B-Nodules 1-Dotlike Fig. 6.21a,b. (Peri)lymphatic (a) vs centrilobular (b) distribution of disease. (a) Patient with sarcoidosis showing numerous subpleural and fissural nodules. Since nodules are also found in other areas where lymphatics are located (peribronchovascular interstitium, interlobular septa and centrilobular) diagnosis of disease with a (peri)lymphatic distribution can be made. (b) Patient with infectious bronchiolitis (tuberculosis) showing centrilobular changes (nodules, branching lines and tree-in-bud), suggesting disease that predominantly involves the airways DOTLIKE : 1- pulmonary edema, 2-lymphangitic carcinomatosis, 3-UIP
B-Nodules2- Ill-defined (Ground-Glass) centri-lobular nodules FIGURE 17.7. Centri-lobular Ground-Glass Nodules in Sub-acute Hypersensitivity Pneumonitis. HRCT shows the typical poorly defined centri-lobular nodules (arrows) of subacute hypersensitivity pneumonitis (bird-fanciers lung). Caption: Picture 5. High-resolution chest CT scan of a patient with hypersensitivity pneumonitis demonstrates centrilobular nodules. These nodules are unlike those of sarcoidosis, in which the nodules are subpleural and along peribronchovascular interstitium Ill-defined (Ground-Glass) centri-lobular nodules represent disease of the bronchiole and adjacent parenchyma : 1- subacute hypersensitivity pneumonitis 2-cryptogenic organizing pneumonia (COP),
B-Nodules3-tree-in-bud appearance Figure 2. Postprimary active tuberculosis in a 66-year-old woman with a chronic cough. High-resolution CT scans of the right lung show peripheral, poorly defined, small (2–4- mm-diameter) centrilobular nodules and branching linear opacities of similar caliber originating from a single stalk (the tree-in-bud pattern) in the lower lobe (arrow)
B-Nodules Centri-lobular (Lobular Core) Abnormalities Tree-in-bud almost always indicates the presence of:1. Endobronchial spread of infection (TB, MAC, any bacterial bronchopneumonia).2. Airway disease associated with infection (cystic fibrosis, bronchiectasis).3. less often, an airway disease associated primarily with mucus retention (allergic bronchopulmonary aspergillosis, asthma). (Mycobacterium Avium Complex Disease) Typical Tree-in-bud appearance in a patient with active TB.
NodulesDot-like tree-in-bud Ill-defined• pulmonary edema. appearance centrilobular• lymphangitic carcinomatosis. • Tree-in-bud almost always nodules• UIP indicates the presence of: represent disease of the • Endobronchial spread of bronchiole and adjacent infection (TB, MAC, any parenchyma: bacterial bronchopneumonia) • in subacute hypersensitivity • Airway disease associated pneumonitis with infection (cystic fibrosis, bronchiectasis) • cryptogenic organizing pneumonia (COP). • less often, an airway disease associated primarily with mucus retention (allergic bronchopulmonary aspergillosis, asthma).
B-Nodules sarcoidosis •Nodules predominating in the peribronchovascular, interlobular, and subpleural regions those portions of the interstitium where the lymphatics lie are said to have a perilymphatic distributionSarcoidosis: typical presentation with nodules alongthe bronchovascular bundle and fissures Notice thepartially calcified node in the left hilum.
B-Nodules 4-Conglomerate Masses FIGURE 17.10. Nodules and a Conglomerate Mass in Silicosis. A. Posteroanterior radiograph of a 79-year-old patient with silicosis shows diffuse nodules as well as a conglomerate mass in the right upper lobe (arrow). B. HRCT scan through the upper lobes shows peribronchovascular and subpleural micronodules (small arrows), larger nodules (curved arrow), and a conglomerate mass representing progressive massive fibrosis in the right upper lobe (large arrow). The pleural effusions are caused by concomitant congestive heart failure. Conglomerate Masses: 1- Sarcoidosis 2-Silicosis 3-CWP 4-Radiation fibrosis These conglomerate masses are most often seen in patients with end-stage sarcoidosis but can occur in complicated silicosis with progressive massive fibrosis (PMF) (Fig. 17.10) or radiation fibrosis
NODULAR PATTERN Sub-pleural nodules Absent Present Random , Centri-lobular distribution uniform distribution ALSO Peri-bronchovascular Septal Tree in bud Random Centri-lobular Peri-lymphaatic Tree in bud absent present patchy distribution In distribution distributionPeri-bronchiolar peri-vascular Peri-bronchiolar diseases diseases diseses