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Case Studies | Radiology and Medical Imaging Sciences | India | Volume 13 Issue 6, June 2024 | Popularity: 7.2 / 10

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Role of HRCT Thorax in Interstitial Lung Disease (A Study of 100 Patients)

Sahil Patel, Maulik Jethva, Anjana Trivedi, Ravi Patel

Abstract: Introduction: Interstitial lung diseases (ILDs) also called diffuse infiltrative lung diseases are heterogeneous groups of disorders that predominantly affect the lung interstitial and share similar clinical and radiological manifestations. They are characterized by alveolar, septal thickening, fibroblast proliferation and pulmonary fibrosis. (1) Patients with ILD most commonly present with shortness of breath with exertion, fatigue, weakness, loss of appetite, loss of weight, dry cough, and discomfort in the chest. These patients have a diffuse infiltrative pattern on chest X-ray. For their smoldering evolution and non-specificity of symptoms, they may remain undiagnosed and non-treated for a long time. Herein lies the importance of HRCT and other investigations in aiding an early diagnosis. In the diagnosis of interstitial lung diseases, clinical, radiological, and histological correlation is needed on most occasions. The chest radiogram remains the basic radiological tool in the investigation of these patients. However, chest radiography is relatively insensitive and is normal in 10-20% of patients with histologically proven interstitial lung disease. Many diseases remain occult or are not correctly diagnosed on chest X-rays. It is not specific also in that different interstitial lung diseases can have similar radiological appearances. With the advent of CT, Conventional 8-10 mm collimation scans allowed better assessment of lung parenchyma. However, CT only played a minor role in the diagnosis of interstitial lung diseases until the introduction of High-Resolution Computed Tomography (HRCT). By eliminating the superimposition of structures, HRCT allows for a better assessment of the type, distribution, and severity of parenchymal abnormalities. HRCT scanning with its greater ability to visualize fine. details within the lung have replaced conventional chest radiography as the preferred imaging method for the ILDs. HRCT has been found useful in the evaluation of ILDs in the following areas: Identification of the presence of disease (especially when chest x-ray or other studies are normal or equivocal), evaluation of the extent of disease, characterization of the patterns of the disease, narrowing the differential diagnosis, as a guide to the site of biopsy and assessing the clinical course of the disease and response to therapy. In this study we aim to assess the role of HRCT in the evaluation of interstitial lung disease, to accurately assess the pattern, distribution, and severity of the disease process for the purpose of treatment and management, to differentiate on HRCT reversible changes from those of irreversible which would determine the future prognosis in such patients and to assess the role of HRCT in predicting response to treatment. Materials and Methods: HRCT scan of 100 patients who fulfilled below mentioned inclusion criteria were analyzed and findings. of HRCT were correlated with relevant clinical history/investigations pertaining to patient?s complaint and was evaluated for diagnosis from the case records/registers. The present study was conducted in the Department of Radio diagnosis and Imaging, at our hospital from December 2022 to December 2023. Results: In a study of 100 patients with suspected interstitial lung disease (ILD), HRCT scans revealed specific patterns. Most patients were in their 6th and 7th decades, with males more affected than females. Chronic breathlessness (82%) and cough (62%) were common symptoms. HRCT findings included septal thickening (87%), traction bronchiectasis (60%), honeycombing (58%), and ground glass opacity (49%). Lower lobes were predominantly affected (92%), with UIP being the most common subtype (45%). Smoking was a major risk factor, associated with various ILDs. HRCT outperformed X-rays in detecting abnormalities (76 vs. 26 patients). HRCT is crucial for diagnosing and managing ILD, offering superior detection of subtle changes and aiding in prognosis prediction. It helps confirm the type and extent of ILD, assess reversibility, predict prognosis based on fibrotic changes, and monitor disease progression and complications like infections and tumors. Conclusion: A single HRCT finding is often nonspecific, the combination of the various HRCT findings, together with their anatomical distribution, can suggest the specific type of ILD It can detect lesion even when the chest radiograph is normal. HRCT can confirm the location and extent of disease.

Keywords: ILD, HRCT, Chest XRAY, Fibrosis

Edition: Volume 13 Issue 6, June 2024

Pages: 1892 - 1902

DOI: https://www.doi.org/10.21275/SR24620204543

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