Lung Pathology Differentials

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Pulmonary Pathology

Fleeting Lung Opacities

  • COP
  • Churg-Strauss
  • Pulmonary Edema
  • Aspergilllosis
  • Ascariasis Lumbricoides
  • Tropical Pulmonary Eosinophilia
  • Hypersensitivity Pneumonitis
  • Eosinophilic Pneumonia
  • Endocarditis
  • Pulmonary Contusion
  • Hemosiderosis
  • Farmer’s Lung
  • Crack Lung
  • Silicosis
  • Berylium
  • Metal Fume
  • Polymer Fume

Diffuse Lung Disease

  • UIP (honeycombing, >3 layers of cysts with septal thickening)
  • NSIP (septal lines and ground glass opacities)
  • DIP (GGO – macrophages filling alveoli = desquamation) – smoking associated
  • RB-ILD (tree-in-bud/bronchiolitis) – smoking associated
  • COP
  • LIP
  • Collagen Vascular Disease
  • Granulomatous
  • Cystic

Upper Lung Zone Predominant

  • HP
  • Sarcoid
  • RB-ILD

Central Lung Zone Predominant

  • Sarcoid (in terms especially of lymph nodes)
  • Welder’s lung
  • Lymphoma

Lower Lung Zone Predominant

  • UIP
  • DIP
  • NSIP
  • Collagen-vascular
  • Asbestosis (peripheral interlobular septal thickening, subpleural  findings, parenchymal lines, pleural plaques)

Peripheral

  • IPF
  • Collagen-vascular
  • Asbestos
  • EP
  • COP
  • DIP
  • Drug rxn

Cystic

  • Lymphangiomyomatosis (sm muscle proliferations in lymph channels which can also been seen in the kidneys making well cirucumscribed cysts that are uniform in character)
  • Langerhan’s Cell Histiocytosis (irregular cysts with irregular nodules, can also affect the kidneys)
  • CF
  • PCP (PJP)
  • Birt Hogg Dube

Types of Emphysema

  • Paraseptal
  • Panacinar
  • Centrilobular

Bronchiectasis – saccular, cylindrical, varicose – Etiologies

  • Acquired obstruction (aspiration, tumors, mucoid impaction)
  • Congenital (yellow-nail syndrome)
  • Immunodeficiency (IgG 2&4, IgA)
  • Kartagener’s
  • CF
  • Young’s
  • α1-antitrypsin deficiency
  • RA
  • Scleroderma
  • Toxins
  • Chronic rejection

Types of Environmental/Drug Lung Irritants

  • Silicosis
  • Coal
  • Graphite
  • Asbestos
  • Talc
  • Welder’s
  • Beryllium
  • Aluminum
  • Hard metal
  • Organic dust (often causes HP)
  • Chemicals
  • Nitrofurantoin
  • Methotrexate

Sarcoidosis Findings

  • Nodules (peribronchovascular)
  • GGO
  • Bronchiectasis
  • Focal consolidation
  • Parenchymal distortion
  • Honeycombing
  • L.N. (areas 1,2,3)
  • Air trapping

RA Findings

  • ILD (primarily UIP  or NSIP, can be COP, LIP, DIP
  • Follicular bronchiolitis (can cause obstruction)
  • Nodules
  • Pleural effusion (with low glucose, high LDH) & Pleuritis
  • Vasculitis

SLE Findings

  • Pleural effusion & Pleuritis
  • ILD (NSIP, UIP, KIP, COP, Amyloid)
  • PHTN
  • Shrinking lung syndrome
  • Pulmonary hemorrhage
  • ARDS
  • PVOD

Scleroderma Findings

  • NSIP (occ UIP)

Aspergillus Associated Lung Disease

  • ABPA – asthma and CP (IgE > 1000).  Treated with steroids and itrconazole. 
  • Aspergilloma (mycetoma in existing cavity)
  • Chronic Cavitary Pulmonary Aspergillosis.  Treated with antifungals
  • Invasive Aspergillosis – usually in immunosuppressed pts, develop systemic symptoms, treated with voriconazole

Mediastinum

  • Anterior
    • Thymus
    • Extrapericardial aorta&veins
    • Lymphatics
  • Middle
    • Pericardial sac
      • Heart
      • Great vessels
      • Pericardium
    • Lung
    • Trachea
  • Posterior
    • Vagus nerve
    • Hiatal hernias
    • Esophagus
    • Spine/Cord (shwanomas, gangliomas, sarcoma, Potts, extramedullary hematopoiesis)
    • Lung
    • Thoracic duct
    • Azygous vein