Clinical Information: Patient is a 70yo female who is on prednisone for arthritis and presents with

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Clinical InformationPatient is a 70y/o female
who is on prednisone for arthritis and presents
with recent onset of cough. CXR shows prominent
interstitial markings.
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Patient is a 54y/o female who had an interstitial
pattern on CXR.
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Differential diagnosis
Sarcoid Langerhans Idiopathic Desquamative Coal
workers Bagassosis Silicosis Drug
reaction Asbestosis Lymphangitic Erdheim
Chester Lymphangiomyomatosis Chronic
failure Farmers lung Ankylosing
Spondylitis Neurofibromatosis Rheumatoid Scleroder
ma Hard metal disease Emphysema PAP Aspiration Gau
chers Sjogrens LIP Mushroom workers
lung Methotrexate lung Respiratory
bronchiolitis BOOP Periarteritis
nodosa Lupus Bronchiectasis Berylliosis Bronchioli
tis obliterans Alveolar microlithiasis Metastatic
calcification
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Differential diagnosis
More than 100 entities manifest as diffuse lung
disease. Fortunately only 10-20 of these account
for about 90 of all diffuse lung disease that is
assessed by open lung biopsy. Sarcoid Langerhans
granulomatosis Idiopathic pulmonary
fibrosis Lymphangitic tumor Edema Asbestosis Colla
gen vascular diseases Silicosis Farmers
lung Drugs
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Differential diagnosis
HONEYCOMBING BRONCHIECTASIS Pulmonary fibrosis
(IPF, RA, scleroderma, drug reaction, asbestosis,
end-stage hypersensitivity pneumonitis) Sarcoidosi
s BRONCHIECTASIS Sarcoidosis Pulmonary
fibrosis Hypersensitivity pneumonitis Allergic
bronchopulmonary aspergilosis Cystic fibrosis
MOSAIC ATTENUATION Bronchiolitis
Obliterans Cystic fibrosis Chronic PE AIR
TRAPPING Obliterative bronchiolitis Asthma Hyperse
nsitivity pneumonitis Normal variant (seen in
superior segement of left lobe, middle lobe or
lingula) NODULAR SEPTAL THICKENING, HONEYCOMBING
BRONCHIECTASIS Idiopathic pulmonary
fibrosis Sarcoidosis (end-stage)
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Differential diagnosis
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Diagnosis
Pulmonary Fibrosis associated with Rheumatoid
Arthritis
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Information from literature
Diseases such as rheumatoid arthritis
and scleroderma are also associated with
diffuse interstitial thickening. Pathologically,
there may be a UIP or NSIP pattern,
indistinguishable from IPF. Dyspnea is a common
complaint. Prognosis is variable and
life-expectancy is longer with NSIP than UIP.
Practical Approach HRCT Jud W Gurney MD
FACR Charles A Dobry Professor of
Radiology University of Nebraska
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Information from literature
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Information from literature
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Rheumatoid Arthritis
Thoracic involvement often develops in patients
as their disease progresses. Pleural disease is
the most common thoracic manifestation. Pleural
thickening is the next most common finding and is
seen more often than pleural effusion. Pleural
effusions are usually unilateral and may be
loculated. Pulmonary fibrosis occurs in 29 of
patients with rheumatoid arthritis.
High-resolution CT scans show a reticular pattern
and irregular interlobular septal thickening
predominantly in the lung periphery and lower
lung zones Honeycombing and progressive volume
loss develop as the disease progresses. In rare
cases, fibrosis may be limited to the upper lobes
and contain areas of cavitation, characteristics
that mimic those of tuberculosis. Like any
patient with pulmonary fibrosis, patients with
pulmonary fibrosis associated with rheumatoid
arthritis have an increased prevalence of lung
cancer.
RadioGraphics 2000 2016231635
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Rheumatoid Arthritis
Pulmonary nodules are uncommon in patients with
rheumatoid arthritis and are usually associated
with advanced disease and subcutaneous nodules.
Usually multiple and well circumscribed, they
often result in thick walled cavities. Patients
with RA have an increased prevalence of airway
diseases such as bronchiolitis obliterans and
BOOP. Obliterative bronchiolitis occurs with
increased frequency in patients with rheumatoid
arthritis regardless of whether they have
received penicillamine or gold therapy. HRCT may
show a characteristic mosaic pattern of
attenuation and perfusion. The predominant
radiographic and high-resolution CT finding in
patients with BOOP is airspace consolidation that
is usually bilateral and tends to have a patchy
peripheral or peribronchial distribution.
RadioGraphics 2000 2016231635