Faces of Hypersensitivity Pneumonitis

Hypersensitivity Pneumonitis is a disease that most commonly affects the midlung field Next in frequency are the upper lung field and lastly diffuse involvement. Anatomically the small airways and the alveoli are affected with inflammation and granulomas are present
Ashley Davidoff MD TheCommonvein.net lungs-0732b01

Acute
Alveolar Disease
Small Airways

Chronic
Alveolar
Small Airways

Acute
Acute Alveolar Disease

Ground Glass

Cheese Head Sign

Axial CT – Hypersensitivity Pneumonitis Bird Fancier’s Disease
55-year-old female with shortness of breath. She keeps birds for pets Axial CT through the mid lung fields shows diffuse ground glass changes with a combination of mosaic attenuation and normal lung giving the appearance of the cheese head sign.
Ashley Davidoff MD TheCommonVein.net 13551a

Coronal CT – Hypersensitivity Pneumonitis Bird Fanciers Disease
55-year-old female with shortness of breath. She keeps birds for pets Coronal CT through the mid lung fields shows diffuse ground glass changes with a combination of mosaic attenuation and normal lung giving the appearance of the cheese head sign.
Ashley Davidoff MD TheCommonVein.net 135552a

Sagittal CT – Hypersensitivity Pneumonitis Bird Fancier’s Disease
55-year-old female with shortness of breath. She keeps birds for pets Sagittal CT through the mid lung fields shows diffuse ground glass changes with a combination of mosaic attenuation and normal lung giving the appearance of the cheese head sign.
Ashley Davidoff MD TheCommonVein.net 13552b

Inspiration Expiration Normalization of Mosaic Attenuation

Axial CT – Inspiration Expiration Hypersensitivity Pneumonitis Bird Fancier’s Disease Right Lower Lobe
55-year-old female with shortness of breath. She keeps birds for pets Axial CT through the mid lung fields on inspiration (upper image) shows diffuse ground glass changes with low attenuation regions Expiration images (below)shows increase in the density of this region indicating that this region is normal lung
Ashley Davidoff MD TheCommonVein.net 13554

Inspiration Expiration – Air Trapping

Axial CT – Inspiration Expiration Hypersensitivity Pneumonitis Bird Fancier’s Disease Right Middle Lobe
55-year-old female with shortness of breath. She keeps birds for pets Axial CT through the mid lung fields on inspiration (upper image) shows diffuse ground glass changes with low attenuation regions (mosaic attenuation) Expiration images (below) shows persistent regions of mosaic attenuation indicating air trapping
Ashley Davidoff MD TheCommonVein.net 13557

On Steroids and Off Steroids

lungs probable hypersensitivity pneumonitis 003a 11 months prior LLL subsegmental disease ground glass
Ashley Davidoff MD thecommonvein.net

Consolidation

lungs prbable hypersensitivity pneumonitis 009 10 months after steroid stopped recurrence
Ashley Davidoff MD
thecommonvein.net

Acute Small Airways

lungs probable hypersensitivity pneumonitis 003b 11 months prior RUL ground glass centrilobular nodules
Ashley Davidoff MD
thecommonvein.net

Chronic
Alveolar
Small Airways