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Recognizing Airspace Versus Interstitial Lung Disease


Recognizing the difference between normal anatomy and what is abnormal is critical to your ability to make a correct diagnosis. This chapter begins your exploration into the realm of the abnormal, starting with recognizing patterns of parenchymal lung disease.

Case Quiz 4 Question

A close-up view of the left upper lobe is shown. Is this most likely airspace disease or interstitial lung disease? Given a history of cough, what is a likely diagnosis? See the answer at the end of the chapter.

Classifying Parenchymal Lung Disease

  • Diseases that affect the lung parenchyma can be arbitrarily divided into two main categories based in part on their pathology and in part on the pattern they typically produce on a chest imaging study.

    • Airspace (alveolar) disease

    • Interstitial (infiltrative) disease

  • Why learn the difference?

    • While many diseases produce abnormalities that display both patterns, recognition of these two patterns frequently helps narrow the disease possibilities so that you can form a reasonable differential diagnosis ( Box 4.1 ).

      BOX 4.1
      Classification of Parenchymal Lung Diseases

      Airspace Diseases

      Acute

      • Pneumonia

      • Pulmonary alveolar edema

      • Hemorrhage

      • Aspiration

      • Near-drowning

      Chronic

      • Adenocarcinoma (subtype formerly called bronchoalveolar carcinoma)

      • Alveolar cell proteinosis

      • Sarcoidosis

      • Lymphoma

      Interstitial Diseases

      Reticular

      • Pulmonary interstitial edema

      • Interstitial pneumonia

      • Scleroderma

      • Sarcoid

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