Secondary Lung Lobule
Normal lung histology
This image is a panoramic view of the lung showing secondary lobules and interlobular septa. Within the interalveolar septae, one sees small venules and lymphatics.Courtesy Armando Fraire MD. 32649b
code lung pulmonary alveoli alveolus secondary lobule interlobular septa vein lymphatic histology
interstitium interstitial
32649b

 

Heart Failure Kerley B lines

In these images. a nd c are normal and b and d represent thickened interlobular septa in a patient with congestive heart failure.  These are the well known Kerley lines, often spoken about but rarely seen.  They are identified as thin horizontal lines usually seen in the costophrenic angles, not being longer than 2cms in length and touching the pleural surface.

 42545c01.800 Ashley Davidoff MD

CHF

Acute  CHF
50 year old female with diabetes, chronic renal failure with congestive heart failure.  CT in the coronal plane shows diffuse ground glass changes, Kerley B lines at the right base, 
Ashley Davidoff MD TheCommonvein.net  50-003-CT
50 year old female with diabetes, chronic renal failure with congestive heart failure.  CT in the coronal plane shows diffuse ground glass changes, Kerley B lines  peribronchial cuffing in the right upper lobe and right lower lobe
Ashley Davidoff MD TheCommonvein.net  50-004-CT
50 year old female with diabetes, chronic renal failure with congestive heart failure.  CT in the coronal plane shows diffuse ground glass changes, peribronchial cuffing and mosaic attenuation
Ashley Davidoff MD TheCommonvein.net  50-005-CT
50 year old female with diabetes, chronic renal failure with congestive heart failure.  CT in the axial plane shows diffuse ground glass changes, thickening of the interlobular septa,  centrilobular nodules  peribronchial cuffing  mosaic attenuation in the  right lower lobe, associated with a complex right sided effusion
Ashley Davidoff MD TheCommonvein.net  50-010-CT
50 year old female with diabetes, chronic renal failure with congestive heart failure.  CT in the coronal plane shows diffuse ground glass changes, thickening of the interlobular septa, and centrilobular nodules  
Ashley Davidoff MD TheCommonvein.net  50-007-CT

Acute Eosinophilic Pneumonia (AEP)can cause features reminiscent of interstitial edema due the extension of the inflammatory process into the Interstitium resulting in Kerley B lines and interstitial edema.

The Secondary Lobule in Acute Eosinophilic Pneumonia (AEP)
This diagram reveals the important structural changes in the secondary lobule that includes filling of the  alveoli  with eosinophils and proteinaceous and fibrinous exudate as well as infiltration into the alveolar septa and interstitium (red walls) .  An important component of the disease is the thickening of the interlobular septa (maroon) which results in Kerley B lines and an interstitial pattern reminiscent of  cardiogenic interstitial edema.  
Ashley Davidoff TheCommonVein.net lungs-0758
Interlobular Septal Infiltration with Eosinophils and Inflammatory Exudate – Thickening of the Interlobular Septa – Crazy Paving Kerley B lines
The diagram shows the thickened septum surrounding the secondary lobule due to an inflammatory process, cellular infiltrate and congestion of the venules and lymphatics in the septum (a) .  An anatomic specimen of a secondary lobule from a patient with thickened interlobular septa is shown in c and overlaid in d.  CT of the lungs in a patient with acute eosinophillic pneumonia shows thickened interlobular septa and centrilobular nodules and the thickened septa are overlaid in red (e).
Ashley Davidoff MD The CommonVein.net 
lungs-0761

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