Difference between revisions of "Idiopathic interstitial pneumonias"

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Line 15: Line 15:
 
*Apicobasal gradient - gets worse from apex to base
 
*Apicobasal gradient - gets worse from apex to base
 
*Limited ground glass opacities
 
*Limited ground glass opacities
*Heterogeneous - diseased lung alternating with healthy lung
+
*'''Heterogeneous''' - diseased lung alternating with healthy lung
 
*Exclusion of known causes (toxins, environmental exposure, collagen vascular disease, etc)
 
*Exclusion of known causes (toxins, environmental exposure, collagen vascular disease, etc)
 
*Reduced lung volume on x-ray
 
*Reduced lung volume on x-ray
Line 23: Line 23:
 
'''[[Nonspecific intersitial pneumonia]] (NSIP)'''
 
'''[[Nonspecific intersitial pneumonia]] (NSIP)'''
 
*Basal ground glass opacitis predominate over reticulat opacities
 
*Basal ground glass opacitis predominate over reticulat opacities
*'''UIP without honeycombing'''
+
*Rare minimal honeycombing
*Subpleural sparing
+
*'''Subpleural sparing'''
 
*Potentially reversible with immunosupression
 
*Potentially reversible with immunosupression
 +
*'''Homogeneous'''
 +
*Can be cellular (GGO) and/or fibrotic (traction bronchiectasis"
 +
*Much better prognosis than UIP, esecially cellular NSIP
  
  
 
'''[[Cryptogenic organizing pneumonia]] (COP)'''
 
'''[[Cryptogenic organizing pneumonia]] (COP)'''
 
*Patchy peripheral '''subpleural''' or peribronchovascular consolidation
 
*Patchy peripheral '''subpleural''' or peribronchovascular consolidation
*'''Atoll sign'''
+
*'''Atoll sign''', aka reverse halo
 
*Idiopathic inflammation of the bronchioles and surrounding tissue causing granulation tissue and "non-infectious pneumonia"  
 
*Idiopathic inflammation of the bronchioles and surrounding tissue causing granulation tissue and "non-infectious pneumonia"  
 
*Responds to steroids not antibiotics
 
*Responds to steroids not antibiotics
 
*a/w many systemic diseases (lupus, c-anca, GVHD, etc)
 
*a/w many systemic diseases (lupus, c-anca, GVHD, etc)
 
*No pleural effusion or lymphadenopathy
 
*No pleural effusion or lymphadenopathy
 +
*aka BOOP
 +
*Usually present after treatment with antibiotics and persistent fever and opacities
  
  
Line 47: Line 52:
 
*Smoking related disease
 
*Smoking related disease
 
*Centrilobular nodules
 
*Centrilobular nodules
*Ground glass opacities  
+
*Ground glass opacities
 +
*Same histology as RB-ILD, but further down the spectrum
  
  

Revision as of 15:06, 3 June 2012

  • Rare
  • Reaction to lung injury
  • Variable inflammation and fibrosis
  • Variable response to treatment


Common disorders such as sarcoidosis, vasculitis and connective tissue disorders display an identicle morphologic pattern. Bleomycin drug toxicity can also give a similar appearance.


Idiopathic pulmonary fibrosis (IPF)

  • Usual interstital pneumonia (UIP) is the histologic pattern
  • Basal and peripheral reticular opacities
  • Honeycombing, subpleural cysts
  • Traction bronchiectasis due to surrounding fibrosis
  • Apicobasal gradient - gets worse from apex to base
  • Limited ground glass opacities
  • Heterogeneous - diseased lung alternating with healthy lung
  • Exclusion of known causes (toxins, environmental exposure, collagen vascular disease, etc)
  • Reduced lung volume on x-ray
  • Mean survival 3 years


Nonspecific intersitial pneumonia (NSIP)

  • Basal ground glass opacitis predominate over reticulat opacities
  • Rare minimal honeycombing
  • Subpleural sparing
  • Potentially reversible with immunosupression
  • Homogeneous
  • Can be cellular (GGO) and/or fibrotic (traction bronchiectasis"
  • Much better prognosis than UIP, esecially cellular NSIP


Cryptogenic organizing pneumonia (COP)

  • Patchy peripheral subpleural or peribronchovascular consolidation
  • Atoll sign, aka reverse halo
  • Idiopathic inflammation of the bronchioles and surrounding tissue causing granulation tissue and "non-infectious pneumonia"
  • Responds to steroids not antibiotics
  • a/w many systemic diseases (lupus, c-anca, GVHD, etc)
  • No pleural effusion or lymphadenopathy
  • aka BOOP
  • Usually present after treatment with antibiotics and persistent fever and opacities


Respiratory Bronchiolitis associated Interstitial Lung Disease (RB ILD)

  • Smoking related disease
  • Centrilobular nodules
  • Ground glass opacities
  • Upper lobe predominant


Desquamative Intersitial Pneumonia (DIP)

  • Smoking related disease
  • Centrilobular nodules
  • Ground glass opacities
  • Same histology as RB-ILD, but further down the spectrum


Lymphoid Intersitial Pneumonia (LIP)

  • Groung glass opacities
  • Cystic lesions


Acute Interstial Pneumonia (AIP)

  • Diffuse lung consolidation
  • Groung glass opacities
  • Progress to fibrosis after acute phase


Links

Radiology Assistant webpage