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Year : 2016  |  Volume : 33  |  Issue : 1  |  Page : 113  

Pipe-cleaner sign

1 Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
2 Department of Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
3 Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, New Delhi, India

Date of Web Publication4-Jan-2016

Correspondence Address:
Binit Sureka
Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-2113.173071

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How to cite this article:
Sureka B, Bansal K, Panda D, Mariotta S. Pipe-cleaner sign. Lung India 2016;33:113

How to cite this URL:
Sureka B, Bansal K, Panda D, Mariotta S. Pipe-cleaner sign. Lung India [serial online] 2016 [cited 2020 Jul 3];33:113. Available from: http://www.lungindia.com/text.asp?2016/33/1/113/173071


We would like to highlight an important forgotten sign on chest computed tomography (CT) known as the “pipe-cleaner” sign. This sign is diagnostic of pulmonary sarcoidosis in a given clinical context.[1] The sign is seen due to pulmonary nodules within the bronchovascular lymphatics, also known as perilymphatic nodules. The nodules in the perilymphatic distribution result in nodular bronchovascular interstitial thickening. When this thickening is seen along the major fissures, it resembles a pipe-cleaner. A pipe-cleaner is a type of brush originally intended for removing moisture and residue from smoking pipes [Figure 1] and [Figure 2].
Figure 1: Illustration of a pipe-cleaner used to clean smoking pipe

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Figure 2: (a) Chest radiograph showing nodular thickening of the right fissure (arrow) with ill-.defined nodules in the right lower zone and tenting of the right diaphragm. (b) Axial chest CT scan showing nodular fissural thickening (arrowhead) resembling a pipe-cleaner. In addition, a few perilymphatic and centrilobular nodules are seen in the bilateral lungs

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Perilymphatic nodules are nodules along the lymphatics and are seen along the pleural surface, large vessels and bronchi, interlobular septa, and centrilobular regions and are usually less than 5 mm in size. Diagnostic differentials for perilymphatic distribution of nodules on chest CT are sarcoidosis, lymphangitic carcinomatosis, silicosis, coal worker's pneumoconiosis, lymphoma, lymphoid interstitial pneumonia, and rarely amyloidosis.[2]

We wish to emphasize that both clinicians and radiologists who are regularly seeing and interpreting chest CT scans should be aware of this sign.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Shroff G, Konopka K, Chiles C. Perilymphatic Pulmonary Nodules: Definition, Differential Diagnosis, and Demonstration of the “Pipe-Cleaner” Sign. Contemp Diagn Radiol 2013;36:1-5.  Back to cited text no. 1
Dähnert W. Chest. In: Dähnert W, editor. Radiology Review Manual. 7th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2011. p. 541.  Back to cited text no. 2


  [Figure 1], [Figure 2]


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