Table 4 Summary for the diagnostic approach for the various etiologies of centri-lobular pulmonary nodules
From: Centri-lobular pulmonary nodules on HRCT: incidence and approach for etiological diagnosis
Diagnosis | Age | Clinical data | Lesion distribution | Centri-lobular nodule shape | Associated CT chest findings | Need for other investigation |
|---|---|---|---|---|---|---|
HP | Young and middle age | History of allergen exposure Chronic cough Difficulty in breathing Chest tightness | Bilateral, diffuse, mainly upper and middle lobes | Ill defined | Ground glass opacities and air trapping (mosaic attenuation) in subacute type Mainly upper fibrosis in chronic type | Broncho-alveolar lavage |
RB/RB-ILD | Middle age | Smoker Chronic cough Exertional dyspnea | Bilateral, mainly upper lobar | Ill defined | Ground glass opacities, and bronchial wall thickening Reticulations and fibrosis in advanced RB-ILD | |
Bronchiolitis obliterans | Mostly young age | History of toxin inhalation, lung transplantation, or history of atypical infection Dry cough Progressive difficulty in breathing | Segmental or diffuse according to etiology | Well defined | Bronchiectasis, bronchial wall thickening, oligemic lung and air trapping | |
Viral bronchiolitis | Any age | Fever Dry or productive cough Mild chest pain | Differ from bilateral, unilateral, and single lobe to multiple lobes | Mostly well-defined and some ill-defined, tree-in-bud pattern | Bronchial wall thickening, ground glass opacities, atelectasis | Laboratory tests |
Active granulomatous infection | Mostly middle age | Fever and night sweats Chest pain Occasional blood in the sputum Weight loss Loss of appetite Generalized weakness | Bilateral, mostly multi-segmental | Mostly well-defined, tree-in-bud pattern | Bi-apical reticulations, bronchial wall thickening, bronchiectasis, sometimes cavitation, ground glass, and mediastinal lymphadenopathy | Tuberculin test |
Fungal bronchiolitis | Mostly young | Cough with sputum Difficulty in breathing Fever Blood in sputum Weakness | Mostly bilateral, multi-segment, could be single lobe | Mostly well-defined, tree-in-bud pattern | Bronchial wall thickening, bronchiectasis, cavitation | CBC and sputum analysis |
Autoimmune | Middle age | Dry cough Difficulty in breathing | Differ from few to diffuse, single segment to multiple segment, and unilateral to bilateral | Mostly well defined | Peri-lymphatic nodules, ground glass opacities, bronchial wall thickening, bronchiectasis and air trapping | Laboratory studies |
Sarcoidosis | Middle age | Persistent dry cough Chest pain Difficulty in breathing Wheezing | Bilateral, few to multiple, multiple segments, and multiple lobes | well defined | Peri-lymphatic nodules and mediastinal lymphadenopathy Upper lobe fibrosis in advanced case | Kveim test and LN biopsy |
Aspiration pneumonitis | Any age | History of esophageal or neurological disorder Cough with sputum Difficulty in breathing Fever Foul odor breath | Bilateral, multiple segments, mostly posterior segments of upper and lower lobes | Mostly well-defined, tree-in-bud pattern | Ground glass, bronchial wall thickening, bronchiectasis and atelectasis | |
Pulmonary edema | Any age | Cough with sputum Difficulty in breathing especially at night | Bilateral, multiple, multiple segments, middle and lower lobes | Ill defined | Ground glass opacities, smooth interlobular septal thickening, bronchial wall thickening and pleural effusion | Echo-cardiography and laboratory tests |
Alveolar hemochromatosis | Young aged | Fatigue Difficulty in breathing on exertion Joint pain Abdominal pain Failure to gain weight | Bilateral, diffuse, all lung lobes | Ill define and fluffy | Mild interstitial fibrosis and interlobular septal thickening with repeated hemorrhage | Laboratory tests |
Langerhans cell histiocytosis | Young age | Male Dry cough Difficulty in breathing Chest pain Weight loss | Bilateral, multiple, upper and middle lobar predominance | Well defined | Irregular cysts and cavitary lesions | Biopsy |