Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Evaluation of diffuse lung disease by conventional chest radiography

Topic Outline

GRAPHICS

INTRODUCTION

The pulmonologist and radiologist commonly recognize a variety of abnormal patterns of diffuse parenchymal lung disease on the conventional chest radiograph. Identification of these patterns, along with recognition of other associated findings, can be extremely useful in guiding the development of a differential diagnosis [1]. The diagnostic approach to diffuse lung disease based on interpretation of the conventional chest radiograph will be discussed here, using examples to illustrate many of the radiographic features.

CRITIQUE OF PATTERN USE

The traditional approach to radiographic assessment of diffuse lung disease first involves determining whether the pulmonary parenchymal process is located within the interstitium or the alveolar spaces. However, although radiographic criteria for both types of processes have been established over the years, the correlation is relatively poor between the accuracy of the radiologic localization (to either the airspaces or the interstitium) and the actual pathologic findings. Specific issues include the following:

Nodular patterns can be produced by either interstitial or alveolar disease.

Interstitial pneumonias usually also involve the alveolar compartment.

So-called alveolar disease regularly involves the interstitium as well. The paradigm of pure alveolar disease is pulmonary alveolar proteinosis, yet high resolution computed tomographic (HRCT) scanning has shown that, even in this entity, the interlobular and intralobular septa are thickened, forming the “crazy paving” pattern on thin-section CT.

                     

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Oct 2014. | This topic last updated: Jan 17, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.