interstitial thickening radiology

Nodular septal thickening occurs most commonly in patients with lymphangitic carcinomatosis ( Figs. High-resolution CT scan at the level of the lower lung zones shows smooth septal lines perpendicular to the pleura. On the left we see focal irregular septal thickening in the right upper lobe in a patient with a known malignancy. Idiopathic pulmonary fibrosis (IPF), accounts for more than 60% of the cases of UIP. Interstitial marking: This is frequently a non specific finding on radiographic evaluation of the lungs can be exaggerated by infection, fluid in lungs of cardiac or other origin and scarring from previous infection. On the other hand, mild and even moderately severe panlobular emphysema can be very subtle and difficult to detect on HRCT(1). Thickening of the interstitium or alveolar walls below the spatial resolution of the HRCT as seen in fibrosis. The term is used to describe multiple diffusely enlarged airspaces (diffuse cystic lung disease) seen in Langerhans cell histiocytosis, lymphangioleiomyomatosis, and lymphoid interstitial pneumonia (although rarely, Birt-Hogg-Dubé syndrome, amyloidosis, and light-chain deposition disease can also manifest with this imaging appearance); in end-stage fibrosis (honeycombing) as may be seen in idiopathic pulmonary fibrosis; and, less commonly, in chronic hypersensitivity pneumonitis, nonspecific interstitial pneumonia, asbestosis, and sarcoidosis. Intralobular linear opacities reflect thickening of the interstitium within the secondary pulmonary lobule and are most commonly caused by fibrosis. HRCT features in five patients were described as diffuse reticulonodular changes with peribronchovascular interstitial thickening and traction bronchiectasis with thickened airway walls and surrounding fibrosis. (C) High-resolution CT scan at the level of the lung bases shows diffuse involvement similar to that in the upper lobes. It is usually associated with other findings of fibrosis, such as reticulation, traction bronchiectasis, and traction bronchiolectasis, and is seldom the predominant pattern. Tree-in-bud describes the appearance of an irregular and often nodular branching structure, most easily identified in the lung periphery. Conclusions: PIG is associated with alveolar growth abnormalities and has to be considered in … Smooth septal thickening in acute lung rejection. Infiltrative process adjacent to normal lung. High-resolution CT scan at the level of bronchus intermedius shows bilateral subpleural irregular intralobular linear opacities and irregular septal thickening resulting in a fine reticular pattern. In 60% of patients a predominant peripheral distribution is apparent on the radiograph. Knowledge of the lung anatomy is essential for understanding HRCT. (A) Magnified view of right lower lung zone shows linear opacities, Septal pattern in a patient with interstitial pulmonary edema from left heart failure. Ground glass opacification is a radiology term that refers to a hazy area of increased attenuation in the lung on an x-ray, explain Radiopaedia.org medical experts. It was a patient with low-grade fever, progressive shortness of breath and an abnormal chest radiograph. (B) High-resolution CT scan at the level of the lung apices shows numerous bilateral thin-walled cysts. It is the smallest lung unit that is surrounded by connective tissue septa. 1A). 32 years experience Diagnostic Radiology. The radiographic manifestations consist of a diffuse bilateral reticular pattern and, commonly, evidence of hyperinflation manifested by an increase in the retrosternal clear space or flattening of the diaphragm ( Fig. The location of the abnormalities in ground glass pattern can be helpfull: The ground glass pattern itself is rather unspecific. Proliferation of these cells along the bronchioles leads to air trapping and the development of thin-walled lung cysts. Basic Interpretation As the disease progresses, the reticular pattern becomes coarser and is associated with progressive loss of volume. 33. Upper zone predominance: Respiratory bronchiolitis, Pneumocystis pneumonia. (B) Coronal reformation shows extensive septal thickening in the transplanted left lung and lower lung zone fibrosis in the native right lung. (D) Coronal reformation shows diffuse distribution of cysts and large lung volumes. Centrilobular distribution Ground-glass opacity is nonspecific, but a highly significant finding since 60-80% of patients with ground-glass opacity on HRCT have an active and potentially treatable lung disease. NSIP is characterized histologically by a relatively uniform pattern of cellular interstitial inflammation associated with variable degrees of fibrosis. The interlobular septal thickening in patients with bronchiectasis is presumably due to impaired lymphatic drainage, and the extent of septal lines correlates with the extent and severity of bronchiectasis. Nonspecific interstitial pneumonia. In the proper clinical setting suspect active endobronchial spread of TB. Most patients die within 10 years of the onset of symptoms. This may result in a combined perilymphatic-centrilobular pattern which can simulate the random pattern. Septal pattern in a patient with lymphangitic carcinomatosis. Interstitial lung disease includes a group of diseases that have thickening of the supporting tissues between the air sacs of the lungs as the common factor. Other common findings include unilateral or asymmetric hilar lymph node enlargement and pleural effusion. This combination of findings is typical for Lymphangiomyomatosis (LAM). The distribution of nodules shown on HRCT is the most important factor in making an accurate diagnosis in the nodular pattern. 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 Transbronchial biopsy specimens of the left lung showed acute rejection. Unlike perilymphatic and random nodules, centrilobular nodules spare the pleural surfaces. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Trabecular Thickening, Edema The reticular pattern is usually associated with irregular pleural, vascular, and bronchial interfaces; evidence of architectural distortion; and dilation of bronchi and bronchioles (traction bronchiectasis and bronchiolectasis) (see Figs. Septal thickening as a result of lymphangitic carcinomatosis. Cardiogenic pulmonary edema generally results in a combination of septal thickening and ground-glass opacity. Perilymphatic area is the peripheral part of the secundary lobule. Single or multiple cysts typically superimposed on ground-glass opacities also are seen in approximately 60% of patients with lymphoid interstitial pneumonia and 13% of patients with subacute hypersensitivity pneumonitis. The interpretation of interstitial lung diseases is based on the type of involvement of the secondary lobule. Talk to your doctor about what it means for you. 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). It also occurs in patients with chronic bronchitis, COPD and cystic fibrosis. Sometimes the term reticulonodular is used. A septal pattern results from thickening of the interlobular septa (i.e., the tissue that separates the secondary pulmonary lobules) ( Fig. Patients with COP typically present with a several-month history of nonproductive cough. When they are confluent, HRCT shows diffuse ground glass. Advertisement . Under normal conditions only a few of these very thin septa can be seen. (C) Coronal reformation shows that the abnormalities involve mainly the peripheral lung regions and lower lung zones. Most patients who are evaluated with HRCT, will have chronic consolidation, which limits the differential diagnosis. Honeycombing is defined by the presence of small cystic spaces with irregularly thickened walls composed of fibrous tissue. 5.15 and 5.16 ). There was no history of smoking and this was a 40 year old female. In the other 20-40% of the cases the lung disease is not treatable and the ground-glass pattern is the result of fibrosis. Typically in sarcoidosis there is an upper lobe and perihilar predominance and in this case we see the majority of nodules located along the bronchovascular bundle (yellow arrow). Cavities are defined as radiolucent areas with a wall thickness of more than 4mm and are seen in infection (TB, Staph, fungal, hydatid), septic emboli, squamous cell carcinoma and Wegener's disease. (A) Contrast-enhanced CT scan shows large anterior (prevascular) mediastinal mass. Many diseases involve predominantly or exclusively the pulmonary interstitium. (B) Magnified view of the left lower lung zone shows reticular pattern. Interstitial thickening, irregular interface, coarse reticular pattern, and parenchymal band manifested in the process of the disease may be predictors of pulmonary fibrosis. 5.11 ). Hilar lymphadenopathy is visible in 50% and usually there is a history of malignancy. Because of the cystic appearance, honeycombing is also discussed in the chapter on the low attenuation pattern. They usually measure 0.2 to 2 cm in diameter and, unlike pulmonary Langerhans cell histiocytosis, are distributed diffusely throughout the lungs without any zonal predominance. There is uniform destruction of the underlying architecture of the secondary pulmonary lobules, leading to widespread areas of abnormally low attenuation. Interstitial lung disease describes a large group of lung disorders which cause progressive scarring of lung tissue, according to Mayo Clinic. Common additional findings are an enlarged heart and pleural fluid. On the left we see a chest film with a typical finger-in-glove shadow. Broncho-alveolar cell carcinoma with both areas of ground glass opacity and consolidation. 5.21 ). The characteristic high-resolution CT findings of idiopathic pulmonary fibrosis consist of a reticular pattern in a patchy distribution and involving all lobes but being most severe in the subpleural lung regions and in the lung bases (see Figs. (C) Coronal reformation shows reticulation in all lobes, but it is most severe in the subpleural lung regions and lung bases. Smooth septal thickening is usually seen in interstitial pulmonary edema (Kerley B lines on chest film); lymphangitic spread of carcinoma or lymphoma and alveolar proteinosis. It can be caused by a thickening of the pulmonary artery walls, heart failure, lung disease (such as interstitial lung disease), and clots within the lungs' blood vessels.It's common for ILD patients to also develop pulmonary hypertension. The final diagnosis was cryptogenic organizing pneumonia (COP). If the nodules are diffuse and uniformly distributed, it is likely a random distribution. NSIP Radiology. Numerous studies have shown that CT, particularly high-resolution CT, is superior to chest radiography in the detection of parenchymal abnormalities and is more accurate in the differential diagnosis. Introduction • Interstitial lung diseases (ILD’s)represent a large number of conditions that involve the parenchyma of lung- the alveoli, the alveolar epithelium, the capillary endothelium, and the spaces between these structures, as well as perivascular and lymphatic tissues. nonspecific interstitial pneumonia (NSIP), organizing pneumonia (COP), adult respiratory distress syndrome and pulmonary hemorrhage. This case is one of the possible patterns of nonspecific interstitial pneumonia (NSIP). The history was typical for hypersensitivity pneumonitis. Bronchoalveolar carcinoma can also look like this. The histologic, radiographic, and high-resolution CT manifestations of scleroderma are usually those of nonspecific interstitial pneumonia ; rheumatoid arthritis tends to result in findings of usual interstitial pneumonia and, less commonly, nonspecific interstitial pneumonia. Depending on filling with fluid or with tumor cells, septal thickening is irregular or smooth. Talk to our Chatbot to narrow down your search. The cysts can be seen on high-resolution CT in patients who have normal radiographs or radiographs showing only reticular opacities. 5.22 ). Lymphocytic interstitial pneumonitis is a benign lymphoproliferative disorder characterized by lymphocyte predominant infiltration of the lungs. The CT findings of RB-ILD include ground-glass opacities, centrilobular nodules, and interstitial thickening with upper-lung-zone predominance [6, 7]. The diagnosis based on this CT was cardiogenic pulmonary edema. Airway disease associated with infection: cystic fibrosis, bronchiectasis. When thickened, interlobular septa (septal lines) are seen on the radiograph as short (1–2 cm) lines perpendicular to and continuous with the pleura (Kerley B lines) or as longer (2–6 cm) lines oriented toward the hila (Kerley A lines) ( Fig. Common diseases like pneumonias, pulmonary emboli, cardiogenic edema and lungcarcinoma are already ruled out. The characteristic findings on high-resolution CT consist of cysts (present in ≈80% of patients) and nodules (present in 60%–80%). It may be impossible, however, to distinguish fibrotic nonspecific interstitial pneumonia with a predominantly reticular pattern from usual interstitial pneumonia. Nodules are randomly distributed relative to structures of the lung and secondary lobule. Reticular pattern on chest radiography in idiopathic pulmonary fibrosis. Here a typical random nodular pattern in a patient with Langerhans cell histiocytosis (LCH). Identical clinical, radiologic, and pathologic pulmonary changes are seen in about 1% of patients with tuberous sclerosis. Again the ground glass appearance is the result of hyperperfused lung with large vessels adjacent to oligemic lung with small vessels due to chronic thromboembolic disease. A reticular pattern also frequently is seen in patients with nonspecific interstitial pneumonia. These may be single or multiple, occur mainly in the upper lobes, and are typically superimposed on ground-glass opacities ( Fig. A 59-year old man was admitted to the chest department with a one-week history of dry cough and acute onset of fever and dyspnea. It is also described as 'unresolved pneumonia'. A reticular pattern is characterized by innumerable interlacing line shadows that suggest a mesh ( Fig. Lymphangiomyomatosis is a rare disease characterized by progressive proliferation of spindle cells, resembling smooth muscle. Usually these patient are not imaged with HRCT as the diagnosis is readily made based on clinical and radiographic findings, but sometimes unsuspected hydrostatic pulmonary edema is found. Like in COP we see patchy non-segmental consolidations in a subpleural distribution. The predominantly middle lung zone distribution of fibrosis and the presence of centrilobular nodules and lobular areas of air trapping allow recognition of hypersensitivity pneumonitis in most cases. Interstitial vs Alveolar Patterns. On the left a patient who had a CT to rule out pulmonary embolism. It is usually the site of diseases, that enter the lung through the airways ( i.e. Peripheral distribution is mainly seen in cryptogenic organizing pneumonia (COP), chronic eosinophilic pneumonia and UIP. Lung apices and bases are relatively spared. Sutton, Textbook of Radiology, 2nd ed.,1975, p325. Schematic drawing of reticular pattern. Here two images af a patient with GGO as the dominant pattern. (A) Chest radiograph shows extensive bilateral reticulonodular pattern involving mainly the upper lobes with associated volume loss. Lymphangioleiomyomatosis is a rare disease limited almost exclusively to women and characterized by cyst formation and an interstitial proliferation of smooth muscle–like cells. All types of interstitial lung disease result into thickening or scarring of the interstitium. This outcome is quite different from that seen in UIP, which has a poor prognosis. Broncho-alveolar cell carcinoma (BAC) may present as: Treatable or not treatable? In certain diseases, nodules are limited to the centrilobular region. Mild subpleural reticulation is seen in the right upper lobe, Nonspecific interstitial pneumonia: relative subpleural sparing. Look at expiratory scans for air trapping, Infection (PCP, viral, Mycoplasma, bacterial), Pulmonary edema due to heart failure or ARDS, Lung cysts (LAM, LIP, Langerhans cell histiocytosis), Irreversible destruction of alveolar walls in the centrilobular portion of the lobule, Upper lobe predominance and uneven distribution, In alpha-1-antitrypsin deficiency, but also seen in smokers with advanced emphysema, Adjacent to the pleura and interlobar fissures, Can be isolated phenomenon in young adults, or in older patients with centrilobular emphysema, In young adults often associated with spontaneous pneumothorax, lack of normal tapering with visibility of airways in the peripheral lung, associated atelectasis and sometimes air trapping, Inhaled particles: pneumoconiosis (silica or coal), Smoking related diseases (centrilobular emphysema, Lymphangitic spread of carcinoma - often unilateral. When we study patients with HRCT, we have to realize that we are looking at a selected group of patients. Langerhans cell histiocytosis (LCH) is an idiopathic disease characterized in its early stages by granulomatous nodules containing Langerhans histiocytes and eosinophils. 5.20 ). a spoken lecture given by Jud W. Gurney for www.chestx-ray, Santiago E. Rossi, MD et al Check the full list of possible causes and conditions now! Hypersensitivity pneumonitis: ill defined centrilobular nodules. Tree-in-bud almost always indicates the presence of: On the left a tree-in-bud is seen. When ground glass opacity presents as mosaic attenuation consider: It can be difficult to distinguish these three entities. The pathogens enter the central area of the secondary lobule via the terminal bronchiole: In many cases centrilobular nodules are of ground glass density and ill defined (figure). In addition to the perilymphatic nodules, there are multiple enlarged lymph nodes, which is also typical for sarcoidosis. They are sometimes called acinair nodules. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Peribronchial Interstitial Thickening 5.2 ), lymphoma ( Fig. Sometimes these can be differentiated with an expiratory scan. Panlobular emphysema In chronic hypersensitivity pneumonitis, the fibrosis is situated predominantly in the middle lung zones or shows no zonal predominance ( Fig. The patient was a smoker and developed pulmonary Langerhans cell histiocytosis. Chronic eosinophilic pneumonia is an idiopathic condition characterized by extensive filling of alveoli by an infiltrate consisting primarily of eosinophils. (B) Contrast-enhanced CT scan shows increased soft tissue in the parasternal region and bilateral chest wall and mediastinal pleural thickening. Histology revealed broncho-alveolar cell carcinoma. The clue here is the enlargement of pulmonary arteries (arrow) in the areas of ground glass. Common causes of a reticular pattern include usual interstitial pneumonia, nonspecific interstitial pneumonia, fibrosis associated with collagen vascular disease, chronic hypersensitivity pneumonitis, sarcoidosis, and asbestosis. (B) Coronal reformation CT scan shows upper lobe distribution of the reticulation and traction bronchiectasis. The nodules in sarcoidosis are typically most numerous along the bronchoarterial and pleural interstitium and along the interlobar fissures (see Fig. (B) High-resolution CT scan at the level of the lung bases shows more extensive reticulation and subpleural honeycombing. Perilymphatic distribution On the left another case of UIP. On the left a typical case of perilymphatic distribution of nodules in a patient with sarcoidosis. Sarcoid end-stage with massive fibrosis in upper lobes presenting as areas of consolidation. Bronchiolectasis and/or honeycombing was present in three patients. 5.23 ). A reticular pattern is seen in 15% to 20% of patients who have sarcoidosis and radiographically evident parenchymal abnormalities. Thickening of the interlobular septa may be caused by edema, cellular infiltration, or fibrosis. Centrilobular emphysema: low attenuation areas without walls. CONCLUSION: Lymphocytic interstitial pneumonia is characterized by the presence of ground-glass attenuation, poorly defined centrilobular nodules, and thickening of the interstitium along the lymphatic vessels. Some lobules are affected and others are not. Interstitial lung diseases- HRCT ... thickened bronchovascular bundles, interlobular septal thickening and thin-walled cysts (1–30 mm). High-resolution CT scan shows nodular thickening of the interlobular septa, Irregular septal thickening in idiopathic pulmonary fibrosis. Up to 20% of patients present with pneumothorax and over 90% of patients are smokers. Some lobules are involved and others are not. The ground-glass opacities reflect the presence of respiratory bronchiolitis (“smoker’s bronchiolitis”). On the left another typical case of sarcoidosis. Because of its low cost and low radiation dose, the chest radiograph remains the initial imaging modality of choice in the evaluation of patients with suspected interstitial lung disease and in the follow-up of these patients. Interstitial thickening, irregular interface, or parenchymal bands were not detected on initial CT examination. Cystic spaces are seen in approximately 30% of patients with Pneumocystis jirovecii pneumonia. Cystic airspaces are round, air-containing parenchymal spaces with a well-defined wall. It represents dilated and impacted (mucus or pus-filled) centrilobular bronchioles. Smooth septal thickening in acute lung rejection. A long list of drugs have been implicated, but this pattern is most commonly the result of cytotoxic chemotherapeutic agents such as bleomycin, busulfan, vincristine, methotrexate, adriamycin, and carmustine (BCNU). 5.16 ). (A) Posteroanterior chest radiograph shows reticulation in the left middle and lower lung zones and, to a lesser extent, right middle lung zone, Pulmonary fibrosis in sarcoidosis. This finding can allow honeycombing to be distinguished from paraseptal emphysema in which subpleural cysts usually occur in a single layer. In GGO the density of the intrabronchial air appears darker as the air in the surrounding alveoli. There are also additional findings, that support this diagnosis like mediastinal lymph nodes and a nodular lesion in the left lung, that probably represents a metastasis. Pulmonary hypertension, or PH, occurs when blood pressure within the lungs becomes abnormally elevated. The pulmonary veins and lymphatics run in the periphery of the lobule within the interlobular septa. Several of the thickened septa have a beaded nodular appearance, Nodular septal thickening in sarcoidosis. The most common cause of a septal pattern as the predominant or only pattern is hydrostatic pulmonary edema ( Figs. hypersensitivity pneumonitis, respiratory bronchiolitis, centrilobular emphysema ). Hypersensitivity pneumonitis: centrilobular nodules, notice sparing of the area next to pleura and fissure. 2003;23:1509-1519, Closed Loop Obstruction in Small bowel obstruction, Breast - Calcifications Differential Diagnosis, Fleischner 2017 guideline for pulmonary nodules, Bone tumor - Osteolytic lesions ill defined, Bone tumor - Osteolytic lesions well defined, Developmental Dysplasia of the Hip - Ultrasound, Differential diagnosis of interstitial lung diseases, 'Crazy-Pavin' Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview, Role of HRCT in diagnosing active pulmonary Tuberculosis, high attenuation (ground-glass, consolidation). It was first thought to be specific for alveolar proteinosis, but later was also seen in other diseases. The HRCT shows focal bronchiectasis with extensive mucoid impaction, which is in the appropriate clinical setting (asthma and serum eosinophilia) typical for Allergic bronchopulmonary aspergillosis (ABPA). If there are pleural nodules and also nodules along the central bronchovascular interstitium and along interlobular septa, you are dealing with a periplymphatic distribution. Increased lung attenuation is called ground-glass-opacity (GGO) if there is a hazy increase in lung opacity without obscuration of underlying vessels and is called consolidation if the increase in lung opacity obscures the vessels. In patients with a perilymphatic distribution, nodules are seen in relation to pleural surfaces, interlobular septa and the peribronchovascular interstitium. The majority of patients are young or middle-aged adults presenting with nonspecific symptoms of cough and dyspnea. 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. This thickening makes it difficult for the blood to absorb oxygen, which can lead to the symptoms of interstitial lung disease, such as breathlessness. In the reticular pattern there are too many lines, either as a result of thickening of the interlobular septa or as a result of fibrosis as in honeycombing. It is an uncommon condition. In 50% of patients the septal thickening is focal or unilateral. On high-resolution CT scan septal lines can be seen as short lines that extend to the pleura in the lung periphery and as polygonal arcades outlining one or more pulmonary lobules in more central lung regions (see Fig. In most cases the predominant abnormalities of Pneumocystis pneumonia, lymphoid interstitial pneumonia, and subacute hypersensitivity pneumonitis are ground-glass opacities. Where is it located within the secondary lobule HR-pattern: Is there an upper versus lower zone or a central versus peripheral predominance. Less common causes of smooth septal thickening include lymphangitic spread of carcinoma (see Fig. In addition to respiratory bronchiolitis, the radiologic differential diagnosis of RB-ILD includes nonspecific interstitial pneumonitis, desquamative interstitial pneumonia, and acute or subacute hypersensitivity pneumonitis. Hyperperfused lung adjacent to hypoperfused lung due to chronic thromboembolic disease. Is it pus, edema, blood or tumor cells (Table on the left). UIP with lung fibrosis is also a common pattern of auto-immune disease and drug-related lung injury. These various conditions tend to result in extensive septal thickening that is usually bilateral and often symmetric. The radiographic findings consist of a symmetric, bilateral reticular pattern that may be diffuse but tend to involve predominantly the lower lung zones (see Fig. Infectious airways diseases (endobronchial spread of tuberculosis or nontuberculous mycobacteria, bronchopneumonia), Uncommon in bronchioloalveolar carcinoma, pulmonary edema, vasculitis. Hypersensitivity pneumonitis (HP) is an allergic lung disease caused by the inhalation of antigens contained in a variety of organic dusts. 5.8 ), particularly in patients with empyema or after pleurodesis, lymphoid interstitial pneumonia, and idiopathic bronchiectasis. In cellular NSIP, the thickening of alveolar septa is primarily caused by inflammatory cells; in fibrosing NSIP, interstitial fibrosis is seen in addition to mild inflammation. (C) High-resolution CT scan slightly above the level of the aortic arch shows numerous bilateral cysts, a few small nodules, and ground-glass opacities. Emboli adherent to the wall and intravascular septa are typical for chronic thromboemboli in which partial recanalization took place. Septal thickening as a result of pleural inflammation in the setting of sternal osteomyelitis after coronary artery bypass graft surgery. Thickening: of the lung interstitial tissues that is long-standing. Non-specific interstitial pneumonia (NSIP) is the second most common morphological and pathological pattern of interstitial lung diseases. The nodules predominate in the early phases, and the cysts predominate in the late stages of the disease. Langerhans cell histiocytosis (LCH): multiple thick walled cysts; smoking history. Nodules are almost always visible in a subpleural location, particularly in relation to the fissures. Allergic bronchopulmonary aspergillosis is a lung disease occurring in patients with asthma or cystic fibrosis, triggered by a hypersensitivity reaction to the presence of Aspergillus fumigatus in the airways. Interstitial lung diseases radiology 1. ), Nodular septal thickening in lymphangitic carcinomatosis. 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). Lymph node enlargement is more common than previously recognized; it was seen in 68% of patients. Drawing of the right lung shows thin lines separated by 1–2 cm that correspond to thickened interlobular septa. Normal lung appearing relatively dense adjacent to lung with air-trapping. 5.1 ). Lymphangiomyomatosis occurs only in women, usually of child-bearing age, between 17 and 50 years.

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