2016;206 (3): . monia; UIP, usual interstitial pneumonia. Acute interstitial pneumonia (AIP) is a rapidly progressive condition of unknown cause that occurs in a previously healthy individual and produces the histologic findings of diffuse alveolar damage ().Because of its acute presentation and histologic features similar to those of acute respiratory distress syndrome (ARDS), AIP has been considered an idiopathic form of ARDS (1, 2). Cryptogenic fibrosing alveolitis ; Idiopathic pulmonary fibrosis; UIP Diagnostic Criteria. 19. 7. 206 (3): 463-71. The distribution of UIP characteristically is with an apicobasal gradient with basal and peripheral (subpleural) predominance, although it is often patchy. The diagnosis of IPF is a complex procedure that requires the support of various specialists, who must integrate clinical, radiological, and histological data. 20. 2009;251 (1): 271-9. 5 ... (CFA), a term that has fallen out of favor since the basic underlying pathology is now thought to be fibrosis, not inflammation. Usual Interstitial Pneumonia (UIP) is the pattern of fibrosis classically described as having geographic and temporal variability. 4. differential diagnoses of airspace opacification, presence of non-lepidic patterns such as acinar, papillary, solid, or micropapillary, myofibroblastic stroma associated with invasive tumor cells. Survival appears to be favorable. Duhig, B.E. We evaluate these diagnostic categories as prognostic markers among patients with IPF. BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease of unknown etiology. asbestos-related interstitial lung disease: reticular opacity-to-ground glass opacity ratio: one or greater, HP usually involves the mid and upper zones of the lung, and also the presence of centrilobular nodules and areas of air trapping are very useful hints to differentiate it from UIP, UIP cases are also thought to have honeycombing and peripheral or lower lung zone predominance of disease, and less likely to have. Lynch DA, Travis WD, Müller NL et-al. In recent times some authors have suggested certain signs within a UIP pattern more suggestive of it being due to connective tissue disorder interstitial lung disease over IPF 22. Idiopathic interstitial lung injury demonstrating temporal and geographic heterogeneity; Alternate/Historical Names. Usual interstitial pneumonia (UIP) is a histologic pattern characterized by nonuniform, lower zone, subpleural, and paraseptal predominant lung injury defined by geographic heterogeneity and architectural distortion. Idiopathic interstitial pneumonia is a term that encompasses the following entities: usual interstitial pneumonia (UIP), desquamative interstitial pneumonia (DIP), acute interstitial pneumonia (AIP), and nonspecific interstitial pneumonia (NSIP) 1.Several recent studies have demonstrated variable treatment responses and survival based on this classification 2–8. This article will focus solely on the usual interstitial pneumonia pattern as a radiological or histopathological descriptor, for further discussion in the clinical aspects, please refer to the parental article on the specific underlying clinical diagnosis (e.g. confidence of a histologic usual interstitial pneumonia (UIP) pattern. Lukas Ebner, Stergios Christodoulidis, Thomai Stathopoulou, Thomas Geiser, Odile Stalder, Andreas Limacher, Johannes T. Heverhagen, Stavroula G. Mougiakakou, Andreas Christe. 2 The term “UIP” was originally introduced by Liebow and Car-rington, 3 Classification and natural history of the idiopathic interstitial pneumonias. non-specific interstitial pneumonia (NSIP), desquamative interstitial pneumonia (DIP), connective tissue disorder interstitial lung disease, diagnostic HRCT criteria for UIP pattern - ATS/ERS/JRS/ALAT (2018), diagnostic HRCT criteria for UIP pattern - Fleischner society guideline (2018), fibrotic non-specific interstitial pneumonia, chronic hypersensitivity pneumonitis (HP), combined pulmonary fibrosis and emphysema (CPFE), acute unilateral airspace opacification (differential), acute bilateral airspace opacification (differential), acute airspace opacification with lymphadenopathy (differential), chronic unilateral airspace opacification (differential), chronic bilateral airspace opacification (differential), osteophyte induced adjacent pulmonary atelectasis and fibrosis, pediatric chest x-ray in the exam setting, normal chest x-ray appearance of the diaphragm, posterior tracheal stripe/tracheo-esophageal stripe, obliteration of the retrosternal airspace, leflunomide-induced acute interstitial pneumonia, cellular non-specific interstitial pneumonia, respiratory bronchiolitis–associated interstitial lung disease, diagnostic HRCT criteria for UIP pattern - ATS/ERS/JRS/ALAT (2011), diagnostic HRCT criteria for UIP pattern - Fleischner society guideline (2018)​, domestically acquired particulate lung disease, lepidic predominant adenocarcinoma (formerly non-mucinous BAC), micropapillary predominant adenocarcinoma, invasive mucinous adenocarcinoma (formerly mucinous BAC), lung cancer associated with cystic airspaces, primary sarcomatoid carcinoma of the lung, large cell neuroendocrine cell carcinoma of the lung, squamous cell carcinoma in situ (CIS) of lung, minimally invasive adenocarcinoma of the lung, diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH), calcifying fibrous pseudotumor of the lung, IASLC (International Association for the Study of Lung Cancer) 8th edition (current), IASLC (International Association for the Study of Lung Cancer) 7th edition (superseeded), 1996 AJCC-UICC Regional Lymph Node Classification for Lung Cancer Staging, connective tissue disorders (CTD associated UIP): falls under the borader spectrum of. %%EOF 14. Pneumothorax is a common complication and can occur at presentation or at other times during the course of the disease. While chest radiographs can be even normal in patients with very early disease, in advanced disease, it may show decreased lung volumes and basal fine to coarse reticulation. Akira M, Inoue Y, Kitaichi M et-al. Usual interstitial pneumonia (UIP) defines idiopathic pulmonary fibrosis and is the most common of the idiopathic interstitial pneumonias. The term usual interstitial pneumonitis (UIP) has also often been used, but again, the -itis part of that name may overemphasize inflammation. Chest. Assessment with serial CT. The revised ATS/ERS/JRS/ALAT diagnostic criteria for idiopathic pulmonary fibrosis (IPF)-practical implications. Akira M, Sakatani M, Ueda E. Idiopathic pulmonary fibrosis: progression of honeycombing at thin-section CT. Radiology. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Usual interstitial pneumonia (UIP) is a histopathologic and radiologic pattern of interstitial lung disease, which is the hallmark pattern for idiopathic pulmonary fibrosis (IPF). ��I�e|EE '�m7$�2��%V�dHJ[�ݑ�M%��&�`Hb������#!-aD(F����D���DV�S�Xsx*b �.44,b�u�C���C��A�X���Y�LD�H7E0�aE���]18��J���,��|�@ǣz��_�[̾�mIN����"+�0�c�����]���IY4�,�*�c4�Pڸ�,[�����u�J CT Features of the Usual Interstitial Pneumonia Pattern: Differentiating Connective Tissue Disease–Associated Interstitial Lung Disease From Idiopathic Pulmonary Fibrosis. European Respiratory Journal. Human lung disease due to an inability to produce SP-B was the first recognized genetic cause of surfactant dysfunction. doi : 10.1038/modpathol.2011.154 . As described in the 2002 statement, the pathology of IPF is that of usual interstitial pneumonia (UIP). disease acute interstitial pneumonia bronchiolitis obliterans anizing pneumonia usual' 'pathology outlines usual interstitial pneumonia uip june 3rd, 2020 - the first or second most mon 17 86 interstitial lung disease clin epidemiol 2013 5 483 rarely younger than 50 years old these patients may have a genetic factor or underlying disease male ��3���� ��"`�,�5��[ ܨ~H�������6[4�DqA/��U�-�+���O;\�I�,k"�����>?��`���8��s���*���$�w���e��6I�=�y�~��1ꭣb����_��&� �����>Cn��7M������:uq0�*[7eE�n�����ϱ���Gs~tN�vO�J)�8�Dl��?��͖ƺ=h�VX�H����S�p��Y1*�l��$����1������5R�1i�p����ӛ���}V=�� �*PW����A�D���As9�����!��^����p�w��=�ߕzϵ�X��������ŀ����ܬ #&��Vs�|�NF��kT��\z�l�������5�ηr)_�R�R���Ϫ�\*�r��(`�._J�. Videos Idiopathic pulmonary fibrosis: the radiologist’s role in making the diagnosis. Kim EA, Lee KS, Johkoh T et-al. Radiology. 15. 6. 2005;236 (1): 10-21. Jeong YJ, Lee KS, Müller NL et-al. In the past, the term usual interstitial pneumonia was used synonymously with IPF. 1996;110 (2): 378-82. Clarke, et al. 21. Proc Am Thorac Soc. 2014;23 (133): 308-19. Respir. Meta-analysis of the radiological and clinical features of Usual Interstitial Pneumonia (UIP) and Nonspecific Interstitial Pneumonia (NSIP). Lee JS, Gong G, Song KS et-al. The revised ATS/ERS/JRS/ALAT diagnostic criteria for idiopathic pulmonary fibrosis (IPF)-practical implications. Gruden J. American Journal of Roentgenology. endstream endobj startxref "Smoking-related interstitial fibrosis (SRIF), pathogenesis and treatment of usual interstitial pneumonia (UIP), and transbronchial biopsy in UIP.". 3. Pathology of Usual Interstitial Pneumonia (UIP) Dr Sampurna Roy MD Usual interstitial pneumonia is the most common form of idiopathic interstitial fibrosis (70% of all cases), and unfortunately carries a poor prognosis. AJR. 11. (2018) The Lancet. h�b```�b�# cb�w�1h30R���_pǜ[�맥� � �P�a`���$@jE��,7�%024;�4p,abf���Ͱ��0cC �C6cՍ ��A��!�q��5�>@�]˼��F)���`Q�������@� � )#� Chest. R.L. Can CT distinguish hypersensitivity pneumonitis from idiopathic pulmonary fibrosis?. Nonspecific interstitial pneumonia (NSIP) Cryptogenic organizing pneumonia (COP) Desquamative interstitial pneumonia Respiratory bronchiolitis-interstitial lung disease (RB-ILD) Acute interstitial pneumonia (AIP) Lymphoid interstitial pneumonia Idiopathic pleuroparenchymal fibroelastosis (PPFE) References and Links. 2006;3 (4): 285-92. IPF is the most important and common form of chronic intersti-tial lung disease (ILD). This condition is characteristically most prominent subpleurally in the lower lobes of the lung. It concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, and perivascular and perilymphatic tissues. Korean J Radiol. However more recently the term idiopathic pulmonary fibrosis has been applied solely to the clinical syndrome associated with the morphologic pattern of UIP, with the specific exclusion of entities such as non-specific interstitial pneumonia (NSIP) and desquamative interstitial pneumonia (DIP) 1. Patients are mostly older women, with mild symptoms and CT findings. 28 Affected infants are generally full-term and develop symptoms and signs of lung disease within hours of birth, and radiographically have diffuse lung disease that resembles RDS in prematurely born infants. What every radiologist should know about idiopathic interstitial pneumonias. NSIP is less common than UIP, but occurs more frequently than the remaining idiopathic interstitial pneumonias. Thorax. Am J Respir Crit Care Med 1999; 160:899. 6 (3): 143-52. (2016) AJR. However, in certain conditions such as leflunomide-induced acute interstitial pneumonia, patients have pre-existing lung disease. The term “bronchiolitis obliterans organizing pneumonia (BOOP)” is a relatively recent term for a clinicopathologic entity that has been recognized for some time.1 The name derives from a series of cases collected in the 1970s and 1980s by Charles Carrington. It is rarely the sole major lung biopsy finding in patients presenting with interstitial lung disease (PBM-ILD). Du bois R, King TE. Otaola M, Quadrelli S, Tabaj G et-al. However more recently the term idiopathic pulmonary fibrosis has been applied solely to the clinical syndrome associated with the morphologic pattern of UIP, with the specific exclusion of entities such as non-specific interstitial pneumonia (NSIP) and desquamative interstitial pneumonia (DIP) 1. 0 Other forms of idiopathic interstitial pneumonia include desquamative interstitial pneumonia, respiratory bronchiolitis–associated interstitial lung disease, … In those with more active inflammation involving the pulmonary interstitium, there is a faster progression of honeycombing in long-term follow-up 10. Truly idiopathic AIP tends to occur in those without pre-existing lung disease and typically affects middle-aged adults (mean ~ 50 years 5). UIP has distinctive morphologic features that allow precise diagnosis in classical cases. endstream endobj 225 0 obj <>/Metadata 28 0 R/Pages 222 0 R/StructTreeRoot 73 0 R/Type/Catalog>> endobj 226 0 obj <>/MediaBox[0 0 595.32 841.92]/Parent 222 0 R/Resources<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 227 0 obj <>stream Idiopathic Interstitial Pneumonias. Acute interstitial pneumonia (AIP) is an idiopathic interstitial lung disease that is clinically characterized by sudden onset of dyspnea and rapid development of respiratory failure. It is sometimes used incorrectly as a synonym for idiopathic pulmonary fibrosis. Usual Interstitial Pneumonia; Silo-Filler's Disease; Organizing Pneumonia; View all Topics. When describing imaging features, the term UIP pattern is often used, which has specific diagnostic criteria on HRCT 16. CLINICAL FEATURES. Jonathan H. Chung, Christian W. Cox, Steven M. Montner, et al. Eur Respir Rev. A key imaging differential on cross-sectional imaging would be: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Mueller-mang C, Grosse C, Schmid K et-al. 6 (2): 138-153. idiopathic pulmonary fibrosis). 2002;22 Spec No : S151-65. On imaging, usual interstitial pneumonia usually presents with a lung volume loss and a craniocaudal gradient of peripheral septal thickening, bronchiectasis, and honeycombing. 165 (4): 807-11. 5. On a typical biopsy, there are areas of normal lung alternating with interstitial fibrosis and honeycombing. Wells AU. h޼�mo�6ǿ Res. Usual interstitial pneumonia (UIP) is a form of lung disease characterized by progressive scarring of both lungs. Wells AU. It is a histomorphologic pattern and has a DDx (see below). Kim DS, Collard HR, King TE. INTRODUCTION Interstitiallungdisease(ILD)includesalargenumber of conditions that are characterized by inflammation or fibrosis of the pulmonary parenchyma. Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fibrotic interstitial lung disease of unknown origin with a characteristic imaging and histologic pattern called usual interstitial pneumonia (UIP). Idiopathic interstitial pneumonias: CT features. Mod Pathol 25 Suppl 1 : S68-78. 15 (1): e0226084. Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. A histologic pattern of nonspecific interstitial pneumonia is associated with a better prognosis than usual interstitial pneumonia in patients with cryptogenic fibrosing alveolitis. Radiology. [1, 2] AIP is histologically characterized by diffuse alveolar damage with subsequent fibrosis. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":16895,"mcqUrl":"https://radiopaedia.org/articles/usual-interstitial-pneumonia/questions/1605?lang=us"}. 2007;62 (11): 1008-12. 12. Usual interstitial pneumonia and nonspecific interstitial pneumonia with and without concurrent emphysema: thin-section CT findings. 2011;140 (4 Meeting Abstracts): . 2014;14 Suppl 1: S2. The histopathologic features of an idiopathic, nonspecific interstitial pneumonia (NSIP) pattern observed on surgical lung biopsy (SLB) have also been thought to be the pulmonary manifestation of this process. 19 (6): 1114. 17. Interstitial lung diseases associated with collagen vascular diseases: radiologic and histopathologic findings. (2020) PLOS ONE. Lynch DA, Newell JD, Logan PM, King TE, Müller NL. Andras Khoor, in Pulmonary Pathology, 2008. American journal of roentgenology. 238 0 obj <>/Filter/FlateDecode/ID[<00F2343D3EDF704B8F9DC3A6B1402614>]/Index[224 38]/Info 223 0 R/Length 76/Prev 595863/Root 225 0 R/Size 262/Type/XRef/W[1 2 1]>>stream Usual interstitial pneumonia and non-specific interstitial pneumonia: serial thin-section CT findings correlated with pulmonary function. 224 0 obj <> endobj Radiographics. Michael P. Mohning, John Caleb Richards, Tristan J. Huie. Download as PDF. Plain film features are non-specific. 1993;189 (3): 687-91. Unable to process the form. These would include: In practice, the diagnosis is usually made in a multidisciplinary approach involving chest physicians, radiologists and pathologists with expertise in interstitial lung disease (ILD) 12. Geographic variability means there are some areas of advanced scarring while other areas are completely normal. %PDF-1.6 %���� Riha, E.E. Honeycombing, particularly if it involves more than 5% of the lung volume, is an almost 100% specific finding. 261 0 obj <>stream Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia. 9. 8. UIP pattern of ILD can be seen in idiopathic pulmonary fibrosis or secondary to underlying systemic diseases. Usually, due to the more extensive involvement of the lower lobes, the major fissure is shifted inferiorly which is best seen on the lateral chest radiograph. Interstitial lung disease (ILD), or diffuse parenchymal lung disease (DPLD), is a group of respiratory diseases affecting the interstitium (the tissue and space around the alveoli (air sacs) of the lungs. Usual interstitial pneumonia: relationship between disease activity and the progression of honeycombing at thin-section computed tomography. 1998;13 (3): 199-203. Inter-society consensus guidelines on IPF diagnosis and management outline radiologic patterns including definite usual interstitial pneumonia (UIP), possible UIP, and inconsistent with UIP. In the past, the term usual interstitial pneumonia was used synonymously with idiopathic pulmonary fibrosis. About this page. Set alert. Differential diagnosis of usual interstitial pneumonia: when is it truly idiopathic?. 1. Pathology Outlines. Challenges in pulmonary fibrosis x 5: the NSIP/UIP debate. Katzenstein AL, Zisman DA, Litzky LA, et al. The average rate of progression of honeycombing in patients with idiopathic usual interstitial pneumonia according to one study was 0.4% of lung volume per month 7. 18. American journal of roentgenology. Pathologically, interstitial fibrosis takes the form of a dense consolidation with some preservation of alveolar septal outlines and demonstrates a distinctly … Foci of fibroblastic activity and honeycomb change are hallmarks of the UIP pattern. 27 (3): 595-615. (2017) American Journal of Roentgenology. J Thorac Imaging. The Value of a Multidisciplinary Approach to the Diagnosis of Usual Interstitial Pneumonitis and Idiopathic Pulmonary Fibrosis: Radiology, Pathology, and Clinical Correlation. The histological diagnosis of UIP is based on temporal and spatial heterogeneity, which is the identification of fibrotic lesions at different stages (fibroblastic infiltrates, mature fibrosis, and honeycombing) within the same biopsy specimen and architectural distortion. 2014;14 Suppl 1: S2. Survival of patients with biopsy-proven usual interstitial pneumonia and nonspecific interstitial pneumonia. Idiopathic pulmonary fibrosis/usual pneumonia pattern. Respiratory medicine. Wuyts WA, Cavazza A, Rossi G et-al. Res. Inflammation is absent or mild and mostly limited to the areas of honeycombing 1-12. (2019) The British Journal of Radiology. Types of interstitial pneumonias One prominent example is the specific pattern of a usual interstitial pneumonia (UIP), which is further classified in a definite, probable or possible UIP pattern according to the current guidelines. Respir. 22. 2. Hartman TE, Primack SL, Kang EY et-al. The positive predictive value of CT in the diagnosis of UIP is high and ranges from 70-100% 1. ILD can occur due to a number of specific causes or may be classified as an idiopathic interstitial pneumonia In summary, PBM is a common histologic finding in various interstitial lung disorders. Lynch DA, Sverzellati N, Travis WD, et al. 16. This granulation tissue polyp is a very non-specific histologic finding as it is seen in most infectious pneumonias, diffuse alveolar damage, aspiration, usual interstitial pneumonia, cryptogenic organizing pneumonia, among other conditions. 13. Radiographics. Idiopathic pulmonary fibrosis (IPF), the most common and lethal of the idiopathic interstitial pneumonias, is defined by a radiological and/or pathological pattern of usual interstitial pneumonia (UIP). Over time, as the understanding of the clinical behavior and histologic features of the IIPs has evolved, the categories of IIP have changed: usual interstitial pneumonia (UIP) and desquamative interstitial pneumonia (DIP) have persisted as important histologic groups, nonspecific interstitial pneumonia (NSIP) has been added, and bronchiolitis obliterans with classical interstitial pneumonia (BIP) and giant cell … Usual Interstitial Pneumonia Definition. 10. atlas of interstitial lung disease pathology pathology with high resolution ct correlations Nov 19, 2020 Posted By Danielle Steel Ltd TEXT ID c91ae8ad Online PDF Ebook Epub Library 978 0 7020 3369 8 3 hasleton flieder spencers pathology of the lung 6th edition cambridge isbn 978 0 521 atlas of interstitial lung disease pathology pathology with high Similar to the pathology specimen, cross-sectional imaging also reveals heterogeneity, with patchy areas of fibrosis alternating with areas of normal lung 5. In patients with UIP, areas of ground-glass attenuation tend to increase in extent or progress to fibrosis despite treatment 8,13. Chung JH, Lynch DA. h�bbd``b`z${A�& ��H0�q�@,%�X,�e"$@�v���@�@Hl(c`bd���B�gd~ ` � Check for errors and try again. }F�N�N��l���cxɨ}��qGF��ݯT8�h�9�Pd�.