Nodular Pattern

  • Johny A. Verschakelen
  • Walter De Wever
Part of the Medical Radiology book series (MEDRAD)


The CT assessment of the nodular pattern, which is characterised by the presence of multiple nodular opacities with a maximum diameter of 3 cm, is typically based on the study of the nodule characteristics (appearance pattern) and on the study of the distribution of the nodules (distribution pattern). This chapter explains how the study of the borders and the density of the nodules together with the study of their regional distribution and of their relation to the components of the secondary pulmonary lobule is very helpful in the diagnosis.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Akira M (2002) High-resolution CT in the evaluation of occupational and environmental disease. Radiol Clin North Am 40:43–59CrossRefPubMedGoogle Scholar
  2. Akira M, Kitatani F, Lee Y-S et al (1988) Diffuse panbronchiolitis: evaluation with high-resolution CT. Radiology 168:433–438CrossRefPubMedGoogle Scholar
  3. Akira M, Atagi S, Kawahara M et al (1999) High-resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients. AJR Am J Roentgenol 173:1623–1629CrossRefPubMedGoogle Scholar
  4. Akira M, Kozuka T, Inoue Y et al (2005) Long-term follow-up CT scan evaluation in patients with pulmonary sarcoidosis. Chest 127:185–191CrossRefPubMedGoogle Scholar
  5. Andreu J, Mauleon S, Pallisa E et al (2002) Miliary lung disease revisited. Curr Probl Diagn Radiol 31:189–197CrossRefPubMedGoogle Scholar
  6. Antao VC, Pinheiro GA, Terra-Filho M et al (2005) High-resolution CT in silicosis: correlation with radiographic findings and functional impairment. J Comput Assist Tomogr 29:350–356CrossRefPubMedGoogle Scholar
  7. Aquino SL, Gamsu G, Webb WR et al (1996) Tree-in-bud pattern: frequency and significance on thin section CT. J Comput Assist Tomogr 20:594–599CrossRefPubMedGoogle Scholar
  8. Austin J, Muller N, Friedman P et al (1996) Glossary of terms for CT of the lungs: recommendations of the nomenclature committee of the Fleischner Society. Radiology 200:327–331CrossRefPubMedGoogle Scholar
  9. Ayuso MC, Gilabert R, Bombi JA et al (1987) CT appearance of localized pulmonary amyloidosis. J Comput Assist Tomogr 11:197–199CrossRefPubMedGoogle Scholar
  10. Bégin R, Bergeron D, Samson L et al (1987) CT assessment of silicosis in exposed workers. AJR Am J Roentgenol 148:509–514CrossRefPubMedGoogle Scholar
  11. Bergin CJ, Müller NL (1987) CT of interstitial lung disease: a diagnostic approach. AJR Am J Roentgenol 148:9–15CrossRefPubMedGoogle Scholar
  12. Bergin CJ, Bell DY, Coblentz CL et al (1989) Sarcoidosis: correlation of pulmonary parenchymal pattern at CT with results of pulmonary function tests. Radiology 171:619–624CrossRefPubMedGoogle Scholar
  13. Braun SR, DoPico GA, Tsiatis A et al (1979) Farmer’s lung disease: long-term clinical and physiologic outcome. Am Rev Respir Dis 119:185–191PubMedGoogle Scholar
  14. Brauner MW, Grenier P, Mompoint D et al (1989) Pulmonary sarcoidosis: evaluation with high-resolution CT. Radiology 172:467–471CrossRefPubMedGoogle Scholar
  15. Brauner MW, Lenoir S, Grenier P et al (1992) Pulmonary sarcoidosis: CT assessment of lesion reversibility. Radiology 182:349–354CrossRefPubMedGoogle Scholar
  16. Brown K, Mund DF, Aberle DR et al (1994) Intrathoracic calcifications: radiographic features and differential diagnosis. Radiographics 14:1247–1261CrossRefPubMedGoogle Scholar
  17. Chan ED, Morales DV, Welsh CH et al (2002) Calcium deposition with or without bone formation in the lung. Am J Respir Crit Care Med 165:1654–1669CrossRefPubMedGoogle Scholar
  18. Cluzel P, Grenier P, Bernadac P et al (1991) Pulmonary alveolar microlithiasis: CT findings. J Comput Assist Tomogr 15:938–942CrossRefPubMedGoogle Scholar
  19. Colby TV, Swensen SJ (1996) Anatomic distribution and histopathologic patterns in diffuse lung disease: correlation with HRCT. J Thorac Imaging 11:1–26CrossRefPubMedGoogle Scholar
  20. Collins J (2001) CT signs and patterns of lung disease. Radiol Clin North Am 39:1115–1135CrossRefPubMedGoogle Scholar
  21. Collins J, Blankenbaker D, Stern EJ (1998) CT patterns of bronchiolar disease: what is tree-in-bud? AJR Am J Roentgenol 171:365–370CrossRefPubMedGoogle Scholar
  22. Cotton A, Boutry N, Cortet B (1998) Percutaneous vertebroplasty: state of the art. Radiographics 18:311–320CrossRefGoogle Scholar
  23. Dawson WB, Müller NL (1990) High-resolution computed tomography in pulmonary sarcoidosis. Semin Ultrasound CT MR 11:423–429PubMedGoogle Scholar
  24. Eisenhuber E (2002) The tree-in-bud sign. Radiology 222:771–772CrossRefPubMedGoogle Scholar
  25. Franquet T, Giménez A, Prats R et al (2002) Thrombotic microangiopathy of pulmonary tumors: a vascular cause of tree-in-bud pattern on CT. AJR 179:897–899CrossRefPubMedGoogle Scholar
  26. Gaeta M, Blandino A, Scribano E et al (1999) Computed tomography halo sign of pulmonary nodules: frequency and diagnostic value. J Thorac Imaging 14:109–113CrossRefPubMedGoogle Scholar
  27. Gallardo X, Castaner E, Mata J et al (2006) Nodular pattern at lung computed tomography in fat embolism syndrome. A helpful finding. J Comput Assist Tomogr 30:254–257CrossRefPubMedGoogle Scholar
  28. Graham CM, Stern EJ, Finkbeiner WE et al (1992) High-resolution CT appearance of diffuse alveolar septal amyloidosis. AJR Am J Roentgenol 158:265–267CrossRefPubMedGoogle Scholar
  29. Grenier P, Valeyre D, Cluzel P et al (1991) Chronic diffuse interstitial lung disease: diagnostic value of chest radiography and high-resolution CT. Radiology 179:123–132CrossRefPubMedGoogle Scholar
  30. Gross BH, Schneider HJ, Proto AV (1980) Eggshell calcification of lymph nodes: an update. AJR Am J Roentgenol. 135(6):1265–1268Google Scholar
  31. Gruden JF, Webb WR (1995) Identification and evaluation of centrilobular opacities on high-resolution CT. Semin Ultrasound CT MR 16:435–449CrossRefPubMedGoogle Scholar
  32. Gruden JF, Webb WR, Warnock M (1994) Centrilobular opacities in the lung on high-resolution CT: diagnostic considerations and pathologic correlation. AJR Am J Roentgenol 162:569–574CrossRefPubMedGoogle Scholar
  33. Hansell DM, Bankier A, MacMahon H et al (2008) Fleischner society: glossary of terms for thoracic imaging. Radiology 246:697–722CrossRefPubMedGoogle Scholar
  34. Heo JN, Choi YW, Jeon SC et al (2005) Pulmonary tuberculosis: another disease showing clusters of small nodules. AJR Am J Roentgenol 184(2):639–642CrossRefPubMedGoogle Scholar
  35. Hirakata K, Nakata H, Haratake J (1993) Appearance of pulmonary metastases on high-resolution CT scans: comparison with histopathologic findings from autopsy specimens. AJR Am J Roentgenol 161:37–43CrossRefPubMedGoogle Scholar
  36. Honda O, Johkoh T, Icfhikado K et al (1999) Differential diagnosis of lymphocytic interstitial pneumonia and malignant lymphoma on high-resolution CT. AJR Am J Roentgenol 173:71–74CrossRefPubMedGoogle Scholar
  37. Hong SH, Im JG, Lee JS et al (1998) High resolution CT findings of military tuberculosis. J Comput Assist Tomogr 22:220–224CrossRefPubMedGoogle Scholar
  38. Howling SJ, Hansell DM, Wells AU et al (1999) Follicular bronchiolitis: thin-section CT and histologic findings. Radiology 212:637–642CrossRefPubMedGoogle Scholar
  39. Im JG, Itoh H, Shim YS et al (1993) Pulmonary tuberculosis: CT findings – early active disease and sequential change with antituberculous therapy. Radiology 186:653–660CrossRefPubMedGoogle Scholar
  40. Im JG, Itoh H, Han MC (1995) CT of pulmonary tuberculosis. Semin Ultrasound CT MR 16:420–434CrossRefPubMedGoogle Scholar
  41. Itoh H, Tokunaga S, Asamoto H et al (1978) Radiologic-pathologic correlations of small lung nodules with special reference to peribronchiolar nodules. AJR Am J Roentgenol 130:223–231CrossRefPubMedGoogle Scholar
  42. Johkoh T, Ikezoe J, Tomiyama N et al (1992) CT findings in lymphangitic carcinomatosis of the lung: correlation with histologic findings and pulmonary function tests. AJR Am J Roentgenol 158:1217–1222CrossRefPubMedGoogle Scholar
  43. Johkoh T, Muller NL, Pickford HA et al (1999) Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients. Radiology 212:567–572CrossRefPubMedGoogle Scholar
  44. Kim HY, Im J-G, Song K-S et al (1999) Localized amyloidosis of the respiratory system: CT features. J Comput Assist Tomogr 23:627–631CrossRefPubMedGoogle Scholar
  45. Kokkarinen J, Tukiainen H, Terho EO (1994) Mortality due to farmer’s lung in Finland. Chest 106:509–512CrossRefPubMedGoogle Scholar
  46. Lee KS, Kim TS, Han J et al (1999) Diffuse micronodular lung disease: HRCT and pathologic findings. J Comput Assist Tomogr 23:99–106CrossRefPubMedGoogle Scholar
  47. Lynch DA, Webb WR, Gamsu G et al (1989) Computed tomography in pulmonary sarcoidosis. J Comput Assist Tomogr 13:405–410CrossRefPubMedGoogle Scholar
  48. Lynch DA, Brasch RC, Hardy KA et al (1990) Pediatric pulmonary disease: assessment with high-resolution ultrafast CT. Radiology 176:243–248CrossRefPubMedGoogle Scholar
  49. Maile CW, Rodan BA, Godwin JD et al (1982) Calcification in pulmonary metastases. Br J Radiol 55:108–113CrossRefPubMedGoogle Scholar
  50. Marchiori E, Souza AS, Franquet T et al (2005) Diffuse high-attenuation pulmonary abnormalities: a pattern-oriented diagnostic approach on high-resolution CT. AJR Am J Roentgenol 184:273–282CrossRefPubMedGoogle Scholar
  51. Marchiori E, Zanetti G, Hochhegger B et al (2011) Sarcoid cluster sign and the reversed halo sign: extending the spectrum of radiographic manifestations in sarcoidosis. Eur J Radiol 80(2):567–568Google Scholar
  52. Milne EN, Zerhouni EA (1987) Blood supply of pulmonary metastases. J Thorac Imaging 2:15–23CrossRefPubMedGoogle Scholar
  53. Mohr LC (2004) Hypersensitivity pneumonitis. Curr Opin Pulm Med 10:401–411CrossRefPubMedGoogle Scholar
  54. Muller N, Fraser R, Lee K et al (2003a) Pulmonary infection. In: Muller N, Fraser R, Lee K (eds) Diseases of the lung. Radiologic and pathologic correlations, 1st edn. Lippincott, Philadelphia, pp 17–76Google Scholar
  55. Muller N, Fraser R, Lee K et al (2003b) Occupational lung disease. In: Muller N, Fraser R, Lee K (eds) Diseases of the lung. Radiologic and pathologic correlations, 1st edn. Lippincott, Philadelphia, pp 183–207Google Scholar
  56. Muller N, Fraser R, Lee K et al (2003c) Bronchiolitis. In: Muller N, Fraser R, Lee K (eds) Diseases of the lung. Radiologic and pathologic correlations, 1st edn. Lippincott, Philadelphia, pp 287–307Google Scholar
  57. Muller N, Fraser R, Lee K et al (2003d) Miscellaneous pulmonary diseases. In: Muller N, Fraser R, Lee K (eds) Diseases of the lung. Radiologic and pathologic correlations, 1st edn. Lippincott, Philadelphia, pp 352–376Google Scholar
  58. Müller NL, Kullnig P, Miller RR (1989) The CT findings of pulmonary sarcoidosis: analysis of 25 patients. AJR Am J Roentgenol 152:1179–1182CrossRefPubMedGoogle Scholar
  59. Müller NL, Miller RR (1995) Diseases of the bronchioles: CT and histopathologic findings. Radiology 196:3–12CrossRefPubMedGoogle Scholar
  60. Murata K, Itoh H, Todo G et al (1986) Centrilobular lesions of the lung: demonstration by high-resolution CT and pathologic correlation. Radiology 161:641–645CrossRefPubMedGoogle Scholar
  61. Murata K, Herman PG, Khan A et al (1989) Intralobular distribution of oleic acid-induced pulmonary edema in the pig: evaluation by high-resolution CT. Invest Radiol 24:647–653CrossRefPubMedGoogle Scholar
  62. Murata K, Takahashi M, Mori M et al (1992) Pulmonary metastatic nodules: CT-pathologic correlation. Radiology 182:331–335CrossRefPubMedGoogle Scholar
  63. Naidich DP, Zerhouni EA, Hutchins GM et al (1985) Computed tomography of the pulmonary parenchyma. Part 1: distal airspace disease. J Thorac Imaging 1:39–53CrossRefPubMedGoogle Scholar
  64. Nakatsu M, Hatabu H, Morikawa K et al (2002) Large coalescent parenchymal nodules in pulmonary sarcoidosis: “sarcoidgalaxy” sign. AJR Am J Roentgenol 178(6):1389–1393Google Scholar
  65. Nishimura K, Kitaichi M, Izumi T et al (1992) Diffuse panbronchiolitis: correlation of high-resolution CT and pathologic findings. Radiology 184:779–785CrossRefPubMedGoogle Scholar
  66. Nishimura K, Itoh H, Kitaichi M et al (1993) Pulmonary sarcoidosis: correlation of CT and histopathologic findings. Radiology 189:105–109CrossRefPubMedGoogle Scholar
  67. Oh YW, Kim YH, Lee NJ et al (1994) High-resolution CT appearance of miliary tuberculosis. J Comput Asist Tomogr 18:862–866CrossRefGoogle Scholar
  68. Okada F, Ando Y, Yoshitake S et al (2007) Clinical/pathologic correlations in 553 patients with primary centrilobular findings on high-resolution CT scan of the thorax. Chest 132(6):1939–1948Google Scholar
  69. Paslawski M, Szafranek J, Krupski W et al (2003) Differentiation of etiology of nodular changes in high resolution computed tomography (HRCT) in interstitial lung diseases. Ann Univ Mariae Curie Sklodowska 58:370–377Google Scholar
  70. Patti A, Tognini G, Spaggiari E et al (2004) Diffuse, micronodular lung disease. The high-resolution CT approach. A pictorial essay. Radiol Med (Torino) 107:139–144Google Scholar
  71. Raoof S, Amchentsev A, Vlahos I et al (2006) Pictorial essay: multinodular disease. A high-resolution CT scan diagnostic algorithm. Chest 129:805–815CrossRefPubMedGoogle Scholar
  72. Remy-Jardin M, Beuscart R, Sault MC et al (1990) Subpleural micronodules in diffuse infiltrative lung diseases: evaluation with thin-section CT scans. Radiology 177:133–139CrossRefPubMedGoogle Scholar
  73. Remy-Jardin M, Remy J, Boulenguez C et al (1993a) Morphologic effects of cigarette smoking on airways and pulmonary parenchyma in healthy adult volunteers: CT evaluation and correlation with pulmonary function tests. Radiology 186:107–115CrossRefPubMedGoogle Scholar
  74. Remy-Jardin M, Remy J, Gosselin B et al (1993b) Lung parenchymal changes secondary to cigarette smoking: pathologic CT correlations. Radiology 186:643–651CrossRefPubMedGoogle Scholar
  75. Ren H, Hruban RH, Kuhlman JE et al (1989) Computed tomography of inflation-fixed lungs: the beaded septum sign of pulmonary metastases. J Comput Assist Tomogr 13:411–416CrossRefPubMedGoogle Scholar
  76. Tsuchiya R (2005) Implication of the CT characteristics of subcentimeter pulmonary nodules. Semin Thorac Cardiovasc Surg 17:107–109CrossRefPubMedGoogle Scholar
  77. Urban BA, Fishman EK, Goldman SM et al (1993) CT evaluation of amyloidosis: spectrum of disease. Radiographics 13:1295–1308CrossRefPubMedGoogle Scholar
  78. Utz JP, Swensen SJ, Gertz MA (1996) Pulmonary amyloidosis. The Mayo clinic experience from 1980 to 1993. Ann Intern Med 124:407–413CrossRefPubMedGoogle Scholar
  79. Voloudaki AE, Tritou IN, Magkanas EG et al (1999) HRCT in miliary lung disease. Acta Radiol 40:451–456CrossRefPubMedGoogle Scholar
  80. Ward S, Heyneman LE, Reittner P et al (2000) Talcosis associated with IV abuse of oral medications: CT findings. AJR Am J Roentgenol 174:789–793CrossRefPubMedGoogle Scholar
  81. Webb WR (1989) High-resolution CT of the lung parenchyma. Radiol Clin North Am 27:1085–1097PubMedGoogle Scholar
  82. Xia L, Li E, Gong J et al (2002) Role of high resolution CT in pulmonary nodules. Zhonghua Zhong Liu Za Zhi 24:494–496PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2018

Authors and Affiliations

  • Johny A. Verschakelen
    • 1
  • Walter De Wever
    • 1
  1. 1.Department of RadiologyUZ LeuvenLeuvenBelgium

Personalised recommendations