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Demetris Patsios, BA (Oxon), BM BCh,MRCP (UK) FRCR(UK) Assistant Professor of Radiology, University of Toronto, Staff Radiologist in Thoracic Imaging, UHN, Mount Sinai and Womens College Hospitals Joint Department of Medical Imaging 13th November 2010
Case 1
Ground glass Lobular areas of lower attenuation Normal lung parenchyma Normal lung volumes No architectural distortion No nodules No reticulation
Case 1
Ground glass Lobular areas of lower attenuation Normal lung parenchyma Normal lung volumes No architectural distortion No nodules No reticulation
Case 1
Main differential diagnosis on imaging
Subacute Hypersensitivity Pneumonitis Atypical Infection with associated bronchiolitis Nonspecific Interstitial Pneumonia (NSIP) Sarcoidosis
Case 2
Case 2
Case 2
Minor subpleural lung reticulation Minimal architectural distortion with fine honeycomb lung (Right Upper Lobe for example)+/traction bronchiectasis bronchiolectasis No significant ground glass remote from areas of involvement
Case 2
Upper, mid and lower zonal distribution Mild heterogeneity of lung parenchyma Pattern of reticulation extends to the pleura with no subpleural lung sparing No nodules No consolidation Difficult to comment on lung volumes on study provided scout suggest slight loss of volume
Case 2
Main differential diagnosis on imaging:
Early Idiopathic Pulmonary Fibrosis of a UIP pattern Chronic Hypersensitivity Pneumonitis Pulmonary manifestation of collagen vascular disease in a Fibrotic pattern of NSIP Pulmonary manifestation of drug reaction Sarcoidosis
Discussion
Idiopathic Pulmonary Fibrosis /Usual Interstitial Pneumonia (IPF/UIP) Nonspecific Interstitial Pneumonia (NSIP)
Hypersensitivity Pneumonitis
Acute Subacute Chronic
Drug reaction
Chronic Hypersensitivity
More commonly associated with manifestation of connective tissue disease, hypersensitivity pneumonitis, drug induced lung disease interstitial lung disease complicating diffuse alveolar damage
Less commonly idiopathic
Hypersensitivity Pneumonitis
Immune mediated inflammatory form of diffuse interstitial pulmonary disease caused by inhalation of antigens Can be seen in drug toxicity Traditionally three different types of presentation Acute Subacute Chronic
Inspiratory
Expiratory
Drug Reaction
Respiratory complications are common up to 7.7% of all adverse drug reactions in the US More than 350 medications and drugs may result in adverse pulmonary reactions Nonspecific clinical, radiologic and histologic manifestations and mimic those of acute and chronic lung diseases
Drug Reaction
They include
Diffuse Alveolar Damage Diffuse Alveolar Haemorrhage NSIP Organising pneumonia Hypersensitivity Pneumonitis Eosinophilic pneumonia UIP,LIP, DIP, Giant Cell Interstitial Pneumonia
More characteristic is the high density accumulation of Amiodarone in Lung and liver Should be considered in interstitial lung disease that does not have a characteristic constellation of signs and shows asymmetry
Conclusions
Highlighted the main constellation of radiological signs associated with interstitial lung disease commonly seen
Although not pathognomonic some radiological signs may help narrow the differential diagnosis