Interstitial lung abnormalities (ILAs) represent radiological entities that comprise changes compatible with an interstitial process, occurring in individuals not suspected to have interstitial lung disease (ILD). The prevalence of ILAs ranges from 2.5% to 16.7% in lung cancer screening and population-based cohorts. ILAs have consistently been associated with mortality. Risk factors include older age, smoking, and genetic polymorphisms such as MUC5B. Progression of ILAs occurs in 20%-76% of cases over 2-6 years of follow-up. The clinical approach to ILAs involves risk stratification based on radiological features, extent of involvement, and associated clinical and physiological findings. ILAs pose a significant challenge in distinguishing inconsequential radiological findings from early ILD. This review summarises the current understanding of ILAs, including prevalence, risk factors, progression, associated biomarkers, and clinical management strategies.