Padrões tomográficos das doenças intersticiais pulmonares difusas com correlação clínica e patológica

Elicker, Brett M.; Pereira, Carlos Alberto de Castro; Webb, Richard; Leslie, Kevin O.

doi:10.1590/s1806-37132008000900013

Cited by 49 publications

(32 citation statements)

References 117 publications

(92 reference statements)

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“…To make things even more complicated, there may be overlap of HRCT patterns in one entity. In everyday clinical practice one should try to combine the different HRCT patterns or identify the predominant pattern in order to make the correct diagnosis [2, 3]. Integration of HRCT findings with clinical findings and the knowledge of acute or chronic symptoms is crucial to reach the correct diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Mimics in chest disease: interstitial opacities

Oikonomou

Prassopoulos

2012

Insights Imaging

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Septal, reticular, nodular, reticulonodular, ground-glass, crazy paving, cystic, ground-glass with reticular, cystic with ground-glass, decreased and mosaic attenuation pattern characterise interstitial lung diseases on high-resolution computed tomography (HRCT). Occasionally different entities mimic each other, either because they share identical HRCT findings or because of superimposition of patterns. Idiopathic pulmonary fibrosis (IPF), fibrosis associated with connective tissue disease, asbestosis, end-stage sarcoidosis or chronic hypersensitivity pneumonitis (HP) may present with lower zone, subpleural reticular pattern associated with honeycombing. Lymphangiomyomatosis may be indistinguishable from histiocytosis or extensive emphysema. Both pulmonary oedema and lymphangitic carcinomatosis may be characterised by septal pattern resulting from thickened interlobular septa. Ill-defined centrilobular nodular pattern may be identically present in HP and respiratory bronchiolitis–associated with interstitial lung disease (RBILD). Sarcoidosis may mimic miliary tuberculosis or haematogenous metastases presenting with miliary pattern, while endobronchial spread of tuberculosis may be indistinguishable from panbronchiolitis, both presenting with tree-in-bud pattern. Atypical infection presenting with ground-glass mimics haemorrhage. Ground-glass pattern with minimal reticulation is seen in desquamative interstitial pneumonia (DIP), RBILD and non-specific interstitial pneumonia (NSIP). Obliterative bronchiolitis and panlobular emphysema may present with decreased attenuation pattern, while obliterative bronchiolitis, chronic pulmonary embolism and HP may manifest with mosaic attenuation pattern. Various mimics in interstitial lung diseases exist. Differential diagnosis is narrowed based on integration of predominant HRCT pattern and clinical history.Teaching Points• To learn about the different HRCT patterns, which are related to interstitial lung diseases.• To be familiar with the more “classical” entities presenting with each HRCT pattern.• To discuss possible overlap of different HRCT patterns and the more common mimics in each case.• To learn about some clues that help differentiate the various diagnostic mimics on HRCT.

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Section: Introductionmentioning

confidence: 99%

Mimics in chest disease: interstitial opacities

Oikonomou

Prassopoulos

2012

Insights Imaging

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“…The diagnosis of suspected ILD has always been difficult but with comprehensive clinical information, laboratory results, and the aid of high-resolution CT, a presumptive diagnosis can be made without lung biopsy in many cases15. However, as in this case, metastatic lung cancer can also appear as ground glass opacities, mimicking interstitial lung disease.…”

Section: Discussionmentioning

confidence: 97%

Ground-Glass Opacity in Lung Metastasis from Breast Cancer: A Case Report

et al. 2013

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A 43-year-old woman with breast cancer who was on neoadjuvant chemotherapy presented with cough, sputum and mild fever. High-resolution computed tomography showed diffuse ground glass opacities in bilateral lungs and subpleural patchy consolidations. Initially, she was thought to have pneumonia or interstitial lung diseases such as drug-induced pneumonitis and treated with antibiotics and steroids. She subsequently got breast cancer surgery because of disease progression, and concurrent thoracoscopic lung biopsy revealed metastatic carcinoma of the lung from breast cancer. The diagnosis of suspected interstitial lung disease can be made without lung biopsy, but malignancy should always be considered and lung biopsy should be performed in the absence of a definitive clinical diagnosis.

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“…( 1 ) On the basis of histological and CT patterns, ILDs can be subdivided into categories, as follows: granulomatous diseases; lymphoid diseases; miscellaneous; idiopathic diseases; and diseases of known cause, which include connective tissue diseases (CTDs). ( 1 , 2 ) There is considerable radiological, functional, and histological overlap among the abovementioned categories, especially between the last two. …”

Section: Introductionmentioning

confidence: 99%

“…( 1 , 4 ) In addition, the ILD patterns that are most commonly identified in this population can be quite similar to idiopathic forms. ( 2 - 10 )…”

Section: Introductionmentioning

confidence: 99%

“…( 1 ) O agrupamento em padrões tomográficos e histológicos permite a classificação das DPIs em categorias, a saber, granulomatosas, linfoides, miscelânea, idiopáticas e de causas conhecidas, nas quais se incluem as colagenoses. ( 1 , 2 ) Existe uma grande sobreposição radiológica, funcional e histológica entre elas, especialmente entre as duas últimas categorias.…”

Section: Introductionunclassified

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Interpretation of autoantibody positivity in interstitial lung disease and lung-dominant connective tissue disease

2013

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The initial evaluation of patients with interstitial lung disease (ILD) primarily involves a comprehensive, active search for the cause. Autoantibody assays, which can suggest the presence of a rheumatic disease, are routinely performed at various referral centers. When interstitial lung involvement is the condition that allows the definitive diagnosis of connective tissue disease and the classical criteria are met, there is little debate. However, there is still debate regarding the significance, relevance, specificity, and pathophysiological role of autoimmunity in patients with predominant pulmonary involvement and only mild symptoms or formes frustes of connective tissue disease. The purpose of this article was to review the current knowledge of autoantibody positivity and to discuss its possible interpretations in patients with ILD and without clear etiologic associations, as well as to enhance the understanding of the natural history of an allegedly new disease and to describe the possible prognostic implications. We also discuss the proposition of a new term to be used in the classification of ILDs: lung-dominant connective tissue disease.

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Padrões tomográficos das doenças intersticiais pulmonares difusas com correlação clínica e patológica

Cited by 49 publications

References 117 publications

Mimics in chest disease: interstitial opacities

Mimics in chest disease: interstitial opacities

Ground-Glass Opacity in Lung Metastasis from Breast Cancer: A Case Report

Interpretation of autoantibody positivity in interstitial lung disease and lung-dominant connective tissue disease

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