Evaluation of diffuse lung disease by conventional chest radiography
- Paul Stark, MD
Paul Stark, MD
- Professor of Radiology
- University of California San Diego
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 . 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.
- Felson B. A new look at pattern recognition of diffuse pulmonary disease. AJR Am J Roentgenol 1979; 133:183.
- Genereux GP. Radiologic assessment of diffuse lung disease. In: Radiology, Diagnosis, Imaging, Intervention, Taveras, Ferrucci (Eds), JP Lippincott, Philadelphia 1992. Vol 1, p.1-18.
- McLoud TC, Carrington CB, Gaensler EA. Diffuse infiltrative lung disease: a new scheme for description. Radiology 1983; 149:353.
- McLoud TC. Chronic infiltrative lung disorders. In: Radiology, Diagnosis, Imaging, Intervention, Taveras, Ferrucci (Eds), JP Lippincott, Philadelphia 1992. Vol 1, p.1-17.
- Russell, A (Ed). International Labour Office: Guidelines for the Use of ILO International Classification of Radiographs of Pneumoconioses. Revised Edition 1980. Medical Radiography and Photography 1981; 1:2.
- Franquet T. Imaging of pulmonary viral pneumonia. Radiology 2011; 260:18.
- Mueller-Mang C, Grosse C, Schmid K, et al. What every radiologist should know about idiopathic interstitial pneumonias. Radiographics 2007; 27:595.
- Ravin CE. Pulmonary vascularity: radiographic considerations. J Thorac Imaging 1988; 3:1.
- Müller NL, Coiby TV. Idiopathic interstitial pneumonias: high-resolution CT and histologic findings. Radiographics 1997; 17:1016.
- CRITIQUE OF PATTERN USE
- Large opacities
- BASIC PATTERNS
- - Acute diseases
- - Chronic diseases
- LUNG VOLUMES
- DISEASE DISTRIBUTION
- ASSOCIATED FINDINGS
- Pleural disease
- Lymph node enlargement
- Cor pulmonale
- NORMAL RADIOGRAPHS IN SYMPTOMATIC PATIENTS