Interstitial lung disease (ILD) is an umbrella term that encompasses a large number of disorders that are characterised by diffuse cellular infiltrates in a periacinar location. The spectrum of conditions included is broad, ranging from occasional self-limited inflammatory processes to severe debilitating fibrosis of the lungs.
Interstitial lung disease is considered a misnomer by some, as many of the diseases also involve the alveolar spaces.
Interstitial lung diseases classically produce the "3Cs": cough, clubbing of the nails, and coarse crackles on auscultation 6.
Functional respiratory tests commonly show an abnormal restrictive pattern and reduced diffusing capacity.
The radiological appearances are not specific for the underlying cause of diffuse lung disease in many cases. It is therefore key to determine whether there is an underlying cause for the changes. A number of precipitants can cause diffuse interstitial disease such as:
- smoking 1
- organic dusts (causing extrinsic allergic alveolitis)
- inorganic dusts (causing pneumoconioses)
- gases or fumes
Eliciting a history of underlying systemic disease is also helpful since they may involve the lungs in a diffuse and infiltrative manner. Examples include:
- granulomatous diseases, e.g. sarcoidosis, Langerhans cell histiocytosis
- inherited diseases, e.g. neurofibromatosis
- autoimmune and collagen vascular diseases 3
- systemic lupus erythematosus
- rheumatoid arthritis
- progressive systemic sclerosis
- anti-Jo-1 antibody positive interstitial lung disease
- ankylosing spondylitis
- Sjögren syndrome
- mixed connective tissue disease
- psoriasis - pulmonary manifestations of psoriasis
- miscellaneous, e.g. amyloidosis, alveolar proteinosis
Where a cause is not determined, the idiopathic interstitial pneumonia (IIP) should be considered:
- usual interstitial pneumonia (UIP): idiopathic pulmonary fibrosis
- cryptogenic organising pneumonia (COP): previously termed BOOP
- non-UIP IIP
- non-specific interstitial pneumonia (NSIP): non-smokers
- respiratory bronchiolitis-interstitial lung disease (RB-ILD): smokers
- desquamative interstitial pneumonia (DIP): end state of RB-ILD
- lymphoid interstitial pneumonia (LIP): women
- acute interstitial pneumonitis (AIP)
- other entities
The diffuse lung diseases tend to cause infiltrative opacification in the periphery of the lung, but patterns vary among the different aetiologies. Please refer to the articles in each specific aetiology listed above for specific details on their imaging pattern.
- 1. Attili AK, Kazerooni EA, Gross BH et-al. Smoking-related interstitial lung disease: radiologic-clinical-pathologic correlation. Radiographics. 28 (5): 1383-96. doi:10.1148/rg.285075223 - Pubmed citation
- 2. Mueller-mang C, Grosse C, Schmid K et-al. What every radiologist should know about idiopathic interstitial pneumonias. Radiographics. 27 (3): 595-615. doi:10.1148/rg.273065130 - Pubmed citation
- 3. Kim EA, Lee KS, Johkoh T et-al. Interstitial lung diseases associated with collagen vascular diseases: radiologic and histopathologic findings. Radiographics. 2002;22 Spec No : S151-65. Radiographics (full text) - Pubmed citation
- 4. Wittram C, Mark EJ, Mcloud TC. CT-histologic correlation of the ATS/ERS 2002 classification of idiopathic interstitial pneumonias. Radiographics. 23 (5): 1057-71. doi:10.1148/rg.235035702 - Pubmed citation
- 5. Ferguson EC, Berkowitz EA. Lung CT: Part 2, The interstitial pneumonias-clinical, histologic, and CT manifestations. AJR Am J Roentgenol. 2012;199 (4): W464-76. doi:10.2214/AJR.10.7309 - Pubmed citation
- 6. Wallis A, Spinks K. The diagnosis and management of interstitial lung diseases. (2015) BMJ (Clinical research ed.). 350: h2072. Pubmed