Ct scan of the chest in Nonspecific Interstitial Pneumonia
Ct scan chest of Nonspecific Interstitial Pneumonia
- • Katzenstein : Described in 1994
- • Does not fit definition of other IIPs: UIP, RB-ILD, DIP, OP, AIP
- • Represents a variety of etiologies: Collagen vascular disease, drug reaction, inhaled antigen, Inadequately sampled UIP or OP
- • Median age 45
- • Onset gradual with wide range: 6 months to 3 years
- • Better prognosis
Katzenstein, Am J Resp Crit Care 1994 Nicholson, Am J Respir Crit Care Med 2001
Nonspecific Interstitial Pneumonitis Histology
• 3 categories : Cellular, Fibrosing, Mixed
• Prognosis=fibrosis
• OP common
• Temporally uniform
Nonspecific Interstitial Pneumonitis Imaging
• Few reports on chest radiography
• Wide variety of CT patterns: Ground glass, consolidation, reticular and honeycombing
• Traction bronchiectasis=fibrosis
• CT pattern indistinguishable: UIP 32%, Hypersensitivity 20%, OP 14%, Other 12%
Hartman, Radiology 2000
Nonspecific Interstitial Pneumonia NSIP ATS Consensus Conference
• Pathologists
• Radiologists
• Pulmonalogists
• 300 cases submitted : 11 cases agreed to be NSIP by all pathologists
• Imaging: Lower lobe, Peribronchiolar reticulation and distortion, Subpleural clearing
NSIP Fibrosis with IPF Imaging
• Areas of NSIP commonly found in proven cases of UIP
• NSIP and UIP: Different severity of injury?. Different mechanism of injury?
• Prognosis in these cases is driven by the imaging
Katzenstein AA et al, Amer J of Surg Path 2002
ct scan of the chest OP-NSIP is peribronchovascular with UIP is peripheral
The Idiopathic Interstitial Pneumonias Current List
• Idiopathic Pulmonary Fibrosis (IPF): Usual Interstitial Pneumonia (UIP)
• Respiratory Bronchiolitis-Interstitial Lung Disease (RB-ILD)
• Desquamative Interstitial Pneumonia (DIP)
• Acute Interstitial Pneumonia (AIP)
• Cryptogenic Organizing Pneumonia (COP)
• NonSpecific Interstitial Pneumonia (NSIP)
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