jointly provided by the potomac center for medical...
TRANSCRIPT
![Page 1: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/1.jpg)
Jointly provided by The Potomac Center for Medical Education and Rockpointe
This activity is supported by an independent educational grant from
Boehringer Ingelheim Pharmaceuticals, Inc.
![Page 2: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/2.jpg)
Steering Committee
Jonathan H. Chung, MDAssociate Professor of Radiology
Associate Section Chief, Thoracic Radiology
The University of Chicago Medicine
Chicago, IL
Mary M. Salvatore, MD, MBAAssistant Professor of Thoracic Radiology
Mount Sinai Hospital
New York, NY
![Page 3: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/3.jpg)
Disclosures
Steering Committee and Program Faculty
The steering committee and faculty reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:
Jonathan H. Chung, MD – Consultant: ACI Clinical, Boehringer Ingelheim, Genentech, Veracyte; Speaker: Elsevier
Mary M. Salvatore, MD, MBA – Speaker's Bureau: Boehringer Ingelheim, Genentech
Non-faculty Content Contributors
Non-faculty content contributors and/or reviewers reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:
Jeanelle Spencer, PhD; Blair St. Amand; Jay Katz, CHCP; Lindsay Scott, PT, DPT, ATC:Nothing to disclose
![Page 4: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/4.jpg)
Polling Question
Please rate your level of confidence in determining definite, possible, and inconsistent UIP patterns in HRCT images?
1. Not confident
2. Slightly confident
3. Confident
4. Very confident
5. Expert
![Page 5: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/5.jpg)
Polling Question
How familiar are you with non-radiological features of IPF?
1. Not familiar
2. Slightly familiar
3. Familiar
4. Very familiar
5. Expert
![Page 6: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/6.jpg)
Learning Objectives
• Recognize IPF-specific patterns and differentiate usual interstitial pneumonia (UIP) categories (definite, possible, and inconsistent) in HRCT images, distinguishing IPF from other pulmonary conditions
• Identify barriers to effective communication with referring physicians and initiate strategies to enhance the quality of the communication to gather relevant histories, discuss analyses of HRCTs, and ensure accurate diagnoses
![Page 7: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/7.jpg)
Interstitial Lung Disease
Known causes
• Hypersensitivity pneumonitis
• Asbestosis
• Drug reactions
• Connective tissue disease
Idiopathic
UIP Usual interstitial pneumonia
NSIP Nonspecific interstitial
pneumonia
COP Cryptogenic organizing
pneumonia
AIP Acute interstitial pneumonitis
RBILD Respiratory bronchiolitis-
associated interstitial lung
disease
DIP Desquamative interstitial
pneumonia
LIP Lymphocytic interstitial
pneumonia
PPFE Pleuroparenchymal
fibroelastosis
![Page 8: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/8.jpg)
Factors which increase a person’s risk for pulmonary fibrosis
Pulmonary fibrosis
Male
Genetic
Drugs
Occupation
Smoking
Older age
![Page 9: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/9.jpg)
Idiopathic Pulmonary Fibrosis (IPF) 101
• Idiopathic pulmonary fibrosis (IPF) most common and deadly type of pulmonary fibrosis
• Similar survival as compared to non-small cell lung cancer
• Usual interstitial pneumonitis (UIP) is the imaging pattern and histology in IPF
• Conversely, UIP almost always IPF (>95%)
• In 2014, FDA-approved new therapies for the treatment of patients with IPF
Xia, Meng, et al. American Thoracic Society, 2016;A2697-A2697.
![Page 10: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/10.jpg)
Recognizing the IPF Pattern
![Page 11: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/11.jpg)
Secondary Pulmonary Lobule
Interlobular
septa
Bronchus
Artery
Alveoli
![Page 12: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/12.jpg)
ATS Guidelines for UIP
• Subpleural basilar predominant fibrosis
• Reticulations
• Honeycombing
• Absence of features that would suggest and alternative diagnosis
Raghu G, et al. Am J Respir Crit Care Med. 2011;183:788-824.
![Page 13: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/13.jpg)
CANNOT B UIP
• Consolidation
• Air trapping
• Nodules
• Non-solid or ground glass
• O is for holes or cysts
• T is for top
• B is for bronchovascular
![Page 14: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/14.jpg)
Polling Question
What key radiological feature is depicted in this image?
1. Honeycombing
2. Bronchiectasis
3. Cysts
4. Ground-glass opacities
5. Nodules
![Page 15: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/15.jpg)
Honeycombing vs Bronchiectasis
![Page 16: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/16.jpg)
Polling Question
The pattern seen in this HRCT scan meets the ATS Guidelines criteria for…
1. IPF
2. Definite UIP
3. Possible UIP
4. Inconsistent with UIP
5. NSIP
![Page 17: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/17.jpg)
ATS Guidelines for Possible UIP
• Subpleural basilar predominant fibrosis
• Reticulations
• Honeycombing
• Absence of features that would suggest and alternative diagnosis
![Page 18: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/18.jpg)
Possible UIP
Subpleural and basilar
predominant
![Page 19: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/19.jpg)
Possible UIP
Reticulations
![Page 20: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/20.jpg)
Pre-honeycombing to Honeycombing
Reticulations Honeycombing
![Page 21: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/21.jpg)
ATS Guidelines for Inconsistent with UIP
• Inconsistent with UIP pattern (any of the seven features)
– Upper or mid-lung predominance
– Peribronchovascular predominance
– Extensive ground-glass abnormality (extent>reticular abnormality)
– Consolidation in bronchopulmonary segment(s)/lobe(s)
– Profuse micronodules (bilateral, predominantly upper lobes)
– Discrete cysts (multiple, bilateral, away from areas of honeycombing)
– Diffuse mosaic attenuation/air-trapping (bilateral, in three or more lobes)
Distribution
Increased
density
Decreased
density
Raghu G, et al. Am J Respir Crit Care Med., 2011;183:788-824.
![Page 22: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/22.jpg)
Upper Lobe Fibrosis
• Upper lobe fibrosis with volume loss
• Relative sparing of the lower lobes
• Centrilobular nodules
![Page 23: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/23.jpg)
Ground-glass Opacity
• Ground-glass opacity and traction bronchiectasis in NSIP
![Page 24: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/24.jpg)
Polling Question
55-year-old female with dyspnea – What is the most likely diagnosis?
1. CHP
2. IPF
3. NSIP
4. Sarcoidosis
5. UIP
![Page 25: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/25.jpg)
Polling Question
37-year-old with chronic cough – What is the most likely diagnosis?
1. CHP
2. IPF
3. NSIP
4. Sarcoidosis
5. UIP
![Page 26: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/26.jpg)
Other Common Non-UIP Diagnoses
![Page 27: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/27.jpg)
Mimickers of Fibrosis
Fibrosis caused
by osteophyte
Reversible
atelectasis
![Page 28: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/28.jpg)
SarcoidCHP
NSIPUIP
![Page 29: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/29.jpg)
NSIP
• Lower lobe fibrosis
• Follows bronchovasculardistribution
• Homogeneous
• Ground-glass opacity
• Dilated esophagus
Sasaki, Shinichi, et al. American Thoracic Society, 2016. A4999-A4999.
![Page 30: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/30.jpg)
NSIP
• Lower lobe fibrosis
• Follows bronchovasculardistribution
• Homogeneous
• Ground-glass opacity
• Dilated esophagus
![Page 31: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/31.jpg)
Chronic Hypersensitivity Pneumonitis
• Upper lobe predominant
• Bronchovasculardistribution
• Air trapping
Silva C, et al. Radiology. 2008;246:288-297.
![Page 32: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/32.jpg)
Chronic Hypersensitivity Pneumonitis
Centrilobular nodules and early fibrosis
![Page 33: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/33.jpg)
Stage 4 Sarcoidosis
• Upper lobe predominant fibrosis
• Bronchovasculardistribution
Brauner MW, et al. Radiology 1989;172:467-471.
![Page 34: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/34.jpg)
Stage 4 Sarcoidosis
Upper lobe predominant fibrosis
that follows bronchovascular
distribution
![Page 35: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/35.jpg)
Important Non-pulmonary Findings
![Page 36: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/36.jpg)
Hiatal Hernia
Hiatal hernia and gastro-esophageal reflux are associated
with fibrosis of the lung
![Page 37: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/37.jpg)
Pulmonary Artery
• Pulmonary artery enlargement is associated with pulmonary hypertension and can be seen in patients with fibrosis
![Page 38: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/38.jpg)
Enlarged Lymph Nodes
• Mediastinal lymphadenopathy can occur in patients with pulmonary fibrosis
Souza CA, al. Am J Roentgenol. 2006;186:995-999.
![Page 39: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/39.jpg)
Combined Pulmonary Fibrosis and Emphysema
Honeycombing
Emphysema
![Page 40: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/40.jpg)
Non-radiological Features that Point Toward IPF Diagnosis
• Older age
• Male sex
• History of smoking
• Basilar crackles
• Decreased DLCO, FVC
• Decreased performance on 6 minute walk test
Raghu G, et al. Am J Respir Crit Care Med. 2011;183:788-824. Rosewarne D, et al. Imaging. 2014;20:289-302.
![Page 41: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/41.jpg)
Radiological Features that Point Toward IPF Diagnosis
• Lower lobe predominant fibrosis
• Sub-pleural fibrosis
• Reticulations and traction bronchiectasis
• Honeycombing
• Volume loss
• Absence of consolidation, air trapping, nodules
Raghu G, et al. Am J Respir Crit Care Med. 2011;183:788-824. Rosewarne D, et al. Imaging. 2014;20:289-302.
![Page 42: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/42.jpg)
Case Review
![Page 43: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/43.jpg)
Case 1: 55-year-old Female with Dyspnea
What is the most likely diagnosis?
![Page 44: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/44.jpg)
Case 1: 55-year-old Female with Dyspnea
• NSIP
– Lower lobe predominant fibrosis
– Bronchovasculardistribution
– Absence of honeycombing
– Ground-glass opacity
![Page 45: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/45.jpg)
Case 2: 73-year-old Female with Long-standing Dyspnea
What is the most likely diagnosis?
![Page 46: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/46.jpg)
Case 2: 73-year-old Female with Long-standing Dyspnea
• CHP
– Upper lobe fibrosis
– Bronchovascular
– Air trapping
![Page 47: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/47.jpg)
Case 3: 37-year-old with Chronic Cough
What is the most likely diagnosis?
![Page 48: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/48.jpg)
Case 3: 37-year-old with Chronic Cough
• Stage 4 Sarcoid
– Upper lobe fibrosis
– Bronchovasculardistribution
– Cystic changes
![Page 49: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/49.jpg)
Case 4: 45-year-old with Chronic Cough
What is the most likely diagnosis?
![Page 50: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/50.jpg)
Case 4: 45-year-old with Chronic Cough
• Organizing pneumonia
– Consolidation
– Bronchovasculardistribution
![Page 51: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/51.jpg)
Case 5: 68-year-old Female with Increasing Shortness of Breath and Cough
What is the most likely diagnosis?
![Page 52: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/52.jpg)
Case 5: 68-year-old Female with Increasing Shortness of Breath and Cough
• Possible UIP
– Subpleuralbasilar predominant fibrosis
– Absence of honeycombing
– Reticulations and traction bronchiectasis
![Page 53: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/53.jpg)
Case 6: 78-year-old Man with Shortness of Breath
What is the most likely diagnosis?
![Page 54: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/54.jpg)
Case 6: 78-year-old Man with Shortness of Breath
• UIP
– Subpleural basilar predominant fibrosis
– Honeycombing
– Reticulations and traction bronchiectasis
![Page 55: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/55.jpg)
Radiology and Pulmonary Communication
• Radiology report should provide supporting words for correct diagnosis
• Ancillary findings in report include pulmonary artery size, hiatal hernia, and liver cirrhosis
• Discussion with pulmonologist for first CT to review clinical information
• Multidisciplinary conference is gold standard
![Page 56: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/56.jpg)
Post-activity Survey
![Page 57: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/57.jpg)
Polling QuestionPost-activity Survey
What key radiological feature is depicted in this image?
1. Honeycombing
2. Bronchiectasis
3. Cysts
4. Ground-glass opacities
5. Nodules
![Page 58: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/58.jpg)
Polling QuestionPost-activity Survey
The pattern seen in this HRCT scan meets the ATS Guidelines criteria for…
1. IPF
2. Definite UIP
3. Possible UIP
4. Inconsistent with UIP
5. NSIP
![Page 59: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/59.jpg)
Polling QuestionPost-activity Survey
55-year-old female with dyspnea – What is the most likely diagnosis?
1. CHP
2. IPF
3. NSIP
4. Sarcoidosis
5. UIP
![Page 60: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/60.jpg)
Polling QuestionPost-activity Survey
37-year-old with chronic cough – What is the most likely diagnosis?
1. CHP
2. IPF
3. NSIP
4. Sarcoidosis
5. UIP
![Page 61: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/61.jpg)
Questions
![Page 62: Jointly provided by The Potomac Center for Medical ...alarad.org/images/2017_documents/IPF_Imaging_Slides.pdfJointly provided by The Potomac Center for Medical Education and Rockpointe](https://reader034.vdocument.in/reader034/viewer/2022042021/5e781ca1ba951d34db1de71a/html5/thumbnails/62.jpg)
Thank you for joining us today!
Please remember to complete the EVALUATION FORM.
Your participation will help shape future CME activities.