Learning Radiology xray montage

Usual Interstitial Pneumonia

  • The most common of the diffuse interstitial pneumonias

  • Begins with diffuse damage to alveolar walls

  • Necrosis of alveolar lining cells is followed by regeneration

  • There is an abundance of polys in bronchial washings in contrast to lymphocytes found in sarcoid or hypersensitivity pneumonias


  • Earliest manifestation consists of fine reticular pattern, particularly at the lung bases

  • Becomes coarser as disease progresses and ends with honeycomb lung

  • Progressive loss of volume is characteristic of either UIP or scleroderma


  • Symptoms include SOB, non-productive cough and fatigue

  • Clubbing of the fingers is very common (85%)

  • Cyanosis and pulmonary hypertension usually occur late in the disease

  • “Velcro” rales on auscultation

  • About 1/3 have +ANA titers and 1/3 have + Rheumatoid factors

Other chronic interstitial pneumonias

  • BIP (Bronchiolitis obliterans and diffuse interstitial pneumonia)–favors upper lobes

  • DIP (desquamative interstitial pneumonia)–second most common chronic interstitial pneumonia

  • Heavy concentration of mononuclear cells rather than polys as in UIP

  • Loss of type I alveolar epithelial cells and proliferation of type II cells

  • Ground glass pattern in both lower lung fields

  • LIP (lymphoid interstitial pneumonia) — like lymphoma

  • No characteristic x-ray picture

  • GIP (giant cell interstitial pneumonia) — characterized by multinucleated giant cells in the alveoli

  • No characteristic x-ray picture