4 Diffuse Reticular or Reticulonodular Pattern

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig C 4-1 Lymphangitic metastases. (A) Coarsened bronchovascular markings of irregular contour and poor definition primarily involve the right lower lung. Note the septal (Kerley) lines and the left mastectomy in this patient with carcinoma of the breast. (B) In this patient with metastatic carcinoma of the stomach, a superimposed nodular component representing hematogenous deposits produces a coarse reticulonodular pattern.

• Fig C 4-2 Lymphoma. Diffuse reticular and reticulonodular changes, with striking prominence of the left hilar region.

• Fig C 4-3 Silicosis. Prominence of interstitial markings, upward retraction of the hila, and bilateral calcific densities that tend to conglomerate in the upper lobes.

• Fig C 4-4 Asbestosis. Severe disorganization of lung architecture with generalized coarse reticulation, which has become confluent in the right base and obliterates the right hemidiaphragm. There is marked pleural thickening, particularly in the apical and axillary regions. A spontaneous pneumothorax is on the left.7

• Fig C 4-5 Berylliosis. Diffuse reticulonodular pattern throughout both lungs, with relative sparing of the apices and bases.

• Fig C 4-6 Coal-workers' pneumoconiosis. Ill-defined masses of fibrous tissue in the perihilar region extend to the right base.

• Fig C 4-7 Talc granulomatosis. File nodular opacities and areas of coalescence in an intravenous drug abuser.11

• Fig C 4-8 Pigeon-breeder's lung. Diffuse reticulonodular infiltrate primarily involves the perihilar and upper lobe regions.

• Fig C 4-9 Byssinosis. Prolonged exposure has resulted in irreversible pulmonary insufficiency and a diffuse reticular pattern.

• Fig C 4-10 Oxygen toxicity. (A) Initial chest radiograph of an infant demonstrates a typical granular parenchymal pattern with air bronchograms due to hyaline membrane disease. (B) After intensive oxygen therapy, multiple small round lucencies resembling bullae have developed, giving the lungs a sponge-like appearance.

• Fig C 4-11 Busulfan-induced lung disease. Severe coarse reticular pattern.

• Fig C 4-12 Methotrexate-induced lung disease. Diffuse interstitial pattern with patches of alveolar consolidation in a child treated for myelogenous leukemia. After methotrexate therapy ended, there was rapid clinical and radiographic improvement.14

• Fig C 4-13 Rheumatoid lung. (A) Frontal and (B) lateral views of the chest show diffuse thickening of the interstitial structures with prominent pleural thickening.

• Fig C 4-14 Chronic bronchitis. Coned view of the right lower lung demonstrates a coarse increase in interstitial markings. The arrows point to the characteristic parallel-line shadows (“tramlines”) outside the boundary of the pulmonary hilum.

• Fig C 4-15 Interstitial pulmonary edema. Edema fluid in the interstitial space causes a loss of the normal sharp definition of pulmonary vascular markings and a perihilar haze. At the bases, note the thin horizontal lines of increased density (Kerley-B lines) that represent fluid in the interlobular septa.

• Fig C 4-16 Secondary tuberculosis. Diffuse interstitial fibrosis pattern.

• Fig C 4-17 Blastomycosis. Diffuse interstitial disease with upper lobe predominance. Note the volume loss in the upper lobe and the overdistention of the lower lobes along with the formation of bullae at the bases.4

• Fig C 4-18 Viral pneumonia. Diffuse interstitial infiltrates with perihilar haze in (A) a child and (B) an adult.

• Fig C 4-19 Mycoplasma pneumoniae. Diffuse, fine reticular pattern represents acute interstitial inflammation. The radiographic pattern is indistinguishable from that of most viral pneumonias.

• Fig C 4-20 Pneumocystis carinii. Diffuse reticular pattern in a patient with acute myelogenous leukemia. Note the early development of alveolar consolidations at the bases. A later film showed the typical pulmonary edema pattern.

• Fig C 4-21 Sarcoidosis. Diffuse reticulonodular pattern widely distributed throughout both lungs.

• Fig C 4-22 Sarcoidosis. In end-stage disease, there is severe fibrous scarring, bleb formation, and emphysema.

• Fig C 4-23 Pulmonary Langerhans cell histiocytosis. (A) Frontal view shows widespread cystic changes in the lung and subsequent diffuse reticular opacities produced by the overlapping cysts. (B) Magnified view of the right upper lung shows the confluent superimposed lung cysts in detail.15

• Fig C 4-24 Cystic fibrosis. Diffuse peribronchial thickening appears as a perihilar infiltrate associated with hyperexpansion and flattening of the hemidiaphragms.

• Fig C 4-25 Dysautonomia. Pattern identical to that of cystic fibrosis.

• Fig C 4-26 Usual interstitial pneumonia. Diffuse, coarse reticulonodular pattern.

• Fig C 4-27 Desquamative interstitial pneumonia. Diffuse reticulonodular pattern indicating interstitial disease, combined with bibasilar air-space consolidation that obscures the borders of the heart.

• Fig C 4-28 Amyloidosis. Diffuse interstitial fibrosis pattern.

• Fig C 4-29 Pulmonary lymphangiomyomatosis. Diffuse reticulonodular interstitial pattern throughout both lungs.