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A. Pneumonitis

  1. Inflammation of lung tissue
  2. Requires demonstration of inflammatory cells on bronchoalveolar lavage (BAL)

B. Acute Pneumonitis

  1. Bacterial Infection
  2. Atypical Organisms
    1. Legionella
    2. Myoplasma
    3. Nocardia
    4. Pneumocystis
  3. Viral Infection
    1. Adenovirus
    2. Influenza Virus
    3. Parainfluenza
    4. Respiratory Syncitial Virus (SRV)
  4. Toxic Inhalation Reaction
  5. Hypersensitivity Reaction to Drugs
    1. Methotrexate
    2. Sulfa drugs
    3. Gold
    4. Bleomycin

C. Subacute and Chronic Pneumonitis

  1. Atypical Bacterial Infections
    1. Legionella
    2. Myoplasma
    3. Nocardia
    4. Pneumocystis
  2. Mycobacteria
    1. M. tuberculosis
    2. Atypical mycobacteria
  3. Fungal Infections
    1. Candida
    2. Aspirgillus
    3. Histoplasma
    4. Coccidioides
    5. Cryptococcus
    6. Blastomyces
  4. Viral Infection
    1. Herpes Simplex Virus
    2. Herpes Zoster Virus
    3. Cytomegalovirus
    4. Respiratory Syncitial Virus (SRV)
    5. Human herpesvirus 6
  5. Parasite: toxoplasmosis
  6. Hypersensitivity (Allergic) Pneumonitis [3]
    1. Aspirgillus fumigatus
    2. Micropolyspora faeni
    3. Thermoactinomyces candidus
    4. T. sacchari
    5. T. vulgaris
    6. Pigeon serum
  7. Vasculitis
    1. Wegener's Granulomatosis
    2. Churg-Strauss Syndrome
  8. Inflammatory Disease
    1. Rheumatoid Arthritis
    2. Inflammatory Myositis
    3. Systemic Lupus Erythematosus
    4. Systemic Sclerosis > Limited Scleroderma (CREST)
    5. Primary Biliary Cirrhosis

D. Chest Radiography Patterns in ILD (Table 2, Ref [4])

  1. Consolidation
    1. Acute: infection, ARDS, hemorrhage, aspiration, pneumonia, BOOP
    2. Chronic: infection (tuberculosis, fungal), chronic eosihophilic pneumonia, BOOP, lymphoid disorders, pulmonary alveolar proteinosis
  2. Linear or Reticular Opacities
    1. Acute: infection (viral, mycoplasma), pulmonary edema
    2. Chronic: IPF, inflammatory disease associated fibrosis, asbestosis, sarcoidosis, hypersensitivity pneumonitis, drug induced lung disease
  3. Small (<1cm diameter) Nodules
    1. Acute: infection (tuberculosis, fungal, viral), hypersensitivity pneumonitis
    2. Chronic: sarcoidosis, hypersensitivity pneumonitis, pneumoconiosis (silicosis, coal-worker's lung), bronchiolitis, metastases, alveolar microlithiasis
  4. Cystic Airspaces
    1. Acute: Pneumocystis carinii pneumonia (PCP), septic embolism
    2. Chronic: histiocytosis, lymphangioleiomyomatosis, honeycomb lung (IPF, others)
  5. Ground-Glass Opacities
    1. Acute: infection (PCP, cytomegalovirus), pulmonary edema, hemorrhage, hypersensitivity pneumonitis, acute inhalation exposure, drug induced lung disease, interstitial pneumonia
    2. Chronic: nonspecific interstitial pneumonia, desquamative interstitial pneumonia, drug- induced lung disease, pulmonary alveolar proteinosis
  6. Thickened Intralobular Septa
    1. Acute: pulmonary edema
    2. Chronic: lymphangitic carcinomatosis, pulmonary alveolar proteinosis, sarcoidosis, pulmonary veno-occlusive disease
  7. Lung Zone Involvement
    1. Upper Lung Predominance: histiocytosis, silicosis, coal worker's lung, carmustine related, reactivation tuberculosis, PCP on pentamidine prophylaxis
    2. Lower Lung Predominance: IPF, inflammatory disease associated fibrosis, asbestosis, chronic aspiration
    3. Central (Perihilar) Predominance: sarcoidosis, berylliosis
    4. Peripheral Predominance: IPF, chronic eosinophilic pneumonia, BOOP
  8. Pleural Effusion or Thickening
    1. Pulmonary edema, connective tissue (inflammatory) diseases, asbestosis, lymphoma
    2. Lymphangitic carcinomatosis, lymphagniogioleiomyomatosis, drug induced
  9. Lymphadenopathy
    1. Infections
    2. Sarcoidosis (may be calcified)
    3. Silicosis (may be calcified)
    4. Berylliosis
    5. Neoplastic: lymphangitic carcinomatosis or lymphoma
    6. Lymphocytic interstitial pneumonia

References

  1. Elias AD and Mark EJ. 1997. NEJM. 337(7):480 (Case Report)
  2. Reilly JJ Jr and Mark EJ. 1998. NEJM. 338(18):1293 (Case Report)
  3. Schwartzstein RM and Mark EJ. 2000. NEJM. 343(9):642 (Case Record)
  4. Ryu JH, Olson EJ, Midthun DE, Swensen SJ. 2002. Mayo Clin Proc. 77:1221 abstract