Pulmonary fibrosis - Thoracic Imaging


Title: Thoracic Imaging - Pulmonary fibrosis
Diagnosis: Pulmonary fibrosis
Author: Martins Martina
Comment: Howarth Nigel
Hospital: HUG
Department: Département de Radiologie
State: Terminée
Date: 21.03.2003
: 3423
KeyWords: Pulmonary fibrosis; interstitial pneumopathy;dyspnea
Anatomy: Thorax
Chapter: Interstitial pneumopathy
ACR: 6.273


Clinical Presentation: Worsening exertionaldyspnea.
Comment: Idiopathic pulmonary fibrosis (IPF) is the most commondiffuse interstitial
pneumonia. IPF has numerous synonyms:cryptogenic fibrosing alveolitis (UK), usual
interstitial pneumonia(US), chronic interstitial pulmonary fibrosis, diffuse interstitialpulmonary
fibrosis, and interstitial pulmonary fibrosis. Onstandard X-rays, the early signs are reticular
opacitiespredominant in the basal areas. At a later stage, IPF produces ahoneycomb
pattern with a marked decrease in pulmonary volume. CTimages demonstrate bilateral and
symmetrical lesions, predominantin the periphery of the lower zones (subpleural lesions).
Asymmetrical, subpleural honeycomb pattern, predominant in the basalareas and
associated with traction bronchiectasis is highlysuggestive of idiopathic pulmonary fibrosis.
Description: The frontal and lateral chest X-rays shows a diffusereticulonodular
infiltrate. CT images demonstrate severeparenchymal destruction with inter- and
intralobular septalthickening, cysts and ground glass infiltrates. Histologicalsections: Image
1 ñ established dense fibrosis (*) andfibro-proliferative focus demonstrating active fibrosis
(arrow).Image 2 ñ fibrosis of subpleural area (arrow) and intact alveolarsepta (*). Image 3 -
fibro-proliferative focus(arrow).


Order: 0
Dislocation: 0
Polytrauma: 0
Open: 0
Pathologic: 0
Operation: 00.00.00
Graft: 0


References: American thoracic society/ European respiratorysociety.
International Multidisciplinary Consensus Classificationof the Idiopathic Interstitial
Pneumonias. Am J Respir Crit CareMed 2002;165: 277-304. MacDonald SL, Rubens MB,
Hansell DM et al.Nonspecific interstitial pneumonia and usual interstitialpneumonia:
comparative appearances at and diagnostic accuracy ofthin-section CT. Radiology
2001;221:600-5. Gross TJ, HunninghakeGW. Idiopathic pulmonary fibrosis. N Engl J Med
2001;345:517- 525.King TE Jr, Schwarz MI, Brown K, Tooze JA, Colby TV et al.Idiopathic
pulmonary fibrosis: relationship between histopathologicfeatures and mortality. Am J Respir
Crit Care Med2001;164:1025-32.

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