Shirt-sleeve or scanning magnification as an aid to the diagnosis of commonly encountered medical lung diseases

Shirt-sleeve magnification (holding a slide over a white sleeve) and low-power magnification serve as useful adjuncts in the general categorization of noninfectious medical lung disease. This article divides medical lung disease into chronic and acute, where the temporality is determined first by clinical circumstances and then confirmed by histopathology. The low-power patterns of various lung diseases overlap, sometimes greatly. Nevertheless, classic examples of chronic disease can be sorted as linear, lobular filling, nodular dispersed, nodular lymphangitic, or cystic patterns at shirt-sleeve or low-power magnification. Classic examples of acute disease generally produce a solidifying pattern at shirt-sleeve or low-power magnification, which can be followed by a determination as to whether alveolar filling is principally fibrotic or principally fluid or cells at higher magnification. This article gives a simple system for the categorization of medical lung disease by this approach, with an emphasis on the most common diseases to be encountered in a general surgical pathology practice. In our experience, this system also proves useful in arriving at some therapeutic decisions.