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Brady D, Berkowitz EA, Sharma A, Ackman JB, Bernheim A, Chung M, Veeraraghavan S, Little BP. CT Morphologic Characteristics and Variant Patterns of Interstitial Pulmonary Fibrosis in Systemic Lupus Erythematosus. Radiol Cardiothorac Imaging 2021; 3:e200625. [PMID: 34498003 DOI: 10.1148/ryct.2021200625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/31/2021] [Accepted: 06/21/2021] [Indexed: 11/11/2022]
Abstract
Purpose To assess CT features of pulmonary fibrosis in patients with systemic lupus erythematosus (SLE) and to assess the presence of several distinctive patterns of fibrosis associated with connective tissue disease. Materials and Methods A cross-sectional retrospective analysis was performed. An institutional clinical database was queried for the years of 2005-2015 to identify CT examination reports of patients with SLE and fibrotic lung disease, which yielded 50 patients (median age, 49 years; age range, 22-71 years; 46 women). CT examination reports were scored by two subspecialty thoracic radiologists using a standard multilevel semiquantitative system. Readers noted the presence or absence of several recently described CT signs of variant patterns of fibrosis in connective tissue disease (the "anterior upper lobe," "straight-edge," and "exuberant honeycombing" signs), as well as two other morphologic characteristics (an "island-like" appearance of areas of well-defined fibrosis with angular margins surrounded by normal lung and confluent regions of lucent lung destruction). Results The most common CT patterns were characterized as either fibrotic nonspecific interstitial pneumonia (38%, 19 of 50) or variant fibrosis (44%, 22 of 50). CT signs of variant fibrosis were identified by both readers in up to 62% of patients, with good κ agreement (0.44-0.64); the island-like sign (62%) and anterior upper lobe sign (52%) were most commonly observed. Pulmonary function test results showed correlations with several imaging findings but did not show correlations with CT signs of variant fibrosis. Conclusion When present, pulmonary fibrosis in SLE often has a distinctive appearance and may also manifest as several variant fibrotic patterns.Keywords: CT, Lung© RSNA, 2021See also the commentary by White in this issue.
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Affiliation(s)
- Darragh Brady
- Department of Radiology, Children's National Hospital, Washington, DC (D.B.); Department of Radiology and Imaging Sciences (E.A.B.) and Department of Medicine, Division of Pulmonary and Critical Care Medicine (S.V.), Emory University, Atlanta, Ga; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., J.B.A., B.P.L.); and Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.B., M.C.)
| | - Eugene A Berkowitz
- Department of Radiology, Children's National Hospital, Washington, DC (D.B.); Department of Radiology and Imaging Sciences (E.A.B.) and Department of Medicine, Division of Pulmonary and Critical Care Medicine (S.V.), Emory University, Atlanta, Ga; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., J.B.A., B.P.L.); and Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.B., M.C.)
| | - Amita Sharma
- Department of Radiology, Children's National Hospital, Washington, DC (D.B.); Department of Radiology and Imaging Sciences (E.A.B.) and Department of Medicine, Division of Pulmonary and Critical Care Medicine (S.V.), Emory University, Atlanta, Ga; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., J.B.A., B.P.L.); and Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.B., M.C.)
| | - Jeanne B Ackman
- Department of Radiology, Children's National Hospital, Washington, DC (D.B.); Department of Radiology and Imaging Sciences (E.A.B.) and Department of Medicine, Division of Pulmonary and Critical Care Medicine (S.V.), Emory University, Atlanta, Ga; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., J.B.A., B.P.L.); and Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.B., M.C.)
| | - Adam Bernheim
- Department of Radiology, Children's National Hospital, Washington, DC (D.B.); Department of Radiology and Imaging Sciences (E.A.B.) and Department of Medicine, Division of Pulmonary and Critical Care Medicine (S.V.), Emory University, Atlanta, Ga; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., J.B.A., B.P.L.); and Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.B., M.C.)
| | - Michael Chung
- Department of Radiology, Children's National Hospital, Washington, DC (D.B.); Department of Radiology and Imaging Sciences (E.A.B.) and Department of Medicine, Division of Pulmonary and Critical Care Medicine (S.V.), Emory University, Atlanta, Ga; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., J.B.A., B.P.L.); and Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.B., M.C.)
| | - Srihari Veeraraghavan
- Department of Radiology, Children's National Hospital, Washington, DC (D.B.); Department of Radiology and Imaging Sciences (E.A.B.) and Department of Medicine, Division of Pulmonary and Critical Care Medicine (S.V.), Emory University, Atlanta, Ga; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., J.B.A., B.P.L.); and Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.B., M.C.)
| | - Brent P Little
- Department of Radiology, Children's National Hospital, Washington, DC (D.B.); Department of Radiology and Imaging Sciences (E.A.B.) and Department of Medicine, Division of Pulmonary and Critical Care Medicine (S.V.), Emory University, Atlanta, Ga; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., J.B.A., B.P.L.); and Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.B., M.C.)
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Hellemons ME, Moor CC, von der Thüsen J, Rossius M, Odink A, Thorgersen LH, Verschakelen J, Wuyts W, Wijsenbeek MS, Bendstrup E. Desquamative interstitial pneumonia: a systematic review of its features and outcomes. Eur Respir Rev 2020; 29:29/156/190181. [PMID: 32581140 PMCID: PMC9488565 DOI: 10.1183/16000617.0181-2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/29/2020] [Indexed: 12/31/2022] Open
Abstract
Background Desquamative Interstitial Pneumonia (DIP) is a rare form of idiopathic interstitial pneumonia (IIP). Data on clinical features, aetiology, prognosis and effect of treatment strategies are limited. We aimed to collect all published cases to better characterise DIP. Methods A systematic literature search was performed for all original cases of adult patients with histopathologically-confirmed DIP. Individual patient data were extracted and summarised. Results We included 68 individual cases and 13 case series reporting on 294 cases. Most common presenting symptoms were dyspnoea and cough. Pulmonary function showed a restrictive pattern (71%) with decreased diffusion capacity. We found a high incidence (81%) of ever smoking in patients with DIP and 22% of patients had other (occupational) exposures. Characteristic features on high-resolution computed tomography (HRCT) scan were bilateral ground-glass opacities with lower lobe predominance (92%). Treatment and duration of treatment widely varied. Initial response to treatment was generally good, but definitely not uniformly so. A significant proportion of patients died (25% of individual cases) or experienced a relapse (18% of individual cases). Conclusion DIP remains an uncommon disease, frequently but not always related to smoking or other exposures. Furthermore, DIP behaves as a progressive disease more often than generally thought, possibly associated with different underlying aetiology. This systematic review is the most comprehensive collection of published cases of DIP to date and yields novel information about aetiology, clinical characteristics, radiology and pathology features, treatment and outcomes.http://bit.ly/394YRPv
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Affiliation(s)
- Merel E Hellemons
- Dept of Interstitial Lung Disease, Erasmus Medical Center, Rotterdam, The Netherlands.,This centre is a member of the European Reference Network for Rare Lung Diseases/Interstitial Lung Diseases (ERN-LUNG ILD).,These authors share first authorship
| | - Catharina C Moor
- Dept of Interstitial Lung Disease, Erasmus Medical Center, Rotterdam, The Netherlands.,This centre is a member of the European Reference Network for Rare Lung Diseases/Interstitial Lung Diseases (ERN-LUNG ILD).,These authors share first authorship
| | - Jan von der Thüsen
- Dept of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands.,This centre is a member of the European Reference Network for Rare Lung Diseases/Interstitial Lung Diseases (ERN-LUNG ILD)
| | - Mariska Rossius
- Dept of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.,This centre is a member of the European Reference Network for Rare Lung Diseases/Interstitial Lung Diseases (ERN-LUNG ILD)
| | - Arlette Odink
- Dept of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.,This centre is a member of the European Reference Network for Rare Lung Diseases/Interstitial Lung Diseases (ERN-LUNG ILD)
| | | | - Johny Verschakelen
- Dept of Radiology, University Hospital Leuven, Leuven, Belgium.,This centre is a member of the European Reference Network for Rare Lung Diseases/Interstitial Lung Diseases (ERN-LUNG ILD)
| | - Wim Wuyts
- Unit of Interstitial Lung Disease, University Hospital Leuven, Leuven, Belgium.,This centre is a member of the European Reference Network for Rare Lung Diseases/Interstitial Lung Diseases (ERN-LUNG ILD).,These authors share senior authorship
| | - Marlies S Wijsenbeek
- Dept of Interstitial Lung Disease, Erasmus Medical Center, Rotterdam, The Netherlands .,This centre is a member of the European Reference Network for Rare Lung Diseases/Interstitial Lung Diseases (ERN-LUNG ILD).,These authors share senior authorship
| | - Elisabeth Bendstrup
- Dept of Respiratory Diseases and Allergy, Center for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark.,This centre is a member of the European Reference Network for Rare Lung Diseases/Interstitial Lung Diseases (ERN-LUNG ILD).,These authors share senior authorship
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Chen Y, Wang Y, Chen X, Liang H, Yang X. Association of Interstitial Lung Disease With Clinical Characteristics of Chinese Patients With Systemic Lupus Erythematosus. Arch Rheumatol 2020; 35:239-246. [PMID: 32851373 DOI: 10.46497/archrheumatol.2020.7583] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/16/2019] [Indexed: 12/18/2022] Open
Abstract
Objectives This study aims to evaluate the frequency and clinical and laboratory features of interstitial lung disease (ILD) in Chinese patients with systemic lupus erythematosus (SLE) and to evaluate the association of ILD with the clinical features. Patients and methods The study included 505 SLE patients (64 males, 441 females; mean age 35.3±15.3 years; range, 14 to 87 years) who were categorized into two groups as 449 patients without ILD and 56 patients with ILD based on evidence obtained from high-resolution computed tomography images. The demographic data, clinical and laboratory findings, SLE disease activity index score, and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index of all patients were also recorded and statistically analyzed. Results The ILD frequency in patients with SLE was 11.1%. Compared to the group of SLE patients without ILD, the group of SLE patients with ILD possessed the following statistical differences: elderly age, longer illness duration, lower level of anti-double-stranded deoxyribonucleic acid, and higher level of serum complement 3, increased ratios of Raynaud's phenomenon, moist rales and tachypnea. Multivariate logistic regression results suggested that elderly age (≥60 years), long illness duration (1-10 years, ≥10 years), Raynaud's phenomenon, and tachypnea were statistically associated with the occurrence of ILD in SLE patients. Conclusion Chinese SLE patients who possessed the factors that were statistically associated with ILD, namely, elderly age (≥60 years old), long illness duration (≥1 years), Raynaud's phenomenon, and tachypnea, were recommended to be monitored for the possibility of ILD.
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Affiliation(s)
- Yaling Chen
- Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yanqing Wang
- Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiangfang Chen
- Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huishun Liang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xuwei Yang
- Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, China
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Bak SH, Lee HY. Overlaps and uncertainties of smoking-related idiopathic interstitial pneumonias. Int J Chron Obstruct Pulmon Dis 2017; 12:3221-3229. [PMID: 29138550 PMCID: PMC5677302 DOI: 10.2147/copd.s146899] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Smoking-related interstitial lung disease (ILD) consists of a heterogeneous group of disorders that are considered a distinct entity. The 2013 American Thoracic Society and European Respiratory Society recommendations classified respiratory bronchiolitis (RB)/RB-ILD and desquamative interstitial pneumonia (DIP) as smoking-related idiopathic interstitial pneumonias (IIPs). The overlapping histopathological and radiological patterns of smoking-related IIPs must be considered. Overlap patterns of smoking-related IIPs are not easily classified as a single disorder. The initial radiological manifestation and follow-up changes are heterogeneous, even when diagnosed pathologically as RB or DIP. Therefore, a clinical–radiological–pathological consensus is important in the diagnosis of smoking-related IIPs, and long-term evaluation is essential to monitor the morphological changes in these patients. In this article, we reviewed the clinical, radiological, and pathological findings, and also the changes in radiological manifestations of smoking-related IIPs over time.
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Affiliation(s)
- So Hyeon Bak
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.,Department of Radiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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Palmucci S, Roccasalva F, Puglisi S, Torrisi SE, Vindigni V, Mauro LA, Ettorre GC, Piccoli M, Vancheri C. Clinical and radiological features of idiopathic interstitial pneumonias (IIPs): a pictorial review. Insights Imaging 2014; 5:347-64. [PMID: 24844883 PMCID: PMC4035488 DOI: 10.1007/s13244-014-0335-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/10/2014] [Accepted: 04/15/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To illustrate the clinical and radiological features of idiopathic interstitial pneumonias (IIPs), according to the American Thoracic Society (ATS)/European Respiratory Society (ERS) classification updated in 2013. METHODS IIPs include a subset of diffuse and restrictive lung diseases, resulting from damage to the parenchyma characterised by inflammation and fibrosis of the interstitium. Classification into major and rare IIPs is based on the 2013 ATS/ERS committee. RESULTS The diagnosis of idiopathic pulmonary fibrosis (IPF) needs to exclude other well-known causes of interstitial lung diseases. According to the 2011 evidence-based guidelines, usual interstitial pneumonia (UIP) can be diagnosed by HRCT when all criteria are fulfilled. Non-specific interstitial pneumonia (NSIP) is characterised by patchy ground-glass opacities and irregular linear/reticular opacities. The imaging patterns of respiratory bronchiolitis associated-interstitial lung disease (RB-ILD) and desquamative interstitial pneumonia (DIP) show centrolobular nodules and ground-glass opacities. Cryptogenic organising pneumonia (COP) consists of patchy peripheral or peribronchial consolidations, while ground-glass opacities are typically associated with diffuse lung consolidation, evolving to fibrosis, in acute interstitial pneumonia (AIP). Rare IIPs include lymphoid interstitial pneumonia and idiopathic pleuro-parenchymal fibroelastosis (IPPFE). CONCLUSIONS The knowledge of IIP imaging features on HRCT images help radiologists in diagnosis. Moreover, the overlap of imaging features needs a multidisciplinary approach. TEACHING POINTS • UIP findings are reticulations, bronchiectasis, honeycombing and absence of inconsistent features. • Bilateral patchy ground-glass areas represent the most encountered features in NSIP. • Poorly defined centrilobular nodules are typical of RB-ILD, whereas a ground-glass appearance is typical of DIP. • HRCT features of COP include characteristic peripheral or peribronchial patchy consolidations. • Rare IIPs include idiopathic LIP and idiopathic pleuro-parenchymal fibroelastosis (PPFE).
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Affiliation(s)
- Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, University Hospital Policlinico-Vittorio Emanuele, Via Santa Sofia 78, 95123, Catania, Italy,
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