Interlobular septal thickening

1. Universidade Federal Fluminense, Niteroi (RJ) Brasil. 2. Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil. 3. Faculdade de Medicina de Petropolis, Petropolis (RJ) Brasil. 4. Santa Casa de Misericordia de Porto Alegre, Porto Alegre (RS) Brasil. 5. Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre (RS) Brasil. A 52-year-old female patient presented with progressive dyspnea. One year prior, she had undergone gastrectomy for gastric cancer. An HRCT scan of the chest revealed nodular interlobular septal thickening (ILST) at the right lung base (Figure 1). Although ILST is often seen in association with other CT findings, such as consolidation and ground-glass opacities, it can be the predominant (or sole) finding, as was the case here. ILST can be smooth, irregular (spiculated), or nodular. Smooth ILST is the most common and least specific of the three and can be found in a large number of venous, lymphatic, and infiltrative diseases, especially pulmonary edema. Irregular ILST is basically indicative of interstitial fibrosis and is seen in patients with fibrotic lung disease; rather than being the predominant finding, it is generally found in association with other fibrotic patterns. Nodular ILST (which was found in our patient) is a finding that is associated with a very specific group of diseases. Although it can be found in cases of amyloidosis, sarcoidosis, lymphoproliferative disorders (lymphomas and lymphocytic interstitial pneumonia), and silicosis, it is an uncommon finding in such cases. It is primarily seen in patients with lymphangitic carcinomatosis (LC).

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