Pathology confirmed a diagnosis of DIP
Ashley Davidoff MD TheCommonVein.net 253Lu 136014c
CHF
CT scan through the chest at the level of the left atrium shows, ground glass changes dominant in the lower lobes, extensive interlobular septal thickening, Kerley B lines, and mosaic perfusion abnormalities
Ashley Davidoff
TheCommonVein.net
Ashley Davidoff MD, Davidoff Art – TheCommonVein.com (b79784-06)
Photograph showing a mosaic of different shades of the grayscale from off white to gray to black. In terms of the lung densities the extreme black is trapped air the less black is normal lung, and the shades of white reflect ground glass opacity
Ashley Davidoff MD TheComonVein.com lungs-0787
Artistic memory image evoking chest CT: sharply marginated, lobular regions of differing attenuation aligned with secondary pulmonary lobules, illustrating heterogeneous ventilation–perfusion. A centrally placed, stylized enlarged heart (Picasso-inspired) underscores cardiogenic drivers of interstitial edema and vascular engorgement that coexist with mosaic hypoperfusion.
Ashley Davidoff MD, AI-assisted, Davidoff-edited — Memory Image – TheCommonVein.com (b79784.MAD-03)
Artistic memory image evoking chest CT: sharply marginated, lobular regions of differing attenuation aligned with secondary pulmonary lobules, illustrating heterogeneous ventilation–perfusion. A centrally placed, stylized enlarged heart (Picasso-inspired) underscores cardiogenic drivers of interstitial edema and vascular engorgement that coexist with mosaic hypoperfusion.
Ashley Davidoff MD, AI-assisted, Davidoff-edited — Memory Image – TheCommonVein.com (b79784.MAD-03)
🎵 1B. Lyrics
2. The Poem
The Tiled Floor
I am the pattern, the patchwork of gray,
A mosaic of tiles in a mixed display.
Some parts are black (lucency’s dark hue),
Some parts are white (opacity’s new).
On inspiration, I am NEVER benign,
I am a pathologic, troubling sign.
But which is the sick one? The dark or the light?
That is the question, to get the case right.
Is the black part the sickness? (A trapped, final breath,
From airway disease… or a vascular death?)
Or is the white part the sickness? (The interstitial stain,
The GGO’s hazy, fibrotic rain?)
(And the black is the normal lung, trying to fight?)
You must check expiration, to bring the truth to light.
A little air-trapping is normal, you see,
But widespread… proves airway disease.
3. 📜 History, Etymology & Descriptors
| Title (with Wiki link) | Comments |
| History | • This is a modern radiologic pattern, impossible to see before High-Resolution CT (HRCT) in the 1980s.
• Radiologists like W. Richard Webb and Nestor L. Müller (1990s) were pioneers in describing and classifying these patterns. • The key breakthrough was realizing the cause of the pattern could be differentiated by using expiratory CT scans. • A. G. G. J. M. van Beek et al. (1990s) helped popularize the use of expiratory CT to prove that the “black” (hypodense) areas were abnormal air trapping. |
| Etymology | • From the Latin mosaica, which is from the Greek mouseion, meaning “of the Muses.”
• It refers to the Mosaic art form, which is a picture or pattern created by arranging small, colored pieces (tiles, glass) of different colors. • The CT pattern is a direct visual analogy to a floor made of different-colored tiles. |
| Key Descriptors | • Mosaic Attenuation: The pattern of mixed high- and low-attenuation areas seen on inspiration.
• Inspiration: A mosaic pattern on an inspiratory scan is always abnormal. • Expiration (Air Trapping): The test to find the cause. • Normal (Physiologic): A small, patchy amount of air trapping on expiration is normal. • Abnormal (Pathologic): Widespread, geographic air trapping on expiration is abnormal and confirms obliterative small airways disease. • 1. “Black is Bad” (Airways): Caused by obliterative small airways disease (e.g., constrictive bronchiolitis). • 2. “Black is Bad” (Vessels): Caused by occlusive vascular disease (e.g., CTEPH). This specific type is called “Mosaic Perfusion.” • 3. “White is Bad” (Interstitial): Caused by multifocal interstitial lung disease (e.g., GGO from HP or sarcoidosis). The white areas are abnormal, and the black areas are normal lung. |
4. 🏛️ Cultural Context
| Title (with Wiki link) | Comments |
| Art (Tiling) | • The literal origin of the term.
• A Roman mosaic floor, made of small black, white, and gray tiles (tesserae) arranged in a patchwork pattern. |
| Geography (Land Use) | • Checkerboarding land, where some square-mile plots are forested (white/abnormal) and some are clear-cut (black/normal), or vice-versa, creating a stark patchwork.
• Also, a patchwork quilt. |
| Music (Piano Keys) | • The CT scan is a “song” played on a piano keyboard.
• The pattern is the mix of black and white keys. • The radiologist’s job is to figure out if the white keys are out of tune (interstitial disease) or if the black keys are stuck (air trapping/vascular disease). |
| Photography (Negatives) | • The diagnostic dilemma is like looking at a patchwork and not knowing if you’re seeing the photograph or the negative.
• Is the white part the “real” thing (the disease)? Or is the black part the “real” thing (the disease)? |
5. 👥 Notable People
| Category | Names & Comments |
| Contributors | • W. Richard Webb & Nestor L. Müller (1990s): Radiologists who are considered the “fathers” of HRCT and wrote the foundational textbooks that defined patterns like mosaic attenuation.
• The Fleischner Society: The international group that provides the formal definitions for these radiologic terms. • A. G. G. J. M. van Beek (1990s): Radiologist whose work was key in using expiratory CT to differentiate the causes of mosaic attenuation (air-trapping vs. interstitial). |
| Patients | • (This is a pattern, not a single disease. This lists patients with the causes.)
• (General) Lung Transplant Recipients: At high risk for Constrictive Bronchiolitis (an “airway” cause of the mosaic pattern). • (General) Patients with Scleroderma: A classic example, as they can get all three causes: interstitial (NSIP), vascular (pulmonary hypertension), and airway (bronchiolitis) disease. • (General) “Bird Fancier’s Lung”: Patients with Hypersensitivity Pneumonitis (HP), a classic “interstitial” (white is bad) cause of the mosaic pattern. |