Presence of Air Trapping and Mosaic Attenuation on Chest Computed Tomography Predicts Survival in Chronic Hypersensitivity Pneumonitis

Chung, Jonathan H.; Zhan, Xi; Cao, Mengshu; Koelsch, Tilman; Manjarres, D.C. Gomez; Brown, Kevin K.; Lynch, David A.; Russell, Gloria; Pérez, Evans R. Fernández

doi:10.1513/annalsats.201701-035oc

Cited by 64 publications

(55 citation statements)

References 25 publications

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“…Significant mosaic attenuation with associated air trapping is an important and common finding in HP. 26,28 Although it may be present to any extent, to increase the likelihood of HP, it should be bilateral and in at least three lobes.…”

Section: Mosaic Attenuation and Air Trappingmentioning

confidence: 99%

“…The extent of fibrotic changes (e.g., reticulation, traction bronchiectasis, and honeycombing) in HP, while not helpful in diagnosis, have a significant prognostic value. 28,32,33 For example, a recent study noted that in FHP, >5% extent of honeycombing was present in 12% of patients and was associated with a shorter transplant-free survival (2.8 years) compared with those with minimal (<5%) or no honeycombing (>8 years). 34 Pulmonary reticular abnormality represents intralobular lines and interlobular septal thickening, and may be among the earliest findings to suggest histological fibrosis.…”

Section: Fibrosismentioning

confidence: 99%

“…The disease is more commonly diffuse in the craniocaudal plane without a clear zonal predominance. 28,34 A diffuse pattern of fibrosis, if seen with other features of HP, may still allow for a confident diagnosis of FHP. A lower lung zone predominant pattern of fibrosis, commonly seen in NSIP and UIP, can also be seen in FHP.…”

Section: Fibrosismentioning

confidence: 99%

“…A lower lung zone predominant pattern of fibrosis, commonly seen in NSIP and UIP, can also be seen in FHP. 28 Although other features may be helpful in suggesting FHP, these cases of lower lung FHP may be indistinguishable from a UIP (►Fig. 4a, b) or NSIP pattern (►Fig.…”

Section: Fibrosismentioning

confidence: 99%

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Clinical Decision-Making in Hypersensitivity Pneumonitis: Diagnosis and Management

Pérez

Koelsch

Leone

et al. 2020

Semin Respir Crit Care Med

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This review provides an updated approach to the diagnosis and management of hypersensitivity pneumonitis (HP). The importance of using a multidisciplinary discussion to increase diagnostic and treatment confidence is emphasized. The role of Bayesian reasoning is highlighted throughout, underscoring the importance of hypothesis generation (differential diagnosis) and diagnostic test interpretation based on the probability of HP. Probability estimates of diagnostic certainty (i.e., a confident versus a working diagnosis) and treatment thresholds are carefully examined.Therapeutically, beyond antigen avoidance and newly available antifibrotic therapy for patients with a progressive fibrosing phenotype; the role, timing, and expected response to anti-inflammatory therapy in individual patients are unanswered questions. Since the evidence and validation of testing generally performed during the diagnostic work-up and longitudinal monitoring of HP is feeble at best, the viewpoints discussed are not intended to resolve current controversies but rather to provide a conceptual framework for evaluating discordant information when evaluating and caring for patients with HP.

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Section: Mosaic Attenuation and Air Trappingmentioning

confidence: 99%

Section: Fibrosismentioning

confidence: 99%

Section: Fibrosismentioning

confidence: 99%

Section: Fibrosismentioning

confidence: 99%

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Clinical Decision-Making in Hypersensitivity Pneumonitis: Diagnosis and Management

Pérez

Koelsch

Leone

et al. 2020

Semin Respir Crit Care Med

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“…Patients with so much fibrosis that there is little mosaic attenuation or air trapping have a worse prognosis than those without extensive fibrosis. 25…”

Section: Treatmentmentioning

confidence: 99%

Hypersensitivity pneumonitis: A fibrosing alveolitis produced by inhalation of diverse antigens

Greenberger

2019

Journal of Allergy and Clinical Immunology

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Hypersensitivity pneumonitis (HP) is a T H 1 lymphocyte-biased fibrosing alveolitis caused by antigens ranging from avian excreta, fungi, thermophilic bacteria, and protozoa to reactive chemicals found in the workplace. Mimicking a viral syndrome, acute exposures to inciting antigens cause abrupt onset of nonproductive cough, dyspnea, and chills with arthralgias or malaise usually from 4 to 8 hours later so that the temporal relationship between antigen exposure and symptoms might be unsuspected. The histology of HP reveals prominent lymphocyte infiltrates that thicken the alveolar septa with poorly formed granulomas or giant cells. Bronchoalveolar lavage fluid demonstrates greater than 20% lymphocytes in nearly all patients. Abnormalities on high-resolution computed tomographic examinations range from nodular centrilobular opacities in acute/subacute disease to increased reticular markings and honeycombing fibrosis, which typically are predominant in the upper lobes, in patients with advanced disease. Descriptors include ''mosaic'' attenuation and groundglass opacities. Repeated episodes can result in nodular pulmonary infiltrates and suspected nonspecific interstitial pneumonia or idiopathic pulmonary fibrosis. Clinicians require a high level of suspicion to make an early diagnosis of HP before extensive pulmonary fibrosis or restrictive lung disease has occurred.

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Exogen-allergische Alveolitis

Koschel

2022

Seltene Lungenerkrankungen

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Presence of Air Trapping and Mosaic Attenuation on Chest Computed Tomography Predicts Survival in Chronic Hypersensitivity Pneumonitis

Abstract: Among subjects with chronic HP, the presence of CT AT/MA may identify subjects with better prognosis.

Cited by 64 publications

References 25 publications

Clinical Decision-Making in Hypersensitivity Pneumonitis: Diagnosis and Management

Clinical Decision-Making in Hypersensitivity Pneumonitis: Diagnosis and Management

Hypersensitivity pneumonitis: A fibrosing alveolitis produced by inhalation of diverse antigens

Exogen-allergische Alveolitis

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