PHYSICIANS’ MEET 09.04.2009 Prof.  S.SUNDAR ’s unit
AN INTERESTING C.T. Dr.N. Arun Kumar Prof.  S.SUNDAR ’s unit
<ul><li>Dhanushkodi, an 84 year old male Pt. got admitted in urology  department as a case of BPH.  </li></ul><ul><li>h/o ...
 
 
 
HRCT FEATURES <ul><li>LUNG PARENCHYMA-  </li></ul><ul><li>bilateral diffuse interlobular  septal thickening with ground-gl...
IMPRESSION <ul><li>INTERSTITIAL LUNG DISEASE </li></ul><ul><li>- ? Idiopathic Pulmonary Fibrosis </li></ul>
INTERSTITIAL LUNG DISEASE <ul><li>Exertional dyspnoea </li></ul><ul><li>Persistent, non productive cough </li></ul><ul><li...
CHEST ROENTGENOGRAPHIC FINDINGS <ul><li>Bibasilar reticular pattern </li></ul><ul><li>Nodular/mixed pattern of alveolar fi...
Contd… <ul><li>Basal reticular opacities –often visible on CXR even several years before the development of symptoms </li>...
COMPUTED TOMOGRAPHY <ul><li>HRCT is superior to CXR </li></ul><ul><li>Better assessment of the extent & distribution of th...
RESPIRATORY SYMPTOMS & SIGNS <ul><li>Dyspnoea </li></ul><ul><li>In some patients with  </li></ul><ul><li>sarcoidosis  exte...
SYSTEMIC EXAMINATION OF RS <ul><li>Tachypnoea </li></ul><ul><li>Bi-basilar end inspiratory dry crackles </li></ul><ul><li>...
ATYPICAL FINDINGS IN HRCT <ul><li>Extensive ground-glass abnormalities </li></ul><ul><li>Nodular opacities </li></ul><ul><...
DIFFERENTIAL DIAGNOSES <ul><li>Connective Tissue Diseases (scleroderma, RA) </li></ul><ul><li>Asbestosis (parenchymal band...
Contd… <ul><li>Lymphangitic Carcinomatosis  </li></ul><ul><li>Cardiogenic Pulmonary Edema  reticular pattern </li></ul><ul...
<ul><li>THANK U </li></ul>
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CT: Interstitial lung disease

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CT: Interstitial lung disease

  1. 1. PHYSICIANS’ MEET 09.04.2009 Prof. S.SUNDAR ’s unit
  2. 2. AN INTERESTING C.T. Dr.N. Arun Kumar Prof. S.SUNDAR ’s unit
  3. 3. <ul><li>Dhanushkodi, an 84 year old male Pt. got admitted in urology department as a case of BPH. </li></ul><ul><li>h/o breathlessness on exertion + </li></ul><ul><li>vitals normal </li></ul><ul><li>ECG- WNL </li></ul><ul><li>ECHO- Normal Study </li></ul><ul><li>CXR- reticulo nodular pattern involving lower zones of both the lungs </li></ul>
  4. 7. HRCT FEATURES <ul><li>LUNG PARENCHYMA- </li></ul><ul><li>bilateral diffuse interlobular septal thickening with ground-glass opacities. </li></ul><ul><li>Honeycomb changes in both the lung fields. </li></ul>
  5. 8. IMPRESSION <ul><li>INTERSTITIAL LUNG DISEASE </li></ul><ul><li>- ? Idiopathic Pulmonary Fibrosis </li></ul>
  6. 9. INTERSTITIAL LUNG DISEASE <ul><li>Exertional dyspnoea </li></ul><ul><li>Persistent, non productive cough </li></ul><ul><li>Hemoptysis, wheezing, chest pain </li></ul><ul><li>Involvement of parenchyma of the lung </li></ul><ul><li>alveoli </li></ul><ul><li>alveolar epithelium </li></ul><ul><li>capillary endothelium </li></ul><ul><li>perivascular tissues </li></ul><ul><li>lymphatic tissues </li></ul>
  7. 10. CHEST ROENTGENOGRAPHIC FINDINGS <ul><li>Bibasilar reticular pattern </li></ul><ul><li>Nodular/mixed pattern of alveolar fillings & increased reticular markings </li></ul><ul><li>Nodular opacities with predilection of upper lung zones </li></ul><ul><li>sarcoidosis </li></ul><ul><li>PLCH </li></ul><ul><li>Chronic Hypersensitivity Pneumonitis </li></ul><ul><li>silicosis </li></ul><ul><li>berylliosis </li></ul><ul><li>RA </li></ul><ul><li>Ankylosing Spondylitis </li></ul>
  8. 11. Contd… <ul><li>Basal reticular opacities –often visible on CXR even several years before the development of symptoms </li></ul><ul><li>CXR correlates poorly with clinical/HP stage of the disease </li></ul><ul><li>CXR finding of honeycombing- pathologic findings of cystic spaces & progressive fibrosis (poor prognosis) </li></ul><ul><li>CXR is nonspecific </li></ul>
  9. 12. COMPUTED TOMOGRAPHY <ul><li>HRCT is superior to CXR </li></ul><ul><li>Better assessment of the extent & distribution of the disease </li></ul><ul><li>useful in patients with normal CXR </li></ul><ul><li>Co-existing disease- best recognized by HRCT –mediastinal adenopathy, carcinoma, emphysema </li></ul><ul><li>HRCT- to preclude the need of lung biopsy in IPF, sarcoidosis, hypersensitivity pneumonitis, asbestosis, lymphangitic carcinoma, PLCH </li></ul><ul><li>Determination of the most appropriate area from which biopsy samples should be taken </li></ul>
  10. 13. RESPIRATORY SYMPTOMS & SIGNS <ul><li>Dyspnoea </li></ul><ul><li>In some patients with </li></ul><ul><li>sarcoidosis extensive parenchymal </li></ul><ul><li>silicosis lung ds.on CXR without </li></ul><ul><li>PLCH significant dyspnoea </li></ul><ul><li>Hs.Pneumonitis </li></ul><ul><li>Wheezing </li></ul><ul><li>clinically significant chest pain uncommon </li></ul><ul><li>Hemoptysis </li></ul><ul><li>fatigue & weight loss </li></ul>
  11. 14. SYSTEMIC EXAMINATION OF RS <ul><li>Tachypnoea </li></ul><ul><li>Bi-basilar end inspiratory dry crackles </li></ul><ul><li>Crackles may present in the absence of CXR findings </li></ul><ul><li>Scattered late inspiratory high-pitched rhonchi (inspiratory squeaks) in bronchiolitis </li></ul><ul><li>In mid & late stages of disease- Pulm.HTN & Cor Pulmonale </li></ul><ul><li>Cyanosis & clubbing- in advanced disease </li></ul>
  12. 15. ATYPICAL FINDINGS IN HRCT <ul><li>Extensive ground-glass abnormalities </li></ul><ul><li>Nodular opacities </li></ul><ul><li>Upper zone/Middle zone predominance </li></ul><ul><li>Prominent hilar/mediastinal lymphadenopathy </li></ul>
  13. 16. DIFFERENTIAL DIAGNOSES <ul><li>Connective Tissue Diseases (scleroderma, RA) </li></ul><ul><li>Asbestosis (parenchymal bands of fibrosis & pleural plaques) </li></ul><ul><li>Subacute/chronic hypersensitivity pneumonitis (lack the bibasilar predominence seen in IPF) </li></ul><ul><li>Sarcoidosis </li></ul><ul><li>Desquamative Interstitial Pnemonitis extensive ground- </li></ul><ul><li>Respiratory bronchiolitis glass opacity </li></ul><ul><li>Hypersensitivity Pneumonitis without basal or </li></ul><ul><li>Idiopathic BOOP peripheral </li></ul><ul><li>Non-Specific Interstitial Pneumonitis (NSIP) predominence </li></ul>
  14. 17. Contd… <ul><li>Lymphangitic Carcinomatosis </li></ul><ul><li>Cardiogenic Pulmonary Edema reticular pattern </li></ul><ul><li>Alveolar Proteinosis </li></ul><ul><li>Miliary TB </li></ul><ul><li>PLCH nodular pattern </li></ul><ul><li>Respiratory Bronchiolitis </li></ul><ul><li>Cryptogenic Organizing Pneumonia </li></ul><ul><li>Lymphangiomyomatosis </li></ul><ul><li>Centrilobular Emphysema </li></ul>
  15. 18. <ul><li>THANK U </li></ul>

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