Hello, there are numerous conditions which can give rise to patchy airspace disease. Evaluation of persistent pulmonary infiltrate differentials. The disease part is when those spaces fill with a solid or liquid substance. The airspace can be thought of as the parts of the lung at the end of the branching br. This may be due to atelectasis think of this as though the lungs were a sponge and the bottom of the sponge was compressed. Dec 18, 2012 septal, reticular, nodular, reticulonodular, groundglass, crazy paving, cystic, groundglass with reticular, cystic with groundglass, decreased and mosaic attenuation pattern characterise interstitial lung diseases on highresolution computed tomography hrct. Occasionally different entities mimic each other, either because they share identical hrct findings or because of superimposition of. If the disease persists beyond 46 weeks after treatment, differential diagnosis for chronic airspace disease should be considered. Diseases that principally involve the airspaces are common but the radiological approach to diagnosis is potentially daunting since opacification of the air spaces is a nonspecific sign. A 45yearold man was admitted with nonresolving fever, cough, and dyspnea 2 months after a common cold. Called a pneumothorax, or sometimes collapsed lung, it can have any number of causes from injury to spontaneous development 1. Round atelectasis is also called blesovsky syndrome, or folded lung.
The three categories are airspace filling process, interstitial process, and mixed airspace and interstitial process. The craniocaudal distribution of nodules is helpful in the differential diagnosis of nodular lung disease. Airspace disease may also be made up of atelectasis, pneumonia or fat embolism. The classic presentation of cop is the development of nonspecific systemic e. On ct, there may be groundglass opacities in a patchy, mosaic or multifocal pattern of distribution. Alveolar lung disease may be divided into acute or chronic. Depending on what the substance is, dictates treatment. Airspace disease can be acute or chronic and commonly present as consolidation or groundglass opacity on chest imaging. B is a patient with chronic obstructive lung disease whose fev1fvc ratio is low but whose lung volumes are increased. Iv focal and multifocal lung disease emory university. Differential diagnosis of upper lobepredominant diseases of.
Apr 10, 2020 a study of 23 patients with hsv1 pneumonia showed patchy segmental or subsegmental airspace opacities in 100% and a lobar distribution and groundglass opacities in 48%. It should be remembered that pure airspace disease without any interstitial abnormality, just like pure. Many conditions can cause a focal infiltrate that is visible on the chest radiograph see table 1. Diffuse interstitial lung disease diagnosis and treatment. Certain types of infectious, inflammatory, and neoplastic conditions can result in chronic airspace disease.
Chronic bilateral airspace opacification differential. Airspace disease can be acute or chronic and have a wide range of differential diagnosis. The chest radiograph cxr demonstrated bilateral multifocal areas of patchy airspace disease, as well as a dominant focal area of density in the right upper lobe fig. Imaging of the pulmonary manifestations of systemic disease. A 45yearold man with a history of previous tuberculosis tb infection presented with a cough and chest pain. The airspace filling can be partial, with some alveolar aeration remaining, or complete, producing densely opacified, nonaerated lung t. Organizing pneumonia, sometimes known as cryptogenic organizing pneumonia now the preferred designation for bronchiolitis obliterans organizing pneumonia boop, is a condition in which an organizing inflammatory exudate with fibroblast proliferation occurs after an episode of pneumonia. A common finding on thinsection ct in infectious lung disease is the treeinbud pattern, in which centrilobular bronchial dilatation and filling by mucus, pus, or fluid resembles a budding tree the pattern of patchy clusters of small nodules and branching softtissue opacities is generally most pronounced in the lung periphery within 35. Differential diagnosis of upper lobepredominant diseases of the. Any pathological process that displaces air from the alveoli will be depicted as airspace opacification but this pattern is most commonly seen when either fluid accumulates as in pulmonary. Reversed halo sign on ct as a presentation of lymphocytic. His chest radiograph demonstratedbilateral symmetrical upperlobe opacities reminiscent of tuberculosis.
The pattern was diffuse and multifocal in all, scattered in 82%, peripheral in 9%, and central in 4%. Diffuse interstitial inturstishul lung disease refers to a large group of lung disorders that affect the interstitium, which is the connective tissue that forms the support structure of the alveoli air sacs of the lungs. Jun 21, 2019 a is a patient with restrictive lung disease idiopathic pulmonary fibrosis, low forced vital capacity fvc, but an increased ratio of forced expiratory volume in 1 second fev1 to fvc because of increased elastic recoil. Alveolar lung disease refers to filling of the airspaces with fluid or other material water, pus, blood, cells, or protein. Figure 10a wegener granulomatosis in a 56yearold woman who presented with malaise, fever, and chronic sinusitis. About 30% of patients had additional reticular opacities. Air space opacification radiology reference article. Diagnosed with patchy airspace disease in my left lung also moderate to patchy airspace disease in the right what treatments are there for this and is it a lifethreatening. The consolidation often is patchy and may be fleeting. Air space lung disease is an unofficial term that refers to air caught in the space between the outside of the lung and the inside of the chest cavity, between the pleural layers that are normally air tight. More chest ct scan patients with diffuse cutaneous systemic scleroderma are at an increased risk of developing interstitial lung disease early, but patients with limited cutaneous disease can also develop the condition. Organizing pneumonia an overview sciencedirect topics. Airspace opacification is a descriptive term that refers to filling of the lung parenchyma with material that attenuates xrays more than the unaffected surrounding lung tissue. Patients with advanced periodontal disease are at particular risk for the development of aspiration pneumonitis, 33.
It is one of the many patterns of lung opacification and is equivalent to the pathological diagnosis of pulmonary consolidation. Air space opacification is a descriptive term that refers to filling of the pulmonary tree with material that attenuates xrays more than the surrounding lung parenchyma it is one of the many patterns of lung opacification and is equivalent to the pathological diagnosis of pulmonary consolidation in radiological studies, it presents as increased attenuation of the lung parenchyma causing. Diffuse bilateral airspace opacities extending from the perihilar region. Causes of acute alveolar lung disease include pulmonary edema cardiogenic or neurogenic, pneumonia bacterial or viral, systemic lupus erythematosus, bleeding in the lungs e.
Nonspecific radiographic manifestations of cytomegalovirus. This unusual type of bibasilar atelectasis happens when the lung is trapped as a result of pleural disease while being devoid of air. Bronchial, airspace, interstitial, pleural and thoracic are general anatomic areas that help describe and classify diseases. This phrase suggests that your lungs did not appear fully expanded especially at the bottom portion such as on chest xray or chest ct. Consolidation or groundglass opacity occurs when alveolar air is replaced by fluid, pus, blood, cells, or other material.
Patchy airspace consolidation in the right pneumonia outlining the horizontal fissure with minor obscuration of the right superior mediastinum. It is common during asbestosisa lung disease caused by the inhalation of asbestos particles. Airspace disease is considered chronic when it persists beyond 46 weeks after treatment. Certain diseases, such as sarcoidosis and other granulomatous diseases, tend to predominate in the upper lobes fig. The oral cavity is densely populated by sitespecific flora. Pulmonary opacities on chest xray litfl ccc differential. It is the radiological correlate of the pathological diagnosis of pulmonary consolidation. The lesions tend to be segmental with a patchy distribution 15,16. A solid substance would be like a tumor which is either surgicall. The airspacepredominant types of noninfectious inflammatory lung disease are either idiopathic or secondary to collagen vascular diseases, infection, 35. Oct 02, 20 strong association with cigarette smoking insiduous onset of dyspnoea and cough. Airspace opacification summary radiology reference.
Air space opacification is a descriptive term that refers to filling of the pulmonary tree with material that attenuates xrays more than the surrounding lung parenchyma. Symptoms include persistent cough, dyspnoea, and recurrent chest infections. Any pathologic process that fills the alveoli with fluid, pus, blood, cells or protein can result in lobar. Interstitial lung diseases hrct linkedin slideshare. T his chapter includes diseases in which the predominant histologic changes occur within airspaces, including bronchiolar lumens, alveolar duct lumens, and alveolar spaces, rather than in the interstitium. Certain types of infectious, inflammatory, and neoplastic conditions can result in chronic airspace disease table 1. When a focal infiltrate is dense, it is likely that pus, blood, water, or tissue is filling alveolar spaces. Fat embolism occurs from bone marrow necrosis and is thought by some to play a key role in the pathogenesis of the syndrome. A focal infiltrate that is patchy and less dense suggests a less advanced stage of disease process. Chronic bilateral airspace opacification is a subset of the differential diagnosis for airspace opacification.
An exhaustive list of all possible causes of chronic bilateral airspace opacities is long, but a useful framework is as follows. The management depends upon the symptoms, mainly to focus ease the breath as possible maintenance of vital parameters control of respiratory drives. Learningradiology acute, chest, syndrome, acs, sickle, cell. This disease is fluffy and indistinct in its margins, it is confluent and tends to be homogeneous. A cavity is the result of any of a number of pathological processes including suppurative necrosis e. This is an alveolar airspace disease, in this case pulmonary edema on a noncardiogenic basis. The differential diagnosis of multifocal consolidation is wide and can be challenging. Radiographic findings in patients with periodontal disease include focal or patchy, illdefined lung consolidations and progressive abscess formation.
Hypersensitivity pneumonitis, although a noninfectious inflammation, is a wellrecognized disease primarily caused by organic or inorganic dust exposure and will not be discussed in. Transbronchial biopsy revealed inflammatory nonspecific alveolarlesions suggestive of bronchiolitis obliterans organizing pneumonia, which responded well clinically and radiologically to. Alveolar, or airspace, filling process refers to a condition in which the disease mainly affects the terminal airspaces. Patchy areas of ground glass attenuation with a background of interlobular septal thickening.
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