Honeycombing (lungs)

Changed by Calum Worsley, 16 Jun 2022

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Disclosures - updated 12 Apr 2022: Nothing to disclose

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Honeycombing is a CT imaging descriptor referring to clustered cystic air spaces (between 3-10 mm in diameter, but occasionally as large as 2.5 cm) that are usually subpleural, peripheral and basal in distribution. They can be subdivided into:

The walls of the cysts are well-defined and often thick (1-3 mm) ⁴. They represent an irreversible finding commonly seen in diffuse pulmonary fibrosis (usual interstitial pneumonia ~~UIP~~(UIP)).

Pathology

Honeycombing consists of enlarged air spaces with thick fibrotic walls lined by bronchiolar epithelium and often filled with mucin and inflammatory cells ⁶.

History and etymology

The term “honeycomb lung” is thought to have originated in the 19^thcentury in Germany and is thought to have first appeared in 1949 in a study by N Oswald and T Parkinson ⁵.

Differential diagnosis

in some situations
- paraseptal emphysema and paracicatricial emphysema ³
- traction bronchiolectasis
airspace consolidation in the presence of pulmonary emphysema can mimic this appearance

-</ul><p>The walls of the cysts are well-defined and often thick (1-3 mm) <sup>4</sup>. They represent an irreversible finding commonly seen in diffuse <a href="/articles/pulmonary-fibrosis">pulmonary fibrosis</a> (<a href="/articles/usual-interstitial-pneumonia">usual interstitial pneumonia UIP</a>). </p><h4>Pathology</h4><p>Honeycombing consists of enlarged air spaces with thick fibrotic walls lined by bronchiolar epithelium and often filled with mucin and inflammatory cells <sup>6</sup>.</p><h4>History and etymology</h4><p>The term “honeycomb lung” is thought to have originated in the 19<sup>th </sup>century in Germany and is thought to have first appeared in 1949 in a study by N Oswald and T Parkinson <sup>5</sup>.</p><h4>Differential diagnosis</h4><ul>
+</ul><p>The walls of the cysts are well-defined and often thick (1-3 mm) <sup>4</sup>. They represent an irreversible finding commonly seen in diffuse <a href="/articles/pulmonary-fibrosis">pulmonary fibrosis</a> (<a title="Usual interstitial pneumonia (UIP)" href="/articles/usual-interstitial-pneumonia">usual interstitial pneumonia (UIP)</a>). </p><h4>Pathology</h4><p>Honeycombing consists of enlarged air spaces with thick fibrotic walls lined by bronchiolar epithelium and often filled with mucin and inflammatory cells <sup>6</sup>.</p><h4>History and etymology</h4><p>The term “honeycomb lung” is thought to have originated in the 19<sup>th </sup>century in Germany and is thought to have first appeared in 1949 in a study by N Oswald and T Parkinson <sup>5</sup>.</p><h4>Differential diagnosis</h4><ul>

References changed:

1. Austin J, Müller N, Friedman P et al. Glossary of Terms for CT of the Lungs: Recommendations of the Nomenclature Committee of the Fleischner Society. Radiology. 1996;200(2):327-31. <a href="https://doi.org/10.1148/radiology.200.2.8685321">doi:10.1148/radiology.200.2.8685321</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8685321">Pubmed</a>
2. Mueller-Mang C, Grosse C, Schmid K, Stiebellehner L, Bankier A. What Every Radiologist Should Know About Idiopathic Interstitial Pneumonias. Radiographics. 2007;27(3):595-615. <a href="https://doi.org/10.1148/rg.273065130">doi:10.1148/rg.273065130</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17495281">Pubmed</a>
3. Arakawa H & Honma K. Honeycomb Lung: History and Current Concepts. AJR Am J Roentgenol. 2011;196(4):773-82. <a href="https://doi.org/10.2214/AJR.10.4873">doi:10.2214/AJR.10.4873</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21427324">Pubmed</a>
4. Watadani T, Sakai F, Johkoh T et al. Interobserver Variability in the CT Assessment of Honeycombing in the Lungs. Radiology. 2013;266(3):936-44. <a href="https://doi.org/10.1148/radiol.12112516">doi:10.1148/radiol.12112516</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23220902">Pubmed</a>
5. Johkoh T, Sakai F, Noma S et al. Honeycombing on CT; Its Definition, Pathologic Correlation, and Future Direction of Its Diagnosis. Eur J Radiol. 2014;83(1):27-31. <a href="https://doi.org/10.1016/j.ejrad.2013.05.012">doi:10.1016/j.ejrad.2013.05.012</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23806532">Pubmed</a>
6. Wuyts W, Cavazza A, Rossi G, Bonella F, Sverzellati N, Spagnolo P. Differential Diagnosis of Usual Interstitial Pneumonia: When is It Truly Idiopathic? Eur Respir Rev. 2014;23(133):308-19. <a href="https://doi.org/10.1183/09059180.00004914">doi:10.1183/09059180.00004914</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25176967">Pubmed</a>
7. Nishino M, Itoh H, Hatabu H. A Practical Approach to High-Resolution CT of Diffuse Lung Disease. Eur J Radiol. 2014;83(1):6-19. <a href="https://doi.org/10.1016/j.ejrad.2012.12.028">doi:10.1016/j.ejrad.2012.12.028</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23410907">Pubmed</a>
1. Austin JH, Müller NL, Friedman PJ et-al. Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology. 1996;200 (2): 327-31. <a href="http://radiology.rsna.org/content/200/2/327.citation">Radiology (citation)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/8685321">Pubmed citation</a><div class="ref_v2"></div>
2. Mueller-mang C, Grosse C, Schmid K et-al. What every radiologist should know about idiopathic interstitial pneumonias. Radiographics. 27 (3): 595-615. <a href="http://dx.doi.org/10.1148/rg.273065130">doi:10.1148/rg.273065130</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/17495281">Pubmed citation</a><div class="ref_v2"></div>
3. Arakawa H, Honma K. Honeycomb lung: history and current concepts. AJR Am J Roentgenol. 2011;196 (4): 773-82. <a href="http://dx.doi.org/10.2214/AJR.10.4873">doi:10.2214/AJR.10.4873</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/21427324">Pubmed citation</a><span class="ref_v3"></span>
4. Watadani T, Sakai F, Johkoh T et-al. Interobserver variability in the CT assessment of honeycombing in the lungs. Radiology. 2013;266 (3): 936-44. <a href="http://dx.doi.org/10.1148/radiol.12112516">doi:10.1148/radiol.12112516</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/23220902">Pubmed citation</a><span class="auto"></span>
5. Johkoh T, Sakai F, Noma S, Akira M, Fujimoto K, Watadani T, Sugiyama Y. Honeycombing on CT; its definition, pathologic correlation, and future direction of its diagnosis. (2014) European journal of radiology. 83 (1): 27-31. <a href="https://doi.org/10.1016/j.ejrad.2013.05.012">doi:10.1016/j.ejrad.2013.05.012</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23806532">Pubmed</a> <span class="ref_v4"></span>
6. Wuyts WA, Cavazza A, Rossi G et-al. Differential diagnosis of usual interstitial pneumonia: when is it truly idiopathic?. Eur Respir Rev. 2014;23 (133): 308-19. <a href="http://dx.doi.org/10.1183/09059180.00004914">doi:10.1183/09059180.00004914</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/25176967">Pubmed citation</a><span class="auto"></span>
7. Nishino M, Itoh H, Hatabu H. A practical approach to high-resolution CT of diffuse lung disease. (2014) European journal of radiology. 83 (1): 6-19. <a href="https://doi.org/10.1016/j.ejrad.2012.12.028">doi:10.1016/j.ejrad.2012.12.028</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23410907">Pubmed</a> <span class="ref_v4"></span>