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Supplemental Chapter 2

Intersitial Lung Disease: A Picture Book

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Normal
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Comments:
Note that the pulmonary vessels are the only structures seen within the air-filled lung. They branch, taper, and are barely visible
as they reach the pleura. Bronchi are barely visible beyond the inner third of the lung.

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Ground-Glass Opacification (Synonyms: foggy, hazy, and semiopaque)


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Comments:
This is like looking at the anatomy through a frosted shower door or glass. The lung is an intermediate shade of gray but the
pulmonary vessels are visible within the gray areas. The diminished aeration may be due to: 1) decreased air in the alveoli due
to partial alveoli filling; 2) decreased air in the alveoli due to thickened interstitium encroaching upon the alveoli; or 3) decreased
air in the alveoli due to hypoventilation and atelectasis.
Causes:
atelectasis
aspiration pneumonitis
infection, such as pneumocystis
edema, ARDS
pulmonary hemorrhage
idiopathic (e.g., desquamative interstitial pneumonitis (DIP), chronic organizing pneumonia)

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Reticular (Synonyms: linear and irregular)


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Comments:
Acute or chronic thickening of the interlobular septa or the bronchovascular bundles causes linear or lacelike thickening. This may
be smooth or irregular.
Causes:
edema (Kerley lines)
lymphangitic tumor
sarcoidosis
Langerhans histiocytosis (eosinophilic granuloma)
fibrosis (any cause)

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Micro Nodules (Synonym: miliary nodules)


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Comments:
Tiny, sharp, discreet nodules (<3 mm) are seen throughout the lung. They are generally the size of birdseed (millet seeds). It is often
difficult to detect the individual nodules on chest x-ray but not on CT.
Causes:
Hematogenous spread of granulomatous disease (tuberculosis, fungal infection)
metastatic cancer
silicosis
sarcoidosis
viral pneumonia

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Macro Nodules (Synonym: small nodules)


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Comments:
Nodules bigger than 3 mm are easily seen on the chest x-ray and better seen on the CT. The margins may be sharp or indistinct.
Cavitation may occur.
Causes:
metastatic cancer
septic emboli
diffuse granulomatous infections
Langerhans histiocytosis (eosinophilic granuloma)
vasculitis
sarcoidosis
silicosis

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Cystic (Synonyms: bulla, blebs, and holes)


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Comments:
Macroscopic cystic spaces may be due to: 1) overinflation and destruction of lung tissue leading to very thin-walled spaces
(D=emphysema) or 2) inflammation, lung destruction, and thickening of the residual surrounding tissue (C=eosinophilic granuloma).
Microcystic spaces are termed honeycombing (see next page).
Causes:
Smoking related (COPD)
Alpha 1 antitrypsin deficiency
Langerhans histiocytosis (eosinophilic granuloma)
lymphangiomyomatosis

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Honeycombing (Synonyms: stacked cysts and microcystic)


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Comments:
This is a type of pulmonary fibrosis that results in multiple small, sharply outlined cysts most frequently stacked in the periphery of
the lung base. This is end-stage lung disease and results in severe restrictive physiology.
Causes:
usual interstitial pneumonitis (UIP) (idiopathic pulmonary fibrosis, cryptogenic alveolitis)
asbestosis
collagen vascular disease
hypersensitivity pneumonic (chronic)
pneumonia or pneumonitis

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Fibrosis (Synonym: scarring)


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Comments:
There is linear thickening and distortion of the lung parenchyma. Linear bands are often seen running in nonanatomic directions.
Volume loss frequently accompanies the fibrosis.
Causes:
scarring from any cause common causes include sarcoidosis, tuberculosis, silicosis, radiation pneumonitis, or late stage ARDS

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Quiz

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B.

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Ground glass
Miliary
Cystic

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Ground glass

Fibrosis

Normal

Choose from
following answers

C.

Fibrosis
Macro nodules

Reticular

Honeycombing
Reticular

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Quiz
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Honeycombing

Normal

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F.

Ground glass

Ground glass

Fibrosis
Choose from
following answers

Miliary

Ground glass
Miliary
Cystic

Fibrosis
Macro nodules

Honeycombing
Reticular

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Quiz

III
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B.

Normal
Choose from
following answers

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C.

Honeycombing
Ground glass
Miliary
Cystic

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Macro nodules
Fibrosis
Macro nodules

Cystic (Emphysema)

Honeycombing
Reticular

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Quiz

IV

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B.

Normal

Choose from
following answers

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Ground glass
Miliary
Cystic

C.

Miliary

Fibrosis
Macro nodules

Fibrosis

Honeycombing
Reticular

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