HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)

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This is the second part of this series on HRCT in diffuse lung diseases, focussing on the diagnosis of honeycombing, UIP pattern and IPF and the associated complications and differential diagnoses

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HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)

  1. 1. HRCT in Diffuse Lung Diseases - II Dr. Bhavin Jankharia Jankharia Imaging
  2. 2. The key to learning HRCT interpretation in interstitial lungdiseases is to learn how to identifyhoneycombing, which allows us to recognize the Usual Interstitial Pneumonia (UIP) pattern
  3. 3. Honeycombing – layered peripheral cysts, stacked one on top of the other
  4. 4. D/D of Honeycombing
  5. 5. Honeycombing Bronchiectasis
  6. 6. Bronchiectasis presents withbranching cystic and tubular areas extending from the hilum to the periphery
  7. 7. Honeycombing Emphysema
  8. 8. Emphysema presents withcentrilobular cystic areas without walls
  9. 9. Honeycombing Cystic lung
  10. 10. Cystic interstitial lung disease presents with cysts with wallsrandomly distributed throughout the lung parenchyma
  11. 11. The presence of honeycombingallows us to confidently make a diagnosis of a usual interstitial pneumonia pattern (UIP)
  12. 12. Reticular pattern – no honeycombing Reticular pattern - honeycombing
  13. 13. The absence of honeycombing as seen on the left image does not rule out a UIP pattern, but adiagnosis of UIP cannot be madewith any specificity in that context. A non-specific interstitial pneumonia with fibrosis (NSIP) pattern also then comes into the differential diagnosis
  14. 14. The Diagnosis of a UIP Pattern
  15. 15. IPFUIP CriteriaReticular abnormalityHoneycombing with orwithout tractionbronchiectasisSubpleural basalpredominanceAbsence of other signs likeground glass, nodules, etc New IPF criteria – ATS/ERS
  16. 16. IPFUIP Criteria• Reticular abnormality• Honeycombing with or without traction bronchiectasis• Subpleural basal predominance• Absence of features inconsistent with these New IPF criteria – ATS/ERS
  17. 17. Lower zone – UIP pattern Upper zone - chronic hypersensitivity pneumonitis
  18. 18. Long standing sarcoidosis with fibrosis – upper and mid-zone fibrosis
  19. 19. Upper zone predominance ofhoneycombing usually implies chronic hypersensitivity pneumonitis or long standngparenchymal sarcoidosis with fibrosis
  20. 20. IPFUIP CriteriaReticular abnormalityHoneycombing with orwithout tractionbronchiectasisSubpleural basalpredominanceAbsence of other signs likeground glass, nodules, etc New IPF criteria – ATS/ERS
  21. 21. If all these criteria are met, then we can confidently make the diagnosis of a UIP pattern
  22. 22. New IPF criteria – ATS/ERS
  23. 23. This is the new algorithm to make a diagnosis of Idiopathic Pulmonary Fibrosis (IPF)
  24. 24. In the presence of a UIP pattern, in the absence of an identifiable cause (e.g. rheumatoid arthritis, familial, etc), the presence of a UIP pattern implies IPF
  25. 25. IPFIssues• Complications – neoplasm, infection
  26. 26. IPF with superimposed opacity in the left lower lobe – TB on biopsy
  27. 27. IPF with progressive consolidation over a year – invasive mucinous adenocarcinoma on biopsy
  28. 28. Patients with IPF have an increased incidence of superimposed infection andneoplasm. The HRCTs of patients of IPF on follow-up should beexamined for superimposed / new pathology
  29. 29. IPFIssues• Complications – neoplasm, infection• Combined emphysema with fibrosis (CPFE)
  30. 30. This patient has both emphysema in the upper lobes and a UIP pattern in the lower lobes
  31. 31. This occurs in smokers, with emphysema in the upper lobesand IPF in the lower lobes. It hasa worse prognosis than IPF and clinically can be a challenge to diagnose
  32. 32. The next presentation will be on NSIP and other idiopathic interstitial pneumonias
  33. 33. Thank You

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