Case 4
Section 1
Image 1
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1. What are the abnormalities in this case? a) Linear
opacities 2. What is the distribution of the abnormalities? | ||||||||
Section 2
Look at images 1 and 2 below.
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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. | ||||||||
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Find an example of centrilobular nodules connected by linear structures: tree-in-bud. | ||||||
Section 3: Histologic Features
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This histologic section illustrates partially confluent, lobular consolidation. Find two of several centrilobular nodules, which represent endobronchial spread of this disease. | ||||||||
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Here is a closer view of a typical lesion. What is the diagnosis?
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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). | ||||||
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).
1. b. & c. Nodules and consolidation in the anterior right upper lobe.
2. Centrilobular and confluent lobular, right upper lobe
Partially confluent lobular consolidation
Homogeneous, mass-like consolidation
Palisading histiocytes around central necrosis
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