Alveolar lung pattern Flashcards
Air normally present in alveoli may be displaced by ____, ____ or ____ of alveoli.
fluid, cells, collapse
The most common etiologies for alveolar lung patterns are:
- Pneumonia
- Pulmonary edema
- Hemorrhage
- Neoplasia
- Atelectasis
Absence of alveolar air results in loss of visulization of which plumonary soft tissues?
- Blood vessels and adjacent borders of the heart and diaphragm which are no longer visible.
- Soft tissue pumonary masses and modules may be obscured
Alveolar filling or collapse intially presents as _____, ill-difined areas of soft tissue opacity. As filling or collapse progresses, these areas spread and coalesce until all air is displaced from the ____ ____.
fluffy- Opacity is often described as fluffy, cotton wool-like, or cloud-like
lung lobe
Lobar margination occurs when alveolar filling or collapse reaches the edge of a _____ _____ and is blocked from further spread by _____. The result is a well-defined soft tissue _____ that is sharply _____ from adjacent air-filled lung.
lung lobe
pleura
boarder
distinct
_____ ______ are classic features of alveolar patterns. They appear as linea, gas opacity, branching sturctures that are _____ distinct from nonaerated, soft-tissue-opacity lung, which are caused by air remaining in the _____ after the alveoli are filled. They are present in less than ____ of cases b/c bronchi may also fill with fluid or cells
AIR BRONCHOGRAMS
sharply
bronchi
25%
Air space opacification
is a descriptive term that refers to filling of the pulmonary tree with material that attenuates x-rays 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.
(right upper lobe consolidation)
In radiological studies ________ _______ presents as increased attenuation of the lung parenchyma causing obscuration of pulmonary vessels, without significant loss of volume, in the segment(s) affected. Air bronchograms can also be found
Lung Consolidation
(right lower lung consolidation)
The opacification is caused by fluid or solid material within the airways that causes a difference in the relative attenuation of the lung:
transudate, e.g. pulmonary oedema secondary to heart failure
pus, e.g. bacterial pneumonia
blood, e.g. pulmonary haemorrhage
cells, e.g. bronchoalveolar carcinoma
protein, e.g. alveolar proteinosis
fat, e.g. lipoid pneumonia
gastric contents, e.g. aspiration pneumonia
water, e.g. drowning
(upper right lung pneumonia)
When considering the likely causes of airspace opacification, it is useful to determine chronicity (by reviewing previous radiographs) and considering laterality. Additionally, the presence of mediastinal or hilar lymphadenopathy further refines the massive list of differentials:
acute unilateral air space opacification
acute bilateral air space opacification
acute airspace opacification with lymphadenopathy
chronic unilateral airspace opacification
chronic bilateral airspace opacification
(left basal lobe consolidation)
Acute airspace opacification with lymphadenopathy is a subset of the differential diagnosis for generalised airspace opacification and includes:
post obstructive causes (usually chronic, but ‘new’ changes can occur)
primary bronchogenic carcinoma
pulmonary metastases
lymphoma / leukaemia
infection
primary pulmonary tuberculosis
fungal lung infection
atypical lung infection, e.g. EBV, mycoplasma
Acute bilateral airspace opacification is a subset of the larger differential diagnosis for airspace opacification. An exhaustive list of all possible causes of acute bilateral airspace opacities is long, but a useful way to consider the huge list is by the material within the airways:
(acute pulmonary edema)
infections, including aspiration-bacterial lung infection, fungal lung, infection
viral lung infection
fluid (put first if big heart)–pulmonary oedema
blood pulmonary contusion–pulmonary haemorrhage–anticoagulation –bleeding diatheses. Goodpasture syndrome- (antiglomerular basement antibody disease, or anti-GBM disease) is a rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs andkidney failure)
emboli-(is any detached, traveling intravascular mass (solid, liquid, or gaseous) carried by circulation, which is capable of clogging arterial capillary beds (create an arterial occlusion) at a site distant from its point of origin)– pulmonary embolism (PE), fat embolism, amniotic fluid embolism
sarcoidosis- is the growth of tiny collections of inflammatory cells (granulomas)
ARDS-Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs.
Chronic bilateral airspace opacification is a subset of the differential diagnosis for airspace opacification. a useful framework is as follows:
inflammatory
sarcoidosis ( is an inflammatory disease that affects multiple organs in the body, but mostly the lungs and lymph glands)–Wegener’s granulomatosis ( is a rare disorder in which blood vessels become inflamed.)–eosinophilic pneumonia--cryptogenic organizing pneumonia( formerly bronchiolitis obliterans organizing pneumonia (BOOP))–polyarteritis nodosa is a systemic vasculitis of small- or medium-sized muscular arteries, typically involving renal and visceral vessels but sparing the pulmonary circulation)(PAN)–Churg-Strauss syndrome (s an autoimmune condition that causes inflammation of small and medium-sized blood vessels (vasculitis) in persons with a history of airway allergic hypersensitivity (atopy))
infective
tuberculosis ( in the past also called phthisis, phthisis pulmonalis, or consumption, is a widespread, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis.[1] Tuberculosis generally affects the lungs, but can also affect other parts of the body. It is spread through the air when people who have an active TB infection cough, sneeze, or otherwise transmit respiratory fluids through the air)–fungal lung infection (especially in immunocompromised patients)–incompletely treated infection
neoplastic / lymphoproliferative –lymphoma –lymphoid interstitial pneumonia (LIP)–bronchoalveolar carcinoma (BAC)post obstructive
other
lipoid pneumonia–recurrent pulmonary haemorrhage–alveolar proteinosis
(sarcoidosis)
What is this?
Chest X-ray of a person with advanced tuberculosis: Infection in both lungs is marked by white arrow-heads, and the formation of a cavity is marked by black arrows.
Chronic unilateral airspace opacification is a subset of the differential diagnoses for airspace opacification, a useful framework is as follows:
neoplastic
post obstructive–lymphoma –lymphocytic interstitial pneumonia (LIP)–bronchoalveolar carcinoma (BAC)
infective
tuberculosis–fungal lung infection (especially in immunocompromised patients)–incompletely treated infection
inflammatory (usually bilateral, but may be asymmetrical.)
sarcoidosis–granulomatosis with polyangiitis (Wegener granulomatosis)–eosinophilic pneumonia–cryptogenic organizing pneumonia, formerly bronchiolitis obliterans with organizing pneumonia (BOOP)
other
lipoid pneumonia–pulmonary haemorrhage (not chronic, but recurrent)—alveolar proteinosis (usually bilateral, by may be asymmetrical.)
radiation pneumonitis
(Bronchoaveolar carcinoma)
A commonly used mnemonic for recalling the features of consolidation is:
A2BC3
A2BC3
A: acinar rosettes- refers to any cluster of cells that resembles a many-lobed “berry”,
A: air bronchogram/alveologram
B: bat-wing distribution- Bat’s wing or butterfly pulmonary opacities refer to a pattern of bilateral perihilar shadowing
C: coalescent/confluent ill-defined “fluffy” appearnce
C: consolidation: diffuse, perihilar/bibasilar, lobar/segmental, locular/multifocal
C: changes occur rapidly
Bat wing lung pattern is?
Bat’s wing or butterfly pulmonary opacities refer to a pattern of bilateral perihilar shadowing
