Computed tomography of inflation-fixed lungs: The beaded septum sign of pulmonary metastases

Hua Ren, Ralph H. Hruban, Janet E. Kuhlman, Elliot K. Fishman, Paul S. Wheeler, Elias A. Zerhouni, Grover M. Hutchins

Research output: Contribution to journalArticlepeer-review

60 Scopus citations


Radiographic identification of pulmonary metastases has proved to be a challenging problem. We applied high resolution CT (HRCT) to 180 postmortem lung specimens prepared by a method that allows for direct one-to-one pathologic-radiologic correlation. Of the 180 lungs, 32 had pulmonary metastases. The location, number, size, and interstitial changes were evaluated in 32 cases with pulmonary metastases. The pulmonary metastases were peripheral lesions in 94% of these 32 patients, and multiple tumors were found in 91% of these cases. The metastases were <1 cm in diameter in 78%. Twenty-two of the 32 cases (69%) had obvious interstitial changes. In 19 of these 22 cases the interstitial change was characterized by the appearance of a “beaded septum” on HRCT. This beaded septal change corresponded directly to tumor growth in pulmonary capillaries and lymphatics and the septal interstitium. This sign was not noted in any of the specimens with pulmonary edema or fibrosis or in normal lungs. We believe that detection of the beaded septum sign on HRCT is highly suggestive of pulmonary metastases.

Original languageEnglish (US)
Pages (from-to)411-416
Number of pages6
JournalJournal of computer assisted tomography
Issue number3
StatePublished - 1989


  • Computed tomography, techniques
  • Lungs, diseases
  • Lungs, neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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