Nodular pattern
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Transcript of Nodular pattern
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Nodular Patternitie
By
Gamal Rabie Agmy , MD , FCCP Professor of Chest Diseases ,Assiut University
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Nodular Pattern
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Nodular pattern A nodular pattern consists of multiple round opacities,
generally ranging in diameter from 1 mm to 1 cm
Nodular opacities may be described as miliary (1 to 2 mm,
the size of millet seeds), small, medium, or large, as the
diameter of the opacities increases
A nodular pattern, especially with predominant distribution,
suggests a specific differential diagnosis
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Perilymphatic distribution
Centrilobular distribution
Random distribution
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ARE NODULES IN CONTACT WITH PLEURA
NO
CENTRILOBULAR
YES
PERILYMPHATIC RANDOM
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TO SUM UP..
• Random
– touch pleura
– scattered in lung
• Centrilobular
–away from pleura
• Perilymphatic
– around vessels, bronchi
– touch pleura or fissure
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Size, Distribution, Appearance
Nodules and Nodular Opacities
Size
Small Nodules: <10 mm Miliary - <3 mm
Large Nodules: >10 mm Masses - >3 cms
Appearance
Interstitial opacity:
Well-defined, homogenous,
Soft-tissue density
Obscures the edges of vessels or adjacent structure
Air space:
Ill-defined, inhomogeneous.
Less dense than adjacent vessel – GGO
small nodule is difficult to identify
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Interstitial
nodules Air space opacity
Miliary tuberculosis
sarcoidosis
in a lung transplant patient
with bronchopneumonia
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RANDOM: no consistent relationship to any structures
PERILYMPHATIC: corresponds to distribution of lymphatics
CENTRILOBULAR: related to centrilobular structures Distribution
13
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Angiocentric
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Bronchocentric, ill Defined
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Bronchocentric, well Defined
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Lymphocentric
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Disseminated histoplasmosis and nodular ILD.
CT scan shows multiple bilateral round circumscribed
pulmonary nodules.
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Notice the nodules along the fissures indicating a
perilymphatic distribution (red arrows).
The majority of nodules located along the bronchovascular
bundle (yellow arrow).
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Sarcoidosis
The majority of nodules located
along the bronchovascular bundle
(yellow arrow).
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PERILYMPHATIC NODULES
Perilymphatic and Random distribution of
nodules , seen in sarcoidosis.
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Centrilobular distribution
Hypersensitivity pneumonitis
Respiratory bronchiolitis in
smokers
infectious airways diseases
(endobronchial spread of
tuberculosis or
nontuberculous
mycobacteria,
bronchopneumonia)
Uncommon in
bronchioloalveolar
carcinoma, pulmonary
edema, vasculitis
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Random distribution
Small random nodules
are seen in:
Hematogenous
metastases
Miliary tuberculosis
Miliary fungal infections
Sarcoidosis may mimick
this pattern, when very
extensive
Langerhans cell
histiocytosis (early
nodular stage)
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Langerhans cell histiocytosis: early nodular stage before the typical cysts appear.
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Differential diagnosis of a nodular
pattern of interstitial lung disease
SHRIMP Sarcoidosis
Histiocytosis (Langerhan cell
histiocytosis)
Hypersensitivity pneumonitis
Rheumatoid nodules
Infection (mycobacterial, fungal, viral)
Metastases, Miliary TB
Microlithiasis, alveolar
Pneumoconioses (silicosis, coal
worker's, berylliosis)
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Reticulonodular pattern A reticulonodular pattern results from a
combination of reticular and nodular opacities.
This pattern is often difficult to distinguish from a purely reticular or nodular pattern, and in such a case a differential diagnosis should be developed based on the predominant pattern.
If there is no predominant pattern, causes of both nodular and reticular patterns should be considered.
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