Idiopathic Pulmonary Fibrosis: Spectrum of High-Resolution CT Findings
Carolina Althoff Souza1,
Nestor L. Müller1,
Julia Flint2,
Joanne L. Wright2 and
Andrew Churg2
1 Department of Radiology, Vancouver General Hospital, University of British
Columbia, 899 W. 12th Ave., Vancouver, BC V5Z 1M9, Canada.
2 Department of Pathology, Vancouver General Hospital, University of British
Columbia, Vancouver, BC V5Z 1M9, Canada.
View larger version (143K):
[in a new window]
|
Fig. 1A —Classic idiopathic pulmonary fibrosis in 70-year-old man.
High-resolution CT shows bilateral subpleural reticulation, traction
bronchiectasis (curved arrow), and honeycombing (straight
arrows).
|
|
View larger version (151K):
[in a new window]
|
Fig. 1B —Classic idiopathic pulmonary fibrosis in 70-year-old man.
Coronal reformatted image shows characteristic predominance of abnormalities
in subpleural and basal regions.
|
|
View larger version (165K):
[in a new window]
|
Fig. 2 —Photomicrograph of histopathologic specimen of 57-year-old
man with mild usual interstitial pneumonia shows paucicellular dense fibrosis
concentrated in periphery of lobule (arrows). (H and E,
x50)
|
|
View larger version (117K):
[in a new window]
|
Fig. 3A —54-year-old man with severe idiopathic pulmonary fibrosis who
underwent lung transplantation. Extremely low-power view of pathologic
specimen from transplanted lung shows extensive honeycomb changes (curved
arrows) and less severely affected areas (straight arrow). (H
and E, x10)
|
|
View larger version (164K):
[in a new window]
|
Fig. 3B —54-year-old man with severe idiopathic pulmonary fibrosis who
underwent lung transplantation. Photomicrograph of histopathologic specimen
(higher-power view) of less severely affected areas shows patchy interstitial
fibrosis and occasional fibroblast foci (arrows). (H and E,
x50)
|
|
View larger version (125K):
[in a new window]
|
Fig. 4A —42-year-old woman with biopsy-proven idiopathic pulmonary
fibrosis. High-resolution CT shows patchy bilateral ground-glass opacities and
mild predominantly subpleural reticulation.
|
|
View larger version (126K):
[in a new window]
|
Fig. 4B —42-year-old woman with biopsy-proven idiopathic pulmonary
fibrosis. Photomicrograph of histopathologic specimen (low-power view) shows
typical patchy interstitial fibrosis and areas of microscopic honeycombing
(arrows). (H and E, x30)
|
|
View larger version (131K):
[in a new window]
|
Fig. 5 —High-resolution CT (HRCT) in 56-year-old woman with
biopsy-proven idiopathic pulmonary fibrosis (IPF) shows subtle areas of
ground-glass opacity involving both lungs and minimal subpleural reticulation.
HRCT findings are more suggestive of hypersensitivity pneumonitis or
nonspecific interstitial pneumonia than IPF.
|
|
View larger version (110K):
[in a new window]
|
Fig. 6A —68-year-old man with biopsy-proven idiopathic pulmonary
fibrosis (IPF). High-resolution CT shows patchy ground-glass opacities and
fibrosis with reticulation and traction bronchiectasis (straight
arrow). Some lobules appear relatively radiolucent, reflecting mosaic
perfusion and air-trapping (curved arrows). Findings are more
suggestive of hypersensitivity pneumonitis than IPF.
|
|
View larger version (126K):
[in a new window]
|
Fig. 6B —68-year-old man with biopsy-proven idiopathic pulmonary
fibrosis (IPF). Low-power view of autopsy specimen shows severe fibrosis and
honeycombing consistent with idiopathic pulmonary fibrosis. Microscopic
findings were characteristic of usual interstitial pneumonia; there was no
microscopic evidence of hypersensitivity pneumonitis. (H and E, x10)
|
|
View larger version (149K):
[in a new window]
|
Fig. 7A —61-year-old woman with biopsy-proven idiopathic pulmonary
fibrosis. High-resolution CT shows subpleural ground-glass opacity
(arrow) and mild reticulation.
|
|
View larger version (165K):
[in a new window]
|
Fig. 7B —61-year-old woman with biopsy-proven idiopathic pulmonary
fibrosis. Photomicrograph of histopathologic specimen obtained from region of
ground-glass opacity on CT shows microscopic honeycombing with airspaces
filled by mucus and inflammatory cells (arrows). (H and E,
x150)
|
|
View larger version (149K):
[in a new window]
|
Fig. 8A —57-year-old man with biopsy-proven idiopathic pulmonary
fibrosis. High-resolution CT (HRCT) shows patchy bilateral areas of
ground-glass opacity. Fine reticulation is observed in subpleural regions.
|
|
View larger version (151K):
[in a new window]
|
Fig. 8B —57-year-old man with biopsy-proven idiopathic pulmonary
fibrosis. HRCT at same approximate level as A, 2 years later, shows
ground-glass opacities more prominent in subpleural regions, reticulation, and
mild honeycombing.
|
|
View larger version (149K):
[in a new window]
|
Fig. 8C —57-year-old man with biopsy-proven idiopathic pulmonary
fibrosis. HRCT at same approximate level as A, 3 years later, shows
extensive reticular opacities, traction bronchiectasis, and honeycombing in
areas previously involved by ground-glass opacities.
|
|
View larger version (132K):
[in a new window]
|
Fig. 8D —57-year-old man with biopsy-proven idiopathic pulmonary
fibrosis. Gross pathologic specimen from autopsy shows predominantly lower
lobe, peripheral, and subpleural fibrotic lesions that alternate with areas of
normal lung (asterisks). Honeycombing cysts are seen in subpleural
regions (arrow).
|
|
View larger version (102K):
[in a new window]
|
Fig. 9A —Accelerated idiopathic pulmonary fibrosis (IPF) in
62-year-old man. High-resolution CT (HRCT) shows patchy bilateral ground-glass
opacities and subpleural reticulation.
|
|
View larger version (86K):
[in a new window]
|
Fig. 9B —Accelerated idiopathic pulmonary fibrosis (IPF) in
62-year-old man. HRCT obtained 10 days later shows extensive areas of
ground-glass opacity and patchy consolidation involving both lungs.
|
|
View larger version (147K):
[in a new window]
|
Fig. 9C —Accelerated idiopathic pulmonary fibrosis (IPF) in
62-year-old man. Low-power view of lung at autopsy shows extensive fibrosis
and honeycombing (arrow). (H and E, x30)
|
|
View larger version (163K):
[in a new window]
|
Fig. 9D —Accelerated idiopathic pulmonary fibrosis (IPF) in
62-year-old man. Another area of same lung shows hyaline membranes of diffuse
alveolar damage (arrows). Changes of diffuse alveolar damage are
typical microscopic finding in accelerated IPF. (H and E, x150)
|
|
View larger version (130K):
[in a new window]
|
Fig. 10 —High-resolution CT of 71-year-old man with idiopathic
pulmonary fibrosis shows extensive reticulation, subpleural honeycombing, and
architectural distortion. Subpleural irregular nodule (curved arrow)
is seen within area of severe fibrosis in right lung. Diagnosis of pulmonary
carcinoma was proven by biopsy.
|
|
View larger version (122K):
[in a new window]
|
Fig. 11A —74 year-old-man with idiopathic pulmonary fibrosis and
pulmonary ossification. High-resolution CT (HRCT) shows subpleural
reticulation and mild ground-glass opacity.
|
|
View larger version (97K):
[in a new window]
|
Fig. 11B —74 year-old-man with idiopathic pulmonary fibrosis and
pulmonary ossification. HRCT image photographed using soft-tissue windows at
same level as A shows bilateral small calcified nodules (curved
arrows) within areas of fibrosis.
|
|
View larger version (109K):
[in a new window]
|
Fig. 12A —63-year-old man with biopsy-proven desquamative interstitial
pneumonia (DIP). High-resolution CT (HRCT) shows patchy bilateral areas of
ground-glass opacity and mild reticulation.
|
|
View larger version (172K):
[in a new window]
|
Fig. 12B —63-year-old man with biopsy-proven desquamative interstitial
pneumonia (DIP). Photomicrograph of histopathologic specimen obtained by
surgical biopsy shows mild thickening of alveolar septa and extensive airspace
filling by macrophages (arrows). (H and E, x100) Inset:
Higher-power view shows airspace macrophages and chronic interstitial
inflammatory infiltrate (arrow). (H and E, x250) Findings are
characteristic of DIP.
|
|
View larger version (148K):
[in a new window]
|
Fig. 12C —63-year-old man with biopsy-proven desquamative interstitial
pneumonia (DIP). HRCT scan at same approximate level as A 13 years
later shows extensive fibrotic changes with irregular reticular opacities,
traction bronchiectasis, and subpleural honeycombing (arrows).
Findings are those of end-stage fibrosis and mimic those of idiopathic
pulmonary fibrosis.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2005 by the American Roentgen Ray Society.
