CT Approach to Lung Injury.

Area of Science:

• Pulmonary Medicine
• Radiology
• Pathology

Background:

• Diffuse alveolar damage (DAD) involves acute lung injury with airspace disease evolving to interstitial changes and fibrosis.
• Organizing pneumonia (OP) is a histologic pattern of intra-alveolar fibroblast plugs, with debated significance and pathogenesis.
• Both DAD and OP can present with airspace disease on CT, requiring careful differentiation.

Purpose of the Study:

• To differentiate the imaging findings of diffuse alveolar damage (DAD) and organizing pneumonia (OP) in acute lung injury.
• To emphasize the importance of consistent radiologic terminology for these entities in multidisciplinary patient management.
• To guide radiologists in recognizing and describing DAD and OP patterns on chest CT.

Main Methods:

• Review of CT imaging features associated with diffuse alveolar damage (DAD) and organizing pneumonia (OP).
• Correlation of imaging findings with clinical information and histologic patterns.
• Emphasis on descriptive terminology for radiologic reporting of lung injury.

Main Results:

• DAD presents acutely as airspace disease, evolving into heterogeneous interstitial disease with volume loss and fibrosis.
• OP typically manifests as bilateral, relatively homogeneous airspace disease at CT.
• Combined clinical and imaging data aid diagnosis, with biopsy reserved for atypical cases.

Conclusions:

• Accurate radiologic characterization of DAD and OP is crucial for patient management.
• Consistent and meaningful terminology enhances communication among the multidisciplinary team.
• Radiologists play a key role in recognizing and describing these lung injury patterns.