Varicose and cystic (saccular) bronchiectases are often evident on plain radiography as cystic lesions up to 2 cm in diameter and often containing a small air-fluid level at the bottom. 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. 6.17 Mitral stenosis (2 cases). 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, A graphic or morphometric classification is a better approach and is enumerated in Box 7-3. 6.2 Bronchiectases. Chest Radiology > Pathology > Interstitial Disease. 7-11). Langerhans cell histiocytosis (eosinophilicgranuloma) (Fig. 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. Nodular pattern of miliary tuberculosis. The pathology is often inflammatory and always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis. Amyloidosis (diffuse alveolar septal form), Talc granulomatosis secondary to intravenous drug abuse. Interstitial Pulmonary Fibrosis. Interstitial lung disease is considered a misnomer by some, as many of the diseases also involve the alveolar spaces. Diffuse bilateral poorly defined small nodular densities are present, but only shown for the right lower lung field. Note also the lytic involvement of the left fifth rib with pathologic fracture (arrow). Figure 7-8 Centrilobular nodules in respiratory bronchiolitis. Fig. The patterns are described as nodular, irregular or linear, cystic, ground-glass, and parenchymal consolidation. Patients are often hypoxemic, and pulmonary function tests typically demonstrate a restrictive pattern, with reduced diffusing capacity. 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. 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. Both congenital and acquired bronchiectases can be mistaken radiographically for localized interstitial lung disease (Fig. Cystic bronchiectases may produce a radiographic picture similar to honeycombing. Diseases that cause a characteristic honeycomb pattern are summarized in Table 6.2. Fig. The reticular pattern consists of a network of linear densities (Fig. Finally, fibrotic scars may be the sequelae of virtually any disease capable of damaging the lung parenchyma severely enough. 6.17). Varicose and cystic (saccular) bronchiectases are often evident on plain radiography as cystic lesions up to 2 cm in diameter and often containing a small air-fluid level at the bottom. d Ground-glass appearance produced by the summation of innumerable tiny retlculogranular densities (sarcoidosis). Finely granular and relatively dense stippling preferentially located in the posterior (dependent) parts of the lungs and most obvious a few hours after lymphography. This usually extends from the centrilobular vessel peripherally to join a thickened septum. Centrilobular abnormalities can also be seen in patients with diseases of the peripheral airways (i.e., bronchioles). A nodular pattern (Fig. Figure 7-2 Linear opacities of nonspecific interstitial pneumonia. Figure 7-12 Masses of fibrosis in end-stage sarcoidosis. 6.7 Aspergillosis. Physiologically, the abnormalities primarily affect gas exchange and result in hypoxemia. 6.1f). 2. 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. Fig. More often, however, nodular and reticular patterns are combined in the same patient, resulting in a reticulonodular appearance of the interstitial disease. Physical examination frequently finds only dry rales or crackles. Plate-like (discoid) atelectases and localized fibrotic strands can be differentiated from Kerley lines by their lack of a characteristic anatomic location and by the great variation in length and width of these densities. Multiple poorly defined nodules are seen bilaterally. A purely nodular pattern is found with the hematogenous spread of certain infections and tumors, but can also be encountered with other diseases (Table 6.1). 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). Finally, fibrosis of the interlobular septa can be associated with any form of pulmonary fibrosis, but is most frequently observed with pneumoconiosis. Traction bronchiectasis of usual interstitial pneumonitis in scleroderma. 7-4). 6.16 Langerhans cell histiocytosis (eosinophilic granuloma). 6.7). Large masses of fibrous tissue may occur, usually in the central or axial interstitium (Fig. It is often accompanied by other signs of interstitial lung disease, especially the patterns associated with reticular opacities and architectural distortion. Pleural plaques, an uncommon feature, are produced almost exclusively by asbestos exposure. The process of evaluating a surgical lung biopsy for disease involves answering several questions. 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. For example, the adult ILD … Ill-defined nodules up to 1 cm in diameter are identified in both lungs. Adenopathy (Box 7-6), which is recognized on standard radiographs, is associated with silicosis and sarcoidosis, lymphangitic carcinomatosis, and lymphoma. Thick-walled cystic spaces can be seen subpleurally in the bases. It is found, besides in interstitial diseases, also with air-space disease (e.g. Coccidioidomycosis, blastomycosis, and Cryptococcosis (Fig. Many diseases demonstrate more than one pattern (see Box 7-3). Smoking cessation often improves symptoms; the disease also … Fig. Multiple, small (1 to 3 mm) nodules are distributed diffusely throughout the lungs. Interstitial lung disease (ILD) consists of a large and heterogeneous group of rare pulmonary disorders, characterized by abnormalities involving the alveoli and airway. Finely granular stippling uniformly distributed over both lung fields. 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 pulmonary fibrosis has many causes. Notice the dilated esophagus (e). Fig. 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. Thickening of the interlobular septa (Fig. They are most numerous at the base of the lungs. Numerous relatively poorly defined miliary nodules and bilateral hilar enlargement are present, but are only shown for the right side. 4 to 10 mm, poorly defined (early acute stage of disease). Finally, fibrosis of the interlobular septa can be associated with any form of pulmonary fibrosis, but is most frequently observed with pneumoconiosis. Honeycombing typically is in the peripheral portions of the lungs subpleurally, particularly in idiopathic pulmonary fibrosis. 6 Interstitial Lung Disease. 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. 7-5). Underlying chILD pathologies are markedly different from adult ILD. 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. Lung damage from ILDs is often irreversible and gets worse over time. Table 6.3 summarizes all disorders that demonstrate radiographically a diffuse reticular or reticulonodular pattern characteristic of interstitial lung disease. These disorders are grouped together because of similarities in their clinical presentations, plain chest radiographic appearance, and… 6.1e). Miliary and larger, often poorly defined; can form microabscesses. 6.13 Stannosis (inhalation of tin oxide). Multiple small nodules of variable sizes are seen bilaterally, but are only shown for the right mid lung field. They are usually associated with architectural distortion and volume loss. Bronchioloalveolar carcinoma (alveolar cell carcinoma) (Fig 6.3). First described in asbestosis, a subpleural line occasionally is seen in normal lungs and results from dependent atelectasis. 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. , especially the patterns associated with obscuration of underlying vascular markings often become diffuse, Veal CF,! The appearance of honeycombing is produced pathologically by the dissolution of alveolar walls with the formation of randomly distributed that... Standard radiographs, but are only shown for the right lung are occasionally seen in patients with diseases the. Pneumonia and respiratory bronchiolitis-associated interstitial lung disease but ground-glass and cystic disease patterns much... Is prominent, and a comprehensive List is provided in Box 7-3 ) are relatively uniform in size and containing... 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