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PPS 09 Radiology-Pathology Correlation of Lung Disease

Posted Jun 30 2009 12:00am

Dr. Teri Franks and Dr. Jeff Galvin, both from the AFIP, delivered a very informative presentation on rad-path correlation of lung disease.  One very helpful approach is the connection between pathology and radiology patterns:

Six pathology patterns of lung disease:

  1. Acute lung injury
  2. Fibrosis
  3. Cellular infiltrates
  4. Alveolar "filling", e.g. edema, fibrin, cells
  5. Nodules
  6. "Minimal change"

Four CT patterns of lung disease:

  1. Ground glass and consolidation
  2. Fibrosis/honeycombing
  3. Nodules/masses
  4. Airtrapping and cysts

The rest of the presentation presented hrCT and pathology images to correlate the basic CT patterns with the pathology patterns.

Definitions:
Ground glass infiltrates: hazy areas of attenuation with airways and vasculature still visible through it
Consolidation: opacification of lung parenchyma obscuring underlying detail

  1. Radiology pattern 1, ground glass infiltrates and consolidation--correlates with acute lung injury, cellular infiltrates and/or alveolar filling
  2. Radiology pattern 2 fibrosis (linear vs reticular opacities) with/without honeycombing--correlates with fibrosis
  3. Radiology pattern 3--correlates with nodules/masses: cf. large/small, single/multiple
  4. Radiology pattern 4 mosaic pattern and cysts--correlates with a variety of entities such as pulmonary HTN, lymphangioleiomyomatosis

Then overlaid on this matrix is consideration of the d/dx based on distribution and anatomic location of the lesions.

Bottom line: We pathologists interpreting lung specimens (of all types!) must be aware of these patterns as they are extremely helpful, really critical actually, in making a diagnosis (rather than a description) on lung specimens.

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