Air Space Diseases.pptx

air space diseases

1. AIR SPACE DISEASES By: Dr. NITIN WADHWANI D.Y.PATIL MEDICAL COLLEGE,RESEARCH INSTITUTE AND HOSPITAL KOLHAPUR.

2. DEFINITION: Any pathological process that displaces air from the alveoli will be depicted as airspace opacification WHAT FILLS THE AIRSPACES IN AIRSPACE DISEASE? f luid Pus Blood Cells

3. CHARACTERISTICS OF AIRSPACE DISEASE Produces opacities in the lung that can be described as fluffy, cloudlike, and hazy. The opacities tend to be confluent, merging into one another. The margins of airspace disease are fuzzy and indistinct. Air bronchograms or the silhouette sign may be present.

4. Air bronchogram • The visibility of air in the bronchus because of surrounding airspace disease is called an air bronchogram. An air bronchogram is a sign of airspace disease. Bronchi are normally not visible because their walls are very thin, they contain air, and they are surrounded by air. When something like fluid or soft tissue replaces the air normally surrounding the bronchus, then the air inside of the bronchus becomes visible

5. The silhouette sign The silhouette sign occurs when two objects of the same radiographic density (such as water and soft tissue)touch each other so that the edge or margin between them disappears. It will be impossible to tell where one object begins and the other ends.

6. Radiological Signs of Airspace Disease N odular pattern G round-glass opacification C onsolidation.

7. A nodular pattern as a sole manifestation of airspace disease is relatively uncommon. ‘ A cinar nodules’ or ‘acinar rosettes’ has been used to describe the appearance of poorly defined infiltrates on chest radiography and HRCT B acterial infection or pulmonary haemorrhage NODULAR PATTERN

8. Ground-glass opacity (GGO) represents: Filling of the alveolar spaces with pus, edema, hemorrhage, inflammation or tumor cells. Thickening of the interstitium or alveolar walls below the spatial resolution of the HRCT as seen in fibrosis. So ground-glass opacification may either be the result of air space disease (filling of the alveoli) or interstitial lung disease (i.e. fibrosis). On plain radiography - hazy increased lung opacity with the margins of pulmonary vessels may be indistinct o n CT appears as a hazy increase in lung attenuation but without obscuration of bronchial and vascular markings

9. T he location of the abnormalities in ground glass pattern can be helpful: Upper zone predominance : Respiratory bronchiolitis, Pneumocystis pneumonia. Lower zone predominance : UIP, NSIP, DIP. Centrilobular distribution : Hypersensitivity pneumonitis, Respiratory bronchiolitis

10. Consolidation I ncrease in lung density on chest radiography or CT in which the margins of vessels and airways are obscured An air bronchogram may be seen.

11. P athologic processes can result in air-space consolidation : 1. Water (e.g., the various types of pulmonary edema) 2. Blood (e.g., pulmonary hemorrhage) 3. Pus (e.g., pneumonia) 4. Cells (e.g., pulmonary adenocarcinoma, lymphoma, eosinophilic pneumonia, organizing pneumonia [OP]) 5. Other substances (e.g., lipoprotein in alveolar proteinosis, lipid in lipoid pneumonia

12. CONSOLIDATION Acute Pneumonia Pulmonary alveolar edema Hemorrhage Acute eosinophilic pneumonia Chronic Bronchoalveolar cell carcinoma Alveolar cell proteinosis Aspiration Near-drowning Sarcoidosis Lymphoma Chronic eosinophilic pneumonia Fibrosis in UIP and NSIP

13. Radiographic and CT Findings of Consolidation Homogeneous opacity obscuring vessels Air bronchograms Ill-defined or fluffy opacities “Air alveolograms ” Patchy opacities “Acinar” or air-space nodules Preserved lung volume Extension to pleural surface “CT angiogram” sign

14. Homogeneous Opacity Obscuring Vessels With complete replacement of alveolar air, homogeneous opacification of the lung results. Vessels within the consolidated lung are invisible

15. Patterns of Consolidation Diffuse or Extensive Consolidation . Water (Edema) Hydrostatic (cardiogenic) pulmonary edema Increased permeability (noncardiogenic) pulmonary edema Blood (hemorrhage) Aspiration of blood Bleeding diathesis Collagen-vascular disease and immune complex vasculitis Goodpasture's syndrome Idiopathic pulmonary hemosiderosis Trauma Vasculitis Other substances Alveolar proteinosis (lipoprotein) Lipoid pneumonia (lipid) Cells Neoplasm - Pulmonary adenocarcinoma Lymphoma and other lymphoproliferative diseases Eosinophilic pneumonia or other eosinophilic diseases Organizing pneumonia (OP) Idiopathic interstitial pneumonias Sarcoidosis

16. Perihilar “Bat-Wing” Consolidation S hows central consolidation with sparing of the lung periphery P ulmonary edema This pattern also may be seen with : pulmonary hemorrhage pneumonias (including bacteria and atypical pneumonias such as Pneumocystis jiroveci pneumonia [PCP] and viral pneumonia) inhalational lung injury.

17. Peripheral or subpleural consolidation is the opposite of a bat-wing pattern (i.e., a reverse bat wing pattern). Consolidation is seen adjacent to the chest wall, with sparing of the perihilar regions. It is classically associated with eosinophilic lung diseases, particularly eosinophilic pneumonia but may also occur with OP, sarcoidosis, radiation pneumonitis, lung contusion, or mucinous adenocarcinoma. Peripheral or Subpleural Consolidation

18. Diffuse Patchy Consolidation seen with any pneumonia (bacterial, mycobacterial, fungal, viral, PCP), pulmonary edema (hydrostatic and permeability), acute respiratory distress syndrome (ARDS), pulmonary hemorrhage aspiration, inhalational diseases eosinophilic diseases invasive mucinous adenocarcinoma. .

19. Diffuse Air-space Nodules This appearance is seen in patients with endobronchial spread of infection such as : T uberculosis (TB) or Mycobacterium avium complex (MAC) bacterial bronchopneumonia viral pneumonia (cytomegalovirus [CMV], measles) invasive mucinous adenocarcinoma with endobronchial spread pulmonary hemorrhage aspiration.

20. Diffuse Homogeneous Consolidation P ulmonary edema, ARDS P ulmonary hemorrhage P neumonias (including viral and PCP) A lveolar proteinosis E xtensive atelectasis.

21. Differential Diagnosis of Focal Consolidation Water (Edema) Edema in a patient with Pulmonary artery obstruction (e.g., pulmonary embolism) Pulmonary vein occlusion Atelectasis with drowned lung Cells Neoplasm Pulmonary adenocarcinoma Lymphoma and other lymphoproliferative diseases Eosinophilic pneumonia or other eosinophilic diseases Organizing pneumonia (OP) Sarcoidosis Pus (pneumonia) Bacterial Tuberculosis or nontuberculous mycobacterial Fungal Virus (uncommon) Pneumocystis (uncommon) Aspiration pneumonia Atelectasis with postobstructive pneumonia Blood (hemorrhage) Contusion Infarction Aspiration of blood Vasculitis

22. Lobar Consolidation Consolidation involving a single (or more than one) lobe is most typical of pneumonia (including Streptococcus pneumoniae , Klebsiella , Legionella, and TB) and abnormalities associated with bronchial obstruction. Consolidation can be localized to one or more lobes if its relationship to a specific fissure or fissures is apparent on either frontal or l ateral radiographs, or on CT.

23. Segmental (or Subsegmental ) Consolidation Segmental (or subsegmental ) consolidation may be diagnosed if a wedge-shaped opacity of more than a few centimeters in size is visible with the apex of the wedge pointing toward the hilum This finding suggests an abnormality related to a segmental (or subsegmental ) bronchus or artery such as bronchial obstruction due to mucus or tumor, bronchopneumonia , focal aspiration, or pulmonary embolism with infarction.

24. Differential Diagnosis of Consolidation Based on Time Course Rapidly Appearing Consolidation or Consolidation with Acute Symptoms atelectasis with drowned lung, aspiration, pulmonary edema, pulmonary hemorrhage, pulmonary embolism with infarction, or rapidly progressing pneumonia, particularly in an immunocompromised host . Of these, only pulmonary edema and drowned lung may clear quickly.

25. Long-standing Consolidation or Consolidation with Chronic Symptoms Long-standing (chronic) consolidation (4 to 6 weeks or longer) suggests eosinophilic pneumonia, organizing pneumonia mucinous adenocarcinoma lymphoma lipoid pneumonia indolent pneumonias caused by fungal organisms. Recurrent processes (e.g., recurrent pulmonary edema, pulmonary hemorrhage, or aspiration) may appear to be chronic if radiographs are obtained only during the acute episodes.

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