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Semin Respir Crit Care Med 2003; 24(4): 365-376
DOI: 10.1055/s-2003-42373
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Fibrotic Idiopathic Interstitial Pneumonia: High-Resolution Computed Tomography Considerations

David A. Lynch
  • Department of Radiology, University of Colorado Health Sciences Center, School of Medicine, Denver, Colorado
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Publication History

Publication Date:
18 October 2003 (online)

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ABSTRACT

The fibrotic idiopathic interstitial pneumonias comprise usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP). The characteristic high-resolution computed tomography findings of UIP are reticular abnormality and honeycombing with basal and peripheral predominance. Honeycombing is the strongest predictor of UIP. The extent of fibrosis on computed tomography (CT) is an important prognostic indicator in idiopathic pulmonary fibrosis (IPF). When ground-glass attenuation is seen in IPF it commonly progresses to fibrosis and honeycombing. Imaging may help to detect complications of IPF, including accelerated progression, lung cancer, and secondary infection. Our understanding of the clinical and radiological features of NSIP is still evolving. The CT finding of extensive ground-glass abnormality and some reticular abnormality, with basal and peripheral predominance, is strongly suggestive of NSIP. However, the CT appearances of NSIP overlap with those of UIP, organizing pneumonia (OP), and desquamative interstitial pneumonia (DIP), and biopsy may be necessary to sort this out. Other idiopathic pneumonias that may be associated with CT evidence of lung fibrosis include DIP, OP, acute interstititial pneumonia, and lymphoid interstitial pneumonia.

KEYWORDS

Idiopathic interstitial pneumonia - usual interstitial pneumonia - nonspecific interstitial pneumonia - desquamative interstitial pneumonia - high-resolution chest CT

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