Kerley B lines are thinner and shorter than Kerley A lines (up to 2 cm) and lie in the lung periphery perpendicular to the lateral pleural surface (Fig. When tissue is obtained, the lung parenchyma may contain any combination of abnormalities, including inflammation, fibrosis, and granulomas. The ILD consist of disorders of known cause (e.g., collagen vascular diseases, drug-related diseases) as well as … Underlying chILD pathologies are markedly different from adult ILD. e Honeycomb pattern (idiopathic interstitial fibrosis). 6.17 Mitral stenosis (2 cases). Interstitial lung disease is diagnosed radiographically when a reticular, nodular, or honeycomb pattern or any combination thereof is recognizable. Small nodules up to 4 mm in diameter are identified in both lungs. Acute Kerley lines are frequently associated with prominent interlobar fissures caused by subpleural edema. Small nodules up to 4 mm in diameter are identified in both lungs. Often less evident in apices and bases. Thin-walled cysts are seen in the lungs of a patient with lymphangioleiomyomatosis. 6 Interstitial Lung Disease Plate-like (discoid) atelectases and localized fibrotic strands can be differentiated from Kerley lines by their lack of a characteristic anatomic location and by the great variation in length and width of these densities. Traditional interpretation of chest radiographs separates these processes into two groups: diseases that radiographically appear to involve the terminal airspaces or alveoli and those that appear to involve the interstitium. This presentation is seen in the active stage, which may completely resolve or progress to the chronic fibrotic stage. It may present radiographically in a reticulonodular pattern, too, but this presentation is also found with many other disorders, including various acute abnormalities that can resolve completely with time. Cystic bronchiectases may produce a radiographic picture similar to honeycombing. Roentgenographic pattern of disseminated alveolar cell carcinoma may be fairly uniform throughout both lungs or vary regionally. The chest radiograph, however, is often nonspecific. Healing may result in punctate calcifications years later. A honeycomb pattern is characterized by round or oval cystic lesions with a diameter up to 1 cm (Fig. Extensive, predominantly cystic bronchiectases in the right lung and left lower lobe are associated with loss of volume in the affected lung and compensatory overinflation of the nonaffected left upper lobe. Fig. 6.1e). Figure 7-12 Masses of fibrosis in end-stage sarcoidosis. 6.1d) is caused by a hazy increase in lung density that is not associated with obscuration of underlying vascular markings. Density of the tiny nodules depends on the atomic number of the inhaled element. Both congenital and acquired bronchiectases can be mistaken radiographically for localized interstitial lung disease (Fig. 6.4 Metastases from breast carcinoma. 17 Special Considerations for Asthma and Interstitial Lung Disease For additional ancillary materials related to this chapter, please visit thePoint. Irregular linear opacities (. Chest Radiology > Pathology > Interstitial Disease. For example, the adult ILD … Pulmonary arterial hypertension usually indicates end-stage disease with pronounced obliteration of the pulmonary vasculature. c Nodular pattern (silicosis). Differential diagnosis. Multiple, small (1 to 3 mm) nodules are distributed diffusely throughout the lungs. There are numerous interstitial lung diseases, but in clinical practice only about ten diseases account for approximately 90% of cases. Both congenital and acquired bronchiectases can be mistaken radiographically for localized interstitial lung disease (Fig. For example, histiocytosis, sarcoidosis, silicosis, and coal worker’s pneumoconiosis typically favor the upper lobes, whereas idiopathic pulmonary fibrosis and fibrosis associated with collagen vascular disease tend to be a lower-zone phenomenon. Permanent Kerley lines are most often present in chronic and severe pulmonary venous hypertension (especially mitral stenosis) that eventually results in fibrosis and hemosiderin deposition within the interlobular septa. Pneumoconiosis (inorganic dust) (e.g., silicosis, coal miner’s lung, berylliosis) (Figs. Bilateral poorly defined nodules are present. Publicationdate 2007-12-20. * Pattern that is predominant or usually associated with a specific disorder. Varicella (chickenpox) pneumonia (Fig. The fibrotic disorders are characterized by marked restriction, and small lungs invariably are seen in idiopathic pulmonary fibrosis and related disorders. bronchiolitis–associated interstitial lung disease (RB-ILD); desquama-tive interstitial pneumonia (DIP); lymphoid interstitial pneumonia (LIP); and acute interstitial pneumonia (AIP). Brendan M. Corcoran, Edinburgh, Scotland. Acute or transient Kerley lines are usually found with hydrostatic pulmonary edema (elevated microvascular pressure caused by left ventricular failure, renal disease and fluid overload), and occasionally with pneumonia and pulmonary hemorrhage. The nodular pattern (Fig. Centrilobular nodules in respiratory bronchiolitis. This appearance is typical for silicosis and for coal worker’s pneumoconiosis, but it may also occur in end-stage sarcoidosis. Figure 7-3 Thin-walled cysts are seen in the lungs of a patient with lymphangioleiomyomatosis. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Table 6.1 Disseminated Pulmonary Nodules Measuring Less than 1 cm in Diameter, Pulmonary Edema and Symmetrical Bilateral Infiltrates. Hemosiderosis-like pulmonary calcifications are occasionally seen in chronic renal failure (see Fig. Linear opacities of nonspecific interstitial pneumonia. Interstitial Lung Disease (ILD) Interstitial lung disease (ILD) is an umbrella term used for a large group of diseases that cause scarring (fibrosis) of the lungs. A nodular pattern (Fig. They have been called parenchymal bands and long lines. congestive heart failure). Many diseases demonstrate more than one pattern (see Box 7-3). Figure 7-5 Parenchymal consolidation (i.e., airspace or alveolar disease). However, they can usually be differentiated from honeycombing by their larger and less uniform size and by the presence of tiny meniscus-like fluid levels at the bottom of these cystic lesions. Thick-walled cysts are seen in the both lung bases. d Ground-glass appearance produced by the summation of innumerable tiny retlculogranular densities (sarcoidosis). 6.1a). Depending on the mesh size, one can distinguish between fine, medium, and coarse reticular patterns, although this distinction has no obvious differential diagnostic significance. These diseases represent specific clinicopathologic entities characterized by varying degrees of lung parenchymal inflammation and fibrosis. Depending on the mesh size, one can distinguish between fine, medium, and coarse reticular patterns, although this distinction has no obvious differential diagnostic significance. When the chest radiograph shows a clear pattern of ILD or ALD, one can render a differential diagnosis on the basis of the pattern of parenchymal disease (Table 3.1). 7-9). pneumocystis carinii pneumonia) and increased capillary blood volume (e.g. Figure 7-4 Honeycombing pattern in the usual interstitial pneumonitis of scleroderma. Prone scans are necessary to differentiate dependent atelectasis, a physiologic phenomenon that usually occurs posteriorly in the basal areas of the lungs, from true early interstitial lung disease. Patients usually present (Box 7-2) with dyspnea as the predominant symptom. a Punctate densities (hemosiderosis), and b larger calcified nodules (pulmonary ossification) are seen bilaterally, but only shown for the right side. They are most numerous at the base of the lungs. Cylindrical bronchiectases present as tubular opacities with parallel walls of 1 mm or slightly larger thickness. Development of high-resolution computed tomography (HRCT) has resulted in markedly improved accuracy in diagnosing interstitial lung disease. The patterns are described as nodular, irregular or linear, cystic, ground-glass, and parenchymal consolidation. Finally, fibrosis of the interlobular septa can be associated with any form of pulmonary fibrosis, but is most frequently observed with pneumoconiosis. (A) Axial CT at the level of the lung bases demonstrates diffuse bilateral ground-glass opacities, consistent with NSIP caused by busulfan. They are usually associated with architectural distortion and volume loss. Nonspecific interstitial pneumonia (NSIP): CT appearance. Notice the subpleural sparing at the fissures. It concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, and perivascular and perilymphatic tissues. a Reticular pattern (Pneumocystis carinii pneumonia). Thickened interlobular septa (hexagons) and a fine reticular pattern are visible within the lobules. In the more central portion of the lung, the thickened septa can outline the secondary pulmonary lobules, producing polygonal structures that are 1 to 2.5 cm in diameter. This appearance is virtually diagnostic, although under very rare circumstances both pulmonary papillomatosis and paragonimiasis may mimic cystic bronchiectases. The size of the lung (i.e., lung volumes) may be a clue to the differential diagnosis (Box 7-7). Keywords Diffuse parenchymal lung disease, Interstitial lung disease, Lung disease, Lung transplantation, Parenchymal lung disease, Pulmonary Langerhans cell histiocytosis Key Points • For selected parenchymal lung disease (DPLD) patients who fail to respond to medical therapy and demonstrate declines in function that place them at increased risk for mortality, lung transplantation … Read "High-resolution CT of diffuse interstitial lung disease: key findings in common disorders, European Radiology" on DeepDyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Development of high-resolution computed tomography (HRCT) has resulted in markedly improved accuracy in diagnosing interstitial lung disease. Fig. Fig. Note also the lytic involvement of the left fifth rib with pathologic fracture (arrow). Pneumoconiosis caused by radiopaque dusts (iron, tin, barium, antimony and rare-earth compounds) (Figs. Truly localized interstitial lung disease is relatively rare and most often of an infectious etiology. Miliary and larger, often poorly defined; can form microabscesses. However, several problems limit this approach to differential diagnosis. b Kerley A lines (long arrows, touched up) and Kerley B lines (short arrows) (mitral stenosis). Diseases have zonal preferences in the lungs (Box 7-4), although severe diseases often become diffuse. 6.11 Berylliosis. Langerhans cell histiocytosis (eosinophilicgranuloma) (Fig. Honeycombing represents an end-stage lung that is destroyed by fibrosis. More sensitive in detection of adenopathy than radiography. Some types of autoimmune diseases, such as rheumatoid … ■ Describe application of secondary lobular anatomy to interpretation of thin-se… Fig. 6.1b). The reticular pattern consists of a network of linear densities (Fig. Many chronic diseases can produce diffuse opacities in the lung. A ground-glass appearance (Fig. Varicose and cystic (saccular) bronchiectases are often evident on plain radiography as cystic lesions up to 2 cm in diameter and often containing a small air-fluid level at the bottom. Numerous relatively poorly defined miliary nodules and bilateral hilar enlargement are present, but are only shown for the right side. Crossref, Medline, Google Scholar; 49 Myers JL, Veal CF Jr, Shin MS, Katzenstein AL. A purely nodular pattern is found with the hematogenous spread of certain infections and tumors, but can also be encountered with other diseases (Table 6.1). (B) Axial CT in another patient with NSIP caused by nitrofurantoin at the level of the main bronchi shows bilateral ground-glass opacities and reticulation mainly in the peripheral lung. Other features should be considered in the differential diagnosis. They may be located in the axial interstitium along the peribronchovascular bundles, in the interlobular septa in a subpleural location adjacent to fissures, and in the central portion of the secondary pulmonary lobule. These structures typically have a central dot that represents the pulmonary artery. Traction bronchiectasis of usual interstitial pneumonitis in scleroderma. Involvement of the interstitium within the lobule around the central artery and bronchiole or related to the interlobular septum may produce a fine reticular pattern within the lobule itself (Fig. The reticular pattern consists of a network of linear densities (Fig. Thickening of the axial interstitium (i.e., interstitium in a peribronchovascular location) (Fig. Extrinsic allergic alveolitis (e.g., farmer’s lung, bird-fancier’s lung, mushroom-worker’s lung, bagassosis, and others) (Figs. They have been called, Septal thickening in lymphangitic carcinomatosis. Interstitial (in-tur-STISH-ul) lung disease describes a large group of disorders, most of which cause progressive scarring of lung tissue. Prominence of the central dot (Fig. Some investigators have attempted to differentiate interstitial from airspace or acinar nodules on HRCT. When these bronchiectatic segments become filled with retained secretion, they appear as homogeneous band-like densities (“gloved-finger” shadows). 6.3 Bronchioloalveolar carcinoma. Thick-walled cystic spaces can be seen subpleurally in the bases. Gallium scanning and positron emission tomography (PET) have also been used in the evaluation of interstitial lung disease and are discussed in more detail in, A graphic or morphometric classification is a better approach and is enumerated in Box 7-3. 6.6 Histoplasmosis (2 cases). Figure 7-6 Axial interstitial thickening in a patient with sarcoidosis. Irregular linear opacities (Fig. 3. Calcification extremely rare. Intrauterine infection with high mortality rate. Peripheral septal lines lie perpendicular to the pleural surface (open arrow). Finely granular stippling uniformly distributed over both lung fields. Interstitial Lung Disease Jeffrey T. Chapman The term interstitial lung disease (ILD) refers to a broad category of lung diseases rather than a specific disease entity.1,2 It includes a variety of illnesses with diverse causes, treatments, and prognoses. 6.16). They typically produce traction bronchiectasis centrally in the bronchi that they encompass. Large masses of fibrous tissue seen centrally in the upper lobes are associated with traction bronchiectasis, Cystic abnormalities include honeycombing, traction bronchiectasis, lung cysts, and cavitary nodules. Confluent, diffuse consolidation and air bronchograms in both upper lobes can be seen in this example of an alveolar pattern in a patient with interstitial lung disease (i.e., sarcoidosis). The five classifications of patterns of diffuse parenchymal lung disease on HRCT are linear or reticular opacities, nodular opacities, cystic lesions, ground-glass opacification, and parenchymal consolidation (i.e., alveolar or airspace disease). Fig. Multiple small nodules are scattered throughout both lung fields. Interstitial lung disease (ILD) comprises a broad category of lung diseases rather than a specific disease entity. 6.4). The patterns are described as nodular, irregular or linear, cystic, ground-glass, and parenchymal consolidation. Physical examination frequently finds only dry rales or crackles. Notice the dilated bronchus in the right upper lobe (thin arrow) and the subpleural honeycomb cysts (thick arrow). Numerous fairly well defined miliary nodules are seen bilaterally besides diffuse reticular changes and early honeycombing, but are only shown for the right side. However, as many of these pathologies involve beyond or do not involve the interstitium at all, ILD in children and infants (chILD) is often considered a syndrome of diffuse ILD. In t… They are not truly acinar but may be considered airspace nodules (Fig. 6.10 and 6.11). The scarring causes stiffness in the lungs which makes it difficult to breathe and get oxygen to the bloodstream. Bilateral small nodules with preferential involvement of the mid and lower lung zones are seen in this arc welder that are not associated with hilar adenopathy or fibrosis and resolved after exposure was discontinued. Acute Kerley lines are frequently associated with prominent interlobar fissures caused by subpleural edema. 6.9 Sarcoidosis. It is found, besides in interstitial diseases, also with air-space disease (e.g. 6.1a). 7-7) is common in many interstitial lung diseases. Chapter 56: Interstitial Lung Diseases. However, histiocytosis X and sarcoidosis in the early stages are usually associated with normal lung volumes, but lymphangioleiomyomatosis produces air trapping with large lung volumes. Clinical and radiologic correlation can aid the pathologist and refine the diagnosis. Bronchiectases are often associated with loss of volume and crowding of the lung markings in the affected area together with compensatory overinflation of the spared lung (Fig. The term interstitial lung disease (ILD) (also called diffuse interstitial lung disease, fibrotic interstitial lung disease, pulmonary fibrosis, and pneumoconiosis) refers to a broad group of inflammatory lung disorders. Ground-glass attenuation is a term used almost exclusively with CT. * More sensitive in detection of adenopathy than radiography. Mycoplasma and viral pneumonias can present in their early stages as localized interstitial diseases of fine reticular appearance before the extension of the inflammation into the air spaces causes a consolidation. First described in asbestosis, a subpleural line occasionally is seen in normal lungs and results from dependent atelectasis. Fig. Notice the subpleural sparing at the fissures. Figure 7-13 Honeycombing in idiopathic pulmonary fibrosis. More than 180 disease entities are characterized by acute, subacute, or chronic inflammatory infiltration of alveolar walls by cells, fluid, and connective tissue. Kerley B lines are thinner and shorter than Kerley A lines (up to 2 cm) and lie in the lung periphery perpendicular to the lateral pleural surface (Fig. Miliary nodulation only manifest 2–5 weeks after initial exposure (third phase of disease). Honeycombing is the only dependable radiographic sign of interstitial fibrosis. Kerley lines refer to septal lines that are thickened either by fluid accumulation, cellular infiltration, or connective tissue proliferation within the interlobular septa. Gallium scanning and positron emission tomography (PET) have also been used in the evaluation of interstitial lung disease and are discussed in more detail in Nuclear Medicine: The Requisites. In interstitial disease it is produced when the fine reticulogranular pattern has progressed to such an extent that the overall density of the involved lung is increased, but the individual interstitial lesion is no longer recognizable. Central septal lines outline the secondary pulmonary lobule, which appears as a polyhedral structure. Findings related to emphysema and small airways disease (e.g., bronchiolitis, which may cause decreased lung opacity) are discussed in Chapters 10 and. Box 7-3 Patterns of Opacities in Interstitial Lung Disease, Usual interstitial pneumonitis (idiopathic pulmonary fibrosis)*, Fibrosis associated with collagen vascular disease, Idiopathic pulmonary fibrosis (honeycombing), Congestive heart failure (interstitial edema). 4 to 10 mm, poorly defined (early acute stage of disease). 6.14 and 6.15). The characteristic com-puted tomographic findings in UIP are predominantly basal and pe-ripheral reticular opacities with honeycombing and traction bronchiec-tasis. Thick-walled cystic spaces can be seen subpleurally in the bases. 2 to 4 mm, discrete. Pleural disease may take one of several forms (. In the peripheral lung, it appears as 1- to 2-cm lines that extend perpendicularly from the pleural surface into the substance of the lung. Although these disorders have frequently been referred to as, Diffuse Interstitial (Parenchymal) Lung Diseases, IMMUNOLOGIC AND CONNECTIVE TISSUE DISORDERS, The standard chest radiograph remains the basic and, in some cases, the only imaging technique that is useful. b Kerley A lines (long arrows, touched up) and Kerley B lines (short arrows) (mitral stenosis). For example, histiocytosis, sarcoidosis, silicosis, and coal worker’s pneumoconiosis typically favor the upper lobes, whereas idiopathic pulmonary fibrosis and fibrosis associated with collagen vascular disease tend to be a lower-zone phenomenon. However, thin-slices MDCT has a limited ability to detect active inflammation, which is an important target of newly developed ILD drug therapy. e Honeycomb pattern (idiopathic interstitial fibrosis). Abstract: The idiopathic interstitial pneumonias (IIPs) are the most commonly diagnosed forms of interstitial lung disease. 6.7). Lymphatic obstruction appears to be a major factor in the development of Kerley lines associated with malignancies (e.g., lymphangitic carcinomatosis, bronchogenic carcinoma, and lymphoma), since at least histologically, ipsilateral hilar involvement with tumor is almost invariably present under such conditions. 6.2 Bronchiectases. Different kinds of Kerley lines are distinguished: Kerley A lines are straight lines measuring 2–6 cm in length and approximately 1 mm in thickness. Ill-defined nodules up to 1 cm in diameter are identified in both lungs. Multiple, small (1 to 3 mm) nodules are distributed diffusely throughout the lungs. Large masses of fibrous tissue seen centrally in the upper lobes are associated with traction bronchiectasis (arrow). In the peripheral lung, it appears as 1- to 2-cm lines that extend perpendicularly from the pleural surface into the substance of the lung. Thin-slices multi-detector computed tomography (MDCT) plays a key role in the differential diagnosis of interstitial lung disease (ILD). It usually involves the more central bronchi. Coccidioidomycosis, blastomycosis, and Cryptococcosis (Fig. Miliary, discrete (DD: tuberculomas that are larger than 5 mm and can calcify). Masses of Fibrosis or Conglomerate Masses, Masses of fibrosis in end-stage sarcoidosis. Most patterns can be readily identified on standard radiographs, but ground-glass and cystic disease patterns are much more readily appreciated on HRCT. Miliary and larger (up to 3 cm). Reticular opacities usually are caused by interstitial thickening by cells, fluid, or fibrous tissue (Box 7-8). Hemosiderosis and pulmonary ossification secondary to mitral stenosis (Fig. Fig. They are most numerous at the base of the lungs. a Reticular pattern (Pneumocystis carinii pneumonia). ■ List the imaging features of the full spectrum of disorders in the 2013 American Thoracic Society chILDclassification system. A ground-glass appearance (Fig. Septal lines are a common feature of many interstitial lung disorders but are particularly predominant in lymphangitic spread of carcinoma and in congestive heart failure. CT is more sensitive in the identification of adenopathy and may demonstrate mildly enlarged lymph nodes in idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, fibrosis associated with the collagen vascular diseases, and lymphangioleiomyomatosis. 7-15, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Many chronic diseases can produce diffuse opacities in the lung. Discrete and extremely sharply defined, less than 1 mm in diameter. HIGH-RESOLUTION COMPUTED TOMOGRAPHY FEATURES OF INTERSTITIAL LUNG DISEASE. Parenchymal consolidation (i.e., airspace or alveolar disease). Fig. 7-12). Cystic bronchiectases may produce a radiographic picture similar to honeycombing. Fig. 6.19). Oily contrast material embolism (e.g., secondary to lymphography) (Fig. Figure 7-11 Airspace nodules in bronchioloalveolar carcinoma. Interstitial lung disease is diagnosed radiographically when a reticular, nodular, or honeycomb pattern or any combination thereof is recognizable. 6.2). Bronchial wall thickening (white arrow) and small nodules are seen subpleurally along the fissures and lateral chest wall. This chapter on interstitial lung disease (ILD) is followed by a chapter on alveolar lung disease (ALD). Fig. Most patterns can be readily identified on standard radiographs, but ground-glass and cystic disease patterns are much more readily appreciated on HRCT. 6.15 Bird-fancier’s lung. Fig. 6.17). HIGH-RESOLUTION COMPUTED TOMOGRAPHY FEATURES OF INTERSTITIAL LUNG DISEASE, High-Resolution Computed Tomography Findings for Linear Opacities, Axial interstitial thickening in a patient with sarcoidosis. Intralobular interstitial thickening (i.e., reticular opacities) in pulmonary alveolar proteinosis. They are located in radiating fashion midway between the hilum and pleura and appear to cross over bronchoarterial bundles showing no anatomic relationship with the latter. ILD is also termed diffuse parenchymal lung disease (DPLD). The six most common causes of diffuse interstitial pulmonary fibrosis are idiopathic (IPF, >50% of cases), collagen vascular disease, cytotoxic agents and nitrofurantoin, pneumoconioses, radiation, and sarcoidosis. It is often accompanied by other signs of interstitial lung disease, especially the patterns associated with reticular opacities and architectural distortion. Airspace nodules in bronchioloalveolar carcinoma. Pattern that is predominant or usually associated with a specific disorder. The chest radiograph, however, is often nonspecific. Fairly well defined in silicosis and poorly in berylliosis. Miliary and larger, usually poorly defined (acute stage). Interstitial lung disease (ILD) consists of a large and heterogeneous group of rare pulmonary disorders, characterized by abnormalities involving the alveoli and airway. Thickened interlobular septa (hexagons) and a fine reticular pattern are visible within the lobules. Honeycomb spaces usually are 1 cm or less in diameter with relatively thick walls (>2 mm), and they are a pathologic correlate of end-stage lung disease with fibrosis (Fig. Honeycombing typically is in the peripheral portions of the lungs subpleurally, particularly in idiopathic pulmonary fibrosis. Fig. In the more central portion of the lung, the thickened septa can outline the secondary pulmonary lobules, producing polygonal structures that are 1 to 2.5 cm in diameter. Patients invariably present with dyspnea of varying time course and severity. 7-11). When these bronchiectatic segments become filled with retained secretion, they appear as homogeneous band-like densities (“gloved-finger” shadows). 7-14) is a phenomenon that occurs in the presence of severe lung fibrosis and distortion of lung architecture, in which the fibrous tissue produces traction on the bronchial walls, resulting in irregular bronchial dilation. In patients with isolated bronchiectasis, there are no other signs of lung disease. Dr. Sally Suliman presents "Interstitial Lung Disease" by first introducing the classification of ILDs. Figure 7-9 Intralobular interstitial thickening (i.e., reticular opacities) in pulmonary alveolar proteinosis. Bronchial wall thickening, Thickening of the interlobular septa (Fig. f Bronchiectases evident as cystic lesions varying considerably in size and characteristically containing small air-fluid levels (arrows). Finally, fibrosis of the interlobular septa can be associated with any form of pulmonary fibrosis, but is most frequently observed with pneumoconiosis. The intralobular bronchiole is visible ( arrowhead ) slightly larger interstitial lung disease radiology key the findings... Often irreversible and gets worse over time often accompanied by other signs of lung.. ( white arrow ) is less than 1 mm to 1 cm in are! 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Mm ) nodules are distributed diffusely throughout the lungs relevant and clinically histopathological! Fibrosis of the tiny nodules depends on the atomic number of the lung parenchyma severely.... In nodular calcifications 1 to 3 mm ) thick ( see Fig key...

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