Dados do Trabalho

Título

Interstitial Lung Abnormalities: What, How and Why to Report

Descrição sucinta do(s) objetivo(s)

Define interstitial lung abnormalities (ILAs), describe tomographic patterns and how to report them, present the main differential diagnoses and highlight the radiologist's contribution to the management of ILAs.

Descrição da(s) doença(s), método(s) e/ou técnica(s)

The presence of tomographic changes potentially compatible with interstitial lung disease (ILD) in a patient without clinical suspicion for ILD is defined as ILAs. Three tomographic subcategories have been described and are related to the risk of progression to pulmonary fibrosis.

Discussão

Such categories are described as follows. Non-subpleural: ground-glass opacities (GGO) with central predominance, which is often non progressive; subpleural non-fibrotic: subpleural GGO and reticular abnormalities without evidence of fibrosis; subpleural fibrotic: GGO and reticular abnormalities associated with traction bronchiectasis and architectural distortion . ILD can lead to worsening lung function and may evolve to fibrotic ILD, especially idiopathic pulmonary fibrosis. Since some alterations are subtle, quantitative CT (QCT) can help in assessing early changes in lung tissues, ​ allowing for reproducible measurements, and​ evaluating severity and extent of disease​. Main differential diagnosis for ILA include desquamative pneumonia, osteophyte-related focal fibrosis, decubitus dependent abnormalities and aging lung.

Conclusões

ILA is an underdiagnosed lung finding , but has had a crescent identification with implementation of lung cancer screening and use of CT for other diagnostic purposes It is important to recognize its findings because they are associated with radiological progression, increased mortality, and the risk of complications from medical interventions, especially the fibrotic subcategory. ​ Radiologists must familiarize themselves with ILA findings, since this is an image based diagnosis, frequently in subclinical or asymptomatic patients, representing an opportunity for early diagnosis and treatment, potentially helping avoid the evolution to lung fibrosis, a fundamental contribution to the interdisciplinary care team, also helping to distinguish between ILA , ILD​ and age related abnormalities.

Palavras Chave

Interstitial lung abnormalities; chest; fibrosis

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