- What is it:
The arcade-like sign in the lungs refers to the appearance of curvilinear or arched opacities in the peripheral lung parenchyma, forming a loop or “arcade” pattern. It represents perilobular fibrosis, often seen in organizing pneumonia or other fibrotic lung diseases.
- Etymology:
Derived from “arcade,” meaning a series of arches, describing the curved arrangement of linear opacities.
- AKA:
Perilobular pattern.
How does it appear on each relevant imaging modality?
- Chest X-ray (CXR):
- May not be clearly visible.
- Peripheral opacities can suggest the presence of organizing pneumonia but lack the detail for the arcade-like pattern.
- CT (Chest CT):
- Parts: Curvilinear opacities outlining the secondary pulmonary lobules.
- Size: Corresponds to the boundaries of the secondary pulmonary lobule.
- Shape: Arched or curvilinear.
- Position: Peripheral lung zones; may involve multiple lobes.
- Character: Ground-glass or consolidative density, often with a perilobular distribution.
- Time: Can evolve over weeks to months, either resolving or progressing to fibrosis.
- Differential Diagnosis:
- Cryptogenic organizing pneumonia (COP)
- Chronic eosinophilic pneumonia
- Fibrotic hypersensitivity pneumonitis
- Idiopathic interstitial pneumonias (e.g., NSIP)
- Resolving pulmonary edema
- Pulmonary hemorrhage (perilobular distribution)
- Recommendations:
- Correlate with clinical and laboratory findings (e.g., autoimmune panels, eosinophil count).
- Consider biopsy if the diagnosis remains uncertain and imaging findings are atypical.
- Follow up with serial imaging to assess response to treatment.
Key Points and Pearls:
- Commonly associated with cryptogenic organizing pneumonia (COP).
- The arcade-like sign is often seen in cases with ill-defined linear opacities representing fibrosis along perilobular connective tissues.
- Contrast with honeycombing, which represents end-stage fibrosis with clustered cystic spaces.
- Timely recognition can guide treatment, often involving corticosteroids for organizing pneumonia.
| Feature |
Subpleural Band |
Arcade-like Sign |
Linear Atelectasis |
| Definition |
Linear opacity parallel to the pleura |
Curvilinear opacity outlining lobules |
Thin linear opacity, gravity-dependent |
| Cause |
Chronic fibrosis |
Organizing pneumonia |
Dependent lung collapse |
| Histopathology |
Dense fibrosis in intralobular interstitium |
Fibroblast proliferation in perilobular tissue |
Compressed but reversible alveoli |
| HRCT |
Persistent thin lines; honeycombing may occur |
Perilobular curvilinear opacities; reversible |
Thin lines resolving with position change |
| CXR |
Subtle linear opacity in peripheral lung |
Patchy consolidation or curvilinear lines |
Faint linear opacity in dependent lung regions |
| Reversibility |
Irreversible |
Partially reversible with treatment |
Reversible with positional changes |
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Subpleural Band
Arcade-like Sign
Linear Atelectasis
Definition
Linear opacity parallel to the pleura
Curvilinear opacity outlining lobules
Thin linear opacity, gravity-dependent
Cause
Chronic fibrosis
Organizing pneumonia
Dependent lung collapse
Histopathology
Dense fibrosis in intralobular interstitium
Fibroblast proliferation in perilobular tissue
Compressed but reversible alveoli
HRCT
Persistent thin lines; honeycombing may occur
Perilobular curvilinear opacities; reversible
Thin lines resolving with position change
CXR
Subtle linear opacity in peripheral lung
Patchy consolidation or curvilinear lines
Faint linear opacity in dependent lung regions
Reversibility
Irreversible
Partially reversible with treatment
Reversible with positional changes
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Subpleural Band
Arcade-like Sign
Linear Atelectasis
Definition
Linear opacity parallel to the pleura
Curvilinear opacity outlining lobules
Thin linear opacity, gravity-dependent
Cause
Chronic fibrosis
Organizing pneumonia
Dependent lung collapse
Histopathology
Dense fibrosis in intralobular interstitium
Fibroblast proliferation in perilobular tissue
Compressed but reversible alveoli
HRCT
Persistent thin lines; honeycombing may occur
Perilobular curvilinear opacities; reversible
Thin lines resolving with position change
CXR
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Patchy consolidation or curvilinear lines
Faint linear opacity in dependent lung regions
Reversibility
Irreversible
Partially reversible with treatment
Reversible with positional changes
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DOMElement Object
(
[schemaTypeInfo] =>
[tagName] => td
[firstElementChild] => (object value omitted)
[lastElementChild] => (object value omitted)
[childElementCount] => 1
[previousElementSibling] =>
[nextElementSibling] => (object value omitted)
[nodeName] => td
[nodeValue] => Feature
[nodeType] => 1
[parentNode] => (object value omitted)
[childNodes] => (object value omitted)
[firstChild] => (object value omitted)
[lastChild] => (object value omitted)
[previousSibling] => (object value omitted)
[nextSibling] => (object value omitted)
[attributes] => (object value omitted)
[ownerDocument] => (object value omitted)
[namespaceURI] =>
[prefix] =>
[localName] => td
[baseURI] =>
[textContent] => Feature
)
