Interstitial lung markings on CXR DDx
Overview
Increased interstitial markings seen on chest x-ray may also be referred to as a fine reticular pattern
Features
Peribronchovascular connective tissue thickening
- Peribronchial cuffing (bronchus on-end)
- “Tram tracks” (side view of bronchus)
- Blurred vascular markings (indistinct margins)
Septal connective tissue thickening
- Thickened interlobular septa (called Kerley B or septal lines)
- Fine reticular pattern (Kerley C lines = superimposed Kerley B lines)
- Kerley A lines (thickened deep intraparenchymal septal bands that radiate from the hilum in the upper lungs)
- Thickened interlobar fissures (subpleural connective tissue thickening)
Causes
Acute—often associated with airspace filling
- Interstitial pulmonary edema
- Interstitial pneumonitis — viral, mycoplasma
Chronic interstitial lung diseases
- Neoplastic infiltration (lymphangitic carcinomatosis, lymphoma)
- Sarcoidosis
- Collagen-vascular diseases Interstitial pneumonitis
- Idiopathic pulmonary fibrosis
- Pneumoconiosis (silicosis, asbestosis)
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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