Interlobular septal thickening that is marked and irregular may simulate lymphangitic carcinomatosis. However, lymphangitic carcinomatosis is characterized by more extensive and more severe involvement of the interlobular septa and subpleural space on high-resolution CT images than is typical either in lymphoma or in sarcoidosis ( 46 ) ( Fig 12 ) The pulmonary lobule is the smallest anatomic unit of the lung surrounded by a connective tissue septum, and in some ways the lobule resembles a lung in miniature 20 ().Within the interlobular septa lie lymphatic channels and venules ().Abnormal thickening of the septa between the lobules is responsible for the short subpleural horizontal (Kerley B) lines seen on a chest radiograph GGO in the acute setting is nonspecific, but when interlobular septal thickening (arrow) is a significant associated finding, pulmonary edema is the most likely etiology. Figure 4.6 Desquamative interstitial pneumonia (DIP) with a peripheral distribution of ground glass opacity (GGO) 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%). At a lobar level, 69% (514 of 748) of lobes with bronchiectasis had septal thickening Crazy paving. Dr Yuranga Weerakkody and Dr Behrang Amini et al. Crazy paving refers to the appearance of ground-glass opacities with superimposed interlobular septal thickening and intralobular septal thickening, seen on chest HRCT or standard CT chest. It is a non-specific finding that can be seen in a number of conditions
They also had more interlobular septal thickening (75% vs 28%, P < .001), higher prevalence of air bronchograms (70% vs 32%, P = .004), and pleural effusions (40% vs 14%, P = .017). Conclusion Ground-glass opacities with or without consolidation in a peripheral and basilar predominant distribution were the most common findings in COVID-19. 1 Department of Radiology, Haihe Clinical College of Tianjin Medical University, Tianjin 300350, China. respectively.Interlobular septal thickening (88.6% vs 38.9%), intralobular septal thickening (97.1% vs 0), bronchial or bronchovascular bundle thickening (74.3% vs 19.4%) and galaxy or cluster sign (37.1% vs 0) in perilymphatic group were. 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. Only 2 of 13 (15.4%) patients with COVID-19 presented intralobular septal thickening, while none showed interlobular septal thickening The intralobular lines reflect the presence of interstitial fibrosis. Interlobular septal thickening reflects the presence of fibrosis in the periphery of the secondary lobules and patchy areas of GGO reflects areas of inflammation or fibrosis
Lymphangitic carcinomatosis is characterised by nodular—and less commonly by smooth—thickening of any part of the peribronchovascular interstitium, apart from the interlobular septal thickening (i.e. intralobular interstitium, centrilobular interstitium, fissures). Lymphangitic carcinomatosis may be caused by pulmonary or extrapulmonary. Reticulation. Reticulation results from thickening of the interlobular or intralobular septa and appears as several linear opacities that resemble a mesh or a net on HRCT scans. 7 The presence of reticulation is indicative of interstitial lung disease. 7
Visible intralobular bronchioles (62/80), bronchiolectasis within fibrotic consolidations (47/80), and honeycombing (61/80) were more common in patients with idiopathic pulmonary fibrosis (p < 0.0001). The frequencies of interlobular septal thickening, ground-glass opacities, fibrotic consolidation, and emphysema were similar in both groups 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
GGA superimposed on interlobular septal thickening and intralobular lines alternating with areas of normal lung defines the crazy paving pattern and occurs in several subacute lung diseases (see Table 4). The intralobular lines indicate that the process is not acute allowing distinction from more acute causes of diffuse or multifocal GGA Crazy-Paving Pattern. Fig. Axial CT of the chest shows diffuse bilateral ground-glass opacities superimposed by interlobular septal thickening (arrowheads) and intralobular lines (blue arrows). Note a left chest tube used to treat left pneumothorax, which brought this patient to the hospital is ground glass defined by thickened interlobular septa usually with intralobular septal thickening as well. Radiology - follows the pathology a bit but mostly lots of ground-glass with dependent regions being more consolidative. pleural effusions and nice demonstration of interlobular septal thickening is someone with gross fluid overload The crazy-paving pattern is a linear pattern superimposed on a background of ground-glass opacity, resembling irregularly shaped paving stones. The crazy-paving pattern is initially described as the pathognomonic sign of alveolar proteinosis. Nowadays this pattern is a common finding on high-resolution CT imaging, and can be seen in a number of acute and chronic diseases Septal line thickening was more frequent in CEP than in BOOP (72.1% vs. 39.5%, p < 0.005). Peribronchial distribution of consolidation was more frequent in BOOP than in CEP (28.9% vs. 9.3%, p < 0.05). A correct diagnosis was made in 69.7% of cases, and the diagnostician was confident in 21.7%. Interobserver agreement was good (κ = 0.6)
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. In some cases, it is the predominant radiological finding. This article reviews the spectrum of entities that commonly present with. Chest CT demonstrated extensive upper lobe predominant subpleural consolidation with air bronchograms and extensive ground glass opacities with intralobular septal thickening (B-D). Given the diagnostic uncertainty, bronchoscopy including transbronchial biopsy was conducted and eventually facilitated a definite diagnosis Anatomy. The interstitium of the lung can be divided into a central (or axial) compartment that surrounds the bronchovascular bundles, and the peripheral (or septal) interstitium that includes the interlobular septa and the subpleural interstitium .The smallest anatomic unit visible on high-resolution CT is the secondary pulmonary lobule ().The walls of the lobules are the interlobular septa.
INTERLOBULAR SEPTAL THICKENING Normally, only a few septa seen On HRCT, if numerous interlobular septas are seen, it almost always indicate abnormality. Septal thickening d/t -interstitial fluid, cellular infiltration or fibrosis. The thickened interstitium outline the secondary pulmonary lobules and are perpendicular to the pleura. D/D are. Diffuse interlobular . and . intralobular. septal thickening. CT w/o contrast on day 55 shows diffuse bilateral groundglass and consolidative opacities & interlobular and intralobular septal thickening as well as mild bilateral bronchiectasis. McGovern Medical School. Differential Diagnosis (based on imaging findings) ARDS
Superimposed interlobular and intralobular septal thickening (Fig. 4B) were frequently observed in the first 2 weeks and superimposed irregular linear opacities (Fig. 4C) became more common. Interlobular Septal Thickening (DDx) Interlobular Septal Thickening Algorithm. Parenchymal Bands. interlobular and intralobular septal thickening. Crazy-Paving (DDx) Ground Glass Opacity Algorithm. Cystic Lung Disease (DDx) Radiology - [Week 5] - Basic chest CT & Diseases of the chest. 73 terms
Crazy paving in ILD is a CT feature of interstitial lung disease and is characterised by diffuse ground glass caused by a combination of interlobular septal and intralobular septal thickening resulting well demarcated patchy densities in the lungs. The crazy paving pattern 12 is described at HRCT of the lungs ( Fig. 6 ) Other disorders of lung. J98.4 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2021 edition of ICD-10-CM J98.4 became effective on October 1, 2020. This is the American ICD-10-CM version of J98.4 - other international versions of ICD-10 J98.4 may differ Examples include smooth or beaded interlobular septal thickening described in lymphangitic carcinomatosis, irregular perilymphatic distribution of nodules in sarcoidosis, and intralobular cyst formation seen in lymphangioleiomyomatosis (Fig 2, 3A-C).3 The chest CT signs described in the present essay can be broadly categorized into four groups. There is vascular thickening and associated intralobular septal thickening crazy paving pattern, as noted in the case report (Figs. 6 and 9b). The peak stage (10-13 days) includes consolidation and can include secondary complications of the disease
lobular septa or pulmonary veins. Interlobular septal thickening was defined as abnormal widening of the interlobular septa . Intralobular reticular opacity was considered present when interlacing line shadows were separated by a few millimetres [12, 13]. The distribution of parenchymal disease was also noted. Whether the abnormal findings. Examples include smooth or beaded interlobular septal thickening described in lymphangitic carcinomatosis, irregular perilymphatic distribution of nodules in sarcoidosis, and intralobular cyst formation seen in lymphangioleiomyomatosis (Fig 2, 3A-C). 3. Download : Download high-res image (557KB) Download : Download full-size image; Figure 2 . Fig. 29. A 37-year-old woman with non-Hodgkin's lymphoma who developed adenovirus pneumonia 1 year after allogeneic peripheral blood stem cell transplantation
Jul 17, 2014 - Crazy paving refers to the appearance of ground-glass opacities with superimposed interlobular septal thickening and intralobular septal thickening, seen on chest HRCT or standard CT chest. It is a non-specific finding that can be seen in a numbe.. Interlobular septal thickening or intralobular lines may be seen as a component of reticular abnormality, but the lobular architecture is usually so distorted that these are impossible to recognize. Honeycombing is recognized by the presence of one or more rows of clustered cysts, almost always subpleural in location, and usually less than 5 mm.
CT shows diffuse ground glass change with crazy paving morphology characterized by bilateral diffuse ground-glass opacities (GGO) with interlobular and intralobular septal thickening. There is a geographical distribution . CRAZY PAVING Ashley Davidoff MD CRAZY PAVING Ashley Davidoff MD Ashley Davidoff MD CRAZY PAVING Ashley Davidoff MD CRAZY PAVIN coronal (B) computed tomography of the chest showed smooth thickening of the interlobular and intralobular septal lines, and ground glass opacities, causing crazy paving pattern. Bronchoalveolar lavage confirmed the pulmonary alveolar proteinosis. The patient also had left-sided pneumothorax, with a chest tube in place. Courtesy of Lila. Chest CT findings of severe/critical COVID-19 pneumonia (CT score = 18), a 60-year-old man with dyspnea and pleural effusion. A, An axial CT image showed diffuse large regions of crazy-paving pattern (GGO with superimposed interlobular and intralobular septal thickening) with partial consolidation and bronchial wall thickening II The high-resolution computed tomography (HRCT) detection and diagnosis of diffuse lung disease is primarily based on the recognition of (a) a limited number of specific abnormal findings, (b) specific combinations or patterns of these abnormalities, (c) one or more specific distributions of abnormal findings, and (d) the use of basic history and clinical information Small nodules may coalesce into focal opacity (alveolar sarcoidosis) Tiny nodules around a larger dominant nodule (galaxy sign) Interlobular septal thickening. Pulmonary Infarct. Lower lung predominant, peripheral/subpleural, wedge-shaped consolidation. In setting of acute pulmonary arterial thromboembolism
and thickening of the mesorectal fascia were also seen (Figure2). On the chest CT, typical imaging features of COVID-19 interstitial pneumonia were clearly visible, with patchy bilateral ground-glass opacities associated with interlobular and intralobular septal thickening (Figure3). Unfortunately, the patient died 12 h after admission to the. Multiple newer articles have been published since the systematic review by Salehi et al which have described many atypical CT imaging features in patients with COVID-19 such as pulmonary vascular enlargement, intralobular and interlobular septal thickening, adjacent pleural thickening, air bronchograms, subpleural lines, crazy paving. Interlobular septal thickening might be present, and pleural effusion and enlarged mediastinal lymph nodes were rarely seen. 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
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. Ground-glass opacity (GGO) is a finding seen on chest x-ray (radiograph) or computed tomography (CT) imaging of the lungs.It is typically defined as an area of hazy opacification (x-ray) or increased attenuation (CT) due to air displacement by fluid, airway collapse, fibrosis, or a neoplastic process. When a substance other than air fills an area of the lung it increases that area's density The chest CT imaging data of COVID-19 patients at the last time of admission and the first follow-up after discharge were retrospectively analyzed, including: primary manifestations (ground-glass opacity, consolidation, fibrous strip shadow), concomitant manifestations (interlobular and/or intralobular septal thickening, subpleural curvilinear. Meanwhile, a crazy-paving pattern refers to the superimposition of irregular linear structures on a background of GGO. The linear morphology of this pattern is contributed by interlobular or intralobular septal thickening and interstitial arrangement . This feature is also nonspecific and commonly found on high-resolution lung CT in many diseases
A 35-year-old man who was an active smoker presented with shortness of breath and cough. A and B: Axial (A) and coronal (B) computed tomography of the chest showed smooth thickening of the interlobular and intralobular septal lines, and ground glass opacities, causing crazy paving pattern In the later stages, consolidations and linear opacities can be observed, as can thickened interlobular and intralobular septa, as well as the mosaic (crazy-paving) pattern and the reverse halo sign (7 7 Bernheim A, Mei X, Huang M, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology.
Background: In the current coronavirus disease-2019 (COVID-19) pandemic, lung ultrasound (LUS) has been extensively employed to evaluate lung involvement and proposed as a useful screening tool for early diagnosis in the emergency department (ED), prehospitalization triage, and treatment monitoring of COVID-19 pneumonia. However, the actual effectiveness of LUS in characterizing lung. 1: Review: A Career in Lung Cancer: Pushing Beyond Chemotherapy. 2019: Patil, Pradnya Dinkar / Shepherd, Frances / Johnson, David H. · 1 Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH. · 2 Princess Margaret Cancer Centre, Toronto, Ontario, Canada. · 3 The University of Texas Southwestern School of Medicine, Dallas, TX. · Am Soc Clin Oncol Educ Book · Pubmed #31099660 eral interstitial lines are interlobular septal thickening, termed Kerley B lines, commonly due to mild pulmonary oedema (Fig. 4b). One of the other representative HRCT ﬁndings is the crazy-paving appearance referring to the appearance of GGOs with superimposed inter- and intralobular septal thickening (Fig. 5). In COVID-19 pneumonia, the crazy interlobular septal thickening, traction bronchiectasis, intralobular reticular opacity, reversed halo sign, sub-pleural linear opacity, architectural distortion, enlarged hilar/mediastinal lymph node(s) (.1cmindiameterof the short axis) and pleural effusion. Areas of ground-glass opacity were defined as hazy increases in attenuatio Interlobular septal thickening was defined as abnormal widening of the interlobular septa . Intralobular reticular opacity was considered to be present when interlacing line shadows were separated by a few millimetres [17, 18]. Table 1. Characteristics of the 151 patients with each type of pneumonia MRSA MSSA Characteristics (n568) (n583) M.
3. Signs and patterns of disease . 3.1 Linear pattern: Reticulation . 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) CT images were assessed for the following radiological features: ground-glass opacity, consolidation, nodule, centrilobular nodules, bronchial wall thickening, interlobular septal thickening, intralobular reticular opacity, bronchiectasis, enlarged hilar/mediastinal lymph node(s) (>1 cm diameter short axis) and pleural effusion
In addition to pleural effusion and atelectasis or opacities, intralobular reticulations and interlobular septal thickening were the most common HRCT findings. GGO, hilar and mediastinal lymphadenopathy, bronchial wall thickening, enlarged heart size, and pericardial fluid have also been described Interlobular Septal Lines Interstitial edema Lymphangitis carcinomatosis Sarcoidosis Idiopathic pulmonary fibrosis Intralobular lines IPF Asbestosis Alveolar proteinosis Hypersensiticity pneumonitis (chronic) Thickened fissures Pulmonary edema Sarcoidosis Lymphangitis carcinomatosis Peribronchovascular interstitial thickening Pulmonary edema Sarcoidosis Lymphangitis carcinomatosis. rounded opacities and interlobular septal thickening, with the absence of nodules and tree-in-bud sign, and with the typical European Radiology (2020) 30:5463-5469. global health emergency. By April 1, 2020, 823,626 con- superimposed interlobular septal thickening and intralobular septal thickening; (11) halo sign, which was defined. Other findings included intralobular or interlobular septal thickening, and a crazy-paving pattern. However, none of the CT features of COVID-19 seem to be specific or diagnostic, and COVID-19 pneumonia shares CT features with other non-infectious conditions that present as subpleural air-space disease They indicate the presence of intralobular septal thickening (as against the conventional 'septal thickening' which is interlobular). Fleishner Society defines radiologic honeycombing as 'clustered cystic air spaces, cysts of comparable diameters, and cyst diameters typically <10 mm surrounded by well-defined walls'