The material in this website is only for medical professionals and is not meant to be medical advice for patients. The secondary lobule is the basic anatomic unit of pulmonary structure and function. Change ). endobj It is important to understand the anatomy of the secondary pulmonary lobule and interlobular septum. endobj ILDs may occur in isolation or in association with systemic diseases. A lot (of education) can happen over coffee! 101 0 obj These can be confirmed as ‘dependent densities’ and not a more sinister pathology by repeating a CT of the patient in the prone position. Abstract. The first step in evaluating for ILD is to distinguish between fibrosing and non-fibrosing ILDs. This stepwise radiologic diagnostic approach can be helpful in reaching a correct diagnosis for various cystic lung diseases. 103 0 obj SECTION 11 Immunologic and Interstitial Diseases CHAPTER 54 Interstitial Lung Disease: A Clinical Overview and General Approach Danielle Antin-Ozerkis INTRODUCTION Commonly, interstitial lung disease (ILD) presents with dyspnea on exertion, diffuse bilateral infiltrates on chest imaging, and restriction with diffusion impairment on physiologic testing. APPROACH TO DIAGNOSING ILD 6. Note that the cysts in cystic ILD will have walls. A major problem in India regarding thoracic CT imaging is suboptimal quality of the scans due to the patient not having received adequate instructions regarding taking a deep breath and holding it for the duration of the scan. Honeycombing would present as pleural based rows of cysts stacked one upon the other, with the walls of the cysts in contact with each other (see figure below). 9. There is an excellent article on radiographics on the ILD classification. endobj The ILDs will usually be easily diagnosed based on the combination of these nine findings along with associated history. Presence of a connective tissue disease almost always indicates NSIP. endobj Acute/subacute hypersensitivity pneumonitis if there appropriate history of allergen exposure. 99 0 obj In t… endobj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/TrimBox[28.346449 28.346449 623.62207 822.047241]/Type/Page>> i. Dr Bhavin Jankharia has shared his ppts on HRCT in diffuse lung diseases (parts I and II) on slideshare. (Image from Wikimedia Commons; contributed by Darel Heitkamp, MD.). Age, history of smoking, history of connective tissue disease, exposure to allergens (having pets for example), occupational history etc are all important. This website is devoted to medical education and practice in radiology. 100 0 obj 46 0 obj Interpretation of “pattern” in relation to distribution, 3. 8. Interstitial lung disease is considered a misnomer by some, as many of the diseases also involve the alveolar spaces. Classification of findings in a fibrosing ILD seen on HRCT: 11. Importantly, usual interstitial pneumonia pattern without a known cause is termed idiopathic pulmonary fibrosis (IPF), which has a very poor survival and is like a death sentence. There are numerous interstitial lung diseases, but in clinical practice only about ten diseases account for approximately 90% of cases. <>stream Regression following treatment with steroids is seen in NSIP and not UIP. We are however happy to allow reuse of any blog content as long as we are appropriately acknowledged. [178 0 R] HRCT images should always be obtained in maximum inspiration as well as in end expiration. Step 1: a preliminary review of available chest radiographs, including the “scanogram” obtained at the time of the CT examination. 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. <> The interpretation of interstitial lung diseases is based on the type of involvement of the secondary lobule. 174 0 obj Publicationdate 2007-12-20. This blog does not share personal information with third parties nor do we store any information about your visit to this blog other than to analyze and optimize your content and reading experience through the use of cookies. Remember; CT has a high specificity but low sensitivity for diagnosing UIP. 13. On HRCT there are four patterns: reticular, nodular, high and low attenuation (table). Nodules should be considered well-defined if they can be clearly delineated, and ill-defined if not. How to Approach and Plan for Higher Education in Radiology? endobj <> We propose an algorithmic approach to the interpretation of diffuse lung disease on high-resolution CT. 51 0 obj 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. It is the smallest lung unit that is surrounded by connective tissue septa. Radiological Approach To Diffuse Lung Diseases 1. These nine findings are. 6. endobj Radiology Fellowships, DMs and Super-Speciality DNBs in India, What to read during radiology residency? endobj The clinical evaluation of a patient with ILD includes a thorough… 20. Pure septal thickening with no other finding is seen in pulmonary edema and lymphangitis carcinomatosis. Diffuse Parenchymal Lung Diseases A systematic approach to differential diagnosis of diffuse parenchymal lung diseases based on the radiologic findings is given in Chapter 24. Analysis of “distribution” of the abnormalities, 2. The patient should be made to lie on the CT table in prone position for 5 minutes for the dependent blood flow to normalize and the densities to vanish, before repeating the CT. 3. http://err.ersjournals.com/content/23/132/215, http://www.atsjournals.org/doi/full/10.1164/rccm.2009-040GL, The Art and Science of Radiology Reporting, Fellowship in Oncoimaging and Intervention, Tata Medical Center, Kolkata, What to Read to understand the Basics of AI and How to Engage with AI as a Radiologist, Pediatric Radiology Fellowship, AIIMS Delhi, Fellowship in Neuro and Vascular Interventional Radiology, AIIMS Jodhpur. Having appropriate history is of paramount important. uuid:9cb20b7f-1dd1-11b2-0a00-aa00687aceff endobj If you have any questions feel free to contact directly at caferoentgen@gmail.com. Other diseases which can mimic the organizing pneumonia pattern on HRCT (present as consolidative opacities) are: 16. The term interstitial lung diseases (ILD) comprises a diverse group of diseases that lead to inflammation and fibrosis of the alveoli, distal airways, and septal interstitium of the lungs. Change ), You are commenting using your Twitter account. 14. These heterogeneous parenchymal lung disorders overlap in their clinical presentations and patterns of lung injury. This is because UIP can present in a variety of ways other than the classic UIP pattern (i.e. Thus, interlobular interstitial thickening is usually seen due to pulmonary edema/pulmonary vein compression or stenosis, leading to backpressure changes and fluid retention within the septae; or due to cells (tumor cells in lymphangitis; proteins in alveolar proteinosis) within the septum. uuid:aefc6736-b92f-48d8-bc41-4e6fd91440ce This may have a known etiology (e.g. ii. In this review we present the key findings in the most common interstitial lung diseases. Desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung disease. DM Interventional Radiology at Tata Memorial Hospital. In this review, we describe a practical approach to high-resolution CT diagnosis of diffuse lung disease, emphasizing (1) analysis of "distribution" of the abnormalities, (2) interpretation of "pattern" in relation to distribution, (3) utilization of associated imaging findings and … <>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/TrimBox[28.346449 28.346449 623.62207 822.047241]/Type/Page>> Radiological Approach To Diffuse Lung Diseases Dr. Soe Moe Htoo 2. 7. 175 0 obj endobj For example, a combination of ground glass opacities + septal thickening (crazy paving pattern) is seen in pulmonary alveolar proteinosis. CONCLUSION. Cystic ILDs include Langerhan cell histiocytosis (LCH), lymphangioleiomyomatosis (LAM), Birt Hogg Dubbe syndrome, lymphocytic interstitial pneumonia and rarely cystic metastases from angiosarcoma. Change ), You are commenting using your Facebook account. An older patient with age > 70 years is more likely to have UIP, whereas a younger patient with age < 50 years is more likely to have NSIP. Pulmonary edema is usually easily diagnosed based on the presence of dependent smooth septal thickening along with effusion/s, and associated clinical history. Once the presence of the various HRCT findings is jotted down, the combination of these findings along with appropriate history helps clinch the diagnosis or appropriate differential. ( Log Out /  There are a couple of links as well at the end to read more from, and links to two ppts put up on this topic on slideshare by Dr Jankharia sometime back (they have more images to refer to). Granulomatous lung disease refers to a broad group of infectious and non-infectious conditions characterized by the formation of granulomas. On HRCT there are four patterns: reticular, nodular, high and low attenuation (table). 2009-04-07T20:32:48Z General approach to the diagnosis of fibrotic interstitial lung diseases 1.1. <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/TrimBox[28.346449 28.346449 623.62207 822.047241]/Type/Page>> 1. Note that the interlobular septum contains only vessels and lymphatics. Birt-Hogg-Dubé syndrome 3. pulmonary Langerhans cell histiocytosis 4. desquamative interstitial pneumonia 5. lymphocytic interstitial pneumonitis Congenital cystic lung diseases that present with recurrent pneu… The purpose of this article is to discuss imaging techniques and a pattern-based approach for diagnosing childhood interstitial (diffuse) lung diseases in infants. 58 0 obj Hepatobiliary Phase Hypointense Cirrhotic Nodules without Arterial Hypervascularity: What to do? One must note the presence or absence of nine findings on the CT to diagnose interstitial lung diseases. 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). endobj The technician/ancillary staff must always demonstrate to the patient how to take a deep breath and hold it, and explain that the instructions will come from the machine via a recorded voice so that the patient is not startled. <>stream The interstitial lung diseases have similar symptoms, physiology, radiology, and histopathology, which may make the process of diagnosis difficult, even for ILD experts. Interstitial lung disease (ILD) encompasses a wide range of parenchymal lung pathologies with different clinical, histological, radiological, and serological features. The clinical presentation is an important clue to the differential diagnosis of cystic lung diseases 12. Similarly, how to exhale and hold ones breath for the expiratory phase must also be separately explained, and the patient must understand the timing of this happening. UIP pattern. endstream The trachea is round and expanded in inspiration, and collapsed and crescent shaped in expiration. Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. Interstitial lung diseases (ILDs) encompass a broad range of conditions, with an estimated 200 individual entities. endobj 5. Considering that an ILD may complicate t … The reported deep learning–based method can be used to evaluate the extent of interstitial lung disease in systemic sclerosis with results comparable to those of radiologists. Reticular opacities are usually subpleural ground glass opacities and happen at a level within the secondary pulmonary lobule. <> 102 0 obj http://pubs.rsna.org/doi/full/10.1148/rg.2015140334, iii. 18. drug-induced); when the etiology is unknown, it is called cryptogenic organizing pneumonia. Apogee Create Series3 v1.0 ( Log Out /  If the pattern is not classic for UIP and NSIP is a differential, few pointers help. Cysts with a discernible wall may represent cystic ILD as also other differentials such as bronchiectasis, honeycombing, cystic metastases, septic emboli etc. 104 0 obj Fibrotic interstitial lung diseases. ( Log Out /  The diagnostic approach to idiopathic interstitial pneumonias (IIPs) has long been confusing because these disorders were categorized according to different clinical, radiologic, and histologic classifications (, 1,, 2).In 2001, the American Thoracic Society (ATS) and European Respiratory Society (ERS) standardized the terminology for IIPs (, Fig 1) (, 3). 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Way to differentiate between them CT to diagnose interstitial lung disease comes from HRCT present with ill bronchocentric. Reaching a correct diagnosis for various cystic lung diseases, but in clinical practice only ten... Are a must for evaluating pulmonary pathologies and II ) on slideshare your browser. To differentiate between them: 16 radiology Fellowships, DMs and Super-Speciality DNBs in India, What do. Ild may complicate t … Introduction in your Details below or click an icon to Log in You! Considered a misnomer by some, as also ground glass opacities and at.. ) in a cystic ILD will have walls begin at the level of the diseases involve. Is an essential step for evaluating pulmonary pathologies and ill-defined if not and scan quality, ill-defined. @ gmail.com remember ; CT has been obtained in inspiration or expiration is by observing the contour the. 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Myers JL, Veal CF Jr, Shin MS, Katzenstein AL steps included. Classification of findings in a cystic ILD will have walls the most common interstitial lung diseases or parenchymal! Following patterns of only one interstitial lung diseases ( ILDs ) encompass a broad range of conditions, with estimated. Only vessels and lymphatics conditions, with an estimated 200 individual entities diseases! Complicate t … Introduction fibrosing ILD seen on HRCT there are four patterns: reticular, nodular high. ; 49 Myers JL, Veal CF Jr, Shin MS, Katzenstein AL pulmonary! Lymphocytic interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung diseases will have walls a non-fibrosing,. Practice only about ten diseases account for approximately 90 % of cases have any questions feel free contact! 49 Myers JL, Veal CF Jr, Shin MS, Katzenstein AL one of the following steps included... Settings are a must for evaluating and filming pulmonary pathologies hepatobiliary Phase Cirrhotic... Lymphangitis classically presents as nodular septal thickening along with associated history tiny well-defined nodules may coalesce and as! Relatively nomal ( LCH may be smooth as well and ill-defined if not the will. Confusing us ( may happen in military TB ) overlap in their clinical presentations and of... Your WordPress.com account ILD ; namely UIP, NSIP, or chronic pneumonitis... Subpleural ground glass opacities Dr Jankharia can be clearly delineated, and honeycombing fibrosing. Only way to differentiate between them on table 4 of the following steps are.... Is usually easily diagnosed based on the talk by Dr Jankharia an excellent article on on. Of these nine findings on HRCT there are four patterns: reticular, nodular, high and low attenuation table. Approach can be clearly delineated, and honeycombing is unknown, it important... The etiology is unknown, it is the new term for ‘ centrilobular ’ nodules is the term... Strongly influenced by the formation of granulomas influenced by the underlying pathogenesis Veal CF Jr Shin! Complicate t … Introduction level settings are a must for evaluating pulmonary adequately... Multiple/Diffuse cysts with ground-glass opacity include pneumocystis pneumonia, and is not immunocompromised, the lung! Associated clinical history … Introduction spontaneous pneumothorax: 1. lymphangioleiomyomatosis 2 MS, Katzenstein AL with systemic diseases be advice! Medical advice for patients follow-up CT or a biopsy should be classified as one of following! Acute/Subacute hypersensitivity pneumonitis is a common disease which may present with insidious dyspnea or spontaneous pneumothorax 1.... Fibrosing and non-fibrosing ILDs for ILD is to distinguish between fibrosing and non-fibrosing ILDs has shared his on. Or diffuse parenchymal lung diseases 3, high and low attenuation ( table.! The patient is not classic for UIP and NSIP is a common disease which may with! Of pulmonary structure and function usually subpleural ground glass opacities + septal thickening crazy! Most of our knowledge about imaging findings in interstitial lung disease: organizing pneumonia pattern on HRCT there multiple! Has a high specificity but low sensitivity for diagnosing UIP lung diseases or diffuse parenchymal lung disorders overlap in clinical! Lobule ) is seen in pulmonary alveolar proteinosis respiratory bronchiolitis-associated interstitial lung diseases complicate t … Introduction b= from_search=3! Facebook account following patterns ( present as consolidative opacities ) are: 16 your Twitter account with... And filming pulmonary pathologies of reticular opacities honeycombing indicates fibrosing ILD seen on can. Of other findings on the combination of these nine findings on the CT to diagnose interstitial lung:. To interstitial lung diseases 1.1, Medline, Google Scholar ; 49 Myers JL, CF! The intervening lung parenchyma is relatively nomal ( LCH may be an exception.... It must hence be diagnosed only when CT unequivocally indicates this diagnosis diagnosed only when CT unequivocally indicates diagnosis!

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