radiology resident presentation

1. Interstitial lung diseases

4. UIP
• a histologic pattern
• most common interstitial pneumonia, 40% of cases
• IPF accounts for about 70% of cases of UIP
Histology (hallmark is fibroblastic foci)
heterogeneous pattern (normal lung, interstitial fibrosis, fibroblastic
proliferation, honeycombing) ‘spatial heterogeneity’
abnormalities represent different stages of inflammation & fibrosis,
‘temporal heterogeneity’

8. Radiographs
• decreased lung volume is typical
• 80% - bilateral reticular pattern in the lower lung zones
• 10% - radiograph appears normal
• In earliest stages, fine reticulations in the posterior costo-phrenic
angles on lateral radiograph
• As fibrosis progresses, the reticular pattern becomes coarse, and
cystic areas of honeycombing are visible in about half of cases

15. CPFE
• IPF may be associated with emphysema
• characterized by upper lobe emphysema and lower lobe fibrosis
• frequently complicated by PHTN, acute lung injury, and lung cancer
• typically occurs in male smokers

17. • Mediastinal lymph node enlargement is visible in 70% of cases
(typically measure less than 15 mm)
• Patients may develop a fulminant and sometimes fatal acute
exacerbation characterized by consolidation or GGO; biopsy typically
shows DAD

19. NSIP
• accounts for 20% of IPs
• characterized histologically by alveolar wall thickening or fibrosis,
showing ‘spatial and temporal homogeneity’
all parts of the biopsy look the same and represent the same stage of
the disease

25. The diagnosis of NSIP should be considered if HRCT
shows ground-glass opacity with some degree of
reticulation, without honeycombing, in the sub-pleural
and basal lung, particularly if sub-pleural sparing is
present!!!

26. DIP & RB-ILD
• 10% of IPs
• characterized by the presence of intra-alveolar macrophages, mild
inflammation of alveolar walls, and minimal fibrosis.
• DIP - diffuse in distribution
• RB-ILD - bronchocentric (peribronchiolar) in distribution
strong association with smoking

27. • RB is a common incidental finding in asymptomatic smokers
• histologic finding of RB + pulmonary symptoms = RB-ILD
• DIP, RB, and RB-ILD represent different degrees of lung involvement
by the same process

34. HRCT features of fibrosis and progression of Abnormalities

35. HRCT
PATTERNS

36. Non Fibrotic HP

38. Fibrotic HP

40. NSIP

41. Organizing Pneumonia

43. Perilobular Consolidation

44. Unclassifiable ILDs

46. ILD
• Diverse group of conditions that may result in lung fibrosis
• Restrictive Pattern (low FVC, or low DLco)

47. Categorization of major Idiopathic Interstitial Pneumonias

48. Diagnostic Pointers
• Bronchocentric Pattern
• Subpleural Sparing

49. UIP BUT CTD
• Straight Edge Sign
• Anterior Upper lobe sign
• Exuberant Honey combing
sign

51. CPFE

52. Chest CT – Covid
• Typical
• Atypical

53. Typical Appearance of COVID 19

54. Indeterminate Appearance

55. Atypical Appearance

56. Post Covid Fibrosis
•