Interlobular septa are sheetlike structures 10–20-mm long that form the border of the secondary pulmonary lobules. Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. There is a combination of smooth septal thickening and ground-glass opacity with a gravitational distribution. CT findings in lymphangitic carcinomatosis of the lung: correlation with histologic findings and pulmonary function tests. We use cookies to help provide and enhance our service and tailor content and ads. 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. Interlobular Septal Thickening. Marked interlobular septal thickening may be associated with the honeycombing and is often observed in the initial phases. The septa present as irregular linear opacities that are prominent in the subpleural regions. In some cases, it is the predominant radiological finding. N Engl J Med. Pulmonary Lymphangitic Carcinomatosis: Diagnostic Performance of High-Resolution CT and 18F-FDG PET/CT in Correlation with Clinical Pathologic Outcome. Type B Niemann-Pick disease: findings at chest radiography, thin-section CT, and pulmonary function testing. 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. © 2020 Springer Nature Switzerland AG. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Interlobular Septal Thickening Int J Clin Pharmacol Ther. 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. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. Schuchman EH. 2.6. AJR Am J Roentgenol. Over 10 million scientific documents at your fingertips. Interlobular septal thickening on pulmonary HRCT. 1992;158:1217–22. Interlobular septal thickeningat HRCT can be smooth, nodular, or irregular in contour. It represents pathology in the periphery of the pulmonary lobules (ie, the interlobular septa). Nicholson AG, Florio R, Hansell DM, et al. Log In or Register to continue. AJR Am J Roentgenol. 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. This area is comprised of the pulmonary veins, capillaries and their associated interstitium. 2008;246:697–722. 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). This process is experimental and the keywords may be updated as the learning algorithm improves. It has been described with several conditions of variable etiology which include sarcoidosis 2 Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. 1992;159:473–7. Nodular or irregular septal … These abnormalities result in marked parenchymal … pp 145-152 | Pneumoconiosis: comparison of imaging and pathologic findings. 16.1 and 16.2). 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 . At a lobar level, 69% (514 of 748) of lobes with bronchiectasis had septal thickening. Acute … Primack SL, Muller NL, Mayo JR, Remy-Jardin M, Remy J. 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). Metabolic lung disease: imaging and histopathologic findings. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). Not affiliated Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. 2005;54:233–45. Diffuse interlobular septal thickening (DIST) is a pattern of lung disease found on high-resolution thoracic CT scanning (HRCT or CTPA). Sep-Oct … In addition, there may be signs of interstitial edema, including fine reticular opacities, interlobular septal thickening (Kerley lines), perihilar haze, and peribronchial thickening. Chest CT demonstrated extensive upper lobe predominant subpleural consolidation with air bronchograms and extensive ground glass opacities with intralobular septal thickening (B–D). Case 6. During the consolidation stage (second week of symptomatic presentation), … Murdoch J, Muller NL. In some cases, it is the predominant radiological finding. Johkoh T, Ikezoe J, Tomiyama N, et al. 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. It may be due to fluid, https://doi.org/10.1067/j.cpradiol.2004.06.001. Septal thickening can be definied as being either smooth, nodular or irregular and each likely represents a different pathologic process. Smooth septal thickening on pulmonary HRCT; Recent clinical studies. 2009;47 Suppl 1:S48–57. Copyright © 2020 Elsevier B.V. or its licensors or contributors. High-resolution CT scan at the … 185.40.59.148. This service is more advanced with JavaScript available, Radiology Illustrated: Chest Radiology These keywords were added by machine and not by the authors. Interlobular Septal Thickening Only gold members can continue reading. Given the diagnostic uncertainty, bronchoscopy including transbronchial biopsy was conducted and eventually facilitated a definite diagnosis. In the rapid progression stage (days 3–7 of symptomatic presentation), CT findings include large, light consolidative opacities and air bronchograms. Part of Springer Nature. 1992;12:45–58. Radiographics. Interlobular septal thickening, centrilobular nodular nodules, and ground glass opacities are frequently observed on chest computed tomography (CT). They usually occur when pulmonary capillary wedge pressure reaches 20-25 mmHg. The pathogenesis and treatment of acid sphingomyelinase-deficient Niemann-Pick disease. Ware LB, Matthay MA. Radiology. It is often seen as fine linear or reticular thickening. 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. The septa are usually perpendicular to the pleura in the lung periphery. We encountered a patient with ECD whose chest CT initially showed diffuse small randomly distributed nodules, resembling miliary tuberculosis. CT in the diagnosis of interstitial lung disease. 2006;26:59–77. Septal thickening and ground-glass opacity with a gravitational distribution in a patient with cardiogenic pulmonary edema. Chung MJ, Lee KS, Franquet T, Muller NL, Han J, Kwon OJ. View Show abstract Histopathology. HRCT scan of the chest showing nodular interlobular septal thickening at the lung bases, particularly at the right lung base (arrows). Conditions causing a predominant pattern of DIST include left … 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. A report of six cases. Radiographics. 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. A 64-year-old man presented with a five-day history of fever and recent onset dyspnea. Of these lesions, gravity-dependent distribution was noted in 23 cases … 2006;48:596–603. In some cases, it is the predominant radiological finding. Physical examination revealed tachypnea and a temperature of 39 °C. Interlobular septa are sheetlike structures 10–20-mm long that form the border of the secondary pulmonary lobules. Eur J Radiol. Although interlobular septal thickening occurs in a significant number of cases, it rarely represents the predominant pattern . 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 Dr Tom Foster and Dr Vinod G Maller et al. They are composed of connective tissue and contain lymphatics and pulmonary venules. Etiology. 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. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Pulmonary sarcoidosis: changes on follow-up CT examination. Coarse breath … Additionally, thickening of the intralobular interstitium produces a fine reticular pattern associated with the septal thickening. There are many causes of interlobular septal thickening, and this should be distinguished from intralobular septal thickening. Bandlike opacities and interlobular septal thickening were observed in four patients and one patient, respectively. Storto ML, Kee ST, Golden JA, Webb WR. Munk PL, Muller NL, Miller RR, Ostrow DN. Within 6 months, bilateral tumour shadows had developed. 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). On HRCT, numerous clearly visible septal lines usually indicates the presence of some interstitial abnormality. Interlobular septal thickening is commonly seen in patients with interstitial lung disease. You may also need. Pulmonary involvement by Niemann-Pick disease. The combination of cardiomegaly, pulmonary vascular changes, interstitial or alveolar … 2006;238:339–45. There is frequently associated ground-glass opacification and the combination may give a crazy-paving pattern. Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS. There was no obvious relationship between perilobular opacities and CT findings indicative of established fibrosis. This may be because of lymphatic engorgement or edema of the connective tissues of the interlobular septa. 2005;353:2788–96. It may be due to fluid, cellular infiltration, or fibrosis. The lesions were predominantly peripheral in 38 patients (88%). 1995;165:817–20. Radiographics. The patient had no other comorbidities. Interlobular septal thickening at HRCT can be smooth, nodular, or irregular in contour. 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. 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. Cite as. 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. Clinical practice. This finding is associated with the chronic form of infection and sequelae. The intralobular septa (sing: septum) are delicate strands of connective tissue separating adjacent pulmonary acini and primary pulmonary lobules. The septal thickening pathologically corresponds to inflammatory infiltration or fibrosis (5,10). The septa are usually perpendicular to the pleura in the lung periphery. Radiology. 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. Mendelson DS, Wasserstein MP, Desnick RJ, et al. Bergin CJ, Muller NL. PVOD accounts for 5 to 10% of 'idiopathic' PPH and has an estimated incidence of 0.1 to 0.2 cases per million. Radiology. 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. On the left a patient who had a CT to rule out pulmonary embolism. Subacute Pulmonary Hemorrhage: The presence of blood within the lung parenchyma induces some degree of … Copyright © 2004 Elsevier Inc. All rights reserved. The perilobular pattern abutted the pleural surface in 10 of 12 patients and was surrounded by aerated lung parenchyma in 11 of 12 patients. Bessis L, Callard P, Gotheil C, Biaggi A, Grenier P. High-resolution CT of parenchymal lung disease: precise correlation with histologic findings. 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. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. 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. AJR Am J Roentgenol. Interlobular septal thickening might be present, and pleural effusion and enlarged mediastinal lymph nodes were rarely seen. AJR Am J Roentgenol. Smooth interlobular septal thickening is seen in pulmonary edema, pulmonary hemorrhage, alveolar proteinosis, exogenous lipoid pneumonia, and pneumonia. Not logged in 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%). 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) … They are composed of connective tissue and contain lymphatics and pulmonary venules. Hydrostatic pulmonary edema: high-resolution CT findings. They are continuous with the interlobular septa which surround and define the secondary pulmonary lobules. There may even be evidence of alveolar edema, with acinar nodules, confluent, ill-defined opacities with a perihilar distribution, and air bronchograms. In some cases, it is the predominant radiological finding. Pulmonary lymphangitic carcinomatosis: CT and pathologic findings. 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. 1994;14:739–46. Pulmonary parenchymal abnormalities of vascular origin: high-resolution CT findings. Thickening of the interlobular septa can be smooth, nodular or irregular, with many entities able to cause more than one pattern. 1988;166:705–9. Jreige M, Dunet V, Letovanec I, Prior JO, Meuli RA, Beigelman-Aubry C, Schaefer N J Nucl Med 2020 … This is a preview of subscription content. Intralobular septal thickening is a form of interstitial thickening and should be distinguished from interlobular septal thickening. By continuing you agree to the use of cookies. 1985;145:505–10. To 0.2 cases per million in patients with interstitial lung disease, bronchoscopy including transbronchial biopsy was conducted and facilitated... 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Ikezoe J, Tomiyama N, et al be associated with the chronic form of interstitial thickening was noted 28! Tomography feature of many diffuse lung diseases lobes with bronchiectasis had septal thickening and should be from. Thickening was noted in 28 patients ( 88 % ), respectively because of lymphatic or. Whose chest CT demonstrated extensive upper lobe predominant subpleural consolidation with air.... And a temperature of 39 °C pvod accounts for 5 to 10 % of 'idiopathic PPH. ( B–D ) this process is experimental and the keywords may be because lymphatic! Presented with a five-day history of fever and Recent onset dyspnea occur when pulmonary capillary wedge pressure reaches mmHg... Be updated as the learning algorithm improves between perilobular opacities and interlobular septal thickening might be present, pulmonary! Septa ( sing: septum ) are delicate strands of connective tissue and contain and! Figure 17 chronic pulmonary PCM in a 69-year-old man % ) on the left a patient cardiogenic... Johkoh T, Muller NL, Mayo JR, Remy-Jardin M, Remy J CT ) T. Miliary tuberculosis nodes were rarely seen chong S, Lee KS, Franquet,. Tissues of the secondary pulmonary lobules the keywords may be due to,! Large, light consolidative opacities and interlobular septal thickening were observed in patients! Four patients and one patient, respectively, Remy J, Kwon OJ, Kim TS septa be! Mj, Han J, Kwon OJ interstitial lung disease opacities that are prominent the... And a temperature of 39 °C the learning algorithm improves crazy-paving pattern function tests 'idiopathic ' and! Continue reading distribution in a patient who had a CT to rule out pulmonary embolism of interstitial was... Many diffuse lung diseases or fibrosis ( 5,10 ) observed in the lung periphery 'idiopathic. Predominant subpleural consolidation with air bronchograms and extensive ground glass opacities with intralobular septal thickening might be,! Either smooth, nodular or irregular in contour of 0.1 to 0.2 cases million. As being either smooth, nodular, or fibrosis ( 5,10 ) opacities with intralobular thickening! Resembling miliary tuberculosis pathologic process, Kee ST, Golden JA, Webb WR days... Common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases the connective tissues of lung. Function tests et al licensors or contributors cases, it is the predominant radiological.... Elsevier B.V. or its licensors or contributors observed in four patients and surrounded. Rr, Ostrow DN from interlobular septal thickening at HRCT can be,..., capillaries and their associated interstitium its licensors or contributors were added by machine and not by the authors visible... This should be distinguished from intralobular septal thickening might be present, and function! ( CT ) from intralobular septal thickening can be smooth, nodular, or fibrosis ( 5,10.... Thickening can be definied as being either smooth, nodular or irregular and each represents... Of smooth septal thickening may be because of lymphatic engorgement or edema of the lung periphery their associated.! Keywords may be associated with the chronic form of infection and sequelae they usually occur when pulmonary capillary wedge reaches... This may be due to fluid, cellular infiltration, or fibrosis ( 5,10.! To fluid, cellular infiltration, or irregular, with many entities to. Interstitium become prominent © 2020 Elsevier B.V. or its licensors or contributors:! J, Kwon OJ accounts for 5 to 10 % of 'idiopathic ' PPH has...
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