대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Nonspecific interstitial pneumonia, group I

Radiologic Findings

High-resolution (1-mm collimation) CT scan obtained at level of bronchus intermedius shows multifocal patchy areas of ground-glass opacity with irregular linear opacity predominantly in subpleural region. CT scan obtained at level of liver dome reveals widespread areas of ground-glass opacity with irregular linear opacity and thickening of bronchovascular bundles. Architecture is preserved and bronchial dilatation is not seen. There is no honeycombing change suggestive of usual interstial pneumonia. Microscopic examination of biopsy specimen obtained from lingular segment revealed diffuse interstitial thickening with lymphocytic infiltration with little fibrosis. Alveolar architecture is preserved.

54/F
CC: Dypnea on exertion
Finding
CT scan obtained at right atrial level reveals areas of ground-glass opacity and consolidation with bronchial dilatation and fissural distortion, which suggest interstitial fibrosis. Note thickening of bronchovascular bundles.
Microscopic examination of biopsy specimen obtained from anterior basal segment of right lower lobe reveals extensive collagen-type interstitial fibrosis. Cellular interstitial infiltration is mild. Disease process is relatively homogenous in age.
Diagnosis: Nonspecific interstitial pneumonia, group III

Brief Review

Nonspecific interstitial pneumonia with fibrosis had been a diagnosis of exclusion, but recently has been considered to be a new discrete clinicopathologic entity of idiopathic interstitial pneumonia. The pathologic features consist of a spectrum ranging from pure inflammation to dense fibrosis. Histologically nonspecific interstitial pneumonia with fibrosis is characterized by temporal uniformity of the disease process (developing over a specific time) with varying degrees of interstitial inflammation and/or fibrosis. It can be subcategorized into three groups according to the relative amounts of inflammation and fibrosis: predominant inflammation as group 1, inflammation and fibrosis as group 2, and predominant fibrosis as group 3. The predominant high-resolution CT finding is bilateral patchy areas of ground-glass opacity with or without areas of consolidation. Irregular linear opacity, thickening of bronchovascular bundles, and bronchial dilatation are also frequently seen. Honeycombing is rare. All parenchymal abnormalities show subpleural predominance. Areas of ground-glass opacity with or without irregular linear opacity and/or bronchial dilatation on CT correspond pathologically to areas of interstitial thickening caused by varying degrees of interstitial inflammation and fibrosis showing temporal uniformity.

References

1. Katzenstein AA, Fiorelli RF. Nonspecific interstitial pneumonia/fibrosis: histologic features and clinical significance. Am J Surg Pathol 1994; 18:136-147
2. Park JS, Lee KS, Kim JS, et al. Nonspecific interstitial pneumonia 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 1998 (In press)

Keywords

Lung, Interstitium, Idiopathic interstitial pneumonia, NSIP, IIP,