Intralobular septal thickening on chest CT in a patient with pulmonary amyloidosis: a rare case study Yasuhito Suzuki, Junpei Saito, Ryuichi Togawa, Hiroyuki Minemura, Mitsuru Munakata A 54-year-old female presented with chronic dry cough and dyspnoea over 3 months and was referred to our outpatient clinic. The true incidence of lymphangitic carcinomatosis is unknown, but less than 1% of all solid tumors present with this pattern. Conclusions: In summary, our study described HS/DS cases with pulmonary manifestations including, ARDS, bacterial pneumonia and pulmonary hemorrhage. Diffuse Lung Disease Despite the well-established role of chest radiography in accurately and inexpensively displaying a wide range of pulmonary parenchymal pathology, equally well established limitations have been documented (1, 2, 3). Aunt Minnie’s Pearls. Diffuse centrilobular nodules in a person exposed to organic dust are characteristic of subacute hypersensitive pneumonitis. His cortisol level was undetectable; he was diagnosed with adrenal insufficiency and fludrocortisone was initiated. Then the patient underwent computed tomography (CT) which showed intralobular and interlobular septal thickening and ground glass with geographic distribution showing a crazy paving pattern (Fig. At a lobar level, 69% (514 of 748) of lobes with bronchiectasis had septal thickening. Only 2 of 13 (15.4%) patients with COVID-19 presented intralobular septal thickening, while none showed interlobular septal thickening. MedGen UID: 909861 • Concept ID: C4280727 • Finding. There was strong correlation between the extent of septal thickening and the extent interlobular septal thickening, intralobular interstitial thickening, wall cysts of honeycombing, peribronchovas-cular interstitial thickening and traction bronchiectasis/ bronchiolectasis [4]. It may be due to fluid, cellular infiltration, or fibrosis. Mediastinal lymph-adenopathy in stations 4R and 10R with no calcifica-tion was observed. Thickening of the lungs, also called pleural thickening, is an asbestos-related health problem that forms when asbestos fibers cause lung scarring, which causes the lung lining to thicken. air bronchogram, tree-in-bud sign, interlobular septal thickening, intralobular septal thickening, and pleural effusion were evaluated in COVID-19 and influenza pneumonia cohorts. This area is comprised of the pulmonary veins, capillaries and their associated interstitium. Normally, no septal lines can be identified on the radiograph, and only a few can be seen on high-resolution CT, mostly in the anterior and lower aspects of the lower lobes. Common ancillary findings included pulmonary vascular enlargement (64%), intralobular septal thickening (60%), adjacent pleural thickening (41.7%), air bronchograms (41.2%), subpleural lines, crazy paving, bronchus distortion, bronchiectasis, and interlobular septal thickening. IUPVA should be differentiated from other causes of unilateral interlobular septal thickening such as focal chronic inflammatory disease (bronchiectasis, radiation pneumonitis), Sjogren syndrome, systemic sclerosis, and pulmonary circulatory diseases (proximal PA sarcoma, venous thrombosis, and unilateral pulmonary vein stenosis). On presentation she was tachycardic and tachypneic, with oxygen saturation of 81% on 2 L/min of oxygen. 3 . Presence of thickening of the interlobular septa of the lungs as seen on a CT scan. Chest X-ray findings in HS/DS cases frequently showed diffuse shadows, and the combination of GGO and interlobular septal thickening … HRCT scan of the chest showing nodular interlobular septal thickening at the lung bases, particularly at the right lung base (arrows). A significant correlation was established between arterial oxygen tension level and extent of disease at CT (r = -0.84, P <.05). Author information: (1)Respiratory Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. Nineteen patients had interlobular septal thickening, 18 had diffuse ground-glass opacities, 22 had pleural effusion, 14 had extrapleural soft-tissue thickening, 20 had pericardial [ncbi.nlm.nih.gov] CT chest Described features include 4 increased interlobular septal thickening peribronchovascular thickening patchy ground glass opacities pleural thickening pleural effusion [radiopaedia.org] [from HPO] Term Hierarchy. Results Peripheral and non-specific distributions in COVID-19 showed a markedly higher frequency compared with the influ-enza group (p<0.05). There were no crackles on auscultation with oxygen saturation of 95% on room air despite a wide range of abnormal shadows on chest X-ray and CT. Based on the available clinical and radiographic findings, the … Interlobular septal lines and centrilobular opacities were observed more frequently in antibiotic agent-induced pneumonitis, and intralobular interstitial thickening was observed more frequently in antineoplastic agent-induced pneumonitis. A thirty-four-year-old woman with chronic dyspnea and pulmonary interlobular septal thickening. Interlobular septal thickening at HRCT can be smooth, nodular, or irregular in contour. This in turn leads to thickening of the alveolar septae and the bronchovascular bundles, giving rise to the typical radiographic pattern of diffuse intralobular and interlobular septal thickening. Interlobular Septal Thickening Interlobular Septal Thickening SmallSmall Intralobular Interstitial Thickening Intralobular Interstitial Thickening IntermediateIntermediate HoneycombingHoneycombing. CT of the chest during that admission revealed mild intralobular and interlobular septal thickening. Erdheim-Chester Disease. Interlobular septal thickening on pulmonary HRCT. Additionally, although interlobular and intralobular septal thickening was a typical characteristic of COVID-19 in recent published studies [7, 8, 11, 24], it was rarely found in this study. The condition is incurable, but some treatments can improve symptoms. Ribeiro Neto ML(1), Arrossi A, Maskey A, Yadav R, Heresi GA. Nodular interlobular septal thickening … Intralobular septal thickening is a finding on chest CT in which the interstitial structures inside the secondary pulmonary lobule are thickened, not the outer connective layer. It represents pathology in the periphery of the pulmonary lobules (ie, the interlobular septa). 2a,b,c). It has been broadly divided into smooth regular, irregular or nodular. Pneumocystis jiroveci is an atypical fungus that causes pneumonia in immunocompromised human hosts, particularly those with deficiency in cell-mediated immunity.P. Although ILST is often seen in association with other CT findings, such as consolidation and ground-glass opacities, it can be the predominant (or sole) … In interlobular septal thickening, lobules outlined by the thickened septa are recognised by their characteristic shape and centrally located pulmonary vessels seen as a dot-like hyperdensity. Findings in fibrosis include intralobular interstitial thickening, irregular interfaces, irregular interlobular septal thickening, honeycombing, and traction bronchiectasis. superimposed interlobular septal thickening and intralobular septal thickening; (11) halo sign, which was defined as the GGO surrounding a pulmonary nodule or mass; (12) cavita-tion; (13) pleural effusion; (14) pericardial effusion; and (15) lymphadenopathy,whichwasdefinedasalymphnode>1cm in short-axis diameter. Fig. HPO: HP:0030879: Definition. On HRCT, numerous clearly visible septal lines usually indicates the presence of some interstitial abnormality. Septal thickening can be definied as being either smooth, nodular or irregular and each likely represents a different pathologic process. She was diagnosed with pneumonia by her chest CT scan, which revealed a small right hemithorax, interlobular septal thickening, and ground-glass opacity of the right lung (Fig 1A), and was treated with antibiotics. She was in mild respiratory distress. Both the intralobular pulmonary artery and bronchiole are centrilobular structures. jiroveci lives almost exclusively in the pulmonary alveoli, adhering to the alveolar epithelium. She also reported new fevers, night sweats, and a rash on her face and torso. She had no history of smoking, allergy or respiratory disorders. Interlobular septal thickening was also frequently shown (67%), always accompanying GGO in upper lobes. ground glass opacities (GGOs) with intralobular septal thickening (figure 1B–D). Discussion. Mediastinal lymphadenopathy in stations 4R and 10R with no calcification was observed. Presence of thickening of the interlobular septa of the lungs as seen on a CT scan. Chest CT revealed extensive upper lobe predominant subpleural consolidation with air bronchograms as well as extensive ground glass opacities (GGOs) with intralobular septal thickening (figure 1B–D). Smooth interlobular septal thickening is seen in pulmonary edema, pulmonary hemorrhage, alveolar proteinosis, exogenous lipoid pneumonia, and pneumonia. Diffuse interlobular septal thickening (DIST) is a pattern of lung disease found on high-resolution thoracic CT scanning (HRCT or CTPA). PMID: 23652220 [Indexed for MEDLINE] Publication Types: She soon became afebrile, but still felt shortness of breath during intense exercise. In one study of 458 patients with histologically confirmed infiltrative lung disease, 44, or nearly 10%, had normal prebiopsy chest radiographs (1). Case 1. Interlobular septal thickening is commonly seen in patients with interstitial lung disease. Septal thickening Thickening of the lung interstitium by fluid, fibrous tissue, or infiltration by cells results in a pattern of reticular opacities due to thickening of the interlobular septa. A bronchoscopy with BAL and transbronchial biopsies did not show acute cellular rejection, but the BAL fluid was positive for coronavirus. The major constituents of reticulation in HRCT include: (1) interlobular septal thickening, (2) intralobular septal thickening, (3) subpleural interstitial thickening and (4) centrilobular branching lines and (5) parenchymal bands (9). A 50-year-old woman presented with 3 months of cough, dyspnea, and fatigue. The lesions were predominantly peripheral in 38 patients (88%). Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Interlobular Septal Thickening and Crazy Paving Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. intralobular: (ĭn″tră-lŏb′ū-lăr) [″ + lobulus , a lobule] Within a lobule. A septal pattern results from thickening of the interlobular septa (i.e., the tissue that separates the secondary pulmonary lobules) ( Fig. 5.1 ). CT in early follow-up period generally showed an increase in size, number, and density of GGOs, with … It is usually caused by exposure to asbestos, but it also can … IX.a IX - Neuromuscular / CNS involvement - Disordered breathing during sleep IX.a - Diaphragm/inspiratory muscle weakness/paralysis (w/wo ARF) XV.ar XV - Pathology XV.ar - Path: Barium lung XVI.n XVI - Imaging XVI.n - Imaging: Intralobular septal thickening - Crazy paving XVI.am XVI - Imaging XVI.am - Imaging: Contrast tracheo- and/or bronchogram XVII.a XVII - Infections & … Kerley B lines are due to interlobular septal thickening. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). Interlobular septal thickening infers disease infiltration. 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