Imaging of Pulmonary Involvement in Rheumatic Disease

Nair, Arjun; Walsh, Simon L.F.

doi:10.1016/j.rdc.2014.12.001

Cited by 11 publications

(12 citation statements)

References 186 publications

(199 reference statements)

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“…46,51 • NSIP is the most frequent radiological and histological ILD pattern seen in association with CTD. 23,[35][36][37] • Lung biopsy generally does not contribute significant additional diagnostic or prognostic information and should be reserved for cases of major diagnostic uncertainty following ILD-MDM discussion. 37,[39][40][41] APPROACH TO MANAGEMENT OF CTD-ILD…”

Section: Discussionmentioning

confidence: 99%

“…The exception is RA where the usual interstitial pneumonia (UIP) pattern predominates and is predictive of poorer outcome 24,25 . Other common radiological patterns include OP, lymphocytic interstitial pneumonia (LIP) and some patients may demonstrate a variety of overlapping HRCT patterns 23,26–28 …”

Section: Approach To Diagnosing Ctd‐ildmentioning

confidence: 99%

“…Indeed, airways disease can be an early manifestation of RA‐associated ILD (RA‐ILD), and inspiratory sequences may appear normal or near‐normal 29,30 . HRCT also aids the assessment of complications such as infection, drug‐induced pneumonitis, acute exacerbations and malignancy, with increased incidence among certain CTD 23,27,29–32 . HRCT also allows rapid evaluation of ILD extent, largely independent of confounding factors (e.g.…”

Section: Approach To Diagnosing Ctd‐ildmentioning

confidence: 99%

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Diagnosis and management of connective tissue disease‐associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

et al. 2020

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Pulmonary complications in CTD are common and can involve the interstitium, airways, pleura and pulmonary vasculature. ILD can occur in all CTD (CTD-ILD), and may vary from limited, non-progressive lung involvement, to fulminant, life-threatening disease. Given the potential for major adverse outcomes in CTD-ILD, accurate diagnosis, assessment and careful consideration of therapeutic intervention are a priority. Limited data are available to guide management decisions in CTD-ILD. Autoimmunemediated pulmonary inflammation is considered a key pathobiological pathway in these disorders, and immunosuppressive therapy is generally regarded the cornerstone of treatment for severe and/or progressive CTD-ILD. However, the natural history of CTD-ILD in individual patients can be difficult to predict, and deciding who to treat, when and with what agent can be challenging. Establishing realistic therapeutic goals from both the patient and clinician perspective requires considerable expertise. The document aims to provide a framework for clinicians to aid in the assessment and management of ILD in the major CTD. A suggested approach to diagnosis and monitoring of CTD-ILD and, where available, evidence-based, diseasespecific approaches to treatment have been provided.

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Section: Discussionmentioning

confidence: 99%

Section: Approach To Diagnosing Ctd‐ildmentioning

confidence: 99%

Section: Approach To Diagnosing Ctd‐ildmentioning

confidence: 99%

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Diagnosis and management of connective tissue disease‐associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

et al. 2020

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“…6 In the case of this patient, with an established diagnosis of SSc and respiratory symptoms, we expected to find pulmonary complications. These typically present in the form of ILD as non-specific interstitial pneumonia or, less commonly, usual interstitial pneumonia, 9 but none of these patterns fitted the radiologic findings on the CT scan. A multidisciplinary discussion of the case led to the diagnosis of silicosis.…”

Section: Discussionmentioning

confidence: 94%

Erasmus Syndrome: An Underrecognized Entity

et al. 2022

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We present a case of a 33-year-old male who worked as a plumber and a locksmith. The patient presented with diffuse myalgia and asthenia, skin sclerosis and puffy fingers, Raynaud’s phenomenon, exertional dyspnea and erectile dysfunction. The presence of specific autoantibodies enabled the diagnosis of systemic sclerosis. Chest-computed tomography revealed upper lobe consolidation. After extensive evaluation, the multidisciplinary interstitial lung disease team concluded that the patient also had advanced silicosis. After a year, there was significant clinical, radiologic, and functional deterioration of the lung disease. The patient was referred for lung transplant. Silica inhalation is the cause of silicosis but is also implicated in the development of systemic sclerosis (Erasmus syndrome). Although they share a common risk factor, it is rare to find both diseases co-existing. We present this case of a young patient where both diseases presented aggressively in order to raise awareness to this association.

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“…Conversely, ground-glass opacity (GGO) with no signs of fibrosis (so-called "free-standing GGO") may be seen and reflect a lingering inflammatory infiltrate, or perhaps even a superimposed viral infection, as it may do in ILD. 33,34 Radiological distinction of these two underlying causes of GGO is virtually impossible and relies on correlation with the patient's clinical course and other laboratory parameters; however, the presence of such freestanding GGO could prompt physicians to consider additional investigations, including bronchoalveolar lavage to aid therapeutic decision-making, particularly as consideration of immunomodulatory therapy requires careful negotiation of a precarious riskebenefit balance after recent infection or in the presence of an opportunistic infection. As such, it seems sensible to provide a pragmatic estimate of whether the pattern on CT is predominantly fibrotic or inflammatory, and to use all available tools, for example sagittal reformats (Fig 11), to assess for early signs of volume loss.…”

Section: Lung Parenchymal Complicationsmentioning

confidence: 99%

COVID-19: looking beyond the peak. Challenges and tips for radiologists in follow-up of a novel patient cohort

et al. 2021

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As the coronavirus pandemic evolves, the focus of radiology departments has begun to change. The acute phase of imaging a new disease entity whilst rationalising radiology services in the face of lockdown has passed. Radiologists are now becoming familiar with the complications of COVID-19, particularly the lung parenchymal and pulmonary vascular sequelae and are considering the impact follow-up imaging may have on departments already struggling with a backlog of suspended imaging in the face of reduced capacity. This review from the British Society of Thoracic Imaging explores both the thoracic and extra-thoracic complications of COVID-19, recognising the importance of a holistic approach to patient follow-up. The British Thoracic Society guidelines for respiratory follow-up of COVID-19 will be discussed, together with newly developed reporting templates, which aim to provide consistency for clinicians as well as an opportunity for longer-term data collection.

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Imaging of Pulmonary Involvement in Rheumatic Disease

Cited by 11 publications

References 186 publications

Diagnosis and management of connective tissue disease‐associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

Diagnosis and management of connective tissue disease‐associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

Erasmus Syndrome: An Underrecognized Entity

COVID-19: looking beyond the peak. Challenges and tips for radiologists in follow-up of a novel patient cohort

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