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

Abstract

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.

Uncommon Causes of Interlobular Septal Thickening on CT Images and Their Distinguishing Features

“…In chronic HP, the most common findings are traction bronchiectasis, ILST, and intralobular reticulation, with a distribution that is mainly peribronchovascular without areas of predominance [ 14 ]. In fibrotic HP, CT sometimes shows a tortoise shell or a hexagonal pattern which is created by the alternating bands of thickened and normal interlobular septa [ 15 ] ( Figure 5 ).…”