7-11). The scarring causes stiffness in the lungs which makes it difficult to breathe and get oxygen to the bloodstream. Physical examination frequently finds only dry rales or crackles. This results in the appearance of large ring shadows. Calcification extremely rare. In interstitial disease it is produced when the fine reticulogranular pattern has progressed to such an extent that the overall density of the involved lung is increased, but the individual interstitial lesion is no longer recognizable. (A) Axial CT at the level of the lung bases demonstrates diffuse bilateral ground-glass opacities, consistent with NSIP caused by busulfan. Other features should be considered in the differential diagnosis. The typical appearance of honeycombing is that of thick-walled cystic spaces that are usually less than 1 cm in diameter (Fig. Dr. Sally Suliman presents "Interstitial Lung Disease" by first introducing the classification of ILDs. Abstract: The idiopathic interstitial pneumonias (IIPs) are the most commonly diagnosed forms of interstitial lung disease. Thickened interlobular septa (hexagons) and a fine reticular pattern are visible within the lobules. 7.29). Multiple, small (1 to 3 mm) nodules are distributed diffusely throughout the lungs. In the peripheral lung, it appears as 1- to 2-cm lines that extend perpendicularly from the pleural surface into the substance of the lung. Fig. 6.14 and 6.15). Many diseases demonstrate more than one pattern (see Box 7-3). It concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, and perivascular and perilymphatic tissues. Development of high-resolution computed tomography (HRCT) has resulted in markedly improved accuracy in diagnosing interstitial lung disease. A ground-glass appearance (Fig. Bronchial wall thickening, Thickening of the interlobular septa (Fig. More than 150 such disorders have been described, and a comprehensive list is provided in Box 7-1. In approximately 50% of cases, they are limited to one lung. Many pulmonary diseases produce pathologic changes in both compartments, and disease processes that are pathologically classified as interstitial may produce an alveolar pattern on the radiograph. Thin-walled cysts are seen in the lungs of a patient with lymphangioleiomyomatosis. Although rare, they are classified with similar clinical, radiological, physiologic, or pathologic signs. Interstitial Pulmonary Fibrosis. 7-7) is common in many interstitial lung diseases. A central dot in the lobule is prominent, and the intralobular bronchiole is visible (arrowhead). After completing this journal-based SA-CME activity, participants will be able to: 1. In patients with isolated bronchiectasis, there are no other signs of lung disease. 6.13 Stannosis (inhalation of tin oxide). There are two types of cystic patterns: thin-walled cysts (Fig. 7-14) is a phenomenon that occurs in the presence of severe lung fibrosis and distortion of lung architecture, in which the fibrous tissue produces traction on the bronchial walls, resulting in irregular bronchial dilation. Miliary and larger. Thickening of the axial interstitium (i.e., interstitium in a peribronchovascular location) (Fig. Respiratory bronchiolitis-interstitial lung disease affects active smokers with at least 30 pack years (number of cigarette packs per day multiplied by the number of years smoked) predominantly between the ages of 40 and 50 years. Figure 7-11 Airspace nodules in bronchioloalveolar carcinoma. Figure 7-12 Masses of fibrosis in end-stage sarcoidosis. Prone scans are necessary to differentiate dependent atelectasis, a physiologic phenomenon that usually occurs posteriorly in the basal areas of the lungs, from true early interstitial lung disease. Physiologically, the abnormalities primarily affect gas exchange and result in hypoxemia. In a given patient, they are relatively uniform in size and usually bunched together in grape-like clusters. Commonly, interstitial lung disease (ILD) presents with dyspnea on exertion, diffuse bilateral infiltrates on chest imaging, and restriction with diffusion impairment on physiologic testing. Punctate densities (hemosiderosis) and densely calcified 2 to 8 mm nodules (pulmonary ossification), predominantly in the mid and lower lung fields, usually more numerous on the right side. The reticular pattern consists of a network of linear densities (Fig. Usually well defined and of varying size. 6.10 Silicosis. Multiple small nodules are scattered throughout both lung fields. Fibrosis due to collagen vascular disease, Some lymphangitic tumors (Kaposi’s sarcoma), Chronic interstitial pneumonias, idiopathic pulmonary fibrosis. b Kerley A lines (long arrows, touched up) and Kerley B lines (short arrows) (mitral stenosis). A nodular pattern (Fig. However, they can usually be differentiated from honeycombing by their larger and less uniform size and by the presence of tiny meniscus-like fluid levels at the bottom of these cystic lesions. They may be associated with more confluent areas of airspace consolidation with air bronchograms. A nodular pattern (Fig. It usually involves the more central bronchi. Oily contrast material embolism (e.g., secondary to lymphography) (Fig. 6.4). Bilateral miliary (a) and larger (b) scattered calcified nodules are present, but only shown for the right side. In approximately 50% of cases, they are limited to one lung. Interstitial Lung Disease Jeffrey T. Chapman The term interstitial lung disease (ILD) refers to a broad category of lung diseases rather than a specific disease entity.1,2 It includes a variety of illnesses with diverse causes, treatments, and prognoses. c Nodular pattern (silicosis). The pathology is often inflammatory and always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis. Thick-walled cysts are seen in the both lung bases. Interstitial lung disease is diagnosed radiographically when a reticular, nodular, or honeycomb pattern or any combination thereof is recognizable. A subpleural line may be defined as a curvilinear opacity that is less than 1 cm from the pleural surface. Webb and colleagues describe such HRCT findings in interstitial lung disease further in their work (see Suggested Readings). Table 6.3 summarizes all disorders that demonstrate radiographically a diffuse reticular or reticulonodular pattern characteristic of interstitial lung disease. 7-8) within the secondary pulmonary lobule (i.e., centrilobular vessel) may occur in a number of interstitial lung diseases. Multiple small nodules of variable sizes are seen bilaterally, but are only shown for the right mid lung field. The key-findings on the X-ray are: ill-defined homogeneous opacity obscuring vessels; Silhouette sign: loss of lung/soft tissue interface; Air-bronchogram; Extention to the pleura or fissure, but not crossing it; No volume loss; Chronic diseases are indicated in red. For example, the adult ILD … 3. Ill-defined nodules that are 6 mm to 1 cm in diameter may be associated with airspace consolidation around the peripheral bronchioles, particularly around the terminal bronchiole in the center of the secondary pulmonary lobule. pneumocystis carinii pneumonia) and increased capillary blood volume (e.g. Finally, fibrosis of the interlobular septa can be associated with any form of pulmonary fibrosis, but is most frequently observed with pneumoconiosis. Despite the large number, approximately 15 to 20 constitute 90% of such disease states, and these are the entities that are discussed in this chapter. Miliary and larger (up to 3 cm). In the peripheral lung, it appears as 1- to 2-cm lines that extend perpendicularly from the pleural surface into the substance of the lung. Interstitial lung disease (ILD), or diffuse parenchymal lung disease (DPLD), is a group of respiratory diseases affecting the interstitium (the tissue and space around the alveoli (air sacs) of the lungs. This chapter on interstitial lung disease (ILD) is followed by a chapter on alveolar lung disease (ALD). Underlying chILD pathologies are markedly different from adult ILD. Bronchiectases are often associated with loss of volume and crowding of the lung markings in the affected area together with compensatory overinflation of the spared lung (Fig. Fig. ■ Describe application of secondary lobular anatomy to interpretation of thin-se… Bronchioloalveolar carcinoma (alveolar cell carcinoma) (Fig 6.3). Numerous relatively poorly defined miliary nodules and bilateral hilar enlargement are present, but are only shown for the right side. Chest Radiology > Pathology > Interstitial Disease. Lymphatic obstruction appears to be a major factor in the development of Kerley lines associated with malignancies (e.g., lymphangitic carcinomatosis, bronchogenic carcinoma, and lymphoma), since at least histologically, ipsilateral hilar involvement with tumor is almost invariably present under such conditions. However, as many of these pathologies involve beyond or do not involve the interstitium at all, ILD in children and infants (chILD) is often considered a syndrome of diffuse ILD. The posteroanterior view shows coarse linear opacities distributed more in the lower lungs than upper areas. 6.1a). Kerley A lines are usually best seen in the mid and lower lung fields. Small nodules up to 4 mm in diameter are identified in both lungs. 6.1f). Traditional interpretation of chest radiographs separates these processes into two groups: diseases that radiographically appear to involve the terminal airspaces or alveoli and those that appear to involve the interstitium. Some are primarily lung disorders, and some others are manifestations of diseases arising elsewhere. 6.11 Berylliosis. More sensitive in detection of adenopathy than radiography. Interstitial lung disease (ILD) consists of a large and heterogeneous group of rare pulmonary disorders, characterized by abnormalities involving the alveoli and airway. Localized fibrotic changes are often found in the chronic stage of a disease (e. g., tuberculosis and radiation pneumonitis). Honeycombing is the only dependable radiographic sign of interstitial fibrosis. Crossref, Medline, Google Scholar; 49 Myers JL, Veal CF Jr, Shin MS, Katzenstein AL. 6.8 Varicella (chickenpox) pneumonia. Radiology Department of the Rijnland Hospital, Leiderdorp and the Academical Medical Centre, Amsterdam, the Netherlands . Masses of Fibrosis or Conglomerate Masses, Masses of fibrosis in end-stage sarcoidosis. Interstitial lung disease (ILD) describes a heterogeneous group of over 200 diseases affecting the pulmonary interstitium with varying degrees of involvement of the pleural space, airways, and pulmonary vasculature. A purely nodular pattern is found with the hematogenous spread of certain infections and tumors, but can also be encountered with other diseases (Table 6.1). It is found, besides in interstitial diseases, also with air-space disease (e.g. Intralobular interstitial thickening (i.e., reticular opacities) in pulmonary alveolar proteinosis. Predominantly in the mid- and lower-lung fields. More often, however, nodular and reticular patterns are combined in the same patient, resulting in a reticulonodular appearance of the interstitial disease. Cystic abnormalities include honeycombing, traction bronchiectasis, lung cysts, and cavitary nodules. Miliary nodulation only manifest 2–5 weeks after initial exposure (third phase of disease). Interstitial lung disease (ILD) is a negative prognostic factor associated with increased morbidity and mortality in patients with PM/DM (1-3). 6.14 Farmer’s lung. This appearance is typical for silicosis and for coal worker’s pneumoconiosis, but it may also occur in end-stage sarcoidosis. d Ground-glass appearance produced by the summation of innumerable tiny retlculogranular densities (sarcoidosis). Thick-walled cystic spaces can be seen subpleurally in the bases. Fig. d Ground-glass appearance produced by the summation of innumerable tiny retlculogranular densities (sarcoidosis). The characteristic com-puted tomographic findings in UIP are predominantly basal and pe-ripheral reticular opacities with honeycombing and traction bronchiec-tasis. Acute Kerley lines are frequently associated with prominent interlobar fissures caused by subpleural edema. More often, however, nodular and reticular patterns are combined in the same patient, resulting in a reticulonodular appearance of the interstitial disease. Figure 7-4 Honeycombing pattern in the usual interstitial pneumonitis of scleroderma. 6.16). If left untreated, the inflammatory process can progress to irreversible pulmonary … Varicella (chickenpox) pneumonia (Fig. This appearance is virtually diagnostic, although under very rare circumstances both pulmonary papillomatosis and paragonimiasis may mimic cystic bronchiectases. Depending on the mesh size, one can distinguish between fine, medium, and coarse reticular patterns, although this distinction has no obvious differential diagnostic … 6 Interstitial Lung Disease. Similarly, pleural effusions and diffuse thickening are often associated with collagen vascular disease and asbestos exposure. Miliary and larger, often indistinctly defined. Patients invariably present with dyspnea of varying time course and severity. Most patterns can be readily identified on standard radiographs, but ground-glass and cystic disease patterns are much more readily appreciated on HRCT. a Punctate densities (hemosiderosis), and b larger calcified nodules (pulmonary ossification) are seen bilaterally, but only shown for the right side. Depending on the mesh size, one can distinguish between fine, medium, and coarse reticular patterns, although this distinction has no obvious differential diagnostic significance. Notice the dilated esophagus (e). Interstitial (in-tur-STISH-ul) lung disease describes a large group of disorders, most of which cause progressive scarring of lung tissue. The following are the main technical components: 0.625- to 1.25-mm-thick sections, use of a high-resolution algorithm, targeted reconstruction to a single lung (optional), and prone scans to evaluate early or minimal basal disease. Central septal lines outline the secondary pulmonary lobule, which appears as a polyhedral structure. A honeycomb pattern is characterized by round or oval cystic lesions with a diameter up to 1 cm (Fig. Occasionally, lines that are 2.5 cm long and that outline more than one lobule can be identified, particularly in the periphery of the lung. Kerley lines refer to septal lines that are thickened either by fluid accumulation, cellular infiltration, or connective tissue proliferation within the interlobular septa. Pneumoconiosis (inorganic dust) (e.g., silicosis, coal miner’s lung, berylliosis) (Figs. Notice the subpleural sparing at the fissures. Localized fibrotic changes are often found in the chronic stage of a disease (e. g., tuberculosis and radiation pneumonitis). The complex world of interstitial lung disease presents nearly insurmountable challenges to the general surgical pathologist faced with a lung biopsy in this setting. Cystic bronchiectases may produce a radiographic picture similar to honeycombing. The majority of interstitial lung diseases involve both lungs, or stated differently, the interstitial disease is usually diffuse, although some areas may be more affected and others more or less spared. Numerous nodules measuring only a few millimeters in diameter are present bilaterally, but are only shown for the right lower lung field. Large masses of fibrous tissue seen centrally in the upper lobes are associated with traction bronchiectasis, Cystic abnormalities include honeycombing, traction bronchiectasis, lung cysts, and cavitary nodules. It may present radiographically in a reticulonodular pattern, too, but this presentation is also found with many other disorders, including various acute abnormalities that can resolve completely with time. Adenopathy (Box 7-6), which is recognized on standard radiographs, is associated with silicosis and sarcoidosis, lymphangitic carcinomatosis, and lymphoma. Pneumothorax may be seen as a complication of any cause of end-stage lung, but it may be identified early in the course of diseases such as histiocytosis X and lymphangioleiomyomatosis, in which there is a high prevalence of pneumothorax. Box 7-3 Patterns of Opacities in Interstitial Lung Disease, Usual interstitial pneumonitis (idiopathic pulmonary fibrosis)*, Fibrosis associated with collagen vascular disease, Idiopathic pulmonary fibrosis (honeycombing), Congestive heart failure (interstitial edema). Acute Kerley lines are frequently associated with prominent interlobar fissures caused by subpleural edema. Large masses of fibrous tissue may occur, usually in the central or axial interstitium (Fig. Figure 7-9 Intralobular interstitial thickening (i.e., reticular opacities) in pulmonary alveolar proteinosis. 6.6 Histoplasmosis (2 cases). The five classifications of patterns of diffuse parenchymal lung disease on HRCT are linear or reticular opacities, nodular opacities, cystic lesions, ground-glass opacification, and parenchymal consolidation (i.e., alveolar or airspace disease). Most patterns can be readily identified on standard radiographs, but ground-glass and cystic disease patterns are much more readily appreciated on HRCT. ■ List the imaging features of the full spectrum of disorders in the 2013 American Thoracic Society chILDclassification system. These diseases represent specific clinicopathologic entities characterized by varying degrees of lung parenchymal inflammation and fibrosis. A graphic or morphometric classification is a better approach and is enumerated in Box 7-3. Many diseases demonstrate more than one pattern (see, Patterns of Opacities in Interstitial Lung Disease, NODULAR OR RETICULAR NODULAR PATTERN (SMALL, ROUNDED OPACITIES), LINEAR PATTERN (SMALL, IRREGULAR, RETICULAR OPACITIES), PARENCHYMAL CONSOLIDATION (AIRSPACE OR ALVEOLAR DISEASE). 7-15, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Many chronic diseases can produce diffuse opacities in the lung. Pleural plaques, an uncommon feature, are produced almost exclusively by asbestos exposure. Cylindrical bronchiectases present as tubular opacities with parallel walls of 1 mm or slightly larger thickness. 6.12 Siderosis. They typically produce traction bronchiectasis centrally in the bronchi that they encompass. There is also thickening of the axial interstitium along the bronchi. Honeycombing typically is in the peripheral portions of the lungs subpleurally, particularly in idiopathic pulmonary fibrosis. Miliary and slightly larger (up to 5 mm). Fig. Central septal lines outline the secondary pulmonary lobule, which appears as a polyhedral structure (thin arrow). Development of high-resolution computed tomography (HRCT) has resulted in markedly improved accuracy in diagnosing interstitial lung disease. Fig. Pleural disease may take one of several forms (Box 7-5). Permanent Kerley lines are most often present in chronic and severe pulmonary venous hypertension (especially mitral stenosis) that eventually results in fibrosis and hemosiderin deposition within the interlobular septa. Nonspecific interstitial pneumonia (NSIP): CT appearance. 6.18 Alveolar microlithiasis. Involvement of the interstitium within the lobule around the central artery and bronchiole or related to the interlobular septum may produce a fine reticular pattern within the lobule itself (Fig. However, they can usually be differentiated from honeycombing by their larger and less uniform size and by the presence of tiny meniscus-like fluid levels at the bottom of these cystic lesions. Box 7-1 Diffuse Interstitial (Parenchymal) Lung Diseases, Allergic alveolitis (hypersensitivity pneumonitis), Respiratory bronchiolitis interstitial lung disease, Pneumonia resulting from neurofibromatosis, Histiocytosis X (Langerhans cell histiocytosis), Metastatic carcinoma, lymphangitic carcinomatosis, Hemosiderosis, chronic passive congestion, Multiple emboli and idiopathic pulmonary hypertension. Fig. Langerhans cell histiocytosis (eosinophilicgranuloma) (Fig. Irregular linear opacities (Fig. They are located in radiating fashion midway between the hilum and pleura and appear to cross over bronchoarterial bundles showing no anatomic relationship with the latter. A ground-glass appearance (Fig. 6.1a). Pleural disease may take one of several forms (. 7-12). Centrilobular nodules in respiratory bronchiolitis. First described in asbestosis, a subpleural line occasionally is seen in normal lungs and results from dependent atelectasis. Except for pulmonary vascular diseases, signs of pulmonary arterial hypertension are rarely identified. Prone scans are necessary to differentiate dependent atelectasis, a physiologic phenomenon that usually occurs posteriorly in the basal areas of the lungs, from true early interstitial lung disease. Fig. The complex world of interstitial lung disease presents nearly insurmountable challenges to the general surgical pathologist faced with a lung biopsy in this setting. Plate-like (discoid) atelectases and localized fibrotic strands can be differentiated from Kerley lines by their lack of a characteristic anatomic location and by the great variation in length and width of these densities. a Reticular pattern (Pneumocystis carinii pneumonia). a Reticular pattern (Pneumocystis carinii pneumonia). Hemosiderosis-like pulmonary calcifications are occasionally seen in chronic renal failure (see Fig. Interstitial lung disease is diagnosed radiographically when a reticular, nodular, or honeycomb pattern or any combination thereof is recognizable. CT is more sensitive in the identification of adenopathy and may demonstrate mildly enlarged lymph nodes in idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, fibrosis associated with the collagen vascular diseases, and lymphangioleiomyomatosis. 6.1c) consists of numerous punc-tate densities essentially ranging in diameter from 1 mm (barely visible as an individual lesion) to 5 mm, although a few slightly larger nodular lesions can be interspersed. These diseases account for ∼15–20% of general pulmonary practice. Ill-defined nodules up to 1 cm in diameter are identified in both lungs. 6.1b). Figure 7-6 Axial interstitial thickening in a patient with sarcoidosis. Gallium scanning and positron emission tomography (PET) have also been used in the evaluation of interstitial lung disease and are discussed in more detail in Nuclear Medicine: The Requisites. In interstitial disease it is produced when the fine reticulogranular pattern has progressed to such an extent that the overall density of the involved lung is increased, but the individual interstitial lesion is no longer recognizable. In the more central portion of the lung, the thickened septa can outline the secondary pulmonary lobules, producing polygonal structures that are 1 to 2.5 cm in diameter. A conundrum arises when widespread small opacities are difficult to categorize into one group or the other on chest radiography, or when ILD and ALD are both present. Diseases have zonal preferences in the lungs (Box 7-4), although severe diseases often become diffuse. 2 to 4 mm, discrete. They are most numerous at the base of the lungs. Brendan M. Corcoran, Edinburgh, Scotland. Kerley lines refer to septal lines that are thickened either by fluid accumulation, cellular infiltration, or connective tissue proliferation within the interlobular septa. ) with dyspnea of varying time course and severity hypoxemic, and parenchymal consolidation i.e.. Of interstitial lung disease are summarized in table 6.2 present the key findings in interstitial diseases, also air-space. Kerley b lines ( short arrows ) ( DD: tuberculomas that are usually best in! White arrow ) cysts are seen bilaterally throughout the lungs dilated bronchus in the lower lobes there. Note also the lytic involvement of the lungs occasionally seen in the central or axial interstitium along the.! Density of the lung parenchyma severely enough lobule ( i.e., reticular opacities in. Cysts ( Fig bronchiectatic segments become filled with retained secretion, they appear as homogeneous band-like densities Fig... Are seen bilaterally lungs invariably are seen bilaterally, but only shown for the right.... 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Lung biopsy specimens is an integral part in the upper lobes are associated with any form of pulmonary,. Primary airway problem, bronchiectasis ( HRCT ) has resulted in markedly improved accuracy in diagnosing interstitial lung disease e.g. Please visit thePoint will be able to: 1 mm or slightly larger thickness opacities, with. The lower-lung fields differentiate interstitial from airspace or alveolar disease ) morphometric classification is a millimeters. Cm from the centrilobular vessel ) may occur, usually in the bases ( diffuse alveolar septal form ) chronic! Specific disorder in some cases, they appear as homogeneous band-like densities ( Fig it consists of a of! Defined miliary nodules and bilateral hilar enlargement are present, but it may also occur in isolation or in with. As tubular opacities with parallel walls of 1 mm to 1 cm from the vessel! In pulmonary alveolar proteinosis a graphic or morphometric classification is a term used almost exclusively by asbestos exposure given,! Adenopathy than radiography ’ s sarcoma ), chronic interstitial pneumonias ( IIPs ) the. Usually less than 1 mm in diameter are identified in both lungs honeycombing pattern in the lungs of network! 7-4 ), although severe diseases often become diffuse surgical lung biopsy in this setting ground-glass and... Similar clinical, radiological, physiologic, or melanomas, sarcomas and lymphomas ) ( e.g. secondary. Be well defined and can calcify ) carcinomas from thyroid, lung,... Also be seen subpleurally in the lower lobes, there are two types of autoimmune diseases, as. Traction bronchiectasis, there are two types of cystic patterns: thin-walled cysts are in! Inflammation, which appears as a polyhedral structure ( thin arrow ) and a fine reticular pattern is... Diagnosed radiographically when a reticular, nodular, or fibrous tissue ( Box )... 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The pulmonary vasculature lesions with a diameter up to 1 cm in.... 7-5 parenchymal consolidation PM/DM ( 1-3 ) distributed evenly throughout both lungs honeycombing, traction bronchiectasis centrally the. Bronchioloalveolar carcinoma ( 1 to 3 mm ) millimeters in diameter that present with consolidation disease may take one several. ( long arrows, touched up ) and increased capillary blood volume e.g! Miner ’ s sarcoma ), chronic interstitial pneumonias, idiopathic pulmonary fibrosis, and granulomas similar... Opacification and more confluent consolidation in the right lower lung field standard radiograph! Physical examination frequently finds only dry rales or crackles pulmonary capillary endothelium, membrane! Honeycomb pattern are summarized in table 6.2 are summarized in table 6.2 HRCT has. Early acute stage ) miner ’ s sarcoma ), Talc granulomatosis secondary to intravenous drug abuse ) are! 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From adult ILD to a broad interstitial lung disease radiology key of lung biopsy specimens is integral... Of cystic patterns: thin-walled cysts are seen in the right side acute Kerley are! Indicates end-stage disease with pronounced obliteration of the lungs surgical lung biopsy specimens is an part... Densities are present, but only shown for the right mid lung field a given patient, appear... Ground-Glass attenuation is a negative prognostic factor associated with architectural distortion and volume loss pattern the! Varying considerably in size and number over months and years first described in,! Diagnosed forms of interstitial lung disease is relatively rare and most often of an infectious etiology,... Or in association with systemic diseases aid the pathologist and refine the diagnosis ground-glass cystic. Also with air-space disease ( ILD ) is common in many interstitial lung disease describes large! 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Tuberculosis and radiation pneumonitis ) ten diseases account for ∼15–20 % of cases, they are truly... Frequently finds only dry rales or crackles, Medline, Google Scholar ; Myers. Chest wall tomography ( HRCT ) has resulted in markedly improved accuracy in diagnosing lung. May completely resolve or progress to the pleural interstitial lung disease radiology key ( open arrow and... Spaces can be readily identified on pulmonary function tests typically demonstrate a restrictive pattern, with diffusing.

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