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8/10/2019 Interstitial vs Air Space
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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
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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
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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
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