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Patient is a 54y/o female who had an interstitial pattern on CXR. - PowerPoint PPT Presentation


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Clinical Information: Patient is a 70y/o female who is on prednisone for arthritis and presents with recent onset of cough. CXR shows prominent interstitial markings. Patient is a 54y/o female who had an interstitial pattern on CXR. Differential diagnosis. Sarcoid Langerhans Idiopathic

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Presentation Transcript
slide1
Clinical Information:Patient is a 70y/o female who is on prednisone for arthritis and presents with recent onset of cough. CXR shows prominent interstitial markings.
differential diagnosis
Differential diagnosis

Sarcoid

Langerhans

Idiopathic

Desquamative

Coal workers

Bagassosis

Silicosis

Drug reaction

Asbestosis

Lymphangitic

Erdheim Chester

Lymphangiomyomatosis

Chronic failure

Farmer’s lung

AnkylosingSpondylitis

Neurofibromatosis

Rheumatoid

Scleroderma

Hard metal disease

Emphysema

PAP

Aspiration

Gauchers

Sjogrens

LIP

Mushroom workers lung

Methotrexate lung

Respiratory bronchiolitis

BOOP

Periarteritisnodosa

Lupus

Bronchiectasis

Berylliosis

Bronchiolitisobliterans

Alveolar microlithiasis

Metastatic calcification

differential diagnosis9
Differential diagnosis

More than 100 entities manifest as diffuse lung disease. Fortunately only 10-20 of these account for about 90% of all diffuse lung disease that is assessed by open lung biopsy.

Sarcoid

Langerhans granulomatosis

Idiopathic pulmonary fibrosis

Lymphangitic tumor

Edema

Asbestosis

Collagen vascular diseases

Silicosis

Farmer’s lung

Drugs

differential diagnosis10
Differential diagnosis

HONEYCOMBING & BRONCHIECTASIS

Pulmonary fibrosis (IPF, RA, scleroderma, drug reaction, asbestosis, end-stage hypersensitivity pneumonitis)

Sarcoidosis

BRONCHIECTASIS

Sarcoidosis

Pulmonary fibrosis

Hypersensitivity pneumonitis

Allergic bronchopulmonaryaspergilosis

Cystic fibrosis

MOSAIC ATTENUATION

BronchiolitisObliterans

Cystic fibrosis

Chronic PE

AIR TRAPPING

Obliterativebronchiolitis

Asthma

Hypersensitivity pneumonitis

Normal variant (seen in superior segement of left lobe, middle lobe or lingula)

NODULAR SEPTAL THICKENING, HONEYCOMBING & BRONCHIECTASIS

Idiopathic pulmonary fibrosis

Sarcoidosis (end-stage)

diagnosis
Diagnosis

Pulmonary Fibrosis associated with Rheumatoid Arthritis

information from literature
Information from literature

“Diseases such as rheumatoid arthritis and

scleroderma are also associated with diffuse

interstitial thickening. Pathologically, there may be a UIP or NSIP pattern, indistinguishable from IPF.

Dyspnea is a common complaint. Prognosis is

variable and life-expectancy is longer with NSIP

than UIP.”

Practical Approach HRCT

Jud W Gurney MD FACR

Charles A Dobry Professor of Radiology

University of Nebraska

rheumatoid arthritis
Rheumatoid Arthritis

Thoracic involvement often develops in patients as their disease progresses. Pleural disease is the most common thoracic manifestation. Pleural thickening is the next most common finding and is seen more often than pleural effusion. Pleural effusions are usually unilateral and may be loculated.

Pulmonary fibrosis occurs in 2%–9% of patients with rheumatoid arthritis. High-resolution CT scans show a reticular pattern and irregular interlobular septal thickening predominantly in the lung periphery and lower lung zones Honeycombing and progressive volume loss develop as the disease progresses.

In rare cases, fibrosis may be limited to the upper lobes and contain areas of cavitation, characteristics that mimic those of tuberculosis. Like any patient with pulmonary fibrosis, patients with pulmonary fibrosis associated with rheumatoid arthritis have an increased prevalence of lung cancer.

RadioGraphics 2000; 20:1623–1635

rheumatoid arthritis17
Rheumatoid Arthritis

Pulmonary nodules are uncommon in patients with rheumatoid arthritis and are usually associated with advanced disease and subcutaneous nodules. Usually multiple and well circumscribed, they often result in thick walled cavities.

Patients with RA have an increased prevalence of airway diseases such as bronchiolitis obliterans and BOOP. Obliterative bronchiolitis occurs with increased frequency in patients with rheumatoid arthritis regardless of whether they have received penicillamine or gold therapy. HRCT may show a characteristic mosaic pattern of attenuation and perfusion.

The predominant radiographic and high-resolution CT finding in patients with BOOP is airspace consolidation that is usually bilateral and tends to have a patchy peripheral or peribronchial distribution.

RadioGraphics 2000; 20:1623–1635

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