However, in patients with small subpleural
lesions, a better diagnostic yield has been reported with an indirect approach that involves a longer intrapulmonary needle path (28, 32).
Macroscopic and microscopic pulmonary findings supporting the diagnosis of SUDEP Macroscopic Evaluation n % Subpleural
petechiae 16 14.
Caption: CECT Chest showing Subpleural
and Parenchymal Haemorrhagic Metastasis
Chest computed tomography showed ground-glass opacities and subpleural
curvilinear shadows in the lower lobes of both lungs (Figure 1b).
10) Computed tomography (CT) of the chest can detect small pneumothoraces as well as reveal pneumatoceles and subpleural
blebs secondary to PCP infection; these will appear as thin-walled cystic structures with almost imperceptible walls in the subpleural
space and lung parenchyma.
NSIP, the most common pattern of fibrosis seen in DI-ILD, is characterized by basal-predominant subpleural
reticular opacities, an absence of honeycombing pattern and scattered ground glass opacities.
5,8) The gradient of negative pleural pressure increases from the lung base to the apex, so that alveoli at the lung apex in tall individuals are subject to significantly greater distending pressure than those at the base of the lung, and the vectors in theory, predispose to the development of apical subpleural
Thoracic scan results showed cylindrical bronchiectasis and subpleural
consolidations in both lungs; culture of a sputum sample obtained on October 22 was positive for N.
Microscopic description: inflamed lung tissue showing nodular collection of lymphocytes and subpleural
granulomas with multinucleated giant cells.
The characteristic imaging findings of ELP on high resolution CT chest (HRCT) can be summarized into three major categories: (1) alveolar filling (ground glass pattern) with or without crazy paving, often with subpleural
sparing, (2) consolidative pulmonary lesion with spontaneous angiogram sign on unenhanced HRCT (pulmonary vessels may spontaneously be visible within the areas of parenchymal filling without IV contrast), and (3) low-density pulmonary consolidation (-30 to -150 Hounsfield units) in a bronchocentric distribution [16-18].
It is proposed that it is inflammatory in nature, causing newly formed vessels bridging subpleural
pulmonary veins and intercostal veins through pleural adhesions .
Typical findings of small centrilobular, subpleural
nodules, and heterogeneous conglomerate masses containing high-density amorphous areas, with or without panlobular emphysema in the lower lobes, are highly suggestive of pulmonary talcosis [6, 7].