Imaging |

Comparison of HRCT Findings Between Chronic Sarcoidosis and Chronic Hypersensitivity Pneumonitis: What to Look for Beyond Upper Lobe Fibrosis FREE TO VIEW

Shahram Kahkouee, MD; Sandbad Armand, MD; Ramin Pourghorban, MD; Leila Mosadegh, MD
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National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

Chest. 2013;144(4_MeetingAbstracts):590A. doi:10.1378/chest.1702829
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 10:45 AM - 11:45 AM

PURPOSE: Pulmonary sarcoidosis and hypersensitivity pneumonitis may have some similar features not only in their clinical aspects but also in their imaging findings, especially at their chronic stage. We sought to compare high resolution computed tomography (HRCT) manifestations of chronic pulmonary sarcoidosis (CPS) with those of chronic hypersensitivity pneumonitis (CHP).

METHODS: Thirty-five patients with CPS (male, n=19; mean age, 51 years) and 35 cases of CHP (male, n=16; mean age, 54 years) were enrolled in the current study. Final diagnoses of CPS or CHP in the whole study population were based on either percutaneous or transbronchial biopsy results. Thereafter, HRCT findings of both groups were reviewed, retrospectively.

RESULTS: The following HRCT findings were significantly (P < 0.05) more prevalent in patients with CPS compared to CHP: progressive massive fibrosis (PMF) (13 vs. 0), parenchymal calcification (10 vs. 0) perilymphatic nodule (15 vs. 1), parenchymal metastasis like nodule (10 vs. 1), whorled lung (12 vs. 1), lymphadenopathy (10 vs. 2), calcified lymph node (19 vs. 8), fibrotic band (14 vs. 6), fibrobronchiectasis (22 vs. 9), peribronchial wall thickening (29 vs. 16), mosaicism (17 vs. 5), consolidation (13 vs. 5), reticulonodular pattern (17 vs. 5) and central or perihilar dominance (19 vs. 0), anterior sparing (18 vs. 0) In addition, despite a higher prevalence of bronchovascular bundle thickening, thick wall cavity, punctate lymph node calcification and fungus ball in patients with CPS, the difference between the two groups were not statistically significant (P > 0.05). On the other hand, HRCT findings with significantly (P < 0.05) more prevalence in patients with CHP compared to CPS were as follows: fibrotic plate (12 vs. 2), peripheral subpleural dot shape opacity (18 vs. 3), traction bronchiolectasis (20 vs. 9), pseudoplaque (15 vs. 4), diffuse craniocaudal pulmonary involvement (22 vs. 7) and peripheral involvement (15 vs. 3)

CONCLUSIONS: Prevalence of PMF, parenchymal calcification, pulmonary nodule, lymph node involvement, whorled lung, bronchial involvement, mosacism, fibrotic band or plate, pseudoplaque, consolidation, reticulonodular pattern, traction bronchiolectasis and dominant region of involvement was significantly different between CPS and CHP on HRCT.

CLINICAL IMPLICATIONS: Despite several common features e.g., upper lobe fibrosis in both diseases, CPS can be differentiated from CHP on HRCT.

DISCLOSURE: The following authors have nothing to disclose: Shahram Kahkouee, Sandbad Armand, Ramin Pourghorban, Leila Mosadegh

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