Alveolar Disease

Question 1

Pulmonary Calcinosis

Answer 1

• calcium accumulation in alveolar, vessel, airway wall, +/- fibrosis
• abnormal calcium and phosphate metabolism
  
  • ESRD
  • HPT
  • CVD
  • liver Tx
  • infiltrative bone dz

Question 2

Chronic Alveolar Filling Diseases

Answer 2

• Uncommon - Intra-alveolar accumulation
  
  • PIE (eosinophilic pneumonia)
  • PAP
  • Pulmonary calcinosis
  • lipoid pneumonia
• Common
  
  • infection
  • neoplasm
  • airway obstruction/disease
  • primary interstitial disease

Question 3

Nonresolving pneumonia

Answer 3

BALLS

• BAC
• Atypical infection
• Lipoid pneumonia
• Lymphoma
• Sarcoidosis

Question 4

Eosinophilic pneumonia

Answer 4

• Idiopathic
  
  • acute
  • simple - Loeffler’s
  • chronic
• Secondary
  
  • infection
  • drug/radiation
  • immune d/o
• Most chronic cases are idiopathic
• Hx of asthma
• female gender
• steroid response, but recurrent

Question 5

Dx of eosinophilic pneumonia

Answer 5

• Peripheral eosinophilia
• BAL

Question 6

Findings of EP

Answer 6

• Reverse edema
  
  • peripheral
  • upper zonal
• Migratory

Question 7

Pulmonary alveolar proteinosis

Answer 7

• altered surfactant homeostasis
• congenital - abnormal surfactant production
• secondary
  
  • infection
  • hematologic malignancy
  • inorganic dust exposure
  • HIV, transplant
• Rx - whole lung lavage

Question 8

Lipoid Pneumonia

Answer 8

• aspiration or inhalation of animal, vegetable, or petroleum-based lipid
• lipid-laden macrophages within normal alveoli

Question 9

CT findings of lipoid pneumonia

Answer 9

• low-density conslidation
  
  • -35 to -70 HU
  • mass like
  • slowly enlarging
• crazy paving pattern

Question 10

Imaging findings of pulmonary calcinosis

Answer 10

• calcified nodules/masses
• airspace conslidation
• soft-tissue calcfication

Question 11

DDx of high density parenchymal infiltrates

Answer 11

• pneumoconioses
  
  • silicosis
  • CWP
  • siderosis
  • stannosis
• amyloidosis
• microlithiasis
• pulmonary ossification
  
  • mitral stenosis

Question 12

Chronic small airway obstruction leading to

chronic alveolar opacities

Answer 12

BOOP

• idiopathic - COP
• post-infectious
• durg/radiation
• CVD
• post-transplantation

Question 13

Organizing pneumonia

Answer 13

• bilateral, asymmetric
• subsegmental, nodular
• peribronchial
• subpleural
• migratory

Question 14

Primary interstitial disease can also lead to

chronic alveolar filling

Answer 14

• sarcoidosis - necrotizing sarcoid angiitis
• idiopathic pneumonia