ct scan of the chest in case Idiopathic Interstitial Pneumonias

Current List-ATS/ERS Consensus Classification

Idiopathic Pulmonary Fibrosis

Usual Interstitial Pneumonia: histologic pattern
5th-7th decade : 66% > 60 years, 7/100,000 women and 10/100,000 men
Insidious onset of dyspnea : 6 months before diagnosis, Restrictive ventilatory defect, Rales and clubbing
Associations: Cigarette smoke, Dusty environments: farming, wood dust, metal dust, GE reflux, Autoantibodies common (ANA, RA)
Median survival 2.5-3.5 years

Usual Interstitial Pneumonia: Histology

(Katzenstein, Am J Respir Crit Care Med 1998 Selman, Ann Int Med 2001King, Am J Respir Crit Care Med 2001)

Idiopathic Pulmonary Fibrosis Imaging:

• Radiograph abnormal-95%: Volume loss, Reticulonodular opacities, Lower lobe, Honeycombing
• Computed tomography : Peripheral and lower lobe, Reticulation and ground glass, Progress to honeycombing, Ground glass in areas of traction bronchiectasis

(Hartman, Chest 1996)

Ct scan of the chest Typical peripheral reticulation and honeycombing and traction bronchiectasis in a patient with IPF

Utilility of Biopsy for Diagnosis of IPF

Prospective, multi-center study : 91 patients suspected of IPF
Clinical diagnosis : Positive predictive value with a confident diagnosis-87%
Imaging diagnosis: Positive predictive value with a confident diagnosis-96%, CT always abnormal in patients with proven IPF
Histologic diagnosis: Agreement regarding the presence or absence of IPF-85%, Agreement in patients without IPF-48%, Relevance to NSIP
Uncertain diagnosis
Discordant data
Disease other than IPF: Hypersensitivity pneumonitis, Collagen-vascular disease, Infection

(Hunninghake, Am J Respir Crit Care Med 2001)

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Radiology Imaging