hrct in diffuse lung diseases - ii (honeycombing, uip pattern, ipf)
DESCRIPTION
This is the second part of this series on HRCT in diffuse lung diseases, focussing on the diagnosis of honeycombing, UIP pattern and IPF and the associated complications and differential diagnosesTRANSCRIPT
![Page 1: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/1.jpg)
HRCT in Diffuse Lung Diseases - II
Dr. Bhavin JankhariaJankharia Imaging
![Page 2: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/2.jpg)
The key to learning HRCT interpretation in interstitial lung
diseases is to learn how to identify honeycombing, which allows us to
recognize the Usual Interstitial Pneumonia (UIP) pattern
![Page 3: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/3.jpg)
Honeycombing – layered peripheral cysts, stacked one on top of the other
![Page 4: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/4.jpg)
D/D of Honeycombing
![Page 5: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/5.jpg)
BronchiectasisHoneycombing
![Page 6: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/6.jpg)
Bronchiectasis presents with branching cystic and tubular areas
extending from the hilum to the periphery
![Page 7: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/7.jpg)
EmphysemaHoneycombing
![Page 8: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/8.jpg)
Emphysema presents with centrilobular cystic areas without
walls
![Page 9: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/9.jpg)
Cystic lung disease
Honeycombing
![Page 10: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/10.jpg)
Cystic interstitial lung disease presents with cysts with walls
randomly distributed throughout the lung parenchyma
![Page 11: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/11.jpg)
The presence of honeycombing allows us to confidently make a diagnosis of a usual interstitial
pneumonia pattern (UIP)
![Page 12: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/12.jpg)
Reticular pattern - honeycombingReticular pattern – no honeycombing
![Page 13: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/13.jpg)
The absence of honeycombing as seen on the left image does not
rule out a UIP pattern, but a diagnosis of UIP cannot be made with any specificity in that context.
A non-specific interstitial pneumonia with fibrosis (NSIP) pattern also then comes into the
differential diagnosis
![Page 14: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/14.jpg)
The Diagnosis of a UIP Pattern
![Page 15: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/15.jpg)
IPF
UIP Criteria
Reticular abnormality
Honeycombing with or without traction bronchiectasis
Subpleural basal predominance
Absence of other signs like ground glass, nodules, etc
New IPF criteria – ATS/ERS
![Page 16: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/16.jpg)
IPF
UIP Criteria
•Reticular abnormality
•Honeycombing with or without traction bronchiectasis
•Subpleural basal predominance
•Absence of features inconsistent with these
New IPF criteria – ATS/ERS
![Page 17: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/17.jpg)
Upper zone - chronic hypersensitivity pneumonitis
Lower zone – UIP pattern
![Page 18: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/18.jpg)
Long standing sarcoidosis with fibrosis – upper and mid-zone fibrosis
![Page 19: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/19.jpg)
Upper zone predominance of honeycombing usually implies
chronic hypersensitivity pneumonitis or long standng parenchymal sarcoidosis with
fibrosis
![Page 20: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/20.jpg)
IPF
UIP Criteria
Reticular abnormality
Honeycombing with or without traction bronchiectasis
Subpleural basal predominance
Absence of other signs like ground glass, nodules, etc
New IPF criteria – ATS/ERS
![Page 21: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/21.jpg)
If all these criteria are met, then we can confidently make the
diagnosis of a UIP pattern
![Page 22: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/22.jpg)
New IPF criteria – ATS/ERS
![Page 23: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/23.jpg)
This is the new algorithm to make a diagnosis of Idiopathic Pulmonary Fibrosis (IPF)
![Page 24: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/24.jpg)
In the presence of a UIP pattern, in the absence of an identifiable cause (e.g. rheumatoid arthritis, familial, etc), the presence of a
UIP pattern implies IPF
![Page 25: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/25.jpg)
IPF
Issues• Complications – neoplasm, infection
![Page 26: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/26.jpg)
IPF with superimposed opacity in the left lower lobe – TB on biopsy
![Page 27: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/27.jpg)
IPF with progressive consolidation over a year – invasive mucinous adenocarcinoma on biopsy
![Page 28: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/28.jpg)
Patients with IPF have an increased incidence of
superimposed infection and neoplasm. The HRCTs of patients
of IPF on follow-up should be examined for superimposed / new
pathology
![Page 29: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/29.jpg)
IPF
Issues• Complications – neoplasm, infection• Combined emphysema with fibrosis (CPFE)
![Page 30: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/30.jpg)
This patient has both emphysema in the upper lobes and a UIP pattern in the lower lobes
![Page 31: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/31.jpg)
This occurs in smokers, with emphysema in the upper lobes
and IPF in the lower lobes. It has a worse prognosis than IPF and clinically can be a challenge to
diagnose
![Page 32: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/32.jpg)
The next presentation will be on NSIP and other idiopathic
interstitial pneumonias
![Page 33: HRCT in Diffuse Lung Diseases - II (Honeycombing, UIP pattern, IPF)](https://reader035.vdocuments.site/reader035/viewer/2022081416/554b1466b4c90562098b4bf5/html5/thumbnails/33.jpg)
Thank You