104 Acute Interstitial Pneumonia (AIP)

CASE 104


image Clinical Presentation


50-year-old woman with persistent fever, progressive dyspnea, and non-productive cough for several weeks despite antibiotics for presumed community-acquired pneumonia


image Radiologic Findings


Baseline frontal chest X-ray (Fig. 104.1A) reveals mild hypoaeration but is otherwise unremarkable. Follow-up chest X-ray eight days later (Fig. 104.1B) shows bilateral, patchy ground glass and subtle reticular opacities. The heart is not enlarged. Lung volumes remain mildly diminished. Chest CT (lung window) through the upper (Fig. 104.1C), mid (Figs. 104.1D, 104.1E), and lower (Figs. 104.1E, 104.1F) lung zones performed two days later demonstrates bilateral ground glass opacities with sparing of some secondary pulmonary lobules, resulting in a geographic appearance to the lungs. Smooth septal thickening, intralobular lines, and ground glass result in a “crazy paving” pattern. Mild bronchial dilatation is present. Patient required mechanical ventilator support two days later. Subsequent open lung biopsy confirmed the diagnosis.


image Diagnosis


Acute Interstitial Pneumonia (AIP)


image Differential Diagnosis


• Permeability Edema


• Diffuse Pneumonia


• Diffuse Alveolar Hemorrhage


• Acute Hypersensitivity Pneumonitis


image Discussion


Background


The idiopathic interstitial pneumonias (IIP) are the most common group of diffuse parenchymal lung diseases. They were recently reclassified by a multidisciplinary panel of experts in a collaborative effort by the American Thoracic Society (ATS), the European Respiratory Society (ERS), and the American College of Chest Physicians (ACCP). The new classification includes seven distinct clinico-pathologic entities: (1) idiopathic pulmonary fibrosis (IPF) or cryptogenic fibrosing alveolitis (CFA); (2) non-specific interstitial pneumonia (NSIP); (3) cryptogenic organizing pneumonia (COP); (4) acute interstitial pneumonia (AIP); (5) lymphocytic interstitial pneumonia (LIP); (6) respiratory bronchiolitis–interstitial lung disease (RB-ILD); and (7) desquamative interstitial pneumonitis (DIP).


Acute interstitial pneumonia (AIP

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Jan 14, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on 104 Acute Interstitial Pneumonia (AIP)
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