Images hosted on other servers : End stage IPF. Honeycomb lung.
JaypeeDigital | Imaging in ILD
Microscopic histologic description. Microscopic histologic images. Scroll to see all images. Peripheral dense fibrosis adjacent to normal parenchyma. PAP-like change within honeycomb. Fibroblastic focus. Respiratory bronchiolitis macrophage. Low power magnification. Dense fibrosis with smooth muscle hyperplasia.
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Fat metaplasia. Peribronchiolar metaplasia. Perilobular involvement. Squamous metaplasia. Bone metaplasia. Dense fibrosis and architectural destruction. Dense fibrosis and honeycomb. The recognized mortality associated with surgical biopsy and use of a MDT as a new diagnostic standard in ILD have both reduced the number of patients in whom pathological tissue is now available, or necessary, for diagnosis. A management conundrum arises with regard to unclassifiable ILD patients, as they have no diagnosis with which to base treatment strategies.
A recently published clinical classification of disease behaviour goes some ways to addressing this management issue. In so doing, it may obviate the need for a formal clinical diagnosis before appropriate management and monitoring can be instituted. An acute exacerbation of interstitial disease has been defined as an episode of unexplained new or worsening shortness of breath that has developed within the previous 30 days and is characterized by ground glass opacification representing diffuse alveolar damage and generalized leakage on HRCT superimposed on a background of fibrosis Fig. An acute exacerbation of interstitial lung disease.
There was no evidence of infection and an echocardiogram demonstrated normal ventricular function. The appearances are in keeping with an acute exacerbation of interstitial disease; the patient died less than 2 weeks after the HRCT was performed. Although an acute exacerbation may be the presenting feature of IPF, 62 evidence suggests that it is more likely to complicate patients with more extensive baseline fibrosis. The lack of specific imaging characteristics essentially the rapid development of ground glass opacification on a background of FLD requires that an acute exacerbation is essentially a diagnosis of exclusion.
Differential diagnoses include concomitant infection such as Pneumocystis pneumonia or cytomegalovirus infection and pulmonary oedema due to left ventricular failure. When excluding the diagnosis of pulmonary embolus with a CT pulmonary angiogram CTPA , intravenous contrast enhancement unpredictably increases the attenuation of the background lung parenchyma, which can complicate the evaluation of whether the lungs are of abnormally increased attenuation i.
Effect of contrast enhancement as part of a computed tomography pulmonary angiogram CTPA. The administration of intravenous contrast results in an increase in density within areas of lung parenchyma, visible as foci of ground glass opacification. If not recognized as artefactual, the ground glass opacities may be thought to represent early acute exacerbation of interstitial lung disease. HRCT phenotypes of this small group of diseases usually fit into one or two out of five potential differential diagnoses.
How is diffuse interstitial lung disease diagnosed and evaluated?
The diagnosis can then be further refined following discussion in a MDT setting. Consideration of disease behaviour as well as patient age are increasingly being explored to refine the diagnosis of HRCT identified FLD. Volume 20 , Issue 6. The full text of this article hosted at iucr.
If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username. Respirology Volume 20, Issue 6. David M. Email: davidhansell rbht. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article.
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Figure 2 Open in figure viewer PowerPoint. Figure 3 Open in figure viewer PowerPoint. Traction bronchiectasis As defined in the Fleischner Society, glossary of terms for thoracic imaging, traction bronchiectasis and bronchiolectasis represent irregular bronchial and bronchiolar dilatation caused by surrounding retractile fibrosis. Figure 4 Open in figure viewer PowerPoint. Figure 5 Open in figure viewer PowerPoint.
Figure 6 Open in figure viewer PowerPoint. Ancillary features of fibrosis HRCT signs such as reticulation and ground glass opacification are seen in many conditions other than FLD; nevertheless, they can be helpful as they are commonly associated with fibrosis. Figure 7 Open in figure viewer PowerPoint. Figure 8 Open in figure viewer PowerPoint.
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Figure 9 Open in figure viewer PowerPoint. Figure 10 Open in figure viewer PowerPoint. Fibrosing variant of OP Organizing pneumonia has numerous causes and associations, including CTD when it may coexist with NSIP ; and as a consequence of various forms of transplantation. Figure 12 Open in figure viewer PowerPoint. Figure 13 Open in figure viewer PowerPoint. Figure 14 Open in figure viewer PowerPoint. Fibrotic sarcoidosis Sarcoidosis when fibrotic, predominantly results in fibrosis that radiates off the hila and tends to involve the posterior segments of the upper lobes Fig.
FLD associated with smoking A complex relationship that has yet to be fully elucidated exists between the effects of cigarette smoking and interstitial lung fibrosis. Figure 17 Open in figure viewer PowerPoint. Figure 18 Open in figure viewer PowerPoint. Imaging of acute exacerbation of FLD An acute exacerbation of interstitial disease has been defined as an episode of unexplained new or worsening shortness of breath that has developed within the previous 30 days and is characterized by ground glass opacification representing diffuse alveolar damage and generalized leakage on HRCT superimposed on a background of fibrosis Fig.
Figure 19 Open in figure viewer PowerPoint.
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Figure 20 Open in figure viewer PowerPoint. Honeycomb lungs. Crossref PubMed Google Scholar. Citing Literature. Volume 20 , Issue 6 August Pages Pneumoconiosis: Comparison of imaging and pathologic findings. Radiographics ; CT assessment of silicosis in exposed workers.
Diffuse Lung Diseases: Clinical Features, Pathology, HRCT / Edition 1
Computed tomography scan in the early detection of silicosis. Am Rev Respir Dis ; Patterns of coal workers' pneumoconiosis in Appalachian former coal miners. J Natl Med Assoc ; Coal worker's pneumoconiosis: CT assessment in exposed workers and correlation with radiographic findings. Solitary mass in the lungs of coal miners. Pneumoconiosis- related lung cancers: Preferential occurrence from diffuse interstitial fibrosis-type pneumoconiosis. Asbestos: When the dust settles an imaging review of asbestos-related disease.
Radiographics ;22 Spec No: S Diffuse pleural thickening in an asbestos-exposed population: Prevalence and causes. Akira M. High-resolution CT in the evaluation of occupational and environmental disease. Radiol Clin North Am. Asbestos- related focal lung masses: Manifestations on conventional and high-resolution CT scans.
A possible case of pneumoconiosis in a limestone quarry worker. Occup Med Lond ; Doig AT. Disabling pneumoconiosis from limestone dust. Br J Ind Med ; Imaging of occupational lung disease. Inhalation pulmonary talcosis: High-resolution CT findings in 3 patients.