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Radiology Quiz

Classic spectrum of interstitial lung diseases on HRCT

Harkaran Singh Mann, Roopkamal Sidhu1, Lavina Sinha2, Harshad Shah1
Mann Scanning and Diagnostic Centre, Jalandhar, Punjab, 1Department of Radiology, CU Shah Medical College and Hospital,
Surendranagar, 2Department of Medicine, GMERS Medical College and Hospital, Valsad, Gujarat, India

Address for correspondence: Dr. Roopkamal Sidhu, Department of Radiology, CU Shah Medical College and Hospital, Surendranagar ‑ 363 001, Gujarat,
India. E‑mail: roopkamal27@gmail.com

CLINICAL PROFILE Patient 3

Patient 1
Figure 1 ‑ A 17‑year‑old female presents with complaints
of progressive dyspnea for the last 2 months. She has been
on anti‑epileptic drug therapy for the last 3 years.
Patient 2
Figure 2 ‑ A 35‑year‑old male presents with breathlessness
and pleutic chest pain for 3 months. He has a past history
of smoking, quit 1 year back.
Figure 3 ‑ A 50‑year‑old female, known case of rheumatoid
arthritis presents with dyspnea when climbing stairs and
chest pain for last 6 months.
Patient 4
Figure 4 ‑ A 55‑year‑old male, non‑smoker presents with
sudden onset of dry cough, breathlessness and malaise
for 20 days.
QUESTIONS

Q1. What are the imaging findings on CT and the likely

diagnosis of each?
Q2. Delineate the characteristic clinical and HRCT
findings of each of these interstitial lung diseases.

b c
Figure 1: (a) HRCT thorax, axial section shows thin walled
cysts (red arrows) distributed throughout the lung fields in
lymphangiomyomatosis. (b) CT brain, axial scan shows the classic
Figure 2: HRCT thorax, axial scan delineates ill-defined cysts within
subependymal nodules (green arrows). (c) CECT abdomen, coronal
the lung parenchyma bilaterally with nodules (green arrows)
scan, arterial phase, shows a right kidney mid-pole fat containing
exophytic lesion which enhances inhomogeneously (pink arrows),
suggestive of renal angiomyolipoma
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DOI: How to cite this article: Mann HS, Sidhu R, Sinha L, Shah H.
10.4103/0970-2113.173076 Classic spectrum of interstitial lung diseases on HRCT. Lung India
2016;33:92-4.

92 © 2016 Indian Chest Society | Published by Wolters Kluwer - Medknow

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Mann, et al.: Interstitial lung diseases

a b
Figure 4: HRCT thorax (a) axial section and (b) coronal reformatted
image reveal patchy consolidation in peribronchial areas (green arrows)
with reticular peribronchial nodules and bronchial wall thickening

HRCT features:[2]
• Early changes: 1‑10 mm centrilobular nodules
• Late changes: Bizarre‑shaped cysts
Figure 3: HRCT thorax, axial section, shows typical subpleurally • Emphysema
layered peripheral cysts stacked one over the other, suggestive of • Ground glass opacities.
“honeycombing” (purple arrows)
Patient 3
HRCT thorax [Figure 3] shows typical subpleurally layered
ANSWERS
peripheral cysts stacked one over the other, suggestive
of “honeycombing” (purple arrows) in a case of usual
Patient 1
interstitial pneumonia.
HRCT thorax [Figure 1a] shows characteristic thin‑walled
cysts (red arrows) distributed throughout the lung
fields in a young female with seizures suggests changes Clinically:[3]
of lymphangiomyomatosis. On CT screening of the • Associated with a connective tissue disorder or
brain [Figure 1b], the classic well‑defined calcified nodules asbestosis.
are noted along the supependymal surface of the lateral
ventricles (green arrows). CECT abdomen [Figure 1c] HRCT features:[3]
shows an incidental mid‑pole fat containing exophytic • Subpleural basal predominance
lesion which enhances inhomogeneously (pink arrows), • Honeycombing in the absence of nodules of ground
suggestive of renal angiomyolipoma. The patient was thus glass opacities
diagnosed as a case of tuberous sclerosis. • Traction bronchiectasis.

Clinically:[1] Patient 4
• A female of child bearing age group HRCT thorax axial [Figure 4a] and coronal [Figure 4b]
• May be associated with tuberous sclerosis. sections demonstrate patchy consolidation in peribronchial
areas (green arrows) with reticular peribronchial nodules
HRCT features:[1] and bronchial wall thickening, suggestive of cryptogenic
• Thin‑walled cysts of equal size throughout the lung organizing pneumonia.
parenchyma
• Interlobular septal thickening Clinically:[4]
• May show dilated thoracic duct • Commonest in 55‑60 years of age groups
• May demonstrate areas of high attenuation due to • Acute onset of dyspnea, malaise, non‑productive cough
hemorrhage • No association with smoking.
• Recurrent pneumothoraces
• Absence of nodules. HRCT features:[4]
• Patchy consolidation distributed subpleurally or in
Patient 2 peribronchial regions
HRCT thorax [Figure 2] shows ill‑defined cysts within the • Nodules of various sizes which may coalesce
lung parenchyma bilaterally with nodules (green arrows) • Interlobular septal thickening
in late cystic Langerhans cell histiocytosis. • Peribronchial thickening
• Ground glass opacities.
Clinically:[2]
• Pediatric patient with Langerhans cell histiocytosis Financial support and sponsorship
• Young adult male smoker. Nil.

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Mann, et al.: Interstitial lung diseases

Conflicts of interest 2. Wells AU, Hansell DM, Corrin B, Harrison NK, Goldstraw P, Black CM,

There are no conflicts of interest.
REFERENCES
1. Eisenberg H. The interstitial lung diseases associated with the
collagen‑vascular disorders. Clin Chest Med 1982;3:565‑78.
et al. High resolution computed tomography as a predictor of lung
histology in systemic sclerosis. Thorax 1992;47:738‑42.
3. Bodolay E, Szekanecz Z, Dévényi K, Galuska L, Csípo I, Vègh J,
et al. Evaluation of interstitial lung disease in mixed connective tissue
disease (MCTD). Rheumatology (Oxford) 2005;44:656‑61.
4. Remy‑Jardin M, Remy J, Cortet B, Mauri F, Delcambre B. Lung changes
in rheumatoid arthritis: CT findings. Radiology 1994;193:375‑82.

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