Radiologic findings: A plain film (A) on 7/21, 4 weeks after the biopsy, shows large, irregular, patchy opacities, predominantly at the periphery of the lungs and worse at the bases.

A

Question: Which of the following diseases typically have prominent involvement of the periphery of the lung?

Answer

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One month later (8/18) (B), there is marked improvement with residual patchy opacities in the lower lobes.

B

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Answer: Eosinophilic pneumonia, bland pulmonary infarcts, rounded atelectasis, cryptogenic organizing pneumonia, and usual interstitial pneumonia all classically are most prominent at the lung periphery [1,2]. Pulmonary alveolar edema and Kaposi's sarcoma may affect the entire lung, but are often more central (perihilar) in location [1,3]. Kaposi's sarcoma also has a basilar predominance.

Cryptogenic organizing pneumonia appears radiographically as large foci of non-segmental, patchy consolidation [4]. The distribution is diffuse but with a basilar predominance and a peripheral location (often best seen on CT). The consolidations may wax and wane, but rarely cavitate. The most common HRCT findings are patchy consolidation and ground-glass opacity seen in a peribronchial and peripheral location [5]. In regions of abnormal lung, the bronchial walls are usually thickened, and lumens may be dilated. Less commonly, ill-defined peribronchovascular nodules or small centrilobular nodules are seen.

References:

1. Armstrong P. Basic patterns in lung disease. In P Armstrong, A Wilson, P Dee, D Hansell (eds): Imaging of Diseases of the Chest, 2nd ed. St. Louis, Mosby-Year Book, 1996, pp 58-124.

2. Reed J. Chest Radiology: Plain Film Patterns and Differential Diagnoses, 4th ed. St Louis, Mosby-Year Book, 1997, pp 25-43, 251-279.

3. Dee P. AIDS and other forms of immunocompromise. In P Armstrong, A Wilson, P Dee, D Hansell (eds): Imaging of Diseases of the Chest, 2nd ed. St. Louis, Mosby-Year Book, 1996, pp 240-242.

4. Wilson AG. Pulmonary diseases of unknown origin and miscellaneous lung disorders. In P Armstrong, A Wilson, P Dee, D Hansell (eds): Imaging of Diseases of the Chest, 2nd ed. St. Louis, Mosby-Year Book, 1996, pp 599-601.

5. Webb W, Müller N, Naidich D. High-resolution CT of the Lung. 2nd ed. Philadelphia, Lippincott-Raven, 1996, pp 206-210.

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