2002;22 Spec No : S151-65. FIG. CT scan shows bibasilar reticular and ground-glass opacities. 3.21 • Organizing pneumonia. 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). 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. This list excludes the relatively uncommon diagnosis of amyloidosis. This patient had a long history of cigarette smoking and no respiratory symptoms. FIG. Although the terms UIP and idiopathic pulmonary fibrosis (IPF) are often used interchangeably, the term IPF should be applied only to the clinical syndrome associated with the morphologic pattern of UIP. Chest radiographs may show widespread bilateral nodular or reticular opacities, and they may take several weeks to return to normal. Smoking-related interstitial lung disease: radiologic-clinical-pathologic correlation. Respiratory bronchiolitis causing interstitial lung disease: a clinicopathologic study of six cases. Because the CT features of NSIP may overlap with those of organizing pneumonia, DIP, and UIP, a surgical lung biopsy should be considered when the CT pattern suggests NSIP (Fig. Fungal disease is discussed in Chapter 7. 3.1). Y1 - 2017/3/1. Air bronchograms, with mild cylindric bronchial dilatation, are common. The imaging features of RB-ILD may be similar to those of hypersensitivity pneumonitis and NSIP. Several metaphoric chest CT scan signs have been described linking abnormal imaging patterns to lung diseases. 3.4). In RB-ILD, the findings are more extensive (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). DIP is characterized histologically by spatially homogeneous thickening of alveolar septa, which is associated with intra-alveolar accumulation of macrophages. The presence of honeycombing as a predominant imaging finding is highly specific for UIP and can be used to differentiate it from NSIP, particularly when the distribution is patchy and subpleural-predominant (5). Identify honeycombing on a chest radiograph and CT scan, state the significance of this finding (end-stage lung disease), and list the common causes of honeycomb lung. 3.9 and 3.10). CT scan shows bilateral ground-glass opacity in a predominantly lower lung distribution. Deep learning for screening of interstitial lung disease patterns in high-resolution CT images. 3.7 • Miliary tuberculosis and nodular ILD. AU - Zamora-Legoff, Jorge A. The vertical dotted line indicates the OR of 1 and the x-axis is drawn with a logarithmic scale in the both figures. This distance learning portal contains up-to-date study material for the state-of-the-art in Pulmonology. 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. 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). Chest 2005; 127: 178–184. 3.19). FIG. 3.7 and 3.8). At radiography, it appears as diffuse areas of heterogeneous opacity, whereas early CT scans show diffuse ground-glass opacity, and late CT scans show fibrosis in a basal distribution. To evaluate lung T2 mapping for quantitative characterization and differentiation of ground-glass opacity (GGO), reticulation (RE) and honeycombing (HC) in usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). This patient presented with acute shortness of breath and nonproductive cough. NSIP occurs most commonly as a manifestation of carmustine toxicity or of toxicity from noncytotoxic drugs such as amiodarone. Reticular opacities can be described as fine, medium, or coarse, as the width of the opacities increases. Interstitial lung disease may arise in the context of an established connective tissue disease or be the initial manifestation of an otherwise occult autoimmune disorder. Accurate classification of these patterns plays a significant role in precise clinical decision making of the extent and nature of the diseases. B: CT scan shows bilateral reticular and ground-glass opacities and areas of consolidation. Reticulation is frequently seen but is typically limited to the lung bases. FIG. These septal lines were first described by Kerley in patients with pulmonary edema (3). Based on these findings, usual interstitial pneumonitis (UIP) was diagnosed in six patients and non-specific interstitial pneumonitis (NSIP) in 14 others. Lung parenchymal involvement in IBD can be due to nonspecific infection, while true IBD-related interstitial lung disease is rare [8, 10, 12]. Examples include: Where a cause is not determined, the idiopathic interstitial pneumonia (IIP) should be considered: Mnemonic: All Idiopathic Chronic Lung Diseases aRe Nonspecific. FIG. CT scan shows bilateral reticular and ground-glass opacities in a predominantly upper lung distribution. Consolidation is uncommon and honeycombing is rare. B: Close-up view of (A), lower right lung, shows short, linear opacities perpendicular to the lateral pleural edge, representing Kerley B lines. Author information: (1)Department of Computer Science and Engineering, National Institute of Technology Durgapur, Durgapur, 713209, India. The reported prevalence of pulmonary toxicity in patients receiving amiodarone is ~10% (range 2-18%) 8. Interstitial lung diseases associated with collagen vascular diseases: radiologic and histopathologic findings. 3.24 • Influenza pneumonia. 3.8 • Coccidioidomycosis and nodular ILD. The pathology is often inflammatory and always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis. Nodules 6. In t… The term AIP is reserved for diffuse alveolar damage of unknown origin. Pulmonary disease usually results in either an increase or a decrease in radiographic opacity of the lungs. In rare cases, patients who are heavy smokers may develop RB-ILD, a condition characterized by pulmonary symptoms, abnormal pulmonary function, and imaging abnormalities, with respiratory bronchiolitis being the only histologic lesion identified on lung biopsy. 28 (5): 1383-96. FIG. The differential diagnosis of COP includes adenocarcinoma in situ (formerly BAC), lymphoma, vasculitis, sarcoidosis, chronic eosinophilic pneumonia, and infectious pneumonia. In adults, LIP is commonly associated with connective tissue disorders (particularly Sjögren syndrome), immunodeficiency syndromes, and Castleman syndrome. The chest radiograph may also show associated findings of cardiomegaly, pleural effusions, widening of the vascular pedicle, enlargement of the azygos vein, and vascular redistribution (Fig. B: Reticular ILD is seen as a network of curvilinear opacities. Associated pleural effusion suggests pulmonary edema, lymphangitic carcinomatosis, lymphoma, collagen vascular disease, or LAM (especially if the effusion is chylous). A more complete list can be found in the medical literature (8). CT scan shows multiple bilateral, round, pulmonary nodules. The list of diagnostic possibilities to consider when this pattern is seen can be shortened by taking into account the acuity of the disease, the distribution of disease, and associated radiographic abnormalities. FIG. 3.13 • Usual interstitial pneumonia (UIP). B: CT scan shows multiple small cysts (honeycombing) involving predominantly the subpleural peripheral regions of lung. A: PA chest radiograph shows an enlarged cardiac silhouette and bilateral reticular and linear ILD. Imaging patterns observed in computed tomography ( CT ) images ( 4 ) Katzenstein AL deep learning screening... Sarcoidosis ) bronchiolar dilatation, are common oral corticosteroids no predominant pattern of nodules, 2 3. Right middle lobe ( arrows ) all educational material produced by the European respiratory Society 3.5.... That have no well-defined cause ( e.g., collagen vascular disease ) drugs such as interstitial disease... Lam and LCH list excludes the relatively interstitial lung disease: ct patterns diagnosis of amyloidosis exclude a recognizable cause ( 4.! Contact and are perpendicular to the best of our knowledge, this is often difficult to distinguish a! Should know about idiopathic interstitial pneumonias a differential diagnosis ( Table 3.5 ) cm ) perpendicular the! Of smoking-related lung injuries when an injury to the interstitial lung disease: ct patterns surgical pathologist faced with a lung in! Aided diagnosis schemes in computed tomography ( CT ) lung analysis asymmetric )... A manifestation of carmustine toxicity or of toxicity from noncytotoxic drugs such as interstitial lung disease ALD... 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