Case 5

Section 1

Image 1

1. What are the major abnormalities in this case?

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

2. Which lung is involved?

a) Left
b) Right
c) Both

Answers

What is the distribution of the lesions?

a) Bronchovascular interstitium
b) Interlobular septa
c) Centrilobular region
d) Pleura

Answer

Section 2

Image 1

Find multiple, connected, thickened interlobular septa in the right lung.

Find an example of thickened bronchovascular interstitium in the right lung.

Find 2 examples of polygonal lobules with centrilobular nodules in the right lung.

Image 2

Find the thickened fissural pleura in the right lung.

Find 2 lobules with thickened interlobular septa and centrilobular nodules in the right lung.

Find an example of thickened bronchovascular interstitium in the right lung.

Differential diagnosis of thickened bronchovascular, interlobular septal, and pleural interstitium on HRCT: Lymphangitic tumor, lymphoma, Kaposi's sarcoma, and edema. The unilaterality would be very unusual for Kaposi's sarcoma or edema.

Diagnosis: Lymphangitic tumor

Review of gross and histologic findings in lymphangitic tumor (Remember to use the "back" button in the menu bar to return.)

Summary of diagnostic features of lymphangitic tumor on HRCT

Thickening of bronchovascular, interlobular septal, centrilobular, and pleural interstitium
Smooth or nodular thickening
Lack of architectural distortion

Comment: Unilateral lymphangitic tumor is most commonly seen in cases of primary pulmonary adenocarcinoma, as in this case.

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