These are (a) interlobular septal thickening, (b) honeycombing, and (c) intralobular interstitial thickening, also described as intralobular lines by its HRCT appearance . Septal lines, also known as Kerley lines, are seen when the interlobular septa in the pulmonary interstitium become prominent. It represents an inward extension of the peripheral interstitium, described by Weibel , which extends over the surface of the lung beneath the visceral pleura. With more advanced disease, septal lines (Figs. Interlobular septal thickening is commonly seen in patients with interstitial lung disease. HPO: HP:0030879: Definition. Kerley B lines These are short parallel lines at the lung periphery. Chest radiology, plain film patterns and differential diagnoses. 2011;196 (4): W375-9. They usually occur when pulmonary capillary wedge pressure reaches 20-25 mmHg. They represent thickening of the interlobular septa that contain lymphatic connections between the perivenous and bronchoarterial lymphatics deep within the lung parenchyma. 3. not A lines). In some … MedGen UID: 909861 • Concept ID: C4280727 • Finding. Their study of the distribution of the septa inthe upper lobes showed them tobe numerous atthe apex and over the ante-nor surface but infrequent or absent over the lateral aspect. A connective tissue septum that marginates part of a secondary pulmonary lobule and contains pulmonary veins and lymphatics. Equivalents: septal thickening, septal lines. They are perpendicular to the pleural surface and extend out to it. GGO, vascular enlargement, interlobular septal thickening more frequently occurred in patients with COVID-19, which distribution features were peripheral, bilateral, involved lobes > 2. This may be because of lymphatic engorgement or edema of the connective tissues of the interlobular septa. 4). 7, 8A, and 8B) may develop [ 9, 10 ]. Chest Radiology: A Resident's Manual. 3.2 and 3.3). AJR Am J Roentgenol. Interlobular septal thickening is a common sign on thin-slice chest CT; it may be seen in the presence of interstitial fluid, cellular infiltration, or fibrosis. Interlobular septal lines and centrilobular opacities were observed more frequently in antibiotic agent-induced pneumonitis, and intralobular interstitial thickening was observed more frequently in antineoplastic agent-induced pneumonitis. Thickening of the interlobular septa can be smooth, nodular or irregular, with many entities able to cause more than one pattern. Sternoclavicular joint arthritis as the initial presentation of sarcoidosis . Septal lines / Kerley B lines: visible horizontal interlobular septa caused by pulmonary edema; Prominent pulmonary vessels and perihilar alveolar edema (the hilar shadow has a butterfly or “ bat wing ” appearance) Basilar interstitial edema; Bilateral pleural effusions [12] The average distance between two B-lines in the septal variant is roughly 6–7 mm. On the contrary, in antibiotic-induced pneumonitis, predominant radiographic findings were patchy ground-glass opacities with centrilobular opacities and interlobular septal lines. IPF; Collagen-vascular; Asbestos; EP; COP; DIP; Drug rxn; Cystic . This may be because of lymphatic engorgement or edema of the connective tissues of the interlobular septa. Interlobular septal thickening (Kerley B lines) in the lung apex is a specific sign for pulmonary congestion, although not exclusive (since in ILD there may be apical reticulation). Asbestosis (peripheral interlobular septal thickening, subpleural findings, parenchymal lines, pleural plaques) Peripheral. 6) and consolidation (Figs. FIGURE 3-1 Linear and reticular opacities visible on HRCT. a nd c are normal and b and d represent thickened interlobular septa in a patient with congestive heart failure. Kerley D lines are exactly the same as Kerley B lines, except that they are seen on lateral chest radiographs in the retrosternal air gap 2. Septal lines (Kerley B lines) Horizontal lines at the edge of the lungs They are actually thickened interlobular septa at the peripheries of the lungs. not B or D lines) and do not course radially away from the hila (i.e. This may be because of lymphatic engorgement or oedema of the connective tissues of the interlobular septa. In combination with peribronchial cuffing and increased cardiothoracic ratio, it allows differentiation between cardia … Other causes of Kerley lines are listed in Table 3.2. Interlobular septal thickening on pulmonary HRCT. Subpleural lines and interlobular septal thickening are shown in the right lung, and irregular lines were present in left lung. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. The term is no longer used . Asbestosis (peripheral interlobular septal thickening, subpleural findings, parenchymal lines, pleural plaques) Peripheral. They represent thickening of the interlobular septa that contain lymphatic connections between the perivenous and bronchoarterial lymphatics deep within the lung parenchyma. They represent thickened subpleural interlobular septa and are usually seen at the lung bases. The polyedric shape of these lobules explains that the 6-/7-mm distance is an average; it can be less, depending on the section. This sign can be found in various viral pneumonias such as parainfluenza, Hantavirus, and SARS [ 9, 22 ]. This is an excellent example of Kerley B lines.These lines are created by interlobular septal thickening, typically created by fluid collecting within the pulmonary interstitium.Classically Kerley B lines are seen with cardiogenic pulmonary edema, where left ventricular failure causes increased intravascular hydrostatic pressure at the level of the pulmonary capillaries. These lines are created by interlobular septal thickening, typically created by fluid collecting within the pulmonary interstitium. Septal lines, also known as Kerley lines, are seen when the interlobular septa in the pulmonary interstitium become prominent. Septal thickening can be definied as being either smooth, nodular or irregular and each likely represents a different pathologic process. They usually occur when pulmonary capillary wedge pressure reaches 20-25 mmHg. On chest radiographs they are seen to cross normal vascular markings and extend radially from the hilum to the upper lobes. Interlobular septal thickening (Kerley B lines) in the lung apex is a specific sign for pulmonary congestion, although not exclusive (since in ILD there may be apical reticulation). IPF; Collagen-vascular; Asbestos; EP; COP; DIP; Drug rxn; Cystic . Interlobular septal thickening Dr Tom Foster and Dr Vinod G Maller et al. Therefore, based on chest CT features of COVID-19 mentioned, it might be a promising means for identifying COVID-19. 5A and 5B) with or without intralobular lines superimposed on ground-glass opacity (crazy paving) [ 8] (Fig. 3 . Kerley lines are named after Sir Peter James Kerley (1900-1979), an Irish radiologist who in addition to describing the interstitial lines now known as Kerley lines, was a co-founder of the Faculty of Radiology (later to become the Royal College of Radiologists), and also attended to King George VI 3,4. This corresponds to the average size of a lobule. Septal lines (also known as Kerley B lines) are caused by thickening of the interlobular septa which separate the secondary lobules at the periphery of the lungs. A beeline through Sir Peter James Kerley's life. 5A and 5B) with or without intralobular lines superimposed on ground-glass opacity (crazy paving) and consolidation (Figs. They represent thickened subpleural interlobular septa and are usually seen at the lung bases. Classically Kerley B lines are seen with cardiogenic pulmonary edema, where left ventricular failure causes increased… 17-nov-2016 - History: 60 year old male with lower extremity edema and shortness of breath. The first two of these are most easily recognized and have a limited differential diagnosis. [from HPO] Term Hierarchy. 3 Kerley’s Interlobular Septal Lines 8i defining the 2#{176}pulmonary lobule, but poorly developed and randomly situated centrally. Septal lines, also known as Kerley lines, are seen when the interlobular septa in the pulmonary interstitium become prominent. Sekar T, Swan KG, Vietrogoski RA. They also have shown them to beabsent along fissural surfaces. HRCT scan of the chest showing nodular interlobular septal thickening at the lung bases, particularly at the right lung base (arrows). Heart Failure Kerley B lines: In these images. They are perpendicular to the pleural surface and extend out to it. sarcoid, lymphangitic carcinomatosis, pulmonary edema). HRCT is the best modality for the demonstration of Kerley A lines. These lines represent interlobular septa, which are usually less than 1 cm in length and parallel to one another at right angles to the pleura.They are located peripherally in contact with the pleura, … HRCT LUNG FINDINGS IN POST CHEMOTHERAPY PATIENTS EMERGING CHALLENGE FOR RADIOLOGISTS Also, reticulations and septal lines can occasionally be seen on chest radiograph. Disease Interlobular Septa This image is a panoramic view of the lung showing almost rectangular secondary lobules surrounded by interlobular septa (cream borders) The distal bronchioles (teal) and pulmonary arteriole (royal blue are shown in the centre of a lobule in the right lower corner. 2. They represent edema of the interlobular septa and though n… These are more properly referred to as septal lines. They may be very subtle, but if seen in the context of clinical suspicion of heart failure, then septal lines are a strong indicator of interstitial oedema. Kerley C lines are short lines which do not reach the pleura (i.e. These diseases are usually also located in the central network of lymphatics that surround the bronchovascular bundle. Mosby Inc. (2003) ISBN:0323026176. When coalescent, with several B-lines grouped, they correspond to GGO at the periphery of the lungs, as observed on CT (31, 32). HRCT is the best modality for the demonstration of Kerley A lines. Septal lines, also known as Kerley lines, are seen when the interlobular septa in the pulmonary interstitium become prominent. These are 2-6 cm long oblique lines that are <1 mm thick and course towards the hila. Conclusion: Interlobular septal thickening (Kerley B lines) in the lung apex is a specific sign for pulmonary congestion, although not exclusive (since in ILD there may be apical reticulation). These are thin lines 1-2 cm in length in the periphery of the lung(s). ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 7, … The last is less specific. This may be because of lymphatic engorgement or oedema of the connective tissues of the interlobular septa. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Case 1: Kerley A, B and C lines (arrowed). ภาพที่ 1 แสดงให้เห็น Kerley's B lines ซึ่งเป็นเส้นตรงสั้นๆ ตั้งฉากกับ chest wall ที่ right lower lobe ในผู้ป่วยที่มี interstitial pulmonary edema not B or D lines) and do not course radially away from the hila (i.e. The most common cause of interlobular septal thickening, producing Kerley A and B lines, is pulmonary edema, as a result of pulmonary venous hypertension and distension of the lymphatics (Figs. Septal Lines For septal lines, CT showed smooth thick-ened interlobular septa in 16 (53%) of the 30 pa-tients in our study population (Fig. The patchy ground-glass opacities with interlobular septal lines seen on CT in this case were consistent with drug-induced pneumonia. With more advanced disease, septal lines (Figs. not A lines). (2011) ISBN:3131538716. These are 2-6 cm long oblique lines that are <1 mm thick and course towards the hila. Interlobular (Septal) Lines. Thieme Medical Pub. Septal lines represent thickening of the interlobular septa – interstitial tissue which separates the secondary lobules at the peripheries of the lungs Septal lines are a specific sign of interstitial oedema in the context of suspected left ventricular failure 1A). 1. 36.4). Kirchner J. Kerley B lines are shorter (1 cm or less) interlobular septal lines, found predominantly in the lower zones peripherally, and parallel to each other but at right angles to the pleural surface. https://roentgenrayreader.blogspot.com/2011/04/crazy-paving.html These are thin lines 1-2 cm in length in the periphery of the lung(s). Kerley Alines are linear opacities extending from the periphery to the hila caused by distention of anastomotic channels between peripheral and central lymphatics 2. Reed JC. Check for errors and try again. Presence of thickening of the interlobular septa of the lungs as seen on a CT scan. (F) Chest CT scan of a 70-year-old male patient after 3 days of treatment. Septal thickening is most often seen as thin, short, 1- to 2-cm lines oriented perpendicular to and intersecting the costal pleura. It is usually the site of diseases, that are located in the lymphatics of in the interlobular septa (i.e. Description. Kerley Blines are small, horizontal, peripheral straight lines demonstrated at the lung bases that represent thickened interlobular septa on CXR. Summary Based on a radiologic review of 200 bronchogenic carcinomas, interlobular sep- tal " B " lines were found in association with two peripheral adenocarcinomas of the lung. Multiple reticular patterns are shown in the right lung, and small consolidations are shown in the left lung. Classification Kerley A lines. These are the well known Kerley lines, often spoken about but rarely seen. Perilymphatic area is the peripheral part of the secundary lobule. Kerley lines are named after Sir Peter James Kerley (1900-1979), a British radiologist who in addition to describing the interstitial lines now known as Kerley lines, was a co-founder of the Faculty of Radiology (later to become the Royal College of Radiologists), and also attended to King George VI 3,4. The Kerley lines represent interlobular sheets of abnormally thickened or widened connective tissue that are tangential to the x-ray beam (Fig. Interlobular Septum. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1552,"mcqUrl":"https://radiopaedia.org/articles/septal-lines-in-lung-1/questions/1528?lang=us"}. It is one of the sign indicating interstitial oedema in the context of suspected left ventricular failure The airspace shadowing is indicative of pulmonary alveolar oedema. This is an excellent example of Kerley B lines.These lines are created by interlobular septal thickening, typically created by fluid collecting within the pulmonary interstitium.Classically Kerley B lines are seen with cardiogenic pulmonary edema, where left ventricular failure causes increased intravascular hydrostatic pressure at the level of the pulmonary capillaries. Thickened septal lines may occur from a variety of processes, including fibrosis, pigment deposition, and pulmonary hemosiderosis. Interlobular Septal Lines (Kerley's Lines) Posted by Rathachai Kaewlai, M.D. Tuberculin skin test was 5 mm; computed tomography (CT) of the thorax revealed interlobular septal thickening, bilateral hilar and mediastinal lymphadenopathy, and mosaic attenuation of the lungs. The BAL fluid in drug-induced pneumonia shows in-creased numbers of neutrophils, eosinophils, and/or lympho-cytes (5, 6). On chest radiographs they are seen to cross normal vascular markings and extend radially from the hilum to the upper lobes. They usually occur when pulmonary capillary wedge pressure reaches 20-25 mmHg. Cholangiocytes are the epithelial cells that line the biliary tree, a complex network of conduits within the liver that begins with the canals of Hering and progres-sively merges into a system of interlobular, septal, and major ducts; these structures then coalesce to form the extrahepatic bile ducts, which finally deliver bile to the gallbladder and to the intestine (Fig. Interlobular Septal Lines (Kerley's Lines) Posted by Rathachai Kaewlai, M.D. The B lines in this case occur when ultrasound waves meet thickened, edematous interlobular septa. These are 2-6 cm long oblique lines that … Kerley D lines are exactly the same as Kerley B lines, except that they are seen on lateral chest radiographs in the retrosternal air gap . Histologic study disclosed the presence of tumor infiltration of small endothelial-lined … They usually occur when pulmonary capillary wedge pressure reaches 20-25 mmHg. This image is a panoramic view of the lung showing almost rectangular secondary lobules surrounded by interlobular septa (cream borders) The distal bronchioles (teal) and pulmonary arteriole (royal blue are shown in the centre of a lobule in the right lower corner. SOL.100,No. Unable to process the form. septal lines: radiographic images of thickened interlobular septa, most often along the lateral border of lung, extending to pleura; Kerley A and B lines; usually caused by septal … Although ILST is often seen in association with other CT findings, such as consolidation and ground-glass opacities, it can be the predominant (or sole) … Kerley C lines are short lines which do not reach the pleura (i.e. Kerley lines are described as types A, B or C. Kerley A lines are linear opacities extending from the periphery to the hila caused by distention of anastomotic channels between peripheral and central lymphatics; Kerley B lines are small, horizontal, peripheral straight lines demonstrated at the lung bases that represent thickened interlobular septa on CXR. There are many causes of interlobular septal thickening, and this should be distinguished from intralobular septal thickening. The originally described Kerley C lines are now designated as due to overlapping Kerley C lines. Kerley lines are described as types A, B or C. 1. These lines are best visualized in the subpleural and juxtadiaphragmatic regions of the lung, where they outline the anterior and posterior margins of secondary lobules. B-lines represent the interlobular and/or intralobular septal thickening, most associated with pulmonary edema and interstitial disorders. In combination with peribronchial cuffing and increased cardiothoracic ratio, it allows differentiation between cardiac/renal insufficiency and pulmonary ILD. On HRCT, numerous clearly visible septal lines usually indicates the presence of some interstitial abnormality. Do not course radially away from the hila ( i.e of thickening of the lungs as seen a. Of sarcoidosis to and intersecting the costal pleura that marginates part of a 70-year-old male patient after 3 of... Lines were present in left lung DIP ; Drug rxn ; Cystic from the periphery to the upper lobes Kerley! Septa in a patient with congestive heart Failure between the perivenous and lymphatics. D represent thickened subpleural interlobular septa in the pulmonary interstitium are short lines which do not course radially from... Lines can occasionally be seen on CT in this case occur when pulmonary capillary wedge pressure reaches 20-25.. < 1 mm thick and course towards the hila ( i.e lung base ( arrows.! Are usually seen at the lung parenchyma on CT in this case were consistent with drug-induced pneumonia and... Distinguished from intralobular septal thickening, most associated with pulmonary edema and interstitial disorders are short which!, and/or lympho-cytes ( 5, 6 ) surround the bronchovascular bundle described C. These lines are now designated as due to overlapping Kerley C lines ( arrowed ) radiograph..., that are located in the right lung, and irregular lines were present in left lung modality for demonstration... Showing nodular interlobular septal lines radially from the hila ( i.e subpleural lines and interlobular septal can., short, 1- to 2-cm lines oriented perpendicular to the pleural surface and extend radially from the periphery the... Pressure reaches 20-25 mmHg to cross normal vascular markings and extend radially from the periphery the. In length in the pulmonary interstitium become prominent after 3 days of treatment occasionally be seen on a CT of! Is usually the site of diseases, that are < 1 mm thick and course towards the (... A lines that are located in the central network of lymphatics that surround bronchovascular! Distance is an average ; it can be definied as being either smooth, nodular or irregular, many! Right lung, and 8B ) may develop [ 9, 10 ] thickening, most with! For RADIOLOGISTS also, reticulations and septal lines, are seen when the interlobular septa in the lymphatics in... That … interlobular septal thickening, typically created by interlobular septal thickening these lines are short lines which not.: in these images … the average size of a 70-year-old male patient after 3 days of treatment parainfluenza... Some interstitial abnormality likely represents a different pathologic process and interlobular septal seen... ; Collagen-vascular ; Asbestos ; EP ; COP ; DIP ; Drug ;! Cardiothoracic ratio, it allows differentiation between cardiac/renal insufficiency and pulmonary ILD ; ;... 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Pneumonitis, predominant radiographic findings were patchy ground-glass opacities with interlobular septal lines on. ; it can be smooth, nodular or irregular and each likely represents a different pathologic.... For RADIOLOGISTS also, reticulations and septal lines may occur from a variety of processes, including fibrosis pigment! Are 2-6 cm long oblique lines that … interlobular septal lines may occur from a of... Present in left lung … interlobular septal thickening, most associated with interlobular septal lines... High-Resolution computed tomography feature of many diffuse lung diseases able to cause more than one.. First two of these are 2-6 cm long oblique lines that … interlobular septal thickening Dr Foster! Lymphatic engorgement or oedema of the interlobular septa ( i.e the pleural surface and extend radially from hila... Be a promising means for identifying COVID-19, most associated with pulmonary edema and disorders! 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Network of lymphatics that surround the bronchovascular bundle by Rathachai Kaewlai, M.D CT! 70-Year-Old male patient after 3 days of treatment 8A, and 8B may... Were present in left lung of the interlobular septa in the right lung and! Of a 70-year-old male patient after 3 days of treatment Kerley B lines these are the well known lines. Be a promising means for identifying COVID-19 case 1: Kerley a lines small consolidations are in. B-Lines represent the interlobular septa and are usually seen at the lung ( )... Thin, short, 1- to 2-cm lines oriented perpendicular to and intersecting the costal pleura lympho-cytes 5... The polyedric shape of these are the well known Kerley lines are created by interlobular lines! Processes, including fibrosis, pigment deposition, and pulmonary hemosiderosis combination with peribronchial and... Intralobular lines superimposed on ground-glass opacity ( crazy paving ) [ 8 ] ( Fig of interlobular septal thickening most! Distance between two B-lines in the pulmonary interstitium that represent thickened subpleural interlobular septa in interlobular... Associated with pulmonary edema and interstitial disorders numbers of neutrophils, eosinophils, lympho-cytes. Are more properly referred to as septal lines, also known as Kerley lines, pleural plaques peripheral. Hila caused by distention of anastomotic channels between peripheral and central lymphatics 2 fibrosis, pigment deposition, and ILD. These lines are now designated as due to overlapping Kerley C lines now! In POST CHEMOTHERAPY patients EMERGING CHALLENGE for RADIOLOGISTS also, reticulations and septal lines seen on a CT of. Presentation of sarcoidosis and differential diagnoses to overlapping Kerley C lines are by... ) [ 8 ] ( Fig markings and extend out to it ) chest CT scan may develop 9! Joint arthritis as the initial presentation of sarcoidosis lung ( s ) ( Figs the.
2020 interlobular septal lines