Imaging diagnosis of classical and new pneumoconiosis: predominant reticular HRCT pattern

AbstractOur understanding of the manifestations of pneumoconioses is evolving in recent years. Associations between novel exposures and diffuse interstitial lung disease have been newly recognized. In advanced asbestosis, two types of fibrosis are seen, probably related to dose of exposure, existence of pleural fibrosis, and the host factor status of the individual. In pneumoconiosis of predominant reticular type, nodular opacities are often seen in the early phase. The nodular pattern is centrilobular, although some in metal lung show perilymphatic distribution, mimicking sarcoidosis. High-resolution computed tomography enables a more comprehensive correlation between the pathologic findings and clinically relevant imaging findings. The clinician must understand the spectrum of characteristic imaging features related to both known dust exposures and to historically recent new dust exposures.

Download Full-text

Imaging Review of the Lung Parenchymal Complications in Patients with IPF

Medicina ◽

10.3390/medicina55100613 ◽

2019 ◽

Vol 55 (10) ◽

pp. 613

Author(s):

Baratella ◽

Fiorese ◽

Marrocchio ◽

Salton ◽

Cova

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Interstitial Lung Disease ◽

Poor Prognosis ◽

Clinical Course ◽

Final Diagnosis ◽

Imaging Findings ◽

Clinical Context ◽

High Resolution Computed Tomography ◽

Clinical Scenarios

Idiopathic pulmonary fibrosis (IPF) is a chronic, pulmonary-limited, interstitial lung disease with a poor prognosis. This condition is characterized by different clinical scenarios, ranging from the most typical slow and progressive deterioration of symptoms to a rapid and abrupt decline of lung function. Rapid worsening of clinical course is due to superimposed complications and comorbidities that can develop in IPF patients, with a higher incidence rate compared to the general population. These conditions may require a different management of the patient and a therapy adjustment, and thus it is fundamental to recognize them. High Resolution Computed Tomography (HRCT) is sensitive, but not specific, in detecting these complications, and can evaluate the presence of radiological variations when previous examinations are available; it recognizes ground glass opacities or consolidation that can be related to a large spectrum of comorbidities, such as infection, lung cancer, or acute exacerbation. To reach the final diagnosis, a multidisciplinary discussion is required, particularly when the clinical context is related to imaging findings.

Download Full-text

High-Resolution Computed Tomography Based Comparative Analysis of Asbestosis vs. Fibrotic Hypersensitivity Pneumonitis

10.21203/rs.3.rs-1071023/v1 ◽

2021 ◽

Author(s):

Ruimin Ma ◽

Shuang Li ◽

Yuanying Wang ◽

Shuqiao Yang ◽

Na Bao ◽

...

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Hypersensitivity Pneumonitis ◽

Interobserver Reliability ◽

High Specificity ◽

Imaging Features ◽

Imaging Findings ◽

High Resolution Computed Tomography ◽

Disease Manifestation ◽

Pleural Thickening

Abstract BackgroundAsbestosis and fibrotic hypersensitivity pneumonitis (FHP) are fibrotic interstitial lung diseases that develop secondary to inhalation exposure. The differential diagnosis is based on clinical evaluation of imaging findings, particularly in developing countries. We compared the imaging features between asbestosis and FHP to gain a better understanding of the differential diagnostic value of these conditions.MethodsThis comparative study included 204 patients with asbestosis and 74 patients with FHP. We compared patients’ clinical data and chest high-resolution computed tomography (HRCT) images obtained from a predesigned chart. The International Classification of HRCT for Occupational and Environmental Respiratory Diseases was used to categorize chest imaging findings in patients. Diagnostic tests were used to compare the imaging features of asbestosis and FHP.ResultsPatients with asbestosis were older and had a longer latent period until disease manifestation than those with FHP. Asbestosis was characterized by irregular and/or linear opacities, with lower lung preponderance, accompanied by ground-glass opacities and mosaic attenuation. Notably, 98.5% of patients with asbestosis showed benign pleural abnormalities, and >33% of these patients had diffuse pleural thickening with parenchymal bands and/or rounded atelectasis. Abnormalities of the mediastinal and diaphragmatic pleura were observed only in cases of asbestosis, and this finding showed high specificity for the diagnosis for asbestosis compared with that for FHP. Subpleural dots or diaphragmatic pleural abnormalities showed moderate sensitivity and high specificity for diagnosis of asbestosis compared with that for FHP. Interobserver reliability was good for evaluation of imaging findings including honeycombing, pleural calcification, lymphadenectasis, and lymph node calcification.ConclusionsHRCT-based imaging findings can distinguish between asbestosis and FHP to a certain extent, particularly with regard to subpleural dots and diaphragmatic pleural abnormalities that characterize the former.

Download Full-text

AB0605 CLINICAL PROFILE AND CHEST HIGH-RESOLUTION COMPUTED TOMOGRAPHY (HRCT) FINDINGS IN PATIENTS WITH CONNECTIVE TISSUE DISEASES AND INTERSTITIAL LUNG DISEASE: EXPERIENCE OF A SINGLE REFERENCE RHEUMATOLOGY CENTER

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3758 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1598.2-1599

Author(s):

I. Rusu ◽

L. Muntean ◽

M. M. Tamas ◽

I. Felea ◽

L. Damian ◽

...

Keyword(s):

Computed Tomography ◽

Systemic Sclerosis ◽

High Resolution ◽

Interstitial Lung Disease ◽

Connective Tissue ◽

Lung Disease ◽

Interstitial Pneumonia ◽

Connective Tissue Diseases ◽

High Resolution Computed Tomography ◽

Hrct Patterns

Background:Interstitial lung disease (ILD) is a common manifestation of connective tissue diseases (CTDs), and is associated with significant morbidity and mortality. Chest high-resolution computed tomography (HRCT) play an important role in the diagnosis of ILD and may provide prognostic information.Objectives:We aimed to characterize the clinical profile and chest HRCT abnormalities and patterns of patients diagnosed with CTDs and ILD.Methods:In this retrospective, observational study we included 80 consecutive patients with CTDs and ILD referred to a tertiary rheumatology center between 2015 and 2019. From hospital charts we collected clinical data, immunologic profile, chest HRCT findings. HRCT patterns were defined according to new international recommendations.Results:Out of 80 patients, 64 (80%) were women, with a mean age of 55 years old. The most common CTD associated with ILD was systemic sclerosis (38.8%), followed by polymyositis (22.5%) and rheumatoid arthritis (18.8%). The majority of patients had dyspnea on exertion (71.3%), bibasilar inspiratory crackles were present in 56.3% patients and 10% had clubbing fingers. Antinuclear antibodies (ANA) were present in 78.8% patients, and the most frequently detected autoantibodies against extractable nuclear antigen were anti-Scl 70 (28.8%), followed by anti-SSA (anti-Ro, 17.5%), anti-Ro52 (11.3%) and anti-Jo (7.5%). Intravenous cyclophosphamide therapy for 6-12 months was used in 35% of patients, while 5% of patients were treated with mycophenolate mofetil.The most frequent HRCT abnormalities were reticular abnormalities and ground glass opacity. Non-specific interstitial pneumonia (NSIP) was identified in 46.3% CTDs patients. A pattern suggestive of usual interstitial pneumonia (UIP) was present in 32.5% patients, mainly in patients with systemic sclerosis. In 21.3% patients the HRCT showed reticulo-nodular pattern, micronodules and other abnormalities, not diagnostic for UIP or NSIP pattern.Conclusion:Nonspecific interstitial pneumonia (NSIP) is the most common HRCT pattern associated with CTDs. Further prospective longitudinal studies are needed in order to determine the clinical and prognostic significance of various HRCT patterns encountered in CTD-associated ILD and for better patient management.References:[1]Ohno Y, Koyama H, Yoshikaua T, Seki S. State-of-the-Art Imaging of the Lung for Connective Tissue Disease (CTD). Curr Rheumatol Rep. 2015;17(12):69.[2]Walsh SLF, Devaraj A, Enghelmeyer JI, Kishi K, Silva RS, Patel N, et al. Role of imaging in progressive-fibrosing interstitial lung diseases. Eur Respir Rev. 2018;27(150)Disclosure of Interests:None declared

Download Full-text