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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