Nodules – Fissural

    • sarcoidosis (classic association)
    • amyloidosis – nodular form
    • lymphocytic interstitial pneumonia (LIP)
    • lymphangitic carcinomatosis:
    • silicosis
    • coal worker’s pneumoconiosis:

Sarcoidosis

42 year old male with a history of sarcoidosis.
The axial  CTscan shows  thickening and irregularity of the major fissure, a band of fibrosis in the right upper lobe, thickening of a segmental bronchus in the right upper lobe and bronchocentric fibrosis in the left upper lobe and multiple micronodules
Ashley Davidoff MD TheCommonvein.net lungs sarcoid 002
Bilateral fissural thickening CT 2 months later
Courtesy Paul Kohanteb MD
TheCommonVein.net
Patient with sarcoidosis showing nodules along the chains of lymphatic distribution including the pleura, and fissures
keywords lung pleura fissures and around the bronchi
key words lymphatics interstitium interstitial disease fx nodules dx sarcoidosis CTscan 446843
Ashley Davidoff MD TheCommonVein.net
FISSURAL BASED NODULES
51-year-old male with history of sarcoidosis
Fissural based nodules Subpleural nodules Micronodules along the lymphovascular and
bronchovascular bundles of the secondary lobule
Calcified nodule some of which are surrounded by soft tissue of the granuloma
Ashley Davidoff MD TheCommonVein.net

Amyloidosis

Fissural Based Amyloid Nodule with Central Calcification
Axial CT images through the right upper lobe shows a solid amyloid nodule with central calcification abutting the major fissure. These features, although not pathognomonic are characteristic. Sarcoidosis would be a radiological consideration as well
Ashley Davidoff Boston Medical Center TheCommonvein.net LV-006
Fissural Based Amyloid Nodule and Centrilobular Nodules
Axial CT images through the chest shows a Fissural based amyloid nodule along the left major fissure (a,b) Images c and d show posterior peripheral centrilobular nodules. In image c the nodules are associated with mosaic attenuation. The ground glass nodule in d could reflect alveolar septal disease withground glass changes surrounding a centrilobular nodule
Ashley Davidoff Boston Medical Center TheCommonvein.net LV-014c

TB

Coronal CTscan Shows Calcified Granulomata on the Fissure in the Anterior Segment of the Left Lower Lobe
CT scan of TB with Calcified Graulomata Centered around Major fissure and Bronchioles with Atelectasis and Bronchiolectasis
Ashley Davidoff MD The CommonVein.net granulomata-along-fissures-010
Axial CTscan Shows Small Airway Associated with a Calcified Granuloma and Granulomas along the Major Fissure in the Anterior Segment of the Left Lower Lobe with Bronchiole Wall Thickening
CT scan of TB with Calcified Granulomata Centered around Major fissure and Bronchioles with Atelectasis and Bronchiolectasis
Ashley Davidoff MD The CommonVein.net granulomata-along-fissures-006
Axial CTscan Shows Small Airway Associated with a Calcified Granuloma in the Anterior Segment of the Left Lower Lobe with Bronchiole Wall Thickening
CT scan of TB with Calcified Graulomata Centered around Major fissure and Bronchioles with Atelectasis and Bronchiolectasis
Ashley Davidoff MD The CommonVein.net granulomata-along-fissures-007