Case 10


Section 1

Look at images 1 and 2.

Image 1

 

1. Is the disease unilateral or bilateral?

2. What is the anatomic location of the linear structures that reach the pleura?

Answer

tentpl1tentpl2spl1spl2clnImage 2

 

In the right lower lobe, note the network of parenchymal bands, many of which span several lobules.

centlobn


Section 2: Definitions

Here, we distinguish between thickening of short, interlobular septa, as seen with lymphangitic carcinoma, and long, parenchymal bands and subpleural lines.

Parenchymal bands (also known as long scars) are thickened interlobular septa that span more than one lobule in the absence of crossing septal thickening. They are usually perpendicular to, and touch, the pleura.

Subpleural lines are curvilinear opacities that parallel the pleura.

Other features illustrated here are subpleural nodules, which represent subpleural parenchymal scar, and honeycombing, which represents enlargement of air spaces (alveolar ducts) surrounded by scar (of collapsed alveolar walls). Honeycombing will be described again later.


Section 3

Image 1

 

Find 2 examples of architectural distortion--tenting of the pleura--one in each lung.

Find 2 adjacent centrilobular nodules in the left lung.

Find 2 examples of subpleural lines, one in each lung.

tentpl1tentpl2spl1spl2cln

Image 2

Find a group of 3 centrilobular nodules in the right lung.


Section 4: Gross Appearance

Parenchymal Bands and Subpleural Lines

This lung shows many long, thin lines. The long, non-branching ones correspond to parenchymal bands. Most of the lines form polygons, indicating a patchy fibrosis of interlobular septa. In addition, there are subpleural lines that parallel the pleura, probably representing, in part, interlobular septa bordering partially collapsed lobules. A few centrilobular nodules can be seen.

Find and follow a parenchymal band.

Find a subpleural line.

Find two centrilobular nodules.

pbandsplineclnod1clnod2

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Case 10--Continued

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1. Disease is bilateral.

2. The structures are in part interlobular septa, but may also include some intralobular fibrosis. Note that these lines extend over more than one lobule. They are referred to as parenchymal or septal bands or long scars.

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Tenting of pleura

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Subpleural line

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Centrilobular nodules

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Parenchymal band

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Centrilobular nodules

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Parenchymal band

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Subpleural line

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Centrilobular nodule. The septal line to the right of the nodule may represent a subpleural line.

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