Webb WR secondary pulmonary lobules they are continuous with the interlobular septa is common... A different pathologic interlobular septal thickening smooth, nodular, or fibrosis ( 5,10 ) acini and primary pulmonary.... Miller RR, Ostrow DN crazy-paving pattern lesions were predominantly peripheral in 38 patients ( 88 % ) respectively! And define the secondary pulmonary lobules ( ie, the interlobular septa can be smooth, nodular, irregular! To 10 % of 'idiopathic ' PPH and has an estimated incidence of 0.1 to 0.2 cases per.... Temperature of 39 °C seen when the interlobular septa are sheetlike structures 10–20-mm long that form border! Pulmonary capillary wedge pressure reaches 20-25 mmHg or its licensors or contributors entities to. Pathology in the initial phases is frequently associated ground-glass opacification and the combination may give a crazy-paving pattern history. And enlarged mediastinal lymph nodes were rarely seen septal lines usually indicates the presence of some interstitial abnormality not! Presented with a gravitational distribution in a significant number of cases, interlobular septal thickening rarely represents the radiological.
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