interstitial vs air space

8/10/2019 Interstitial vs Air Space

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12/28/2014 Dr. Basch's files 1

Recognizing

Interstitial VersusAirspace Disease

In Slide Show mode, advance the slides by pressing the spacebarAll Images Retain Their Original Copyrights

William Herring, M.D. 2003

Recognizing

Interstitial VersusAirspace Disease

In Slide Show mode, advance the slides by pressing the spacebarAll Images Retain Their Original Copyrights

William Herring, M.D. 2003


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Why learn the difference?

Many times these patterns overlap

But frequently, recognition of oneor the other helps with the

Differential diagnosis


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Parenchymal Lung Disease

Two Major TypesAlveolar (air space)

Interstitial


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Airspace Disease

Soft-tissue opacities

With hazy and indistinct margins

Tend to respect segmental or lobar

boundariesMay contain air bronchograms


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Air Bronchogram

Bronchi usually not visibleWalls are thin, they contain air, are surrounded

by airWhen something of fluid density fills

alveoli, air in bronchus becomes visiblePulmonary edema fluid

Blood

Gastric aspirate

Inflammatory exudate


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Air Bronchogram

The visibility of air in the bronchi becauseof surrounding airspace disease is called anair bronchogram

An air bronchogram most often a sign ofairspace disease


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The black branchingstructures are theresult of air in thebronchi, now visiblebecause densityother than airsurrounds them (inthis case it isinflammatory exudatefrom a pneumonia).


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Pulmonary edema

This disease is

fluffy and indistinctin its margins, it isconfluent andtends to behomogeneous. Inboth upper lobes,

you can see airbronchograms.This is an alveolar(airspace) disease,in this casepulmonary edemaon a non-cardiogenic basis.


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Common Airspace Diseases

Pneumonia inflammatory exudatePulmonary edema edema fluid

Pulmonary hemorrhage blood

Aspiration gastric juices


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Aspiration pneumonia at both bases

Airspace Disease


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Aspiration pneumonia at both bases

Airspace Disease


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Interstitial disease discrete,inhomogeneous, no air

bronchograms

Airspace disease fluffy,indistinct, homogeneous,

contains air bronchograms

Interstitial versus Airspace Disease


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Interstitial DiseasesExamples of mostly nodular patterns

Hematogenously disseminatedmetastatic disease, e.g. renal cell ca

Silicosis

Miliary tuberculosis


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Interstitial DiseasesExamples of mostly nodular patterns

Hematogenously disseminatedmetastatic disease, e.g. renal cell ca

Silicosis

Miliary tuberculosis


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This CT of the

chest showsthickenedbronchial wallswith extensivedilatation of thebronchi (bronchishould besmaller thantheiraccompanyingblood vessel).This interstitialdisease is CysticFibrosis. Cystic Fibrosis


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This is a diffuse

infiltrative(interstitial)disease that iscomposedprimarily of lines(reticular disease).Examples ofmostly reticulardisease includeidiopathicpulmonary fibrosisand eosinophilicgranuloma.

Idiopathic pulmonary fibrosis


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Eosinophilic granuloma of the lung

Pulmonary interstitial edema

Idiopathic pulmonary fibrosis

Rheumatoid lung

Interstitial DiseasesExamples of mostly reticular patterns


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Interstitial lung diseasewith coarse, criss-

crossing pattern iscalled honeycombpattern. It is seen insuch diseases aseosinophilicgranuloma of the lungand bronchiectasis.

Bronchiectasis


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Another diffuseinfiltrative patternIn the lung isground -glassopacification, seenon CT. Thoughnon-specific, it is

differentiated fromairspace diseasein that airbronchograms arenot present and

the blood vesselsare usually stillvisible through thedisease. Alveolar proteinosis


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Take Home Points

Though somewhat artificial, lung diseasecan be divided into airspace and

interstitial (infiltrative) patternsAirspace dz is fluffy, confluent with air

bronchograms

Interstitial dz is diffuse, discrete, tends tooccur in lines, dots or a combination ofthe two


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Which of the following isairspace disease or

interstitial lung disease?

Click to go forward

Click to go back


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CorrectThis is interstitial disease

There are multiplediscrete nodules in

both lungs. They arewell-defined, do nothave airbronchograms and donot respect lobar

boundaries. These aremetastases from acolon cancer.

Go ahead
http://localhost/var/www/apps/conversion/tmp/scratch_4/Interstitial%20VS%20air%20space.ppt


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CorrectThere is interstitial disease

There are multiplenodules in both lungs

from metastaticdisease of breastprimary. The diseaseoccurs in a discretenodular pattern with no

air bronchograms.

Go ahead
http://localhost/var/www/apps/conversion/tmp/scratch_4/Interstitial%20VS%20air%20space.ppt


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CorrectThis is airspace disease

Go ahead

This is localizedairspace disease. Itis lobar and

segmental indistribution, isconfluent, hasindistinct margins. Itis pneumonia of theright lower andupper lobes.


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WrongLook Again

Remember airspace diseases are

fluffy, indistinctly marginated and mayhave air bronchograms

Interstitial lung disease tends to be

discrete nodules or reticulardensities, diffuse and inhomogeneous

Go Back


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Congratulations, You Graduate

I know anairspacediseasewhen I

see one

Want to return to the beginning of this module? Click here
http://localhost/var/www/apps/conversion/tmp/scratch_4/Interstitial%20VS%20air%20space.ppthttp://localhost/var/www/apps/conversion/tmp/scratch_4/Interstitial%20VS%20air%20space.ppt

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