INTERSTITIAL LUNG

DISEASES RADIOLOGY

By Danial Ashoori Zadeh

Group 1
• Interstitial lung disease is a group of lung diseases that affects the connective tissue
that forms the support structure of the air sacs, or alveoli, of the lungs.
• During inhalation, the alveoli fill with air.
• Oxygen within the air passes through the walls of the alveoli into the blood stream.
• In reverse fashion, carbon dioxide passes from the blood into the alveoli and is
exhaled. When affected by an interstitial lung disease, the tissue supporting the air
sacs—called the interstitium—becomes inflamed and stiff, making it difficult for air
sacs to fully expand, limiting the delivery of oxygen to the body and the removal of
carbon dioxide from the body.
• As the disease progresses, the tissue scars and thickens the alveolar walls, further
decreasing lung function.
• This inflammation of the interstitium is typically diffuse, meaning it occurs throughout
both lungs rather than being confined to one area.
The diseases in this group include:

- idiopathic pulmonary fibrosis (IPF)

- acute interstitial pneumonia (AIP)
- cryptogenic organizing pneumonia (COP)
- non-specific interstitial pneumonia (NSIP)

Some forms of interstitial pneumonia are related to the inhalation of cigarette smoke and
occur as a spectrum of injury that includes respiratory bronchiolitis-interstitial lung disease
and desquamative interstitial pneumonia.

Others are associated with multi-systemic diseases such as rheumatoid arthritis,

scleroderma, dermatomyositis and asbestosis.

As the disease progresses, weight loss, muscle and joint pain and fatigue may also occur
.
At a more advanced stage, individuals may develop an enlarged heart, an enlargement of
the fingertips called clubbing, and cyanosis—a blue coloration in the lips, skin and
fingernails as a result of reduced oxygen levels in the blood.
 How is interstitial lung disease evaluated.

To diagnose and determine the cause of interstitial

lung disease, a physician will need to perform a
physical examination and order diagnostic tests,
including: blood tests, spirometry, pulse oximetry,
chest x-ray , CT imaging of the chest , bronchoscopy
and biopsy, surgical biopsy
Blood tests:

These are focused on identifying autoimmune

diseases such as lupus and rheumatoid arthritis
which can result in interstitial lung disease as a
result.
Spirometry:

This is a test of lung function, in which the patient

exhales quickly and forcefully through a tube
connected to a machine that measures how much air
the lungs can hold and how quickly the air moves in
and out of the lungs. Spirometry can help determine if
there is an issue with air getting into the lungs
(restriction, such as fibrosis) versus air getting out of
the lungs (obstruction, such as asthma).
Pulse oximetry:

This test uses a small device placed on a finger tip to measure

the oxygen saturation of the blood. It shines a specific
wavelength of light though the end of the finger painlessly to
measure the amount of oxygen in the blood.
Chest x-ray :

The patterns of lung damage associated with

various types of interstitial lung disease are often
identifiable on a chest x-ray. Chest x-rays may
also be used to track the progression of the
disease.
CT imaging of the chest :

Computed tomography (CT) scanning, particularly a specific technique known

as high resolution CT, is used to see the fine detail of the interstitium where the
disease is occurring. Based on the imaging appearance, a diagnosis
(specifically idiopathic pulmonary fibrosis) can sometimes be confirmed, thus
avoiding the need for lung biopsy. The CT scan can also help determine the
extent of damage to the lungs and help determine appropriate treatment.
Bronchoscopy and biopsy:

In this procedure, a very small sample of tissue is removed from the lung
using a small, flexible tube called a bronchoscope that is passed through
the mouth or nose and into the lungs.
Surgical biopsy:

A surgical biopsy is often needed to obtain a larger sample tissue than is

possible with bronchoscopy. During this procedure, surgical instruments
and a small camera are inserted through two or three small incisions
between the ribs that allow a physician to see and remove tissue samples
from the lungs.
 X-Ray chest.

It is important modality for diagnosis of ILDs. The correlation between the

radiographic pattern and the stage of the disease(clinical or histological) is
generally poor. Review all previous film to assess the rate of changes on
disease activity. Honeycombing correlated a poor prognosis.
X-Ray limitations: X-Ray chest is normal in 10-15% of symptomatic
patients with infiltrative lung disease. The X-Ray sensitivity and a specificity
of 80% for detection of DPLD.
The X-Ray can provide a confident diagnosis in 25% of cases. A diffuse
ground glass pattern- early in the disease, progress,- nodules, linear
(reticular) infiltrate, or a combination. - Infiltrate become coarser and lung
volume is lost- honeycomb pattern.
CT pattern of diffuse lung diseases.

Four major patterns (ground-glass opacity, nodular opacity, reticular

opacity, and honeycombing) on thin section computed tomographic
images were identified.
 Idiopathic Pulmonary Fibrosis with subpleural reticular marking,
traction bronchiectasis and honeycombing in a lower lobe distribution.
Drug-related lung disease.
Alveolar Proteinosis.
Organizing Pneumonia
Lymphomatoid granulomatosis (LYG)

2 cases of bronchoalveolar carcinoma

Thank you !