Nodules – Centrilobular

Infection and Inflammation

Another Case of Extensive Segmental Subsegmental and Small Airway Disease with Centrilobular Nodules

Keywords lungs airways segmental subsegmental small airway disease micronodules
Ashley Davidoff MD TheCommonVein.net

Keywords
lungs airways segmental subsegmental small airway disease micronodules
Ashley Davidoff MD
TheCommonVein.net

Keywords
lungs airways segmental subsegmental small airway disease micronodules
Ashley Davidoff MD
TheCommonVein.net

Keywords
lungs airways segmental subsegmental small airway disease micronodules
Ashley Davidoff MD
TheCommonVein.net

Keywords
lungs airways segmental subsegmental small airway disease micronodules
Ashley Davidoff MD TheCommonVein.net

RSV Pneumonia

Pneumonia due to respiratory syncytial virus in a 23-year-old man with leukemia. Thin-section CT scan shows peripheral poorly defined centrilobular nodules and tree-in-bud opacities bilaterally. Note the scattered lung nodules surrounded by halos of ground-glass attenuation.
Rossi, SE et al Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview RadioGraphicsVol. 25, No. 3 2005

Cytomegalovirus Pneumonia

Cytomegalovirus pneumonia in a 51-year-old man with chronic myelogenous leukemia who underwent bone marrow transplantation. (a) Thin-section CT scan of the right lung shows centrilobular ground-glass opacities in addition to nodules and tree-in-bud opacities (arrow). (b) Photomicrograph (original magnification, ×400; hematoxylin-eosin stain) shows cytomegalic inclusion bodies in the lung tissue (arrows).
Rossi, SE et al Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview RadioGraphicsVol. 25, No. 3 2005

H influenzae Pneumonia

H influenzae pneumonia in a 49-year-old woman with breast cancer, fever, and a productive cough. High-resolution CT scan shows diffuse centrilobular nodules and branching linear opacities, resulting in the tree-in-bud pattern.
Rossi, SE et al Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview RadioGraphicsVol. 25, No. 3 2005

Staph Aureus

S aureus bronchiolitis in a 32-year-old man with acquired immunodeficiency syndrome (AIDS). (a) High-resolution CT scan shows small peripheral centrilobular nodules and branching linear opacities, resulting in the tree-in-bud pattern. (b) Photomicrograph (original magnification, ×400; hematoxylin-eosin stain) shows inflammatory material composed of leukocytes filling the bronchiolar lumen (arrow).
Rossi, SE et al Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview RadioGraphicsVol. 25, No. 3 2005

TB

Postprimary active tuberculosis in a 66-year-old woman with a chronic cough. High-resolution CT scans of the right lung show peripheral, poorly defined, small (2–4-mm-diameter) centrilobular nodules and branching linear opacities of similar caliber originating from a single stalk (the tree-in-bud pattern) in the lower lobe (arrow). These findings represent endobronchial spread of tuberculosis.
Rossi, SE et al Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview RadioGraphics Vol. 25, No. 3 2005

Representative images of computed tomography (CT) scans in patients with small airways disease. a) An inspiratory CT scan in a patient with hypersensitivity pneumonitis showing mosaic pattern of attenuation. b) Expiratory CT scan in the same patient showing air trapping that is characteristic of small airways disease. c) Ill-defined centrilobular nodules in a patient with farmer’s lung (personal communication; J.C. Dalphin). d) Localised micronodules branching with bronchovascular structures (tree-in-bud pattern) related to tuberculosis in a patient with rheumatoid arthritis receiving treatment with anti-tumour necrosis factor-α. Reproduced from [21] with permission from the publisher.
Burgel, P-R et al Small airways diseases, excluding asthma and COPD: an overview European Respiratory Review 2013 22: 131-147; figs only web lungs 368

CALCIFICATION ALONG LYMPHOVASCULAR BUNDLES (red arrows)
INACTIVE SECONDARY TB WITH EXTENSIVE PARENCHYMAL AND LYMPHOVASCULAR INVOLVEMENT
48-year-old male with history of TB presents with back pain
AP view of the spine shows complex lesion in the right apex characterized by fibronodular opacities. There are scattered calcifications throughout the lungs but some are centered around the lymphatics, including the interlobular septa and centrilobular region
Ashley Davidoff MD TheCommonVein.net

ZOOMED IN VIEW
CALCIFICATION ALONG LYMPHOVASCULAR BUNDLES (red arrows)
INACTIVE SECONDARY TB WITH EXTENSIVE PARENCHYMAL AND LYMPHOVASCULAR INVOLVEMENT
48-year-old male with history of TB presents with back pain
AP view of the spine shows complex lesion in the right apex characterized by fibronodular opacities. There are scattered calcifications throughout the lungs but some are centered around the lymphatics, including the interlobular septa and centrilobular region
Ashley Davidoff MD TheCommonVein.net

CALCIFICATION ALONG LYMPHOVASCULAR BUNDLES, IN BOTH INTERLOBULAR AND CENTRILOBULAR DISTRIBUTION
INACTIVE SECONDARY TB WITH EXTENSIVE PARENCHYMAL AND LYMPHOVASCULAR INVOLVEMENT
48-year-old male with history of TB presents with back pain
AP view of the spine shows complex lesion in the right apex characterized by fibronodular opacities. There are scattered calcifications throughout the lungs but some are centered around the lymphatics, including the interlobular septa and centrilobular region
Ashley Davidoff MD TheCommonVein.net

Aspergillosis

Tree in Bud Sign Bronchopulmonary Aspergillosis (ABPA)
CT scan through the chest shows medium sized bronchi, bronchioles and small airways impacted with fluid. This collage is presented to reveal tree in bud changes resulting from impaction in the smaller terminal bronchioles and respiratory units. The tree-in-bud pattern also results in small centrilobular nodules connected to multiple branching linear structures of similar caliber from a single stalk. Originally it was felt to result from endobronchial spread of Mycobacterium tuberculosis, but is is now recognized in diverse entities including peripheral airway diseases caused by infection (bacterial, fungal, viral, or parasitic), congenital disorders, idiopathic disorders (obliterative bronchiolitis, pan bronchiolitis), aspiration or inhalation of foreign substances, immunologic disorders, connective tissue disorders and peripheral pulmonary vascular diseases such as neoplastic pulmonary emboli.
In this case there are also dilated medium sized airways, impacted with soft tissue characteristic of the finger in glove sign and most likely due to allergic bronchopulmonary aspergillosis (ABPA)
Ashley Davidoff MD Ashley Davidoff MD TheCommonVein.net
47113c01

Sarcoidosis

MIP and Lung Nodule Appreciation Centrilobular and PAraseptal Nodules – Small Airway and Mosaic Attenuation
77F with long history of dyspnea and cough showing medium and small airway disease, centri-lobular nodules, para-septal nodules ground glass changes and mosaic attenuation Diagnosis includes Stage 3 sarcoidosis
Ashley Davidoff
TheCommonVein.net

Para-septal and Centrilobular Nodules Airway Disease
77F with long history of dyspnea and cough showing medium and small airway disease, centri-lobular nodules, para-septal nodules ground glass changes and mosaic attenuation Diagnosis includes Stage 3 sarcoidosis
Ashley Davidoff TheCommonVein.net

Centrilobular Nodule – Small Airway and Mosaic Attenuation
77F with long history of dyspnea and cough showing medium and small airway disease, centri-lobular nodules, para-septal nodules ground glass changes and mosaic attenuation Diagnosis includes Stage 3 sarcoidosis
Ashley Davidoff TheCommonVein.net

Para-septal and Centrilobular Nodules
77F with long history of dyspnea and cough showing medium and small airway disease, centri-lobular nodules, para-septal nodules ground glass changes and mosaic attenuation Diagnosis includes Stage 3 sarcoidosis
Ashley Davidoff TheCommonVein.net

Centrilobular Nodules
77F with long history of dyspnea and cough showing medium and small airway disease, centrii-lobular nodules, paraseptal nodules ground glass changes and mosaic attenuation Diagnosis includes Stage 3 sarcoidosis
Ashley Davidoff TheCommonVein.net

CT WITH SUBPLEURAL AND LYMPHOVASCULAR NODULES IN THE RIGHT UPPER LOBE – INTERLOBULAR SEPTA AND CENTRILOBULAR
SARCOIDOSIS, ACTIVE – ALVEOLAR FORM
48-year-old previously well presented with dyspnea and initial CXR showed an infiltrate at the right base, and clinically resolved. He presented a year later with right chest pain and low grade ever and the CXR showed patchy opacities in the LUL and in the RLL
A subsequent CT showed LUL nodular opacities and subpleural rim of consolidation in the LUL and more prominently at both lung bases, associated with significant mediastinal adenopathy. Lymphovacscular nodularity was noted in the bronchovascular bundles as well as in the interlobular septa, consistent with sarcoidosis
CXR and CT 4 years later showed almost complete resolution of the parenchymal findings and the CT findings except for minimal reticulation and scarring in the subpleural regions
Ashley Davidoff MD

Hypersensitivity Pneumonitis

lungs probable hypersensitivity pneumonitis 003b 11 months prior RUL ground glass centrilobular nodules
Ashley Davidoff MD
thecommonvein.net

lungs probable hypersensitivity pneumonitis 003c 11 months prior RUL ground glass centrilobular nodules
Ashley Davidoff MD
thecommonvein.net

lungs probable hypersensitivity pneumonitis 003d 11 months prior RUL ground glass centrilobular nodules
Ashley Davidoff MD thecommonvein.net

Carcinoma

ADENOCARCINOMA OF LEFT LUNG WITH BILATERAL LYMPHANGITIC SPREAD
50 year old female with primary adenocarcinoma of the left lung with diffuse bilateral lymphangitic spread of disease characterized by lymphovascular distribution.
The nodularity on the fissures characterize the lymphatic distribution and the nodules are likely of a mixed nature, some being in the interlobular septa, and some in a centrilobular distribution .
Ashley Davidoff MD

ADENOCARCINOMA OF LEFT LUNG WITH BILATERAL LYMPHANGITIC SPREAD
50 year old female with primary adenocarcinoma of the left lung with diffuse bilateral lymphangitic spread of disease characterized by lymhovascular distribution.
The nodularity on the fissures characterize the lymphatic distribution and the nodules are likely of a mixed nature, some being in the iinterlobular septa, and some in a centrilobular distribution .
Ashley Davidoff MD

63 year old male witdiffuse bilateral infiltrates reflecting an unusual form of adenocarcinoma with lepidic growth
The lower panels demonstrate centrilobular distribution of someof the nodules
Ashley Davidoff MD
TheCommonVein.net
134336c

NODULES IN ILD
Micronodules in ILD is another CT feature of interstitial lung disease and is characterised by nodules of a variety of shapes and sizes and likely centrilobular in origin. Sometimes they are ill defined such as in this case.

Obliterative bronchiolitis after bone marrow transplantation

Obliterative bronchiolitis after bone marrow transplantation in a 47-year-old man with myeloma. (a) Expiratory high-resolution CT scan shows diffuse centrilobular nodules connected to branching linear opacities bilaterally. Note the air trapping in the right lower lobe. (b) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) of a specimen from open lung biopsy shows the bronchiolar walls surrounded by concentric chronic inflammatory infiltrates (arrows).
Rossi, SE et al Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview RadioGraphicsVol. 25, No. 3 2005
Rossi, SE et al Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview RadioGraphicsVol. 25, No. 3 2005

Tumor Emboli from Gastric Adenocarcinoma

Pulmonary neoplastic thrombotic microangiopathy caused by gastric adenocarcinoma in a 48-year-old man. (a) High-resolution CT scan shows multiple centrilobular nodules and branching lines with the tree-in-bud appearance (arrows), which is caused by tumor emboli. (b) Photograph of a cut section of the lung from an autopsy specimen shows normal interlobular septa (arrowheads) and pulmonary veins (PV) in the periphery of a secondary pulmonary lobule. Multiple branching opacities can be seen in the central portion of the lobule. (c) Photomicrograph (original magnification, ×400; hematoxylin-eosin stain) of a histopathologic specimen shows complete arteriolar occlusion by fibrocellular proliferation. Clumps of tumor cells are visible in the recanalized organized lesion (arrows). (Reprinted, with permission, from reference ,31.)
Rossi, SE et al Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview RadioGraphicsVol. 25, No. 3 2005

CHF and Centrilobular Nodules

Pre Dialysis 3 days earlier

Ground Glass Changes Kerley B Lines Centrilobular Nodular Congestion

Pre Dialysis 3 days earlier
Ground Glass Changes Kerley B Lines Centrilobular Nodular Congestion
Ashley Davidoff MD TheCommonVein.net 04

Focused View of the Region Post dialysis – 6.5 Liters
Ground Glass Changes Significantly Improved, Kerley B Lines and Centrilobular Congestion Resolved with Possible Mosaic Attenuation and Mosaic Attenuation
Ashley Davidoff MD TheCommonVein.net 04

Focused View of the Region Pre Dialysis 3 days earlier

Ground Glass Changes Kerley B Lines Centrilobular Nodular Congestion

Pre Dialysis 3 days earlier
Ground Glass Changes Kerley B Lines Centrilobular Nodular Congestion
Ashley Davidoff MD TheCommonVein.net 05

Focused View of the Region Post dialysis – 6.5 Liters

Ground Glass Changes Significantly Improved, Kerley B Lines and Centrilobular Congestion Resolved with Possible Mosaic Attenuation and Mosaic Attenuation

Post dialysis – 6.5 Liters
Ground Glass Changes Significantly Improved, Kerley B Lines and Centrilobular Congestion Resolved with Possible Mosaic Attenuation
Ashley Davidoff MD TheCommonVein.net 05

Amyloidosis

Both Small Vessels and Small Airway are Involved

Diffuse alveolar-septal amyloidosis
CT scan in the axial projection at the base of the lungs show many features of amyloidosis including lung nodules (white arrowheads) and infiltrates (b), and diffuse deposition within the alveolar septa (red arrowheads, c) and centrilobular nodules(yellow arrow c)
Ashley Davidoff MD Boston Medical Center
TheCommonVein.net septal-amyloidosis-001b