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Nodular pattern
This document discusses nodular patterns seen on chest imaging. It defines nodular opacities as round opacities 1 mm to 1 cm in diameter. Nodular patterns can be described by size, distribution, and appearance. Distribution is classified as perilymphatic along lymphatic vessels and pleura, centrilobular around central lobular structures, or random. Differential diagnoses are suggested based on distribution and other characteristics. A reticulonodular pattern contains both reticular and nodular opacities and requires considering causes of both patterns.
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Nodular pattern
- 2. Nodular Patternitie By Gamal RabieAgmy , MD , FCCP Professor of Chest Diseases ,Assiut University
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- 4. Nodular pattern Anodular pattern consists of multiple round opacities, generally ranging in diameter from 1 mm to 1 cm Nodular opacities may be described as miliary (1 to 2 mm, the size of millet seeds), small, medium, or large, as the diameter of the opacities increases A nodular pattern, especially with predominant distribution, suggests a specific differential diagnosis
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- 6. ARE NODULES INCONTACT WITH PLEURA NO CENTRILOBULAR YES PERILYMPHATIC RANDOM
- 9. TO SUM UP.. •Random – touch pleura – scattered in lung • Centrilobular –away from pleura • Perilymphatic – around vessels, bronchi – touch pleura or fissure
- 11. Size, Distribution, Appearance Nodulesand Nodular Opacities Size Small Nodules:<10 mm Miliary - <3 mm Large Nodules: >10 mm Masses - >3 cms Appearance Interstitial opacity: Well-defined, homogenous, Soft-tissue density Obscures the edges of vessels or adjacent structure Air space: Ill-defined, inhomogeneous. Less dense than adjacent vessel – GGO small nodule is difficult to identify
- 12. Interstitial nodules Air space opacity Miliarytuberculosis sarcoidosis in a lung transplant patient with bronchopneumonia
- 13. RANDOM: no consistentrelationship to any structures PERILYMPHATIC: corresponds to distribution of lymphatic CENTRILOBULAR: related to centrilobular structuresDistribution 13
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- 18. Disseminated histoplasmosis andnodular ILD. CT scan shows multiple bilateral round circumscribed pulmonary nodules.
- 19. Notice the nodulesalong the fissures indicating a perilymphatic distribution (red arrows). The majority of nodules located along the bronchovascular bundle (yellow arrow).
- 20. Sarcoidosis The majority ofnodules located along the bronchovascular bundle (yellow arrow).
- 21. PERILYMPHATIC NODULES Perilymphatic andRandom distribution of nodules , seen in sarcoidosis.
- 22. Centrilobular distribution Hypersensitivity pneumonitis Respiratorybronchiolitis in smokers infectious airways diseases (endobronchial spread of tuberculosis or nontuberculous mycobacteria, bronchopneumonia) Uncommon in bronchioloalveolar carcinoma, pulmonary edema, vasculitis
- 23. Random distribution Small randomnodules are seen in: Hematogenous metastases Miliary tuberculosis Miliary fungal infections Sarcoidosis may mimick this pattern, when very extensive Langerhans cell histiocytosis (early nodular stage)
- 24. Langerhans cell histiocytosis:early nodular stage before the typical cysts appear.
- 25. Differential diagnosis ofa nodular pattern of interstitial lung disease SHRIMP Sarcoidosis Histiocytosis (Langerhan cell histiocytosis) Hypersensitivity pneumonitis Rheumatoid nodules Infection (mycobacterial, fungal, viral) Metastases, Miliary TB Microlithiasis, alveolar Pneumoconioses (silicosis, coal worker's, berylliosis)
- 26. Reticulonodular pattern A reticulonodularpattern results from a combination of reticular and nodular opacities. This pattern is often difficult to distinguish from a purely reticular or nodular pattern, and in such a case a differential diagnosis should be developed based on the predominant pattern. If there is no predominant pattern, causes of both nodular and reticular patterns should be considered.