Radiologist
is
Great doctor
Fundamentals of
HRCT of the Chest (Part – 3)
By:
Dr/ Ismail Sayed Ismail
Linear / Reticular Nodular Parenchymal Low attenuation /
pattern pattern opacification cystic pattern
Mosaic
attenuation
Linear and reticular opacities
1. Peribronchovascular interstitial
thickening.
2. Interlobular septal thickening.
3. Intralobular interstitial thickening.
4. The interface sign.
5. Subpleural line.
6. Subpleural interstitial thickening.
7. Parenchymal bands.
8. Crazy paving appearance.
9. Honeycombing appearance.
There are two lymphatic systems :
❑ Central network,
that runs along the bronchovascular
bundle.
❑ Peripheral network,
that is located within the interlobular
septa.
1
❑ Peribronchovascular interstitial thickening.
❑ Peribronchovascular interstitial
thickening (Peribronchial cuffing),
the pulmonary artery branches
appear similar in diameter to the
cuffed bronchi.
❑ Also note interlobular septal
thickening and subpleural nodules.
❑ In a patient with unliteral (left-sided)
lymphangitis carcinomatosis.
❑ Nodular peribronchovascular
interstitial thickening.
❑ Also note small nodules
surrounding bronchi and vessels.
❑ In a patient with sarcoidosis.
2
The black arrows point to ….. ?
❑ Interlobular septal thickening.
❑ Diffuse interlobular septal
thickening outlining numerous
2ry pulmonary lobules.
❑ Some nodularity seen near the
fissures.
❑ Long septae that marginate several
lobules termed parenchymal bands.
❑ In a patient with lymphangitis
carcinomatosis.
❑ Interlobular septal thickening.
❑ Smooth interlobular septal
thickening.
❑ Smooth peribronchovascular
interstitial thickening with
peribronchial cuffing.
❑ Smooth subpleural interstitial
thickening seen along the fissures.
❑ Pleural effusion is noted as well.
❑ In a patient with pulmonary edema.
3
The blue arrow point to ….. ?
❑ Intralobular interstitial thickening.
❑ A fine network of lines in the
anterior lung.
❑ Patient with IPF.
❑ Intralobular interstitial thickening.
❑ A fine network of lines in the
posterior lung.
❑ Patient with early IPF.
1. Peribronchovascular interstitial
thickening.
2. Interlobular septal thickening.
3. Intralobular interstitial thickening.
4. The interface sign.
5. Subpleural line.
6. Subpleural interstitial thickening.
7. Parenchymal bands.
8. Crazy paving appearance.
9. Honeycombing appearance.
4
Pleural surface irregularity is called …. ?
❑ The interface sign refers to the
presence of irregular interfaces
between the lung parenchyma and
the pleural surface, fissures or
vessels.
❑ It suggests interstitial thickening.
5
The white arrows point to ….. ?
❑ Subpleural line.
Curvilinear opacity , less than 1cm
from the pleural surface and runs
parallel to the pleura.
❑ Patient with early IPF.
❑ Subpleural line.
❑ Patient with scleroderma / NSIP.
❑ Subpleural line.
Dependent atelectasis resulting in
posterior subpleural line.
No other findings to suggest fibrosis.
This line disappeared on prone
scan.
❑ Normal case with dependent density
with resultant posterior subpleural
line.
6
❑ Subpleural interstitial thickening.
Best seen adjacent to major fissures.
If thickening is smooth, it mimics
fissural effusion.
1. Peribronchovascular interstitial
thickening.
2. Interlobular septal thickening.
3. Intralobular interstitial thickening.
4. The interface sign.
5. Subpleural line.
6. Subpleural interstitial thickening.
7. Parenchymal bands.
8. Crazy paving appearance.
9. Honeycombing appearance.
7
The red arrow point to ….. ?
❑ Parenchymal bands. It may represents an isolated scar like
Non-tapering reticular opacity. this case.
1-3 mm in thickness.
2-5 cm in length.
Seen with atelectasis, pulmonary
fibrosis, other causes of interstitial
thickening.
Usually peripheral.
The related pleural surface is thickened
and retracted inwards.
In some patients, it represents several
contiguous thickened interlobular septae.
❑ Parenchymal bands.
❑ Irregular interlobular septal
thickening with irregular
peribronchovascular interstitial
thickening.
❑ Irregular pleural surface (interface
sign) with distortion of lung
architecture.
❑ Patient with pulmonary fibrosis and
end-stage sarcoidosis.
8
The blue arrow point to ….. ?
❑ Crazy paving describes interlobular
septal thickening with superimposed
ground glass opacification, which is
thought to resemble the appearance
of broken pieces of stone.
❑ As in pulmonary alveolar
proteinosis (PAP).
9
The red arrow points to ….. ?
❑ Honeycombing.
Multiple air-filled thick-walled small
cysts.
Having peripheral and subpleural
distribution.
Arranged in several layers.
Associated with architectural
distortion and loss of normal
lobular anatomy.
❑ Patient with IPF.
❑ Honeycombing.
It indicates end-stage lung disease
lung fibrosis.
It is cystic (air-filled) with definable
wall.
It have peripheral distribution.
Size from few mm to > 1 cm.
Wall thickness about 1-3 mm.
Arranged in more than one layer.
❑ Patient with IPF.
1. Peribronchovascular interstitial
thickening.
2. Interlobular septal thickening.
3. Intralobular interstitial thickening.
4. The interface sign.
5. Subpleural line.
6. Subpleural interstitial thickening.
7. Parenchymal bands.
8. Crazy paving appearance.
9. Honeycombing appearance.
Case discussion
1. Peribronchovascular interstitial
thickening.
2. Interlobular septal thickening.
3. Intralobular interstitial thickening.
4. The interface sign.
5. Subpleural line.
6. Subpleural interstitial thickening.
7. Parenchymal bands.
8. Crazy paving appearance.
9. Honeycombing appearance.
Intralobular interstitial Peribronchovascular Interlobular septal
thickening interstitial thickening thickening
Subpleural interstitial
thickening Subpleural line The interface sign
Honeycombing appearance Crazy paving appearance Parenchymal bands
Irregular reticular opacities.
❑ Irregular bands of fibrosis seen
along the lung periphery within or
bridging through the pulmonary
lobules.
❑ Commonly seen in UIP and NSIP.
Lung architectural distortion.
❑ It refers disruption of the normal
pulmonary bronchial, vascular,
fissural or septal anatomy.
❑ Manifested as loss of smooth course
of the fissures, crowding of dilated
bronchioles or vessels with
angulated course.
❑ Caused by pulmonary fibrosis.
❑ Accompanying features include:
– lung volume loss
– pulmonary parenchymal bands
– traction bronchiectasis
Pulmonary edema
❑ Smooth interlobular septal
thickening.
❑ Patchy areas of ground glass
opacities.
❑ Bilateral pleural effusion.
❑ Cardiomegaly.
Pulmonary edema from
congestive heart failure.
Lymphangitis carcinomatosa
❑ Nodular interlobular septal
thickening.
❑ Nodular peribronchovascular
interstitial thickening.
❑ Mediastinal lymphadenopathy.
❑ Left axillary lymphadenopathy.
❑ Left breast mass with skin
thickening.
Lymphangitis carcinomatosa from
Breast cancer.
Lower lobe fibrotic changes
❑ DD :
1. IPF.
2. Fibrotic NSIP.
3. Asbestosis.
4. Scleroderma.
❑ CT shows UIP pattern characterized by bibasilar fibrosis and
honeycombing, with relative sparing of the upper lobes.
❑ DD :
Lower lobe interstitial lung disease – idiopathic pulmonary fibrosis (IPF).
❑ CT shows UIP pattern characterized by reticular opacity, honeycombing and
traction bronchiectasis worse in the bases. Calcified pleural plaques are seen.
❑ DD :
Lower lobe interstitial lung disease – Asbestosis.
❑ CT shows fibrotic changes with honeycombing throughout the lower lobes
with sparing of the upper lobes & dilated/patulous, fluid-filled esophagus.
❑ DD :
Lower lobe interstitial lung disease – Scleroderma.
Upper lobe fibrotic changes
❑ DD :
1. Tuberculosis.
2. End-stage sarcoidosis.
3. End-stage silicosis.
4. Chronic hypersensitivity pneumonitis.
❑ CT shows multiple 2 to 3 mm nodules, interlobular septal thickening with
traction bronchiectasis, and scarring with distortion of the normal
architecture within the upper lobes. Occupational history.
❑ DD :
Upper lobe interstitial lung disease - Complicated silicosis.
❑ CT shows bilateral upper lobes mostly posterior segments fibrosis and
traction bronchiectasis, cicatricial emphysema & distortion of upper airway.
❑ DD :
Upper lobe interstitial lung disease - Tuberculosis.
1. Peribronchovascular interstitial
thickening.
2. Interlobular septal thickening.
3. Intralobular interstitial thickening.
4. The interface sign.
5. Subpleural line.
6. Subpleural interstitial thickening.
7. Parenchymal bands.
8. Crazy paving appearance.
9. Honeycombing appearance.
Intralobular interstitial Peribronchovascular Interlobular septal
thickening interstitial thickening thickening
Subpleural interstitial
thickening Subpleural line The interface sign
Honeycombing appearance Crazy paving appearance Parenchymal bands
