State of the art in the diagnosis and management of interstitial lung disease

Abstract

The interstitial lung diseases (ILDs) are a diverse group of disorders characterized by a varying combination of inflammation and fibrosis of the pulmonary parenchyma. Treatment and prognosis of ILD typically depend on the underlying ILD subtype, highlighting the importance of accurate classification and diagnosis. Besides a thorough history and clinical examination, the protocol should include a 6-minute walk test, chest radiography, high-resolution computed tomography, biochemical analysis, pulmonary function tests, blood gas analysis, bronchoalveolar lavage, and, when necessary, a lung biopsy. The final diagnosis of ILD entities requires dynamic interaction between clinicians, radiologists and pathologists to reach a clinico-radiologic-pathologic diagnosis, the gold standard no longer being the histology but rather a multidisciplinary approach.

Keywords: diagnosis; interstitial lung disease; nonspecific interstitial pneumonia; pulmonary fibrosis; usual interstitial pneumonia.

Figure 1

76-year-old patient with UIP pattern on HRCT: bilateral reticular opacities, due to intra- and interlobular septal thickening, associated with traction bronchiectasis and honeycombing, predominantly in the postero-bazal and subpleural regions of segment 10.

Figure 2

58-year-old patient with (cellular) NSIP pattern on HRCT: symmetric ground-glass opacities in both lung bases, with sparing of the subpleural regions (arrowheads).