What is the role of imaging studies in the diagnosis of diffuse parenchymal lung diseases (DPLDs)?

Updated: Sep 15, 2020
  • Author: Eleanor M Summerhill, MD, FACP, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Chest radiography findings are frequently abnormal in patients with fibrotic lung disease. Reticular and/or nodular opacities are the hallmark (see image below).

Frontal chest radiograph demonstrating bilateral r Frontal chest radiograph demonstrating bilateral reticular and nodular interstitial infiltrates with upper zone predominance.

Honeycombing is a late finding and correlates with severe histopathologic findings. [3]  Findings may be normal in 10% of patients with histologically proven disease. Therefore, a complete evaluation including pulmonary function testing and, in some cases, pulmonary exercise testing, should be undertaken in all patients clinically suspected to have underlying interstitial lung disease.

Certain patterns and distributions of abnormality seen on chest radiographs are suggestive of particular diseases. Sarcoid-associated interstitial disease often demonstrates symmetric hilar adenopathy. IPF, asbestosis, and connective-tissue disease–related changes are most often basilar and peripheral in distribution. Radiation fibrosis is restricted to the previous radiation port but also may have upper lung zone predominance, as may sarcoidosis, PLCH, HSP, pneumoconioses, and drug-related DPLD due to gold or nitrofurantoin therapy. Some patterns of abnormality, such as reverse congestive heart failure or a bat-wing pattern, are described with eosinophilic pneumonia.

High-resolution chest computed tomography (CT) scanning is more sensitive than chest radiography and may reveal characteristic, if not diagnostic, findings (see image below). [4, 5]

High-resolution chest CT scan of patient with bila High-resolution chest CT scan of patient with bilateral reticular and nodular interstitial infiltrates with upper zone predominance.

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