Air-trapping in extrinsic allergic alveolitis on computed tomography

Small, J; Flower, C. D. R.; Traill, Zoë; Gleeson, Fergus

doi:10.1016/s0009-9260(96)80238-8

Cited by 89 publications

(27 citation statements)

References 18 publications

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“…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%

Small airways diseases: detection and insights with computed tomography

Dm¹

2001

Eur Respir J

145

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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: 99%

Small airways diseases: detection and insights with computed tomography

Dm¹

2001

Eur Respir J

145

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“…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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“…Ground-glass opacities are slightly more marked in the middle and lower lung zones. Areas of decreased attenuation and air-trapping, consistent with small airway disease, are also common findings (Small et al 1996). Areas of ground-glass opacities and centrilobular nodules decreased during the follow-up (Tateishi et al 2011).…”

Section: Extrinsic Allergic Alveolitismentioning

confidence: 84%

High-Resolution CT of the Lung in Children: Clinical Applications

Pointe

2014

Pediatric Chest Imaging

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Air-trapping in extrinsic allergic alveolitis on computed tomography

Cited by 89 publications

References 18 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?

High-Resolution CT of the Lung in Children: Clinical Applications

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