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498

 

 

 

P. Spagnolo and N. Bernardinello

 

 

 

 

 

Table 28.2  (continued)

 

 

 

 

 

 

 

 

 

 

 

Age of onset of

 

 

Diagnosis

 

 

pulmonary

Mode of

Extrapulmonary

 

 

Disease

manifestations

presentation

manifestations

Suggestive features

Con rmatory tests

Familial

Variable

Granulomatous

Chondrocalcinosis

Hypocalciuria

24-h urine calcium/

hypocalciuric

 

lung disease

 

 

creatinine clearance

hypercalcemia

 

 

 

 

ratio

 

 

 

 

 

 

 

 

Pulmonary

Acute pancreatitis

Hypercalcemia

Genetic testing

 

 

brosis

 

 

 

 

 

 

 

No signs or symptoms

 

 

 

 

 

of primary

 

 

 

 

 

hyperparathyroidism

 

Neuro bromatosis

Fourth to sixth

Pulmonary

Neurological

Café-au-lait spots,

Genetic testing

Type 1

decade

brosis (lower

involvement

axillary and inguinal

 

 

 

zones)

 

freckling

 

 

 

 

 

 

 

 

 

Bullous changes

Optic gliomas

Lisch nodules

 

 

 

(upper zones)

 

 

 

 

 

Pulmonary

Osseous lesions

 

 

 

 

neuro bromas

 

 

 

 

 

 

 

 

 

 

 

Pulmonary

Cutaneous

 

 

 

 

hypertension

neuro bromas

 

 

Surfactant

Birth-childhood

Respiratory

Variable (depending on

Variable (depending on

Genetic testing

dysfunction

 

distress

the speci c disease)

the speci c disease)

 

disordersa

 

syndrome

 

 

 

 

 

Interstitial lung

 

 

 

 

 

disease

 

 

 

a See also Table 28.1

 

 

 

 

 

Table 28.3  Radiographic patterns of lung involvement on high-­ resolution computed tomography

Disease

Radiographic pattern

Hermansky-Pudlak

Diffuse, peripheral reticulation; subpleural

syndrome

cysts; ground glass opacity,

 

peribronchovascular thickening;

 

bronchiectasis

 

 

Dyskeratosis

Subpleural bibasal honeycombing, traction

congenita

bronchiectasis, reticular opacities

Gaucher’s disease

Reticular changes, ground glass opacities

Nieman-Pick Type

Ground glass opacities with an upper lobe

disease

predominance, and basilar predominant

 

interlobular septal thickening

Fabry’s disease

Diffuse ground glass and mosaic

 

attenuation

 

 

Lysinuric protein

Ground glass opacities superimposed over a

intolerance

pattern of ne overlapping lines forming

 

irregular polygonal shapes (“crazy paving”)

Familial

Reticulo-nodular in ltrates, honeycombing

hypocalciuric

 

hypercalcemia

 

Neuro bromatosis

Bibasilar (usually symmetrical) reticular

Type 1

changes, ground glass opacities, upper lobe

 

predominant (usually asymmetrical) small

 

cysts, and thin-walled bullae

Surfactant

Diffuse ground glass opacities, septal

dysfunction disorders

thickening, parenchymal cysts

 

 

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Part VI

Interstitial Lung Diseases, Non Systemic

Imaging Approach to Interstitial Lung

29

Disease

Teresa M. Jacob, Tahreema N. Matin, and Joseph Jacob

Clinical Vignette

T. M. Jacob

Department of Radiology, St Georges Hospital, London, UK e-mail: Teresa.jacob@stgeorges.nhs.uk

T. N. Matin

Education and Quality, Health Education England, London, UK e-mail: tahreema.matin@hee.nhs.uk

J. Jacob (*)

Department of Respiratory Medicine, Rayne Institute, University College London, London, UK

Centre for Medical Image Computing, University College London, London, UK

e-mail: j.jacob@ucl.ac.uk

A 71-year-old male 100-pack-year ex-smoker presented with a cough to his local hospital. On the initial axial computed tomography (CT) image (left), there was evidence of lower zone predominant brosis in a basal, peripheral and subpleural distribution. Traction bronchiectasis and reticulation were evident in the right lower lobe, but no honeycombing was present. According to the 2011 ATS/ERS/JRS/ALAT consensus guidelines for idiopathic pulmonary brosis, the patient demonstrated a possible usual interstitial pneumonia pattern on CT imaging. The major change to CT categorisation that has resulted following the publication of the 2018 ATS/ERS/JRS/ALAT consensus guidelines for idiopathic pulmonary brosis is that this pattern of lower zone predominant traction bronchiectasis without honeycombing is now classi ed as a probable usual interstitial pneumonia pattern.

The clinical history suggested an idiopathic cause for the brosis and following discussion by a multidisciplinary team the patient was diagnosed with idiopathic pulmonary brosis. The patient did not attend

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