Alternatively, dense airspace opacity may be seen involving one or several lobes. CT scan shows small nodules, reticular opacities, and septal thickening. The presence of predominant ground-glass and reticular opacities is highly characteristic of NSIP, but there is a subset of patients with UIP who have this pattern and may require biopsy for differentiation from NSIP (Fig. Histologically, organizing pneumonia is distinguished by patchy areas of consolidation characterized by polypoid plugs of loose organizing connective tissue with or without endobronchiolar intraluminal polyps. Patients are often hypoxemic, and pulmonary function tests typically demonstrate a restrictive pattern, with reduced diffusing capacity. It may occur when an injury to the … The … Interstitium is the scaffolding that supports the alveolar walls and surrounds both the alveoli and the terminal bronchioles. Distinction of UIP from other IIPs is important, because UIP is associated with a poorer prognosis than the other entities. A lower lung–predominant distribution with decreased lung volumes suggests idiopathic pulmonary fibrosis, asbestosis, collagen vascular disease, or chronic aspiration. Organizing pneumonia, which is commonly caused by bleomycin and cyclophosphamide (as well as gold salts and methotrexate), appears on radiographs as hetero- and homogeneous peripheral opacities in both upper and lower lobes and on CT scans as poorly defined nodular consolidation, centrilobular nodules, and bronchial dilatation. 3.2 and 3.3). If there is no predominant pattern, causes of both nodular and reticular patterns should be considered. Abstract. Interstitial lung disease (ILD) comprises a diverse group of lung diseases with overlapping clinical, radiological, ... their presence is not routinely recorded on radiology reports, even at academic centres.20 ILAs are likely to be increasingly identified with the implementation of lung cancer screening and increased use of CT for other diagnostic purposes. FIG. No clinical or serological features appear to be useful to predict its presence, severity or progression, and chest high-resolution computed tomography (CT) remains the gold standard … In all cases, RB-ILD is typically associated with heavy smoking (usually of 30 pack-years or more) and is often seen in young middle-aged patients (30-40 years of age). An uncommon pattern of edema is more common than an uncommon cause of ILD. 3.8 • Coccidioidomycosis and nodular ILD. HRCT performed (A) before and (B) after clinical deterioration in a patient with biopsy proven usual interstitial pneumonia. Findings usually improve with steroid treatment. CT Features of the Usual Interstitial Pneumonia Pattern: Differentiating Connective Tissue Disease–Associated Interstitial Lung Disease From Idiopathic Pulmonary Fibrosis. Idiopathic pulmonary fibrosis: the radiologist’s role in making the diagnosis. Architectural distortion, reflecting lung fibrosis, is often prominent. 2 The temporal presentation and correlation are inconsistent and can vary with different drug classes. Identifying and determining the cause of interstitial lung disease can be challenging. 13 University and IRCCS Policlinico S. Matteo Foundation of Pavia, Pavia, Italy. FIG. Radiographics. Background: Spontaneous pneumothorax is a complication that occurs in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD); however, few studies on the clinical implications of pneumothorax for patients with CTD-ILD have been performed. Dr. Sethi is Editor-in-Chief of Internet Journal of Radiology. Lung CT: Part 2, The Interstitial Pneumonias?? 3.24). When describing imaging features, the term UIP pattern is often used, which has specific diagnostic criteria on HRCT 16. Interstitial lung disease (ILD) is an umbrella term used for a large group of diseases that cause scarring (fibrosis) of the lungs. HRCT Primer. Wells AU. Sometimes DRP coexists with COVID-19 pneumonia or radiation pneumonitis. Interstitial lung diseases radiology 1. 14 Departamento de Reumatologia, Hospital General Dr. Manuel Gea González, Ciudad de México, México. A nodular pattern consists of multiple round opacities, generally ranging in diameter from 1 mm to 1 cm, which may be difficult to distinguish from one another as individual nodules on a chest radiograph. On imaging, usual interstitial pneumonia usually presents with a lung volume loss and a craniocaudal gradient of peripheral septal thickening, bronchiectasis, and honeycombing. 3.11 • Cardiogenic pulmonary edema. B: CT scan shows bilateral reticular and ground-glass opacities and areas of consolidation. Associated lymphadenopathy suggests sarcoidosis; neoplasm (lymphangitic carcinomatosis, lymphoma, metastases); infection (viral, mycobacterial, or fungal); and silicosis. The revised ATS/ERS/JRS/ALAT diagnostic criteria for idiopathic pulmonary fibrosis (IPF)-practical implications. interstitial lung disease radiology However, patients with septic arthritis and only a past history of gout, but without intra‐articular monosodium urate or tophi in the same joints, were not included. The typical CT feature of NSIP is predominantly basilar ground-glass and reticular opacities (Fig. Radiology, National Jewish Health, Denver, CO, USA. 3.7 and 3.8). Fungal disease is discussed in Chapter 7. The most common cause of interlobular septal thickening, producing Kerley A and B lines, is pulmonary edema, as a result of pulmonary venous hypertension and distension of the lymphatics (Figs. Drug-induced interstitial lung disease (DI-ILD), defined as an interstitial abnormality secondary to administration of a drug, can be acute or chronic. 4 Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, University of Duisburg-Essen, Essen, Germany. Can CT distinguish hypersensitivity pneumonitis from idiopathic pulmonary fibrosis?. This page considers all aspects of the appearances of interstitial and alveolar opacity demonstrated on chest plain film imaging. “Cystic” areas represent pulmonary emphysema. In support of our mission, we are committed to advancing interstitial lung disease research in part through the following ways.. We perform research. We will present six posts in this series called as Interstitial Lung Disease Series. The scarring causes stiffness in the lungs which makes it difficult to breathe and get oxygen to the bloodstream. These septal lines were first described by Kerley in patients with pulmonary edema (3). 7. 10. Integrative Imaging Self-Assessment Modules LIFELONG LEARNING FOR RADIOLOGY Review. Chung JH, Lynch DA. CT scan of a patient living in Arizona shows numerous small nodules in a random distribution and pleural effusions. C: Close-up of (A), right upper lung, shows linear opacities (arrow) radiating outward from the hila, representing Kerley A lines. FIG. D: Nodular ILD will often, but not always, have an upper and middle lung–predominant distribution. Consolidation is present on CT images in 90% of patients with COP, with a subpleural or peribronchial distribution in up to 50% of cases (4) (Figs. Radiographers who are able to differentiate alveolar from interstitial lung patterns are operating at a very high level and will find a whole new appreciation of chest radiography. The interstitium of the lung is not normally visible radiographically; it becomes visible only when disease (e.g., edema, fibrosis, tumor) increases its volume and attenuation. Table 3.3 DIFFERENTIAL DIAGNOSIS OF A NODULAR PATTERN OF INTERSTITIAL LUNG DISEASE, Pneumoconioses (silicosis, coal worker’s, berylliosis). A large number of disorders fall into this broad category. 1993;189 (3): 687-91. 6. Recently, clinicians have begun to notice the increased incidence of DRP associated with molecular targeted therapy and immunotherapy in patients with cancer and pre-existing interstitial lung disease (ILD) or interstitial lung abnormality (ILA). CT scan shows bilateral patchy ground-glass opacities in a bronchovascular distribution. The spatial and temporal homogeneity of this pattern is important in distinguishing NSIP from UIP. Associated pleural thickening and/or calcification suggest asbestosis. Interstitial lung disease can be triggered by many things — including autoimmune diseases, exposure to organic and inorganic agents in the home or workplace, medications, and some types of radiation. The architecture of the lung is preserved. The pathology is often inflammatory and always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis. This patient had a history of emphysema and acute respiratory symptoms. Jeong YJ, Lee KS, Müller NL et-al. List the common causes of lower lobe–predominant ILD (idiopathic pulmonary fibrosis, asbestosis, chronic aspiration, collagen vascular disease). 2014;23 (133): 308-19. In this section of Radiology Rounds, we will discuss HRCT technique, identification of radiologic features such as honeycombing and reticulation, which are typical for interstitial lung disease, and CT features of comorbid conditions such as pulmonary arterial hypertension. 2Pulmonary Unit, GB Morgagni Hospital, Forlı`, Italy. Methods: Patients who had ILD events reported as an adverse drug … Usual interstitial pneumonia (UIP) is the most common of the IIPs. On HRCT there are four patterns: reticular, nodular, high and low attenuation (table). This chapter on interstitial lung disease (ILD) is followed by a chapter on alveolar lung disease (ALD). Despite substantial limitations, radiography remains the most widely used method for diagnosis and monitoring of many occup… Viruses that cause pneumonia in immunocompromised patients include Cytomegalovirus, varicella-zoster, and herpesvirus. by Marvin I. Schwartz (Author), Talmadge E. King (Author) Sign in with Facebook . Interstitial lung disease describes a large group of lung disorders which cause progressive scarring of lung … American journal of roentgenology. FIG. 5. The PA chest radiograph shows a diffuse pattern of nodules, 6 to 10 mm in diameter. Mechanical ventilation is usually required. 27 (3): 595-615. Patients with AIP present with respiratory failure developing over days or weeks. Kerley lines help limit the differential diagnosis (see Table 3.2). Akira M, Inoue Y, Kitaichi M et-al. This 69-year-old woman presented with left ventricular failure and a predominantly interstitial pattern of pulmonary edema. 11. Diffuse Interstitial Lung Disease. 27 28 These diseases may be acute or chronic and have a variety of underlying causes, including infection, exposure to dust or other particles, or an underlying genetic predisposition. 6 Dept of Radiology, National Heart and Lung … The typical CT features of UIP are a predominantly basal and subpleural reticular interstitial pattern with honeycombing and traction bronchiectasis (Fig. 3. Interstitial lung disease (ILD), or diffuse parenchymal lung disease (DPLD), is a group of respiratory diseases affecting the interstitium (the tissue and space around the alveoli (air sacs) of the lungs. FIG. asbestos-related interstitial lung disease: reticular opacity-to-ground glass opacity ratio: one or greater, HP usually involves the mid and upper zones of the lung, and also the presence of centrilobular nodules and areas of air trapping are very useful hints to differentiate it from UIP, UIP cases are also thought to have honeycombing and peripheral or lower lung zone predominance of disease, and less likely to have. Patients with hypersensitivity pneumonitis often have a history of exposure to an inciting agent and are usually nonsmokers. Interstitial lung diseases are a group of diffuse parenchymal lung disorders associated with substantial morbidity and mortality. Inflammation is absent or mild and mostly limited to the areas of honeycombing 1-12. 2. Consolidation is uncommon and honeycombing is rare. Make a specific diagnosis of ILD when supportive findings are present in the history or on radiologic imaging (e.g., dilated esophagus and ILD in scleroderma; enlarged heart, pacemaker or defibrillator, prior sternotomy, and ILD in a patient with amiodarone drug toxicity). 2014;14 Suppl 1: S2. Radiology. 3.11). J Thorac Imaging. An ILA refers to a subtle or mild parenchymal abnormality identified in more than 5% of lungs on CT scans in patients in whom interstitial lung disease was not previously clinically suspected (Fig 1). Define “asbestos-related pleural disease” and “asbestosis”; identify each on a chest radiograph and CT scan. The Value of a Multidisciplinary Approach to the Diagnosis of Usual Interstitial Pneumonitis and Idiopathic Pulmonary Fibrosis: Radiology, Pathology, and Clinical Correlation. Well-defined cysts can occur within the areas of ground-glass opacity. The interstitial pneumonias are a heterogeneous group of nonneoplastic diffuse parenchymal lung diseases that result from damage to the lungs by varying combinations of inflammation and fibrosis [1?? D: CT shows interlobular septal thickening (arrows), representing Kerley lines. FIG. Patients invariably present with dyspnea of varying time course and severity. Classification and natural history of the idiopathic interstitial pneumonias. In a study from a large tertiary referral center in the United Kingdom, the biopsy specimens in 168 cases over an 18-year period were retrospectively reviewed, and 13 (8%) of these showed a dominant pattern of RB-ILD. The radiographic appearance of viral pneumonias is typically a diffuse interstitial pattern with a diffuse, patchy, often nodular appearance (Fig. 13. Usual interstitial pneumonia and nonspecific interstitial pneumonia with and without concurrent emphysema: thin-section CT findings. The scarring associated with interstitial lung disease eventually affects your ability to breathe and get enough oxygen into your bloodstream.Interstitial lung disease can be caused by long-term exposure to hazardous materials, such as asbestos. 3.20) but are at least partially reversible in patients who stop smoking. Knowledge achieved in recent years has resulted in the publication of the new classification of idiopathic interstitial pneumonias, according to which there are three groups: major, rare and unclassified. We will present six posts in this series called as Interstitial Lung Disease Series. 22. Heart … Table 3.5 IMAGING FEATURES OF IDIOPATHIC INTERSTITIAL PNEUMONIAS, Morphologic Pattern (Histologic and Radiologic), Basal and subpleural–predominant distribution, reticular opacities (often with honeycombing), traction bronchiectasis, and architectural distortion, Basal-predominant distribution, ground-glass and reticular opacities, Basal and lower lung–predominant distribution, ground-glass opacities, sometimes with cysts, Respiratory bronchiolitis (clinical diagnosis of RB-ILD), Centrilobular distribution, ground-glass opacity, typically nodular, Organizing pneumonia (clinical diagnosis of COP), Basal and subpleural–predominant distribution, ground-glass opacity, and consolidation; bronchovascular distribution is also common, Diffuse alveolar damage (clinical diagnosis of AIP), Diffuse ground-glass opacity and consolidation, Bronchovascular distribution is common, ground-glass and reticular opacities and perivascular cysts. 2014;14 Suppl 1: S2. A large number of disorders fall into this broad category. 3.13). The prognosis of NSIP is substantially better than that of UIP. The lung interstitium is the space where the air sacs, called alveoli, come in contact with connective tissue and blood vessels to exchange oxygen and carbon dioxide. PA chest radiograph shows enlargement of the cardiac silhouette, bilateral ILD, enlargement of the azygos vein (solid arrow), and peribronchial cuffing (dashed arrow). In the past, the term usual interstitial pneumonia was used synonymously with IPF. This patient had Sjögren syndrome and new respiratory symptoms. Respiratory bronchiolitis is a histopathologic lesion found in cigarette smokers and is characterized by the presence of pigmented intraluminal macrophages within respiratory bronchioles (4). UIP pattern of ILD can be seen in idiopathic pulmonary fibrosis or secondary to underlying systemic diseases. 2011;140 (4 Meeting Abstracts): . Some types of autoimmune … Usual interstitial pneumonia and non-specific interstitial pneumonia: serial thin-section CT findings correlated with pulmonary function. 3.22 • Organizing pneumonia. ; We fund research. CT scan shows numerous Kerley B lines (short arrows), thickening of the right major fissure from subpleural edema (arrowheads), patchy areas of ground-glass opacification (long arrows), and a right pleural effusion (curved arrows). 5 27 Infectious pneumonia resulting in a diffuse interstitial pattern is unusual; however, viral, fungal, mycobacterial, and Mycoplasma pneumonias may be predominantly interstitial or interstitial-appearing. AIP is a rapidly progressive form of interstitial pneumonia characterized histologically by hyaline membranes within the alveoli and diffuse, active interstitial fibrosis indistinguishable from the histologic pattern found in acute respiratory distress syndrome caused by sepsis and shock. 3. 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