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

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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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Chest X Ray Imaging