Utility of expiratory thin-section CT for fibrotic interstitial pneumonia

Tokura, Sayoko; Okuma, Tomohisa; Akira, Masanori; Arai, Toru; Inoue, Yoshikazu; Kitaichi, Masanori

doi:10.1177/0284185113512300

Cited by 26 publications

(14 citation statements)

References 23 publications

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“…In a recent study, the threshold of five or more lobules of mosaic attenuation in each of three or more lobes bilaterally was found to have the highest specificity for fibrotic HP and helped differentiate this disorder from IPF ( 123 ). Because air trapping is a nonspecific finding reflecting small airway alterations of variable cause and/or severity, it is not surprising that it is also found in non-HP ILDs ( 8 ), especially connective tissue disease (CTD)-associated ILD (CTD-ILD) ( 129 ) and sarcoidosis ( 130 ).…”

Section: Radiological Featuresmentioning

confidence: 99%

Diagnosis of Hypersensitivity Pneumonitis in Adults: An Official ATS/JRS/ALAT Clinical Practice Guideline

Raghu¹,

Rémy‐Jardin²,

Ryerson³

et al. 2020

Am J Respir Crit Care Med

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633

684

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Background: This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax. Methods: Systematic reviews were performed for six questions. The evidence was discussed, and then recommendations were formulated by a multidisciplinary committee of experts in the field of interstitial lung disease and HP using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Results: The guideline committee defined HP, and clinical, radiographic, and pathological features were described. HP was classified into nonfibrotic and fibrotic phenotypes. There was limited evidence that was directly applicable to all questions. The need for a thorough history and a validated questionnaire to identify potential exposures was agreed on. Serum IgG testing against potential antigens associated with HP was suggested to identify potential exposures. For patients with nonfibrotic HP, a recommendation was made in favor of obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis, and suggestions for transbronchial lung biopsy and surgical lung biopsy were also made. For patients with fibrotic HP, suggestions were made in favor of obtaining BAL for lymphocyte cellular analysis, transbronchial lung cryobiopsy, and surgical lung biopsy. Diagnostic criteria were established, and a diagnostic algorithm was created by expert consensus. Knowledge gaps were identified as future research directions. Conclusions: The guideline committee developed a systematic approach to the diagnosis of HP. The approach should be reevaluated as new evidence accumulates.

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Section: Radiological Featuresmentioning

confidence: 99%

Diagnosis of Hypersensitivity Pneumonitis in Adults: An Official ATS/JRS/ALAT Clinical Practice Guideline

Raghu¹,

Rémy‐Jardin²,

Ryerson³

et al. 2020

Am J Respir Crit Care Med

Self Cite

633

684

View full text Add to dashboard Cite

show abstract

“…TOKURA et al [53] have reported a higher frequency of air trapping on expiratory CT scanning in rheumatoid arthritis-related ILD than in IPF, which may reflect coexisting airway disease. In addition, SONG et al [54] have shown that patients with rheumatoid arthritis are more likely to have a nontypical UIP pattern (e.g.…”

Section: Amiodarone Pulmonary Toxicitymentioning

confidence: 96%

Differential diagnosis of usual interstitial pneumonia: when is it truly idiopathic?

Wuyts

Cavazza

Rossi

et al. 2014

European Respiratory Review

109

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Idiopathic pulmonary fibrosis (IPF), the most common and lethal of the idiopathic interstitial pneumonias, is defined by a radiological and/or pathological pattern of usual interstitial pneumonia (UIP). However, UIP is not synonymous with IPF as other clinical conditions may be associated with UIP, including chronic hypersensitivity pneumonitis, collagen vascular disease, drug toxicity, asbestosis, familial IPF and Hermansky-Pudlak syndrome. Differentiating IPF ("idiopathic UIP") from conditions that mimic IPF ("secondary UIP") has substantial therapeutic and prognostic implications. A number of radiological and histological clues may help distinguish IPF from other conditions with a UIP pattern of fibrosis, but their appreciation requires extensive expertise in interstitial lung disease as well as an integrated multidisciplinary approach involving pulmonologists, radiologists and pathologists. In addition, multidisciplinary discussions may decrease the time to initial IPF diagnosis and, thus, enable more timely management. This concept was strongly emphasised by the 2011 ATS/ERS/JRS/ALAT guidelines. This article highlights, with the aid of a clinical case, the difficulties in making a diagnosis of IPF in clinical practice. Yet, an accurate diagnosis is critical, particularly given the availability of drugs that may reduce the pace of functional decline and disease progression in IPF.

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“…15 Air trapping on expiratory CT has also been shown to be present in the majority of cases in patients with RA-ILD. 16 HRCT features of obliterative bronchiolitis also appear to be more extensive in patients demonstrating anticyclic citrullinated peptide antibody (ACCPA). 17 Follicular bronchiolitis is an exudative small airways disease characterized pathologically by bronchiolar lymphoid hyperplasia.…”

Section: Airways Diseasementioning

confidence: 99%

“…24 HRCT features of airways disease may also point the radiologist to a diagnosis of RA-ILD, with expiratory air trapping significantly more prevalent than in IPF. 16 Of patients with RA and non-UIP ILD, a nonspecific interstitial pneumonia (NSIP) or unclassifiable HRCT morphologies are the next most common phenotypes, being present in around 10 to 15% of patients. 21,25,26 Fibrotic organizing pneumonias (OPs), lymphocytic interstitial pneumonias, and desquamative interstitial pneumonias (DIPs) are rare.…”

Section: Parenchymal Diseasementioning

confidence: 99%

Computed Tomographic Imaging in Connective Tissue Diseases

Devaraj

Wells

Hansell³

2019

Semin Respir Crit Care Med

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Pulmonary disease represents a significant extra-articular manifestation in the majority of connective tissue diseases (CTDs). The identification, classification, and staging of pulmonary involvement are centrally important to the management of patients, aiding the prognostication of disease behavior and treatment decisions. We present a review of the high-resolution computed tomographic pulmonary features of CTD in the lung and their significance to the reporting radiologist.

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Utility of expiratory thin-section CT for fibrotic interstitial pneumonia

Abstract: The presence of air trapping on expiratory HRCT suggests CVD-ILD rather than IPF.

Cited by 26 publications

References 23 publications

Diagnosis of Hypersensitivity Pneumonitis in Adults: An Official ATS/JRS/ALAT Clinical Practice Guideline

Diagnosis of Hypersensitivity Pneumonitis in Adults: An Official ATS/JRS/ALAT Clinical Practice Guideline

Differential diagnosis of usual interstitial pneumonia: when is it truly idiopathic?

Computed Tomographic Imaging in Connective Tissue Diseases

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