Chest X-Ray : Lung Disease – 4 Pattern Approach

On a chest x-ray lung abnormalities will either present as areas of increased density or as areas of decreased density.

Lung abnormalities with an increased density – also called opacities – are the most common.
A practical approach is to divide these into four patterns:

  1. Consolidation – any pathologic process that fills the alveoli with fluid, pus, blood, cells (including tumor cells) or other substances resulting in lobar, diffuse or multifocal ill-defined opacities.
  2. Interstitial – involvement of the supporting tissue of the lung parenchyma resulting in fine or coarse reticular opacities or small nodules.
  3. Nodules or masses – any space occupying lesion either solitary or multiple.
  4. Atelectasis – collapse of a part of the lung due to a decrease in the amount of air in the alveoli resulting in volume loss and increased density.

In this article we will focus on this four-pattern approach.
At the end we will also discuss diseases that present as areas of decreased density.

Here are the most common examples of these four patterns on a chest x-ray.

  • Consolidation
    • Lobar consolidation
    • Diffuse consolidation
    • Multifocal ill-defined consolidations
  • Interstitial
    • Reticular interstitial opacities
    • Fine Nodular interstitial opacities
  • Nodule or mass
    • Solitary Pulmonary Nodule
    • Multiple Masses
  • Atelectasis



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