reddy hrct for interstitial - scbtmr · hrct for interstitial lung disease. reticular...
TRANSCRIPT
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Gautham P. Reddy, MD, MPHUniversity of Washington
Gautham P. Reddy, MD, MPHUniversity of Washington
HRCT for InterstitialLung Disease
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Reticular OpacitiesReticular OpacitiesReticular Opacities
LargeLargeLarge
Interlobular Septal
Thickening
Interlobular Interlobular SeptalSeptal
ThickeningThickening
SmallSmallSmall
Intralobular Interstitial Thickening
Intralobular Intralobular Interstitial Interstitial ThickeningThickening
IntermediateIntermediateIntermediate
HoneycombingHoneycombingHoneycombing
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Case 1
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Septal ThickeningSeptal ThickeningSeptal Thickening
Large PatternLarge PatternLarge Pattern•• Variety of diseasesVariety of diseases•• Length 1Length 1--2 cm2 cm•• Diameter of lobules 1Diameter of lobules 1--2 cm2 cm•• Central arteryCentral artery•• Smooth, nodular or irregularSmooth, nodular or irregular
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Interlobular Septal ThickeningInterlobular Septal ThickeningInterlobular Septal Thickening
NodularNodularNodular Irregular,Lung distortion
Irregular,Irregular,Lung distortionLung distortionSmoothSmoothSmooth
Thick septa predominantThick septa Thick septa predominantpredominant
• Edema• Lymphangitic
tumor• Hemorrhage
•• EdemaEdema•• Lymphangitic Lymphangitic
tumortumor•• Hemorrhage Hemorrhage
GGO predominant
GGO GGO predominantpredominant
“Crazy Paving”• Edema• PCP, CMV• Hemorrhage• Alveolar
proteinosis
““Crazy PavingCrazy Paving””•• EdemaEdema•• PCP, CMVPCP, CMV•• HemorrhageHemorrhage•• Alveolar Alveolar
proteinosisproteinosis
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Pulmonary Edema
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Lymphagitic Tumor
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Lymphagitic Tumor
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Pulmonary Edema
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CMV Pneumonia
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PCP
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Alveolar Proteinosis
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Case 2
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Interlobular Septal ThickeningInterlobular Septal ThickeningInterlobular Septal Thickening
NodularNodularNodular Irregular,Lung distortion
Irregular,Irregular,Lung distortionLung distortionSmoothSmoothSmooth
• Sarcoid • Lymphangitic
tumor
•• Sarcoid Sarcoid •• Lymphangitic Lymphangitic
tumor tumor
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Lymphagitic Tumor
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Sarcoid
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Case 3
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Interlobular Septal ThickeningInterlobular Septal ThickeningInterlobular Septal Thickening
NodularNodularNodular Irregular,Lung distortion
Irregular,Irregular,Lung distortionLung distortionSmoothSmoothSmooth
HoneycombingDifferential
HoneycombingHoneycombingDifferentialDifferential
• IPF• Sarcoid• Asbestosis
•• IPFIPF•• SarcoidSarcoid•• AsbestosisAsbestosis
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Rheumatoid
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Case 4
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HoneycombingHoneycombingHoneycombing
Intermediate PatternIntermediate PatternIntermediate Pattern•• Extensive fibrosis / destructionExtensive fibrosis / destruction•• Reticular and cystic (0.5 Reticular and cystic (0.5 -- 1 cm)1 cm)•• Architectural distortionArchitectural distortion•• Secondary lobules difficult or Secondary lobules difficult or
impossible to recognizeimpossible to recognize•• No need to biopsyNo need to biopsy
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HoneycombingHoneycombingHoneycombing
SubpleuralPosterior
Lower lobe predominance
SubpleuralSubpleuralPosteriorPosterior
Lower lobe Lower lobe predominancepredominance
Other(Central,
Upper Lobe)
OtherOther(Central,(Central,
Upper Lobe)Upper Lobe)
• Usual interstitial pneumonia / IPF
• Collagen vasc dz • Hypersensitivity
pneumonitis (chronic)
•• Usual interstitial Usual interstitial pneumonia / IPFpneumonia / IPF
•• Collagen vasc dz Collagen vasc dz •• Hypersensitivity Hypersensitivity
pneumonitis pneumonitis (chronic)(chronic)
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IPF
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Chronic HP
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Rheumatoid
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Case 5
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HoneycombingHoneycombingHoneycombing
SubpleuralPosterior
Lower lobe predominance
SubpleuralSubpleuralPosteriorPosterior
Lower lobe Lower lobe predominancepredominance
Other(Central,
Upper Lobe)
OtherOther(Central,(Central,
Upper Lobe)Upper Lobe)
• Sarcoid• Radiation • Hypersensitivity
pneumonitis (chronic)
•• SarcoidSarcoid•• Radiation Radiation •• Hypersensitivity Hypersensitivity
pneumonitis pneumonitis (chronic)(chronic)
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Sarcoid
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Sarcoid
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Sarcoid
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Case 6
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Intralobular ThickeningIntralobular ThickeningIntralobular Thickening
Small PatternSmall PatternSmall Pattern•• Can be early sign of fibrosisCan be early sign of fibrosis•• Can be seen with honeycombingCan be seen with honeycombing•• Fine, irregular reticulationFine, irregular reticulation•• Outlines Outlines ““holesholes”” a few mm aparta few mm apart
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Intralobular ThickeningIntralobular ThickeningIntralobular Thickening
GGO presentGGO GGO
presentpresentSeptal Thickening
present
Septal Septal ThickeningThickening
presentpresentIsolated
abnormality OR
Fibrosis
Isolated Isolated abnormality abnormality
ORORFibrosisFibrosis
Honeycombing Diff Dx
Honeycombing Diff Honeycombing Diff DxDx
NSIP“Crazy Paving”• Edema• PCP, CMV• Hemorrhage• Alv proteinosis
NSIPNSIP““Crazy PavingCrazy Paving””•• EdemaEdema•• PCP, CMVPCP, CMV•• HemorrhageHemorrhage•• Alv proteinosisAlv proteinosis
SeptalThickening
Diff Dx
SeptalSeptalThickening Thickening
Diff DxDiff Dx
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NSIP: Mixed Conn Tissue d/o
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SLE
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IPF