CHAPTER 5

Recognizing Airspace versus

Interstitial Lung Disease
We have reviewed the normal imaging anatomy of the heart and
lungs in the last two chapters. Feel free to come back to them
for a brush up whenever needed. Recognizing the difference
between normal anatomy and what is abnormal is critical to
your ability to make the correct diagnosis. In this chapter, we
are going to examine the major patterns of parenchymal lung
disease.
CLASSIFYING PARENCHYMAL LUNG DISEASE
■ Diseases that affect the lung parenchyma can be arbitrarily
divided into two main categories based in part on their
pathology and in part on the pattern they typically produce
on a chest imaging study.
♦ Airspace (alveolar) disease
♦ Interstitial (infiltrative) disease
■ Why learn the difference?
♦ While many diseases produce abnormalities that
display both patterns, recognition of these patterns
frequently helps narrow the disease possibilities so
that you can form a reasonable differential diagnosis
(Box 5-1).
CHARACTERISTICS OF AIRSPACE DISEASE
Airspace disease characteristically produces opacities in
the lung which can be described as fluffy, cloudlike, or hazy.
■ These fluffy opacities tend to be confluent, meaning they
blend into one another with imperceptible margins.
■ The margins of airspace disease are indistinct, meaning
it is frequently difficult to identify a clear demarcation point
between the disease and the adjacent normal lung.
■ Airspace disease may be distributed throughout the lungs,
as in pulmonary edema (Fig. 5-1), or it may appear more
localized, as in a segmental or lobar pneumonia (Fig. 5-2).
■ Airspace disease may contain air bronchograms.
♦ 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,