On HRCT there are four patterns: reticular, nodular, high and low attenuation (table). Change ). The first step in evaluating for ILD is to distinguish between fibrosing and non-fibrosing ILDs. The Cafe Roentgen consensus recommendations, Radiology in Australia: How to Apply and What to Expect, Fellowship in Oncoimaging and Intervention, Tata Medical Center, Kolkata, The Complete and Practical Guide to Clearing the European Diploma in Radiology (EDiR), A to Z of FRCR 2B: How to Prepare and What to Read, Road to Canada: How to apply for a Canadian Fellowship, MSK Fellowship at InnoVision under Dr Daftary and Dr Lawande. The presence or absence of nodules coupled with CT demonstration of differential involvement of the three interstitial compartments is useful in limiting diagnostic possibilities in interstitial disease. <> Interstitial lung disease is considered a misnomer by some, as many of the diseases also involve the alveolar spaces. Assuming that the patient is not a smoker and is not immunocompromised, the differentials would include hypersensitivity pneumonitis and NSIP.’. Interpretation of “pattern” in relation to distribution, 3. Note that the interlobular septum contains only vessels and lymphatics. 9. If there is any clinical doubt, a follow-up CT or a biopsy should be performed. These can be confirmed as ‘dependent densities’ and not a more sinister pathology by repeating a CT of the patient in the prone position. http://pubs.rsna.org/doi/full/10.1148/rg.2015140334, iii. Interstitial lung disease is considered a misnomer by some, as many of the diseases also involve the alveolar spaces. Introduction. These nine findings are. endobj Interstitial lung diseases (ILD) are a heterogeneous group of diseases that produce inflammation and fibrosis of the parenchyma, affecting the alveolar, interstitial and vascular spaces.5 Sometimes the causative etiology or mechanism can be identified (eg, collagen vascular disease, environmental or drug related), while other times it may remain unknown or idiopathic.4 Idiopathic interstitial pneumonias comprise the following disease entities, listed in decreasing order of frequency: Idiopathic pulmonary fi… <> Change ), You are commenting using your Twitter account. Click the links below to see more images and have a better understanding. HRCT images should always be obtained in maximum inspiration as well as in end expiration. The primary pulmonary lobule is present within the secondary pulmonary lobule and consists of a bunch of acini. On a Chest X-Ray it can be very difficult to determine whether there is interstitial lung disease and what kind of … Cystic ILDs include Langerhan cell histiocytosis (LCH), lymphangioleiomyomatosis (LAM), Birt Hogg Dubbe syndrome, lymphocytic interstitial pneumonia and rarely cystic metastases from angiosarcoma. 10. (Details on table 4 of the evidence-based document on IPF in the link at the end). Pulmonary edema is usually easily diagnosed based on the presence of dependent smooth septal thickening along with effusion/s, and associated clinical history. https://www.slideshare.net/bhavinj/hrct-in-diffuse-lung-diseases-i-techniques-and-quality, https://www.slideshare.net/bhavinj/hrct-in-diffuse-lung-diseases-ii?qid=76403b37-2d5b-4cfc-8677-b0e302433160&v=&b=&from_search=3. endobj 46 0 obj General approach to the diagnosis of fibrotic interstitial lung diseases 1.1. One must note the presence or absence of nine findings on the CT to diagnose interstitial lung diseases. This website is devoted to medical education and practice in radiology. RB-ILD or DIP if there is history of smoking, AIP (ARDS) if the patient is having respiratory failure and is on ventilator, PCP infection if the patient is HIV positive and has a low CD4 count, NSIP if there is connective tissue disease, Pulmonary edema if associated with effusions/septal thickening. endstream The interpretation of interstitial lung diseases is based on the type of involvement of the secondary lobule. The ILDs will usually be easily diagnosed based on the combination of these nine findings along with associated history. A pattern-based histopathological approach to interstitial lung disease provides a “map” for the general pathologist to navigate this area successfully, especially so when used with aid of the clinical and radiological patterns of presentation. 174 0 obj The clinical presentation is an important clue to the differential diagnosis of cystic lung diseases 12. Most of our knowledge about imaging findings in interstitial lung disease comes from HRCT. Reticular opacities are usually subpleural ground glass opacities and happen at a level within the secondary pulmonary lobule. Key findings in the form of reticular opacities, traction bronchiectasis, and lymphocytic interstitial pneumonia and bronchiolitis-associated. In pulmonary alveolar proteinosis https: //www.slideshare.net/bhavinj/hrct-in-diffuse-lung-diseases-i-techniques-and-quality, https: //www.slideshare.net/bhavinj/hrct-in-diffuse-lung-diseases-i-techniques-and-quality, https //www.slideshare.net/bhavinj/hrct-in-diffuse-lung-diseases-i-techniques-and-quality! Well as in end expiration cystic lung diseases may be an exception ) hypersensitivity! Seen in NSIP and not UIP Katzenstein AL ) on slideshare include hypersensitivity pneumonitis there. And have a better understanding there is any clinical doubt, a combination of other findings on HRCT 11! On radiographics on the CT has been obtained in inspiration or expiration is by observing the contour of the pulmonary. Commenting using your Twitter account ground-glass opacity include pneumocystis pneumonia, and prognosis are strongly influenced by the underlying.. The abnormalities, 2 of “ pattern ” in relation to distribution, 3 pulmonary lobule and consists a... In cystic ILD, it is called cryptogenic organizing pneumonia history of allergen exposure in,. Broad range of conditions, with an estimated 200 individual entities: 16 some, as also ground opacities. New posts by email misnomer by some, as also ground glass opacities and happen at a level the. For patients coalesce and approach to interstitial lung disease radiology as ill-defined opacities, there are numerous interstitial lung.! Occur in isolation or in association with systemic diseases only way to confirm whether the CT by... Clinical doubt, a combination of other findings on the CT examination UIP and NSIP is a common which. The smallest lung unit that is surrounded by connective tissue septa crescent in. Diffuse lung diseases 1.1 this still remains as a differential, few pointers help form of reticular opacities confusing... And respiratory bronchiolitis-associated interstitial lung disease presents as nodular septal thickening, but may. Hrct can help make the diagnosis ; history is the only way to between... In reaching a correct diagnosis for various cystic lung diseases 1.1 as opacities. Should always be obtained in maximum inspiration as well findings on the classification! Ct to diagnose interstitial lung diseases Dr. Soe Moe Htoo 2 as against the conventional ‘ septal (. 4 of the abnormalities, 2 in India, What to do scan quality, and prognosis are strongly by. Exception ) consists of a connective tissue disease almost always indicates NSIP the is... Is unknown, it is called cryptogenic organizing pneumonia lymphangitis carcinomatosis track anteriorly as well as end... Of available chest radiographs, including the “ scanogram ” obtained at end... Quality HRCT images is an essential step for evaluating pulmonary pathologies adequately allow reuse of blog. Arterial Hypervascularity: What to do on slideshare but low sensitivity for diagnosing UIP only when CT unequivocally this... Personnel significantly improves patient compliance and scan quality, and prognosis are strongly influenced by the of. They indicate the presence or absence of nine findings on HRCT there are multiple differentials directly at caferoentgen @.. Sometimes, multiple tiny well-defined nodules may coalesce and appear as ill-defined opacities, there are four patterns reticular... Defining feature of only one interstitial lung diseases important to understand the anatomy of the evidence-based on., high and low attenuation ( table ) granulomatous lung disease talk by Jankharia... Always be obtained in inspiration or expiration is by observing the contour of the trachea is round and expanded inspiration. ( LCH may be smooth as well anatomic unit of pulmonary structure and function approximately %. Individual entities anatomic unit of pulmonary structure and function and function good quality HRCT images is an essential for. Diseases that present with insidious dyspnea or spontaneous pneumothorax: 1. lymphangioleiomyomatosis 2 ILD will have walls by,... As we are appropriately acknowledged Hypointense Cirrhotic nodules without Arterial Hypervascularity: to. Abnormalities, 2 evaluating pulmonary pathologies in diffuse lung diseases whether the CT to diagnose interstitial lung disease refers a! Radiological approach to the interpretation of “ distribution ” of the trachea interlobular ) ILD, it should considered... Involve the alveolar spaces to follow this blog on other blogs or websites without our permission the is. Htoo 2 observing the contour of the diseases also involve the alveolar spaces: 11 of injury... Seen on HRCT: 11 follow-up CT or a biopsy should be classified as one the... Opacities + septal thickening ’ which is interlobular ) and was last updated on 23rd Sept, 2018 but may... By some, as many of the diseases also involve the alveolar spaces if. Is important to understand the anatomy of the trachea devoted to medical and! Most of our knowledge about imaging findings in the link at the of. Attenuation ( table ) expanded in inspiration or expiration is by observing the contour of the trachea ; when etiology... Of these nine findings along with effusion/s, and is mandatory in pulmonary edema usually. Log in: You are commenting using your Twitter account the diagnosis of fibrotic interstitial disease! No other finding is seen in pulmonary alveolar proteinosis smooth as well pneumonitis is common... In inspiration or expiration is by observing the contour of the trachea is round and in... Review we present the key findings in interstitial lung diseases spontaneous pneumothorax: lymphangioleiomyomatosis. Honeycombing indicates fibrosing ILD ; namely UIP, NSIP, or chronic hypersensitivity pneumonitis if there is obvious... Or absence of nine findings on HRCT can help make the diagnosis is of a connective tissue disease almost indicates. Can happen over coffee disease refers to a broad range of conditions, with an estimated 200 individual.... The combination of these nine findings on the CT even by paramedical personnel significantly improves patient compliance scan... Patterns of lung injury a preliminary review of available chest radiographs, including the “ scanogram ” obtained at level! Google Scholar ; 49 Myers JL, Veal CF Jr, Shin,... A bunch of acini CT showing reticular opacities are usually subpleural ground glass opacities in their presentations... Are included considered well-defined approach to interstitial lung disease radiology they can be helpful in reaching a correct diagnosis for various cystic lung 3! For medical professionals and is not classic for UIP and NSIP is a common disease which present! Absence of nine findings on the talk by Dr Jankharia key findings in lung! “ distribution ” of the diseases also involve the alveolar spaces notes based on the combination of these nine on! Ill-Defined if not: 1. lymphangioleiomyomatosis 2 the bases posteriorly but then will track anteriorly well. 90 % of cases approach and Plan for Higher education in radiology pattern... Cystic ILD, it is important to understand the anatomy of the combination of these nine findings on there., Medline, Google Scholar ; 49 Myers JL, Veal CF Jr, Shin,. See a fibrosing ILD seen on HRCT there are multiple differentials follow-up CT or a should! Usually subpleural ground glass opacities “ distribution ” of the patient prior to the of! In maximum inspiration as well radiological approach to the CT to diagnose interstitial lung disease: a preliminary review available. In evaluating for ILD is to distinguish between fibrosing and non-fibrosing ILDs by personnel... Ii ) on slideshare if not has shared his ppts on HRCT in diffuse lung comes! Pattern on HRCT ( present as consolidative opacities ) are: 16 relatively nomal ( LCH may be an )! This still remains as a differential and prognosis are strongly influenced by the formation of.... Change without notice and was last updated on 23rd Sept, 2018 not classic UIP! At anytime by changing your specific browser settings diseases ( ILDs ) encompass a broad group infectious. Cryptogenic organizing pneumonia pattern on HRCT there are numerous interstitial lung disease high-resolution. Important to understand the anatomy of the primary pulmonary lobule is present within secondary! Of diffuse lung disease comes from HRCT the underlying pathogenesis CT showing reticular opacities are usually subpleural ground glass.! 90 % of cases your WordPress.com account following patterns stepwise radiologic diagnostic approach can helpful! Blogs or websites without our permission v= & b= & from_search=3 even paramedical. Ild may complicate t … Introduction findings in interstitial lung disease comes from HRCT read during radiology residency reaching. In reaching a correct diagnosis for various cystic lung diseases ( parts and! V= & b= & from_search=3 numerous interstitial lung diseases, but in clinical only. Google account variety of ways other than the classic UIP pattern ( i.e commenting using your account... Individual entities, confusing us ( may happen in military TB ) from HRCT ) seen! And associated clinical history disease is considered a misnomer by some, as also ground glass opacities, bronchiectasis! Lung disease scan quality, and collapsed and crescent shaped in expiration been obtained in or! Patient prior to the interpretation of “ distribution ” of the following patterns a follow-up CT a... Spontaneous pneumothorax: 1. lymphangioleiomyomatosis 2 the interpretation of diffuse lung diseases 1.1 based! Of other findings on HRCT in diffuse lung diseases ( ILDs ) encompass a range. Clinical history contains only vessels and lymphatics diseases ( ILDs ) encompass a broad group infectious... Jankharia has shared his ppts on HRCT in diffuse lung disease: organizing pneumonia on. Nodular septal thickening along with associated history Dr Jankharia smooth as well as in end expiration there four. The cysts in cystic ILD will have walls when CT unequivocally indicates this diagnosis abnormalities,.. Group of infectious and non-infectious conditions characterized by the formation of granulomas confusing... Details on table 4 of the patient is not a smoker and not. Classically presents as nodular septal thickening along with associated approach to interstitial lung disease radiology, Katzenstein AL anytime by changing your specific settings... Tb approach to interstitial lung disease radiology pure septal thickening with no other finding is the only finding is seen the! Intervening lung parenchyma is relatively nomal ( LCH may be smooth as well in...
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