Hypersensitivity pneumonitis: correlation of individual CT patterns with functional abnormalities.

Hansell, D.M.; Wells, Athol U.; Padley, Simon; Müller, Néstor L.

doi:10.1148/radiology.199.1.8633133

Cited by 225 publications

(102 citation statements)

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“…Although the identification of emphysema in the presence of interstitial fibrosis is controversial [138], it is possible that areas of emphysema occur interspersed among pulmonary fibrosis in chronic cases of hypersensitivity pneumonitis. Nevertheless, in a study of patients with subacute, but not chronic, extrinsic allergic alveolitis, multivariate analysis showed that there was no independent relationship between the extent of decreased attenuation on CT and DL,CO; but there was a relationship with RV/TLC, which would favour bronchiolitis, rather than emphysema, as the cause of areas of decreased attenuation [134].…”

Section: Miscellaneous Conditions With Small Airways Involvementmentioning

confidence: 93%

“…14); these patterns reflect lymphocytic interstitial pneumonitis, peribronchiolar exudate, and bronchiolitis respectively. There is a strong correlation between the extent of the areas of decreased attenuation (a component of the mosaic attenuation pattern) on HRCT and pulmonary function indices of air-trapping [134,135]. The airtrapping, graphically shown on expiratory CT, is present in the great majority of patients with subacute disease, and reflects the underlying component of bronchiolitis.…”

Section: Miscellaneous Conditions With Small Airways Involvementmentioning

confidence: 99%

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Small airways diseases: detection and insights with computed tomography

Dm¹

2001

Eur Respir J

146

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Diseases affecting the small airways are difficult to detect by traditional diagnostic tests. Widespread involvement is needed before symptoms and abnormalities on pulmonary function testing or chest radiography become apparent. Obstruction of the bronchioles may be detected indirectly by computed tomography (CT) because regional under-ventilation results in reduced perfusion which in turn is shown as a mosaic attenuation pattern of the lung parenchyma. When there is inflammation of the bronchioles with accompanying exudate, the airways may become directly visible on CT, for example in cases of diffuse panbronchiolitis.Quantification of the various morphological features of small airways disease is possible from CT images and this increased precision has aided investigations of structure/function relationships.An understanding of the pathology and microscopic distribution of disease in relation to the airways allows some prediction of the likely computed tomography appearances in this wide spectrum of conditions, and thus helps to refine the differential diagnosis.

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Section: Miscellaneous Conditions With Small Airways Involvementmentioning

confidence: 93%

Section: Miscellaneous Conditions With Small Airways Involvementmentioning

confidence: 99%

Small airways diseases: detection and insights with computed tomography

Dm¹

2001

Eur Respir J

146

View full text Add to dashboard Cite

show abstract

“…Honeycombing, which is a requirement for a diagnosis of UIP/IPF, has been reported in 16% to 69% of CHP cases, 12,15,16 and in contrast to the honeycombing in patients with UIP/IPF, honeycombing in patients with CHP seldom has a basal predominance. The reticulation in CHP can be patchy, random or peribronchovascular or have a predominantly subpleural distribution, mimicking UIP/IPF.…”

mentioning

confidence: 99%

“…Lobular areas of decreased attenuation and vascularity ( Figure 1, E and F) are described in approximately 80% of patients, with poorly defined centrilobular nodules in approximately 50% of patients. 12,[16][17][18][19][20][21] In contrast, UIP/IPF shows reticulation in all lobes; no or minimal ground-glass opacities; honeycombing, which is often extensive; and a peripheral and basal distribution. 12 However, as noted, these criteria fail to provide separation in 50% of cases; in particular, there can be considerable overlap between CHP and UIP/IPF.…”

mentioning

confidence: 99%

Pathology of Chronic Hypersensitivity Pneumonitis What Is It? What Are the Diagnostic Criteria? Why Do We Care?

Churg

Bilawich

Wright

2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Chronic hypersensitivity pneumonitis (CHP) has emerged from obscurity during the past 15 years and is now recognized as a very common form of fibrosing interstitial pneumonia but one that is frequently misdiagnosed both clinically and on surgical lung biopsy as usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF) or fibrotic nonspecific interstitial pneumonia. Objective.— To review the pathologic features of CHP. Data Sources.— Clinical, pathology, and radiology literature were used. Conclusions.— Upper lobe–predominant fibrosis and/or air-trapping on computed tomography scan are features of CHP but not UIP/IPF; however, radiologic separation is possible in only about 50% of cases. Morphologically, CHP sometimes mimics UIP/IPF, but CHP often shows isolated foci of peribronchiolar (centrilobular) fibrosis, frequently associated with fibroblast foci, and in CHP, fibrosis may bridge from the centrilobular region to another bronchiole, an interlobular septum, or the pleura (“bridging fibrosis”). This set of findings is uncommon in UIP/IPF. In addition, CHP may produce a picture of fibrotic nonspecific interstitial pneumonia. Although giant cells/granulomas are usually present in subacute hypersensitivity pneumonitis, they are much less frequently found in CHP, and their absence does not contradict the diagnosis. This diagnostic separation is clinically important because CHP is treated differently than UIP/IPF is (immunosuppressive agents versus antifibrotic agents); further, there are some data to suggest that removing the patient from antigen exposure improves outcome, and there is evidence that patients with CHP have a much better survival prognosis after lung transplantation than do patients with UIP/IPF. In most cases, accurate diagnosis of CHP requires consultation among clinicians, radiologists, and pathologists.

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“…59 Their extension correlates with severity of air trapping, as indicated by an increased residual volume. 60 When air-trapping areas, ground-glass opacities, and normal lung are seen at the same HRCT section, the pattern is called "headcheese sign". The CT imaging pattern is reminiscent of the variegated appearance of headcheese cold cut meat.…”

Section: Pereira Et Almentioning

confidence: 99%

Chronic Hypersensitivity Pneumonitis

2010

High-Yield Imaging: Chest

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Hypersensitivity pneumonitis: correlation of individual CT patterns with functional abnormalities.

Abstract: Areas of decreased attenuation and mosaic perfusion are an important ancillary CT finding in hypersensitivity pneumonitis, and obstructive functional abnormalities indicate that this phenomenon is caused by bronchiolitis.

Cited by 225 publications

References 0 publications

Small airways diseases: detection and insights with computed tomography

Small airways diseases: detection and insights with computed tomography

Pathology of Chronic Hypersensitivity Pneumonitis What Is It? What Are the Diagnostic Criteria? Why Do We Care?

Chronic Hypersensitivity Pneumonitis

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