The end-stage lung: pathogenesis, pathology, and radiology

The morphological concept of an end-stage lung implies a pathologically and radiologically nonspecific appearance of diffuse lung disease which can be caused by many different disease processes. The lung can respond to injury in only a limited and stereotyped fashion; with persistent injury, these pathological changes telescope toward a common appearance, the end-stage lung, which is characterized by cystic spaces of variable size and extent throughout both lungs caused by alveolar septal dissolution, bronchiolectasia, and obstructive emphysema. The most important radiological manifestation is cystic spaces, a sign of severe, irreversible damage to that portion of the lung. Pleural thickening, cor pulmonale, spontaneous pneumothorax, calcific nodules, or scar carcinoma may also be seen.