Centrilobular nodule

Fig. 26.8. RB-ILD in a 44-year-old female cigarette smoker. Coronal CT image shows scattered, poorly defined centrilobular nodules that are predominantly located in the upper lung lobes. Note mild coexisting centrilobular emphysema (arrows)...

Fig. 26.9. RB-ILD. Axial CT image shows centrilobular nodules (thin black arrow), patchy ground-glass opacities (arrowheads), and mild bronchial wall thickening (white arrow). Note discrete paraseptal emphysema (thick black arrow)...

Fig. 26.22. Chronic hypersensitivity pneumonitis in a 52-year-old man, related to mold exposure. Axial CT image shows patchy ground-glass opacities with associated centrilob-ular nodules (inset magnified view of centrilobular nodules). Also note mild subpleural reticular opacities (black arrowheads) indicating fibrosis, and subtle mosaic attenuation (white arrowhead)...

Fig. 26.28. LIP in a 44-year-old woman with Sjogren s syndrome. Axial CT image shows several thin-walled cysts (white arrowhead), bilateral patchy ground-glass opacities (arrow), and poorly defined centrilobular nodules (black arrowhead)...

Figure 6 HRCT of a patient with RR-TT.D showing a mosaic pattern, thickened bronchi, and centrilobular nodules best appreciated in the magnified view. Abbreviations HRCT, high-resolution computed tomogr hy RB-ILD, respiratory bronchioHtis-associated interstitial lung disease.

Thickened central and proximal bronchi Centrilobular nodules Focal GGO... 

Lymphocytic interstitial pneumonia (LIP) is a benign disorder most commonly associated with CVD (particularly Sjogren s syndrome), Castleman s disease, and diverse autoimmune and immunodeficiency states (including HIV infection) (47 9). Salient CT features of LIP include GGO (100%), centrilobular nodules (86%), interlobular septal thickening (93%), thickened bronchovascular bundles (93%), air cysts (71%), lymph node enlargement (71%), architectural... 

Figure 8 HRCT of a patient with LIP demonstrating cystic airspaces (A), ground glass opacities, thickened bronchovascular bundles, and centrilobular nodules (B). Abbreviations HRCT, high-resolution computed tomography LIP, l3miphocytic interstitial pneumtmia.

Cysts likely reflect airway obstruction caused by peribronchiolar lymphocytic infiltration (50). Peribronchovascular and subpleural cystic airspaces may be observed in up to two-thirds of patients and may progress over time (49,51,54). Honeycomb cysts are uncommon (5-20%) (49-51) but may develop in areas of prior consolidation (50). In a study of 14 patients of LIP who had serial CT scans, 9 improved, 4 worsened, and 1 remained stable (50). Many parenchymal abnormalities were reversible (50). However, cysts or architectural distortion either worsened or did not change on follow-up (50). Additional cysts often developed in areas where centrilobular nodules had been present on initial CT scans. 

Peripheral, basilar, and peribronchiolar predominance (>80%) Centrilobular nodules (30-63%)... 

Figure 13 HRCT of a patient with acute HP demonstrating diffuse heterogeneous bilateral ground glass opacities throughout hoth lungs. Centrilobular nodules can be appreciated best in the magnified image. Abbreviations. HRCT, high-resolution computed tomography HP, hypersensitivity pneumonitis.

Figure 2 (A) A 36-year-old female with subacute HP. HRCT scan shows bilateral poorly defined centrilobular nodules and ground-glass opacities. (B) A 43-year-old female with subacute HP. HRCT illustrates ground-glass opacities and areas of decreased attenuation (mosaic pattern). Abbreviations HP, h3fpersensitivity pneumonitis HRCT, high-resolution computed tomography.

HRCT often discloses a complex admixture of lesions, termed rheumatoid lung. Bronchiectasis is present in 8% to 75% of patients, but the distinction between primary bronchiectasis and traction bronchiectasis due to pulmonary fibrosis is often difficult (139,140,149,151,152,155,166,177). Bronchiolitis is also frequent, manifesting as centrilobular nodules, tree-in-bud sign, mosaic perfusion, or air trapping (139,149,151,152,155,166,177). Emphysema is present in 5% to 43% of patients (13,139,140,149,151,152,155,166,174,177) and is widely viewed as a trait of RA-ILD, unlike findings in other CTDs. Emphysema is more frequent with an HRCT pattern of UIP, as opposed to NSIP (155). Other features include pulmonary rheumatoid nodules and pleural effusion or thickening can be observed. Pulmonary artery enlargement has been observed in nearly half of patients with RA-ILD, in spite of the fact that overt PH is rare in RA (155). 

Centrilobular nodules and branching lines (tree in bud) Cellular bronchiolitis Membranous and respiratory bronchioles... 

Centrilobular nodules (with Cellular bronchiolitis Respiratory bronchioles... 

Figure 2 HRCT. Bilateral small centrilobular nodules ( tree in bud pattern) in patient with Haemophilus Influenzae bronchiolitis.

This pattern, found in some patients (40,41), was described as diffusely scattered centrilobular nodules (5 mm) within ground glass opacities in eight of nine patients investigated by Choi et al (39). These lesions, located in centrilobular spaces, correspond to pulmonary vasculitis and perivascular infiltration. 

The radiographic features on the acute initial stage vary from normality to typical pulmonary edema (Fig. 12.11). The chest radiographs of patients with pathologically proved bronchiolitis obliterans have shown discrete nodularity with or without confluence (Ramirez and Dowell 1971). Bronchiolitis obliterans may appear as hyperinflation, mosaic pattern, centrilobular nodules, or bronchiectasis on thin-section CT. Expiratory thin-section CT may he useful in the detection of bronchiolitis obliterans. 

Fig. 13.10. Subacute phase. Poorly defined centrilobular nodules...

Fig. 13.12. Subacute phase. Centrilobular nodules, the pleural and fissural surfaces are spared...

In the centrilobular pattern, the pleural and fissural surfaces are spared (Fig. 13.12). The nodules of ground-glass attenuation are diffuse (Fig. 13.13), and impacted airways are absent. There is a relationship between the nodules and the visible arterial branches, which are themselves centrilobular structures. Centrilobular nodules maybe observed in HP... 

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