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Gautham P. Reddy, MD, MPH University of Washington Gautham P. Reddy, MD, MPH University of Washington HRCT for Interstitial Lung Disease
Gautham P. Reddy, MD, MPHUniversity of Washington
Gautham P. Reddy, MD, MPHUniversity of Washington
HRCT for InterstitialLung Disease
Reticular OpacitiesReticular OpacitiesReticular Opacities
LargeLargeLarge
Interlobular Septal
Thickening
Interlobular Interlobular SeptalSeptal
ThickeningThickening
SmallSmallSmall
Intralobular Interstitial Thickening
Intralobular Intralobular Interstitial Interstitial ThickeningThickening
IntermediateIntermediateIntermediate
HoneycombingHoneycombingHoneycombing
Case 1
Septal ThickeningSeptal ThickeningSeptal Thickening
Large PatternLarge PatternLarge Pattern•• Variety of diseasesVariety of diseases•• Length 1Length 1--2 cm2 cm•• Diameter of lobules 1Diameter of lobules 1--2 cm2 cm•• Central arteryCentral artery•• Smooth, nodular or irregularSmooth, nodular or irregular
Interlobular Septal ThickeningInterlobular Septal ThickeningInterlobular Septal Thickening
NodularNodularNodular Irregular,Lung distortion
Irregular,Irregular,Lung distortionLung distortionSmoothSmoothSmooth
Thick septa predominantThick septa Thick septa predominantpredominant
• Edema• Lymphangitic
tumor• Hemorrhage
•• EdemaEdema•• Lymphangitic Lymphangitic
tumortumor•• Hemorrhage Hemorrhage
GGO predominant
GGO GGO predominantpredominant
“Crazy Paving”• Edema• PCP, CMV• Hemorrhage• Alveolar
proteinosis
““Crazy PavingCrazy Paving””•• EdemaEdema•• PCP, CMVPCP, CMV•• HemorrhageHemorrhage•• Alveolar Alveolar
proteinosisproteinosis
Pulmonary Edema
Lymphagitic Tumor
Lymphagitic Tumor
Pulmonary Edema
CMV Pneumonia
PCP
Alveolar Proteinosis
Case 2
Interlobular Septal ThickeningInterlobular Septal ThickeningInterlobular Septal Thickening
NodularNodularNodular Irregular,Lung distortion
Irregular,Irregular,Lung distortionLung distortionSmoothSmoothSmooth
• Sarcoid • Lymphangitic
tumor
•• Sarcoid Sarcoid •• Lymphangitic Lymphangitic
tumor tumor
Lymphagitic Tumor
Sarcoid
Case 3
Interlobular Septal ThickeningInterlobular Septal ThickeningInterlobular Septal Thickening
NodularNodularNodular Irregular,Lung distortion
Irregular,Irregular,Lung distortionLung distortionSmoothSmoothSmooth
HoneycombingDifferential
HoneycombingHoneycombingDifferentialDifferential
• IPF• Sarcoid• Asbestosis
•• IPFIPF•• SarcoidSarcoid•• AsbestosisAsbestosis
Rheumatoid
Case 4
HoneycombingHoneycombingHoneycombing
Intermediate PatternIntermediate PatternIntermediate Pattern•• Extensive fibrosis / destructionExtensive fibrosis / destruction•• Reticular and cystic (0.5 Reticular and cystic (0.5 -- 1 cm)1 cm)•• Architectural distortionArchitectural distortion•• Secondary lobules difficult or Secondary lobules difficult or
impossible to recognizeimpossible to recognize•• No need to biopsyNo need to biopsy
HoneycombingHoneycombingHoneycombing
SubpleuralPosterior
Lower lobe predominance
SubpleuralSubpleuralPosteriorPosterior
Lower lobe Lower lobe predominancepredominance
Other(Central,
Upper Lobe)
OtherOther(Central,(Central,
Upper Lobe)Upper Lobe)
• Usual interstitial pneumonia / IPF
• Collagen vasc dz • Hypersensitivity
pneumonitis (chronic)
•• Usual interstitial Usual interstitial pneumonia / IPFpneumonia / IPF
•• Collagen vasc dz Collagen vasc dz •• Hypersensitivity Hypersensitivity
pneumonitis pneumonitis (chronic)(chronic)
IPF
Chronic HP
Rheumatoid
Case 5
HoneycombingHoneycombingHoneycombing
SubpleuralPosterior
Lower lobe predominance
SubpleuralSubpleuralPosteriorPosterior
Lower lobe Lower lobe predominancepredominance
Other(Central,
Upper Lobe)
OtherOther(Central,(Central,
Upper Lobe)Upper Lobe)
• Sarcoid• Radiation • Hypersensitivity
pneumonitis (chronic)
•• SarcoidSarcoid•• Radiation Radiation •• Hypersensitivity Hypersensitivity
pneumonitis pneumonitis (chronic)(chronic)
Sarcoid
Sarcoid
Sarcoid
Case 6
Intralobular ThickeningIntralobular ThickeningIntralobular Thickening
Small PatternSmall PatternSmall Pattern•• Can be early sign of fibrosisCan be early sign of fibrosis•• Can be seen with honeycombingCan be seen with honeycombing•• Fine, irregular reticulationFine, irregular reticulation•• Outlines Outlines ““holesholes”” a few mm aparta few mm apart
Intralobular ThickeningIntralobular ThickeningIntralobular Thickening
GGO presentGGO GGO
presentpresentSeptal Thickening
present
Septal Septal ThickeningThickening
presentpresentIsolated
abnormality OR
Fibrosis
Isolated Isolated abnormality abnormality
ORORFibrosisFibrosis
Honeycombing Diff Dx
Honeycombing Diff Honeycombing Diff DxDx
NSIP“Crazy Paving”• Edema• PCP, CMV• Hemorrhage• Alv proteinosis
NSIPNSIP““Crazy PavingCrazy Paving””•• EdemaEdema•• PCP, CMVPCP, CMV•• HemorrhageHemorrhage•• Alv proteinosisAlv proteinosis
SeptalThickening
Diff Dx
SeptalSeptalThickening Thickening
Diff DxDiff Dx
NSIP: Mixed Conn Tissue d/o
SLE
IPF
