interstitial lung disease: ct patterns
Nonspecific interstitial pneumonia (NSIP) is the next most frequent. This patient had a long history of cigarette smoking, chronic cough, and shortness of breath. 3.10 • Aspergillosis and reticulonodular ILD. Thin-section CT is a noninvasive technique for monitoring disease morphology in RA-associated lung disease. differential diagnoses of airspace opacification, presence of non-lepidic patterns such as acinar, papillary, solid, or micropapillary, myofibroblastic stroma associated with invasive tumor cells. Lung Pattern Classification for Interstitial Lung Diseases Using a Deep Convolutional Neural Network ... To train and evaluate the CNN, we used a dataset of 14696 image patches, derived by 120 CT scans from different scanners and hospitals. 2. Twelve patients with stable UIP or NSIP underwent thin-section multislice CT and 1.5-T MRI of the lung. Idiopathic LIP is rare. 3.11 • Cardiogenic pulmonary edema. Table 3.3 DIFFERENTIAL DIAGNOSIS OF A NODULAR PATTERN OF INTERSTITIAL LUNG DISEASE, Pneumoconioses (silicosis, coal worker’s, berylliosis). A lower lung–predominant distribution with decreased lung volumes suggests idiopathic pulmonary fibrosis, asbestosis, collagen vascular disease, or chronic aspiration. Kerley lines help limit the differential diagnosis (see Table 3.2). Cryptogenic organizing pneumonia (COP), desquamative interstitial pneumonia (DIP), respiratory bronchiolitis–associated interstitial lung disease (RB-ILD), and acute interstitial pneumonia (AIP) are less common, and lymphoid interstitial pneumonia (LIP) is rare. This previously healthy man living in the upper midwestern part of the United States presented with mild symptoms of shortness of breath and cough. 3.19 • Respiratory bronchiolitis. A reticular pattern results from the summation or superimposition of irregular linear opacities. B: CT scan shows basilar subpleural ground-glass opacity and mild airway dilatation. Interstitial lung diseases (ILD) involve several abnormal imaging pat- terns observed in computed tomography (CT) images. 6. 3.18 • Desquamative interstitial pneumonia (DIP). 350: h2072. Recognize the changes of congestive heart failure on a chest radiograph (enlarged cardiac silhouette, pleural effusions, vascular redistribution, interstitial or alveolar edema, Kerley lines, enlarged azygos vein, increased ratio of artery-to-bronchus diameter). Radiographics. What every radiologist should know about idiopathic interstitial pneumonias. The histologic feature of LIP is alveolar septal interstitial infiltration by lymphocytes and plasma cells. UIP is characterized histologically by a patchy heterogeneous pattern with foci of normal lung, interstitial inflammation, fibroblastic proliferation, interstitial fibrosis, and honeycombing. DIP is more common in men than in women. A: Linear ILD is seen as Kerley lines. Associated pleural effusion suggests pulmonary edema, lymphangitic carcinomatosis, lymphoma, collagen vascular disease, or LAM (especially if the effusion is chylous). FIG. The typical CT findings are ground-glass and reticular opacities, sometimes associated with perivascular cysts (Fig. 3.6 • Hematogenous metastases and nodular ILD. The differential diagnosis of COP includes adenocarcinoma in situ (formerly BAC), lymphoma, vasculitis, sarcoidosis, chronic eosinophilic pneumonia, and infectious pneumonia. 3.11). 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. Infectious pneumonia resulting in a diffuse interstitial pattern is unusual; however, viral, fungal, mycobacterial, and Mycoplasma pneumonias may be predominantly interstitial or interstitial-appearing. FIG. 3.17 • Desquamative interstitial pneumonia (DIP). This distance learning portal contains up-to-date study material for the state-of-the-art in Pulmonology. Wallis A, Spinks K. The diagnosis and management of interstitial lung diseases. NSIP occurs most commonly as a manifestation of carmustine toxicity or of toxicity from noncytotoxic drugs such as amiodarone. Functional respiratory tests commonly show an abnormal restrictive pattern and reduced diffusing capacity. Kerley A lines radiate out from the hila to the periphery of the lung. The most common viral pneumonias in infants and young children are caused by respiratory syncytial virus, parainfluenza virus, adenovirus, and influenza; in adults, influenza and adenovirus are most common. FIG. The latter include idiopathic interstitial pneumonias, granulomatous lung disorders (e.g., sarcoidosis), and other forms of ILD including lymphangioleiomyomatosis (LAM), Langerhans cell histiocytosis (LCH), and eosinophilic pneumonia (1). FIG. 3.4). 3.12 • Cardiogenic pulmonary edema. Typical CT features of early-stage AIP are ground-glass opacity, bronchiolar dilatation, and dense airspace opacity. T1 - Patterns of interstitial lung disease and mortality in rheumatoid arthritis. 3.22 • Organizing pneumonia. D: Nodular ILD will often, but not always, have an upper and middle lung–predominant distribution. Based on these findings, usual interstitial pneumonitis (UIP) was diagnosed in six patients and non-specific interstitial pneumonitis (NSIP) in 14 others. Pulmonary disease usually results in either an increase or a decrease in radiographic opacity of the lungs. Lung volumes are decreased. 7. FIG. Interstitial edema is seen on chest radiographs and CT scans as blurring of the margins of the blood vessels and bronchial walls (peribronchial cuffing), thickening of the fissures (subpleural edema), and thickening of the interlobular septae (Kerley lines) (Fig. Recognize the typical appearance and upper lobe–predominant distribution of irregular lung cysts or nodules on chest CT of a patient with Langerhans cell histiocytosis (LCH). Typical CT features of each IIP are distinct, but there is overlap (Table 3.5). Risk factors include 6: 1. treatment longer than two months 2. age over 60 years 3. daily dose >400 mg 4. antecedent lung disease or surgery 5. prior angiograp… Interstitial lung disease (ILD) is an umbrella term that encompasses a large number of disorders that are characterized by diffuse cellular infiltrates in a periacinar location. A: PA chest radiograph shows medium to coarse reticular ILD with honeycombing, in a predominantly bibasilar and subpleural distribution. Define “asbestos-related pleural disease” and “asbestosis”; identify each on a chest radiograph and CT scan. CT scan shows small nodules, reticular opacities, and septal thickening. The PA chest radiograph shows a diffuse pattern of nodules, 6 to 10 mm in diameter. Numerous drugs, some of which are listed in Table 3.6, can result in transient or permanent lung injury of varying types and severities (Fig. Mycoplasma pneumoniae usually affects previously healthy individuals between the ages of 5 and 40 years (7). The most common HRCT patterns seen in cases of diffuse interstitial lung diseases are the nodular pattern, linear/reticular opacities, cystic lesions, ground-glass opacities and consolidations. Acute lung injury Ground Glass and Consolidation Fibrosis/ honeycombing Nodules/masses Airtrapping + cysts 20 CT Patterns Histopathology Patterns . A classic reticular pattern is seen with pulmonary fibrosis, in which multiple curvilinear opacities form small cystic spaces along the pleural margins and lung bases (honeycomb lung) (Fig. C: When reticular ILD is seen as a result of chronic, irreversible lung disease, such as usual interstitial pneumonia, honeycombing is seen. If there is no predominant pattern, causes of both nodular and reticular patterns should be considered. 2. The diagnostic process in diffuse lung disease begins with a clinical evaluation that includes a history, physical examination, chest radiograph, and lung function tests. 3.2 • Cardiogenic edema and Kerley lines. FIG. 2012;199 (4): W464-76. Kerley B lines are short, straight lines (1 to 2 cm) perpendicular to and abutting the lower lateral pleural edge. Unable to process the form. In adults, LIP is commonly associated with connective tissue disorders (particularly Sjögren syndrome), immunodeficiency syndromes, and Castleman syndrome. Other findings may include lung nodules, dense airspace opacity, thickening of the bronchovascular bundles, and interlobular septal thickening. Recognize progressive massive fibrosis/conglomerate masses secondary to silicosis or coal worker’s pneumoconiosis on a chest radiograph and CT scan. 3.24). Interstitial lung diseases associated with collagen vascular diseases: radiologic and histopathologic findings. CT scan shows numerous ground-glass nodules in a centrilobular distribution (arrows). CT scan shows bilateral ground-glass opacity in a predominantly lower lung distribution. The histologic features of DIP are similar to those of RB-ILD (a condition seen exclusively in smokers), although the distribution of DIP is diffuse and RB-ILD has a predominantly bronchiolocentric distribution. A nodular pattern, especially with an upper lung–predominant distribution, suggests a specific differential diagnosis (Table 3.3; Figs. A conundrum arises when widespread small opacities are difficult to categorize into one group or the other on chest radiography, or when ILD and ALD are both present. CT scan shows multiple circumscribed, round pulmonary nodules, 2 to 3 mm in diameter, and scattered reticular opacities. 3.15 • Nonspecific interstitial pneumonia (NSIP). Table 3.4 PULMONARY EDEMA WITH A NORMAL-SIZED HEART. Usual interstitial pneumonia (UIP) is the most common of the IIPs. Interstitial lung disease (ILD) may develop as an extra-articular manifestation in patients with RA, either as a preceding entity or, more often, several years after the initial RA diagnosis, and can have a dramatic effect on morbidity and mortality .Patients with RA may present with restrictive and/or obstructive lung disease, which is often clinically underrecognized . FIG. Pneumocystis pneumonia also produces a fine interstitial pattern on chest radiography, and is discussed in Chapter 16. To investigate the histopathologic pattern and clinical features of patients with rheumatoid arthritis (RA)-associated interstitial lung disease (ILD) according to the American Thoracic Society (ATS)/European Respiratory Society consensus classification of idiopathic interstitial pneumonia. 3. No etiologic agent is identified. These characteristic opacity changes are called lung patterns. This list excludes the relatively uncommon diagnosis of amyloidosis. Architectural distortion, reflecting lung fibrosis, is often prominent. FIG. It is therefore key to determine whether there is an underlying cause for the changes. 3.19). This pattern is often difficult to distinguish from a purely reticular or nodular pattern, and in such a case a differential diagnosis should be developed on the basis of the predominant pattern. Interstitial lung diseases (ILD) involve several abnormal imaging patterns observed in computed tomography (CT) images. FIG. Both A and B lines are seen as a result of interlobular septal thickening, most commonly from pulmonary edema. Distinction of UIP from other IIPs is important, because UIP is associated with a poorer prognosis than the other entities. Development of Interstitial Lung Disease (ILD) in Patients With Severe SARS-CoV-2 Infection (COVID-19) (CovILD) ... the similar clinical course in severe cases and overlapping CT patterns in the acute setting, persistent radiological and pulmonary functional changes in survivors are conceivable. 3.17 and 3.18). The 4 CT Patterns of Pulmonary Disease . The term reticular is defined as meshed, or in the form of a network. 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. Mueller-mang C, Grosse C, Schmid K et-al. The radiographic appearance of viral pneumonias is typically a diffuse interstitial pattern with a diffuse, patchy, often nodular appearance (Fig. Rheumatoid arthritis–interstitial lung diseases (RA-ILD) was classified into the four CT image patterns (usual interstitial pneumonia (UIP), probable UIP, non-specific interstitial pneumonia (NSIP) and unclassifiable). 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. In these cases, coming up with a differential diagnosis is not as straightforward. 3.12). 13. In RB-ILD, the findings are more extensive (Fig. The classification is based on histologic criteria, although the diagnosis of IIP is made by correlating the clinical, imaging, and pathologic features. Ground-glass opacity and consolidation can be seen but are not dominant features. CT scan shows bilateral ground-glass opacity in a predominantly lower lung distribution. NSIP is characterized histologically by spatially homogeneous alveolar wall thickening caused by inflammation, fibrosis, or both. Ground-glass opacities are present in about 60% of cases. Patients are usually elderly and have been exposed to amiodarone, usually for at least six months, although there is a poor correlation with dosage or cumulative dose. This patient presented with acute shortness of breath and nonproductive cough. A reticulonodular pattern and larger-than-normal lung volumes can be seen with LAM and LCH. In t… Table 3.1 DIFFERENTIAL DIAGNOSIS OF INTERSTITIAL LUNG DISEASE, Bugs (especially fungi, Mycoplasma, and viruses), Lymphoid interstitial pneumonia and other idiopathic interstitial pneumonias, Scleroderma and other collagen vascular diseases, Histiocytosis (Langerhans cell histiocytosis). 27 (3): 595-615. 3.7 and 3.8). Patients with COP typically present with cough and dyspnea of relatively short duration. When the chest radiograph shows a clear pattern of ILD or ALD, one can render a differential diagnosis on the basis of the pattern of parenchymal disease (Table 3.1). B: CT scan shows bilateral subpleural honeycombing (dashed arrow), traction bronchiectasis (solid arrows), and a background of ground-glass opacity. Interstitial lung diseases classically produce the "3Cs": cough, clubbing of the nails, and coarse crackles on auscultation 6. Interstitial lung disease is a well-recognised manifestation and a major cause of morbidity and mortality in patients with connective tissue diseases. FIG. ILD may result in four patterns of abnormal opacity on chest radiographs and CT scans: linear, reticular, nodular, and reticulonodular (Fig. List and identify on a chest radiograph and computed tomographic (CT) scan the four patterns of interstitial lung disease (ILD): linear, reticular, reticulonodular, and nodular. The interlobular septa contain pulmonary veins and lymphatics. Although COP is primarily an intra-alveolar process, it is included in the classification of the IIPs because of its idiopathic nature and because its appearance may overlap with that of the other IIPs. A number of precipitants can cause diffuse interstitial disease such as: Eliciting a history of underlying systemic disease is also helpful since they may involve the lungs in a diffuse and infiltrative manner. a A CT slice with severe interstitial lung disease and b the manu-ally delineated lungs. 3.20) but are at least partially reversible in patients who stop smoking. 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. The spectrum of conditions included is broad, ranging from occasional self-limited inflammatory processes to severe debilitating fibrosis of the lungs. 28 (5): 1383-96. mildly abnormal lung parenchyma by use of a CT value thresholding technique. An uncommon pattern of edema is more common than an uncommon cause of ILD. Several metaphoric chest CT scan signs have been described linking abnormal imaging patterns to lung diseases. Clinical evaluation must prove that an interstitial pneumonia is idiopathic and exclude a recognizable cause (e.g., collagen vascular disease). One must decide what the predominant pattern is, take into consideration the clinical history and any associated radiographic findings, or further define the pattern(s) and distribution of disease with a CT scan of the lungs. CT scan shows subpleural, dense airspace opacity in the left lung. Mechanical ventilation is usually required. Four major CT patterns were identified: usual interstitial pneumonia (n = 26), nonspecific interstitial pneumonia (n = 19), bronchiolitis (n = 11), and organizing pneumonia (n = 5). IPF to 31%, desquamative interstitial pneumonia to 11%, drug-related lung disease to 9%, and CHP to 8%. Kerley B lines are shorter lines that contact and are perpendicular to the lateral pleural edge, predominantly in the lower lungs. Kim EA, Lee KS, Johkoh T et-al. CT-histologic correlation of the ATS/ERS 2002 classification of idiopathic interstitial pneumonias. PA chest radiograph shows enlargement of the cardiac silhouette, bilateral ILD, enlargement of the azygos vein (solid arrow), and peribronchial cuffing (dashed arrow). This is often the case with sarcoidosis, LCH, silicosis, and coal worker’s lung. 2. 3.25). Radiographics. 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