From the Guidelines
Linear stranding on a chest X-ray (CXR) refers to thin, line-like opacities that appear in the lung fields, representing thickened interstitial tissue, which can be caused by scarring from previous infections, inflammation, fibrosis, or other lung conditions. These linear markings are often associated with chronic lung diseases such as pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), or as a residual finding after pneumonia or tuberculosis 1. When a radiologist identifies linear stranding, they are noting these abnormal linear patterns that differ from the normal lung architecture. The clinical significance depends on the pattern, distribution, and associated findings. Some key points to consider include:
- Linear stranding can be a sign of underlying lung disease, but it is not specific to any particular condition 1.
- The presence of linear stranding on a CXR does not necessarily indicate active disease and may represent stable, chronic changes to the lung tissue 1.
- Additional imaging, such as a CT scan, may be recommended for further evaluation, as it provides more detailed information about the lung tissue 1. If you have linear stranding on your chest X-ray, it's essential to discuss the findings with your healthcare provider, who can interpret them in the context of your symptoms and medical history 1.
From the Research
Definition of Linear Stranding on a CXR
Linear stranding on a chest X-ray (CXR) refers to a pattern of linear opacities that can be seen in the lung fields.
Radiologic Characteristics
- Linear stranding can be associated with interstitial lung diseases, which are a complex group of conditions that cause inflammation and scarring of the lung interstitium 2.
- High-resolution computed tomography (HRCT) is the radiological imaging technique best suited to revealing changes in lung structure, including linear/reticular opacities 3.
- Linear/reticular opacities are one of the most common HRCT patterns seen in cases of diffuse interstitial lung diseases 3.
Clinical Significance
- Interstitial lung abnormalities (ILAs) are radiologic abnormalities found incidentally on chest CT that are potentially related to interstitial lung diseases, and can show radiologic progression 4, 5.
- ILAs are associated with increased mortality, respiratory symptoms, decreased exercise capability, reduced pulmonary function, and increased risk of lung cancer 5.
Diagnosis and Management
- A multidisciplinary approach to diagnosis of interstitial lung disease is the gold standard, including key history and examination features, blood panel, pulmonary function tests, HRCT imaging, and when required bronchoalveolar lavage and lung biopsy results 2.
- Clinically significant interstitial lung disease should be identified and requires clinically driven management by a pulmonologist 5.