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Diffuse Alveolar Damage
Santiago Martínez-Jiménez, MD; Paul P. Pettavel, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Diffuse alveolar damage (DAD)
            • Synonyms

              • Hamman-Rich syndrome = acute interstitial pneumonia (AIP)
              • Acute lung injury (ALI) = mild ARDS
            • Definitions

              • Acute respiratory syndrome (ARDS)
                • Acute diffuse, inflammatory lung injury leading to increased pulmonary vascular permeability with resultant hypoxemia and bilateral opacities on imaging
                • Criteria
                  • Acute onset, within 7 days of defined event (e.g., sepsis, pneumonia, etc.)
                  • Partial pressure of arterial oxygen:fraction of inspired oxygen ratio (PaO₂:FiO₂) ≤ 200 mm Hg
                  • Bilateral pulmonary opacities on radiography or CT
                  • Abnormalities not fully explained by cardiac failure or fluid overload based on clinical parameters
                • Grading
                  • Mild: 200 mm Hg < PaO₂/FiO₂ ≤ 300 mm Hg; formerly acute lung injury (ALI)
                  • Moderate: 100 mm Hg < PaO₂/FiO₂ ≤ 200 mm Hg
                  • Severe: PaO₂/FiO₂ ≤ 100 mm Hg
              • DAD is histologic manifestation of ALI/ARDS
              • Acute interstitial pneumonia: Idiopathic DAD
              • Transfusion-related ALI is ALI/ARDS occurring during or within 6 hours after blood products administration

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • Gross Pathologic & Surgical Features

                      • Microscopic Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. ARDS Definition Task Force et al: Acute respiratory distress syndrome: the Berlin Definition. JAMA. 307(23):2526-33, 2012
                                  2. Sheard S et al: Imaging of acute respiratory distress syndrome. Respir Care. 57(4):607-12, 2012
                                  3. Beasley MB: The pathologist's approach to acute lung injury. Arch Pathol Lab Med. 134(5):719-27, 2010
                                  4. Bernard GR et al: The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 149(3 Pt 1):818-24, 1994
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Diffuse alveolar damage (DAD)
                                            • Synonyms

                                              • Hamman-Rich syndrome = acute interstitial pneumonia (AIP)
                                              • Acute lung injury (ALI) = mild ARDS
                                            • Definitions

                                              • Acute respiratory syndrome (ARDS)
                                                • Acute diffuse, inflammatory lung injury leading to increased pulmonary vascular permeability with resultant hypoxemia and bilateral opacities on imaging
                                                • Criteria
                                                  • Acute onset, within 7 days of defined event (e.g., sepsis, pneumonia, etc.)
                                                  • Partial pressure of arterial oxygen:fraction of inspired oxygen ratio (PaO₂:FiO₂) ≤ 200 mm Hg
                                                  • Bilateral pulmonary opacities on radiography or CT
                                                  • Abnormalities not fully explained by cardiac failure or fluid overload based on clinical parameters
                                                • Grading
                                                  • Mild: 200 mm Hg < PaO₂/FiO₂ ≤ 300 mm Hg; formerly acute lung injury (ALI)
                                                  • Moderate: 100 mm Hg < PaO₂/FiO₂ ≤ 200 mm Hg
                                                  • Severe: PaO₂/FiO₂ ≤ 100 mm Hg
                                              • DAD is histologic manifestation of ALI/ARDS
                                              • Acute interstitial pneumonia: Idiopathic DAD
                                              • Transfusion-related ALI is ALI/ARDS occurring during or within 6 hours after blood products administration

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • Gross Pathologic & Surgical Features

                                                      • Microscopic Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. ARDS Definition Task Force et al: Acute respiratory distress syndrome: the Berlin Definition. JAMA. 307(23):2526-33, 2012
                                                                  2. Sheard S et al: Imaging of acute respiratory distress syndrome. Respir Care. 57(4):607-12, 2012
                                                                  3. Beasley MB: The pathologist's approach to acute lung injury. Arch Pathol Lab Med. 134(5):719-27, 2010
                                                                  4. Bernard GR et al: The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 149(3 Pt 1):818-24, 1994