by Marvin I. Schwartz (Author), Talmadge E. King (Author) Sign in with Facebook . Define “asbestos-related pleural disease” and “asbestosis”; identify each on a chest radiograph and CT scan. 3.12). HRCT Primer. On a Chest X-Ray it can be very difficult to determine whether there is interstitial lung disease and what kind of pattern we are dealing with. ILD may result in four patterns of abnormal opacity on chest radiographs and CT scans: linear, reticular, nodular, and reticulonodular (Fig. CT scan shows multiple bilateral, round, pulmonary nodules. 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). 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. Patients are often hypoxemic, and pulmonary function tests typically demonstrate a restrictive pattern, with reduced diffusing capacity. Patients with hypersensitivity pneumonitis often have a history of exposure to an inciting agent and are usually nonsmokers. idiopathic pulmonary fibrosis). Nonspecific interstitial pneumonia (NSIP) is the next most frequent. Methotrexate and rheumatoid arthritis associated interstitial lung disease Eur Respir J. Interstitial lung disease is the generic term for a group of almost 200 different types of diseases with different causes but with similar clinical and pathological changes. 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. A middle or upper lung–predominant distribution suggests mycobacterial or fungal disease, silicosis, sarcoidosis, LCH, extrinsic allergic alveolitis (hypersensitivity pneumonitis), or, very rarely, ankylosing spondylitis. The complex world of interstitial lung disease presents nearly insurmountable challenges to the general surgical pathologist faced with a lung biopsy in this setting. 3.17 • Desquamative interstitial pneumonia (DIP). 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. Kim DS, Collard HR, King TE. Respiratory bronchiolitis is a histopathologic lesion found in cigarette smokers and is characterized by the presence of pigmented intraluminal macrophages within respiratory bronchioles (4). Table 3.6 COMMONLY USED DRUGS THAT CAN CAUSE LUNG TOXICITY, DIFFERENTIAL DIAGNOSIS OF INTERSTITIAL LUNG DISEASE, DIFFERENTIAL DIAGNOSIS OF A NODULAR PATTERN OF INTERSTITIAL LUNG DISEASE, PULMONARY EDEMA WITH A NORMAL-SIZED HEART, IMAGING FEATURES OF IDIOPATHIC INTERSTITIAL PNEUMONIAS, COMMONLY USED DRUGS THAT CAN CAUSE LUNG TOXICITY, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Upper Lung Disease, Infection, and Immunity. Lung damage from ILDs is often irreversible and gets worse over time. A: PA chest radiograph shows low lung volumes and bibasilar reticular ILD. A key imaging differential on cross-sectional imaging would be: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 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). The term AIP is reserved for diffuse alveolar damage of unknown origin. These patterns are more accurately and specifically defined on CT. A linear pattern is seen when there is thickening of the interlobular septa, producing Kerley lines. J Thorac Imaging. This 45-year-old woman presented with metastatic gastric carcinoma. 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. Riha, E.E. Interstitium is the scaffolding that supports the alveolar walls and surrounds both the alveoli and the terminal bronchioles. The typical CT feature of NSIP is predominantly basilar ground-glass and reticular opacities (Fig. Interstitial Lung Disease and Emphysema. In support of our mission, we are committed to advancing interstitial lung disease research in part through the following ways.. We perform research. 3.13 • Usual interstitial pneumonia (UIP). The classification is based on histologic criteria, although the diagnosis of IIP is made by correlating the clinical, imaging, and pathologic features. 5 27 10. Introduction • Interstitial lung diseases (ILD’s)represent a large number of conditions that involve the parenchyma of lung- the alveoli, the alveolar epithelium, the capillary endothelium, and the spaces between these structures, as well as perivascular and lymphatic tissues. In addition, the signs and symptoms of a wide range of medical conditions can mimic interstitial lung disease, and doctors must rule these out before making a … PA chest radiograph shows enlargement of the cardiac silhouette, bilateral ILD, enlargement of the azygos vein (solid arrow), and peribronchial cuffing (dashed arrow). • The radiographic and pathologic abnormalities in patients can be classified into acute, subacute, … 3.11 • Cardiogenic pulmonary edema. Lee JS, Gong G, Song KS et-al. FIG. Table 3.2 DIFFERENTIAL DIAGNOSIS OF KERLEY LINES. 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). UIP, usual interstitial pneumonia; IPF, idiopathic pulmonary fibrosis; NSIP, nonspecific interstitial pneumonia; DIP, desquamative interstitial pneumonia; RB-ILD, respiratory bronchiolitis–associated interstitial lung disease; COP, cryptogenic organizing pneumonia; AIP, acute interstitial pneumonia; LIP, lymphoid interstitial pneumonia. 3.9 and 3.10). Pulmonary edema can be caused by a number of processes other than chronic heart failure, and it may present with a normal-sized heart (Table 3.4). A large number of disorders fall into this broad category. Radiographics. CT scan shows subpleural, dense airspace opacity in the left lung. 3.24 • Influenza pneumonia. 3.14). Interstitial lung disease may lead to cor pulmonale when the right ventricle has to pump harder to move blood through the lungs. Usual interstitial pneumonia (UIP). Respiratory bronchiolitis interstitial lung disease (RB-ILD) is a smoking related interstitial lung disease closely related to respiratory bronchiolitis, but demonstrating more severe histological, imaging and clinical findings. Ground-glass opacity and consolidation can be seen but are not dominant features. 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. The architecture of the lung is preserved. 3.6 • Hematogenous metastases and nodular ILD. 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. 6 (3): 143-52. The term desquamative refers to an initially incorrect belief that the intra-alveolar macrophages represented desquamated alveolar cells. 3.2 • Cardiogenic edema and Kerley lines. Thorax. Reticular opacities can be described as fine, medium, or coarse, as the width of the opacities increases. Usual interstitial pneumonia and nonspecific interstitial pneumonia with and without concurrent emphysema: thin-section CT findings. This 69-year-old woman presented with left ventricular failure and a predominantly interstitial pattern of pulmonary edema. The majority of patients are cigarette smokers in their fourth or fifth decade of life (6). Drug-induced interstitial lung disease (DI-ILD), defined as an interstitial abnormality secondary to administration of a drug, can be acute or chronic. 22. 3.4 • Farmer’s lung and pulmonary fibrosis. 3Dept of 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. Radiology. The pathology is often inflammatory and always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis. FIG. The diagnostic process in diffuse lung disease begins with a clinical evaluation that includes a history, physical examination, chest radiograph, and lung function tests. 9. FIG. Challenges in pulmonary fibrosis x 5: the NSIP/UIP debate. Mechanical ventilation is usually required. The reticular pattern consists of a network of linear densities (Fig. AMERICAN THORACIC SOCIETY 25 Broadway New York, NY 10004 United States of America Phone: +1 (212) 315-8600 Fax: +1 (212) 315-6498 Email: firstname.lastname@example.org Most of our knowledge about imaging findings in interstitial lung disease comes from HRCT. 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. Honeycombing, particularly if it involves more than 5% of the lung volume, is an almost 100% specific finding. Share Claim CME/SAM Claim CME + Affiliations: 1 Department of Radiology, University of Texas Houston Medical School, 6431 Fannin St, MSB … 1. Adult patients with newly detected interstitial lung disease (ILD) of apparently unknown cause are clinically suspected of having idiopathic pulmonary ﬁbrosis(IPF) if they have unexplained symptomatic or asymptomatic patterns of bilateral ﬁbrosis on a chest 3Dept of C: Close-up of (A), right upper lung, shows linear opacities (arrow) radiating outward from the hila, representing Kerley A lines. 3. Akira M, Inoue Y, Kitaichi M et-al. 9. 3.7 and 3.8). The novelty of the new … 2Pulmonary Unit, GB Morgagni Hospital, Forlı`, Italy. Duhig, B.E. 6 (2): 138-153. 6.1a).Depending on the mesh size, one can distinguish between fine, medium, and coarse reticular patterns, although this distinction has … This 3-year-old Hispanic boy with acquired immunodeficiency syndrome presented with a 2-week history of cough, fever, chills, night sweats, and headache. Wuyts WA, Cavazza A, Rossi G et-al. (2019) The British Journal of Radiology. 6. Fungal disease is discussed in Chapter 7. List the common causes of lower lobe–predominant ILD (idiopathic pulmonary fibrosis, asbestosis, chronic aspiration, collagen vascular disease). Gallium scanning and positron emission tomography (PET) have also been used in the evaluation of interstitial lung disease and are discussed in more detail in Nuclear Medicine: The Requisites. Interstitial lung disease Katerina M. Antoniou 1, George A. Margaritopoulos , Sara Tomassetti2, Francesco Bonella 3, Ulrich Costabel and Venerino Poletti2 Affiliations: 1Dept of Thoracic Medicine and Laboratory of Cellular and Molecular Pneumonology, Medical School, University of Crete, Crete, Greece. FIG. Non specific Interstitial Pneumonia- second commonest amongst pulmonary fibrosis, just after Usual Interstitial Pneumonia ... Hospital Build Middle East, Congress of the Brain Tumor Radiology in Neuro-oncology Society. List four causes of unilateral ILD (aspiration, radiation, lymphangitic carcinomatosis secondary to lung cancer, asymmetric edema). It is necessary to analyze whether the pattern of diffuse opacification in the lung field is alveolar or interstitial. Radiology, National Jewish Health, Denver, CO, USA. Septal thickening without architectural distortion is more likely to represent pulmonary edema. This list excludes the relatively uncommon diagnosis of amyloidosis. CT scan of a 61-year-old man with increasing cough, shortness of breath, and chest pain shows bibasilar reticular and ground-glass opacities. 3.19). A reticulonodular pattern and larger-than-normal lung volumes can be seen with LAM and LCH. The term reticular is defined as meshed, or in the form of a network. The term organizing pneumonia refers to the morphologic imaging or histologic pattern (associated with a wide variety of diseases), whereas COP indicates the associated idiopathic clinical syndrome. Associated pleural thickening and/or calcification suggest asbestosis. CT scan shows bibasilar reticular and ground-glass opacities. These are due to chronic, nonmalignant, noninfectious diseases of the lower respiratory tract that cause disruption and inflammation to the walls of the alveoli. In more advanced stages of … Hydrostatic pulmonary edema is defined as abnormal water in the lungs secondary to elevated pulmonary venous pressure from a failing left ventricle, mitral stenosis, increased circulating blood volume (as with anemias), renal failure (causing fluid retention), or overhydration. 3.20 • Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). Jonathan H. Chung, Christian W. Cox, Steven M. Montner, et al. 2. Respir. Lung CT: Part 2, The Interstitial Pneumonias?? A nodular pattern, especially with an upper lung–predominant distribution, suggests a specific differential diagnosis (Table 3.3; Figs. Unable to process the form. 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. Most of our knowledge about imaging findings in interstitial lung disease comes from HRCT. 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. 18. 7. There are 6 types of Idiopathic Interstitial Pneumonias, also called 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. HRCT obtained during the accelerated phase of the disease demonstrates a generalized increase in lung attenuation and progression of both the reticular and honeycomb patterns. 2020 Jul 9 ... 12 Division of Radiology, Medical School of the University of São Paulo, São Paulo, Brazil. Founded in 1905 to combat TB, the ATS has grown to tackle asthma, COPD, lung cancer, sepsis, acute respiratory distress, and sleep apnea, among other diseases. 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. The interstitial space is defined as a continuum of loose connective tissue throughout the lung composed of three subdivisions: (i) the bronchovascular (axial), surrounding the bronchi, arteries, and veins from the lung root to the level of the respiratory bronchiole; (ii) the parenchymal (acinar), situated betwee… 3.16). 2014;14 Suppl 1: S2. Interstitial lung disease (ILD) comprises a diverse group of lung diseases with overlapping clinical, radiological, physiological, and pathological features.1 Interstitial lung abnormalities (ILAs) refer to the presence of CT scan findings that are potentially compatible with ILD in patients who have partial (eg, abdominal CT including The pathology is often inflammatory and always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis. A large number of disorders fall into this broad category. Interstitial lung disease Katerina M. Antoniou 1, George A. Margaritopoulos , Sara Tomassetti2, Francesco Bonella 3, Ulrich Costabel and Venerino Poletti2 Affiliations: 1Dept of Thoracic Medicine and Laboratory of Cellular and Molecular Pneumonology, Medical School, University of Crete, Crete, Greece. Predominant pattern of diffuse opacification in the left lung emma C. Ferguson 1 and Eugene A. Berkowitz 2 of. 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