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Radiology · Chest and cardiac imaging: random nodule distribution
Sample itemA febrile patient has 1 to 3 mm nodules on HRCT, scattered evenly through both lungs and involving subpleural, perifissural and central regions without relation to the secondary lobule. Which distribution is this?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Random (haematogenous)
Haematogenous spread, as in miliary tuberculosis or metastases, seeds nodules uniformly with no preference for lymphatic or bronchiolar structures. Distribution analysis on HRCT narrows the differential before any biopsy.
Option by option
A. Perilymphatic
Perilymphatic nodules cluster along the pleura, fissures and bronchovascular bundles, as in sarcoidosis.
B. Centrilobular
Centrilobular nodules spare the pleural surface and stay a few millimetres from it, as in airway disease.
C. Random (haematogenous) (correct)
Correct. An even spread unrelated to lobular anatomy is the random pattern.
D. Segmental lobar
Segmental lobar distribution describes airspace consolidation of a lung segment, not scattered nodules.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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