Seminars in ultrasound, CT, and MR
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Semin. Ultrasound CT MR · Feb 2014
ReviewChronic hypersensitivity pneumonitis and pulmonary sarcoidosis: differentiation from usual interstitial pneumonia using high-resolution computed tomography.
The distinction of chronic hypersensitivity pneumonitis (HP) or advanced-stage sarcoidosis from idiopathic pulmonary fibrosis or usual interstitial pneumonia is important because each disease is managed differently and may have a different prognosis. The analyses of pattern and distribution of lung parenchymal abnormalities on high-resolution computed tomography scans help differentiate among the 3 diseases. In chronic HP, the presence of lobular areas of decreased attenuation and centrilobular small nodules and the absence of lower lung zone predominance are characteristically observed. ⋯ Lung bases are usually spared. In idiopathic pulmonary fibrosis or usual interstitial pneumonia, however, the presence of honeycombing with lower lung zone predominance and the absence of centrilobular small nodules are important findings that allow us to differentiate the disease from chronic HP or advanced-stage sarcoidosis. In the 3 diseases, most important prognosis-predicting factor is the extent of fibrotic score (the extent of honeycombing and reticulation) calculated on high-resolution computed tomography scans or fibrosis estimated on chest radiographs.
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Semin. Ultrasound CT MR · Feb 2014
ReviewHigh-resolution computed tomography findings of acute respiratory distress syndrome, acute interstitial pneumonia, and acute exacerbation of idiopathic pulmonary fibrosis.
Diffuse alveolar damage (DAD) is the pathologic feature of rapidly progressive lung diseases, including acute respiratory distress syndrome, acute interstitial pneumonia, and acute exacerbation of idiopathic pulmonary fibrosis. The clinical significance and limitation of high-resolution computed tomography (HRCT) findings in these diseases were reviewed. ⋯ Traction bronchiolectasis or bronchiectasis within areas of increased attenuation on HRCT scan is a sign of progression from the exudative to the proliferative and fibrotic phase of DAD. Extensive abnormalities seen on HRCT scans, which are indicative of fibroproliferative changes, were independently predictive of poor prognosis in patients with clinically early acute respiratory distress syndrome, acute interstitial pneumonia, and acute exacerbation of idiopathic pulmonary fibrosis.
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Semin. Ultrasound CT MR · Feb 2014
Comparative StudyConnective tissue disease-associated interstitial pneumonia and idiopathic interstitial pneumonia: similarity and difference.
Interstitial lung diseases (ILDs) are increasingly recognized in patients with systemic diseases. Patients with early ILD changes may be asymptomatic. Features of ILD overlap among systemic diseases and with idiopathic variety. ⋯ Therapy- and complication-related lung changes would pose difficulty in diagnosing and classifying an ILD. Biology and prognosis of secondary ILDs may differ between different disease-related ILDs and idiopathic variety. Combination of clinical features, serological tests, pulmonary and extrapulmonary imaging findings, and pathology findings may help to diagnose ILDs.
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Semin. Ultrasound CT MR · Feb 2014
Histopathologic features of usual interstitial pneumonia and related patterns: what is important for radiologists?
In interstitial lung diseases, the diagnosis of idiopathic pulmonary fibrosis is important where pathology and radiology show usual interstitial pneumonia (UIP) pattern. Recently, revised guidelines of idiopathic pulmonary fibrosis were published in which the diagnostic algorithm requires a stricter definition for both pathology and radiology. ⋯ However, their distinction is important irrespective of the etiology, because the histologic UIP pattern indicates a significantly worse prognosis than other chronic interstitial lung diseases. In this review, we describe the histologic features of UIP, effects of revised guidelines, interobserver agreement, etiologic variations of UIP pattern, and finally we include a few of our hypothetical thoughts on the "UIP bucket."