59 YO M with history of scleroderma, , Raynaud’s disease,ILD, pulmonary HTN, HTN, DM, HFrEF presents for follow up
The interstitial lung disease appears stable and is characterized by
findings which are in keeping with NSIP including diffuse groundglass changes, subpleural sparing, bronchiolectasis, the absence of honeycombing, and predominant involvement of the lower lobes
There is evidence of pulmonary hypertension characterized by a stable and enlarged main pulmonary artery measuring 3.4 cm
There is evidence of esophageal disease characterized by patulous
esophagus with air-fluid level suggesting reflux
Features of this Case Would Favor the Fibrotic Form of NSIP because
- More reticular and fibrotic changes
- Less ground glass
- More volume loss in the bases
- Tendency to honeycomb changes at the bases
- Pulmonary Hypertension
59-year-old male presents with history of scleroderma, , Raynaud’s disease, and ILD
CXR shows basilar reticular changes and low lung volumes. The heart is enlarged. There is an air bronchogram in the left lower lobe as a result of traction bronchiectasis and fibrotic change surrounding the bronchovascular bundle
Ashley Davidoff MD TheCommonVein.net 110Lu 136589
59-year-old male presents with history of scleroderma, , Raynaud’s disease, and ILD
CXR shows basilar reticular changes and low lung volumes. The heart is enlarged. There is an air bronchogram in the left lower lobe as a result of traction bronchiectasis and fibrotic change surrounding the bronchovascular bundle
Ashley Davidoff MD TheCommonVein.net 110Lu 136589c
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Lateral CXR shows basilar reticular changes and suggestion of left ventricular enlargement
Ashley Davidoff MD TheCommonVein.net 110Lu 136590
CT Scan
Basilar Reticular Changes and Dilated Esophagus
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Coronal
CT in the coronal plain shows volume loss in the lower lung fields, bronchovascular thickening in the left lower lobe and basilar reticular changes
us
Ashley Davidoff MD TheCommonVein.net 110Lu 136591
Volume Loss of the Lower Lobes and Subpleural Sparing
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Coronal CT shows bibasilar volume loss, reticular change, ground glass changes, bronchovascular thickening , bronchiectasis, and subpleural sparing, all features characteristic of NSIP
Ashley Davidoff MD TheCommonVein.net 110Lu 136592
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Coronal CT shows bibasilar volume loss, reticular change, ground glass changes, bronchovascular thickening , bronchiectasis, and subpleural sparing, all features characteristic of NSIP
.
The lower image highlights the bronchovascular thickening volume loss bronchiectasis and subpleural sparing. The fibrotic process has resulted in traction of the secondary lobules in the region of subpleural sparing
Ashley Davidoff MD TheCommonVein.net 110Lu 136592c01
X-Ray and CT Showing Air Bronchograms
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
CXR shows basilar reticular changes and low lung volumes. There is an air bronchogram in the left lower lobe as a result of traction bronchiectasis and fibrotic change surrounding the bronchovascular bundle
The CT highlights the bronchovascular thickening, and bronchiectasis that results in the air bronchogram. In addition there is volume loss, and subpleural sparing. The fibrotic process has resulted in traction of the secondary lobules in the region of subpleural sparing
Ashley Davidoff MD TheCommonVein.net 110Lu 136592c
Prominent Ground Glass Changes Posterior Lowe Lobes
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Coronal CT shows symmetrical lower lobes , ground glass changes traction bronchiectasis and subpleural sparing all features characteristic of NSIP
Ashley Davidoff MD TheCommonVein.net 110Lu 136593
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Axial CT shows peripheral reticular changes, in the anterior segment of the right upper lobe. Note air-fluid level in the distended esophagus
Ashley Davidoff MD TheCommonVein.net 110Lu 136594
Traction Bronchiectasis and Subpleural Sparing with Traction Expansion of the Secondary Lobules
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Axial CT shows peripheral reticular changes, traction bronchiectasis and bronchiolectasis and subpleural sparing in the anterior segment of the right upper lobe. Similar changes are noted in the apical segment of the right lower lobes.
Ashley Davidoff MD TheCommonVein.net 110Lu 136595
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Axial CT shows extensive fibrotic change in the apical segments of the lower lobes and the anterior segments of the upper lobe.
There is volume loss architectural distortion, bronchiolectasis and subpleural sparing exemplified in the right lower lobe. peripheral reticular changes, ground glass, bronchiolectasis volume loss and subpleural sparing .
There are bands of fibrosis in the periphery of the right upper lobe with suggestion of intralobular fibrosis.
The spared secondary lobules in the right upper and right lower lobes have also undergone enlargement secondary to the fibrotic process
Ashley Davidoff MD TheCommonVein.net 110Lu 136596
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Axial CT showsextensive fibrotic change in the apical segments of the lower lobes and the anterior segments of the upper lobes.
There is volume loss architectural distortion, bronchiolectasis and subpleural sparing exemplified in the right lung. In addition there are ground glass changes, and volume loss.
The spared secondary lobules in the right lower lobes have also undergone enlargement secondary to the fibrotic process
Ashley Davidoff MD TheCommonVein.net 110Lu 136597
Traction on the Airways and the Secondary Lobules
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Upper Image
Axial CT shows bibasilar ground glass, bronchiectasis, and bronchiolectasis with volume loss and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing. Note air-fluid level in the distended esophagus.
The lower image focuses on the peripheral sparing. The spared secondary lobules have also undergone enlargement secondary to the fibrotic process
Ashley Davidoff MD TheCommonVein.net 110Lu 136598c01
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Upper Image
Axial CT shows bibasilar peripheral reticular changes, ground glass, bronchiectasis, and bronchiolectasis with volume and with crowding of the bronchovascular bundles posteriorly. There is subpleural sparing posteriorly. Note air-fluid level in the distended esophagus.
Lower Image
The lower image focuses on the traction bronchiectasis caused by the fibrotic process
Ashley Davidoff MD TheCommonVein.net 110Lu 136598c
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Axial CT shows, ground glass changes, bronchiolectasis at both lung bases, volume loss with crowding of the bronchovascular bundles posteriorly and subpleural sparing posteriorly. Note air-fluid level in the distended esophagus.
Ashley Davidoff MD TheCommonVein.net 110Lu 136599
Fibrotic NSIP and Pulmonary Hypertension
59-year-old male presents with history of scleroderma, Raynaud’s disease, and ILD
Axial CT shows evidence of pulmonary hypertension characterized by a stable and enlarged main pulmonary artery measuring 3.4 cm.
Ashley Davidoff MD TheCommonVein.net 110Lu 136600
Right Lung
59-year-old male presents with history of scleroderma, , Raynaud’s disease, and ILD
Sagittal CT shows, ground glass changes, bronchiolectasis at the lung base, volume loss with crowding of the bronchovascular bundles posteriorly and subpleural sparing posteriorly and inferiorly. Similar changes are noted in the middle lobe
Ashley Davidoff MD TheCommonVein.net110Lu 136601
Sagittal CT shows, ground glass changes, bronchiolectasis at the lung base, volume loss with crowding of the bronchovascular bundles posteriorly.
Ashley Davidoff MD TheCommonVein.net 110Lu 136603
Left Lung
59-year-old male presents with history of scleroderma, , Raynaud’s disease, and ILD
Sagittal CT of the left lung, shows, ground glass changes, bronchiolectasis at the lung base with subpleural sparing posteriorly and inferiorly.
Ashley Davidoff MD TheCommonVein.net 110Lu 136603