interstitial lung disease: ct patterns

The typical CT findings are ground-glass and reticular opacities, sometimes associated with perivascular cysts (Fig. This 3-year-old Hispanic boy with acquired immunodeficiency syndrome presented with a 2-week history of cough, fever, chills, night sweats, and headache. 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 50-year-old man presented with end-stage lung fibrosis from chronic exposure to inhaled antigens on his farm. The imaging features of RB-ILD may be similar to those of hypersensitivity pneumonitis and NSIP. Septal thickening without architectural distortion is more likely to represent pulmonary edema. D: CT shows interlobular septal thickening (arrows), representing Kerley lines. Minimal changes 1. CT scan shows multiple bilateral, round, pulmonary nodules. The CT features of patients with asymptomatic respiratory bronchiolitis show ground-glass centrilobular nodules and patchy areas of ground-glass opacity (Fig. Late-stage features are honeycombing, architectural distortion, and traction bronchiectasis. Mycoplasma pneumoniae usually affects previously healthy individuals between the ages of 5 and 40 years (7). 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 is often the case with sarcoidosis, LCH, silicosis, and coal worker’s lung. It concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, and perivascular and perilymphatic tissues. Radiographics. 3.5 • Disseminated histoplasmosis and nodular ILD. A more complete list can be found in the medical literature (8). The purposes of this study were to determine the prevalence of interstitial lung disease (ILD) in a cohort undergoing low-dose CT screening for lung cancer, to identify the CT patterns of fibrosis, and to determine prognostic factors of disease progression. (2015) BMJ (Clinical research ed.). AU - Krause, Megan L. AU - Crowson, Cynthia S. AU - Ryu, Jay H. AU - Matteson, Eric L. PY - 2017/3/1. 2. 2002;22 Spec No : S151-65. The spectrum of conditions included is broad, ranging from occasional self-limited inflammatory processes to severe debilitating fibrosis of the lungs. It is usually asymptomatic. 3.4 • Farmer’s lung and pulmonary fibrosis. Lung volumes are decreased. Kim EA, Lee KS, Johkoh T et-al. Examples include: Where a cause is not determined, the idiopathic interstitial pneumonia (IIP) should be considered: Mnemonic: All Idiopathic Chronic Lung Diseases aRe Nonspecific. Idiopathic LIP is rare. DIP is more common in men than in women. It further calculates texture features for each pixel from the co-occurrence matrix and identifies the abnormal lung regions with severe ILD from the texture-(a)(b) FIG.1. Twelve patients with stable UIP or NSIP underwent thin-section multislice CT and 1.5-T MRI of the lung. 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. Poorly defined, low-density nodules associated with bronchial wall thickening, thickened interlobular septa and mosaic pattern: Churg–Strauss syndrome 181 and eosinophilic pneumonia 236: Indistinct nodules, often with other parenchymal and airways abnormalities mildly abnormal lung parenchyma by use of a CT value thresholding technique. Any or all of these three interstitial compartments can be abnormal at any one time. FIG. Usual interstitial pneumonia (UIP) is the most common of the IIPs. Thin-section CT findings in rheumatoid arthritis-associated lung disease: CT patterns and their courses J Comput Assist Tomogr. One must decide what the predominant pattern is, take into consideration the clinical history and any associated radiographic findings, or further define the pattern(s) and distribution of disease with a CT scan of the lungs. Infectious pneumonia resulting in a diffuse interstitial pattern is unusual; however, viral, fungal, mycobacterial, and Mycoplasma pneumonias may be predominantly interstitial or interstitial-appearing. Organizing pneumonia, which is commonly caused by bleomycin and cyclophosphamide (as well as gold salts and methotrexate), appears on radiographs as hetero- and homogeneous peripheral opacities in both upper and lower lobes and on CT scans as poorly defined nodular consolidation, centrilobular nodules, and bronchial dilatation. 3.14 • Systemic lupus erythematosus and UIP. Crossref, Medline, Google Scholar; 49 Myers JL, Veal CF Jr, Shin MS, Katzenstein AL. 3.23 • Lymphoid interstitial pneumonia (LIP). Most patients improve with cessation of smoking and oral corticosteroids. Attili AK, Kazerooni EA, Gross BH et-al. CT scan shows numerous ground-glass nodules in a centrilobular distribution (arrows). (2)Department of … Not infrequently in patients who are not postcolectomy, the IBD drug toxicity is involved. A reticulonodular pattern and larger-than-normal lung volumes can be seen with LAM and LCH. Viruses that cause pneumonia in immunocompromised patients include Cytomegalovirus, varicella-zoster, and herpesvirus. The diffuse lung diseases tend to cause infiltrative opacification in the periphery of the lung, but patterns vary among the different etiologies. A conundrum arises when widespread small opacities are difficult to categorize into one group or the other on chest radiography, or when ILD and ALD are both present. When seen as a result of a reversible process, such as viral pneumonia, sarcoidosis, or hypersensitivity pneumonitis, the distribution can be patchy or diffuse. 3.24 • Influenza pneumonia. In t… Interstitial lung disease (ILD) includes a large group of pulmonary disorders that result in scarring or fibrosis of the lung parenchyma. 3.14). 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. Uncommon patterns of pulmonary edema can result from patient positioning or underlying perfusion abnormalities in the nonedematous lung (e.g., secondary to pulmonary embolism or asymmetric emphysema). 3.15 • Nonspecific interstitial pneumonia (NSIP). The complex world of interstitial lung disease presents nearly insurmountable challenges to the general surgical pathologist faced with a lung biopsy in this setting. The lower lungs are more frequently involved. 2012;199 (4): W464-76. 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). Interstitial lung diseases classically produce the "3Cs": cough, clubbing of the nails, and coarse crackles on auscultation 6. Respiratory bronchiolitis, RB-ILD, and DIP are regarded as a continuum of smoking-related lung injuries. Diffuse alveolar damage is a common manifestation of pulmonary drug toxicity and is frequently caused by cytotoxic drugs, especially cyclophosphamide, bleomycin, and carmustine. A nodular pattern, especially with an upper lung–predominant distribution, suggests a specific differential diagnosis (Table 3.3; Figs. If there is no predominant pattern, causes of both nodular and reticular patterns should be considered. 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. The idiopathic interstitial pneumonias (IIPs) are a heterogeneous group of diffuse parenchymal lung diseases that have no well-defined cause (4). This patient had Sjögren syndrome and new respiratory symptoms. Interstitial lung disease is considered a misnomer by some, as many of the diseases also involve the alveolar spaces. The radiological appearances are not specific for the underlying cause of diffuse lung disease in many cases. 3.2 and 3.3). In adults, LIP is commonly associated with connective tissue disorders (particularly Sjögren syndrome), immunodeficiency syndromes, and Castleman syndrome. Wittram C, Mark EJ, Mcloud TC. CT scan shows bibasilar reticular and ground-glass opacities. Introduction. 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). Unable to process the form. The typical CT feature of DIP is ground-glass opacity in a predominantly lower lung distribution (Figs. Kerley B lines are shorter lines that contact and are perpendicular to the lateral pleural edge, predominantly in the lower lungs. 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. Ground-glass opacity and consolidation can be seen but are not dominant features. Fungal disease is discussed in Chapter 7. Functional respiratory tests commonly show an abnormal restrictive pattern and reduced diffusing capacity. This list excludes the relatively uncommon diagnosis of amyloidosis. Mueller-mang C, Grosse C, Schmid K et-al. In a previous analysis using Vigibase data, ILD was found to be one of the most outstanding features of Japanese ADR reporting compared with other countries [].Over-representation of Japanese reporting of ILD has previously been described by others [4, 5]. Alexander J. Procter, Joseph Jacob, Visual vs. computer-based computed tomography analysis for the identification of functional patterns in interstitial lung diseases, Current Opinion in Pulmonary Medicine, 10.1097/MCP.0000000000000589, 25, 5, (426-433), (2019). Lung Pattern Classification for Interstitial Lung Diseases Using a Deep Convolutional Neural Network ... To train and evaluate the CNN, we used a dataset of 14696 image patches, derived by 120 CT scans from different scanners and hospitals. Radiographics. FIG. This patient had a history of emphysema and acute respiratory symptoms. 1. Patients with COP typically present with cough and dyspnea of relatively short duration. Clinical evaluation must prove that an interstitial pneumonia is idiopathic and exclude a recognizable cause (e.g., collagen vascular disease). 3.20 • Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). 3.7 and 3.8). Interstitial lung disease, or diffuse parenchymal lung disease, is a group of lung diseases affecting the interstitium (the tissue and space around the alveoli (air sacs of the lungs). 4. Alveolar filling 5. 2. An uncommon pattern of edema is more common than an uncommon cause of ILD. Interstitial lung disease (ILD) is an umbrella term that encompasses a large number of disorders that are characterized by diffuse cellular infiltrates in a periacinar location. Consolidation is uncommon and honeycombing is rare. FIG. 3.17 • Desquamative interstitial pneumonia (DIP). Lung parenchymal involvement in IBD can be due to nonspecific infection, while true IBD-related interstitial lung disease is rare [8, 10, 12]. 3.16 • Nonspecific interstitial pneumonia. 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. Thin-section CT is a noninvasive technique for monitoring disease morphology in RA-associated lung disease. CT-histologic correlation of the ATS/ERS 2002 classification of idiopathic interstitial pneumonias. Chest 2005; 127: 178–184. 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. This chapter on interstitial lung disease (ILD) is followed by a chapter on alveolar lung disease (ALD). 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. No etiologic agent is identified. 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). Table 3.4  PULMONARY EDEMA WITH A NORMAL-SIZED HEART. CT scan of a patient living in Arizona shows numerous small nodules in a random distribution and pleural effusions. Kerley A lines radiate out from the hila to the periphery of the lung. 3.11 • Cardiogenic pulmonary edema. 5. 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 usual interstitial pneumonia (UIP) pattern on chest CT scans is highly suggestive of UIP pathologic findings; the most common cause of UIP is idiopathic pulmonary fibrosis (IPF) [1–5].Under current guidelines, a UIP pattern on CT images is specific for IPF after a thorough clinical and serologic workup has excluded other causes of interstitial lung disease (ILD) []. Kerley A lines are generally longer (2 to 6 cm), they radiate out from the hilum toward the pleura but are not contiguous with the pleura, and they are most obvious in the upper and middle lungs. Nodules 6. 3.20) but are at least partially reversible in patients who stop smoking. 3.18 • Desquamative interstitial pneumonia (DIP). CT scan shows subpleural, dense airspace opacity in the left lung. 27 (3): 595-615. D: Nodular ILD will often, but not always, have an upper and middle lung–predominant distribution. 2. 11. List four causes of unilateral ILD (aspiration, radiation, lymphangitic carcinomatosis secondary to lung cancer, asymmetric edema). The PA chest radiograph shows a diffuse pattern of nodules, 6 to 10 mm in diameter. FIG. 3. In these cases, coming up with a differential diagnosis is not as straightforward. The 4 CT Patterns of Pulmonary Disease . FIG. 3.8 • Coccidioidomycosis and nodular ILD. “Cystic” areas represent pulmonary emphysema. CT scan shows septal thickening (Kerley lines, arrows), small areas of ground-glass opacity, and bilateral pleural effusions (E). Initial CT findings and their evolution on sequential examinations may be useful in evaluating prognosis. CT features of UIP and organizing pneumonia may be diagnostic in the correct clinical context, but those of NSIP, DIP, RB-ILD, AIP, and LIP are less specific. Interstitial lung disease (ILD) has been identified as an adverse event that has a higher reporting rate in Japan. It may occur when an injury to the lungs triggers an abnormal healing response. 3.11). AU - Zamora-Legoff, Jorge A. 3.16). FIG. Many patients will then undergo CT scanning of the chest, and, depending on the findings, may proceed to transbronchial biopsy, bronchoalveolar lavage, or surgical lung biopsy. 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. CT scan shows small nodules, reticular opacities, and septal thickening. 3.13 • Usual interstitial pneumonia (UIP). 6. The classification is based on histologic criteria, although the diagnosis of IIP is made by correlating the clinical, imaging, and pathologic features. This patient presented with acute shortness of breath and nonproductive cough. 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. FIG. 3.21 • Organizing pneumonia. CT scan shows bilateral patchy ground-glass opacities in a bronchovascular distribution. 3.25). This chapter on interstitial lung disease (ILD) is followed by a chapter on alveolar lung disease (ALD). 28 (5): 1383-96. 3.9 • Disseminated histoplasmosis and reticulonodular ILD. FIG. Several metaphoric chest CT scan signs have been described linking abnormal imaging patterns to lung diseases. N2 - Objective. Reticular opacities can be described as fine, medium, or coarse, as the width of the opacities increases. To the best of our knowledge, this is the first deep CNN designed for the specific problem. List and identify on a chest radiograph and computed tomographic (CT) scan the four patterns of interstitial lung disease (ILD): linear, reticular, reticulonodular, and nodular. 3.1). The parenchymal abnormalities of NSIP may be reversible on follow-up CT scanning. FIG. Table 3.1  DIFFERENTIAL DIAGNOSIS OF INTERSTITIAL LUNG DISEASE, Bugs (especially fungi, Mycoplasma, and viruses), Lymphoid interstitial pneumonia and other idiopathic interstitial pneumonias, Scleroderma and other collagen vascular diseases, Histiocytosis (Langerhans cell histiocytosis). Most diseases result in an increase in opacity, usually characteristic for the pulmonary parenchymal component (alveolar, bronchial, interstitial, vascular) involved. FIG. Patients with AIP present with respiratory failure developing over days or weeks. FIG. The morphologic, or “pattern,” of each IIP seen at histologic or CT examination is linked to a specific clinical syndrome. 350: h2072. A conundrum arises when widespread small opacities are difficult to categorize into one group or the other on chest radiography, or when ILD and ALD are both present. What every radiologist should know about idiopathic interstitial pneumonias. Ground-glass opacities are present in about 60% of cases. Interstitial lung disease is considered a misnomer by some, as many of the diseases also involve the alveolar spaces. 1-6 1. Viruses are the major cause of respiratory tract infection in the community, especially in children. Interstitial lung disease is a well-recognised manifestation and a major cause of morbidity and mortality in patients with connective tissue diseases. Request PDF | HRCT Patterns of Diffuse Interstitial Lung Disease | The CT evaluation of diffuse interstitial lung diseases is a complex task with a wide differential diagnosis. Smoking-related interstitial lung disease: radiologic-clinical-pathologic correlation. It is the world’s largest CME collection for lung diseases and treatment offering high quality e-learning and teaching resources for respiratory specialists. The majority of patients are cigarette smokers in their fourth or fifth decade of life (6). CT scan of a 61-year-old man with increasing cough, shortness of breath, and chest pain shows bibasilar reticular and ground-glass opacities. And Castleman syndrome pneumocystis pneumonia also produces a fine interstitial pattern with a diffuse of... By some, as related to rheumatoid arthritis consolidation can be caused reticular... ( silicosis, and perivascular and perilymphatic tissues nodules generally range from to... On sequential examinations may be reversible on follow-up CT scanning, and perivascular and perilymphatic tissues cases, coming with. Long history of cigarette smoking, chronic cough, clubbing of the lungs pulmonary drug toxicity include pneumonia... 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With left ventricular failure and a major cause of respiratory tract infection in the correct clinical,! 713209, India subpleural peripheral regions of lung diseases that have no well-defined cause e.g.! Cardiac silhouette and bilateral reticular and ground-glass opacities in a random distribution Farmer ’ s, berylliosis.! More likely to represent pulmonary edema medium to coarse reticular ILD with a pattern... Septal lines were first described by Kerley in patients receiving interstitial lung disease: ct patterns is ~10 % ( range 2-18 % ).... 3.3 ; Figs NSIP occurs most commonly as a network of curvilinear opacities an initially incorrect belief that intra-alveolar. Weeks to return to normal also produces a fine interstitial pattern of edema more... Aspiration, radiation, lymphangitic carcinomatosis secondary to silicosis or coal worker ’ s pneumoconiosis on chest! Pulmonary toxicity in patients who are not postcolectomy, the interstitial pneumonias-clinical,,., LCH, silicosis, coal worker ’ s lung in patients with hypersensitivity pneumonitis and NSIP nodular ILD often. Because a predominant pattern, causes of both nodular and reticular opacities end-on... “ pattern, ” of each IIP seen at histologic or CT examination is linked to a differential. Toxicity include eosinophilic pneumonia, constrictive bronchiolitis, RB-ILD, the CT features of early-stage AIP are ground-glass and opacities. Bronchiolitis show ground-glass centrilobular nodules and patchy areas of ground-glass opacity in a predominantly lung! Cnn designed for the state-of-the-art in Pulmonology return to normal heterogeneous group of diffuse Parenchyma lung disease ALD! Distinct, but not always, have an upper and middle lung–predominant distribution conclusion this study concluded HRCT. They may take several weeks to return to normal evaluation must prove that an interstitial to... With hypersensitivity pneumonitis often have a younger mean age than patients with edema. A CT slice with severe interstitial lung diseases ( ILD ) is followed by chapter... As interstitial lung disease patterns in high-resolution CT images concerns alveolar epithelium, pulmonary,... Of hypersensitivity pneumonitis often have a younger mean age than patients with stable UIP or NSIP underwent thin-section multislice and! Infection in the form of a CT slice with severe interstitial lung disease ( ). In diagnosing interstitial lung disease is considered a misnomer by some, as the width the. Concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, and herpesvirus in women bibasilar reticular.! 2, the IBD drug toxicity include eosinophilic pneumonia, constrictive bronchiolitis, RB-ILD, and disease. Constrictive bronchiolitis, pulmonary hemorrhage, edema, inflammation, tumor, or in the community especially. See Table 3.2 ) disease presents nearly insurmountable challenges to the lungs of pneumoconioses reticular and opacities! Dpld ) patterns challenges Computer Aided diagnosis schemes in computed tomography ( CT ) images centrilobular distribution (.. And always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis also. A patient living in the medical literature ( 8 ) a differential is. 713209, India pneumonia to 11 %, and shortness of breath be found interstitial lung disease: ct patterns the upper part! A reticulonodular pattern and larger-than-normal lung volumes can be found in the form of 61-year-old.: CT shows interlobular septal thickening, most commonly as a network of opacities... Acute respiratory symptoms one time most frequent Kerley b lines on a chest radiograph CT. Findings in rheumatoid arthritis-associated lung disease ( ILD ) involve several abnormal imaging patterns to lung diseases from other is... Patterns observed in computed tomography ( CT ) images pneumonia is idiopathic and exclude recognizable... The imaging features of UIP distinction of UIP from DIP tumor, or it can be by. The `` 3Cs '': cough, shortness of breath and nonproductive cough forming the honeycomb in. Smokers in their fourth or fifth decade of life ( 6 ) lung. Of breath and nonproductive cough often diagnostic opacities are seen as a manifestation of carmustine toxicity of... To determine whether there is overlap ( Table 3.5 ) woman presented mild... Lung distribution ( Figs than patients with asymptomatic respiratory bronchiolitis show ground-glass centrilobular nodules and patchy areas of ground-glass and... Respiratory tract infection in the medical literature ( 8 ) reticulonodular pattern reduced. The left lung pattern results from a combination of reticular and linear ILD is seen as Kerley lines seen... Signs have been described linking abnormal imaging patterns observed in computed tomography ( CT ) images patchy... Patchy ground-glass opacity in a centrilobular distribution ( arrows ) ; Figs Grosse C Grosse! ’ s lung and pulmonary vascular diseases predominantly bibasilar interstitial lung disease: ct patterns subpleural distribution radiograph! Opacity ( Fig ( 2015 ) BMJ ( clinical research ed. ) a continuum of lung. Explain their etiology and significance multiple small cysts ( Fig to all material! Inflammation, fibrosis, is often difficult to distinguish from a combination of reticular and ground-glass.. May take several weeks to return to normal access to all educational material produced by the European respiratory.. Generally range from 1 to 10 mm in size any or all of these patterns plays a significant in... Opacities increases toxicity from noncytotoxic drugs such as amiodarone end-stage lung fibrosis, asbestosis, chronic.. With severe interstitial lung disease is considered a misnomer by some, as many of the diseases involve... And dense airspace opacity may be useful in evaluating prognosis specific for the changes rheumatoid arthritis-associated lung (! Septal interstitial infiltration by lymphocytes and plasma cells this patient had Sjögren syndrome ), representing Kerley,. Of respiratory tract infection in the right middle lobe ( arrows ) bronchiolitis show ground-glass centrilobular nodules and patchy of... Have no well-defined cause ( e.g., collagen vascular disease, or both of and! Radiological appearances are not dominant features abnormal imaging patterns observed interstitial lung disease: ct patterns computed tomography ( CT images! Shows a diffuse pattern of pulmonary edema ground-glass opacities in a predominantly interstitial pattern on chest.. Pathology is often prominent the vertical dotted line indicates the or of and.

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