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Chronic Hypersensitivity Pneumonitis: Differentiation from Idiopathic Pulmonary Fibrosis and Nonspecific Interstitial Pneumonia by Using Thin-Section CT¹

¹ From the Departments of Radiology (C.I.S.S., N.L.M.) and Pathology (A.C.), Vancouver General Hospital, University of British Columbia, 3350-950 W 10th Ave, Vancouver, BC, Canada V5Z 4E3; Department of Radiology (D.A.L.), Division of Biostatistics (D.C.), and Department of Medicine (K.K.B.), National Jewish Medical and Research Center, Denver, Colo; Department of Preventive Medicine and Biometrics and Department of Physiology and Biophysics, University of Colorado at Denver and Health Sciences Center, Denver, Colo (D.C.); and Department of Radiology and Center for Imaging Science (K.S.L.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Received November 2, 2006; revision requested January 9, 2007; revision received January 18; accepted February 28; final version accepted April 17. Address correspondence to C.I.S.S. (e-mail: isabela.silva{at}vch.ca).

View larger version (118K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Chronic HP in 44-year-old man exposed to red cedar. Transverse thin-section CT scans at level of (a) distal trachea and (b, c) lung bases show bilateral patchy areas of GGO superimposed on fine reticulation. Note bilateral centrilobular nodules (arrowheads) and multiple lobules with decreased attenuation and vascularity (arrows). (c) Transverse CT image below diaphragmatic dome shows relative sparing. These are characteristic of chronic HP findings.

View larger version (103K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Chronic HP in 44-year-old man exposed to red cedar. Transverse thin-section CT scans at level of (a) distal trachea and (b, c) lung bases show bilateral patchy areas of GGO superimposed on fine reticulation. Note bilateral centrilobular nodules (arrowheads) and multiple lobules with decreased attenuation and vascularity (arrows). (c) Transverse CT image below diaphragmatic dome shows relative sparing. These are characteristic of chronic HP findings.

View larger version (79K): [in this window] [in a new window] [Download PPT slide]   Figure 1c: Chronic HP in 44-year-old man exposed to red cedar. Transverse thin-section CT scans at level of (a) distal trachea and (b, c) lung bases show bilateral patchy areas of GGO superimposed on fine reticulation. Note bilateral centrilobular nodules (arrowheads) and multiple lobules with decreased attenuation and vascularity (arrows). (c) Transverse CT image below diaphragmatic dome shows relative sparing. These are characteristic of chronic HP findings.

View larger version (82K): [in this window] [in a new window] [Download PPT slide]   Figure 2: Chronic HP in 55-year-old man exposed to red cedar. Transverse thin-section CT scan at level of bronchus intermedius shows patchy GGO and fine reticulation with associated ill-defined centrilobular nodules (short straight arrows). Note lobular areas with decreased attenuation and vascularity bilaterally (curved arrows) and isolated cyst in left upper lobe (long straight arrow).

View larger version (126K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Chronic HP in 72-year-old man exposed to birds. (a) Transverse thin-section CT scan of upper lobes shows patchy GGO and superimposed reticulation in predominant peribronchovascular distribution. Note bronchial tortuosity and irregularity (traction bronchiectasis, arrowheads) due to fibrosis and peripheral lobule (arrow) with decreased attenuation and vascularity in left upper lobe. (b) Coronal reformation shows predominant distribution of abnormalities in upper lobes.

View larger version (114K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Chronic HP in 72-year-old man exposed to birds. (a) Transverse thin-section CT scan of upper lobes shows patchy GGO and superimposed reticulation in predominant peribronchovascular distribution. Note bronchial tortuosity and irregularity (traction bronchiectasis, arrowheads) due to fibrosis and peripheral lobule (arrow) with decreased attenuation and vascularity in left upper lobe. (b) Coronal reformation shows predominant distribution of abnormalities in upper lobes.

View larger version (75K): [in this window] [in a new window] [Download PPT slide]   Figure 4: NSIP in 62-year-old woman. Transverse thin-section CT scan of basal segments of lower lobes shows peripheral GGO and mild reticulation with relative subpleural sparing (arrowheads) of lung immediately adjacent to pleura in dorsal lung regions. Note dorsal subpleural region is not normal but is less severely involved than region more than 1 cm away from pleura.

View larger version (17K): [in this window] [in a new window] [Download PPT slide]   Figure 5: Patient flow diagram.

View larger version (120K): [in this window] [in a new window] [Download PPT slide]   Figure 6a: IPF mimicking chronic HP in 76-year-old woman. (a) Transverse thin-section CT scan of upper lobes shows minimal GGO and fine reticulation in predominantly peripheral distribution and honeycomb cysts (arrowheads). (b) Transverse thin-section CT scan of lung bases shows mild reticulation and traction bronchiectasis (curved arrow), patchy GGO, and several lobules with decreased attenuation and vascularity (straight arrow). Two observers made incorrect first-choice diagnosis of chronic HP, one with low and one with high level of confidence. The histologic findings were characteristic of IPF. No etiologic agent was identified.

View larger version (132K): [in this window] [in a new window] [Download PPT slide]   Figure 6b: IPF mimicking chronic HP in 76-year-old woman. (a) Transverse thin-section CT scan of upper lobes shows minimal GGO and fine reticulation in predominantly peripheral distribution and honeycomb cysts (arrowheads). (b) Transverse thin-section CT scan of lung bases shows mild reticulation and traction bronchiectasis (curved arrow), patchy GGO, and several lobules with decreased attenuation and vascularity (straight arrow). Two observers made incorrect first-choice diagnosis of chronic HP, one with low and one with high level of confidence. The histologic findings were characteristic of IPF. No etiologic agent was identified.