Case 4


Section 1

Image 1

1. What are the abnormalities in this case?

a) Linear opacities
b) Nodules
c) Consolidation
d) Ground-glass opacity

2. What is the distribution of the abnormalities?

Answers

partconfconsclnodclnod1consol


Section 2

Look at images 1 and 2 below.

Image 1

Find 2 centrilobular nodules.

Find an area of partially confluent, lobular consolidation.

Find an area of homogeneous, mass-like* consolidation.

* A mass is a large, rounded opacity, generally greater than 3 cm in diameter.

partconfconsclnodclnod1consolclnodclnod1

Image 2

Find an example of centrilobular nodules connected by linear structures: tree-in-bud.

tib


Section 3: Histologic Features

This histologic section illustrates partially confluent, lobular consolidation.

Find two of several centrilobular nodules, which represent endobronchial spread of this disease.

Here is a closer view of a typical lesion.

What is the diagnosis?

Answer

 

 nonnecgrcnecrosispalhisaerlungaerlungaerlung

 

 

Find the area of necrosis in the granuloma.

Find palisading histiocytes at the margin of the necrosis.

Find a small, non-necrotizing granuloma.

Find aerated alveolar parenchyma (which allows the nodule to be identified radiographically).

 nonnecgrcnecrosispalhisaerlungaerlungaerlung

Differential diagnosis of clusters of centrilobular nodules, tree-in-bud pattern, and masses on HRCT: The findings are most consistent with focal endobronchial infection with areas of confluent spread. This pattern is most commonly seen with tuberculosis. Tumor mass with post-obstructive endobronchial infection should also be considered.

Histologic differential diagnosis: Mycobacterial or fungal infection, Wegener's granulomatosis, and rheumatoid nodule

Diagnosis: Tuberculosis

Summary of diagnostic features of endobronchial tuberculosis on HRCT

See Case Study 32 for other examples of tuberculosis (several are linked to the Discussion).

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1. b. & c. Nodules and consolidation in the anterior right upper lobe.

2. Centrilobular and confluent lobular, right upper lobe

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Partially confluent lobular consolidation

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Centrilobular nodule

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Homogeneous, mass-like consolidation

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Tree-in-bud pattern

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Centrilobular nodule

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Necrotizing granuloma

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Central necrosis

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Palisading histiocytes around central necrosis

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Non-necrotizing granuloma

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Aerated lung

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