Chest: allergic lung

Playlist contributed by: Dr Annabelle Skelley

Hypersensitivity Pneumonitis

3 Phases

  1. Acute
    • Bilateral consolidation and small, ill-defined centrilobular nodules 
  2. Subacute
    • GGO, centrilobular nodules, air trapping, "headcheese", lung cysts
  3. Chronic
    • Fibrosis -> reticular opacities, traction bronchiectasis, honeycombing, patchy/parahilar

Eosinophilic Lung

Idiopathic Eosinophilic Lung Disease:

  1. Simple pulmonary eosinophilia (Loeffler’s syndrome) -> migratory consolidation +/- GGO/nodules; hx of asthma/atopy
  2. Chronic eosinophilic pneumonia -> rapid resolution with steroids
  3. Acute eosinophilic pneumonia -> good response to steroids; bilateral GGO, crazy paving, small pleural effusions
  4. Hypereosinophilic syndrome: cardiac involvement (pulmonary oedema, pleural effusion, cardiomegaly); GGO/focal consolidation; poor prognosis
  5. Churg Strauss Syndrome 
    • Necrotising vasculitis, extravascular granuloma formation & eosinophilic infiltration of various organs
    • P-ANCA
    • Nodules -> usually don't cavitate (useful to differentiate from Wegener's) 

Drug Induced Lung Disease

  1. Hydrostatic and increased permeability pulmonary oedema
  2. Diffuse alveolar damage (DAD) and the acute respiratory distress syndrome (ARDS)
  3. Pulmonary haemorrhage
  4. Organising pneumonia
  5. Eosinophilic pneumonia and hypersensitivity reactions
  6. Chronic interstitial pneumonitis with fibrosis
  7. SLE
  8. Pulmonary vasculitis and pulmonary hypertension
  9. Bronchiolitis obliterans

Amiodarone Lung:

  • Peripheral, peribronchial, consolidation (high-attenuation -> iodine content)
  • Reticulation -> peripheral & basal predominant 
  • Pleural effusion (50%) 
  • Diffuse high attenuation in liver

Radiation Pneumonitis

  • Early manifestation (1-3 months after treatment) 
  • DAD, intra-alveolar proteinaceous exudates & hylaine membranes 
  • Homogeneous or patchy GGO/consolidation
  • Edges correspond to radiation ports

Radiation Fibrosis

  • 6-12 months post-radiation 
  • Unchanging after 2 years 
  • Fibrosis & traction bronchiectasis 
  • Dense consolidation
  • Honeycombing, volume loss, 
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Playlist information

rID: 21871
Visibility: public

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