This document contains descriptions and CT images of various types of alveolar lung disease, including specific conditions such as Legionella pneumonia, tuberculosis, pneumocystis carinii pneumonia, aspergillosis, radiation pneumonitis, pulmonary thromboembolism, septic emboli, eosinophilic pneumonia, alveolar proteinosis, bronchioloalveolar carcinoma, lipoid pneumonia, alveolar sarcoidosis, pulmonary contusion, pulmonary edema, cocaine abuse, crack lung, pulmonary hemorrhage, metastases, and lymphoma. Each condition is exemplified by a CT image showing characteristic imaging findings that can aid in differential diagnosis of alveolar lung diseases seen on CT scans.

1. 49Alveolar Lung Disease on
Computed Tomography*

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig C 49-1 Legionella pneumonia. Central air
bronchograms, abscess formation anteriorly
(arrow), and accompanying pleural
effusions.94

4. • Fig C 49-2 Tuberculous pneumonia. Air
bronchograms and accompanying hilar
lymphadenopathy. (Courtesy of Junpei Ikezoe,
MD.)94

5. • Fig C 49-3 Endobronchial spread of
tuberculosis. Note the patchy peribronchial
and peribronchiolar distribution of the
nodular opacities. (Courtesy of Junpei Ikezoe,
MD.)94

6. Fig C 49-4 Pneumocystis carinii pneumonia in AIDS. Diffuse,
bilateral ground-glass opacities with minimal peripheral
sparing.95

7. • Fig C 49-5 Aspergillosis. Scan performed at the time of bone
marrow recovery in a neutropenic chemotherapy patient
shows a low-attenuation center that probably reflects early
necrosis. The air-filled spaces near the lower border
represent uninvolved emphysematous air spaces.94

8. • Fig C 49-6 Radiation pneumonitis. Two months after radiation
therapy for tracheal carcinoma, localized air-space consolidation
has developed in the right lower lobe. There is also interstitial
disease that produces thickened intralobular septa centrally. Later
scans showed the development of dense scarring.94

9. • Fig C 49-7 Pulmonary thromboembolism. There
are multiple rounded subpleural opacities, some
of which have lung vessels leading to them.
(Courtesy of Robert D. Tarver, MD.)94

10. • Fig C 49-8 Septic emboli. Multiple peripheral
cavitating opacities. The vascular connections,
particularly in the right middle lobe, indicate
their hematogenous origin.96

11. • Fig C 49-9 Eosinophilic pneumonia. Bilateral
patchy infiltrates with a peripheral
distribution.94

12. • Fig C 49-10 Alveolar proteinosis. (A)
Widespread air-space disease and
superimposed reticular interstitial thickening.
Note the nocardial abscess in the left lower
lobe. (B) After bronchoalveolar lavage, the air-
space and interstitial components have
diminished.97

13. • Fig C 49-11 Bronchioloalveolar carcinoma. (A)
Widespread air-space filling with geographic
margination. (B) Note the presence of air
bronchograms. (Courtesy of David P. Naidich,
MD.)94

14. • Fig C 49-12 Lipoid pneumonia. Characteristic
dependent location of the consolidation.94

15. • Fig C 49-13 Alveolar sarcoidosis. (A) Large
central masses with partially well-defined and
partially ill-defined margins. (B) More
peripheral lesions with air bronchograms.94

16. • Fig C 49-14 Pulmonary contusion. There are
accompanying hemothorax, rib fractures,
subcutaneous emphysema, and pleural
drain.94

17. • Fig C 49-15 Pulmonary edema. Central
“ground-glass,” low-grade lung opacification
persists 3 weeks after myocardial infarction.94

18. • Fig C 49-16 Cocaine abuse. Acute pulmonary
edema with bilateral heterogeneous
opacities.11

19. • Fig C 49-17 Crack lung with pulmonary
eosinophilia. Extensive bilateral
heterogeneous central and peripheral
opacities.

20. • Fig C 49-18 Pulmonary hemorrhage. Widespread,
patchy, and geographic air-space filling in this
patient with necrotizing vasculitis.94

21. • Fig C 49-19 Metastases. Multiple pulmonary
nodules with vascular connections indicating
their hematogenous origin.96

22. • Fig C 49-20 Lymphoma. Multiple nodular
opacities, some with welldefined and some
with ill-defined margins. The major differential
diagnostic consideration is fungal infection in
this patient with Hodgkin's disease.94