Ch.3 - Recognizing Airspace Versus Interstitial Lung Disease

Question 1

Characteristics of airspace disease include:

Answer 1

Fluffy, confluent densities that are indistinctly marginated and may demonstrate air bronchograms.

Question 2

Characteristics of interstitial lung disease include:

Answer 2

Discrete “particles” or “packets” of disease with distinct margins that tend to occur in a pattern of lines (reticular), dots (nodular), or very infrequently a combination of lines and dots (reticulonodular).

Question 3

Examples of airspace disease include:

Answer 3

1. Pulmonary alveolar edema.
2. Pneumonia.
3. Aspiration.

Question 4

Examples of interstitial lung disease include:

Answer 4

1. Pulmonary interstitial edema.
2. Pulmonary fibrosis.
3. Metastases to the lung.
4. Bronchogenic carcinoma.
5. Sarcoidosis.
6. Rheumatoid lung.

Question 5

An air bronchogram is typically a sign of:

Answer 5

Airspace disease –> Occurs when something other than air (such as inflammatory exudate or blood) surrounds the bronchus, allowing the air inside the bronchus to become visible.

Question 6

What is the silhouette sign?

Answer 6

When 2 objects of the same radiographic density are in contact with each other, the normal edge or margin between them will disappear.
–> Useful throughout radiology in identifying either the location or the density of the abnormality in question.

Question 7

The differential possibilities of an opacified hemithorax should include:

Answer 7

1. Atelectasis of the entire lung.
2. A very large pleural effusion.
3. Pneumonia of the entire lung.
4. Post-pneumonectomy.

Question 8

With atelectasis, there is a shift … the side of the opacified hemithorax because of volume loss in the affected lung.

Answer 8

toward.

Question 9

With large pleural effusion, there is a shift … from the side of opacification because the large pleural effusion can act as if it were a mass.

Answer 9

AWAY.

Question 10

With pneumonia of an entire lung, there is usually …, but … can be present.

Answer 10

NO SHIFT.

AIR BRONCHOGRAMS.

Question 11

What happens with shifts and malignancy?

Answer 11

Occasionally, the shift of a malignant effusion may be balanced by the opposite shift of atelectasis caused by an underlying, obstructing bronchogenic carcinoma so that the hemithorax will be completely opaque but there will be no shift.

Question 12

In the post-pneumonectomy patient, there is eventually…?

Answer 12

Volume loss on the side from which the lung has been removed, and the clues to such surgery may include surgical absence of the 5th and 6th rib on the affected side or metallic surgical clips in the hilum.

Question 13

Airspace disease characteristically produces what?

Answer 13

Opacities in the lung that can be described as fluffy, cloudlike, or hazy.

Question 14

The fluffy opacities of airspace disease tend to be?

Answer 14

Confluent - To blend into one another with imperceptible margins.

Question 15

Airspace disease may contain?

Answer 15

AIR BRONCHOGRAMS.

Question 16

What is an air bronchogram?

Answer 16

The visibility of air in the bronchus because of surrounding airspace disease is called an air bronchogram.

Question 17

An air bronchogram is a sign of?

Answer 17

Airspace disease.

Question 18

What can fill the airspaces besides air (5)?

Answer 18

1. Fluid - PE.
2. Blood - Pulm. hemorrhage.
3. Gastric juices - Aspiration.
4. Inflammatory exudate.
5. Water - Near drowning.

Question 19

Airspace disease may demonstrate which sign?

Answer 19

The silhouette sign.

Question 20

Classification of acute airspace disease?

Answer 20

1. Pneumonia.
2. Pulmonary alveolar edema.
3. Hemorrhage.
4. Aspiration.
5. Near-drowning.

Question 21

Classification of chronic airspace disease?

Answer 21

1. Bronchoalveolar cell carcinoma.
2. Alveolar cell proteinosis.
3. Sarcoidosis.
4. Lymphoma.

Question 22

3 causes of airspace disease?

Answer 22

1. Pneumonia.
2. Pulmonary alveolar edema.
3. Aspiration.

Question 23

Aspiration of bland (neutralized) gastric juice or water usually clears rapidly within … to … hours.

Answer 23

24-48.

Question 24

Lung’s interstitium consists of?

Answer 24

1. Connective tissue.
2. Lymphatics.
3. Blood vessels.
4. Bronchi.

Question 25

The 3 patterns of presentation of lung disease?

Answer 25

1. Reticular interstitial disease –> Network of lines.
2. Nodular interstitial disease –> Assortment of dots.
3. Reticulonodular interstitial disease –> Both lines and dots.

Question 26

The margins of “particles” of interstitial lung disease are?

Answer 26

SHARPER than the margins of airspace disease that tend to be indistinct.

Question 27

Interstitial lung disease - Air bronchograms?

Answer 27

Usually no.

Question 28

Interstitial lung diseases - Pitfalls?

Answer 28

Sometimes, so much interstitial disease is present that the overlapping elements of disease may superimpose and mimic airspace disease on conventional chest radiographs.
Tiny packets of interstitial disease seem coalescent and more like airspace disease.

Question 29

Interstitial lung disease - Pitfalls - Solution?

Answer 29

Look at the periphery of such confluent shadows in the lung to help in determining whether they are, in fact, caused by airspace disease or a superimposition of numerous reticular and nodular densities.
–> Also, obtain a chest CT.

Question 30

Bibasilar distribution should raise the suspicion of?

Answer 30

Aspiration.

Question 31

5 predominantly RETICULAR ILDs?

Answer 31

1. IPF.
2. Pulm. interstitial edema.
3. RA.
4. Scleroderma.
5. Sarcoidosis.

Question 32

5 Predominantly NODULAR ILDs?

Answer 32

1. Bronchogenic carcinoma.
2. Metastases.
3. Silicosis.
4. Miliary TB.
5. Sarcoidosis.

Question 33

Pulmonary interstitial edema is the PRECURSOR of?

Answer 33

Alveolar edema.

Question 34

The 4 key radiologic findings of pulm. interstitial edema?

Answer 34

1. Fluid in the fissures.
2. Peribronchial cuffing.
3. Pleural effusions.
4. Kerley B lines.

Question 35

DIP/UIP/IPF - Conventional radiographs may show what?

Answer 35

A fine or, later in the disease, a coarse reticular pattern that is BILATERALLY symmetrical, most prominent at the BASES + SUBPLEURAL in location + Associated with volume loss.

Question 36

The 3 MC manifestations of rheumatoid lung in order of decreasing frequency?

Answer 36

1. Pleural effusions.
2. ILDs.
3. Nodules in the lung = NECROBIOTIC nodules.

Question 37

Rheumatoid lung - Pleural effusions?

Answer 37

Usually UNILATERAL and characteristically remain unchanged in appearance for LONG periods of time.

Question 38

Rheumatoid interstitial lung disease is USUALLY?

Answer 38

Reticular –> Most prominent at the lung BASES.

Question 39

Necrobiotic nodules?

Answer 39

Identical to subcutaneous nodules –> Lung BASES near the periphery of the lung –> Frequent CAVITATION.

Question 40

The thoracic manifestation of RA are more frequent in men or women?

Answer 40

MEN. (unlike the joint manifestations)

Question 41

Which type of bronchogenic carcinoma can present as a solitary peripheral pulmonary nodule?

Answer 41

Adenocarcinomas in particular.

Question 42

Hematogenous metastases to the lung?

Answer 42

Usually produce 2 or more nodules in the lungs, sometimes called CANNONBALL metastases because of their LARGE, ROUND APPEARANCE.

Question 43

Lymphangitic spread to the lung tends to resemble?

Answer 43

Pulmonary interstitial edema from CHF, except unlike CHF, it tends to be localized to a segment or involve only one lung.

Question 44

Lymphangitic metastases to lung - 3 findings:

Answer 44

1. Kerley lines.
2. Fluid in the fissures.
3. Pleural effusions.

Question 45

Direct extension would most likely produce?

Answer 45

A LOCALIZED subpleural mass in the lung with frequently adjacent rib destruction.

Question 46

Parenchymal disease can be divided into:

Answer 46

1. Airspace (alveolar).

2. Interstitial (infiltrative) patterns.