Nodular Patternitie: Size, Distribution, Appearance and Differential Diagnosis
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Nodular Patternitie: Size, Distribution, Appearance and Differential Diagnosis
- 2. Nodular Patternitie By Gamal Rabie Agmy , MD , FCCP Professor of Chest Diseases ,Assiut University
- 4. Nodular pattern A nodular 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
- 5. Perilymphatic distribution Centrilobular distribution Random distribution
- 6. ARE NODULES IN CONTACT 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 Nodules and 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 Miliary tuberculosis sarcoidosis in a lung transplant patient with bronchopneumonia
- 13. RANDOM: no consistent relationship to any structures PERILYMPHATIC: corresponds to distribution of lymphatic CENTRILOBULAR: related to centrilobular structuresDistribution 13
- 14. Angiocentric
- 17. Lymphocentric
- 18. Disseminated histoplasmosis and nodular ILD. CT scan shows multiple bilateral round circumscribed pulmonary nodules.
- 19. Notice the nodules along the fissures indicating a perilymphatic distribution (red arrows). The majority of nodules located along the bronchovascular bundle (yellow arrow).
- 20. Sarcoidosis The majority of nodules located along the bronchovascular bundle (yellow arrow).
- 21. PERILYMPHATIC NODULES Perilymphatic and Random distribution of nodules , seen in sarcoidosis.
- 22. Centrilobular distribution Hypersensitivity pneumonitis Respiratory bronchiolitis in smokers infectious airways diseases (endobronchial spread of tuberculosis or nontuberculous mycobacteria, bronchopneumonia) Uncommon in bronchioloalveolar carcinoma, pulmonary edema, vasculitis
- 23. Random distribution Small random nodules 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 of a 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 reticulonodular pattern 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.