Diagnosis and Evaluation of Hypersensitivity Pneumonitis

Pérez, Evans R. Fernández; Travis, William D.; Lynch, David A.; Brown, Kevin K.; Johannson, Kerri A.; Selman, Moisés; Ryu, Jay H.; Wells, Athol U.; Huang, Yuh‐Chin T.; Pereira, C; Scholand, Mary-Beth; Villar, Ana; Inase, Naohiko; Evans, Richard B.; Mette, Stephen A.; Frazer-Green, Lindsy

doi:10.1016/j.chest.2021.03.066

Cited by 124 publications

(144 citation statements)

References 216 publications

(449 reference statements)

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“…Mosaic attenuation, air trapping, or three-density pattern were reported as findings suggestive of fibrotic HP [ 1 , 2 , 6 , 7 ], but no significant difference was observed in this study (Table 2 ). The logistic regression for predicting fibrotic HP is presented in Table 3 .…”

Section: Resultscontrasting

confidence: 60%

“…Two guidelines have recently been proposed for diagnosing hypersensitivity pneumonitis (HP), which state that lung biopsy is not necessary for the diagnosis of HP if antigen exposure, typical high-resolution computed tomography (HRCT) findings, and bronchoalveolar lavage (BAL) lymphocytosis have been identified [ 1 , 2 ]. However, in fibrotic HP, the antigen is often unknown, and most cases need lung biopsy.…”

Section: Introductionmentioning

confidence: 99%

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The new useful high-resolution computed tomography finding for diagnosing fibrotic hypersensitivity pneumonitis: “hexagonal pattern”: a single-center retrospective study

et al. 2022

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Background Centrilobular nodules, ground-glass opacity (GGO), mosaic attenuation, air trapping, and three-density pattern were reported as high-resolution computed tomography (HRCT) findings characteristic of fibrotic hypersensitivity pneumonitis (HP). However, it is often difficult to differentiate fibrotic HP from idiopathic pulmonary fibrosis (IPF). In fibrotic HP, the HRCT sometimes shows tortoiseshell-like interlobular septal thickening that extends from the subpleural lesion to the inner layers. This finding is called “hexagonal pattern,” and this study is focused on the possibility that such finding is useful for differentiating fibrotic HP from IPF. Methods This study included patients with multidisciplinary discussion (MDD) diagnosis of fibrotic HP or IPF undergoing surgical lung biopsy between January 2015 and December 2017 in Kanagawa Cardiovascular and Respiratory Center. Two radiologists have evaluated the HRCT findings without clinical and pathological information. Results A total of 23 patients were diagnosed with fibrotic HP by MDD and 48 with IPF. Extensive GGO, centrilobular nodules, and hexagonal pattern were more frequent findings in fibrotic HP than in IPF. No significant difference was observed between the two groups in the presence or absence of mosaic attenuation, air trapping, or three-density pattern. In the multivariate logistic regression, the presence of extensive GGO and hexagonal pattern was associated with increased odds ratio of fibrotic HP. The sensitivity and specificity of the diagnosis of fibrotic HP in the presence of the hexagonal pattern were 69.6% and 87.5%, respectively. Conclusion Hexagonal pattern is a useful finding for differentiating fibrotic HP from IPF.

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Section: Resultscontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

The new useful high-resolution computed tomography finding for diagnosing fibrotic hypersensitivity pneumonitis: “hexagonal pattern”: a single-center retrospective study

et al. 2022

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“…Recently, the "CHEST guideline" for HP has been proposed by CHEST panel of experts [22]. The most important difference between the the CHEST guideline and the ATS/JRS/ALAT guideline is that the scope of alternative diagnosis that has been expanded to include IPF and indeterminate HP has been limited to only those cases that are truly unknown.…”

Section: Discussionmentioning

confidence: 99%

The effect of hypersensitivity pneumonitis guideline on the pathologic diagnosis of interstitial pneumonia

Ozasa

Bychkov

Zaizen

et al. 2021

Preprint

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Hypersensitivity pneumonitis (HP) and interstitial pneumonia (IP) have several overlapping characteristics, and a high diagnostic concordance rate of HP is rarely obtained. Thus, new guidelines, highly influenced by pathology, were devised for its diagnosis. We attempted to study the impact of the 2020 HP guidelines on pathological diagnosis of previously diagnosed cases of IP. Cases with fibrotic IP diagnosed in 2014 to 2019 were classified according to the 2020 HP guidelines into three categories: typical HP, probable HP, and indeterminate HP. The original pathological diagnosis and categorization based on the HP guidelines were compared. The clinical data including the serum data and the pulmonary function tests were compared among the groups. The study analyzed 247 consecutive cases classified into typical, probable, and indeterminate for HP, and alternative diagnoses. The number of cases that changed from an original diagnosis other than HP to HP based on the guidelines was 56 (23%). The clinical data of these cases bore greater resemblance to cases diagnosed as indeterminate for HP than those cases diagnosed as typical or probable HP. The ratios of typical and probable HP to those of the total cases were significantly low using cryobiopsy. Thus, with the application of the new guidelines, the pathological diagnosis of HP efficiently excluded HP cases but increased the rate of HP diagnosis for cases with fibrotic IP, which may not fit well to an HP diagnosis. Cryobiopsy may not be useful in imparting findings for fibrotic HP diagnosis using the new criteria.

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“…Other patients will require BAL or lung biopsy. An expert panel report for diagnosis and evaluation has been published 64 .…”

Section: Hypersensitivity Pneumonitismentioning

confidence: 99%

Update in Diagnosis and Management of Interstitial Lung Diseases

Salinas

Florenzano

2021

MRAJ

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Interstitial lung diseases (ILD) are a complex and diverse group of disorders. ILD are more frequently diagnosed and prevalent now. In this article, diagnosis approach, including new bronchoscopy and genetic tools, and some recently added concepts are revisited, as progressive fibrosing interstitial lung diseases and interstitial lung abnormalities. Recently information relative to idiopathic pulmonary fibrosis is shown, including genetics and pathophysiology. We look over the dynamic world of interstitial lung diseases related to connective tissue diseases, principal characteristics of this group and the principles that define which of the various available therapies should be chosen. Finally new concepts and guidelines published about the diagnosis and management of hypersensitivity pneumonitis are reported. New data and treatments have changed our traditional vision of these lung diseases and we will new options in the next years.

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Diagnosis and Evaluation of Hypersensitivity Pneumonitis

Cited by 124 publications

References 216 publications

The new useful high-resolution computed tomography finding for diagnosing fibrotic hypersensitivity pneumonitis: “hexagonal pattern”: a single-center retrospective study

The new useful high-resolution computed tomography finding for diagnosing fibrotic hypersensitivity pneumonitis: “hexagonal pattern”: a single-center retrospective study

The effect of hypersensitivity pneumonitis guideline on the pathologic diagnosis of interstitial pneumonia

Update in Diagnosis and Management of Interstitial Lung Diseases

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