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. They are composed of connective tissue and contain lymphatics and pulmonary venules. 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. Jreige M, Dunet V, Letovanec I, Prior JO, Meuli RA, Beigelman-Aubry C, Schaefer N J Nucl Med 2020 … 1992;158:1217–22. Not affiliated 2008;246:697–722. In some cases, it is the predominant radiological finding. Over 10 million scientific documents at your fingertips. Primack SL, Muller NL, Mayo JR, Remy-Jardin M, Remy J. Case 6. 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. AJR Am J Roentgenol. 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. Marked interlobular septal thickening may be associated with the honeycombing and is often observed in the initial phases. It has been described with several conditions of variable etiology which include sarcoidosis 2 They usually occur when pulmonary capillary wedge pressure reaches 20-25 mmHg. 2006;48:596–603. Of these lesions, gravity-dependent distribution was noted in 23 cases … Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. The pathogenesis and treatment of acid sphingomyelinase-deficient Niemann-Pick disease. Metabolic lung disease: imaging and histopathologic findings. Interlobular septal thickening, centrilobular nodular nodules, and ground glass opacities are frequently observed on chest computed tomography (CT). 2006;238:339–45. Interlobular Septal Thickening. Interlobular Septal Thickening Only gold members can continue reading. 2006;26:59–77. Subacute Pulmonary Hemorrhage: The presence of blood within the lung parenchyma induces some degree of … pp 145-152 | 1992;12:45–58. Mendelson DS, Wasserstein MP, Desnick RJ, et al. It may be due to fluid, cellular infiltration, or fibrosis. In some cases, it is the predominant radiological finding. 1985;145:505–10. AJR Am J Roentgenol. Pulmonary involvement by Niemann-Pick disease. Interlobular septal thickening on pulmonary HRCT. CT in the diagnosis of interstitial lung disease. Cite as. Radiology. On HRCT, numerous clearly visible septal lines usually indicates the presence of some interstitial abnormality. There is frequently associated ground-glass opacification and the combination may give a crazy-paving pattern. Interlobular septal thickeningat HRCT can be smooth, nodular, or irregular in contour. The combination of cardiomegaly, pulmonary vascular changes, interstitial or alveolar … We use cookies to help provide and enhance our service and tailor content and ads. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. 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. AJR Am J Roentgenol. AJR Am J Roentgenol. In some cases, it is the predominant radiological finding. High-resolution CT scan at the … Conditions causing a predominant pattern of DIST include left … Nodular or irregular septal … Pulmonary lymphangitic carcinomatosis: CT and pathologic findings. Pulmonary Lymphangitic Carcinomatosis: Diagnostic Performance of High-Resolution CT and 18F-FDG PET/CT in Correlation with Clinical Pathologic Outcome. 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. Pneumoconiosis: comparison of imaging and pathologic findings. Intralobular septal thickening is a form of interstitial thickening and should be distinguished from interlobular septal thickening. 1995;165:817–20. 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. Chest CT demonstrated extensive upper lobe predominant subpleural consolidation with air bronchograms and extensive ground glass opacities with intralobular septal thickening (B–D). Interlobular septal thickening Dr Tom Foster and Dr Vinod G Maller et al. The lesions were predominantly peripheral in 38 patients (88%). Radiographics. They are continuous with the interlobular septa which surround and define the secondary pulmonary lobules. Thickening of the interlobular septa can be smooth, nodular or irregular, with many entities able to cause more than one pattern. 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) … View Show abstract Johkoh T, Ikezoe J, Tomiyama N, et al. 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). 2009;47 Suppl 1:S48–57. It is often seen as fine linear or reticular thickening. Ware LB, Matthay MA. Storto ML, Kee ST, Golden JA, Webb WR. 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. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Smooth septal thickening on pulmonary HRCT; Recent clinical studies. 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. Bandlike opacities and interlobular septal thickening were observed in four patients and one patient, respectively. 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. https://doi.org/10.1067/j.cpradiol.2004.06.001. These abnormalities result in marked parenchymal … Murdoch J, Muller NL. A report of six cases. Interlobular septal thickening might be present, and pleural effusion and enlarged mediastinal lymph nodes were rarely seen. There may even be evidence of alveolar edema, with acinar nodules, confluent, ill-defined opacities with a perihilar distribution, and air bronchograms. Septal thickening and ground-glass opacity with a gravitational distribution in a patient with cardiogenic pulmonary edema. Munk PL, Muller NL, Miller RR, Ostrow DN. The septa are usually perpendicular to the pleura in the lung periphery. 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. 2005;54:233–45. Copyright © 2004 Elsevier Inc. All rights reserved. In the rapid progression stage (days 3–7 of symptomatic presentation), CT findings include large, light consolidative opacities and air bronchograms. Nicholson AG, Florio R, Hansell DM, et al. There is a combination of smooth septal thickening and ground-glass opacity with a gravitational distribution. Int J Clin Pharmacol Ther. On CT scans, diseases affecting one of the components of the septa are responsible for thickening and thus cause the septa visible [1] (Figs. Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. Clinical practice. By continuing you agree to the use of cookies. CT findings in lymphangitic carcinomatosis of the lung: correlation with histologic findings and pulmonary function tests. Acute … N Engl J Med. Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS. Smooth interlobular septal thickening is seen in pulmonary edema, pulmonary hemorrhage, alveolar proteinosis, exogenous lipoid pneumonia, and pneumonia. During the consolidation stage (second week of symptomatic presentation), … Acute pulmonary edema. It represents pathology in the periphery of the pulmonary lobules (ie, the interlobular septa). The patient had no other comorbidities. Part of Springer Nature. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). 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. In some cases, it is the predominant radiological finding. 185.40.59.148. Histopathology. There are many causes of interlobular septal thickening, and this should be distinguished from intralobular septal thickening. HRCT scan of the chest showing nodular interlobular septal thickening at the lung bases, particularly at the right lung base (arrows). PVOD accounts for 5 to 10% of 'idiopathic' PPH and has an estimated incidence of 0.1 to 0.2 cases per million. 1992;159:473–7. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. The septa present as irregular linear opacities that are prominent in the subpleural regions. Interlobular septal thickening at HRCT can be smooth, nodular, or irregular in contour. There was no obvious relationship between perilobular opacities and CT findings indicative of established fibrosis. Although interlobular septal thickening occurs in a significant number of cases, it rarely represents the predominant pattern . Given the diagnostic uncertainty, bronchoscopy including transbronchial biopsy was conducted and eventually facilitated a definite diagnosis. It may be due to fluid, Pulmonary sarcoidosis: changes on follow-up CT examination. Radiographics. In addition, there may be signs of interstitial edema, including fine reticular opacities, interlobular septal thickening (Kerley lines), perihilar haze, and peribronchial thickening. Eur J Radiol. This area is comprised of the pulmonary veins, capillaries and their associated interstitium. Within 6 months, bilateral tumour shadows had developed. This finding is associated with the chronic form of infection and sequelae. Bessis L, Callard P, Gotheil C, Biaggi A, Grenier P. High-resolution CT of parenchymal lung disease: precise correlation with histologic findings. Additionally, thickening of the intralobular interstitium produces a fine reticular pattern associated with the septal thickening. A 64-year-old man presented with a five-day history of fever and recent onset dyspnea. 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). Figure 17 Chronic pulmonary PCM in a 69-year-old man. Septal lines, also known as Kerley lines, are seen when the interlobular septa in the pulmonary interstitium become prominent. Bergin CJ, Muller NL. Coarse breath … The septal thickening pathologically corresponds to inflammatory infiltration or fibrosis (5,10). 16.1 and 16.2). This service is more advanced with JavaScript available, Radiology Illustrated: Chest Radiology Interlobular septa are sheetlike structures 10–20-mm long that form the border of the secondary pulmonary lobules. The intralobular septa (sing: septum) are delicate strands of connective tissue separating adjacent pulmonary acini and primary pulmonary lobules. Chung MJ, Lee KS, Franquet T, Muller NL, Han J, Kwon OJ. They are composed of connective tissue and contain lymphatics and pulmonary venules. The perilobular pattern abutted the pleural surface in 10 of 12 patients and was surrounded by aerated lung parenchyma in 11 of 12 patients. 2.6. Hydrostatic pulmonary edema: high-resolution CT findings. You may also need. Diffuse interlobular septal thickening (DIST) is a pattern of lung disease found on high-resolution thoracic CT scanning (HRCT or CTPA). Septal thickening can be definied as being either smooth, nodular or irregular and each likely represents a different pathologic process. Radiographics. Radiology. Interlobular septa are sheetlike structures 10–20-mm long that form the border of the secondary pulmonary lobules. Pulmonary parenchymal abnormalities of vascular origin: high-resolution CT findings. Not logged in 1994;14:739–46. 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. This process is experimental and the keywords may be updated as the learning algorithm improves. Log In or Register to continue. Interlobular septal thickening is commonly seen in patients with interstitial lung disease. At a lobar level, 69% (514 of 748) of lobes with bronchiectasis had septal thickening. The septa are usually perpendicular to the pleura in the lung periphery. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Schuchman EH. On the left a patient who had a CT to rule out pulmonary embolism. 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. © 2020 Springer Nature Switzerland AG. 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). 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%). Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Interlobular Septal Thickening 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. 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. Type B Niemann-Pick disease: findings at chest radiography, thin-section CT, and pulmonary function testing. 1988;166:705–9. Radiology. This is a preview of subscription content. 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. 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 . We encountered a patient with ECD whose chest CT initially showed diffuse small randomly distributed nodules, resembling miliary tuberculosis. 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). Sep-Oct … These keywords were added by machine and not by the authors. Etiology. , 69 % ( 514 of 748 ) of lobes with bronchiectasis had septal thickening a! Some interstitial abnormality predominant subpleural consolidation with air bronchograms and extensive ground glass are. 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Smooth septal thickening pathogenesis and treatment of acid sphingomyelinase-deficient Niemann-Pick disease rarely seen a common and easily high-resolution... % of 'idiopathic ' PPH and has an estimated incidence of 0.1 to cases... % ), respectively this area is comprised of the pulmonary lobules sphingomyelinase-deficient Niemann-Pick disease: at. When pulmonary capillary wedge pressure reaches 20-25 mmHg function tests Elsevier B.V. or its licensors or contributors give... Continuing you agree to the pleura in the lung: correlation with histologic findings and pulmonary tests. To help provide and enhance our service and tailor content and ads bilateral tumour shadows had.. Mendelson DS, Wasserstein MP, Desnick RJ, et al large, light consolidative opacities and interlobular thickening. Contain lymphatics and pulmonary function testing pulmonary veins, capillaries and their associated.. 0.2 cases per million pathology in the interlobular septal thickening periphery chest radiography, thin-section CT, and pulmonary venules interstitial disease...
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