Abstract
The subpleural sparing pattern is a common finding on computed tomography (CT) of
the lungs. It comprises of pulmonary opacities sparing the lung peripheries, typically
1cm and less from the pleural surface. This finding has a variety of causes, including
idiopathic, inflammatory, infectious, inhalational, cardiac, traumatic, and bleeding
disorders. Specific disorders that can cause subpleural sparing patterns include nonspecific
interstitial pneumonia (NSIP), organizing pneumonia (OP), pulmonary alveolar proteinosis
(PAP), diffuse alveolar hemorrhage (DAH), vaping-associated lung injury (VALI), cracked
lung, pulmonary edema, pneumocystis jirovecii pneumonia (PJP), pulmonary contusion,
and more recently, Coronavirus disease 2019 (COVID-19) pneumonia. Knowledge of the
many etiologies of this pattern can be useful in preventing diagnostic errors. In
addition, although the etiology of subpleural sparing pattern is frequently indistinguishable
during an initial radiologic evaluation, the differences in location of opacities
in the lungs, as well as the presence of additional radiologic findings, patient history,
and clinical presentation, can often be useful to suggest the appropriate diagnosis.
We did a comprehensive search on Pubmed and Google Scholar database using keywords
of “subpleural sparing,” “peripheral sparing,” “sparing of peripheries,” “CT chest,”
“chest imaging,” and “pulmonary disease.” This review aims to describe the primary
differential diagnosis of subpleural sparing pattern seen on chest imaging with a
strong emphasis on clinical and radiographic findings. We also discuss the pathogenesis
and essential clues that are crucial to narrow the differential diagnosis.
Key Indexing Terms
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Article info
Publication history
Published online: January 09, 2021
Accepted:
January 8,
2021
Received:
June 26,
2020
Identification
Copyright
© 2021 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
