• Edema pattern, acutely develop central-basilar consolidation
• Evolves to interstitial thickening over 3 days and clears over 12 days
• Etiology: Both immune and nonimmune
• Common causes: Goodpasture’s, Idiopathic pulmonary hemosiderosis, vasculitis, bone marrow transplantation (BMT)
• Iron deficiency anemia
• Hemoptysis in 80% (importantly may be absent)

Chest radiograph

• Acute basilar consolidation, resembles pulmonary edema
  
• Evolution
  
• Slower to clear than pulmonary edema, evolves over 3 days into reticular interstitial thickening
  
• Interstitial thickening in turn resolves over 12 days
  
• With repeated hemorrhage, interstitial thickening becomes permanent
  
• May have small effusions
  
• Adenopathy may be seen in idiopathic pulmonary hemosiderosis

CT/HRCT

• Spectrum of opacities from focal ground glass to diffuse consolidation
• Subacute: 1-3mm micronodules and interlobular septal thickening

MRI

• Hemorrhage – intermediate signal TA
• Low signal T2 (iron susceptibility effect)

• Cardiogenic pulmonary edema
  
• Infection
  
• BOOP
  
• Chronic interstitial lung disease (IPF, asbestosis, collagen vascular disease, drug reaction)

• Alveolar spaces filled with blood
  
• Hemosiderin-laden macrophages, key finding in BAL
  
• Septal fibrosis with chronic hemorrhage

• Nonspecific cough, dyspnea
  
• Hemoptysis in 80%
  
• Iron deficiency anemia

Albeida SM et al. Diffuse pulmonary hemorrhage: a review and classification. Radiology 154: 289-97, 1985