Abstract
Background: The social strain with increasing incidence of Interstitial lung disease [ILD] has manifested in recent times. Environmental pollution with toxic fumes and inorganic dust lead to alveolitis, interstitial inflammation and fibrosis. Organic dusts exposure results in hypersensitivity pneumonitis while radiation and certain drugs like amiodarone, anti-cancer drugs can lead to ILD. It has become imperative that ILD be detected at an early state so that progression of the disease can be interrupted early and patient leads a longer productive life. Early diagnosis in patients with persistent dyspnoea, unexplained fatigue and stress related respiratory distress with High resolution computed tomography [HRCT] aids in providing appropriate therapy and follow up.
Results: The mean age group of study population of 46 cases was 58 years. Interlobular thickening and peri-bronchial fibrosis were additional features on HRCT suggestive of ILD seen in significant number of cases which was not detected by chest X ray. The sensitivity of chest X ray making radiological diagnosis of ILD was 78.26% while sensitivity by HRCT was 100% provided that all the cases included in this study was supported by clinical diagnosis of ILD as there were no lung biopsy taken in the study population to make a definitive diagnosis of the same.
Conclusion: HRCT can avoid tormenting procedure of open lung biopsy in diagnosing many cases of ILD. Even with equivocal results, HRCT can guide surgeon for lung biopsy site and aid diagnosis of ILD. HRCT in the present era, is indispensable for the diagnosis, prognosis and management and follow up of the cases of interstitial lung disease
Study design: Hospital based prospective & analytical study.
References
- Coultas DB, Zumwalt RE, Black WC, et al: The epidemiology of interstitial lung diseases. Am J Respir Crit Care Med 150:967, 1994
- Katzenstein AL, Myers JL: Idiopathic pulmonary fibrosis: Clinical relevance of pathologic classification. Am J Respir Crit Care Med 1571301, 1998
- Gay SE, Kazerooni EA, Toews GB, et al: Idiopathic pulmonary fibrosis: Predicting response to therapy and survival. Am J Respir Crit Care Med 1571063, 1998
- Bjoraker J, Ryu J, Edwin M, et al: Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 157199, 1998
- Adler BD, Padley SPG, Muller NL, et al: Chronic hypersensitivity pneumonitis: High-resolution CT and radiographic features in 16 patients. Radiology 185:91–95, 1992.
- Akira M, Kita N, Higashihara T, et al: Summer-type hypersensitivity pneumonitis: Comparison of highresolution CT and plain radiographic findings. AJR Am J Roentgenol 158:1223–1228, 1992
- Swensen SJ, Aughenbaugh GL, Douglas WW, et a1 High-resolution CT of the lungs: Findings in various pulmonary diseases. Am J Roentgenol 158971-979, 1992
- Galvin JR, Mori M, Stanford W: High-resolution computed tomography and diffuse lung disease. In Keats TE (ed): Current Problems in Diagnostic Radiology, vol 21. St. Louis, Mosby Year Book, 1992, pp 35-38
- Grenier P, Valeyre D, Cluzel P, et al. Chronic diffuse interstitial lung disease: diagnostic value of chest radiography and high-resolution CT. Radiology 1991; 179:123–32.
- Felson B: Chest Roentgenology. Philadelphia, WB Saunders, 1973
- Simon G: Principles of Chest X-ray Diagnosis, ed 3. London, Butterworth, 1971
- Stern EJ, Webb WR, Gamsu G. Dynamic quantitative computed tomography: a predictor of pulmonary function in obstructive lung diseases. Invest Radiol 1994;29:564–9.
- Stern EJ, Webb WR. Dynamic imaging of lung morphology with ultrafast high-resolution computed tomography. J Thorac Imaging 1993;8:273 –82.
- Grainger RG and Allison D.J, Diagnostic Radiology : An anglo American text book of Imaging, second edition, 1992, Vol I, pg 308
- Grainger and Allisons, Diagnostic Radiology: A text book of medical imaging, fourth edition, 2001, pg 491 – 518
- Webb WR, Mu¨ ller NL, Naidich DP. High-resolution CT of the lung. Philadelphia7 Lippincott Williams and Wilkins; 2001.
- Webb WR, Stein MG, Finkbeiner WE, et al. Normal and diseased isolated lungs: high-resolution CT. Radiology 1988;166:81– 7.
- Akira M, Hamada H, Sakatani M, et a1 CT findings during phase of accelerated deterioration in patients with idiopathic pulmonary fibrosis. AJR Am J Roentgenol 168:79, 1997
- Akira M, Sakatani M, Ueda E: Idiopathic pulmonary fibrosis: Progression of honeycombing at thin-section CT. Radiology 189:687, 1993
- Copley SJ and Bush A, Imaging: HRCT of pediatric lung disease, pediatric respiratory review, 1(2), June 2000, pg 141-7
- Aberle DR, Gamsu G, Ray CS. High-resolution CT of benign asbestos-related diseases: clinical and radiographic correlation. AJR Am J Roentgenol 1988;151: 883– 91.
- Hansel1 DM: High-resolution computed tomography of the lung. In Armstrong P, Wilson AG, Dee P, et a1 (eds): Imaging of Diseases of the Chest, ed 2. St. Louis, Mosby Year Book, 1995, pp 125-130
- Mayo JR, Webb WR, Gould R, et al: High-resolution CT of the lungs: An optimal approach. Radiology 163:507-510, 1987
- Fraser and Pare, Increased lung density, Diagnosis of the disease of chest, 1999,. Third edition, volume I, pg : 456 – 457
- Fujii M et al, ILD in Rheumatoid arthritis assessment with HRCT, Journal of thoracic imaging, 8(1), 1993, pg 54-62
- Sainani GS et al, API text book of medicine, 8th edition, 2009, pg 285
- Mathieson JR, Mayo JR, Staples CA, et a1 Chronic diffuse infiltrative lung disease: Comparison of diagnostic accuracy of CT and chest radiography. Radiology 171:111, 1989
- Nestor L. Muller et al, Fibrosingalveolitis, CT – pathologic correlation, Radiology Vol, 160, No.3, September 1986, pg 585-588
- Volpe J, Storto ML, Lee K, et al: High-resolution CT of the lung: Determination of the usefulness of CT scans obtained with the patient prone based on plain radiographic findings. 'km J Roentgenol 169:'369-374,1997.
- Ooi GC et al, Interstitial lung diseases in systemic sclerosis, acta radiology, May 2003, volume 44(No.3), pg 258-64
- Rotondo et al, interstitial lung diseases in systemic sclerosis, radiology med, 86(3), September 1993, pg 213-9
- Glaspole IN et al, The application of HRCT in diffuse parenchymal lung disease, monalds archive of chest diseases, 56(3), June 2001, pg 233-239
- Kazerooni EA et al, thin section CT obtained at 10mm increment versus limited three level thin section CT for IPF: correlation with pathologic scoring, American Jornal of Roentgenology, 169(4), Oct 1997, Pg 977-983
- Lynch JP 111, Hunninghake GW: Pulmonary complications of collagen vascular disease. AnnuRev Med. 43:17-35, 1992
- Fenlon HM, Casserly I, Sant SM, et al: Plain radiographs and thoracic high-resolution CT in patients with ankylosing spondylitis. AJR Am J Roentgenol 168~1067-1072, 1997
- Casserly IP, Fenlon HM, Breatnach E, et al: Lung findings on high-resolution computed tomography in idiopathic ankylosing spondylitis: Correlation with clinical findings, pulmonary function testing and plain radiography. Br J Rheumatol 36:677482, 1997
- Hansell DM,HRCT in the evaluation of fibrosingalveolitis, clinical chest medicine, vol 20, No.4, December 1991, pg 739-760
- Webb WR, Muller NL, Naidich DP: High-Resolution CT of the Lung, ed 2. Philadelphia, Lippincott-Raven,1996
- Grays Anatomy, The respiratory system, 40th edition, , pg 1248 – 1286
- W i g NS Anatomy. In Dail DH, Hammar SP (eds): Pulmonary Pathology, ed 2. New York, Springer-Verlag, 1994, pp 21-25
- Robbins, Basic pathology, 9th edition, 2010, pg 434
- Aquino SL, Gamsu G, Webb WR, et al: Tree-in-bud pattern: Frequency and significance on thin section CT. J Comput Assist Tomogr 20:594-599, 1996
- Naidich DP: Pulmonary parenchymal high-resolution CT To be or not to be. Radiology 171:22-24, 1989
- Corcoran HL, Renner WR, Milstein MJ: Review of high-resolution CT of the lung. Radiographics 12:917-941, 1992
- Austin JHM, Miiller NL, Friedman PJ, et al: Glossary of terms for CT of the lungs: Recommendations of the nomenclature committee of the Fleischner Society. Radiology 200:327, 1996
- Collins J, Blankenbaker D, Stem EJ: CT patterns of bronchiolar disease: What is ”tree-in-bud”? AJR Am J Roentgenol 171:365-370, 1998
- Collins J, Stem EJ: Ground-glass opacity at CT The ABCs. AJR Am J Roentgenol 169:355-367, 1997
- Curtis AM, Smith GJW, Ravin CE: Air crescent sign of invasive aspergillosis. Radiology 133:17, 1979
- Kang EY, Grenier P, Laurent F, et al: Interlobular septal thickening: Patterns at high-resolution computed tomography. J Thorac Imaging 11:260-264,1996
- ATS/ERS International Multidisciplinary Consensus Classification of Idiopathic Interstitial Pneumonias: General Principles and Guidelines. Toronto, American Thoracic Society, 2000
- Leland L Fan, interstitial lung disease in children, National Jewish medical science, update, volume 13, Number 1, 1995
- King T E jr, interstitial lung disease, Harrison’s principles of internal medicine, 15th edition, 2001, pg 1499.
Corresponding Author
Dr Chaitra Srinivas
Assistant Professor, Dept. of Radiodiagnosis KIMS Medical College, Bangalore, India
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.96
