Leslie, K O

Table 3 The six histopathological patterns of diffuse lung diseases

Pattern 1 (acute lung injury)	Pattern 2 (fibrosis)	Pattern 3 (cellular infiltrates)	Pattern 4 (alveolar filling)	Pattern 5 (nodules; small or large, single or multiple)	Pattern 6 (minimal changes)
Diffuse alveolar damage (any cause; see box 1)	Pneumoconioses	Hypersensitivity pneumonitis (subacute disease)	Pulmonary oedema	Neoplasms (primary or metastatic)	Pulmonary oedema
Infections	Usual interstitial pneumonia	Drug reactions	Acute bronchopneumonia	Granulomatous infections (see box 7 for causes of granulomas in biopsy specimens)	A very subtle interstitial infiltrate
Drug reactions	Chronic hypersensitivity pneumonitis	Related to rheumatic diseases	Acute eosinophilic pneumonia	Pneumoconioses (especially silica-related)	Pulmonary emboli (including fat emboli)
Related to rheumatic disease	Related to rheumatic disease	Lymphoproliferative diseases	Unusual infections with prominent histiocytes (eg, Rhodococcus equi)	Aspiration	Constrictive bronchiolitis
Related to toxins, fumes and gases	Chronic drug reactions	Non-specific interstitial pneumonia	Alveolar haemorrhage	Nodular drug reaction (eg, amiodarone)	Vasculopathic diseases
Acute eosinophilic pneumonia (see box 2)	Advanced sarcoidosis	Certain infections (eg, rickettsia, mycoplasma, HIV)	Desquamative interstitial pneumonia (DIP; see box 6 for causes of DIP-like reactions)	Sarcoidosis/berylliosis	Cystic diseases
Alveolar haemorrhage syndromes (see box 3)	Fibrotic non-specific interstitial pneumonia	Lymphoid interstitial pneumonia	Respiratory bronchiolitis-associated interstitial lung disease	Langerhans cell histiocytosis	Lymphangioleiomyomatosis
Transplant rejection	Chronic aspiration		Organising pneumonia (any cause; see box 5)	Wegener granulomatosis	Langerhans cell histiocytosis
Idiopathic forms (acute interstitial pneumonia and “acute fibrinous and organising pneumonia”)6	Chronic radiation injury		Organising pneumonia (cryptogenic)	Persistent organising pneumonia	Sampling error
	Advanced Langerhans cell histiocytosis		Alveolar proteinosis	Pulmonary hyalinising granuloma
	Hermansky–Pudlak syndrome		Acute fibrinous and organising pneumonia (cryptogenic)	Plasma cell granuloma
	Erdheim–Chester disease (non-Langerhans cell histiocytosis)		Dendrifom calcification	Lung infarct
	Idiopathic airway-centred fibrosis		Alveolar microlithiasis	Rosai–Dorfman disease

My approach to interstitial lung disease using clinical, radiological and histopathological patterns

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