Septal Pattern
A septal pattern is present when thickening of the perilobular interstitium and bronchovascular bundle, both in the centrilobular core and at the central level, is visible. The final effect is that of a regular network of white lines. Lobular architecture
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Septal pattern Septal signs
Giorgia Dalpiaz Alessandra Cancellieri
Definition Septal thickening Subpleural Interstitial thickening Peribronchovascular thickening
Subset smooth and table Subset nodular and table
© Springer International Publishing Switzerland 2017 G. Dalpiaz, A. Cancellieri (eds.), Atlas of Diffuse Lung Diseases, DOI 10.1007/978-3-319-42752-2_3
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Septal Pattern
Radiology Pathology
Septal Pattern
Dalpiaz & Cancellieri
SEPTAL PATTERN Definition
A septal pattern is present when thickening of the perilobular interstitium and bronchovascular bundle, both in the centrilobular core and at the central level, is visible. The final effect is that of a regular network of white lines. Lobular architecture is preserved. Septal pattern can be smooth or nodular in contour depending on the different pathological processes. The septal pattern may be due to the filling of the interstitium by fluid, neoplastic cells, or inflammation. Reticular pattern with preserved architecture, regular linear pattern
Reticular pattern may be also “irregular” due to fibrosis, and therefore this subtype is included and explained in the fibrosing pattern. In this case, the architecture is not preserved resulting in a distorted net. The signs of septal pattern are: • Septal thickening • Subpleural interstitial thickening • Peribronchovascular thickening The prevalent distribution of the signs together with the presence of non-parenchymal signs may be helpful for the diagnosis of a specific disease (please see also the tables at the end of this chapter). As well as in septal diseases, in which this pattern is predominant, there are other diseases in which septal pattern (reticular pattern with preserved architecture) may be found, albeit less important or sporadic. They are therefore described in the relevant chapter (e.g., associated with ground-glass opacity in diffuse alveolar hemorrhage, pneumonia, and NSIP or associated with nodules and/or cysts in LIP). Andreu J (2004) Septal thickening: HRCT findings and differential diagnosis. Curr Probl Diagn Radiol 33(5):226 Hansell DM (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246(3):697 Webb WR (2006) Thin-section CT of the secondary pulmonary lobule: anatomy and the image – the 2004 Fleischner lecture. Radiology 239(2):322
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Atlas of Diffuse Lung Diseases
Septal Signs
Dalpiaz & Cancellieri
SEPTAL SIGNS Septal Thickening
White lines 1–2 cm in length outlining the polygonal boundaries of secondary lobules. A few lines inside the lobule may be also visible. Lobules delineated by thickened septa (¨) commonly contain a visible dot-like or branching centrilobular pulmonary artery (►). Pathologically, septal thickening may be due to interstitial fluid or cellular infiltration; the latter may be secondary to nonneoplastic or neoplastic diseases (e.g., lymphangitic carcinomatosis; please see both pictures below ¨). Interlobular septal thickening, septal lines, Kerley’s lines
Diffuse interlobular sept
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