Acute interstitial pneumonia can be regarded as an idiopathic form of ARDS and is histologically (and clinically) distinct from the other interstitial pneumonias. The histological pattern seen in AIP is that of diffuse alveolar damage (DAD), which is also found in infection, connective tissue disease, drug toxicity and toxic fume inhalation. DAD has an acute exudative phase and a subsequent organising and fibrotic phase. Lung biopsy shows diffuse involvement with temporal homogeneity, which implies lung injury due to a single event. The chest radiograph shows bilateral patchy airspace opacification. HRCT demonstrates a combination of ground-glass opacification, consolidation, bronchial dilatation and architectural distortion. Ground-glass opacification on HRCT is found in all three phases of AIP, but coexistent traction bronchiectasis probably reflects the early incorporation of established fibrosis. Follow-up CT shows reticular opacities consistent with residual fibrosis. Anterior non-dependent fibrotic damage in survivors secondary to barotrauma has also been reported.
Classic HRCT Findings
• Patchy or diffuse ground-glass opacities and consolidation/collapse (the latter mainly in dependent lung)
• Traction bronchiectasis and reticulation may become evident after several days
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