Seminars in ultrasound, CT, and MR
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Semin. Ultrasound CT MR · Feb 2014
ReviewChronic hypersensitivity pneumonitis and pulmonary sarcoidosis: differentiation from usual interstitial pneumonia using high-resolution computed tomography.
The distinction of chronic hypersensitivity pneumonitis (HP) or advanced-stage sarcoidosis from idiopathic pulmonary fibrosis or usual interstitial pneumonia is important because each disease is managed differently and may have a different prognosis. The analyses of pattern and distribution of lung parenchymal abnormalities on high-resolution computed tomography scans help differentiate among the 3 diseases. In chronic HP, the presence of lobular areas of decreased attenuation and centrilobular small nodules and the absence of lower lung zone predominance are characteristically observed. ⋯ Lung bases are usually spared. In idiopathic pulmonary fibrosis or usual interstitial pneumonia, however, the presence of honeycombing with lower lung zone predominance and the absence of centrilobular small nodules are important findings that allow us to differentiate the disease from chronic HP or advanced-stage sarcoidosis. In the 3 diseases, most important prognosis-predicting factor is the extent of fibrotic score (the extent of honeycombing and reticulation) calculated on high-resolution computed tomography scans or fibrosis estimated on chest radiographs.
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Semin. Ultrasound CT MR · Feb 2014
Comparative StudyConnective tissue disease-associated interstitial pneumonia and idiopathic interstitial pneumonia: similarity and difference.
Interstitial lung diseases (ILDs) are increasingly recognized in patients with systemic diseases. Patients with early ILD changes may be asymptomatic. Features of ILD overlap among systemic diseases and with idiopathic variety. ⋯ Therapy- and complication-related lung changes would pose difficulty in diagnosing and classifying an ILD. Biology and prognosis of secondary ILDs may differ between different disease-related ILDs and idiopathic variety. Combination of clinical features, serological tests, pulmonary and extrapulmonary imaging findings, and pathology findings may help to diagnose ILDs.
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Semin. Ultrasound CT MR · Feb 2014
Histopathologic features of usual interstitial pneumonia and related patterns: what is important for radiologists?
In interstitial lung diseases, the diagnosis of idiopathic pulmonary fibrosis is important where pathology and radiology show usual interstitial pneumonia (UIP) pattern. Recently, revised guidelines of idiopathic pulmonary fibrosis were published in which the diagnostic algorithm requires a stricter definition for both pathology and radiology. ⋯ However, their distinction is important irrespective of the etiology, because the histologic UIP pattern indicates a significantly worse prognosis than other chronic interstitial lung diseases. In this review, we describe the histologic features of UIP, effects of revised guidelines, interobserver agreement, etiologic variations of UIP pattern, and finally we include a few of our hypothetical thoughts on the "UIP bucket."
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Semin. Ultrasound CT MR · Dec 2013
ReviewLymphoproliferative lung disorders: a radiologic-pathologic overview. Part I: Reactive disorders.
Lymphoid tissue is a normal component of the lung and manifests as intrapulmonary lymph nodes, bronchus-associated lymphoid tissue (BALT), peripheral lymphocytic aggregates, solitary lymphocytes, and phagocytic cells. Pulmonary lymphoid lesions are thought to develop as a consequence of anomalous stimulation and response of the bronchus-associated lymphoid tissue and manifests as a spectrum of lymphoproliferative disorders that may be reactive or neoplastic. ⋯ Affected patients are often asymptomatic. Imaging findings include focal nodules, diffuse bilateral centrilobular nodules, and hilar or mediastinal masses.
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Chest radiograph is the primary imaging modality for evaluation of chest pathology and computed tomography scan is typically performed when there is a need for better characterization of the pathology or for surgical planning. Ultrasound (US) is mainly used for the evaluation of pleural effusion. ⋯ US of the chest has various advantages including the use of nonionizing radiation, portability, and real-time guidance for interventional procedure. In this review, we discuss the use of US in evaluation of the chest wall, pleural space, lung parenchyma, mediastinum, and diaphragm in children.