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Nodular Patternitie
By
Gamal Rabie Agmy , MD , FCCP Professor of Chest Diseases ,Assiut University
Nodular Pattern
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
Perilymphatic distribution
Centrilobular distribution
Random distribution
ARE NODULES IN CONTACT WITH PLEURA
NO
CENTRILOBULAR
YES
PERILYMPHATIC RANDOM
TO SUM UP..
• Random
– touch pleura
– scattered in lung
• Centrilobular
–away from pleura
• Perilymphatic
– around vessels, bronchi
– touch pleura or fissure
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
Interstitial
nodules Air space opacity
Miliary tuberculosis
sarcoidosis
in a lung transplant patient
with bronchopneumonia
RANDOM: no consistent relationship to any structures
PERILYMPHATIC: corresponds to distribution of lymphatics
CENTRILOBULAR: related to centrilobular structures Distribution
13
Angiocentric
Bronchocentric, ill Defined
Bronchocentric, well Defined
Lymphocentric
Disseminated histoplasmosis and nodular ILD.
CT scan shows multiple bilateral round circumscribed
pulmonary nodules.
Notice the nodules along the fissures indicating a
perilymphatic distribution (red arrows).
The majority of nodules located along the bronchovascular
bundle (yellow arrow).
Sarcoidosis
The majority of nodules located
along the bronchovascular bundle
(yellow arrow).
PERILYMPHATIC NODULES
Perilymphatic and Random distribution of
nodules , seen in sarcoidosis.
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
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)
Langerhans cell histiocytosis: early nodular stage before the typical cysts appear.
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)
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.