This document contains 29 figures showing chest radiographs demonstrating various diffuse reticular or reticulonodular patterns in the lungs. These patterns represent interstitial lung diseases that involve diffuse thickening and fibrosis of the lung interstitium. The document compares and contrasts the radiographic appearances of numerous conditions that can cause these diffuse interstitial changes, including lymphangitic carcinomatosis, lymphoma, silicosis, asbestosis, berylliosis, coal worker's pneumoconiosis, and various drug-induced lung diseases.

1. 4Diffuse Reticular or
Reticulonodular Pattern

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig C 4-1 Lymphangitic metastases. (A) Coarsened
bronchovascular markings of irregular contour
and poor definition primarily involve the right
lower lung. Note the septal (Kerley) lines and the
left mastectomy in this patient with carcinoma of
the breast. (B) In this patient with metastatic
carcinoma of the stomach, a superimposed
nodular component representing hematogenous
deposits produces a coarse reticulonodular
pattern.

4. • Fig C 4-2 Lymphoma. Diffuse reticular and
reticulonodular changes, with striking
prominence of the left hilar region.

5. • Fig C 4-3 Silicosis. Prominence of interstitial markings,
upward retraction of the hila, and bilateral calcific
densities that tend to conglomerate in the upper lobes.

6. • Fig C 4-4 Asbestosis. Severe disorganization of lung architecture with generalized
coarse reticulation, which has become confluent in the right base and obliterates
the right hemidiaphragm. There is marked pleural thickening, particularly in the
apical and axillary regions. A spontaneous pneumothorax is on the left.7

7. • Fig C 4-5 Berylliosis. Diffuse reticulonodular
pattern throughout both lungs, with relative
sparing of the apices and bases.

8. • Fig C 4-6 Coal-workers' pneumoconiosis. Ill-
defined masses of fibrous tissue in the
perihilar region extend to the right base.

9. • Fig C 4-7 Talc granulomatosis. File nodular
opacities and areas of coalescence in an
intravenous drug abuser.11

10. • Fig C 4-8 Pigeon-breeder's lung. Diffuse
reticulonodular infiltrate primarily involves the
perihilar and upper lobe regions.

11. • Fig C 4-9 Byssinosis. Prolonged exposure has
resulted in irreversible pulmonary
insufficiency and a diffuse reticular pattern.

12. • Fig C 4-10 Oxygen toxicity. (A) Initial chest
radiograph of an infant demonstrates a typical
granular parenchymal pattern with air
bronchograms due to hyaline membrane
disease. (B) After intensive oxygen therapy,
multiple small round lucencies resembling
bullae have developed, giving the lungs a
sponge-like appearance.

13. • Fig C 4-11 Busulfan-induced lung disease.
Severe coarse reticular pattern.

14. • Fig C 4-12 Methotrexate-induced lung disease.
Diffuse interstitial pattern with patches of
alveolar consolidation in a child treated for
myelogenous leukemia. After methotrexate
therapy ended, there was rapid clinical and
radiographic improvement.14

15. • Fig C 4-13 Rheumatoid lung. (A) Frontal and
(B) lateral views of the chest show diffuse
thickening of the interstitial structures with
prominent pleural thickening.

16. • Fig C 4-14 Chronic bronchitis. Coned view of the
right lower lung demonstrates a coarse increase
in interstitial markings. The arrows point to the
characteristic parallel-line shadows (“tramlines”)
outside the boundary of the pulmonary hilum.

17. • Fig C 4-15 Interstitial pulmonary edema. Edema fluid in
the interstitial space causes a loss of the normal sharp
definition of pulmonary vascular markings and a
perihilar haze. At the bases, note the thin horizontal
lines of increased density (Kerley-B lines) that
represent fluid in the interlobular septa.

18. • Fig C 4-16 Secondary tuberculosis. Diffuse
interstitial fibrosis pattern.

19. • Fig C 4-17 Blastomycosis. Diffuse interstitial
disease with upper lobe predominance. Note the
volume loss in the upper lobe and the
overdistention of the lower lobes along with the
formation of bullae at the bases.4

20. • Fig C 4-18 Viral pneumonia. Diffuse interstitial
infiltrates with perihilar haze in (A) a child and
(B) an adult.

21. • Fig C 4-19 Mycoplasma pneumoniae. Diffuse, fine
reticular pattern represents acute interstitial
inflammation. The radiographic pattern is
indistinguishable from that of most viral pneumonias.

22. • Fig C 4-20 Pneumocystis carinii. Diffuse reticular
pattern in a patient with acute myelogenous leukemia.
Note the early development of alveolar consolidations
at the bases. A later film showed the typical pulmonary
edema pattern.

23. • Fig C 4-21 Sarcoidosis. Diffuse reticulonodular
pattern widely distributed throughout both
lungs.

24. • Fig C 4-22 Sarcoidosis. In end-stage disease,
there is severe fibrous scarring, bleb
formation, and emphysema.

25. • Fig C 4-23 Pulmonary Langerhans cell histiocytosis. (A) Frontal view
shows widespread cystic changes in the lung and subsequent
diffuse reticular opacities produced by the overlapping cysts. (B)
Magnified view of the right upper lung shows the confluent
superimposed lung cysts in detail.15

26. • Fig C 4-24 Cystic fibrosis. Diffuse peribronchial
thickening appears as a perihilar infiltrate
associated with hyperexpansion and flattening of
the hemidiaphragms.

27. • Fig C 4-25 Dysautonomia. Pattern identical to
that of cystic fibrosis.

28. • Fig C 4-26 Usual interstitial pneumonia.
Diffuse, coarse reticulonodular pattern.

29. • Fig C 4-27 Desquamative interstitial pneumonia.
Diffuse reticulonodular pattern indicating interstitial
disease, combined with bibasilar air-space
consolidation that obscures the borders of the heart.

30. • Fig C 4-28 Amyloidosis. Diffuse interstitial
fibrosis pattern.

31. • Fig C 4-29 Pulmonary lymphangiomyomatosis.
Diffuse reticulonodular interstitial pattern
throughout both lungs.