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Table 5 Thoracic imaging patterns

From: Diagnosis and management of interstitial lung disease

Imaging modality Pattern Consistent ILD diagnoses, mimics of ILD, and/or complications of ILD
Routine CXR Hilar lymphadenopathy Sarcoidosis, silicosis, CBD, infection, malignancy
Septal thickening CHF, malignancy, infection, PVOD
Lower lung zone predominance IPF, asbestosis, DIP, CTD, NSIP
Mid/upper lung zone predominance Sarcoidosis, silicosis, acute HP, LCH, CBD, AS, chronic EP
Peripheral lung zone predominance COP, chronic EP, IPF
Honeycomb change IPF, asbestosis, chronic HP, sarcoidosis, fibrotic NSIP, CTD
Small nodules Sarcoidosis, HP, infection
Cavitating nodules PAG, mycobacterial infection, CA
Migratory or fluctuating opacities HP, COP, DIP
Pneumothorax PLCH, LAM, neurofibromatosis, TS
Pleural involvement Asbestosis, CTD, acute HP, malignancy, sarcoidosis, Radiation fibrosis
Kerley B line prominence Lymphangitic carcinomatosis, CHF
HRCT Nodules Sarcoidosis HP, CBD, pneumoconiosis, RA, malignancy
Septal thickening Edema, malignancy, infection, drug toxicity, PVOD
Cyst formation LAM, LCH, LIP, DIP, SS
Reticular lines IPF, asbestosis, chronic EP, chronic HP, CTD, NSIP
Traction bronchiectasis IPF, other end-stage fibrosis
Honeycomb change IPF, chronic EP and HP, asbestosis, sarcoidosis
Ground-glass opacity AIP, acute EP, PAP, chronic EP, COP, lymphoma, sarcoidosis, NSIP, infection, hemorrhage
  1. AIP = acute interstitial pneumonia; AS = ankylosing spondylitis; CA = cancer; CBD = chronic beryllium diseases; COP = cryptogenic organizing pneumonia; CTD = connective tissue disease; DAH = diffuse alveolar hemorrhage; DM-PM = dermatopolymyositis; DIP = desquamative interstitial pneumonia; EP = eosinophilic pneumonia; HP = hypersensitivity pneumonitis; HPS = Hermansky-Pudlak syndrome; IPF = idiopathic pulmonary fibrosis; LAM = lymphangioleiomyomatosis; LCH = Langerhans cell histiocytosis; LIP = lymphoid interstitial pneumonia; NF = neurofibromatosis; NSIP = non-specific interstitial pneumonia; PAG = polyangiitis with granulomatosis; PAP = pulmonary alveolar proteinosis; P2 = auscultated pulmonic valve closure sound; PH = npulmonary hypertension; PVOD = pulmonary veno-occlusive disease; RA = rheumatoid arthritis; SLE = systemic lupus erythematosus; SS = Sjögren’s syndrome; TS = tuberous sclerosis.
  2. Reprinted with permission from Interstitial Lung Disease: A Practical Approach. Meyer KC, Raghu G: Patient evaluation. Second Edition, New York: Springer; 2011:3–16.