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Acute Interstitial Pneumonia
Carlos S. Restrepo, MD; Jud W. Gurney, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Acute interstitial pneumonia (AIP)
              • Diffuse alveolar damage (DAD)
              • Acute respiratory distress syndrome (ARDS)
            • Synonyms

              • Hamman-Rich syndrome
            • Definitions

              • Idiopathic interstitial pneumonia characterized by rapidly progressive respiratory failure of unknown etiology with histologic features of DAD
              • AIP is defined by following criteria
                • Acute onset of respiratory symptoms resulting in severe hypoxia and in most cases acute respiratory failure
                • Bilateral pulmonary opacities on chest radiography
                • Absence of identifiable etiology (e.g., infection, connective tissue disease, trauma, congestive heart failure, drug toxicity, etc.)
                • Histologic documentation of DAD
              • Formerly called Hamman-Rich syndrome
              • ARDS and AIP are not equivalent: AIP is an idiopathic form of ARDS, but not all patients with ARDS have AIP
                • ARDS is defined clinically based on following criteria
                  • Acute onset, within 7 days of defined event (e.g., sepsis, pneumonia, etc.)
                  • Ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2:FIO2) ≤ 200 mm Hg
                  • Bilateral pulmonary opacities on chest radiography or CT
                  • Abnormalities not fully explained by cardiac failure or fluid overload based on clinical parameters

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    Selected References

                                    1. Travis WD et al: An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 188(6):733-48, 2013
                                    2. Mukhopadhyay S et al: Acute interstitial pneumonia (AIP): relationship to Hamman-Rich syndrome, diffuse alveolar damage (DAD), and acute respiratory distress syndrome (ARDS). Semin Respir Crit Care Med. 33(5):476-85, 2012
                                    3. Araya J et al: Clinically occult subpleural fibrosis and acute interstitial pneumonia a precursor to idiopathic pulmonary fibrosis? Respirology. 13(3):408-12, 2008
                                    4. Mueller-Mang C et al: What every radiologist should know about idiopathic interstitial pneumonias. Radiographics. 27(3):595-615, 2007
                                    5. Parambil JG et al: Causes and prognosis of diffuse alveolar damage diagnosed on surgical lung biopsy. Chest. 132(1):50-7, 2007
                                    6. Ichikado K et al: Prediction of prognosis for acute respiratory distress syndrome with thin-section CT: validation in 44 cases. Radiology. 238(1):321-9, 2006
                                    7. Swigris JJ et al: Acute interstitial pneumonia and acute exacerbations of idiopathic pulmonary fibrosis. Semin Respir Crit Care Med. 27(6):659-67, 2006
                                    8. Thannickal VJ: Idiopathic interstitial pneumonia: a clinicopathological perspective. Semin Respir Crit Care Med. 27(6):569-73, 2006
                                    9. Ichikado K et al: Acute interstitial pneumonia: comparison of high-resolution computed tomography findings between survivors and nonsurvivors. Am J Respir Crit Care Med. 165(11):1551-6, 2002
                                    10. Johkoh T et al: Acute interstitial pneumonia: thin-section CT findings in 36 patients. Radiology. 211(3):859-63, 1999
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Pathology

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Acute interstitial pneumonia (AIP)
                                                • Diffuse alveolar damage (DAD)
                                                • Acute respiratory distress syndrome (ARDS)
                                              • Synonyms

                                                • Hamman-Rich syndrome
                                              • Definitions

                                                • Idiopathic interstitial pneumonia characterized by rapidly progressive respiratory failure of unknown etiology with histologic features of DAD
                                                • AIP is defined by following criteria
                                                  • Acute onset of respiratory symptoms resulting in severe hypoxia and in most cases acute respiratory failure
                                                  • Bilateral pulmonary opacities on chest radiography
                                                  • Absence of identifiable etiology (e.g., infection, connective tissue disease, trauma, congestive heart failure, drug toxicity, etc.)
                                                  • Histologic documentation of DAD
                                                • Formerly called Hamman-Rich syndrome
                                                • ARDS and AIP are not equivalent: AIP is an idiopathic form of ARDS, but not all patients with ARDS have AIP
                                                  • ARDS is defined clinically based on following criteria
                                                    • Acute onset, within 7 days of defined event (e.g., sepsis, pneumonia, etc.)
                                                    • Ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2:FIO2) ≤ 200 mm Hg
                                                    • Bilateral pulmonary opacities on chest radiography or CT
                                                    • Abnormalities not fully explained by cardiac failure or fluid overload based on clinical parameters

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Microscopic Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      Selected References

                                                                      1. Travis WD et al: An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 188(6):733-48, 2013
                                                                      2. Mukhopadhyay S et al: Acute interstitial pneumonia (AIP): relationship to Hamman-Rich syndrome, diffuse alveolar damage (DAD), and acute respiratory distress syndrome (ARDS). Semin Respir Crit Care Med. 33(5):476-85, 2012
                                                                      3. Araya J et al: Clinically occult subpleural fibrosis and acute interstitial pneumonia a precursor to idiopathic pulmonary fibrosis? Respirology. 13(3):408-12, 2008
                                                                      4. Mueller-Mang C et al: What every radiologist should know about idiopathic interstitial pneumonias. Radiographics. 27(3):595-615, 2007
                                                                      5. Parambil JG et al: Causes and prognosis of diffuse alveolar damage diagnosed on surgical lung biopsy. Chest. 132(1):50-7, 2007
                                                                      6. Ichikado K et al: Prediction of prognosis for acute respiratory distress syndrome with thin-section CT: validation in 44 cases. Radiology. 238(1):321-9, 2006
                                                                      7. Swigris JJ et al: Acute interstitial pneumonia and acute exacerbations of idiopathic pulmonary fibrosis. Semin Respir Crit Care Med. 27(6):659-67, 2006
                                                                      8. Thannickal VJ: Idiopathic interstitial pneumonia: a clinicopathological perspective. Semin Respir Crit Care Med. 27(6):569-73, 2006
                                                                      9. Ichikado K et al: Acute interstitial pneumonia: comparison of high-resolution computed tomography findings between survivors and nonsurvivors. Am J Respir Crit Care Med. 165(11):1551-6, 2002
                                                                      10. Johkoh T et al: Acute interstitial pneumonia: thin-section CT findings in 36 patients. Radiology. 211(3):859-63, 1999