Diffuse Alveolar Disease
Butterfly distribution / Medullary distribution
Lobar or segmental distribution
Patchy, confluent shadows
Soft fluffy edges
No significant loss of lung volume
Ground glass appearance on HRCT
Useful Clinical Classification:
Acute Diffuse Alveolar Disease:
Pulmonary edema - Cardiogenic
Neurogenic pulmonary edema
Idiopathic pulmonary hemosiderosis
Pneumocystis carinii pneumonia
Chicken pox pneumonia
Amniotic fluid embolism
Adult respiratory distress syndrome
Chronic Alveolar Disease:
Alveolar cell carcinoma
Mineral oil pneumonia
Alveolar form of sarcoidosis
Alveolar form of lymphoma
Alveolar form of tuberculosis
Alveolar metastases from cancer of the pancreas
Desquamative interstitial pneumonia
Cannot tell whether there is co-existent interstitial disease.
Alveolar and interstitial pattern can be evident in different portions of lung and is of diagnostic significance.
Evolution of changes in x-ray helpful in the diagnosis.
None of the x-ray findings are specific.
History and the clinical setting under which the problem is encountered is of great help in diagnosis.
Presence of co-existing findings helpful, e.g., lympadenopathy, etc.
Options for a diagnostic procedure is based on the working diagnosis: Sputum evaluation, HRCT, bronchoalveolar lavage, brushing, TBB, open lung biopsy, VAT lung biopsy, CBC, ID workup, auto-immune workup, Cardiac workup
Lower lobes / Mineral oil aspiration