ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The interlobular septa (singular: interlobular septum) are located between the secondary pulmonary lobules and are continuous with both the subpleural interstitium (peripheral connective tissue) and the peribronchovascular interstitium (axial connective tissue) as well as the more delicate intralobular septa.. Fig. NIH Understanding HRCT patterns is the key to solving the jigsaw puzzle of Interstitial Lung Diseases. Interlobular septal thickening. Currently, 90% to 95% of the medical imaging examinations for suspected patients with COVID-19 are chest CT, which has a high detection rate of viral pneumonia. 3A, 3B, and 3C) and may give rise to a crazy-paving pattern . Pathology Etiology.  |  On thin-slice CT scans, the interlobular septal thickening can be smooth, nodular or irregular, which is helpful in differential … The NAAT result obtained by RT-PCR detection of SARS-CoV-2 from blood specimens of the patient was positive, and the patient was diagnosed with COVID-19. A 37-year-old woman with non-Hodgkin’s lymphoma who developed adenovirus pneumonia 1 year after allogeneic peripheral blood stem cell transplantation. This article reviews the spectrum of entities that commonly present with thickening of the interlobular septa as the main radiological feature and establishes a practical approach for the differential …  |  When ILS is the predominant abnormality seen on HRCT, the differential diagnosis depends upon the morphology of the thickening. Differential diagnosis of smooth, nodular, and irregular interlobular septal thickening (ILS). {\textcopyright} 2004 Elsvier inc. Interstitial thickening is pathological thickening of the pulmonary interstitium and can be divided into: interlobular septal thickening intralobular septal thickening See also interlobular septa secondary pulmonary lobules HRCT terminology Get the latest public health information from CDC: https://www.coronavirus.gov. Interlobular septal thickening at HRCT can be smooth, nodular, or irregular in contour. Crazy paving refers to the appearance of ground-glass opacity with superimposed interlobular septal thickening and intralobular septal thickening, seen on chest HRCT. The main differential diagnosis is viral pneumonia (particularly CMV) . B-lines represent the interlobular and/or intralobular septal thickening, most associated with pulmonary edema and interstitial disorders. His oxygen saturation decreased to 83-86%, arterial blood gas showed PO2 of 52.2 mm Hg (table 1), and oxygen treatment was initiated. The differential diagnosis of the various entities on the chest radiograph and computed tomography (CT) is based on the pattern and distribution of abnormalities and on the presence of associated findings, such as lymph node enlargement or pleural effusion. Repeat computed tomography showed enlarged subpleural ground glass opacities, new small consolidations, and extensive interlobular and intralobular septal thickening in the lower lung regions (fig 2). 1. This article reviews the spectrum of entities that commonly present with thickening of the inte … Case 3 was a 48-year-old male patient who was quarantined Focal or unilateral abnormalities in 50% … Ann Univ Mariae Curie Sklodowska Med. There were no crackles on auscultation with oxygen saturation of 95% on room air despite a wide … Unable to process the form. Clin. It may be due to fluid, cellular infiltration, or fibrosis. Page 11 of 91 2. Note lobular distrib-ution of ground-glass opacity and mild interlobular septal thicken-ing, anteriorly (arrow). Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. Schaefer-Prokop C, Prokop M, Fleischmann D, Herold C. Eur Radiol. 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. Though viral pneumonias generally show similar imaging features, there are some characteristic CT findings which may help differentiating COVID-19 from influenza pneumonia. Diagnostic Schema for Typical Computed Tomography Findings of Diffuse Pulmonary Diseases As in an identification guide, differential diagnosis of diffuse parenchymal lung diseases is presented on the basis of typical patterns of findings. USA.gov. Check for errors and try again. Therefore, the CT features of these viral infections overlap, so it is mainly the current epidemic context that suggests COVID-19 as the cause of GGOs in patients with fever and respiratory symptoms [ 12 ]. Common causes: acute respiratory distress syndrome (ARDS) bacterial pneumonia It is a non-specific finding that can be seen in a number of conditions. {"url":"/signup-modal-props.json?lang=us\u0026email="}. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. UIP with honeycombing (left) and chronic HP (right) Differential diagnosis of Hypersensitivity Pneumonitis. HRCT scan shows nodular interlobular septal thickening in both lungs with peribronchovascular thickening and minor fissure thickening indicating lymphangitic spread of breast cancer. High-resolution CT: normal anatomy, techniques, and pitfalls. Differential diagnosis of Silicosis / Pneumoconiosis. Within 2–3 days, intralobular lines and smooth interlobular septal thickening superimpose on areas of ground-glass opacity (Figs. 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. On the basis of CT findings, the patient was suspected to have advanced-stage COVID-19. ISBN:3540261877. 1. This site needs JavaScript to work properly. The intralobular septa (sing: septum) are delicate strands of connective tissue separating adjacent pulmonary acini and primary pulmonary lobules. Marked interlobular septal thickening may be associated with the honeycombing and is often observed in the initial phases. She had no history of smoking, allergy or respiratory disorders. interlobular septal thickening, intralobular interstitial thickening, wall cysts of honeycombing, peribronchovas-cular interstitial thickening and traction bronchiectasis/ bronchiolectasis [4]. Interlobular septal thickening might be present, and pleural effusion and enlarged mediastinal lymph nodes were rarely seen. and interlobular septal thickening (Figure 2). Thickening of the interlobular septa is a common and easily recognizable finding at high-resolution computed tomography (HRCT; 1-2 mm collimation high-spatial-frequency reconstruction algorithm). Clipboard, Search History, and several other advanced features are temporarily unavailable. In some cases, it is the predominant radiological finding. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases.In some cases, it is the predominant radiological finding. Springer. This enables rapid orientation and quickly leads to the first suspected diagnosis. At a lobar level, 69% (514 of 748) of lobes with bronchiectasis had septal thickening. Thickening of the interlobular septa can be smooth, nodular or irregular, with many entities able to cause more than one pattern. The most important differential points on chest CT signs between COVID-19 and S. pneumoniae pneumonia were whether disease lesions were distributed in entire lung lobes and segments and whether the crazy paving sign, interlobular septal thickening, and consolidation lesions were found. It is a non-specific finding that can be seen in a number of conditions. Radiol. ... Additionally there is septal and intralobular reticular thickening, indicating already existing irreversible fibrosis. Get the latest research from NIH: https://www.nih.gov/coronavirus. On HRCT, numerous clearly visible septal lines usually indicates the presence of some interstitial abnormality. Apparent thickening of septa at HRCT may also be due to … Additionally, thickening of the intralobular interstitium produces a fine reticular pattern associated with the septal thickening. Septal thickening can be definied as being either smooth, nodular or irregular and each likely represents a different pathologic process. Marked interlobular septal thickening may be associated with the honeycombing and is often observed in the initial phases. sarcoidosis 2; asbestosis 1; some forms of pulmonary edema 5; pneumoconioses 2 The crazy-paving pattern, characterized by scattered or diffuse ground-glass opacities or attenuation with superimposed interlobular septal thickening and intralobular lines, is a common radiologic manifestation. This article reviews the spectrum of entities that commonly present with thickening of the interlobular septa as the main radiological feature and establishes a practical approach for the differential diagnosis. In some cases, it is the predominant radiological finding. 2008 Sep;34(9):715-44. doi: 10.1590/s1806-37132008000900013. However, this overview is not a substitute for complete differential… 2001;11(3):373-92. doi: 10.1007/s003300000648. In some cases, it is the predominant radiological finding. 2. While DIST may be present to variable extents in a number of lung conditions, it is uncommon as a predominant finding except in a few entities. The intralobular septa (sing: septum) are delicate strands of connective tissue separating adjacent pulmonary acini and primary pulmonary lobules. Epub 2019 Jul 13. Mediastinal lymphadenopathy in stations 4R and 10R with no calcification was observed. When coalescent, with several B-lines grouped, they correspond to GGO at the periphery of the lungs, as observed on CT (31, 32). High-resolution computed tomography patterns of diffuse interstitial lung disease with clinical and pathological correlation. 2019 Nov;38(11):3169-3178. doi: 10.1007/s10067-019-04673-4. 29. Septal ThickeningSeptal Thickening Large PatternLarge Pattern • Variety of diseases • Length 1-2 cm • Diameter of lobules 1-2 cm • Central artery • Smooth, nodular or irregular. Imaging Technique High-resolution CT scans were obtained with a Tomoscan AV E1 (Philips, Best, Netherlands), Somatom Sensation 16 (Siemens Medical Imaging, Forchheim, Germany), Somatom Sensation 64 (Siemens Medical Imaging, … It may be due to fluid, cellular infiltration, or fibrosis. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Please enable it to take advantage of the complete set of features! The septa present as irregular linear opacities that are prominent in the subpleural regions. text new page (beta) English (pdf) Article in xml format; How to cite this article: SciELO Analytics; Curriculum ScienTI; Automatic translation Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). 5 References: MR Unit, RESSALTA - Córdoba/ES. This article reviews the spectrum of entities that commonly present with thickening of the interlobular septa as the main radiological feature and establishes a practical approach for the differential diagnosis. Classic entity The prototype entity for reticular pattern is idiopathic pulmonary fibrosis, which is characterised by HHS Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. Depending on filling with fluid or with tumor cells, septal thickening is irregular or smooth. Differential diagnosis of smooth, nodular, and irregular interlobular septal thickening (ILS). Li L, Gao S, Fu Q, Liu R, Zhang Y, Dong X, Li Y, Li M, Zheng Y. Clin Rheumatol. In MERS, the common CT findings include diffuse bilateral subpleural GGOs associated with interlobular and intralobular septal thickening and pleural effusions.  |  ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Differential diagnosis: The interlobular septal thickening could be smooth, nodular or irregular. • CT … Thickening of the interlobular septa is a common and easily recognizable finding at high-resolution computed tomography (HRCT; 1-2 mm collimation high-spatial-frequency reconstruction algorithm). They are continuous with the interlobular septa which surround and define the secondary pulmonary lobules. The interlobular septa (singular: interlobular septum) are located between the secondary pulmonary lobules and are continuous with both the subpleural interstitium (peripheral connective tissue) and the peribronchovascular interstitium (axial connective tissue) as well as the more delicate intralobular septa.. Interlobular septal thickening: patterns at high-resolution computed tomography. The differential diagnosis of COVID-19 can be arbitrary divided into 3 subgroups: Groundglass mimickers There is no real ground-glass but high density lung as a result of insufficient inspiration or normal lung looking like ground-glass because it is next to hypoperfused black lung due to vasoconstriction Furthermore, the differential diagnosis between COVID-19 pneumonia and radiation pneumonitis in caner patients remains a challenge. There are areas of patchy ground-glass opacification with smooth interlobular septal thickening and intralobular interstitial thickening (white circles) a polygonal pattern [learningradiology.com] High-resolution computed tomography (CT) of the chest showed a bilateral ground-glass opacity with interlobular septal thickening , creating a mosaic, or “crazy paving,” pattern [nejm.org] 4. Verschakelen JA, de Wever W. Computed Tomography of the Lung: A Pattern Approach. 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 Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan Correspondence to Dr Junpei Saito, Department of Pulmonary Medicine, School of Medicine, … Elicker B, Pereira CA, Webb R, Leslie KO. Case 1. CT findings include peribronchovascular interstitial thickening, ILST, and smooth or nodular ("beaded") thickening of the subpleural interstitium, with … Interlobular septal thickening at HRCT can be smooth, nodular, or irregular in contour. A preliminary study of lung abnormalities on HRCT in patients of rheumatoid arthritis-associated interstitial lung disease with progressive fibrosis. The septa present as irregular linear opacities that are prominent in the subpleural regions. The lesions were predominantly peripheral in 38 patients (88%). Ann Univ Mariae Curie Sklodowska Med. On CT scans, any component of the lobular septum affected by diseases can lead to interlobular septal thickening. Interlobular septal thickening is commonly seen in patients with interstitial lung disease. Crazy paving refers to the appearance of ground-glass opacity with superimposed interlobular septal thickening and intralobular septal thickening, seen on chest HRCT. RESULTS: Interlobular septal thickening was present in 56 (60%) of 94 patients with idiopathic bronchiectasis, excluding those with trivial septal thickening (34 of 94, 36%). 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). It is often seen as fine linear or reticular thickening. The lesion number and attenuation, air bronchogram, tree-in-bud sign, interlobular septal thickening, and intralobular septal thickening were not significantly different between the two groups (all p > 0.05). It has been described with several conditions of variable etiology which include. NLM There was strong correlation between the extent of septal thickening and the extent Although thickening of the interlobular septa is relatively common in patients with interstitial lung disease, it is uncommon as a predominant finding and has a limited differential diagnosis (Table). Interlobular septal thickening, thickening of fissures and thickening of the peribronchovascular interstitium (bronchial cuffing). Septal Thickening Interlobular Septal Thickening SmallSmall Intralobular Interstitial Thickening Intralobular Interstitial Thickening IntermediateIntermediate HoneycombingHoneycombing. Additionally, thickening of the intralobular interstitium produces a fine reticular pattern associated with the septal thickening. Septal thickening: HRCT findings and differential diagnosis Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. Griffin CB, Primack SL. There are many causes of interlobular septal thickening, and this should be distinguished from intralobular septal thickening. Kang EY, Grenier P, Laurent F, Müller NL. North Am. Rare findings in high resolution computed tomography (HRCT) in interstitial lung diseases. 2003. Diffuse interlobular septal thickening (DIST) is an abnormality seen on high-resolution CT (HRCT) scanning of the thorax. Fig. 2001;39 (6): 1073-90, v. GGO with interlobular septal thickening. 2003;58(2):394-401. High-resolution CT of diffuse interstitial lung disease: key findings in common disorders. Smooth septal thickening is usually associated with venous congestion, lymphatic congestion or infiltrative diseases. Pulmonary lymphatic vessels are found along the veins and bronchovascular sheaths, as well as in the interlobular septa and pleura. Intralobular septal thickening is a form of interstitial thickening and should be distinguished from interlobular septal thickening. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. COVID-19 is an emerging, rapidly evolving situation. When ILS is the predominant abnormality seen on HRCT, the differential diagnosis depends upon the morphology of the thickening. In some cases, it is the predominant radiological finding. upper lobe with intralobular septal thickening. J Bras Pneumol. Interlobular or Intralobular, Nodules or Groundglass? 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