scholarly journals Clinical, radiologic, and morphological diagnosis of hypersensitivity pneumonitis

2022 ◽  
Vol 20 (4) ◽  
pp. 93-102
Author(s):  
A. L. Cherniaev ◽  
E. V. Kusraeva ◽  
M. V. Samsonova ◽  
S. N. Avdeev ◽  
N. V. Trushenko ◽  
...  
Keyword(s):  
Hypersensitivity Pneumonitis ◽  
Clinical Symptoms ◽  
Usual Interstitial Pneumonia ◽  
Giant Cells ◽  
External Respiration ◽  
High Resolution Computed Tomography ◽  
Morphological Diagnosis ◽  
Classical Triad ◽  
Clinical Error ◽  
The Relationship

Aim. To study the relationship between clinical, radiologic, and morphological features in nonfibrotic and fibrotic hypersensitivity pneumonitis.Materials and methods. Clinical symptoms, data of high-resolution computed tomography, parameters of external respiration, and histological changes in the lung tissue obtained via open and transbronchial biopsies were studied retrospectively in 175 patients with hypersensitivity pneumonitis (HP). Statistical analysis was performed using the Statistica software.Results. We found that the clinical error rate in the diagnosis of HP was 84.5%, among pathologists – 92%. Among all the variants of HP, the most common was fibrotic HP. It was shown that non-necrotizing granulomas and giant cells in the cavities of the alveoli, microcells, and interalveolar septa were more typical of nonfibrotic HP. In fibrotic HP, peribronchial fibrosis, smooth muscle metaplasia in fibrotic areas, and the presence of fibroblastic foci in the walls of terminal bronchioles are signs of differential diagnosis with usual interstitial pneumonia. The classical triad of histological signs was observed in 19.2% of patients with nonfibrotic HP and in 5.6% of patients with fibrotic HP.Conclusion. Diagnosis of HP is complex and should be based on a multidisciplinary approach involving clinicians (pulmonologists), radiologists, functional diagnostics specialists, and pathologists. In this case, it is imperative to take into account and identify factors causing development of the disease, as well as the age of patients. 

scholarly journals High-resolution computed tomography and histopathological findings in hypersensitivity pneumonitis: a pictorial essay

2016 ◽  
Vol 49 (2) ◽  
pp. 112-116 ◽  
Author(s):  
Pedro Paulo Teixeira e Silva Torres ◽  
Marise Amaral Rebouças Moreira ◽  
Daniela Graner Schuwartz Tannus Silva ◽  
Roberta Rodrigues Monteiro da Gama ◽  
Denis Masashi Sugita ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Lung Biopsy ◽  
Hypersensitivity Pneumonitis ◽  
Giant Cells ◽  
Clinical Findings ◽  
High Resolution Computed Tomography ◽  
Histopathological Findings ◽  
Pictorial Essay ◽  
Inflammatory Infiltrates

Abstract Hypersensitivity pneumonitis is a diffuse interstitial and granulomatous lung disease caused by the inhalation of any one of a number of antigens. The objective of this study was to illustrate the spectrum of abnormalities in high-resolution computed tomography and histopathological findings related to hypersensitivity pneumonitis. We retrospectively evaluated patients who had been diagnosed with hypersensitivity pneumonitis (on the basis of clinical-radiological or clinical-radiological-pathological correlations) and had undergone lung biopsy. Hypersensitivity pneumonitis is clinically divided into acute, subacute, and chronic forms; high-resolution computed tomography findings correlate with the time of exposure; and the two occasionally overlap. In the subacute form, centrilobular micronodules, ground-glass opacities, and air trapping are characteristic high-resolution computed tomography findings, whereas histopathology shows lymphocytic inflammatory infiltrates, bronchiolitis, variable degrees of organizing pneumonia, and giant cells. In the chronic form, high-resolution computed tomography shows traction bronchiectasis, honeycombing, and lung fibrosis, the last also being seen in the biopsy sample. A definitive diagnosis of hypersensitivity pneumonitis can be made only through a multidisciplinary approach, by correlating clinical findings, exposure history, high-resolution computed tomography findings, and lung biopsy findings.

scholarly journals Imaging features of IRIS caused by AIDS and complicated by tuberculosis

2017 ◽  
Vol 6 (1) ◽  
pp. 20-24
Author(s):  
Wei Li ◽  
Wei Liu ◽  
Guiming Zhou
Keyword(s):  
Computed Tomography ◽  
Immune Reconstitution ◽  
Clinical Symptoms ◽  
Imaging Features ◽  
Common Complication ◽  
High Resolution Computed Tomography ◽  
Imaging Research ◽  
Relationship Of ◽  
Inflammatory Syndrome ◽  
The Relationship

Abstract Immune reconstitution inflammatory syndrome (IRIS), a common complication of AIDS, is further complicated by tuberculosis. Its clinical symptoms lack specificity but can be evaluated using diagnostic imaging. High-resolution computed tomography (HRCT) is useful in evaluating the morphology and internal microstructure of lesions associated with the syndrome, as well as the relationship of the internal microstructure with the surrounding tissues. This paper summarizes the present state and progress of imaging research on IRIS caused by AIDS and complicated by tuberculosis.

scholarly journals Clinico-pathologic presentation of hypersensitivity pneumonitis in Egyptian patients: a multidisciplinary study

2017 ◽  
Vol 12 ◽  
Author(s):  
Dalia Abd El-Kareem ◽  
Yosri M. Akl ◽  
Gina A. Nakhla ◽  
Ali A. Elhindawi ◽  
Mahmoud A. Eltorky
Keyword(s):  
Hypersensitivity Pneumonitis ◽  
Ground Glass Opacity ◽  
Giant Cells ◽  
Cane Sugar ◽  
High Resolution Computed Tomography ◽  
Multidisciplinary Study ◽  
Diffuse Parenchymal Lung Disease ◽  
Egyptian Patients ◽  
Exhaust Fumes ◽  
Exposure History

Background: Hypersensitivity pneumonitis (HP) is a common diffuse parenchymal lung disease in Egypt which can be difficult to recognize due to the dynamic symptoms & associated environmental factors. Methods: Forty-three Egyptian patients were enrolled in this study, presenting with dyspnea and cough, predominant ground-glass opacity (GGO) in high-resolution computed tomography (HRCT) where lung biopsy was needed to establish the diagnosis. Results: The age range was 15 to 60 years. Females represented 90.7% (39 patients) while 9.3% (4 patients) of our patients were males. History of contact with birds was detected in 9 (20.9%) patients. Most of our patients (60.5%) didn’t have exposure history, and only 8 patients (18.6%) were living in geographic areas in Egypt that are known for the exposure to environmental etiologic factors (cane sugar exhaust fumes). The most common HRCT pattern was GGO with mosaic parenchyma in 18 patients (41.86%), followed by GGO with centrilobular nodules in 9 patients (20.93%), then isolated diffuse GGO in 5 patients (11.62%), GGO with traction bronchiectasis in 4 patients (9.3%), GGO with consolidation in 3 patients (6.97%), GGO with reticulations in 2 patients (4.65%), and GGO with cysts in 2 patients (4.65%). The most common histologic finding was isolated multinucleated giant cells in 38 patients (88.3%) commonly found in airspaces (24 patients) and less commonly in the interstitium (14 patients), followed by interstitial pneumonia and cellular bronchiolitis in 36 patients (83.7% each), interstitial ill-formed non-necrotizing granulomas in 12 patients (27.9%), fibrosis in 10 patients (23.2%), and organizing pneumonia pattern in 4 patients (9.3%). Conclusion: The diagnosis of HP presenting with predominant GGO pattern in HRCT requires a close interaction among clinicians, radiologists, and pathologists. Some environmental and household factors may be underestimated as etiologic factors. Further environmental and genetic studies are needed especially in patients with negative exposure history.

scholarly journals Clinical and morphological characteristics of hypersensitivity pneumonitis

2021 ◽  
Vol 10 (3) ◽  
pp. 5-13
Author(s):  
E.V. Kusraeva ◽  
Keyword(s):  
Interstitial Pneumonia ◽  
Hypersensitivity Pneumonitis ◽  
Usual Interstitial Pneumonia ◽  
Connective Tissue Diseases ◽  
Morphological Characteristics ◽  
Interstitial Lung Diseases ◽  
External Respiration ◽  
Morphological Criteria ◽  
Pulmonary Manifestations ◽  
Cellular Components

Hypersensitivity pneumonitis (HP) is an immune-mediated disease that manifests in susceptible individu-als after exposure to a provoking inhalation factor. The literature review describes etiological factors of the disease, its epidemiology and pathogenesis, as well as clinical features of various disease courses. A new clinical and morphological classification of HP is also presented. We analyzed changes in functional tests (external respiration function), CT images, cellular components of bronchoalveolar lavages, and modern approaches to the disease treatment. The review includes detailed morphological criteria according to the new classification, which will facilitate the diagnosis by pathologists. Since the diagnosis of the condition presents significant challenges, there are histological criteria for differential diagnosis of the fibrotic HP and usual interstitial pneumonia (idiopathic pulmonary fibrosis), sarcoidosis, lymphoid interstitial pneumonia, and pulmonary manifestations of connective tissue diseases. Keywords: hypersensitivity pneumonitis, interstitial lung diseases

scholarly journals Lung fibrosis in autoimmune diseases and hypersensitivity: how to separate these from idiopathic pulmonary fibrosis

2021 ◽  
Author(s):  
Helmut Popper ◽  
Elvira Stacher-Priehse ◽  
Luka Brcic ◽  
Andreas Nerlich
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Autoimmune Diseases ◽  
Interstitial Pneumonia ◽  
Lung Fibrosis ◽  
Clinical Symptoms ◽  
Usual Interstitial Pneumonia ◽  
Drug Regimen ◽  
Giant Cells ◽  
Organ Manifestations

AbstractLung involvement in autoimmune diseases (AID) is uncommon, but may precede other organ manifestations. A diagnostic problem is chronicity presenting with lung fibrosis. A new category of interstitial pneumonia with autoimmune features for patients with clinical symptoms of AID and presenting with usual interstitial pneumonia (UIP) enables antifibrotic treatment for these patients. Hypersensitivity pneumonia (HP) and other forms of lung fibrosis were not included into this category. As these diseases based on adverse immune reactions often present with unspecific clinical symptoms, a specified pathological diagnosis will assist the clinical evaluation. We aimed to establish etiology-relevant differences of patterns associated with AID or HP combined with lung fibrosis. We retrospectively evaluated 51 cases of AID, and 29 cases of HP with lung fibrosis, and compared these to 24 cases of idiopathic pulmonary fibrosis (UIP/IPF). Subacute AID and HP most often presented with organizing pneumonia (OP), whereas chronicity was associated with UIP. Unspecified fibrosis was seen in a few cases, whereas NSIP pattern was rare. In 9 cases, the underlying etiology could not be defined. Statistically significant features differentiating chronic AID or HP from UIP/IPF are lymphocytic infiltrations into myofibroblastic/fibroblastic foci. Other features significantly associated with AID and HP were granulomas, isolated Langhans giant cells, and protein deposits, but seen in only a minority of cases. A combination of UIP with one of these features enabled a specific etiology-based diagnosis. Besides the antifibrotic drug regimen, additional therapies might be considered.

scholarly journals Pathology of Chronic Hypersensitivity Pneumonitis What Is It? What Are the Diagnostic Criteria? Why Do We Care?

2017 ◽  
Vol 142 (1) ◽  
pp. 109-119 ◽  
Author(s):  
Andrew Churg ◽  
AnaMaria Bilawich ◽  
Joanne L. Wright
Keyword(s):  
Interstitial Pneumonia ◽  
Hypersensitivity Pneumonitis ◽  
Immunosuppressive Agents ◽  
Usual Interstitial Pneumonia ◽  
Clinical Pathology ◽  
Giant Cells ◽  
Survival Prognosis ◽  
Pathologic Features ◽  
Nonspecific Interstitial Pneumonia ◽  
Chronic Hypersensitivity Pneumonitis

Context.— Chronic hypersensitivity pneumonitis (CHP) has emerged from obscurity during the past 15 years and is now recognized as a very common form of fibrosing interstitial pneumonia but one that is frequently misdiagnosed both clinically and on surgical lung biopsy as usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF) or fibrotic nonspecific interstitial pneumonia. Objective.— To review the pathologic features of CHP. Data Sources.— Clinical, pathology, and radiology literature were used. Conclusions.— Upper lobe–predominant fibrosis and/or air-trapping on computed tomography scan are features of CHP but not UIP/IPF; however, radiologic separation is possible in only about 50% of cases. Morphologically, CHP sometimes mimics UIP/IPF, but CHP often shows isolated foci of peribronchiolar (centrilobular) fibrosis, frequently associated with fibroblast foci, and in CHP, fibrosis may bridge from the centrilobular region to another bronchiole, an interlobular septum, or the pleura (“bridging fibrosis”). This set of findings is uncommon in UIP/IPF. In addition, CHP may produce a picture of fibrotic nonspecific interstitial pneumonia. Although giant cells/granulomas are usually present in subacute hypersensitivity pneumonitis, they are much less frequently found in CHP, and their absence does not contradict the diagnosis. This diagnostic separation is clinically important because CHP is treated differently than UIP/IPF is (immunosuppressive agents versus antifibrotic agents); further, there are some data to suggest that removing the patient from antigen exposure improves outcome, and there is evidence that patients with CHP have a much better survival prognosis after lung transplantation than do patients with UIP/IPF. In most cases, accurate diagnosis of CHP requires consultation among clinicians, radiologists, and pathologists.

scholarly journals The Relationship Between Long-term, Low-dose Macrolide Therapy and Acute Exacerbation in Idiopathic Bronchiectasis Classified by High-resolution Computed Tomography

2020 ◽  
Author(s):  
ZENYA SAITO ◽  
Masahiro Yoshida ◽  
Saiko Nishioka ◽  
Kentaro Tamura ◽  
Nobumasa Tamura ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Acute Exacerbation ◽  
Low Dose ◽  
Clinical Symptoms ◽  
High Resolution Computed Tomography ◽  
Significant Difference ◽  
Severe Group ◽  
The Relationship

Abstract Background: High-resolution computed tomography (HRCT) and long-term, low-dose macrolide therapy has been established as a diagnostic method and treatment for bronchiectasis. HRCT correlates with clinical symptoms, respiratory function and quality of life in bronchiectasis. However, whether it will lead to reduction of macrolide therapy effects is unknown. We investigated the relationship between the efficacy of macrolide therapy and severity assessment performed by HRCT in idiopathic bronchiectasis.Methods: Ninety-nine patients with idiopathic bronchiectasis were selected. Acute exacerbation (AE) incidence was set as a comparison factor for the treatment effect. First, patients were divided into the severe and non-severe group based on HRCT. The severe group was defined to have abnormal findings in three or more lobes and in both lungs and the non-severe group as having two or fewer lobes or one side of the lung. Next, each group was divided into subgroups with and without macrolide therapy. Finally, the relationship between macrolide therapy and the AE incidence in each subgroup was compared.Results: Among the 99 idiopathic patients, 50 and 49 were included in the non-severe and severe groups, respectively. In the non-severe group, the subgroup with macrolide therapy had significantly less AE than the subgroup without macrolide (odds ratio [OR] = 0.10, P < 0.036). No significant difference was found in the severe group (OR = 0.70, P = 0.57).Conclusions: HRCT may be useful in predicting the effect of long-term, low-dose macrolide therapy for idiopathic bronchiectasis.

scholarly journals Clinical diagnosis of patients subjected to surgical lung biopsy with a probable usual interstitial pneumonia pattern on high-resolution computed tomography

2020 ◽  
Author(s):  
Regina Tibana ◽  
Maria Raquel Soares ◽  
Karin Mueller Storrer ◽  
Gustavo de Souza Portes Meirelles ◽  
Katia Nishiyama ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Lung Disease ◽  
Clinical Diagnosis ◽  
Lung Biopsy ◽  
Hypersensitivity Pneumonitis ◽  
Usual Interstitial Pneumonia ◽  
High Resolution Computed Tomography ◽  
Surgical Lung Biopsy

Abstract Background: Usual interstitial pneumonia (UIP) can present with a probable pattern on high-resolution computed tomography (HRCT), but the probability of UIP by surgical lung biopsy in such cases remains controversial. We aimed to determine the final clinical diagnosis in patients with a probable UIP pattern on HRCT subjected to surgical lung biopsy.Methods: HRCT images were assessed and categorized by three radiologists, and tissue slides were evaluated by two pathologists, all of whom were blinded to the clinical findings. The final clinical diagnosis was accomplished via a multidisciplinary discussion. Patients with a single layer of honeycombing located outside of the lower lobes on HRCT were not excluded.Results: A total of 50 patients were evaluated. The most common final clinical diagnosis was fibrotic hypersensitivity pneumonitis (38.0%; 95% CI: 24.7% to 52.8%), followed by idiopathic pulmonary fibrosis (24.0%; 95% CI: 13.1% to 38.2%) and interstitial lung disease ascribed to gastroesophageal reflux disease (12.0%; 95% CI: 4.5% to 24.3%) and familial interstitial lung disease (10.0%; 95% CI: 3.3% to 21.8%). In the group without environmental exposure (n = 22), 10 patients had a final clinical diagnosis of idiopathic pulmonary fibrosis (45.5%; 95% CI: 24.4% to 67.8%). Irrespective of the final clinical diagnosis, by multivariate Cox analysis, patients with honeycombing, dyspnoea and the presence of fibroblastic foci on surgical lung biopsy had a high risk of death.Conclusions: The most common disease associated with a probable UIP pattern on HRCT is fibrotic hypersensitivity pneumonitis, followed by idiopathic pulmonary fibrosis and interstitial lung disease ascribed to gastroesophageal reflux disease. In patients without environmental exposure, the frequency of UIP and a final clinical diagnosis of idiopathic pulmonary fibrosis are not sufficiently high to obviate the indication for surgical lung biopsy.

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