대한흉부영상의학회 Weekly Chest Cases

Case No : 491 Date 2007-03-26

Courtesy of Jeong-Nam Heo, M.D., Choong-Ki Park, M.D. / Hanyang University Guri Hospital, Korea
Age/Sex 60 / F
Chief ComplaintAcute dyspnea

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Diagnosis With Brief Discussion

Diagnosis: Nonspecific interstitial pneumonia, cellular type (confirmed by lung biopsy)
Radiologic Findings: Figs 1. Chest PA shows multifocal patchy increased opacities at both lungs. Fig 2-5. HRCT images show the multifocal patchy ground-glass opacities, consolidations, and reticular opacities at subpleural portion of both lungs.
Brief Review: Nonspecific interstital pneumonia/fibrosis(NSIP) was first described in 1994 as a diagnosis of exclusion. The main pathologic findings is varying degrees of inflammation and fibrosis within alveolar walls that are temporally uniform in all sections. It may be patchy and, if so, often shows a peribronchiolar distribution.
In the original series 46% of patients had possible precipitating events or associated disorder, judged to be significant. These consisted of; (1) in 16% a variety of connective tissue disorders (rheumatoid arthritis, dermato/polymyositis, systemic lupus erythematosus, systemic sclerosis, Sj?ren뭩 syndrom); (2) in 5% autoimmune disorders including primary biliary cirrhosis and Hashimoto thyroiditis; (3) in 8% recent surgery/ pneumonia/ ARDS; and (4) in 17% inhalation of possible noxious agents.
Abnormalities in chest radiography are usually bilateral with a basal predominance. They may be consolidation and patch, reticulonodular, or mixed. Other described features include reduced lung volume, pleural effusion (5%), hilar nodes(6%), and normality(6%). Detailed HRCT descriptions are available in 78 patients. A number of findings are described which may occur singly or in combination. The commonest abnormality (80% to 90%) is bilateral, patch ground-glass opacity either symmetrically or diffusely distributed in all zones or displaying a basal predominance. In 50% to 70% of patients it displays a subpleural predilection. Ground glass opacity occurs as an isolated finding in about one-third of patients. Consolidation is seen in 16%to 35% of patients, almost always combined with ground-glass opacity. Like ground-glass opacity, consolidation is bilateral, basal, and subpleurally predominant. Irregular linear opacities, commonly subpleural, occur in about 50% of cases (range 29% to 87%). Honeycomb changes recorded in 28% of patients in one series have been absent in others. Airway are commonly (38% to71%) dilated in areas of consolidation or ground-glass opacity, and Kim and colleagues described thickened bronchovascular bundles in 65% of cases.
References: 1. Armstrong P, Wilson AG, et al. Image of Disease of the Chest, third edition.London: Mosby Publisher 2000:536-537
2. Park JS, Lee KS, Kim JS, et al. Nonspecific interstitialpneumonia with fibrosis: radiographic and CT findings in seven patients. Radiology 1995; 195:645-648
3. Kim TS, Lee KS, Chung MP, et al: Nonspecific interstitial pneumonia with fibrosis: high resolution CT and pathologic findings. AJR 171:1645-1650, 1988
Keywords: Lung, Idiopathic interstitial pneumonia, NSIP, IIP,

No. of Applicants : 63

▶ Correct Answer : 4/63, 6.3%

- Jikei University, Japan Shigeki Misumi
- Ewha Womans University MokDong Hospital, Korea Yookyung Kim
- Akdeniz University School of Medicine, Radiology Dept Antalya, Turkey Gokhan Arslan
- Osaka University, Japan Osamu Honda

▶ Correct Answer as Differential Diagnosis : 20/63, 31.7%

- China Medical University Hospital, Taiwan Jun-Jun Yeh
- Cathay General Hospital Taipel, Taiwan Chih-Hung Lin
- Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- KAUMS, Kashan, Iran Ebrahim Razi
- Hospital Sotiria, Athens, Greece Vasilios Tzilas
- E-Da hospital, Taiwan Yu-Feng Wei
- Thoracic Imaging Section, Deptt. of Radiological sciences, UCLA, USA Fereidoun Abtin
- Catholic university of Korea, catholic medical center, Korea Kim Yong-sun
- ANNEMASSE, Polyclinique de SAVOIE, France Gay-Depassier Philippe
- Dong-A University Hospital, Busan, Korea Park Seong Hoon
- Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
- Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
- Vital Imaging Centre, Mumbai, India Ganesh Agrawal
- Homs National Hospital, Homs - Syria Rami Abou Zalaf
- Daegu Fatima Hospital, Korea Tae-hun Kim
- Monaldi Hospital,Naples, Italy Gaetano Rea
- Dongguk University International Hosipital, Korea Hee Seok Choi
- IRSA LA ROCHELLE, France Jean-Luc BIGOT
- Doctors Hospital, Nassau, Bahamas N.B.S.Mani
- St. Mary's hospital, The Catholic University, Korea Soo Kyung Yoon

▶ Semi-Correct Answer : 31/63, 49.2%

- Sctimst, trivandrum, kerala, India Santhosh Kannath
- Apollo clinic, kandivali west, mumbai, India Jeshil Shah
- Nanavati hospital, mumbai, India Ajay Kumar Jayaprasad
- Balabhai nanavati hospital, mumbai, Inadia Susheel Kumar
- Chung Moo hospital, Korea Jong Hyeon Mo
- Shinchon severance hospital, Korea Shin Na-young
- EMARTOM Radiology Center, Istanbul, Turkey Ali Elibol
- CHRU Lille hopital calmette, France Toledano Manuel
- Regional Imaging Riverina, Austalia Rashid Hashmi
- KHA inchion branch, Korea Seung-il Baek
- Marien Hospital, Hamm, Germany Davis Chiramel
- Samcheonpo jeil hospital, Korea Su Jin Kang
- Deptt. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
- Lilavati hospital, Mumbai, India Anil P.Ramnani
- Samsung Medical Center, Seoul, Korea DaeKun Oh
- Korea Cheol Gyu Park
- ASCS, Safwa, Saudi Arabia Kalari Adinarayana
- Shengjing Hosptial, China Medical University, China Yong Yue
- University of Colorado Health Sciences Center, Denver, Colorado, USA Jeff Grossman
- Hospital Clinico de la Universidad de Chile Andres Rojas Palacios
- IRSA, La Rochelle, France Denis Chabassiere
- Hangang Sacred Heart Hospital, Korea EIl Seong Lee
- EKH-Berlin, Germany Michael Weber
- Nirman Hi-Tech Duagbistuc Center, Mumbai, Inadia Minal Seth
- Kyunghee University Medical Center, Korea Su Youn Sim
- Ulsan University Hospital, Ulsan, Korea Jong-Chang Jang
- AIIMS,Delhi, India Ashish Gupta
- Annecy hospital, France Gilles Genin
- PGIMER Chandigarh, India Praveen Kumar
- Ultracare Coimbatore, India Debabrata Das

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 491 Date 2007-03-26

Discussion

No. of Applicants : 63