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The Lung Parenchyma: Radiological Presentation of Alveolar Pattern

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Book cover Comparative Interpretation of CT and Standard Radiography of the Chest

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

The alveolar pattern is the imaging representation of a variety of diseases that tend to occupy the lung airspaces. This pattern is the most common alteration identified in imaging studies of the lungs, and results in an increase in density of the lung parenchyma. The majority can be readily detected in chest radiographs, but some cases will only be detected in CT. The air bronchogram, consolidation, and the silhouette sign are usually detected in plain films. The distribution of the pathology and its temporal presentation can provide clues to specific groups of diseases. Combining the imaging signs and the clinical presentation will narrow the differential diagnosis. Acute airspace disease is usually secondary to pulmonary edema, infectious pneumonia, acute respiratory distress syndrome, pulmonary hemorrhage, and drug-related diseases, whereas subacute and chronic alveolar patterns can be produced by organizing pneumonia, bronchioalveolar cell carcinoma, eosinophilic pneumonia, lymphoma, and radiation pneumonitis. CT can further improve the detection and characterization of airspace disease in the lungs. Specific CT signs of airspace pathology are ground-glass opacities, crazy paving pattern, CT angiogram sign, and the leafless tree sign. The radiologist must be aware of the key points in cases of alveolar disease: morphology, temporal presentation, clinical data, and when to use CT.

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References

  • Aberle DR, Wiener-Kronish JP, Webb WR et al (1988) Hydrostatic versus increased permeability pulmonary edema: diagnosis based on radiographic criteria in critically ill patients. Radiology 168:73–79

    PubMed  CAS  Google Scholar 

  • Albelda SM, Gefter WB, Epstein DM et al (1985) Diffuse pulmonary hemorrhage: a review and classification. Radiology 154:289–297

    PubMed  CAS  Google Scholar 

  • Agarwal R, Aggarwal AN, Gupta D (2007) Another cause of reverse halo sign: Wegener’s granulomatosis. Br J Radiol 80:849–850

    Article  PubMed  CAS  Google Scholar 

  • Aquino SL, Chiles C, Halford P (1998) Distinction of consolidative bronchioloalveolar carcinoma from pneumonia: do CT criteria work? AJR Am J Roentgenol 171:359–363

    PubMed  CAS  Google Scholar 

  • Akira M, Atagi S, Kawahara M et al (1999) High-resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients. AJR Am J Roentgenol 173:1623–1629

    PubMed  CAS  Google Scholar 

  • Akira M, Yamamoto S, Sakatani M (1998) Bronchiolitis obliterans organizing pneumonia manifesting as multiple large nodules or masses. AJR Am J Roentgenol 170:291–295

    PubMed  CAS  Google Scholar 

  • Akira M, Ishikawa H, Yamamoto S (2002) Drug-induced pneumonitis: thin-section CT findings in 60 patients. Radiology 224:852–860

    Article  PubMed  Google Scholar 

  • Bae YA, Lee KS, Han J et al (2008) Marginal zone B-cell lymphoma of bronchus-associated lymphoid tissue: imaging findings in 21 patients. Chest 133:433–440

    Article  PubMed  Google Scholar 

  • Bayle JY, Nesme P, Bejui-Thivolet F, Loire R, Guerin JC, Cordier JF (1995) Migratory organizing Pneumonitis primed by radiation therapy. Eur Respir J 8:322–326

    Article  PubMed  CAS  Google Scholar 

  • Benamore RE, Weisbrod GL, Hwang DM et al (2007) Reversed halo sign in lymphomatoid granulomatosis. Br J Radiol 80:162–166

    Article  Google Scholar 

  • Cazzato S, Zompatori M, Baruzzi G et al (2000) Bronchiolitis obliterans-organizing pneumonia: an Italian experience. Respir Med 94:702–708

    Article  PubMed  CAS  Google Scholar 

  • Choi YW, Munden RF, Erasmus JJ et al (2004) Effects of radiation therapy on the lung: radiologic appearances and differential diagnosis. Radiographics 24:985–997

    Article  PubMed  Google Scholar 

  • Collins J (2001) CT signs and patterns of lung disease. Radiol Clin North Am 39:1115–1135

    Article  PubMed  CAS  Google Scholar 

  • Cortese G, Nicali R, Placido R (2008) Radiological aspects of diffuse alveolar haemorrhage. Radiol Med 113:16–28

    Article  PubMed  CAS  Google Scholar 

  • Epler GR (2001) Bronchiolitis obliterans organizing pneumonia. Arch Intern Med 161:158–164

    Article  PubMed  CAS  Google Scholar 

  • Franquet T (2001) Imaging of pneumonia: trends and algorithms. Eur Respir J 18:196–208

    Article  PubMed  CAS  Google Scholar 

  • Frazier AA, Franks TJ, Cooke EO et al (2008) From the archives of the AFIP: pulmonary alveolar proteinosis. Radiographics 28:883–899

    Article  PubMed  Google Scholar 

  • Gaensler EA, Carrington CB (1977) Peripheral opacities in chronic eosinophilic pneumonia: the photographic negative of pulmonary edema. AJR Am J Roentgenol 128:1–13

    PubMed  CAS  Google Scholar 

  • Gasparetto EL, Escuissato DL, Davaus T et al (2005) Reversed halo sign in pulmonary paracoccidioidomycosis. AJR Am J Roentgenol 184:1932–1934

    PubMed  Google Scholar 

  • Goodman LR, Fumagalli R, Tagliabue P et al (1999) Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations. Radiology 213:545–552

    PubMed  CAS  Google Scholar 

  • Green RJ, Ruoss SJ, Kraft SA et al (1996) Pulmonary capillaritis and alveolar hemorrhage update on diagnosis and management. Chest 10:1305–1316

    Article  Google Scholar 

  • Gluecker T, Capasso P, Schnyder P et al (1999) Clinical and radiologic features of pulmonary edema. Radiographics 19:1507–1531

    PubMed  CAS  Google Scholar 

  • Hansell DM, Bankier AA, MacMahon H et al (2008) Fleischner society: glossary of terms for thoracic imaging. Radiology 246:697–722

    Article  PubMed  Google Scholar 

  • Holbert JM, Costello P, Li W et al (2001) CT features of pulmonary alveolar proteinosis. AJR Am J Roentgenol 176:1287–1294

    PubMed  CAS  Google Scholar 

  • Ichikado K, Suga M, Muranaka H et al (2006) Prediction of prognosis for acute respiratory distress syndrome with thin-section CT: validation in 44 cases. Radiology 238:321–329

    Article  PubMed  Google Scholar 

  • Im JG, Han MC, Yu EJ et al (1990) Lobar bronchioloalveolar cell carcinoma: angiogram sign on CT scans. Radiology 176:749–753

    PubMed  CAS  Google Scholar 

  • Jeong YJ, Kim KI, Seo IJ et al (2007) Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. Radiographics 27:617–637

    Article  PubMed  Google Scholar 

  • Johkoh T, Müller NL, Akira M et al (2000) Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients. Radiology 216:773–780

    PubMed  CAS  Google Scholar 

  • Jung JI, Kim H, Park SH et al (2001) CT differentiation of pneumonic-type bronchioloalveolar cell carcinoma and infectious pneumonia. Br J Radiol 74:490–494

    PubMed  CAS  Google Scholar 

  • Kim SJ, Lee KS, Ryu YH et al (2003) Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J Roentgenol 180:1251–1254

    PubMed  Google Scholar 

  • Kim TH, Kim SJ, Ryu YH et al (2006) Differential CT features of infectious pneumonia versus bronchioloalveolar carcinoma (BAC) mimicking pneumonia. Eur Radiol 16:1763–1868

    Article  PubMed  Google Scholar 

  • King LJ, Padley SP, Wotherspoon AC et al (2000) Pulmonary MALT lymphoma: imaging findings in 24 cases. Eur Radiol 10:1932–1938

    Article  PubMed  CAS  Google Scholar 

  • Kinsely BL, Mastey LA, Mergo PJ et al (1999) Pulmonary mucosa-associated lymphoid tissue lymphoma: CT and pathologic findings. AJR Am J Roentgenol 172:1321–1326

    PubMed  CAS  Google Scholar 

  • Lee DK, Im JG, Lee KS et al (2000) B-cell lymphoma of bronchus-associated lymphoid tissue (BALT): CT features in 10 patients. J Comput Assist Tomogr 24:30–34

    Article  PubMed  CAS  Google Scholar 

  • Lohr RH, Boland BJ, Douglas WW et al (1997) Organizing pneumonia. Features and prognosis of cryptogenic, secondary, and focal variants. Arch Intern Med 157:1323–1329

    Article  PubMed  CAS  Google Scholar 

  • Marchiori E, Franquet T, Gasparetto TD et al (2008) Consolidation with diffuse or focal high attenuation: computed tomography findings. J Thorac Imaging 23:298–304

    Article  PubMed  Google Scholar 

  • Maksimovic O, Bethge WA, Pintoffl JP et al (2008) (2008) Marginal zone B-cell non-Hodgkin’s lymphoma of mucosa-associated lymphoid tissue type: imaging findings. AJR Am J Roentgenol 191:921–930

    Article  PubMed  Google Scholar 

  • Maldonado RL (1999) The CT angiogram sign. Radiology 210:323–324

    PubMed  CAS  Google Scholar 

  • Mayo JR, Müller NL, Road J et al (1989) Chronic eosinophilic pneumonia: CT findings in six cases. AJR Am J Roentgenol 153:727–730

    PubMed  CAS  Google Scholar 

  • Milne EN, Pistolesi M, Miniati M et al (1985) The radiologic distinction of cardiogenic and noncardiogenic edema. AJR Am J Roentgenol 144:879–894

    PubMed  CAS  Google Scholar 

  • Murayama S, Onitsuka H, Murakami J et al (1993) “CT angiogram sign” in obstructive pneumonitis and pneumonia. J Comput Assist Tomogr 17:609–612

    Article  PubMed  CAS  Google Scholar 

  • Oymak FS, Demirbaş HM, Mavili E et al (2005) Bronchiolitis obliterans organizing pneumonia. Clinical and roentgenological features in 26 cases. Respiration 72:254–262

    Article  PubMed  Google Scholar 

  • Patsios D, Roberts HC, Paul NS et al (2007) Pictorial review of the many faces of bronchioloalveolar cell carcinoma. Br J Radiol 80:1015–1023

    Article  PubMed  CAS  Google Scholar 

  • Prakash UB, Barham SS, Carpenter HA et al (1987) Pulmonary alveolar phospholipoproteinosis: experience with 34 cases and a review. Mayo Clin Proc 62:499–518

    Article  PubMed  CAS  Google Scholar 

  • Rossi SE, Erasmus JJ, McAdams HP et al (2000) Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics 20:1245–1259

    PubMed  CAS  Google Scholar 

  • Rossi SE, Erasmus JJ, Volpacchio M et al (2003) “Crazy-paving” pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics 23:1509–1519

    Article  PubMed  Google Scholar 

  • Seymour JF, Presneill JJ (2002) Pulmonary alveolar proteinosis: progress in the first 44 years. Am J Respir Crit Care Med 166:215–235

    Article  PubMed  Google Scholar 

  • Storto ML, Kee ST, Golden JA et al (1995) Hydrostatic pulmonary edema: high-resolution CT findings. AJR Am J Roentgenol 165:817–820

    PubMed  CAS  Google Scholar 

  • Souza CA, Müller NL, Lee KS et al (2006) Idiopathic interstitial pneumonias: prevalence of mediastinal lymph node enlargement in 206 patients. AJR Am J Roentgenol 186:995–999

    Article  PubMed  Google Scholar 

  • Travis WD, Colby TV, Corrin B et al (1999) World Health Organization International Histological Classification of Tumors. 3rd edn. Histological typing of lung and pleural tumors. WHO, Berlin, pp 34–38

    Book  Google Scholar 

  • Trapnell BC, Whitsett JA, Nakata KN (2003) Pulmonary alveolar proteinosis. Engl J Med 349:2527–2539

    Article  CAS  Google Scholar 

  • Ujita M, Renzoni EA, Veeraraghavan S et al (2004) Organizing pneumonia: perilobular pattern at thin-section CT. Radiology 232:757–761

    Article  PubMed  Google Scholar 

  • Vilar J, Domingo ML, Soto C et al (2004) Radiology of bacterial pneumonia. Eur J Radiol 51:102–113

    Article  PubMed  Google Scholar 

  • Wahba H, Truong MT, Lei X et al (2008) Reversed halo sign in invasive pulmonary fungal infections. Clin Infect Dis 46:1733–17337

    Article  PubMed  Google Scholar 

  • Ware LB, Matthay MA (2005) Clinical practice acute pulmonary edema. N Engl J Med 353:2788–2796

    Article  PubMed  CAS  Google Scholar 

  • Witte RJ, Gurney JW, Robbins RA et al (1991) Diffuse pulmonary alveolar hemorrhage after bone marrow transplantation: radiographic findings in 39 patients. AJR Am J Roentgenol 157:461–464

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Hospital Universitario Dr Peset, Gaspar Aguilar 90, Valencia, Spain, 46017

    José Vilar

  2. Hospital Universitario Vall D’Hebron, Barcelona, Spain

    Jordi Andreu

Authors
  1. José Vilar
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  2. Jordi Andreu
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Correspondence to José Vilar .

Editor information

Editors and Affiliations

  1. Clinique Saint Luc, Dept. Radiology, Université Catholique Louvain, avenue Hippocrate 10, Bruxelles, 1200, Belgium

    Emmanuel E. Coche

  2. Service Imagerie Médicale, CHU de Liège, Liège, 4000, Belgium

    Benoit Ghaye

  3. Academisch Ziekenhuis, Afd. Radiologie, Vrije Universiteit Brussel, Laarbeeklaan 101, Bruxelles, 1090, Belgium

    Johan de Mey

  4. Academisch Ziekenhuis, Afd. Radiologie, Universiteit Gent, De Pintelaan 185, Gent, 9000, Belgium

    Philippe Duyck

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© 2011 Springer Berlin Heidelberg

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Vilar, J., Andreu, J. (2011). The Lung Parenchyma: Radiological Presentation of Alveolar Pattern. In: Coche, E., Ghaye, B., de Mey, J., Duyck, P. (eds) Comparative Interpretation of CT and Standard Radiography of the Chest. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-79942-9_9

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  • DOI: https://doi.org/10.1007/978-3-540-79942-9_9

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-79941-2

  • Online ISBN: 978-3-540-79942-9

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