Kerley C lines are short lines which do not reach the pleura (i.e. These are more properly referred to as septal lines. Classification Kerley A lines. 1A). Septal lines, also known as Kerley lines, are seen when the interlobular septa in the pulmonary interstitium become prominent. Septal lines represent thickening of the interlobular septa – interstitial tissue which separates the secondary lobules at the peripheries of the lungs Septal lines are a specific sign of interstitial oedema in the context of suspected left ventricular failure 36.4). 3.2 and 3.3). Equivalents: septal thickening, septal lines. https://roentgenrayreader.blogspot.com/2011/04/crazy-paving.html Description. The term is no longer used . Their study of the distribution of the septa inthe upper lobes showed them tobe numerous atthe apex and over the ante-nor surface but infrequent or absent over the lateral aspect. 5A and 5B) with or without intralobular lines superimposed on ground-glass opacity (crazy paving) and consolidation (Figs. Septal lines (also known as Kerley B lines) are caused by thickening of the interlobular septa which separate the secondary lobules at the periphery of the lungs. Multiple reticular patterns are shown in the right lung, and small consolidations are shown in the left lung. Kerley B lines are shorter (1 cm or less) interlobular septal lines, found predominantly in the lower zones peripherally, and parallel to each other but at right angles to the pleural surface. Interlobular septal thickening on pulmonary HRCT. Thieme Medical Pub. Septal lines, also known as Kerley lines, are seen when the interlobular septa in the pulmonary interstitium become prominent. Interlobular septal thickening (Kerley B lines) in the lung apex is a specific sign for pulmonary congestion, although not exclusive (since in ILD there may be apical reticulation). Tuberculin skin test was 5 mm; computed tomography (CT) of the thorax revealed interlobular septal thickening, bilateral hilar and mediastinal lymphadenopathy, and mosaic attenuation of the lungs. not B or D lines) and do not course radially away from the hila (i.e. They usually occur when pulmonary capillary wedge pressure reaches 20-25 mmHg. HRCT is the best modality for the demonstration of Kerley A lines. Interlobular septal lines and centrilobular opacities were observed more frequently in antibiotic agent-induced pneumonitis, and intralobular interstitial thickening was observed more frequently in antineoplastic agent-induced pneumonitis. The polyedric shape of these lobules explains that the 6-/7-mm distance is an average; it can be less, depending on the section. With more advanced disease, septal lines (Figs. It is usually the site of diseases, that are located in the lymphatics of in the interlobular septa (i.e. Septal thickening can be definied as being either smooth, nodular or irregular and each likely represents a different pathologic process. These are thin lines 1-2 cm in length in the periphery of the lung(s). These are 2-6 cm long oblique lines that … This is an excellent example of Kerley B lines.These lines are created by interlobular septal thickening, typically created by fluid collecting within the pulmonary interstitium.Classically Kerley B lines are seen with cardiogenic pulmonary edema, where left ventricular failure causes increased intravascular hydrostatic pressure at the level of the pulmonary capillaries. (F) Chest CT scan of a 70-year-old male patient after 3 days of treatment. Thickening of the interlobular septa is a common and easily recognized high-resolution computed tomography feature of many diffuse lung diseases. Kerley lines are named after Sir Peter James Kerley (1900-1979), an Irish radiologist who in addition to describing the interstitial lines now known as Kerley lines, was a co-founder of the Faculty of Radiology (later to become the Royal College of Radiologists), and also attended to King George VI 3,4. On chest radiographs they are seen to cross normal vascular markings and extend radially from the hilum to the upper lobes. They represent thickening of the interlobular septa that contain lymphatic connections between the perivenous and bronchoarterial lymphatics deep within the lung parenchyma. The BAL fluid in drug-induced pneumonia shows in-creased numbers of neutrophils, eosinophils, and/or lympho-cytes (5, 6). Subpleural lines and interlobular septal thickening are shown in the right lung, and irregular lines were present in left lung. This is an excellent example of Kerley B lines.These lines are created by interlobular septal thickening, typically created by fluid collecting within the pulmonary interstitium.Classically Kerley B lines are seen with cardiogenic pulmonary edema, where left ventricular failure causes increased intravascular hydrostatic pressure at the level of the pulmonary capillaries. It represents an inward extension of the peripheral interstitium, described by Weibel , which extends over the surface of the lung beneath the visceral pleura. Interlobular Septal Lines (Kerley's Lines) Posted by Rathachai Kaewlai, M.D. 3. (2011) ISBN:3131538716. These are the well known Kerley lines, often spoken about but rarely seen. The B lines in this case occur when ultrasound waves meet thickened, edematous interlobular septa. Kerley lines are described as types A, B or C. 1. not A lines). They represent thickening of the interlobular septa that contain lymphatic connections between the perivenous and bronchoarterial lymphatics deep within the lung parenchyma. The originally described Kerley C lines are now designated as due to overlapping Kerley C lines. ภาพที่ 1 แสดงให้เห็น Kerley's B lines ซึ่งเป็นเส้นตรงสั้นๆ ตั้งฉากกับ chest wall ที่ right lower lobe ในผู้ป่วยที่มี interstitial pulmonary edema Interlobular Septal Lines (Kerley's Lines) Posted by Rathachai Kaewlai, M.D. These are 2-6 cm long oblique lines that are <1 mm thick and course towards the hila. 4). Sekar T, Swan KG, Vietrogoski RA. Interlobular septal thickening (Kerley B lines) in the lung apex is a specific sign for pulmonary congestion, although not exclusive (since in ILD there may be apical reticulation). Disease Interlobular Septa This image is a panoramic view of the lung showing almost rectangular secondary lobules surrounded by interlobular septa (cream borders) The distal bronchioles (teal) and pulmonary arteriole (royal blue are shown in the centre of a lobule in the right lower corner. They are perpendicular to the pleural surface and extend out to it. 2. This may be because of lymphatic engorgement or edema of the connective tissues of the interlobular septa. Reed JC. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1552,"mcqUrl":"https://radiopaedia.org/articles/septal-lines-in-lung-1/questions/1528?lang=us"}. Heart Failure Kerley B lines: In these images. Presence of thickening of the interlobular septa of the lungs as seen on a CT scan. The first two of these are most easily recognized and have a limited differential diagnosis. Sternoclavicular joint arthritis as the initial presentation of sarcoidosis . 1. The average distance between two B-lines in the septal variant is roughly 6–7 mm. They also have shown them to beabsent along fissural surfaces. Kerley Alines are linear opacities extending from the periphery to the hila caused by distention of anastomotic channels between peripheral and central lymphatics 2. AJR Am J Roentgenol. Other causes of Kerley lines are listed in Table 3.2. 7, … [from HPO] Term Hierarchy. They usually occur when pulmonary capillary wedge pressure reaches 20-25 mmHg. HRCT is the best modality for the demonstration of Kerley A lines. Septal lines, also known as Kerley lines, are seen when the interlobular septa in the pulmonary interstitium become prominent. Kerley D lines are exactly the same as Kerley B lines, except that they are seen on lateral chest radiographs in the retrosternal air gap 2. They are perpendicular to the pleural surface and extend out to it. In combination with peribronchial cuffing and increased cardiothoracic ratio, it allows differentiation between cardia … Chest Radiology: A Resident's Manual. Interlobular septal thickening is commonly seen in patients with interstitial lung disease. HRCT scan of the chest showing nodular interlobular septal thickening at the lung bases, particularly at the right lung base (arrows). There are many causes of interlobular septal thickening, and this should be distinguished from intralobular septal thickening. This may be because of lymphatic engorgement or oedema of the connective tissues of the interlobular septa. Unable to process the form. Perilymphatic area is the peripheral part of the secundary lobule. These are (a) interlobular septal thickening, (b) honeycombing, and (c) intralobular interstitial thickening, also described as intralobular lines by its HRCT appearance . not A lines). FIGURE 3-1 Linear and reticular opacities visible on HRCT. IPF; Collagen-vascular; Asbestos; EP; COP; DIP; Drug rxn; Cystic . This may be because of lymphatic engorgement or edema of the connective tissues of the interlobular septa. GGO, vascular enlargement, interlobular septal thickening more frequently occurred in patients with COVID-19, which distribution features were peripheral, bilateral, involved lobes > 2. These lines are best visualized in the subpleural and juxtadiaphragmatic regions of the lung, where they outline the anterior and posterior margins of secondary lobules. Mosby Inc. (2003) ISBN:0323026176. Asbestosis (peripheral interlobular septal thickening, subpleural findings, parenchymal lines, pleural plaques) Peripheral. The patchy ground-glass opacities with interlobular septal lines seen on CT in this case were consistent with drug-induced pneumonia. HPO: HP:0030879: Definition. Interlobular (Septal) Lines. On HRCT, numerous clearly visible septal lines usually indicates the presence of some interstitial abnormality. 5A and 5B) with or without intralobular lines superimposed on ground-glass opacity (crazy paving) [ 8] (Fig. 2011;196 (4): W375-9. Kerley D lines are exactly the same as Kerley B lines, except that they are seen on lateral chest radiographs in the retrosternal air gap . Septal thickening is most often seen as thin, short, 1- to 2-cm lines oriented perpendicular to and intersecting the costal pleura. Septal Lines For septal lines, CT showed smooth thick-ened interlobular septa in 16 (53%) of the 30 pa-tients in our study population (Fig. Thickening of the interlobular septa can be smooth, nodular or irregular, with many entities able to cause more than one pattern. It is one of the sign indicating interstitial oedema in the context of suspected left ventricular failure The airspace shadowing is indicative of pulmonary alveolar oedema. These diseases are usually also located in the central network of lymphatics that surround the bronchovascular bundle. not B or D lines) and do not course radially away from the hila (i.e. They represent edema of the interlobular septa and though n… Cholangiocytes are the epithelial cells that line the biliary tree, a complex network of conduits within the liver that begins with the canals of Hering and progres-sively merges into a system of interlobular, septal, and major ducts; these structures then coalesce to form the extrahepatic bile ducts, which finally deliver bile to the gallbladder and to the intestine (Fig. They may be very subtle, but if seen in the context of clinical suspicion of heart failure, then septal lines are a strong indicator of interstitial oedema. On chest radiographs they are seen to cross normal vascular markings and extend radially from the hilum to the upper lobes. This image is a panoramic view of the lung showing almost rectangular secondary lobules surrounded by interlobular septa (cream borders) The distal bronchioles (teal) and pulmonary arteriole (royal blue are shown in the centre of a lobule in the right lower corner. Interlobular Septum. 3 . In combination with peribronchial cuffing and increased cardiothoracic ratio, it allows differentiation between cardiac/renal insufficiency and pulmonary ILD. They usually occur when pulmonary capillary wedge pressure reaches 20-25 mmHg. Kerley lines are named after Sir Peter James Kerley (1900-1979), a British radiologist who in addition to describing the interstitial lines now known as Kerley lines, was a co-founder of the Faculty of Radiology (later to become the Royal College of Radiologists), and also attended to King George VI 3,4. Septal lines / Kerley B lines: visible horizontal interlobular septa caused by pulmonary edema; Prominent pulmonary vessels and perihilar alveolar edema (the hilar shadow has a butterfly or “ bat wing ” appearance) Basilar interstitial edema; Bilateral pleural effusions [12] 6) and consolidation (Figs. The Kerley lines represent interlobular sheets of abnormally thickened or widened connective tissue that are tangential to the x-ray beam (Fig. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. sarcoid, lymphangitic carcinomatosis, pulmonary edema). MedGen UID: 909861 • Concept ID: C4280727 • Finding. These are thin lines 1-2 cm in length in the periphery of the lung(s). When coalescent, with several B-lines grouped, they correspond to GGO at the periphery of the lungs, as observed on CT (31, 32). This may be because of lymphatic engorgement or oedema of the connective tissues of the interlobular septa. Kerley lines are described as types A, B or C. Kerley A lines are linear opacities extending from the periphery to the hila caused by distention of anastomotic channels between peripheral and central lymphatics; Kerley B lines are small, horizontal, peripheral straight lines demonstrated at the lung bases that represent thickened interlobular septa on CXR. septal lines: radiographic images of thickened interlobular septa, most often along the lateral border of lung, extending to pleura; Kerley A and B lines; usually caused by septal … Chest radiology, plain film patterns and differential diagnoses. They usually occur when pulmonary capillary wedge pressure reaches 20-25 mmHg. Septal lines, also known as Kerley lines, are seen when the interlobular septa in the pulmonary interstitium become prominent. These are 2-6 cm long oblique lines that are <1 mm thick and course towards the hila. Therefore, based on chest CT features of COVID-19 mentioned, it might be a promising means for identifying COVID-19. HRCT LUNG FINDINGS IN POST CHEMOTHERAPY PATIENTS EMERGING CHALLENGE FOR RADIOLOGISTS Also, reticulations and septal lines can occasionally be seen on chest radiograph. Conclusion: Interlobular septal thickening (Kerley B lines) in the lung apex is a specific sign for pulmonary congestion, although not exclusive (since in ILD there may be apical reticulation). This sign can be found in various viral pneumonias such as parainfluenza, Hantavirus, and SARS [ 9, 22 ]. A beeline through Sir Peter James Kerley's life. B-lines represent the interlobular and/or intralobular septal thickening, most associated with pulmonary edema and interstitial disorders. 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