Learning objectives
To describe HRCT findings of main complications in patients with idiopathic pulmonary fibrosis (IPF).
Background
IPF is an idiopathic fibrosing lung disease.
There are three main criteria for IPF diagnosis:
1.
exclusion of other known causes of interstitial lung disease;
2.
changes typical of usual interstitial pneumonia (UIP) pattern on chest HRCT represent by bibasilar subpleural reticular abnormality,
traction bronchiectasis,
and honeycombing;
3.
specific combinations of chest HRCT and surgical lung biopsy patterns.
This disease has a variable and unpredictable clinical course,
ranging from slow to rapid deterioration.
Several conditions may worsen IPF patient prognosis such as infection,
lung cancer,...
Imaging findings OR Procedure details
Infections
It is widely demonstrated that IPF patients are more susceptible to pulmonary infections (fig.1)
particularly to Mycobacterium tuberculosis,
Aspergillus species,
and a number of opportunistic infection such as Pneumocystis jirovecii (PJ) and Cytomegalovirus (CMV).
Opportunistic infections manifest specially in patients receiving corticosteroid therapy even if of relatively short duration.
In diffuse fibrotic lung disease the pre-existing fibrotic alteration may modify the typical HRCT presentation of the most common pulmonary infections.
The radiological manifestation of pulmonary tuberculosis (TB) in IPF patients is frequently characterized by...
Conclusion
Radiologists should be aware of complications and HRCT appearances of IPF patients to guide clinicians choosing the best therapeutic strategy.
References
1.
Lloyd C.
R.,
Walsh S.
L.
F.,
Hansell D.
M.
High-resolution CT of complications of idiopathic fibrotic lung disease.
The British Journal of Radiology 2011,
581–592.
2.
Oh S.
Y., Kim M.
Y., Kim J.
E.,
et al.
Evolving Early Lung Cancers Detected During Follow-Up of Idiopathic Interstitial Pneumonia: Serial CT Features.
AJR 2015;204: 1190-1196.
3.
Collard H.R.,
Moore B.B.,
Flaherty K.R.,
et al.
Acute Exacerbations of Idiopathic Pulmonary Fibrosis.
Am J Respir Crit Care Med 2007; 176(7): 636–643.
4.
Pena E.,
Dennie C.,...