Unpaid scientific collaborator & advisor with Veracyte, Inc.
|
|
- Marvin Baker
- 5 years ago
- Views:
Transcription
1 Diagnosis and Classification of Idiopathic Interstitial Pneumonias: Role of Histopathology in the Golden Age of Consensus Jeffrey L. Myers, M.D. A. James French Professor of Diagnostic Pathology Vice Chair for Clinical Affairs & Quality Director, MLabs University of Michigan, Ann Arbor, MI Unpaid scientific collaborator & advisor with Veracyte, Inc. Diagnosis and Classification of Idiopathic Interstitial Pneumonias: Role of Histopathology in the Golden Age of Consensus At the conclusion of this talk those who were actively engaged will be able to, diagnose histologically classic usual interstitial pneumonia (UIP) in surgical lung biopsies, diagnose histologically classic nonspecific interstitial pneumonia (NSIP) in surgical lung biopsies, articulate the significance of a histologic diagnosis of UIP or NSIP in the context of multidisciplinary review
2 Diffuse Parenchymal Lung Diseases DPLD of known cause or association (eg, drugs, CTD, occupational/environmental) Other radiologically distinct DPLDs (eg, LCH, LAM) Granulomatous DPLD (eg, HP, sarcoidosis) Idiopathic interstitial pneumonias clinical & radiology pathology Idiopathic Interstitial Pneumonias Pathology Based Classification 2016 chronic fibrosing IPs smokingrelated IPs acute/ subacute IPs CPR Diagnosis idiopathic pulmonary fibrosis (IPF) idiopathic nonspecific IP (NSIP) respiratory bronchiolitis interstitial lung disease (RBILD) desquamative IP (DIP) cryptogenic organizing pneumonia acute IP (AIP) Morphologic Pattern usual IP (UIP) nonspecific IP (NSIP) respiratory bronchiolitis desquamative IP (DIP) organizing pneumonia diffuse alveolar damage (DAD) Travis et al. Am J Resp Crit Care Med 2013; 188: 733 Idiopathic Interstitial Pneumonias Evidence Based Guidelines for Diagnosis & Management a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause, occurring in older adults, limited to the lungs, and associated with the histopathologic and/or radiologic pattern of UIP Raghu et al. Am J Respir Crit Care Med 2011; 183:
3 Diagnostic Process Diagnostic Process Usual Interstitial Pneumonia (UIP) Histologic Criteria fibrosis heterogeneity (variegated pattern) geographic heterogeneity temporal heterogeneity
4
5 temporal heterogeneity acute chronic fibroblast focus Multiple microscopic foci of injury occurring over time pro-collagen Focal fibroblast proliferation (fibroblast foci) collagen IV Recurrent microscopic injury Alveolar collapse, collagen deposition, architectural distortion Progressive clinical course Death Fibroblast Foci & The Pathogenesis of UIP
6 Usual Interstitial Pneumonia (UIP) Histologic Criteria fibrosis heterogeneity (variegated pattern) geographic heterogeneity temporal heterogeneity architectural distortion honeycomb change fibrotic scarring Usual Interstitial Pneumonia Peripheral Honeycomb Change
7 Usual Interstitial Pneumonia (UIP) Histologic Criteria fibrosis heterogeneity (variegated pattern) geographic heterogeneity temporal heterogeneity architectural distortion honeycomb change fibrotic scarring peripheral/subpleural accentuation fibroblast foci geographic heterogeneity temporal heterogeneity architectural distortion peripheral distribution fibroblast foci geographic heterogeneity TBBx? temporal heterogeneity architectural distortion peripheral distribution
8 Usual Interstitial Pneumonia Role for Transbronchial Lung Biopsies? 7 (32%) diagnostic of UIP (ie, patchwork fibrosis + ff and/or HCC) 22 patients with UIP/IPF HRCT = UIP (4) SLBx = UIP (19) explants = UIP (2) 2 (9%) consistent with UIP (ie, fibrosis + ff and/or HCC) Berbescu et al. CHEST 2006; 129: (59%) nonspecific (9) or insufficient (4) Usual Interstitial Pneumonia Role for Transbronchial Lung Biopsies? patchwork fibrosis + honeycomb change 3/32 (9.4%) TBBx diagnostic of UIP The primary and main role of transbronchial biopsy in diagnosis of usual interstitial pneumonia is thought not to confirm a diagnosis, but to exclude other infiltrative diseases, such as malignancy, sarcoidosis or infections.
9 MultiDisciplinary Discussion MultiDisciplinary Discussion Bell Sympoisum: Idiopathic Interstitial Pneumonias - Myers Pathologists 1 & 2 Respir Res 2012; 13: 96 TBB criteria for UIP patchy fibrosis fibroblast foci honeycomb change 1 = compatible with UIP even modest amount of patchy interstitial fibrosis, fibroblast foci, honeycomb changes detected on TBB can be highly predictive of a UIP pattern. Conversely, the absence of UIP histopathologic criteria on TBB does not rule out UIP. Sensitivity Specificity PPV NPV Pathologist 1* 30% (12/40) 100% (24/24) 100% (12/12) 46% (24/52) Pathologist 2* 30% (12/40) 92% (22/24) 86% (12/14) 55% (22/40) *kappa coefficient of agreement 0.61 (95% CI ) Usual Interstitial Pneumonia Role for Transbronchial Lung Biopsies? History & HRCT review TBBx results SLBx? Final diagnosis Independent HRCT review (3 radiologists) Independent TBBx review (4 pathologists) n = 33 (30 UM, 3 UCLA) HRCT, TBBx, SLBx for ILD UIP 2 patchwork fibrosis, HNCB, FF Sheth et al. CHEST (2016), doi: /j.chest Usual Interstitial Pneumonia Role for Transbronchial Lung Biopsies? History & HRCT review Independent HRCT review (3 radiologists) SLBx results Final diagnosis Independent SLBx review (1 pathologist) 5 months after TBBx MDD no TBBx results included order of review shuffled Sheth et al. CHEST (2016), doi: /j.chest
10 Usual Interstitial Pneumonia Role for Transbronchial Lung Biopsies? All Patients n=33 No SLB n=10 Undecided n=2 Yes SLB n=21 Definite HRCT n=4 No Definite HRCT n=6 No Definite HRCT n=2 No Definite HRCT TBB & SLB Agree n=4 TBB & SLB Agree n=6 TBB & SLB Agree n=2 TBB & SLB Agree n=7 TBB & SLB Incongruent n=14 Sheth et al. CHEST (2016), doi: /j.chest Usual Interstitial Pneumonia Role for Transbronchial Lung Biopsies? TBB specimens n=33 Adequate n=27 Inadequate n=6 Diagnostic n=13 Nondiagnostic n=14 UIP n=9 OP n=1 HP n=3 Diagnostic Performance for UIP All Cases Inadequate excluded Sensitivity 33% (5/15) 50% (5/10) Specificity* 78% (14/18) 76% (13/17) PPV* 56% (5/9) 56% (5/9) NPV 58% (14/24) 72% (13/18) *4 false positives include 2 fibrotic HP with UIP-like features Sheth et al. CHEST (2016), doi: /j.chest Diffuse Parenchymal Lung Diseases Role for Transbronchial Biopsy DPLD Sensitivity Specificity Comment Histologically Distinct DPLDs LCH variable yield Granulomatous DPLDs LAM HP sarcoidosis highest diagnostic value Idiopathic Interstitial Pneumonias UIP/IPF lowest diagnostic non-uip/ipf value
11 Diffuse Parenchymal Lung Diseases Role for Transbronchial Biopsy DPLD Sensitivity Specificity Comment Diagnostic value of TBB in idiopathic interstitial pneumonias is limited to a small subset of patients with UIP, but can never provide specific support for diagnoses of NSIP, RBILD, or DIP. Idiopathic Interstitial Pneumonias UIP/IPF lowest diagnostic non-uip/ipf value Diagnostic Process Usual Interstitial Pneumonia (UIP)/IPF Clinical Features older adults (mean age 59 years) men > women ( 2:1)
12 Idiopathic Pulmonary Fibrosis (IPF) Incidence/Prevalence in Medicare Beneficiaries ( ) All patients Age groups Female Male Unadjusted incidence 93.7 ( ) 63.3 ( ) 95.2 ( ) ( ) ( ) 86.1 ( ) ( ) Adjusted incidence rate 1.00 (reference) 1.53 ( ) 1.92 ( ) 2.14 ( ) 1.00 (reference) 1.29 ( ) Raghu et al. Lancet Respir Med 2014; 2: p value -- <.0001 <.0001 < <.0001 Usual Interstitial Pneumonia (UIP)/IPF Clinical Features older adults (mean age 59 years) men > women ( 2:1) insidious onset dyspnea, dry cough PFTs: restriction, DLco, hypoxemia Idiopathic Interstitial Pneumonias Evidence Based Guidelines for Diagnosis & Management a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause, occurring in older adults, limited to the lungs, and associated with the histopathologic and/or radiologic pattern of UIP Raghu et al. Am J Respir Crit Care Med 2011; 183:
13 Survival (%) Bell Sympoisum: Idiopathic Interstitial Pneumonias - Myers Usual Interstitial Pneumonia (UIP)/IPF Radiological Findings subpleural, basilar reticulations honeycombing ± traction br ectasis minimal ground glass Usual Interstitial Pneumonia (UIP)/IPF Clinical Features older adults (mean age 59 years) men > women ( 2:1) insidious onset dyspnea, dry cough PFTs: restriction, DLco, hypoxemia poor prognosis (mortality 65%) (mean survival 3 years) Usual Interstitial Pneumonia (UIP)/IPF Survival After Diagnosis mean age 58 years M:F 2: yrs median survival Bjoraker et al.: AJRCCM 1998 Years following diagnosis UIP
14 Usual Interstitial Pneumonia (UIP)/IPF Treatment Lung Transplantation Patients listed 98 Waiting list 89 Removed from waiting list 9 Elective 57 High Urgency* 32 Survival After Lung Txplt median survival 120 months (10 years) Dead 22 Actively waiting 8 Transplanted 52 Dead 7 *HU criteria ICU in txplt center Acute life-threatening Imminent need for controlled ventilation OR Assisted/controlled ventilation ten Klooster et al. Lung 2015; 193: Usual Interstitial Pneumonia (UIP)/IPF Treatment Anti-fibrotic Agents $96K Patients receiving nintedanib had significant reductions in the rate of decline in forced vital capacity (FVC) at 1 year. trend toward a reduced rate of death that mirrored the reduced rate of decline in lung function. pirfenidone met the primary end point by showing significant reduction in the 1-year rate of decline in FVC may also reduce mortality in patients with idiopathic pulmonary fibrosis $94K The studies provide little insight into the use of these drugs in patients with more severe disease (FVC <50% of the predicted value) or with an acute disease exacerbation. Hunninghake. A new hope for idiopathic pulmonary fibrosis. NEJM 2014 Sixty-four cases of interstitial pneumonia were identified that could not be classified into one of the three main categories of idiopathic interstitial pneumonia. Nonspecific interstitial pneumonia must be separated from the three main forms of idiopathic interstitial pneumonia because of better prognosis and different treatment options.
15 It should not be considered a specific disease, however, because it may have varying etiologies...; less often it may reflect a nonrepresentative biopsy of another process. Nonspecific Interstitial Pneumonia Histologic Criteria chronic interstitial pneumonia with ( fibrotic NSIP ) or without ( cellular NSIP ) fibrosis temporally uniform without architectural distortion lacking other features (e.g. granulomas, pigmented [ smoker s ] alveolar histiocytes) to allow more specific classification Katzenstein & Fiorelli. Am J Surg Pathol 1994; 18: 136 cellular NSIP
16 fibrotic NSIP fibrotic NSIP NSIP UIP
17 Diagnosis and Classification of Idiopathic Interstitial Pneumonias: Role of Histopathology in the Golden Age of Consensus At the conclusion of this talk those who were actively engaged will be able to, diagnose histologically classic usual interstitial pneumonia (UIP) in surgical lung biopsies, diagnose histologically classic nonspecific interstitial pneumonia (NSIP) in surgical lung biopsies, articulate the significance of a histologic diagnosis of UIP or NSIP in the context of multidisciplinary review Idiopathic Nonspecific Interstitial Pneumonia Definition The final diagnosis in the 67 [of 193] cases was established when, the surgical lung biopsy showed a NSIP pattern (cellular or fibrosing); the HRCT showed a pattern consistent with NSIP and not diagnostic of other entities such as UIP or chronic hypersensitivity pneumonitis; and there were no clinical features of another chronic ILD, such as collagen vascular disease, drug, or inhaled antigen exposure at the time of diagnosis. Travis et al. Am J Resp Crit Care Med 2008; 177: 1338 Idiopathic Nonspecific Interstitial Pneumonia Definition The final diagnosis in the 67 [of 193] cases was established when, the surgical lung biopsy showed a NSIP pattern (cellular or fibrosing); the HRCT showed a pattern consistent with NSIP and not diagnostic of other entities such as UIP or chronic hypersensitivity pneumonitis; and there were no clinical features of another chronic ILD, such as collagen vascular disease, drug, or inhaled antigen exposure at the time of diagnosis. Travis et al. Am J Resp Crit Care Med 2008; 177: 1338
18 Histopathologic Variability in UIP/IPF 109 patients with UIP or NSIP who underwent biopsy of 2 lobes concordant UIP (UIP + UIP) 51 NSIP (NSIP + NSIP) 30 discordant UIP (UIP + NSIP) 28 Flaherty et al. Am J Respir Crit Care Med 2001; 164: 1722 Histopathologic Variability in UIP/IPF NSIP Cumulative proportion surviving Discordant UIP 0.2 Concordant UIP Years Flaherty et al. Am J Respir Crit Care Med 2001; 164: 1722 Histopathologic Variability in UIP/IPF concordant UIP concordant NSIP discordant UIP Flaherty et al UIP is a specific diagnosis that defines natural history key learning point NSIP is not and is always SLBx necessary a diagnosis but of insufficient exclusion for diagnosis of NSIP Monaghan et al discordant UIP concordant NSIP concordant UIP
19 NSIP-like Areas Common in UIP Histologic Study of Biopsy and Explant Specimens areas resembling nonspecific interstitial pneumonia (NSIP-like areas) are present in the majority of UIP cases in both biopsy and explant specimens, and they are extensive in some. Katzenstein et al. Am J Surg Pathol 2002; 26: 1567 Idiopathic Nonspecific Interstitial Pneumonia Diagnosis of Exclusion SLBx = UIP NSIP HP fibrotic/ healed LCH late/persistent/ resolving DAD? systemic CVD? non-diagnostic/ non-classifiable lesions SRIF? NSIP Idiopathic Nonspecific Interstitial Pneumonia Diagnosis of Exclusion our CRP consensus review revealed diagnoses of hypersensitivity pneumonitis, organizing pneumonia, and UIP in cases in which lung biopsies showed a definite or probable NSIP pattern. Travis et al. Am J Resp Crit Care Med 2008; 177: 1338
20 Idiopathic Nonspecific Interstitial Pneumonia Clinical Features women > men (2:1) mean age 52 yrs 69% never smokers N = 67 5 yrs 82.3% 10 yrs 73.2% Travis et al. Am J Resp Crit Care Med 2008; 177: 1338 Usual Interstitial Pneumonia/IPF Role of HRCT in Separating from NSIP Histologic Diagnosis HRCT Dx UIP NSIP Total UIP* *includes definite and probable diagnoses data from Flaherty et al. Thorax 2003; 58: 143 Usual Interstitial Pneumonia/IPF Role of HRCT in Separating from NSIP Histologic Diagnosis HRCT Dx UIP NSIP Total UIP* Indeterminate *includes definite and probable diagnoses data from Flaherty et al. Thorax 2003; 58: 143
21 Radiological Honeycombing Bell Sympoisum: Idiopathic Interstitial Pneumonias - Myers Usual Interstitial Pneumonia/IPF Role of HRCT in Separating from NSIP Histologic Diagnosis HRCT Dx UIP NSIP Total UIP* Indeterminate NSIP* 26 (59%) *includes definite and probable diagnoses data from Flaherty et al. Thorax 2003; 58: 143 Honeycombing in UIP Histopathology Radiology Microscopic Honeycombing Absent Rare Present None Probable Definite CT/SLBx concordance 50% 49% Chung et al. CT scan findings of probable usual interstitial pneumonitis have a high predictive value for histologic usual interstitial pneumonitis. CHEST 2015; 147: 450 Usual Interstitial Pneumonia/IPF Role of HRCT in Separating from NSIP Histologic Diagnosis HRCT Dx UIP confident/ UIP* 27 accurate HRCT diagnosis of UIP Indeterminate 20 in 27 (37%) of 73 NSIP* 26 (59%) patients *includes definite and probable diagnoses data from Flaherty et al. Thorax 2003; 58: 143
22 AJRCCM 2004; 170: n = 58 consecutive patients independent pathology review before step 1 weekend in Michigan AJRCCM 2004; 170: Frequency of UIP/IPF diagnosis Clinician A Clinician B Clinician C Step κ 0.75 Step κ 0.86 κ 0.73 κ 0.75 Step κ 0.80 κ 0.92 Frequency of UIP/IPF diagnosis Clinician A Clinician B Clinician C Step Step Step SLBx results κ 0.75 κ 0.86 AJRCCM 2004; 170: Step κ 0.92 κ 0.73 κ 0.75 κ 0.89 Step κ 0.80 κ 0.92 κ 0.60 κ 0.55 κ 0.50 κ 0.79
23 Consensus Path Dx Radiologist A AJRCCM 2004; 170: Frequency of UIP/IPF diagnosis Radiologist B Step κ 0.92 Step κ 0.95 Step κ 0.90 κ 0.98 Frequency of UIP/IPF diagnosis Consensus Path Dx Radiologist A Radiologist B Step Step Step SLBx results AJRCCM 2004; 170: κ 0.92 κ 0.95 Step Step κ 0.90 κ 0.98 κ 0.20 κ 0.16 κ 0.84 κ 0.88 HRCT SLBx clinical data
24 Histopathologic Diagnosis in Diffuse Lung Disease An Ailing Gold Standard The recent view that a final diagnosis should be made by consensus between histopathologist, radiologist, and clinician is a radical departure from the diagnostic thinking of the late twentieth century. Athol Wells. Am J Respir Crit Care Med 2004; 170: Goals to Improve Diagnosis and Reduce Diagnostic Error Facilitate more effective teamwork in the diagnostic process among health care professionals, patients, and their families Enhance health care professional education and training in the diagnostic process Ensure that health information technologies support patients and health care professionals in the diagnostic process Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice Establish a work system and culture that supports the diagnostic process and improvements in diagnostic performance Develop a reporting environment and medical liability system that facilitates improved diagnosis through learning from diagnostic errors and near misses Design a payment and care delivery environment that supports the diagnostic process Provide dedicated funding for research on the diagnostic process and diagnostic errors Diagnostic Process
25 Intra-observer Kappa Bell Sympoisum: Idiopathic Interstitial Pneumonias - Myers AJRCCM 2004; 170: consensus almost perfect substantial 0.6 HRCT + history discussion moderate Clin A Clin B Clin C Rad A Rad B SLBx results Step 2 Step 3 Step 4 Step 5 fair slight... Lancet Respir Med 2016 N = 70; 22 (31%) SLBx independent review by clinicians, radiologists, pathologists 7 multidisciplinary team meetings (MDTM) 4/7 non-significant increases toward greater prognostic separation for MDTM same analysis not significant for 5 pathologists small subgroup size (22) low IPF prevalence (15/154 diagnoses) Diagnostic Process
26 Diagnostic Process analytical models (slow) non-analytical models (fast) heuristics cognitive strategies/ mental shortcuts that are automatically & unconsciously employed Diagnostic Process analytical models (slow) non-analytical models (fast) representativeness bias tendency to make decisions based on a typical case overconfidence bias tendency to believe that we know more than we do search satisficing (premature closure) tendency to accept the first answer that comes along that explains the facts at hand, without considering whether there might be a different or better solution multidisciplinary discussion analytical models (slow) non-analytical models (fast) heuristics cognitive strategies/ mental shortcuts that are automatically & unconsciously employed
27 Test Case #1 Diagnostic Process Clinical correlation is recommended Diagnostic Process
28 Test Case #1 History 77-year-old man chest pain; no cough or shortness of breath bibasilar crackles on exam abnormal CT scan discovered in course of evaluation no relevant environmental exposures HRCT NSIP-like pattern representativeness bias? search satisficing (premature closure)? overconfidence bias? Diagnostic Process
29 Test Case #2 77-year-old man Test Case #2 History chest pain; no cough or shortness of breath bibasilar crackles on exam abnormal CT scan discovered in course of evaluation no relevant environmental exposures HRCT Definite UIP pattern with lower lobe predominant reticulations, traction bronchiectasis, and bibasilar honeycombing representativeness bias? search satisficing (premature closure)? overconfidence bias?
30 suspected UIP/IPF identifiable causes? DPLD of known cause or no association HRCT (eg, drugs, CTD, ±/not UIP occupational/environmental) Other clinically/radiologically surgical Not UIP distinct DPLDs Other histologically distinct lung biopsy ± UIP/NSIP DPLDs (eg, LCH, LAM) non-classifiable (eg, LCH, NSIP) fibrosis Granulomatous UIP DPLD multidisciplinary Granulomatous DPLD (eg, HP, sarcoidosis) review (eg, HP, sarcoidosis) UIP yes IPF IPF/Not IPF Not IPF! A subset (majority?) of patients with SLBx diagnoses of UIP/IPF will have an NSIPpattern on HRCT. A subset of patients (minority) with UIP/IPF will have SLBx diagnoses of NSIP ( pattern ) as a consequence of sampling bias. The sampling bias inherent in lung biopsies for diffuse lung disease is proportionally worse in patients with smaller closed (i.e., transbronchial forceps & cryo) biopsies. The smaller the biopsy the greater the risk!
31 A subset (majority?) of patients with SLBx diagnoses of UIP/IPF will have an NSIPpattern on HRCT. A subset of patients (minority) with UIP/IPF will have SLBx diagnoses of NSIP ( pattern ) as a consequence of sampling bias. Therefore, a subset of patients with UIP/IPF will be diagnosed as idiopathic NSIP even after multidisciplinary review. Lung, [site], wedge biopsy: UIP... sufficient to establish the diagnosis of, although not the clinical context for, UIP. Lung, [site], wedge biopsy: NSIP... necessary but insufficient to establish the diagnosis of NSIP.
Case 4 History. 58 yo man presented with prox IP joint swelling 2 months later pain and swelling in multiple joints Chest radiograph: bi-basilar
Case 4 History 58 yo man presented with prox IP joint swelling 2 months later pain and swelling in multiple joints Chest radiograph: bi-basilar basilar infiltrates suggestive of pulmonary fibrosis Open
More informationNONE OVERVIEW FINANCIAL DISCLOSURES UPDATE ON IDIOPATHIC PULMONARY FIBROSIS/IPF (UIP) FOR PATHOLOGISTS. IPF = Idiopathic UIP Radiologic UIP Path UIP
UPDATE ON IDIOPATHIC PULMONARY FIBROSIS/IPF () FOR PATHOLOGISTS Thomas V. Colby, M.D. Professor of Pathology (Emeritus) Mayo Clinic Arizona FINANCIAL DISCLOSURES NONE OVERVIEW IPF Radiologic Dx Pathologic
More informationNon-neoplastic Lung Disease II
Pathobasic Non-neoplastic Lung Disease II Spasenija Savic Prince Pathology Program Systematic approach to surgical lung biopsies with ILD Examples (chronic ILD): Idiopathic interstitial pneumonias: UIP,
More informationDisclosures. Fibrotic lung diseases: Basic Principles, Common Problems, and Reporting. Relevant financial relationships: None. Off-label usage: None
Fibrotic lung diseases: Basic Principles, Common Problems, and Reporting Brandon T. Larsen, MD, PhD Senior Associate Consultant Department of Laboratory Medicine and Pathology Mayo Clinic Arizona Arizona
More informationLiebow and Carrington's original classification of IIP
Liebow and Carrington's original classification of IIP-- 1969 Eric J. Stern MD University of Washington UIP Usual interstitial pneumonia DIP Desquamative interstitial pneumonia BIP Bronchiolitis obliterans
More informationProgress in Idiopathic Pulmonary Fibrosis
Progress in Idiopathic Pulmonary Fibrosis David A. Lynch, MB Disclosures Progress in Idiopathic Pulmonary Fibrosis David A Lynch, MB Consultant: t Research support: Perceptive Imaging Boehringer Ingelheim
More information11/10/2014. Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective. Radiology
Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective Radiology Pathology Clinical 1 Role of HRCT Diagnosis Fibrosis vs. inflammation Next step in management Response to treatment
More informationA Review of Interstitial Lung Diseases. Paul J. Wolters, MD Associate Professor Department of Medicine University of California San Francisco
A Review of Interstitial Lung Diseases Paul J. Wolters, MD Associate Professor Department of Medicine University of California San Francisco Outline Overview of diagnosis in ILD Why it is important Definition/Classification
More informationA Review of Interstitial Lung Diseases
Outline A Review of Interstitial Lung Diseases Paul J. Wolters, MD Associate Professor Department of Medicine University of California San Francisco Overview of diagnosis in ILD Why it is important Definition/Classification
More informationCase Presentations in ILD. Harold R. Collard, MD Department of Medicine University of California San Francisco
Case Presentations in ILD Harold R. Collard, MD Department of Medicine University of California San Francisco Outline Overview of diagnosis in ILD Definition/Classification High-resolution CT scan Multidisciplinary
More information5/9/2015. Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective. No, I am not a pulmonologist! Radiology
Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective No, I am not a pulmonologist! Radiology Pathology Clinical 1 Everyone needs a CT Confidence in diagnosis Definitive HRCT +
More informationOutline Definition of Terms: Lexicon. Traction Bronchiectasis
HRCT OF IDIOPATHIC INTERSTITIAL PNEUMONIAS Disclosures Genentech, Inc. Speakers Bureau Tadashi Allen, MD University of Minnesota Assistant Professor Diagnostic Radiology 10/29/2016 Outline Definition of
More informationDiffuse Interstitial Lung Diseases: Is There Really Anything New?
: Is There Really Anything New? Sujal R. Desai, MBBS, MD ESTI SPEAKER SUNDAY Society of Thoracic Radiology San Antonio, Texas March 2014 Diffuse Interstitial Lung Disease The State of Play DILDs Is There
More informationDiagnostic challenges in IPF
Medicine, Nursing and Health Sciences Diagnostic challenges in IPF Dr Ian Glaspole Central and Eastern Clinical School, Alfred Hospital and Monash University March 2015 Disclosures Consultancy fees from
More informationCTD-related Lung Disease
13 th Cambridge Chest Meeting King s College, Cambridge April 2015 Imaging of CTD-related Lung Disease Dr Sujal R Desai King s College Hospital, London Disclosure Statement No Disclosures / Conflicts of
More informationFinancial disclosure COMMON DIAGNOSES IN HRCT. High Res Chest HRCT. HRCT Pre test. I have no financial relationships to disclose. Anatomy Nomenclature
Financial disclosure I have no financial relationships to disclose. Douglas Johnson D.O. Cardiothoracic Imaging Gaston Radiology COMMON DIAGNOSES IN HRCT High Res Chest Anatomy Nomenclature HRCT Sampling
More informationINTERSTITIAL LUNG DISEASE. Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018
INTERSTITIAL LUNG DISEASE Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018 Interstitial Lung Disease Interstitial Lung Disease Prevalence by Diagnosis: Idiopathic Interstitial
More informationDifferential diagnosis
Differential diagnosis Idiopathic pulmonary fibrosis (IPF) is part of a large family of idiopathic interstitial pneumonias (IIP), one of four subgroups of interstitial lung disease (ILD). Differential
More informationThe radiological differential diagnosis of the UIP pattern
5th International Conference on Idiopathic Pulmonary Fibrosis, Modena, 2015, June 12th The radiological differential diagnosis of the UIP pattern Simon Walsh King s College Hospital Foundation Trust London,
More informationPFF HEALTH CARE PROFESSIONAL WEBINAR SERIES. Welcome!
PFF HEALTH CARE PROFESSIONAL WEBINAR SERIES Welcome! AGENDA TOPICS Welcome & Introduction Dr. Gregory Cosgrove, MD Chief Medical Officer Pulmonary Fibrosis Foundation PFF Resources Dolly Kervitsky, RCP,
More informationUsual Interstitial pneumonia and Nonspecific Interstitial Pneumonia. Nitra and the Gangs.
Usual Interstitial pneumonia and Nonspecific Interstitial Pneumonia Nitra and the Gangs. บทน ำและบทท ๓, ๑๐, ๑๒, ๑๓, ๑๔, ๑๕, ๑๗ Usual Interstitial Pneumonia (UIP) Most common & basic pathologic pattern
More informationOverview of Idiopathic Pulmonary Fibrosis: Diagnosis and Therapy
Overview of Idiopathic Pulmonary Fibrosis: Diagnosis and Therapy Jeff Swigris, DO, MS Director, ILD Program National Jewish Health Disclosures Speaker - Boehringer Ingelheim and Genentech Objectives Describe
More informationPathologic Assessment of Interstitial Lung Disease
Pathologic Assessment of Interstitial Lung Disease Dry and itchy? It could be eczema or fungal infection. We don t need to worry, the drugs aren t that dangerous. Kirk D. Jones, MD UCSF Dept. of Pathology
More informationHypersensitivity Pneumonitis Common Diagnostic and Treatment Dilemmas
Hypersensitivity Pneumonitis Common Diagnostic and Treatment Dilemmas Rishi Raj MD Director, Interstitial Lung Diseases Program Clinical Professor of Pulmonary and Critical Care Medicine Stanford University
More informationInternational consensus statement on idiopathic pulmonary fibrosis
Eur Respir J 2001; 17: 163 167 Printed in UK all rights reserved Copyright #ERS Journals Ltd 2001 European Respiratory Journal ISSN 0903-1936 PERSPECTIVE International consensus statement on idiopathic
More informationCOI: no conflicts of interest to declare
Idiopathic versus secondary Usual Interstitial Pneumonia (UIP) pattern in a series of 96 consecutive surgical lung biopsies: The value of histologic ancillary findings in a multidisciplinary discussion
More informationChallenges in the Diagnosis of Interstitial Lung Disease
Challenges in the Diagnosis of Interstitial Lung Disease Kirk D. Jones, MD UCSF Dept. of Pathology kirk.jones@ucsf.edu Overview New Classification of IIP Prior classification Modifications for new classification
More information4/17/2010 C ini n ca c l a Ev E a v l a ua u t a ion o n of o ILD U dat a e t e i n I LDs
Update in ILDs Diagnosis 101: Clinical Evaluation April 17, 2010 Jay H. Ryu, MD Mayo Clinic, Rochester MN Clinical Evaluation of ILD Outline General aspects of ILDs Classification of ILDs Clinical evaluation
More informationManish Powari Regional Training Day 10/12/2014
Manish Powari Regional Training Day 10/12/2014 Large number of different types of Interstitial Lung Disease (ILD). Most are very rare Most patients present with one of a smaller number of commoner diseases
More informationIPF: Epidemiologia e stato dell arte
IPF: Epidemiologia e stato dell arte Clinical Classification Diffuse parenchimal lung diseases Exposure-related: - occupational - environmental - medication Desquamative interstitial pneumonia Idiopathic
More informationUIP Possibile e Probabile
UIP Possibile e Probabile Sergio Harari U.O. di Pneumologia e UTIR Servizio di Emodinamica e Fisiopatologia Respiratoria Ospedale San Giuseppe - Milano Current definition of IPF IPF is a distinct type
More informationLines and crackles. Making sense of ILD
Lines and crackles Making sense of ILD Case JM 65 year old male Gradual shortness of breath, going on over a year Some dry cough Ex-smoker, quit 10 years ago Crackles in the bases CXR presented Sent to
More informationDIFFERENCES IN FIBROPROLIFERATIVE HEALING IN EXOGENEOUS AND IDIOPATHIC ILDs. ARE THERE ANY?
NIHR Southampton Respiratory Biomedical Research Unit DIFFERENCES IN FIBROPROLIFERATIVE HEALING IN EXOGENEOUS AND IDIOPATHIC ILDs. ARE THERE ANY? Fibrosing Interstitial Lung Diseases CPFS/WASOG/AIPO/ERS
More informationBronchoalveolar Lavage and Histopathologic Diagnosis Based on Biopsy
Idiopathic Pulmonary Fibrosis Bronchoalveolar Lavage and Histopathologic Diagnosis Based on Biopsy JMAJ 46(11): 469 474, 2003 Yukihiko SUGIYAMA Professor, Division of Pulmonary Medicine, Department of
More informationINTERSTITIAL LUNG DISEASES: FOCUS ON IDIOPATHIC PULMONARY FIBROSIS (IPF)
INTERSTITIAL LUNG DISEASES: FOCUS ON IDIOPATHIC PULMONARY FIBROSIS (IPF) Marilyn K. Glassberg Csete, M.D. Professor of Medicine, Surgery, and Pediatrics Director, Interstitial and Rare Lung Disease Program
More informationPrognostic Significance of Histopathologic Subsets in Idiopathic Pulmonary Fibrosis
Prognostic Significance of Histopathologic Subsets in Idiopathic Pulmonary Fibrosis JULIE A. BJORAKER, JAY H. RYU, MARK K. EDWIN, JEFFREY L. MYERS, HENRY D. TAZELAAR, DARRELL R. SCHROEDER, and KENNETH
More informationChallenges in the Diagnosis of Interstitial Lung Disease
Challenges in the Diagnosis of Interstitial Lung Disease Kirk D. Jones, MD UCSF Dept. of Pathology kirk.jones@ucsf.edu Overview New Classification of IIP Prior classification Modifications for new classification
More informationIPF - Inquadramento clinico
IPF - Inquadramento clinico Sergio Harari Unità Operativa di Pneumologia UTIR Servizio di Fisiopat. Resp. e Emodinamica Polmonare Ospedale S. Giuseppe, Milano Clinical Classification Diffuse parenchimal
More informationAn earlier and more confident diagnosis of idiopathic pulmonary fibrosis
Eur Respir Rev 2012; 21: 124, 141 146 DOI: 10.1183/09059180.00000812 CopyrightßERS 2012 REVIEW: IPF An earlier and more confident diagnosis of idiopathic pulmonary fibrosis Roland M. du Bois ABSTRACT:
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Idiopathic Pulmonary Fibrosis Page 1 of 10 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Idiopathic Pulmonary Fibrosis (Esbriet /pirfenidone, Ofev /nintedanib)
More informationPulmonary manifestations of CTDs Diagnosis, differential diagnosis and treatment
Prague, June 2014 Pulmonary manifestations of CTDs Diagnosis, differential diagnosis and treatment Katerina M. Antoniou, MD, PhD As. Professor in Thoracic Medicine ERS ILD Group Secretary Medical School,
More informationDiagnosing Idiopathic Pulmonary Fibrosis on Evidence-Based Guidelines
Diagnosing Idiopathic Pulmonary Fibrosis on Evidence-Based Guidelines Rebecca Keith, MD Assistant Professor, Division of Pulmonary and Critical Care Medicine National Jewish Health, Denver, CO Objectives
More informationGuidelines for Diagnosis and Treatment of IPF
Guidelines for Diagnosis and Treatment of IPF Katerina Antoniou, MD, PhD Lecturer in Thoracic Medicine ERS ILD Group Secretary Medical School, University of Crete Classification of Interstitial Lung Disease
More informationCurrent diagnostic recommendations for ILD: The multidisciplinary meeting TSANZSRS ASM
Medicine, Nursing and Health Sciences Current diagnostic recommendations for ILD: The multidisciplinary meeting Dr Ian Glaspole Central and Eastern Clinical School, Alfred Hospital and Monash University
More informationLUNG BIOPSY IN INTERSTITIAL LUNG DISEASE (ILD) AND THE IMPACT OF TRANSBRONCHIAL CRYOBIOPSY
LUNG BIOPSY IN INTERSTITIAL LUNG DISEASE (ILD) AND THE IMPACT OF TRANSBRONCHIAL CRYOBIOPSY Thomas V. Colby MD Professor of Pathology (Emeritus) Mayo Clinic College of Medicine FINANCIAL DISCLOSURES NONE
More informationEpidemiology and classification of smoking related interstitial lung diseases
Epidemiology and classification of smoking related interstitial lung diseases Šterclová M. Department of Respiratory Diseases, Thomayer Hospital, Prague, Czech Republic Supported by an IGA Grant No G 1207
More informationHistopathology of Explanted Lungs from Patients with a Diagnosis of Pulmonary. Sarcoidosis MD 4
1 Word count: 241 (abstract) and 2499(text) 2 3 4 Histopathology of Explanted Lungs from Patients with a Diagnosis of Pulmonary Sarcoidosis 5 6 Chen Zhang, MD, PhD 1, Kevin M. Chan, MD 2, Lindsay A. Schmidt,
More informationCareful histopathological evaluation has shown the traditionally clinical diagnosis of
Demystifying Idiopathic Interstitial Pneumonia Harold R. Collard, MD; Talmadge E. King, Jr, MD REVIEW ARTICLE Careful histopathological evaluation has shown the traditionally clinical diagnosis of idiopathic
More informationIPF AND OTHER FIBROSING LUNG DISEASE: WHAT DRUGS MIGHT WORK AND ON WHOM DO THEY W ORK?
IPF AND OTHER FIBROSING LUNG DISEASE: WHAT DRUGS MIGHT WORK AND ON WHOM DO THEY W ORK? KEVIN K. BROWN, MD PROFESSOR AND VICE CHAIRMAN, DEPARTMENT OF MEDICINE NATIONAL JEWISH HEALTH DENVER, CO Kevin K.
More informationConnective Tissue Disorder- Associated Interstitial Lung Disease (CTD-ILD) and Updates
Connective Tissue Disorder- Associated Interstitial Lung Disease (CTD-ILD) and Updates Maria Elena Vega, M.D Assistant Professor of Medicine Lewis Katz School of Medicine at Temple University Nothing to
More informationCombined Unclassifiable Interstitial Pneumonia and Emphysema: A Report of Two Cases
CASE REPORT Combined Unclassifiable Interstitial Pneumonia and Emphysema: A Report of Two Cases Nobuhiko Nagata 1, Kentaro Watanabe 2, Michihiro Yoshimi 3, Hiroshi Okabayashi 4, Katsuo Sueishi 5, Kentaro
More informationUsual Interstitial Pneumonia (UIP)
, NSIP and their differential diagnoses Belfast Pathology Belfast Tuesday 20 th June 2017 Professor Andrew G Nicholson, DM, FRCPath Usual Interstitial Pneumonia () Consultant Histopathologist, Royal Brompton
More informationIdiopathic Pulmonary Fibrosis: The Importance of Qualitative and Quantitative Phenotyping
Idiopathic Pulmonary Fibrosis: The Importance of Qualitative and Quantitative Phenotyping K. R. Flaherty Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor,
More informationInterstitial Lung Disease ILD: Definition
Interstitial Lung Disease 2007 Paul F. Simonelli,, MD, PhD, FCCP Clinical Director Center for Interstitial Lung Disease Columbia University Medical Center 1. ILD is not one disorder ILD: Definition 2.
More informationIn medicine, the term overlap is very common, to the extent that there is even a
Case Report Payam Mehrian (MD) 1 Ali Cheraghvandi (MD) 2 Atousa Droudnia (PhD) 3 Firouzeh Talischi (MD) 4 Saeid Fallah Tafti (MD) *5 Shahram Kahkouee (MD) 6 Hamidreza Jamaati (MD) 7 1. Pediatric Respiratory
More informationConflicts of Interest. Advisory Board: Boehringer-Ingleheim, Genentech/Roche DSMB: Bristol-Myers Squibb, Fibrogen Clinical Endpoint Committee; Merck
Conflicts of Interest Advisory Board: Boehringer-Ingleheim, Genentech/Roche DSMB: Bristol-Myers Squibb, Fibrogen Clinical Endpoint Committee; Merck The Idiopathic Interstitial Pneumonias Idiopathic pulmonary
More informationBeyond a consensus classification for idiopathic interstitial pneumonias: progress and controversies
Histopathology 2009, 54, 90 103. DOI: 10.1111/j.1365-2559.2008.03173.x REVIEW Beyond a consensus classification for idiopathic interstitial pneumonias: progress and controversies Jeffrey L Myers & Anna-Luise
More informationUpdate on Therapies for Idiopathic Pulmonary Fibrosis. Outline
Update on Therapies for Idiopathic Pulmonary Fibrosis Paul Wolters Associate Professor University of California, San Francisco Outline Classification of Interstitial lung disease Clinical classification
More informationDiagnosing ILD. What is important in 2016? Chris Grainge
Diagnosing ILD What is important in 2016? Chris Grainge Senior Staff Specialist Respiratory Medicine John Hunter Hospital Conjoint A/Prof University of Newcastle Conflict of interest I have acted as a
More information* * APPROACH TO NON- NEOPLASTIC LUNG DISEASE IN TRANSBRONCHIAL AND SURGICAL BIOPSIES. Financial Disclosures: NONE. BIOPSY TECHNIQUES Bronchoscopic
APPROACH TO NON- NEOPLASTIC LUNG DISEASE IN TRANSBRONCHIAL AND SURGICAL BIOPSIES Thomas V. Colby, M.D. Mayo Clinic Arizona Geraldine C. Zeiler Professor of Cytopathology Mayo Clinic Arizona Financial Disclosures:
More informationA case of a patient with IPF treated with nintedanib. Prof. Kreuter and Prof. Heussel
A case of a patient with IPF treated with nintedanib Prof. Kreuter and Prof. Heussel Case Overview This case describes the history of a patient with IPF who, at the time of diagnosis, had symptoms typical
More informationDifficulties Diagnosing Idiopathic Pulmonary Fibrosis
1. er Encuentro Entre Neumólogos y Radiólogos, Madrid, Spain, 2016, October 14th Difficulties Diagnosing Idiopathic Pulmonary Fibrosis Simon Walsh King s College Hospital Foundation Trust London, United
More informationIdiopathic Pulmonary Fibrosis Treatable and Not Idiopathic
Idiopathic Pulmonary Fibrosis Treatable and Not Idiopathic Brett Ley, MD University of California San Francisco CTS 1/26/18 Disclosures Speaker s bureau honorarium from Genentech (makers of pirfenidone)
More informationCriteria for confident HRCT diagnosis of usual interstitial pneumonia (UIP)
Criteria for confident HRCT diagnosis of usual interstitial pneumonia (UIP) Assem El Essawy (1) & Amr A. Nassef (٢) Abstract Identification of interstitial pneumonia (IP) was mainly based on histological
More informationTBLB is not recommended as the initial biopsy option in cases of suspected IPF and is unreliable in the diagnosis of rare lung disease (other than
TBLB is not recommended as the initial biopsy option in cases of suspected IPF and is unreliable in the diagnosis of rare lung disease (other than PAP) BAL is not required as a diagnostic tool in patients
More informationHistopathologic Approach to Interstitial Lung Disease
Histopathologic Approach to Interstitial Lung Disease Kirk D. Jones, MD UCSF Dept of Pathology kirk.jones@ucsf.edu Disclosures I have nothing to disclose 1 Why? Much of interstitial lung disease biopsies
More informationDisclosures. Traditional Paradigm. Overview 4/17/2010. I have relationships with the following organizations and companies:
Disclosures Pharmacological Therapy for ILD What to Use and How to Use It Harold R Collard MD Interstitial Lung Disease Program University of California San Francisco (UCSF) I have relationships with the
More informationIdiopathic Pulmonary of Care
Chapter 6.1 Living Medical etextbook A Digital Tool at the Point of Care From Projects In Knowledge Pulmonology Idiopathic Pulmonary Fibrosis @Point of Care IPF Case Study: Typical Presentation, Role of
More informationI don t need you. Disclosure Statement. Pathology Approach to ILD 11/5/2016. Kirk D. Jones, MD UCSF Dept of Pathology
Pathology Approach to ILD Disclosure Statement Relevant financial relationships with a commercial interest: Boeringer Ingleheim, speaker Kirk D. Jones, MD UCSF Dept of Pathology kirk.jones@ucsf.edu I don
More informationImaging: how to recognise idiopathic pulmonary fibrosis
REVIEW IDIOPATHIC PULMONARY FIBROSIS Imaging: how to recognise idiopathic pulmonary fibrosis Anand Devaraj Affiliations: Dept of Radiology, St George s Hospital, London, UK. Correspondence: Anand Devaraj,
More informationControversies in Clinical Trials. Pirfenidone for Idiopathic Pulmonary Fibrosis (IPF)
Controversies in Clinical Trials Pirfenidone for Idiopathic Pulmonary Fibrosis (IPF) Controversies to be highlighted by IPF Post-hoc analyses Story Primary end point selection Changing prespecified endpoints
More informationBronchoscopic lung cryobiopsy increases diagnostic confidence. in the multidisciplinary diagnosis of idiopathic pulmonary
Bronchoscopic lung cryobiopsy increases diagnostic confidence in the multidisciplinary diagnosis of idiopathic pulmonary fibrosis. Sara Tomassetti, Athol U Wells, Ulrich Costabel, Alberto Cavazza, Thomas
More informationIdiopathic interstitial pneumonias (IIPs) are a group of
SYMPOSIA C. Isabela S. Silva, MD, PhD and Nestor L. Müller, MD, PhD Abstract: The idiopathic interstitial pneumonias (IIPs) are a group of diffuse parenchymal lung diseases of unknown etiology characterized
More informationChallenges in Pulmonary and Critical Care: 2018
Challenges in Pulmonary and Critical Care: 2018 Interstitial Lung Disease: Evolving Our Understanding of a Deadly Disease 1 Faculty Kevin Flaherty, MD, MS Professor in Pulmonary and Critical Care Medicine
More informationReplacement of air with fluid, inflammatory. cells or cellular debris. Parenchymal, Interstitial (Restrictive) and Vascular Diseases.
Parenchymal, Interstitial (Restrictive) and Vascular Diseases Alain C. Borczuk, M.D. Dept of Pathology Replacement of air with fluid, inflammatory cells Pulmonary Edema Pneumonia Hemorrhage Diffuse alveolar
More informationHYPERSENSITIVITY PNEUMONITIS
HYPERSENSITIVITY PNEUMONITIS A preventable fibrosis MOSAVIR ANSARIE MB., FCCP INTERSTITIAL LUNG DISEASES A heterogeneous group of non infectious, non malignant diffuse parenchymal disorders of the lower
More informationWim Wuyts. Treatment of idiopathic interstitial pneumonias. March 12 th Interstitial lung diseases state of the art.
nterstitial ungdiseases euven Department of pneumology Unit for interstitial lung diseases University Hospitals Leuven March 12 th 2015 Interstitial lung diseases state of the art Treatment of idiopathic
More informationInterstitial Lung Disease (ILD)
Interstitial Lung Disease (ILD) ILD comprises more than 130 distinct disorders Characterized by cellular proliferation, cellular infiltration, and/or fibrosis of the lung parenchyma not due to infection
More informationBronkhorst colloquium Interstitiële longziekten. Katrien Grünberg, klinisch patholoog
Bronkhorst colloquium 2013-2014 Interstitiële longziekten De pathologie achter de CT Katrien Grünberg, klinisch patholoog K.grunberg@vumc.nl Preparing: introduction and 3 cases The introduction on microscopic
More informationKaterina M. Antoniou, MD, PhD As. Professor in Thoracic Medicine ERS ILD Group Secretary Medical School, University of Crete Prague, June 2014
Hypersensitivity pneumonitis: Causes, clinical course, diagnosis and differential diagnosis, treatment Katerina M. Antoniou, MD, PhD As. Professor in Thoracic Medicine ERS ILD Group Secretary Medical School,
More informationDaria Manos RSNA 2016 RC 401. https://medicine.dal.ca/departments/depar tment-sites/radiology/contact/faculty/dariamanos.html
Daria Manos RSNA 2016 RC 401 https://medicine.dal.ca/departments/depar tment-sites/radiology/contact/faculty/dariamanos.html STEP1: Is this fibrotic lung disease? STEP 2: Is this a UIP pattern? If yes:
More informationKey words: CT scanners; interstitial lung diseases; polymyositis-dermatomyositis; x-ray
Nonspecific Interstitial Pneumonia Associated With Polymyositis and Dermatomyositis* Serial High-Resolution CT Findings and Functional Correlation Hiroaki Arakawa, MD; Hidehiro Yamada, MD; Yasuyuki Kurihara,
More informationThe Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1135-1140 Role of High Resolution Computed Tomography in Diagnosis of Interstitial Lung Diseases in Patients with Collagen Diseases
More informationINVITED REVIEW SERIES: PULMONARY FIBROSIS SERIES EDITORS: MARTIN KOLB AND GERARD COX
INVITED REVIEW SERIES: PULMONARY FIBROSIS SERIES EDITORS: MARTIN KOLB AND GERARD COX Diagnosing fibrotic lung disease: When is high-resolution computed tomography sufficient to make a diagnosis of idiopathic
More informationNonspecific interstitial pneumonia and usual interstitial pneumonia: comparison of the clinicopathologic features and prognosis
Original Article Nonspecific interstitial pneumonia and usual interstitial pneumonia: comparison of the clinicopathologic features and prognosis Xia Li 1, Chang Chen 2, Jinfu Xu 1, Jinming Liu 1, Xianghua
More informationDIAGNOSTIC NOTE TEMPLATE
DIAGNOSTIC NOTE TEMPLATE SOAP NOTE TEMPLATE WHEN CONSIDERING A DIAGNOSIS OF IDIOPATHIC PULMONARY FIBROSIS (IPF) CHIEF COMPLAINT HISTORY OF PRESENT ILLNESS Consider IPF as possible diagnosis if any of the
More informationUPDATE ON INTERSTITIAL LUNG DISEASE. Thomas V. Colby, M.D.
UPDATE ON INTERSTITIAL LUNG DISEASE Thomas V. Colby, M.D. FINANCIAL DISCLOSURES NONE Topics Discussed 1. Idiopathic pulmonary fibrosis (IPF) 2. Idiopathic interstitial pneumonias (IIPs) 3. Interstitial
More informationT he diagnostic evaluation of a patient with
546 REVIEW SERIES Challenges in pulmonary fibrosis? 1: Use of high resolution CT scanning of the lung for the evaluation of patients with idiopathic interstitial pneumonias Michael B Gotway, Michelle M
More informationRadiologic Approach to Smoking Related Interstitial Lung Disease
Radiologic Approach to Smoking Related Interstitial Lung Disease Poster No.: C-1854 Congress: ECR 2013 Type: Educational Exhibit Authors: K.-N. Lee, J.-Y. Han, E.-J. Kang, J. Kang; Busan/KR Keywords: Toxicity,
More informationUsual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease
Eur Respir J 2010; 35: 1322 1328 DOI: 10.1183/09031936.00092309 CopyrightßERS 2010 Usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease E.J. Kim*, B.M. Elicker #, F.
More informationI n 2002 the American Thoracic Society (ATS) and
1008 REVIEW SERIES Challenges in pulmonary fibrosis? 5: The NSIP/UIP debate Roland du Bois, Talmadge E King Jr... Among the idiopathic interstitial s, the two entities idiopathic pulmonary fibrosis (IPF)
More informationThe role of high-resolution computed tomography in the follow-up of diffuse lung disease
SERIES RADIOLOGY The role of high-resolution computed tomography in the follow-up of diffuse lung disease Brett M. Elicker, Kimberly G. Kallianos and Travis S. Henry Number 2 in the Series Radiology Edited
More informationUNRAVELING THE ETIOLOGY OF FAMILIAL INTERSTITIAL PNEUMONIA: GENETIC INVESTIGATIONS OF A COMPLEX DISEASE. Anastasia Leigh Wise
UNRAVELING THE ETIOLOGY OF FAMILIAL INTERSTITIAL PNEUMONIA: GENETIC INVESTIGATIONS OF A COMPLEX DISEASE by Anastasia Leigh Wise University Program in Genetics and Genomics & Integrated Toxicology and Environmental
More informationParenchymal, Interstitial i (Restrictive) i and Vascular Diseases
Pulmonary Diseases: Structure-Function Correlation II Parenchymal, Interstitial i (Restrictive) i and Vascular Diseases Alain C. Borczuk, M.D. Dept of Pathology Pulmonary Diseases: Structure-Function Correlation
More informationCase Report Clinical Management of Acute Interstitial Pneumonia: ACaseReport
Case Reports in Pulmonology Volume 2012, Article ID 678249, 4 pages doi:10.1155/2012/678249 Case Report Clinical Management of Acute Interstitial Pneumonia: ACaseReport Yang Xia, 1, 2 Zhenyu Liang, 1 Zhenzhen
More informationSummary: Key Learning Points, Clinical Strategies, and Future Directions
Summary: Key Learning Points, Clinical Strategies, and Future Directions Introduction Idiopathic pulmonary fibrosis (IPF), a peripheral lobular fibrosis of unknown cause, is a chronic, progressive lung
More informationINTERSTITIAL LUNG DISEASE Dr. Zulqarnain Ashraf
Indep Rev Jul-Dec 2018;20(7-12) Dr. Zulqarnain Ashraf IR-653 Abstract: ILD is a group of diseases affect interstitium of the lung. Repeated insult to the lung cause the interstitium to be damaged. Similarly
More informationAnnual Rheumatology & Therapeutics Review for Organizations & Societies
Annual Rheumatology & Therapeutics Review for Organizations & Societies A Rheumatologist s Approach to Interstitial Lung Disease Outline ILD classification and patterns in CTD The clinical landscape and
More informationHypersensitivity Pneumonitis Radiologic Phenotypes Are Associated With Distinct Survival Time and Pulmonary Function Trajectory
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 Q31 Q1 Q7 [ Original Research ] Hypersensitivity
More information