Css Edema Intersitial

8/12/2019 Css Edema Intersitial

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Doddy Darmawan


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interstitial Opacity- Definition

The interstitium refers to the supporting structures of the lung.An interstitial opacity on chest X-ray refers to an abnormal

appearance of the lung interstitium


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Basic principal Most lung diseases cause an increase in the

radiodensity of the lung,

If it is due to a relative thickening of the interstitium-this will be manifest as increased prominance of theinterstitial markings on the CXR.

If generalized or diffuse, this will likely appear as a

linear or reticular pattern,whereas i f localized, it may appear as multiple tiny

nodules.


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The interstitium surrounds bronchi, vessels, and

groups of alveoli.When there is disease in the interstitium it manifests

itself by reticulonodular shadowing (criss cross lines ortiny nodules or both).

The main two processes are accumulation of fluid(occurring in pulmonary oedema or in lymphangitiscarcinomatosa)

inflammation leading to fibrosis :

(occurring in industrial lung disease, inf lammatoryarthritides such as rheumatoid arthritis, inflammationof unknown cause such as cryptogenic fibrosingalveolitis and sarcoidosis)


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Causes of Interstitial lung opacity infectious causes, e.g.: non-tuberculous mycobacteria &

certain fungal infections

b) occupational causes, e.g.: asbestos & silica

c) drug reactions, e.g.: methotrexate & amiodarone

d) neoplastic causes, e.g.: metastatic cancer,bronchoalveolar cell carcinoma (a form of lung cancer)

e) radiation pneumonitis

f) hypersensitivity pneumonitis


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g) rheumatologic diseases: (1) systemic lupus erythematosis

(2) rheumatoid arthritis

(3) scleroderma

(4) mixed connective tissue disease

(5) polymyositis

- Diseases of unknown cause, e.g.: sarcoidosis, Langerhan's cellgranulomatosis (eosinophilic granuloma; histiocytosis X),lymphangioleiomyomatosis


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interstitial Lung Patterns on CXR


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Linear interstitial pattern thin linear opacities

which are either 2 to 6cm long within the lungsoriented radially towardthe hila or 1 to 2 cm longat right angles to, and incontact with, the lateral

pleural surfaces.


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Linear opacities: Kerley A : thickening of either the bronchovascular/axial

interstitium

Kerley B : thickening of the peripheral interstitium(pulmonary edema)

Etiologi : Hydrostatic pulmonary edema,

lymphangitic carcinomatosis, atypical interstitial pneumonias such as caused by

mycoplasma, chlamydia, cytomegalovirus (CMV), andrespiratory syncytial virus (RSV).


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Radiologic features


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Kerley's A lines (Arrows): Linear opacities extending from the periphery to thehila. They are caused by distension of anastomotic channels between peripheraland central lymphatics

Kerley's B lines (white arrowheads):Short horizontal lines situated

perpendicularly to the pleural surface at the lung base. They represent edema ofthe interlobular septa.


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Reticular pattern numerous, small, linear

opacities which, bysummation, have been

described as a lace-likeor net-like

Reticular opacities canbe

described as fine,medium, or coarse, asthe width of theopacities increases.


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Diagnose :

Peripheral reticular pattern with small lung volumes,

Diffuse reticular/cystic pattern with normal orIncreased lung volumes, and airway/central reticular

pattern


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chest xray shows mild hyperinflation, and a coarse pattern in thelung fields consisting of reticular interstitial markings andperipheral ring shadows suggesting cysts.


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PA chest radiograph demonstrates increased reticularpattern of the lung parenchyma.Bilateral breast implants with calcifications are noted


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Nodular Pattern multiple small, discrete,

rounded opacities thatrange in diameter from 2

to 10 mm differential diagnosis for

the nodular pattern

No

dular metastases, Nodular

pneumoconioses

granulomatous diseases


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Findings: Multiple, diffusely distributed nodules.

Pattern: Interstitial, specifically dots


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Reticular Interstitial patternA reticulonodular pattern results from a combination

of reticular and nodular opacities.

A reticulonodular pattern is often difficult todistinguish from a purely reticular or nodular pattern,and in such a case a differential diagnosis should bedeveloped based on the predominant pattern


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Reticulonodular pattern in blastomycosis. Radiograph showsbilateral reticulonodular opacities, with a large cavitary lesion inthe right upper lobe


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Reticulonodular pattern in a patient with COPD


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Css Edema Intersitial

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