#infiltrative

[existential-crisis1136]

Downing a mug of caf, and starting to feel jittery, Soren spied the commando. "Thir - Darman." Correcting himself mid-number. "Just return from somewhere?" ~infiltrative

“Hm?” The frown on Darman’s face dropped when he saw Soren, eyebrows raising. He look over his shoulder before making his way to the trooper. “Yeah, I was just in the showers. What’s up?”

[niner1309-archived]

*has a sudden bad feeling for no apparent reason*

[niner1309-archived]

infiltrative

“Hey,” Niner barked. “What’s your designation, trooper?”

[existential-crisis1136]

infiltrative

Darman studied the strange clone on the other side of the mess hall. His face was hard with concentration. He didn’t recognize him.

“Excuse me,” he said as he stalked over. “Are you supposed to be here?”

[radiologyreview]

Diffuse Infiltrative Lung Disease

Air space consolidation

DDX:  Water, Blood, Pus, Cells, Other (lipoid/alveolar proteinosis)

Septal lines 

Kerley A- oblique extension from parahilar region

Kerley B - laterally at CPA

Kerley C - unimportant septal lines en face at the bases

Peribronchial cuffing -  thickening of peribronchovascular interstitium (Kerley A)

HRCT:  interlobular septal thickening is smooth in pulm edema and lymphangitic spread of tumor.  Nodular in sarcoid and lymphangitic spread of tumor.

DDX: Symmetric = hydrostatic pulmonary edema;  Asymmetric = lymphangitic spread of tumor.  Also recurrent pulmonary hemorrhage/hemosiderosis and pulmonary fibrosis.

Reticular or "net like"

multiple intersecting lines outlining irregular spaces; fine, medium (peripheral, posterior, and lower lobe most often), or coarse patterns.

UIP (honeycombing)- IPF, collagen vascular disease (RA and scleroderma), drug related, asbestosis, end-stage HP, end-stage sarcoid

NSIP - associated with collagen vascular disease.  No honeycombing.

Radiation

End-stage ARDS

Cystic lung disease (lung volume is not reduced) - LAM, EG, TS, sjogren, LIP, cystic bronchiectasis, pneumonia, papillomatosis

HRCT:  Traction Bronchiectasis - results from fibrosis even if you don't see.  DDX changes to sarcoidsosi, NSIP, HP.

Nodular Pattern

small nodules few mm to 1cm

Metastasis - diffuse and well-defined

BAC - diffuse and ill-defined

Miliary TB or fungal - diffuse;  TB may be upper lobe

Sarcoid - upper lobe with adenopathy

Silicosis/coal worker's- upper lobe with adenoopathy and eggshell calcs

Histiocytosis - upper lobe with cysts

HP - ill defined

Endobronchial invasion - diffuse/patchy and ill-defined

Reticulonodular - look for predominant pattern and use differential based on that

Ground glass - large ddx based on history.

Source = Thoracic Imaging - Pulmonary and Cardiovascular Radiology, Webb