CTICasesIdiopathic Diffuse Alveolar Damage with Anterior Fibrosis
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Imaging findings
Baseline chest CT shows normal lungs, but a subsequent scan during an acute episode demonstrates geographic, bilateral crazy paving and ground-glass opacities that spare only a few lobules, without peripheral sparing. A follow-up CT obtained nine months later, after clinical recovery with steroid therapy, shows the development of new, permanent fibrosis restricted to the anterior aspects of the upper and middle lungs.
Key takeaways
Diffuse alveolar damage (DAD) of various etieties can heal with a highly characteristic pattern of anteriorly predominant pulmonary fibrosis. One major hypothesis for this distribution is that the posterior, collapsed lung zones are protected from the toxic effects of high-concentration supplemental oxygen therapy during the acute illness, whereas the anterior, aerated zones bear the brunt of the oxygen-mediated injury. DAD should remain in the differential for severe, diffuse acute lung injury even in non-intubated patients.
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