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syndrome

Chest film finding

Other diagnostic clues

Alveolar hemorrhage

Diffuse bilateral alveolar infiltrates

Dyspnea, fever, acute respiratory failure, hemoptysis

Alveolar hypoventilation

Normal or atelectatic changes

Unexplained hypercapnic respiratory failure, difficulty in weaning from mechanical ventilation, guillain-barrésyndrome

Bronchiolitis obliterans

Normal or hyperinflated lung fields, localized acinar or nodular infiltrates

Dyspnea, cough, fever, hypoxia, hypocarpria, high-pitched inspiratory squeak, expiratory wheeze, obstruction unresponsive to bronchodilator therapy, increased lung volumes, decreased D_LCO

Bronchospasm

Normal or hyperinflated lunf fields

Dyspnea, cough, wheezing, occasionally other allergic signs(angioedema, urticarial, conjunctival injection, rhinitis)

Hypersensitive lung disease

Acinar or mixed acinar-interstitial patterm of infiltrates, frequent pleural effusions

Subacute onset and progression of dyspnea, fever, nonproductive cough, chest pain, rash, myalgia, eosinophilia, restrictive ventilatory defect with decreased D_LCO

Noncardiogenic pulmonary edema

Diffuse acinar infiltrates, pleural effusions may be present.

Rapid onset and progression of dyspnea and tachypnea; normal LV filling pressures and systolic function

Pneumonitis/fibrosis

Bilateral reticular or reticulonodular infiltrates;pleural effusions may be present

Slow onset and progression of dyspnea, nonproductive cough, fever, weight loss, clubbing, restrictive ventilatory defect with decreased D_LCO

Pulmonary hypertension

Normal or prominent pulmonary arteries with right ventricular enlargement

Progressive dyspnea, exertional chest pain, presyncope, physical exam findings of right heart pain.

Pulmonary infiltrates and eosinophilia

Pitchy alveolar infiltrates that rapidly migrate (acute disease) or diffuse interstitial (chronic disease)

Fever, dyspnea, nonproductive cough, wheezing

Pulmonary-renal syndrome

Diffuse acinar or reticular infiltrates

Acute onset dyspnea, nonproductive cough, hemoptysis, hematuria; syndrome resembles Goodpasture’s syndrome, but circulating antiglomerular basement membrane antibody is absent

SLE

Pleural effusion;rarely interstitial and alveolar infiltrates, atelectatic changes

Systemic complaints, arthralgias, polyarthritis, pleuritic chest pain, presence of antinuclear antibodies.