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Clinics (Sao Paulo). 2019 Feb 4;74:e225. doi: 10.6061/clinics/2019/e225.

Imaging in idiopathic pulmonary fibrosis: diagnosis and mimics.

Author information

1
Departamento de Radiologia, Laboratorio de Pesquisas em Imagens Medicas (LABIMED), Irmandade Santa Casa de Misericordia de Porto Alegre, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR.
2
Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR.
3
Departamento de Pneumologia, Irmandade Santa Casa de Misericordia de Porto Alegre, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR.
4
Departamento de Patologia, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR.
5
Divisao Pulmonar, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.

Abstract

Idiopathic pulmonary fibrosis is a chronic disease of unknown etiology that usually has a progressive course and is commonly associated with a poor prognosis. The main symptoms of idiopathic pulmonary fibrosis, including progressive dyspnea and dry cough, are often nonspecific. Chest high-resolution computed tomography is the primary modality used in the initial assessment of patients with suspected idiopathic pulmonary fibrosis and may have considerable influence on subsequent management decisions. The main role of computed tomography is to distinguish chronic fibrosing lung diseases with a usual interstitial pneumonia pattern from those presenting with a non-usual interstitial pneumonia pattern, suggesting an alternative diagnosis when possible. A usual interstitial pneumonia pattern on chest tomography is characterized by the presence subpleural and basal predominance, reticular abnormality honeycombing with or without traction bronchiectasis, and the absence of features suggestive of an alternative diagnosis. Idiopathic pulmonary fibrosis can be diagnosed according to clinical and radiological criteria in approximately 66.6% of cases. Confirmation of an idiopathic pulmonary fibrosis diagnosis is challenging, requiring the exclusion of pulmonary fibroses with known causes, such as asbestosis, connective tissue diseases, drug exposure, chronic hypersensitivity pneumonitis, and other forms of idiopathic interstitial pneumonitis. The histopathological hallmark of usual interstitial pneumonia is a heterogeneous appearance, characterized by areas of fibrosis with scarring and honeycombing alternating with areas of less affected or normal parenchyma. The aim of this article was to review the clinical, radiological, and pathological features of idiopathic pulmonary fibrosis and of diseases that might mimic idiopathic pulmonary fibrosis presentation.

PMID:
30726312
PMCID:
PMC6384526
DOI:
10.6061/clinics/2019/e225
[Indexed for MEDLINE]
Free PMC Article

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