Interstitial lung disease (ILD) comprises a broad category of lung diseases rather than a specific disease entity. Patients usually present (Box 7-2) with dyspnea as the predominant symptom. Localized fibrotic changes are often found in the chronic stage of a disease (e. g., tuberculosis and radiation pneumonitis). Differential diagnosis. However, several problems limit this approach to differential diagnosis. Underlying chILD pathologies are markedly different from adult ILD. Density of the tiny nodules depends on the atomic number of the inhaled element. Honeycombing in idiopathic pulmonary fibrosis. They are most numerous at the base of the lungs. Bronchiectases are often associated with loss of volume and crowding of the lung markings in the affected area together with compensatory overinflation of the spared lung (Fig. These structures typically have a central dot that represents the pulmonary artery. 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. Figure 7-13 Honeycombing in idiopathic pulmonary fibrosis. Figure 7-1 Nodular pattern of miliary tuberculosis. Predominantly in the mid- and lower-lung fields. Different kinds of Kerley lines are distinguished: Kerley A lines are straight lines measuring 2–6 cm in length and approximately 1 mm in thickness. 7-13). 6.14 Farmer’s lung. Ill-defined nodules up to 1 cm in diameter are identified in both lungs. Often poorly defined, confluent nodules of varying size. This appearance is virtually diagnostic, although under very rare circumstances both pulmonary papillomatosis and paragonimiasis may mimic cystic bronchiectases. Findings simulate sarcoidosis radiographically. Interstitial (in-tur-STISH-ul) lung disease describes a large group of disorders, most of which cause progressive scarring of lung tissue. Parenchymal consolidation (i.e., airspace or alveolar disease). The fibrotic disorders are characterized by marked restriction, and small lungs invariably are seen in idiopathic pulmonary fibrosis and related disorders. 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. 7-7) is common in many interstitial lung diseases. 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). 6.12 Siderosis. Involvement of the interstitium within the lobule around the central artery and bronchiole or related to the interlobular septum may produce a fine reticular pattern within the lobule itself (Fig. 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). 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. Depending on the mesh size, one can distinguish between fine, medium, and coarse reticular patterns, although this distinction has no obvious differential diagnostic … Interstitial lung diseases (ILDs) are a heterogeneous group with diffuse parenchymal lung disease. 7-9). Fairly well defined in silicosis and poorly in berylliosis. Healing may result in punctate calcifications years later. This usually extends from the centrilobular vessel peripherally to join a thickened septum. 6.8). Amyloidosis (diffuse alveolar septal form), Talc granulomatosis secondary to intravenous drug abuse. They are usually associated with architectural distortion and volume loss. 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. Abstract: The idiopathic interstitial pneumonias (IIPs) are the most commonly diagnosed forms of interstitial lung disease. 6.1a–f Patterns of interstitial lung disease. 2 to 4 mm, discrete. 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. 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. Honeycombing is the only dependable radiographic sign of interstitial fibrosis. Despite the large number, approximately 15 to 20 constitute 90% of such disease states, and these are the entities that are discussed in this chapter. Fig. Central septal lines outline the secondary pulmonary lobule, which appears as a polyhedral structure. 7-1) is composed of multiple, small nodules that range from 1 mm to 1 cm in diameter. 6.14 and 6.15). In this review we present the key findings in the most common interstitial lung diseases. There is also thickening of the axial interstitium along the bronchi. Punctate densities (hemosiderosis) and densely calcified 2 to 8 mm nodules (pulmonary ossification), predominantly in the mid and lower lung fields, usually more numerous on the right side. Fig. 7-7) is common in many interstitial lung diseases. 6.1d) is caused by a hazy increase in lung density that is not associated with obscuration of underlying vascular markings. A nodular pattern (Fig. There are two types of cystic patterns: thin-walled cysts (Fig. This chapter on interstitial lung disease (ILD) is followed by a chapter on alveolar lung disease (ALD). 7.29). A honeycomb pattern is characterized by round or oval cystic lesions with a diameter up to 1 cm (Fig. Calcification extremely rare. These disorders are grouped together because of similarities in their clinical presentations, plain chest radiographic appearance, and… These nodules may be seen in patients with lobular pneumonia, endobronchial spread of tuberculosis, or bronchioloalveolar carcinoma. Pulmonary arterial hypertension usually indicates end-stage disease with pronounced obliteration of the pulmonary vasculature. Acute Kerley lines are frequently associated with prominent interlobar fissures caused by subpleural edema. Thickening of the axial interstitium (i.e., interstitium in a peribronchovascular location) (Fig. Fig. 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. 6.19). 6.2). Fig. Discrete and extremely sharply defined, less than 1 mm in diameter. The reticular pattern consists of a network of linear densities (Fig. More sensitive in detection of adenopathy than radiography. 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. It is manifested by bronchial wall thickening and apparent enlargement of central pulmonary vessels. The reticular pattern consists of a network of linear densities (Fig. 6.1d) is caused by a hazy increase in lung density that is not associated with obscuration of underlying vascular markings. 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). 6.7 Aspergillosis. 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. 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), Table 6.1 Disseminated Pulmonary Nodules Measuring Less than 1 cm in Diameter, Pulmonary Edema and Symmetrical Bilateral Infiltrates. 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. Patients invariably present with dyspnea of varying time course and severity. Diseases have zonal preferences in the lungs (Box 7-4), although severe diseases often become diffuse. In bronchiectasis, the bronchi show evidence of bronchial wall thickening, but they also are dilated and larger than adjacent pulmonary artery branches. Fig. Miliary and larger. HIGH-RESOLUTION COMPUTED TOMOGRAPHY FEATURES OF INTERSTITIAL LUNG DISEASE. 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. 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. Can result in nodular calcifications 1 to several years later. 6.1a). Except for pulmonary vascular diseases, signs of pulmonary arterial hypertension are rarely identified. It is often accompanied by other signs of interstitial lung disease, especially the patterns associated with reticular opacities and architectural distortion. In a given patient, they are relatively uniform in size and usually bunched together in grape-like clusters. 6.1a). Patients are often hypoxemic, and pulmonary function tests typically demonstrate a restrictive pattern, with reduced diffusing capacity. 6.13 Stannosis (inhalation of tin oxide). 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. For example, the adult ILD … Depending on the mesh size, one can distinguish between fine, medium, and coarse reticular patterns, although this distinction has no obvious differential diagnostic significance. Although these disorders have frequently been referred to as interstitial lung diseases, many also involve the alveolar spaces. 6.4 Metastases from breast carcinoma. Discrete, 1 mm and smaller, may slowly increase in size and number over months and years. 6.12 and 6.13). Thick-walled cysts are seen in the both lung bases. A graphic or morphometric classification is a better approach and is enumerated in Box 7-3. The complex world of interstitial lung disease presents nearly insurmountable challenges to the general surgical pathologist faced with a lung biopsy in this setting. Intrauterine infection with high mortality rate. 6.1e). Kerley A lines are usually best seen in the mid and lower lung fields. Multiple tiny nodules of high density are distributed evenly throughout both lungs, sparing only the apices. Table 6.3 summarizes all disorders that demonstrate radiographically a diffuse reticular or reticulonodular pattern characteristic of interstitial lung disease. Interstitial Lung Disease (ILD) Interstitial lung disease (ILD) is an umbrella term used for a large group of diseases that cause scarring (fibrosis) of the lungs. Desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung disease. This appearance is virtually diagnostic, although under very rare circumstances both pulmonary papillomatosis and paragonimiasis may mimic cystic bronchiectases. Kerley A lines are usually best seen in the mid and lower lung fields. Honeycombing is the only dependable radiographic sign of interstitial fibrosis. 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. Figure 7-8 Centrilobular nodules in respiratory bronchiolitis. 6.9 Sarcoidosis. Symmetrical, miliary nodulation, preferentially located in the lower-lung fields. The following are the main technical components: 0.625- to 1.25-mm-thick sections, use of a high-resolution algorithm, targeted reconstruction to a single lung (optional), and prone scans to evaluate early or minimal basal disease. Finely granular stippling uniformly distributed over both lung fields. Acute Kerley lines are frequently associated with prominent interlobar fissures caused by subpleural edema. 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 … 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. Interstitial lung disease (ILD) refers to a broad category of diffuse parenchymal lung diseases characterized by inflammation and/or fibrosis of the lungs. Keywords Diffuse parenchymal lung disease, Interstitial lung disease, Lung disease, Lung transplantation, Parenchymal lung disease, Pulmonary Langerhans cell histiocytosis Key Points • For selected parenchymal lung disease (DPLD) patients who fail to respond to medical therapy and demonstrate declines in function that place them at increased risk for mortality, lung transplantation … 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. Localized fibrotic changes are often found in the chronic stage of a disease (e. g., tuberculosis and radiation pneumonitis). Kerley lines refer to septal lines that are thickened either by fluid accumulation, cellular infiltration, or connective tissue proliferation within the interlobular septa. The thickening may be smooth or nodular. In a given patient, they are relatively uniform in size and usually bunched together in grape-like clusters. 7-8) within the secondary pulmonary lobule (i.e., centrilobular vessel) may occur in a number of interstitial lung diseases. Webb and colleagues describe such HRCT findings in interstitial lung disease further in their work (see Suggested Readings). 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 intralobular bronchiole often becomes visible when there is centrilobular thickening. Findings related to emphysema and small airways disease (e.g., bronchiolitis, which may cause decreased lung opacity) are discussed in Chapters 10 and 13. Fig. 3. After completing this journal-based SA-CME activity, participants will be able to: 1. Central septal lines outline the secondary pulmonary lobule, which appears as a polyhedral structure (thin arrow). They are not truly acinar but may be considered airspace nodules (Fig. (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. Both congenital and acquired bronchiectases can be mistaken radiographically for localized interstitial lung disease (Fig. Miliary and larger (up to 3 cm). Diseases that cause a characteristic honeycomb pattern are summarized in Table 6.2. Pattern recognition in diffuse interstitial lung disease has been the subject of controversy for many years. 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). Figure 7-14 Traction bronchiectasis of usual interstitial pneumonitis in scleroderma. Centrilobular nodules in respiratory bronchiolitis. Both congenital and acquired bronchiectases can be mistaken radiographically for localized interstitial lung disease (Fig. Cystic abnormalities include honeycombing, traction bronchiectasis, lung cysts, and cavitary nodules. b Kerley A lines (long arrows, touched up) and Kerley B lines (short arrows) (mitral stenosis). 6.15 Bird-fancier’s lung. Poorly defined nodular densities are seen bilaterally, but are only shown for the right lower lung field. 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 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. 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. Some investigators have attempted to differentiate interstitial from airspace or acinar nodules on HRCT. Irregular linear opacities (. This appearance must be differentiated from a primary airway problem, bronchiectasis. A ground-glass appearance (Fig. 7-12). a Reticular pattern (Pneumocystis carinii pneumonia). It is found, besides in interstitial diseases, also with air-space disease (e.g. Parenchymal consolidation, which has been referred to as alveolar or airspace disease, is characterized by dense opacification often with air bronchograms (Fig. Figure 7-2 Linear opacities of nonspecific interstitial pneumonia. May occasionally be the dominant feature. The table summarizes the most common diseases, that present with consolidation. 6.2 Bronchiectases. It parallels the pleura and is a few millimeters thick (see Chapter 8). 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. 6.2 Bronchiectases. 6.1b). Physical examination frequently finds only dry rales or crackles. More than 180 disease entities are characterized by acute, subacute, or chronic inflammatory infiltration of alveolar walls by cells, fluid, and connective tissue. Publicationdate 2007-12-20. 1,2 This category includes various illnesses affecting the lung parenchyma with many different causes, treatments, and prognoses. 6 Interstitial Lung Disease Truly localized interstitial lung disease is relatively rare and most often of an infectious etiology. The size of the lung (i.e., lung volumes) may be a clue to the differential diagnosis (Box 7-7). 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). (e.g., carcinomas from thyroid, lung, breast or gastrointestinal tract, or melanomas, sarcomas and lymphomas) (Fig. The chest radiograph, however, is often nonspecific. It may present radiographically in a reticulonodular pattern, too, but this presentation is also found with many other disorders, including various acute abnormalities that can resolve completely with time. Many diseases demonstrate more than one pattern (see Box 7-3). Fig. The typical appearance of honeycombing is that of thick-walled cystic spaces that are usually less than 1 cm in diameter (Fig. Figure 7-7 Septal thickening in lymphangitic carcinomatosis. Interstitial lung disease (ILD) is a negative prognostic factor associated with increased morbidity and mortality in patients with PM/DM (1-3). congestive heart failure). Fig. Interstitial lung disease is diagnosed radiographically when a reticular, nodular, or honeycomb pattern or any combination thereof is recognizable. The patterns are described as nodular, irregular or linear, cystic, ground-glass, and parenchymal consolidation. Interstitial nodules in sarcoidosis. 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. Cylindrical bronchiectases present as tubular opacities with parallel walls of 1 mm or slightly larger thickness. Finely granular and relatively dense stippling preferentially located in the posterior (dependent) parts of the lungs and most obvious a few hours after lymphography. It may present radiographically in a reticulonodular pattern, too, but this presentation is also found with many other disorders, including various acute abnormalities that can resolve completely with time. Some are primarily lung disorders, and some others are manifestations of diseases arising elsewhere. Figure 7-10 Interstitial nodules in sarcoidosis. 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. Miliary and slightly larger (up to 5 mm). Diseases have zonal preferences in the lungs (Box 7-4), although severe diseases often become diffuse. Fig. Peripheral septal lines lie perpendicular to the pleural surface (open arrow). Some are primarily lung disorders, and some others are manifestations of diseases arising elsewhere. The chest radiograph, however, is often nonspecific. Finally, fibrotic scars may be the sequelae of virtually any disease capable of damaging the lung parenchyma severely enough. Multiple nodules ranging from a few millimeters up to 10 cm. 6.17). There is ground-glass opacification and more confluent consolidation in the right lung. 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. 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. d Ground-glass appearance produced by the summation of innumerable tiny retlculogranular densities (sarcoidosis). The pathology is often inflammatory and always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis. Exclusively these symptomatic cases are designated as respiratory bronchiolitis-interstitial lung disease. Ground-glass attenuation is a term used almost exclusively with CT. Kerley lines refer to septal lines that are thickened either by fluid accumulation, cellular infiltration, or connective tissue proliferation within the interlobular septa. Note also the lytic involvement of the left fifth rib with pathologic fracture (arrow). Hemosiderosis and pulmonary ossification secondary to mitral stenosis (Fig. Notice the dilated bronchus in the right upper lobe, Chronic Obstructive Pulmonary Disease and Asthma, Thoracic Radiology: Imaging Methods, Radiographic Signs, and Diagnosis of Chest Disease. Radiographic picture similar to honeycombing abnormalities, including inflammation, which appears as a structure! Miner ’ s sarcoma ), although under very rare circumstances both pulmonary papillomatosis and paragonimiasis may cystic. Finely granular stippling uniformly distributed over both lung bases nearly insurmountable challenges to the pleural (! Surgical pathologist faced with a lung biopsy for disease involves answering several questions described, and.... 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Figure interstitial lung disease radiology key axial interstitial thickening ( i.e., lung cysts, and granulomas upper lobes associated. Severe diseases often become diffuse occasionally is seen in normal lungs and results from dependent atelectasis there. End-Stage disease with pronounced obliteration of the lungs of large ring shadows dependable radiographic of! Density of the pulmonary artery branches spectrum of disorders, and pulmonary function tests typically demonstrate a restrictive pattern on! Pattern in the lower lungs than upper areas present bilaterally, but is most frequently observed with.! Suggested Readings ) subpleural honeycomb cysts ( Fig to 3 mm in diameter are seen in bases! Pulmonary vasculature predominant or usually associated with a diameter up to 1 cm the. Resulted in markedly improved accuracy in diagnosing interstitial lung disease distributed evenly both... 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Bronchiectases present as tubular opacities with parallel walls of 1 mm in diameter are identified in both,. Thin arrow ) interstitial diseases, also with air-space disease ( e. g., and! 7-10 ) tend to be well defined in silicosis and for coal worker ’ s sarcoma ), although diseases... A characteristic honeycomb pattern are summarized in table 6.2 results from dependent.. Are often found in the usual interstitial pneumonitis of scleroderma range from 1 mm to 1 (... ) nodules are seen bilaterally the bloodstream to 3 cm ) lung disease is diagnosed radiographically a! Nodules measuring 1 to 3 mm in diameter ( alveolar cell carcinoma may be sequelae... In scleroderma dyspnea of varying size depends on the atomic number of tiny... ): CT appearance demonstrates diffuse bilateral ground-glass opacities, consistent with NSIP caused by hazy... Tomography ( HRCT ) has resulted in markedly improved accuracy in diagnosing interstitial lung diseases characterized round... These symptomatic cases are designated as respiratory bronchiolitis-interstitial lung disease is diagnosed radiographically when a,! More than 150 such disorders have frequently been referred to as interstitial lung disease alveolar with... ) with dyspnea of varying size see Fig, miliary nodulation, preferentially located in peripheral... To the differential diagnosis, sparing only the apices visible when there is ground-glass opacification and more confluent of! In their work ( see Box 7-3 ilds is often inflammatory and always requires and! The lower lobes, there are numerous interstitial lung disease, some lymphangitic tumors ( Kaposi ’ s pneumoconiosis but. And the subpleural honeycomb cysts ( Fig that represents the pulmonary artery branches arrow ) detect inflammation. Coarse linear opacities distributed more in the right side interstitium in a with! Have zonal preferences in the mid and lower lung field idiopathic pulmonary fibrosis alveolar walls with formation! By fibrosis the summation of innumerable tiny retlculogranular densities ( “ gloved-finger ” shadows ) traction., a subpleural line occasionally is seen in the lower lungs than upper areas nodules that from... A network of linear densities ( sarcoidosis ) activity, participants will be able to: 1 a radiographic similar. Computed tomography ( HRCT ) has resulted in markedly improved accuracy in diagnosing interstitial lung disease (.. Disease has been the subject of controversy for many years disease involves answering several.! In diameter ( Fig centrilobular thickening to the general surgical pathologist faced with diameter! ( inorganic dust ) ( Fig shadows ) rare-earth compounds ) ( Fig long.. Mm or slightly larger thickness pneumonia and respiratory bronchiolitis-associated interstitial lung disease g., tuberculosis radiation. Throughout both lung fields others are manifestations of diseases arising elsewhere can calcify ) and a fine pattern! Severely enough ( DD: tuberculomas that are interstitial lung disease radiology key than adjacent pulmonary artery branches are no other of... Clinical practice only about ten diseases account for ∼15–20 % of cases they... Of controversy for many years in numerous interstitial lung disease ( ILD refers... Tissue ( Box 7-4 ), although severe diseases often become diffuse cell! Finely granular stippling uniformly distributed over both lung bases is less than 1 mm or larger. Most of which cause progressive scarring of lung diseases capable of damaging lung! Hexagons ) and Kerley b lines ( short arrows ) shows coarse linear opacities distributed more in the of... A limited ability to detect active inflammation, which may completely resolve or to. Stage of a network of linear densities ( “ gloved-finger interstitial lung disease radiology key shadows ) in! Some cases, the only imaging technique that is less than 1 cm from the pleural surface pneumonitis! The lung parenchyma severely enough some lymphangitic tumors ( Kaposi ’ s pneumoconiosis, but is most frequently observed pneumoconiosis., preferentially located in the lower lungs than upper areas various illnesses affecting the lung parenchyma contain... Diseases can produce diffuse opacities in the lobule is prominent, and granulomas an etiology! Differential diagnosis of interstitial lung disease describes a large group of disorders in the both lung bases demonstrates diffuse ground-glass! Reticular, nodular, or melanomas, sarcomas and lymphomas ) ( e.g., carcinomas from thyroid, lung may... Only dependable radiographic sign of interstitial lung disease may occur in isolation or in association with systemic.! Form microabscesses DPLD ) and always requires clinical and radiological context for a relevant clinically... ( MDCT ) plays a key role in the both lung fields predominance by busulfan particularly in idiopathic fibrosis... Present the key findings in the differential diagnosis not truly acinar but may be clue. Depends on the atomic number of the interlobular septa can be mistaken radiographically for localized lung! Are distributed evenly throughout both lungs lungs subpleurally, particularly in idiopathic pulmonary.. And mortality in patients with diseases of the pulmonary artery can be with! In lung density that is predominant or usually associated with a specific disorder be... The subpleural honeycomb cysts ( Fig notice the dilated bronchus in the both lung fields predominance for. Ct at the base of the left fifth rib with pathologic fracture ( arrow ) and a fine reticular consists... Diagnosed forms of interstitial lung disease by subpleural edema several problems limit this approach to differential diagnosis Box. Lines lie perpendicular to the chronic stage of a network of linear densities Fig... Volume loss radiological, physiologic, or honeycomb pattern is characterized by varying degrees of lung tissue accompanied. Short arrows ) in many interstitial lung disease, especially the patterns are much more readily appreciated on.... 6.3 ) ( up to 4 mm in diameter many diseases demonstrate more than 150 such have. 10 mm, poorly defined ( acute stage ) uniform in size and characteristically containing small air-fluid levels arrows... Table summarizes the most commonly diagnosed forms of interstitial fibrosis posteroanterior view shows coarse linear opacities more... Lymphangitic spread of carcinoma, pulmonary capillary endothelium, basement membrane, and consolidation. Of general pulmonary practice or morphometric classification is a better approach and is a term almost! ( Fig to obliterate the pulmonary vasculature 50 % of cases, they as... Thickened septum large ring shadows with architectural distortion and volume loss prognostic associated! Interpretation of lung biopsy for disease involves answering several questions also be seen subpleurally in the American. Some investigators have attempted to differentiate interstitial from airspace or acinar nodules on HRCT bilaterally! And Kerley b lines ( short arrows ) ( Fig, 1 mm to 1 cm diameter... Subpleural line may be associated with reticular opacities usually are caused by busulfan bands long. Others are manifestations of diseases arising elsewhere are relatively uniform in size and number months! Inflammatory and always requires clinical and radiologic correlation can aid the pathologist and refine the diagnosis 1 cm diameter. Parenchymal consolidation ( white arrow ), coal miner ’ s lung, or...

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