Idiopathic interstitial pneumonias are currently classified into four categories: usual interstitial pneumonia, nonspecific interstitial pneumonia with fibrosis, acute interstitial pneumonia and desquamative interstitial pneumonia. The fibrotic process in interstitial pneumonias appears to result from a complex interaction between fibroblasts, other lung parenchymal cells and macrophages. The complex relationship between the local release of growth-promoting cytokines by alveolar macrophages and resident fibroblasts represents a necessary step for fibrosis or remodeling after lung injury. Injury to the epithelium and basement membranes is likely necessary for the fibrotic process to occur. Usual interstitial pneumonia, most frequent among interstitial pneumonias and has a poor prognosis, appears on high-resolution CT as patchy subpleural areas of ground-glass attenuation, irregular linear opacity, and honeycombing. Nonspecific interstitial pneumonia with fibrosis, the second most frequent and has a better prognosis than usual interstitial pneumonia, appears as subpleural patchy areas of ground-glass attenuation with associated areas of irregular linear opacity on CT. Acute interstitial pneumonia with high mortality rate presents as extensive bilateral airspace consolidation and patchy or diffuse bilateral areas of ground-glass attenuation. Desquamative interstitial pneumonia with good prognosis presents as patchy subpleural areas of ground-glass attenuation in middle and lower lung zones.
Human ; Lung Diseases, Interstitial/radiography ; Lung Diseases, Interstitial/physiopathology ; Lung Diseases, Interstitial/pathology*

Biopsy ; Diagnosis, Differential ; Humans ; Lung ; diagnostic imaging ; pathology ; Lung Diseases, Interstitial ; classification ; diagnostic imaging ; pathology ; Radiography

A variety of pulmonary complications, including infection and neoplastic and inflammatory diseases, commonly develop in patients with acquired immunodeficiency syndrome. Nonspecific interstitial pneumonitis, one such complication, is not uncommon, and is very difficult to differentiate, clinically and radiologically,from Pneumocystis carinii pneumonia. We describe a case of nonspecific interstitial pneumonitis, including the chest radiographic and HRCT findings, occurring in an AIDS patient and involving complications.
Acquired Immunodeficiency Syndrome* ; Humans ; Lung Diseases, Interstitial* ; Pneumonia, Pneumocystis ; Radiography, Thoracic

PURPOSE: To analyze the causes of delayed detection of lung cancer on chest radiographs. MATERIALS AND METHODS: We retrospectively reviewed 105 cases in which an initial diagnosis of lung cancer, based on anexamination of plain radiographs, had been missed or misinterpreted. All occurred between October 1993 and April1997. We reviewed the initial chest radiographs and compared the features noted with those seen on later chestradiographs and computed tomographic (CT) images. RESULTS: Undetected lung cancer was identified in 56 patients(56/105, 53.3%) It had been hidden by superim-posed structures (41, 73.2%), overlapped by combined benign diseases(12, 21.4%), or the nodules were subtle(3, 5.4%). Of the 41 lung cancers hidden by a superimposed structure, thecentral type accounted for 29 (70.7%) and the peripheral type for 12 (29.3%). The 29 central type had been hiddenby the left hilum (n=15), the right hilum (n=10), the heart (n=3), or a rib (n=1). The twelve peripheral type werehidden by a rib (n=7), the heart (n=2), the diaphragm (n=2), or the left hilum (n=1). Of the 12 lung cancersoverlapped by combined benign diseases, pulmonary tuberculosis (n=6), pleural effusion (n=4), congestive heartfailure (n=1), and dif-fuse interstitial lung disease (n=1) were present at the time of interpretation. Themisinterpreted lung cancers were identified in 49 patients (49/105, 46.7%) and were seen to be combined withbenign disease (16, 32.6%), or as obstructive pneumonia without a central mass (15, 30.6%), air-spaceconsolidation (7, 14.3%), cavity (7, 14.3%), double lesion (2, 4.1%), or young age below 26 years (2, 4.1%). Ofthe 16 lung cancers misinterpreted as combined disease, pulmonary tuberculosis (n=14) and pleural disease (n=2)had been initially diagnosed. CONCLUSION: Most commonly, lung cancer was missed or misinterpreted because it washidden by a normal structure or combined with a benign disease. Perceptual errors can be reduced by appropriatetechniques and the scrutiny of trouble spots such as the parahilar, retrocardiac, retrodiaphragmatic and costalregions. Errors in the analysis of lung cancer can be reduced by increased awareness of growth patterns anduncommon man-ifestations of the disease.
Diagnosis ; Diaphragm ; Estrogens, Conjugated (USP) ; Heart ; Humans ; Lung Diseases ; Lung Diseases, Interstitial ; Lung Neoplasms* ; Lung* ; Pleural Diseases ; Pleural Effusion ; Pneumonia ; Radiography, Thoracic* ; Retrospective Studies ; Ribs ; Thorax* ; Tuberculosis

We report a case of pulmonary LAM occurring in a 24-year-old pregnant woman in whom large areas of air-space consolidation partly masked interstitial lung disease on plain radiography. For correct dignosis, high resolutionCT was considered to still be a potent method for the disclosure of typical interstitial lung changes, including thin-walled cysts. Follow-up CT showed progressive worsening of these interstitial lung lesions.
Disclosure ; Female ; Follow-Up Studies ; Humans ; Lung Diseases, Interstitial ; Lung* ; Lymphangioleiomyomatosis* ; Masks* ; Pregnant Women ; Radiography ; Young Adult

OBJECTIVE: We wanted to demonstrate and compare the serial high-resolution CTs (HRCT) and the pulmonary function test (PFT) findings of the usual interstitial pneumonia (UIP) and the non-specific interstitial pneumonia (NSIP). MATERIALS AND METHODS: The serial HRCT scans and the PFT results were retrospectively analysed and compared for 35 patients having UIP without significant honeycombing (UIP-w/o hc, < 5% of honeycombing at CT), 35 patients having UIP with honeycombing (UIP-w/i hc, > or = 5% of honeycombing), and 25 patients with NSIP. The mortality rates were also compared. Follow-up CT scans were available in 75 patients (29 UIP-w/o hc patients, 22 UIP-w/i hc patients and 24 NSIP patients) and the follow-up periods ranged from 150 to 2, 370 days. The initial and follow-up PFT data were available for 71 patients. RESULTS: On the initial CT, significant differences were present between the UIP-w/i hc patients and both the UIP-w/o hc patients and the NSIP patients in the overall extent, ground-glass opacity (GGO) away from the reticulation, reticulation and honeycombing (all p < 0.05). Improvement was noticed in five (17%) of 29 UIP-w/o hc patients, none of 22 UIP-w/i hc patients, and 9 (37%) of 24 NSIP patients; deterioration was noted in six (21%) UIP-w/o hc patients, two (9%) UIP-w/i hc patients and three (13%) NSIP patients (p = 0.044 between UIP-w/o and UIP-w/i hc; p = 0.637 between UIP-w/o hc and NSIP; p = 0.007 between UIP-w/i hc and NSIP). The serial changes of the pulmonary function in the NSIP patients were different from those noted for the UIP-w/i hc and UIP-w/o hc patients (p = 0.440 between UIP-w/o and UIP-w/i hc; p = 0.022 between UIP-w/o hc and NSIP; p = 0.003 between UIP-w/i hc and NSIP). Five (14%) of the 35 patients with UIP-w/o hc, 16 (46%) of the 35 patients with UIP-w/i hc and three (12%) of the 25 patients with NSIP died (p = 0.002, comparison for the three groups). CONCLUSION: On CT, NSIP and UIP-w/o hc patients have similar patterns of parenchymal abnormalities and a similar likelihood of change in the extent of disease on follow-up. Patients with UIP-w/i hc have distinctive features and a worst prognosis.
*Tomography, X-Ray Computed ; Retrospective Studies ; Lung Diseases, Interstitial/mortality/*physiopathology/*radiography ; Lung/*physiopathology ; Humans ; Follow-Up Studies ; Female ; Aged

Chronic active Epstein-Barr virus (CAEBV) infection is characterized by persistent infectious mononucleosis-like symptoms, an unusual pattern of Epstein-Barr virus (EBV) antibodies, detection of the EBV genome in affected tissues or peripheral blood, and chronic illness that cannot be attributed to any other known disease. This is the first reported Korean case of an immunocompetent adult with CAEBV-associated interstitial pneumonitis. A 28-year-old female was admitted with a fever that persisted for 3 weeks. She had multiple lymphadenopathy, hepatosplenomegaly, pancytopenia, and elevated serum aminotransferase levels. Serology for antibodies was positive and chest computed tomography showed diffuse ground glass opacities in both lungs. Histopathology of the lung tissue showed lymphocyte infiltration, and EBV DNA was detected in those lymphocytes using in situ hybridization with an EBV-encoded RNA probe. After 1 month of hospitalization, she improved without specific treatment.
Adult ; Chronic Disease ; Epstein-Barr Virus Infections/complications/*pathology/radiography ; Female ; *Herpesvirus 4, Human ; Humans ; Immunocompetence ; Lung Diseases/etiology/pathology ; Lung Diseases, Interstitial/etiology/*pathology/radiography

A 47-years-old woman presented with a 2-month history of a dry mouth and dry cough. The patient had been taking medication for Sjogren's syndrome for approximately 7 years. The chest radiography showed multiple cystic lesions and a hazy density in both lower lung fields. The HRCT showed a diffuse ground glass like appearance and multiple variable sized cystic lesions in both lung fields. After medication, the symptoms were aggravated. Bronchoscopy was preformed with a transbronchial lung biopsy. The biopsies showed an infiltration of lymphocytes, neutrophils, monocytes and histiocytes through the interstitial space of the alveola and a widening of the alveolar septa. However, the histological findings of the cysts were not obtained. Sjogren's syndrome is a slowly progressive inflammatory autoimmune disease, which is characterized by lymphocyte mediated destruction of the exocrine glands, with pulmonary involvement in approximately 19-65%, High-resolution CT is a sensitive technique for assessing the pulmonary involvement in patients with Sjogren's syndrome. Although a lung biopsy is not always necessary for establishing a diagnosis of an interstitial lung disease in Sjogren's syndrome. A lung biopsy may reveal a wide spectrum of changes ranging from a mild inflammatory response to end stage fibrosis with honeycombing. Because of the predominantly peribronchiolar inflammatory infiltration and inspissated secretions the cysts were suspected to have been formed by the ballvalve phenomenon. However, no definite evidence was obtained.
Autoimmune Diseases ; Biopsy ; Bronchoscopy ; Cough ; Diagnosis ; Exocrine Glands ; Female ; Fibrosis ; Glass ; Histiocytes ; Humans ; Lung Diseases* ; Lung Diseases, Interstitial* ; Lung* ; Lymphocytes ; Monocytes ; Mouth ; Neutrophils ; Radiography ; Sjogren's Syndrome* ; Thorax

OBJECTIVE: To determine the effects of respiration on the size of lung cysts by comparing inspiratory and expiratory high-resolution CT (HRCT) scans. MATERIALS AND METHODS: The authors evaluated the size of cystic lesions, as seen on paired inspiratory and expiratory HRCT scans, in 54 patients with Langerhans cell histiocytosis (n = 3), pulmonary lymphangiomyomatosis (n = 4),confluent centrilobular emphysema (n = 9), paraseptal emphysema and bullae (n= 16), cystic bronchiectasis (n = 13), and honeycombing (n = 9). Using paired inspiratory and expiratory HRCT scans obtained at the corresponding anatomic level, a total of 270 cystic lesions were selected simultaneously on the basis of five lesions per lung disease. Changes in lung cyst size observed during respiration were assessed by two radiologists. In a limited number of cases (n = 11), pathologic specimens were obtained by open lung biopsy or lobectomy. RESULTS: All cystic lesions in patients with Langerhans cell histiocytosis, lymphangiomyomatosis, cystic bronchiectasis, honeycombing, and confluent centrilobular emphysema became smaller on expiration, but in two cases of paraseptal emphysema and bullae there was no change. CONCLUSION: In cases in which expiratory CT scans indicate that cysts have become smaller, cystic lesions may communicate with the airways. To determine whether, for cysts and cystic lesions, this connection does in fact exist, paired inspiratory and expiratory HRCT scans are necessary.
Comparative Study ; Cysts/*radiography ; Female ; Human ; Lung Diseases/*radiography ; Lung Diseases, Interstitial/radiography ; Male ; Middle Age ; Pulmonary Emphysema/radiography ; Respiration ; Support, Non-U.S. Gov't ; Tomography, X-Ray Computed/*methods

OBJECTIVE: To determine the effects of respiration on the size of lung cysts by comparing inspiratory and expiratory high-resolution CT (HRCT) scans. MATERIALS AND METHODS: The authors evaluated the size of cystic lesions, as seen on paired inspiratory and expiratory HRCT scans, in 54 patients with Langerhans cell histiocytosis (n = 3), pulmonary lymphangiomyomatosis (n = 4),confluent centrilobular emphysema (n = 9), paraseptal emphysema and bullae (n= 16), cystic bronchiectasis (n = 13), and honeycombing (n = 9). Using paired inspiratory and expiratory HRCT scans obtained at the corresponding anatomic level, a total of 270 cystic lesions were selected simultaneously on the basis of five lesions per lung disease. Changes in lung cyst size observed during respiration were assessed by two radiologists. In a limited number of cases (n = 11), pathologic specimens were obtained by open lung biopsy or lobectomy. RESULTS: All cystic lesions in patients with Langerhans cell histiocytosis, lymphangiomyomatosis, cystic bronchiectasis, honeycombing, and confluent centrilobular emphysema became smaller on expiration, but in two cases of paraseptal emphysema and bullae there was no change. CONCLUSION: In cases in which expiratory CT scans indicate that cysts have become smaller, cystic lesions may communicate with the airways. To determine whether, for cysts and cystic lesions, this connection does in fact exist, paired inspiratory and expiratory HRCT scans are necessary.
Comparative Study ; Cysts/*radiography ; Female ; Human ; Lung Diseases/*radiography ; Lung Diseases, Interstitial/radiography ; Male ; Middle Age ; Pulmonary Emphysema/radiography ; Respiration ; Support, Non-U.S. Gov't ; Tomography, X-Ray Computed/*methods