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Pulmonary Fibrosis

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Abstract

This chapter describes the two major types of chronic pulmonary fibrosis (usual interstitial pneumonia [UIP] and nonspecific interstitial fibrosis [NSIP]) and various acute or subacute conditions that can produce pulmonary fibrosis (cryptogenic organizing pneumonia [COP], acute interstitial pneumonia [AIP]). It then addresses smoking-related disease (respiratory bronchiolitis-interstitial lung disease [RB-ILD], desquamative interstitial disease [DIP], and pulmonary Langerhans cell histiocytosis [PLCH]).

Keywords

  • Usual interstitial pneumonia (UIP)
  • Nonspecific interstitial fibrosis (NSIP)
  • Cryptogenic organizing pneumonia (COP)
  • Acute interstitial pneumonia (AIP)
  • Respiratory bronchiolitis-interstitial lung disease (RB-ILD)
  • Desquamative interstitial disease (DIP)
  • Pulmonary Langerhans cell histiocytosis (PLCH)

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Fig. e13.1

Usual interstitial pneumonia. Coarse reticulation with variable-sized, thick-walled cysts producing a honeycomb appearance [1] (TIF 815 kb)

Fig. e13.2

Usual interstitial pneumonia. Coronal CT clearly shows an apicobasal gradient of fibrotic involvement with areas of honeycombing and traction bronchiectasis [1] (TIF 815 kb)

Fig. e13.3

Usual interstitial pneumonia (UIP). Bibasilar and subpleural reticulation and traction bronchiectasis are seen in areas of fibrosis (arrows) [2] (TIF 1289 kb)

Fig. e13.4

Usual interstitial pneumonia. Classic honeycombing, with multiple predominantly subpleural and basilar cysts (arrows) [2] (TIF 2853 kb)

Fig. e13.5

Usual interstitial pneumonia (scleroderma). Basilar ground-glass opacities with especially prominent honeycombing (arrows) that is not seen in NSIP [2] (TIF 1274 kb)

Fig. e13.6

Rapid progression of usual interstitial pneumonia. (a) Initial images show subpleural reticular opacities (arrows), traction bronchiectasis, and minor ground-glass attenuation. (TIF 1647 kb)

Fig. e13.6

Rapid progression of usual interstitial pneumonia. (b) Initial images show subpleural reticular opacities (arrows), traction bronchiectasis, and minor ground-glass attenuation. (TIF 1641 kb)

Fig. e13.6

Rapid progression of usual interstitial pneumonia. (c) Three months later, there has been progression of reticular opacities (arrows) with advancing destruction of lung [2] (TIF 1687 kb)

Fig. e13.6

Rapid progression of usual interstitial pneumonia. (d) Three months later, there has been progression of reticular opacities (arrows) with advancing destruction of lung [2] (TIF 1686 kb)

Fig. e13.7

Nonspecific interstitial pneumonia (early stage). (a) Lower lung predominance of ground-glass attenuation and fine subpleural reticular opacities (arrows), without consolidation or honeycombing [2] (TIF 1553 kb)

Fig. e13.7

Nonspecific interstitial pneumonia (early stage). (b) Lower lung predominance of ground-glass attenuation and fine subpleural reticular opacities (arrows), without consolidation or honeycombing [2] (TIF 1535 kb)

Fig. e13.8

Nonspecific interstitial pneumonia (advanced stage). (a) Subpleural reticular opacities with slight honeycombing (arrows) in the lower lung, but no apicobasal gradient of findings [2] (TIF 1538 kb)

Fig. e13.8

Nonspecific interstitial pneumonia (advanced stage). (b) Subpleural reticular opacities with slight honeycombing (arrows) in the lower lung, but no apicobasal gradient of findings [2] (TIF 1485 kb)

Fig. e13.8

Nonspecific interstitial pneumonia (advanced stage). (c) Subpleural reticular opacities with slight honeycombing (arrows) in the lower lung, but no apicobasal gradient of findings [2] (TIF 1950 kb)

Fig. e13.9

Nonspecific interstitial pneumonia (rheumatoid arthritis). (a) Bilateral subpleural findings (arrows) of fine reticular changes and accompanying ground-glass opacities, without parenchymal distortion or honeycombing [2] (TIF 1467 kb)

Fig. e13.9

Nonspecific interstitial pneumonia (rheumatoid arthritis). (b) Bilateral subpleural findings (arrows) of fine reticular changes and accompanying ground-glass opacities, without parenchymal distortion or honeycombing [2] (TIF 1430 kb)

Fig. e13.10

Cryptogenic organizing pneumonia. (a) Extensive bilateral peribronchial consolidation and ground-glass opacities (arrows). The presence of an endotracheal tube (arrowhead) indicates the need for mechanical ventilation (TIF 2268 kb)

Fig. e13.10

Cryptogenic organizing pneumonia. (b) Repeat study after 3 weeks of corticosteroid, and supportive treatment shows substantial resolution of the lung abnormalities (arrows) [1] (TIF 676 kb)

Fig. e13.11

Acute interstitial pneumonia (sepsis). Distinct bilateral ground-glass opacities and consolidations, primarily located in the dependent lung [2] (TIF 669 kb)

Fig. e13.12

Desquamative interstitial pneumonia. Patchy areas of air-space consolidation (ground-glass attenuation) [1] (TIF 1326 kb)

Fig. e13.13

Pulmonary Langerhans cell histiocytosis. Cystic air spaces with thin walls in the right lower lung. Characteristically, the tip of the middle lobe is spared (arrow) [1] (TIF 565 kb)

Fig. e13.14

Pulmonary Langerhans cell histiocytosis. Irregular nodules and thick-walled cysts in the upper lung. Lower sections (not shown) showed relative sparing of the lung bases [1] (TIF 1053 kb)

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Eisenberg, R.L. (2020). Pulmonary Fibrosis. In: What Radiology Residents Need to Know: Chest Radiology . Springer, Cham. https://doi.org/10.1007/978-3-030-16826-1_13

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  • DOI: https://doi.org/10.1007/978-3-030-16826-1_13

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  • Online ISBN: 978-3-030-16826-1

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