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Reticular pattern
The document discusses the reticular pattern seen on CT scans of the lung. A reticular pattern results from the superimposition of irregular linear opacities, forming a mesh-like or network appearance. Reticular opacities can be fine, medium, or coarse depending on the width of the opacities. A classic reticular pattern is seen in pulmonary fibrosis where curvilinear opacities form small cystic honeycomb spaces along the pleural margins and bases. Potential causes of interlobular septal thickening seen on CT include pulmonary edema, lymphangitic carcinomatosis, fibrosis, and sarcoidosis. Honeycombing signifies the presence of fibrosis and is seen commonly in idiopathic
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Reticular pattern
- 2. Reticular Pattern Gamal RabieAgmy, MD, FCCP Professor of chest Diseases, Assiut university
- 3. Reticular Pattern A reticularpattern results from the summation or superimposition of irregular linear opacities. The term reticular is defined as meshed, or in the form of a network. Reticular opacities can be described as fine, medium, or coarse, as the width of the opacities increases. A classic reticular pattern is seen with pulmonary fibrosis, in which multiple curvilinear opacities form small cystic spaces along the pleural margins and lung bases (honeycomb lung)
- 4. HRCT of thelung Reticular pattern – definition Glossary of Terms for Thoracic Imaging – Radiology 2008; 246:697
- 5. HRCT of thelung thickening of the interstitial fiber network by Reticular pattern – significance fluid fibrous tissue infiltration by cells or other material pulm. edema lymphangitic carcin. veno-occlusive dis. alveolar proteinosis IPF collagen vascular dis. drug-related fibrosis amyloidosis Predominant pattern Associated / occasional finding sarcoidosis pneumoconiosis pulm. hemorrhage asbestosis
- 6. HRCT of thelung Reticular pattern – HRCT numerous, clearly visible interlobular septa outlining lobules of characteristic size and shape interlobular septal thickening very fine network of lines within visible lobules intralobular interstitial thickening several layers of air-filled cysts, 3-10 mm in diameter, with thick walls (1-3 mm) honeycombing
- 7. Reticular pattern Interlobular septalthickening – dd smooth thickening pulm. edema pulm. hemorrhage lymphangitic carc. lymphoma nodular thickening lymphangitic carc. sarcoidosis amyloidosis irregular thickening fibrosis
- 8. Reticular pattern Interlobular septalthickening – pulmonary edema smooth septal thickening, isolated or in combination with ground-glass opacity peribronchovascular and subpleural interstitial th. perihilar and gravitational distribution, bilateral findings of CHF
- 9. Reticular pattern Interlobular septalth. – lymphangitic carcinomatosis tumor filling of pulmonary vessels and lymphatics direct tumor infiltration of the interstitium vascular and lymphatic distension distally to tumor emboli or obstruction breast ca. lung ca. stomach ca. pancreas ca. Secondary to: prostate ca. adenoca. of unknown origin
- 10. Reticular pattern Interlobular septalth. – lymphangitic carcinomatosis smooth or nodular septal thickening smooth or nodular thickening of peribronchovascular interstitium and fissures thickening of the intralobular axial interstitium focal or asymmetric distribution
- 11. Reticular pattern Interlobular septalthickening – sarcoidosis reticulation is not a predominat finding distorsion of the lung architecture and secondary lobule anatomy is common, especially when septal thickening is present upper lobe predominance
- 12. Reticulation or notreticulation …… “crazy paving”
- 13. Reticulation or notreticulation …… alveolar proteinosis
- 14. Reticular pattern Interlobular septalthickening – “crazy paving” scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines described in a variety of infectious, neoplastic, idiopathic, inhalation, and sanguineous disorders of the lung Rossi SE – Radiographics 2003; 23:1509
- 15. Reticular pattern Honeycombing –significance air-containing cystic spaces having thick, fibrous walls lined by bronchiolar epithelium fibrosis is present UIP is likely the histologic pattern IPF is very likely, in the absence of a known disease
- 16. Reticular pattern Honeycombing –differential diagnosis basal distribution middle/upper distribution chronic HP sarcoidosis IPF collagen vasc. dis. asbestosis drugs
- 17. honeycombing / intralobularreticulation basal and peripheral distribution typical HRCT findings sens. 77% spec. 72% PPV 85% PPV 96%* Swigris JJ – Chest 2005; 127:275 lung biopsy in patients who do not show typical features Reticular pattern Honeycombing – idiopathic pulmonary fibrosis * confident diagnosis
- 18. Reticular pattern Honeycombing –collagen vascular diseases rheumatoid arthritis and scleroderma almost indistinguishable from UIP due to IPF associated findings, typical of the disease, may help in the differential diagnosis
- 19. Reticular pattern Honeycombing –drug reaction findings of fibrosis, similar to those seen in IPF peripheral and subpleural predominance highest incidence with cytotoxic agents temporal relationship between drug administration and development of pulmonary abnormalities Honeycombing – chronic hypersensitivity pneum. possible association with poorly defined nodules, mosaic attenuation or air-trapping upper and middle zone predominance
- 20. Reticular pattern Intralobular interstitialthickening – significance thickening of the pulmonary interstitium at a sublobular level isolated (fibrosis) in association with septal thickening or the “crazy paving” pattern very fine linear structures below the resolution of HRCT (gg appearance)
- 21. Reticular pattern adapted from:Webb RW – HRCT of the lung, III ed; 2001 interlobular septal thickening irregular, lung distorsion nodularsmooth •fibrosis (sarcoidosis, asbestosis) •pulm. edema •linf. carc. •hemorrhage • sarcoidosis • linf. carc.
- 22. Reticular pattern adapted from:Webb RW – HRCT of the lung, III ed; 2001 honeycombing •IPF (60%) •collagen vascular dis. • drug reaction •asbestosis (uncommon) subpleural, posterior LL predominance • sarcoidosis • chronic HP • radiation other distribution (UL; parahilar)
- 23. Reticular pattern adapted from:Webb RW – HRCT of the lung, III ed; 2001 intralobular interstitial thickening & septal thickening & GGO isolated NSIP findings of fibrosis honeycombing differential dx
- 24. Reticular pattern In thereticular pattern there are too many lines, either as a result of thickening of the interlobular septa or as a result of fibrosis as in honeycombing.
- 25. Focal septal thickeningin lymphangitic carcinomatosis
- 26. Septal thickening andground-glass opacity with a gravitational distribution in a patient with cardiogenic pulmonary edema.
- 27. Tree-in-bud Centrilobular nodulesm/b further characterized by presence or absence of ‘‘tree-in-bud.’’ Tree-in-bud -- Impaction of centrilobular bronchus with mucous, pus, or fluid, resulting in dilation of the bronchus, with associated peribronchiolar inflammation . Dilated, impacted bronchi produce Y- or V-shaped structures This finding is almost always seen with pulmonary infections. 27
- 28. Tree-in-bud Tree-in-buddescribesthe appearance ofan irregularand often nodular branchingstructure, most easily identifiedin the lung periphery.
- 29. Typical Tree-in-bud appearancein a patient with active TB.
- 30. Attenuation pattern High Attenuationpattern GROUND GLASS CONSOLIDATION Low Attenuation pattern Emphysema Lung cysts (LAM, LIP, Langerhans cell histiocytosis) Bronchiectasis Honeycombing
- 31. Dark bronchus signin ground glass opacity. Complete obscuration of vessels in consolidation.
- 32.
- 33. Broncho-alveolar cell carcinomawith ground-glass opacity and consolidation
- 34.
- 35. Two patients withchronic consolidations as a result of COP (cryptogenic organizing pneumonia)
- 36. Mosaic attenuation The term'mosaic attenuation' is used to describe density differences between affected and non-affected lung areas.
- 37. Mosaic attenuation Lung densityand attenuation depends partially on amount of blood in lung tissue. May be due to vascular obstruction, abnormal ventilation or airway disease 37
- 39. Mosaic pattern ina patient with hypersensitivity pneumonitis
- 40. Mosaic pattern ina patient with chronic thromboemboli
- 41. Crazy Paving Pattern CrazyPaving is a combination of ground glass opacity with superimposed septal thickening Crazy Paving can be seen in: Alveolar proteinosis Sarcoid NSIP Organizing pneumonia (COP/BOOP) Infection (PCP, viral, Mycoplasma, bacterial) Neoplasm (Bronchoalveolarca (BAC) Pulmonary hemorrhage Edema (heart failure, ARDS, AIP)
- 42. CRAZY PAVING PATTERN Itis scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines. Causes: 42
- 43. Crazy Paving ina patient with Alveolar proteinosis.
- 44. Crazy Paving Combination ofground glass opacity and septal thickening : Alveolar proteinosis.
- 45. Combination of ground glassopacity and septal thickening : Alveolar proteinosis45
- 46. Head cheese sign Itrefers to mixed densities which includes # consolidation # ground glass opacities # normal lung # Mosaic perfusion • Signifies mixed infiltrative and obstructive disease
- 47. Head cheese sign Commoncause are : 1. Hypersensitive pneumonitis 2. Sarcoidosis 3. DIP 47
- 48. Headcheese sign Headcheese signin hypersensitivity pneumonitis. HRCT scan shows lung with a geographic appearance, which represents a combination of patchy or lobular ground-glass opacity (small arrows) and mosaic perfusion (large arrows).
- 49. Low Attenuation pattern Emphysema Lungcysts (LAM, LIP, Langerhans cell histiocytosis) Bronchiectasis Honeycombing
- 50. Differential diagnosis of interstitiallung diseases Reticular pattern Nodular pattern High Attenuation pattern Low Attenuation pattern
- 52. Lymphangitic carcinomatosis: irregular septal thickening, usually focalor unilateral 50% adenopathy', known carcinoma.
- 54. Cardiogenic pulmonary edema: incidentalfinding in HRCT, smooth septal thickening with basal predominance (Kerley B lines), ground-glass opacity with a gravitational and perihilar distribution, (peribronchial cuffing)
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- 58. Nodular pattern 1.Hypersensitivity pneumonitis: 2.MiliaryTB: random nodules 3.Sarcoidosis 4.Hypersensitivity pneumonitis
- 59. Nodular pattern Hypersensitivity pneumonitisMiliary TB Sarcoidosis Hypersensitivity pneumonitis
- 60. Low Attenuation pattern Lymphangiomyomatosis(LAM) LCH Honeycombing Centrilobular emphysema
- 61. Low Attenuation pattern(2) Centrilobular emphysema: Langerhans cell histiocytosis (LCH) Honeycombing. Lymphangiomyomatosis (LAM)