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Sesion intersticio pumonar

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    • 1. Sesión Tórax 19 Febrero 2010
    • 2. TCAR Colimación <2mm Algoritmo de reconstrucción adecuado
    • 3. TCAR Colimación <2mm Algoritmo de reconstrucción adecuado 1. Adquisición volumétrica 2. Adquisición secuencial alta resolución
    • 4. TCAR Colimación <2mm Algoritmo de reconstrucción adecuado 1. Adquisición 1. Adquisición volumétrica volumétrica única 2. Adquisición secuencial alta 2. Postproceso resolución
    • 5. TCAR Colimación <2mm Algoritmo de reconstrucción adecuado 1. Adquisición 1. Adquisición volumétrica volumétrica única 2. Adquisición secuencial alta 2. Postproceso resolución Adquisición Postproceso
    • 6. Visible TCAR No visible TCARBronquios hasta 3 cm pleura Alveolos y acinos Arterias pulmonares Capilares Venas pulmonares Vasos linfáticos Septo interlobulillar Septo intralobulillar Pleura visceral (cisura) Pleura visceral (no cisural)
    • 7. Lobulillo secundario Venas pulmonares Bronquiolo Pleura visceral Septo interlobular Arteria pulmonar Vasos linfáticosKazerooni EA. High-resolution CT of the lungs. AJR 2001 Hansell DM. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008
    • 8. 9th The F Fleischner Lecture. Looking into the lung: what can it tell us? leischner Society Sy mposium. J une 1979. ER Weibel Subpleural Peribroncovascular Cutter C. A Treatise on Anatomy, Physiology, and Hygiene. 1852
    • 9. образующий трещины
    • 10. образующий трещины Obrasyushi Treshini
    • 11. образующий трещины Obrasyushi Treshini Patrón intersticial
    • 12. Semiología básica de TCAR en la patología intersticial
    • 13. Vidrio deslustradoNormal Condensación (GGO)
    • 14. Septos interlobulillares
    • 15. Septos interlobulillares
    • 16. Septos interlobulillares
    • 17. Septos interlobulillares
    • 18. Septos intralobulillares
    • 19. Septos intralobulillares
    • 20. Crazy Paving
    • 21. Distorsión de la arquitectura pulmonar Venas pulmonares Bronquiolo Pleura visceral Septo interlobular Arteria pulmonar Vasos linfáticos Kazerooni EA. High-resolution CT of the lungs. AJR 2001
    • 22. Bronquiectasias/Bronquiolectasias de tracción
    • 23. Bronquiectasias/Bronquiolectasias de tracción
    • 24. Patrón en panal
    • 25. Patrón en panal Hansell DM. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008
    • 26. LA SOPA DE LETRAS DPLD EPD IIP NIIIPF/UIP FPI/NIU NSIP NINE COP NOC AIP NIARB-ILD BR-EPI DIP NDI LIP NIL
    • 27. Neumonías intersticiales Neumonías intersticiales idiopáticas secundarias Patrón afectación
    • 28. 11 1 2 3 4 5 6 7
    • 29. Diagnóstico clínico FPI NINE NOC NIA NDI BR-EPI NIL
    • 30. Diagnóstico Patrón clínico histológico FPI NIU NINE NINE NOC NO NIA DAD NDI NDI BR-EPI BR NIL NIL
    • 31. Diagnóstico Patrón Patrón clínico histológico radiológico FPI NIU Basal, periférico. Distorsión arquitectura. Panal. GGO NINE NINE Basal, periférico, simétrico. GGO. Patrón reticular NOC NO Periférico. Condensación parcheada NIA DAD Difuso. Condensación. GGO NDI NDI Basal, periférico. GGO. Patrón reticular Difuso. Engrosamiento bronquial. Nódulos BR-EPI BR centrilobulillares. GGO Difuso. Nódulos centrilobulillares. Engrosamiento NIL NIL bronquial. GGO. Quistes
    • 32. Diagnóstico Patrón Diagnóstico clínico histológico diferencial Asbestosis. Enfermedades del colágeno. Sarcoidosis. FPI NIU Neumonitis por hipersensibilidad NINE NINE FPI. NDI. NOC. Neumonitis por hipersensibilidad NINE. Infección.Vasculitis. Sarcoidosis. NOC NO Bronquioloalveolar. Linfoma. Neumonía eosinófila NIA DAD Edema. Neumonía. Neumonía eosinófila aguda BR-EPI. Neumonitis por hipersensibilidad. NDI NDI Sarcoidosis BR-EPI BR NDI. NINE. Neumonitis por hipersensibilidad NIL NIL Sarcoidosis. Histiocitosis X
    • 33. Key Messages1. The idiopathic interstitial pneumonias (IIPs) comprise a number of clinicopathological entities, which are sufficiently differentfrom one another to be designated as separate disease entities. As a group they can be distinguished from other forms of diffuseparenchymal lung disease by clinical methods including history, physical examination, chest radiology and laboratory studies,and pathology.2. These conditions are rare and few physicians have substantial experience with their diagnosis and management.3. The new ATS/ERS classification proposed in this document comprises the following clinicopathologic entities in order ofrelative frequency: idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), cryptogenic organizingpneumonia (COP), acute interstitial pneumonia (AIP), respiratory bronchiololitis-associated interstitial lung disease (RB-ILD),desquamative interstitial pneumonia (DIP), and lymphoid interstitial pneumonia (LIP).4. NSIP is an area of uncertainty that requires further definition. The panel recommended that the use of the term NSIP beconsidered as a provisional diagnosis until there is further clarity on the nature of the corresponding clinical condition. Under theauspices of the ATS, a multidisciplinary panel is reviewing clinical cases of NSIP from around the world. When published(expected in late 2002), this review will be used to better characterize this entity and to determine its relationship to IPF,hypersensitivity pneumonitis, COP, DIP, and LIP.5. Achieving a correct diagnosis is a dynamic process. During the diagnostic work-up of patients with an IIP, the diagnosis mayneed to be revised, as more details of history are obtained, when new associations are discovered, or when results ofbronchoalveolar lavage, transbronchial biopsy (where appropriate), and surgical lung biopsy become available. It is particularlyimportant to re-evaluate the patient in a search for a specific etiology when NSIP, diffuse alveolar damage (DAD), and LIP arefound on lung biopsy. The final diagnosis should be rendered only after the pulmonologist, radiologist, and pathologist havereviewed all of the clinical, radiological, and pathological data obtained from the patient.6. In order to clarify the relationship between the historical pathologic and clinical terms that have been used for these entities,the new classification defines a set of histologic patterns that provide the basis for a final clinico-radiologic-pathologic diagnosis.Because the histologic patterns seen by pathologists usually allow for better separation of these entities than the imaging patternsseen by radiologists, these histologic patterns provide the primary basis for the various categories of IIP and serve as thefoundation for the classification.7. In the absence of contraindications, surgical lung biopsy is advised in patients with suspected IIP who do not show a classicclinical and HRCT picture of IPF/usual interstitial pneumonia (UIP). The availability of less invasive surgery in the form ofvideo-assisted thoracoscopic lung biopsy has made it more acceptable for clinicians to recommend surgical biopsy to theirpatients with diffuse parenchymal lung disease. Surgical lung biopsies should be obtained from more than one lobe of the lung.8. It is recommended that the term pattern be added to the IIP designations when referring to the lung biopsy pathologic pattern,to distinguish it from the clinico-radiologic- pathologic diagnosis (e.g., NSIP, DIP, or LIP).9. High-resolution computerized tomography (HRCT) scans are indicated for all but a small proportion of patients for whom aspecific diagnosis is strongly suggested on the basis of the standard chest radiograph. Careful attention to technique is necessaryto assure diagnostic accuracy. The HRCT images should be obtained in accordance with established guidelines and interpreted bya radiologist experienced in the evaluation of diffuse lung diseases.10. The primary role of HRCT is to separate patients with typical findings of IPF/UIP from those with the less specific findingsassociated with other idiopathic interstitial pneumonias.11. Transbronchial biopsies are not useful in the diagnosis of most of the IIPs, with the exception of DAD/AIP, and occasionallyorganizing pneumonia (OP)/COP. The primary role of transbronchial biopsies is to exclude sarcoidosis and certain infections.Bronchoalveolar lavage is not always required in the assessment of the IIPs.12. The final diagnosis should be rendered only after the pulmonologist, radiologist, and pathologist have reviewed all of theclinical, radiological, and pathological data obtained from the patient.13. Trials of therapy should be discouraged until a concerted effort has been made to establish a firm diagnosis based on theintegrated approach proposed in this document. These criteria should provide an international standard as the basis for futurestudies and publications on the subject of IIP.
    • 34. Key Messages1. The idiopathic interstitial pneumonias (IIPs) comprise a number of clinicopathological entities, which are sufficiently differentfrom one another to be designated as separate disease entities. As a group they can be distinguished from other forms of diffuseparenchymal lung disease by clinical methods including history, physical examination, chest radiology and laboratory studies,and pathology.2. These conditions are rare and few physicians have substantial experience with their diagnosis and management.3. The new ATS/ERS classification proposed in this document comprises the following clinicopathologic entities in order ofrelative frequency: idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), cryptogenic organizingpneumonia (COP), acute interstitial pneumonia (AIP), respiratory bronchiololitis-associated interstitial lung disease (RB-ILD),desquamative interstitial pneumonia (DIP), and lymphoid interstitial pneumonia (LIP).4. NSIP is an area of uncertainty that requires further definition. The panel recommended that the use of the term NSIP beconsidered as a provisional diagnosis until there is further clarity on the nature of the corresponding clinical condition. Under theauspices of the ATS, a multidisciplinary panel is reviewing clinical cases of NSIP from around the world. When published Because the histologic patterns seen by pathologists usually(expected in late 2002), this review will be used to better characterize this entity and to determine its relationship to IPF,hypersensitivity pneumonitis, COP, DIP, and LIP.5. Achieving a correct diagnosis is a dynamic process. During the diagnostic work-up of patients with an IIP, the diagnosis mayneed to be revised, as more details of history are obtained, when new associations are discovered, or when results ofbronchoalveolar lavage, transbronchial biopsy (where appropriate), and surgical lung biopsy become available. It is particularlyimportant to re-evaluate the patient in a search for a specific etiology when NSIP, diffuse alveolar damage (DAD), and LIP arefound on lung biopsy. The final diagnosis should be rendered only after the pulmonologist, radiologist, and pathologist have allow for better separation ofreviewed all of the clinical, radiological, and pathological data obtained from the patient.6. In order to clarify the relationship between the historical pathologic and clinical terms that have been used for these entities, these entities than the imaging patterns seen by radiologists,the new classification defines a set of histologic patterns that provide the basis for a final clinico-radiologic-pathologic diagnosis.Because the histologic patterns seen by pathologists usually allow for better separation of these entities than the imaging patternsseen by radiologists, these histologic patterns provide the primary basis for the various categories of IIP and serve as thefoundation for the classification.7. In the absence of contraindications, surgical lung biopsy is advised in patients with suspected IIP who do not show a classicclinical and HRCT picture of IPF/usual interstitial pneumonia (UIP). The availability of less invasive surgery in the form ofvideo-assisted thoracoscopic lung biopsy has made it more acceptable for clinicians to recommend surgical biopsy to their these histologic patterns provide the primary basis forpatients with diffuse parenchymal lung disease. Surgical lung biopsies should be obtained from more than one lobe of the lung.8. It is recommended that the term pattern be added to the IIP designations when referring to the lung biopsy pathologic pattern,to distinguish it from the clinico-radiologic- pathologic diagnosis (e.g., NSIP, DIP, or LIP).9. High-resolution computerized tomography (HRCT) scans are indicated for all but a small proportion of patients for whom aspecific diagnosis is strongly suggested on the basis of the standard chest radiograph. Careful attention to technique is necessary the various categories of IIP and serve as the foundation forto assure diagnostic accuracy. The HRCT images should be obtained in accordance with established guidelines and interpreted bya radiologist experienced in the evaluation of diffuse lung diseases.10. The primary role of HRCT is to separate patients with typical findings of IPF/UIP from those with the less specific findings the classification.associated with other idiopathic interstitial pneumonias.11. Transbronchial biopsies are not useful in the diagnosis of most of the IIPs, with the exception of DAD/AIP, and occasionallyorganizing pneumonia (OP)/COP. The primary role of transbronchial biopsies is to exclude sarcoidosis and certain infections.Bronchoalveolar lavage is not always required in the assessment of the IIPs.12. The final diagnosis should be rendered only after the pulmonologist, radiologist, and pathologist have reviewed all of theclinical, radiological, and pathological data obtained from the patient.13. Trials of therapy should be discouraged until a concerted effort has been made to establish a firm diagnosis based on theintegrated approach proposed in this document. These criteria should provide an international standard as the basis for futurestudies and publications on the subject of IIP.
    • 35. Key Messages1. The idiopathic interstitial pneumonias (IIPs) comprise a number of clinicopathological entities, which are sufficiently differentfrom one another to be designated as separate disease entities. As a group they can be distinguished from other forms of diffuseparenchymal lung disease by clinical methods including history, physical examination, chest radiology and laboratory studies,and pathology.2. These conditions are rare and few physicians have substantial experience with their diagnosis and management.3. The new ATS/ERS classification proposed in this document comprises the following clinicopathologic entities in order ofrelative frequency: idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), cryptogenic organizingpneumonia (COP), acute interstitial pneumonia (AIP), respiratory bronchiololitis-associated interstitial lung disease (RB-ILD),desquamative interstitial pneumonia (DIP), and lymphoid interstitial pneumonia (LIP).4. NSIP is an area of uncertainty that requires further definition. The panel recommended that the use of the term NSIP beconsidered as a provisional diagnosis until there is further clarity on the nature of the corresponding clinical condition. Under theauspices of the ATS, a multidisciplinary panel is reviewing clinical cases of NSIP from around the world. When published Achieving a correct diagnosis(expected in late 2002), this review will be used to better characterize this entity and to determine its relationship to IPF,hypersensitivity pneumonitis, COP, DIP, and LIP. is a dynamic process.It is particularly important to re-5. Achieving a correct diagnosis is a dynamic process. During the diagnostic work-up of patients with an IIP, the diagnosis mayneed to be revised, as more details of history are obtained, when new associations are discovered, or when results ofbronchoalveolar lavage, transbronchial biopsy (where appropriate), and surgical lung biopsy become available. It is particularlyimportant to re-evaluate the patient in a search for a specific etiology when NSIP, diffuse alveolar damage (DAD), and LIP arefound on lung biopsy. The final diagnosis should be rendered only after the pulmonologist, radiologist, and pathologist havereviewed all of the clinical, radiological, and pathological data obtained from the patient.6. In order to clarify the relationship between the historical pathologic and clinical terms that have been used for these entities, evaluate the patient in a search for a specific etiology whenthe new classification defines a set of histologic patterns that provide the basis for a final clinico-radiologic-pathologic diagnosis.Because the histologic patterns seen by pathologists usually allow for better separation of these entities than the imaging patternsseen by radiologists, these histologic patterns provide the primary basis for the various categories of IIP and serve as thefoundation for the classification.7. In the absence of contraindications, surgical lung biopsy is advised in patients with suspected IIP who do not show a classicclinical and HRCT picture of IPF/usual interstitial pneumonia (UIP). The availability of less invasive surgery in the form ofvideo-assisted thoracoscopic lung biopsy has made it more acceptable for clinicians to recommend surgical biopsy to their NSIP, diffuse alveolar damage (DAD), and LIP are found onpatients with diffuse parenchymal lung disease. Surgical lung biopsies should be obtained from more than one lobe of the lung.8. It is recommended that the term pattern be added to the IIP designations when referring to the lung biopsy pathologic pattern,to distinguish it from the clinico-radiologic- pathologic diagnosis (e.g., NSIP, DIP, or LIP).9. High-resolution computerized tomography (HRCT) scans are indicated for all but a small proportion of patients for whom aspecific diagnosis is strongly suggested on the basis of the standard chest radiograph. Careful attention to technique is necessary lung biopsy.to assure diagnostic accuracy. The HRCT images should be obtained in accordance with established guidelines and interpreted bya radiologist experienced in the evaluation of diffuse lung diseases.10. The primary role of HRCT is to separate patients with typical findings of IPF/UIP from those with the less specific findingsassociated with other idiopathic interstitial pneumonias.11. Transbronchial biopsies are not useful in the diagnosis of most of the IIPs, with the exception of DAD/AIP, and occasionallyorganizing pneumonia (OP)/COP. The primary role of transbronchial biopsies is to exclude sarcoidosis and certain infections.Bronchoalveolar lavage is not always required in the assessment of the IIPs.12. The final diagnosis should be rendered only after the pulmonologist, radiologist, and pathologist have reviewed all of theclinical, radiological, and pathological data obtained from the patient.13. Trials of therapy should be discouraged until a concerted effort has been made to establish a firm diagnosis based on theintegrated approach proposed in this document. These criteria should provide an international standard as the basis for futurestudies and publications on the subject of IIP.
    • 36. Key Messages1. The idiopathic interstitial pneumonias (IIPs) comprise a number of clinicopathological entities, which are sufficiently differentfrom one another to be designated as separate disease entities. As a group they can be distinguished from other forms of diffuseparenchymal lung disease by clinical methods including history, physical examination, chest radiology and laboratory studies,and pathology.2. These conditions are rare and few physicians have substantial experience with their diagnosis and management.3. The new ATS/ERS classification proposed in this document comprises the following clinicopathologic entities in order ofrelative frequency: idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), cryptogenic organizingpneumonia (COP), acute interstitial pneumonia (AIP), respiratory bronchiololitis-associated interstitial lung disease (RB-ILD),desquamative interstitial pneumonia (DIP), and lymphoid interstitial pneumonia (LIP).4. NSIP is an area of uncertainty that requires further definition. The panel recommended that the use of the term NSIP be The final diagnosis should beconsidered as a provisional diagnosis until there is further clarity on the nature of the corresponding clinical condition. Under theauspices of the ATS, a multidisciplinary panel is reviewing clinical cases of NSIP from around the world. When published(expected in late 2002), this review will be used to better characterize this entity and to determine its relationship to IPF,hypersensitivity pneumonitis, COP, DIP, and LIP.5. Achieving a correct diagnosis is a dynamic process. During the diagnostic work-up of patients with an IIP, the diagnosis mayneed to be revised, as more details of history are obtained, when new associations are discovered, or when results ofbronchoalveolar lavage, transbronchial biopsy (where appropriate), and surgical lung biopsy become available. It is particularly rendered only after theimportant to re-evaluate the patient in a search for a specific etiology when NSIP, diffuse alveolar damage (DAD), and LIP arefound on lung biopsy. The final diagnosis should be rendered only after the pulmonologist, radiologist, and pathologist havereviewed all of the clinical, radiological, and pathological data obtained from the patient. pulmonologist, radiologist, and6. In order to clarify the relationship between the historical pathologic and clinical terms that have been used for these entities,the new classification defines a set of histologic patterns that provide the basis for a final clinico-radiologic-pathologic diagnosis.Because the histologic patterns seen by pathologists usually allow for better separation of these entities than the imaging patternsseen by radiologists, these histologic patterns provide the primary basis for the various categories of IIP and serve as the pathologist have reviewed allfoundation for the classification.7. In the absence of contraindications, surgical lung biopsy is advised in patients with suspected IIP who do not show a classic of the clinical, radiological, and pathological data obtained fromclinical and HRCT picture of IPF/usual interstitial pneumonia (UIP). The availability of less invasive surgery in the form ofvideo-assisted thoracoscopic lung biopsy has made it more acceptable for clinicians to recommend surgical biopsy to theirpatients with diffuse parenchymal lung disease. Surgical lung biopsies should be obtained from more than one lobe of the lung.8. It is recommended that the term pattern be added to the IIP designations when referring to the lung biopsy pathologic pattern,to distinguish it from the clinico-radiologic- pathologic diagnosis (e.g., NSIP, DIP, or LIP). the patient.9. High-resolution computerized tomography (HRCT) scans are indicated for all but a small proportion of patients for whom aspecific diagnosis is strongly suggested on the basis of the standard chest radiograph. Careful attention to technique is necessaryto assure diagnostic accuracy. The HRCT images should be obtained in accordance with established guidelines and interpreted bya radiologist experienced in the evaluation of diffuse lung diseases.10. The primary role of HRCT is to separate patients with typical findings of IPF/UIP from those with the less specific findingsassociated with other idiopathic interstitial pneumonias.11. Transbronchial biopsies are not useful in the diagnosis of most of the IIPs, with the exception of DAD/AIP, and occasionallyorganizing pneumonia (OP)/COP. The primary role of transbronchial biopsies is to exclude sarcoidosis and certain infections.Bronchoalveolar lavage is not always required in the assessment of the IIPs.12. The final diagnosis should be rendered only after the pulmonologist, radiologist, and pathologist have reviewed all of theclinical, radiological, and pathological data obtained from the patient.13. Trials of therapy should be discouraged until a concerted effort has been made to establish a firm diagnosis based on theintegrated approach proposed in this document. These criteria should provide an international standard as the basis for futurestudies and publications on the subject of IIP.
    • 37. Key Messages1. The idiopathic interstitial pneumonias (IIPs) comprise a number of clinicopathological entities, which are sufficiently differentfrom one another to be designated as separate disease entities. As a group they can be distinguished from other forms of diffuseparenchymal lung disease by clinical methods including history, physical examination, chest radiology and laboratory studies,and pathology.2. These conditions are rare and few physicians have substantial experience with their diagnosis and management.3. The new ATS/ERS classification proposed in this document comprises the following clinicopathologic entities in order ofrelative frequency: idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), cryptogenic organizingpneumonia (COP), acute interstitial pneumonia (AIP), respiratory bronchiololitis-associated interstitial lung disease (RB-ILD),desquamative interstitial pneumonia (DIP), and lymphoid interstitial pneumonia (LIP).4. NSIP is an area of uncertainty that requires further definition. The panel recommended that the use of the term NSIP beconsidered as a provisional diagnosis until there is further clarity on the nature of the corresponding clinical condition. Under theauspices of the ATS, a multidisciplinary panel is reviewing clinical cases of NSIP from around the world. When published The primary role of HRCT is to(expected in late 2002), this review will be used to better characterize this entity and to determine its relationship to IPF,hypersensitivity pneumonitis, COP, DIP, and LIP.5. Achieving a correct diagnosis is a dynamic process. During the diagnostic work-up of patients with an IIP, the diagnosis may separate patients with typicalneed to be revised, as more details of history are obtained, when new associations are discovered, or when results ofbronchoalveolar lavage, transbronchial biopsy (where appropriate), and surgical lung biopsy become available. It is particularlyimportant to re-evaluate the patient in a search for a specific etiology when NSIP, diffuse alveolar damage (DAD), and LIP arefound on lung biopsy. The final diagnosis should be rendered only after the pulmonologist, radiologist, and pathologist have findings of IPF/UIP from thosereviewed all of the clinical, radiological, and pathological data obtained from the patient.6. In order to clarify the relationship between the historical pathologic and clinical terms that have been used for these entities,the new classification defines a set of histologic patterns that provide the basis for a final clinico-radiologic-pathologic diagnosis. with the less specific findingsBecause the histologic patterns seen by pathologists usually allow for better separation of these entities than the imaging patternsseen by radiologists, these histologic patterns provide the primary basis for the various categories of IIP and serve as thefoundation for the classification.7. In the absence of contraindications, surgical lung biopsy is advised in patients with suspected IIP who do not show a classicclinical and HRCT picture of IPF/usual interstitial pneumonia (UIP). The availability of less invasive surgery in the form ofvideo-assisted thoracoscopic lung biopsy has made it more acceptable for clinicians to recommend surgical biopsy to theirpatients with diffuse parenchymal lung disease. Surgical lung biopsies should be obtained from more than one lobe of the lung. associated with other idiopathic8. It is recommended that the term pattern be added to the IIP designations when referring to the lung biopsy pathologic pattern,to distinguish it from the clinico-radiologic- pathologic diagnosis (e.g., NSIP, DIP, or LIP). interstitial pneumonias.9. High-resolution computerized tomography (HRCT) scans are indicated for all but a small proportion of patients for whom aspecific diagnosis is strongly suggested on the basis of the standard chest radiograph. Careful attention to technique is necessaryto assure diagnostic accuracy. The HRCT images should be obtained in accordance with established guidelines and interpreted bya radiologist experienced in the evaluation of diffuse lung diseases.10. The primary role of HRCT is to separate patients with typical findings of IPF/UIP from those with the less specific findingsassociated with other idiopathic interstitial pneumonias.11. Transbronchial biopsies are not useful in the diagnosis of most of the IIPs, with the exception of DAD/AIP, and occasionallyorganizing pneumonia (OP)/COP. The primary role of transbronchial biopsies is to exclude sarcoidosis and certain infections.Bronchoalveolar lavage is not always required in the assessment of the IIPs. PATRÓN USUAL vs NO USUAL12. The final diagnosis should be rendered only after the pulmonologist, radiologist, and pathologist have reviewed all of theclinical, radiological, and pathological data obtained from the patient.13. Trials of therapy should be discouraged until a concerted effort has been made to establish a firm diagnosis based on theintegrated approach proposed in this document. These criteria should provide an international standard as the basis for futurestudies and publications on the subject of IIP.
    • 38. Patrón usualDistribución periférica y basalOpacidades reticulares subpleuralesBronquiectasias de tracciónPanalizaciónLimitado vidrio deslustradoAlternancia áreas de fibrosis conpulmón normal
    • 39. Patrón usual FPI
    • 40. Patrón usual Sjögren
    • 41. Patrón usual FPI
    • 42. Patrón usual FPI
    • 43. Patrón NINEDistribución subpleural y simétricaOpacidades reticulares subpleuralesVidrio deslustrado parcheadoNódulos pulmonaresMicroquistesCondensaciones y bronquiectasiasde tracción en fase fibrótica
    • 44. Patrón NINE NINE
    • 45. Patrón NINE NINE
    • 46. Patrón no usual Cocaína
    • 47. ???
    • 48. Patron NINE NINE Bronquio traqueal