Diagnosis and management of interstitial lung disease

Translational Respiratory Medicine

Table 5 Thoracic imaging patterns

Imaging modality	Pattern	Consistent ILD diagnoses, mimics of ILD, and/or complications of ILD
Routine CXR	Hilar lymphadenopathy	Sarcoidosis, silicosis, CBD, infection, malignancy
	Septal thickening	CHF, malignancy, infection, PVOD
	Lower lung zone predominance	IPF, asbestosis, DIP, CTD, NSIP
	Mid/upper lung zone predominance	Sarcoidosis, silicosis, acute HP, LCH, CBD, AS, chronic EP
	Peripheral lung zone predominance	COP, chronic EP, IPF
	Honeycomb change	IPF, asbestosis, chronic HP, sarcoidosis, fibrotic NSIP, CTD
	Small nodules	Sarcoidosis, HP, infection
	Cavitating nodules	PAG, mycobacterial infection, CA
	Migratory or fluctuating opacities	HP, COP, DIP
	Pneumothorax	PLCH, LAM, neurofibromatosis, TS
	Pleural involvement	Asbestosis, CTD, acute HP, malignancy, sarcoidosis, Radiation fibrosis
	Kerley B line prominence	Lymphangitic carcinomatosis, CHF
HRCT	Nodules	Sarcoidosis HP, CBD, pneumoconiosis, RA, malignancy
	Septal thickening	Edema, malignancy, infection, drug toxicity, PVOD
	Cyst formation	LAM, LCH, LIP, DIP, SS
	Reticular lines	IPF, asbestosis, chronic EP, chronic HP, CTD, NSIP
	Traction bronchiectasis	IPF, other end-stage fibrosis
	Honeycomb change	IPF, chronic EP and HP, asbestosis, sarcoidosis
	Ground-glass opacity	AIP, acute EP, PAP, chronic EP, COP, lymphoma, sarcoidosis, NSIP, infection, hemorrhage

AIP = acute interstitial pneumonia; AS = ankylosing spondylitis; CA = cancer; CBD = chronic beryllium diseases; COP = cryptogenic organizing pneumonia; CTD = connective tissue disease; DAH = diffuse alveolar hemorrhage; DM-PM = dermatopolymyositis; DIP = desquamative interstitial pneumonia; EP = eosinophilic pneumonia; HP = hypersensitivity pneumonitis; HPS = Hermansky-Pudlak syndrome; IPF = idiopathic pulmonary fibrosis; LAM = lymphangioleiomyomatosis; LCH = Langerhans cell histiocytosis; LIP = lymphoid interstitial pneumonia; NF = neurofibromatosis; NSIP = non-specific interstitial pneumonia; PAG = polyangiitis with granulomatosis; PAP = pulmonary alveolar proteinosis; P2 = auscultated pulmonic valve closure sound; PH = npulmonary hypertension; PVOD = pulmonary veno-occlusive disease; RA = rheumatoid arthritis; SLE = systemic lupus erythematosus; SS = Sjögren’s syndrome; TS = tuberous sclerosis.
Reprinted with permission from Interstitial Lung Disease: A Practical Approach. Meyer KC, Raghu G: Patient evaluation. Second Edition, New York: Springer; 2011:3–16.