Outcomes of a Typical Fibrotic Hypersensitivity Pneumonitis Pattern on Chest Computed Tomography

Christopher J Ryerson¹, Daniel-Costin Marinescu², Nestor L Muller³, Cameron J Hague⁴, Darra Murphy⁵, Andrew Churg⁶, Joanne L Wright⁷, Amna Al-Arnawoot⁸, Ana-Maria Bilawich³, Patrick Bourgouin⁹, Gerard Cox¹⁰, Tracy Elliot¹¹, Jennifer Ellis³, Jolene H Fisher¹², Derek Fladeland¹³, Amanda Grant-Orser¹⁴, Gillian C Goobie^{15

16}, Zachary Guenther¹¹, Ehsan Haider^{17

18}, Nathan Hambly¹⁹, James Huynh¹¹, Geoffrey Karjala¹³, Nasreen Khalil²⁰, Martin Kolb²¹, Jonathon Leipsic⁵, Stacey Lok²², Sarah MacIaac²¹, Micheal McInnis²³, Helene Manganas²⁴, Veronica Marcoux²⁵, John Mayo²⁶, Julie Morisset²⁷, Ciaran Scallan²⁸, Tony Sedlic²⁹, Shane Shapera³⁰, Kelly Sun³¹, Victoria Tan²¹, Alyson W Wong^{32

33}, Boyang Zheng²⁹, Yet Hong Khor^{34

35}, Kerri A Johannson¹¹

Affiliations

¹ University of British Columbia, Medicine, Vancouver, British Columbia, Canada; chris.ryerson@hli.ubc.ca.
² The University of British Columbia, Medicine, Vancouver, British Columbia, Canada.
³ University of British Columbia, Radiology, Vancouver, British Columbia, Canada.
⁴ University of British Columbia , Department of Radiology, Vancouver , British Columbia, Canada.
⁵ University of British Columbia, Radiology and Diagnostic Imaging, Vancouver, British Columbia, Canada.
⁶ University of British Columbia, Department of Pathology, Vancouver, British Columbia, Canada.
⁷ University of British Columbia, Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada.
⁸ McMaster University, Radiology, Hamilton, Ontario, Canada.
⁹ University of Montreal, Montreal, Quebec, Canada.
¹⁰ St. Joseph's Hospital, Hamilton, Ontario, Canada.
¹¹ University of Calgary, Calgary, Alberta, Canada.
¹² University of Toronto, Medicine, Toronto, Ontario, Canada.
¹³ University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁴ University of Calgary, Medicine, Calgary, Alberta, Canada.
¹⁵ The University of British Columbia Department of Medicine, Vancouver, British Columbia, Canada.
¹⁶ The University of British Columbia Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada.
¹⁷ McMaster University, Department of Radiology, Hamilton , Ontario, Canada.
¹⁸ Saint Joseph's Healthcare Hamilton, Department of Diagnostic Imaging, Hamilton, Ontario, Canada.
¹⁹ McMaster University, Medicine, Hamilton, Ontario, Canada.
²⁰ University of British Columbia, Medicine, Vancouver, British Columbia, Canada.
²¹ McMaster University, Hamilton, Ontario, Canada.
²² University of Saskatchewan, Saskatoon, Canada.
²³ University Health Network, Joint Department of Medical Imaging, Toronto, Ontario, Canada.
²⁴ Centre Hospitalier de l'Université de Montréal Bibliothèque, Département de Médecine, Montreal, Quebec, Canada.
²⁵ University of Saskatchewan, Medicine, Saskatoon, Saskatchewan, Canada.
²⁶ Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
²⁷ Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
²⁸ McMaster University, Hamilton, Canada.
²⁹ The University of British Columbia, Vancouver, British Columbia, Canada.
³⁰ University Health Network, Medicine, Toronto, Ontario, Canada.
³¹ University of Toronto, Toronto, Ontario, Canada.
³² University of British Columbia, Department of Medicine, Vancouver, British Columbia, Canada.
³³ St. Paul's Hospital, Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada.
³⁴ Monash University, Respiratory Research@Alfred, Central Clinical School, Melbourne, Victoria, Australia.
³⁵ Austin Health, Heidelberg, Victoria, Australia.

PMID: 40505139
DOI: 10.1164/rccm.202411-2215OC

Outcomes of a Typical Fibrotic Hypersensitivity Pneumonitis Pattern on Chest Computed Tomography

Christopher J Ryerson et al. Am J Respir Crit Care Med. 2025.

. 2025 Jun 12.

doi: 10.1164/rccm.202411-2215OC. Online ahead of print.

Authors

Affiliations

¹ University of British Columbia, Medicine, Vancouver, British Columbia, Canada; chris.ryerson@hli.ubc.ca.
² The University of British Columbia, Medicine, Vancouver, British Columbia, Canada.
³ University of British Columbia, Radiology, Vancouver, British Columbia, Canada.
⁴ University of British Columbia , Department of Radiology, Vancouver , British Columbia, Canada.
⁵ University of British Columbia, Radiology and Diagnostic Imaging, Vancouver, British Columbia, Canada.
⁶ University of British Columbia, Department of Pathology, Vancouver, British Columbia, Canada.
⁷ University of British Columbia, Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada.
⁸ McMaster University, Radiology, Hamilton, Ontario, Canada.
⁹ University of Montreal, Montreal, Quebec, Canada.
¹⁰ St. Joseph's Hospital, Hamilton, Ontario, Canada.
¹¹ University of Calgary, Calgary, Alberta, Canada.
¹² University of Toronto, Medicine, Toronto, Ontario, Canada.
¹³ University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁴ University of Calgary, Medicine, Calgary, Alberta, Canada.
¹⁵ The University of British Columbia Department of Medicine, Vancouver, British Columbia, Canada.
¹⁶ The University of British Columbia Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada.
¹⁷ McMaster University, Department of Radiology, Hamilton , Ontario, Canada.
¹⁸ Saint Joseph's Healthcare Hamilton, Department of Diagnostic Imaging, Hamilton, Ontario, Canada.
¹⁹ McMaster University, Medicine, Hamilton, Ontario, Canada.
²⁰ University of British Columbia, Medicine, Vancouver, British Columbia, Canada.
²¹ McMaster University, Hamilton, Ontario, Canada.
²² University of Saskatchewan, Saskatoon, Canada.
²³ University Health Network, Joint Department of Medical Imaging, Toronto, Ontario, Canada.
²⁴ Centre Hospitalier de l'Université de Montréal Bibliothèque, Département de Médecine, Montreal, Quebec, Canada.
²⁵ University of Saskatchewan, Medicine, Saskatoon, Saskatchewan, Canada.
²⁶ Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
²⁷ Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
²⁸ McMaster University, Hamilton, Canada.
²⁹ The University of British Columbia, Vancouver, British Columbia, Canada.
³⁰ University Health Network, Medicine, Toronto, Ontario, Canada.
³¹ University of Toronto, Toronto, Ontario, Canada.
³² University of British Columbia, Department of Medicine, Vancouver, British Columbia, Canada.
³³ St. Paul's Hospital, Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada.
³⁴ Monash University, Respiratory Research@Alfred, Central Clinical School, Melbourne, Victoria, Australia.
³⁵ Austin Health, Heidelberg, Victoria, Australia.

PMID: 40505139
DOI: 10.1164/rccm.202411-2215OC

Abstract

Background: Guidelines have defined a "typical hypersensitivity pneumonitis (HP)" imaging pattern for fibrotic HP (fHP); however, the frequency, characteristics, and outcomes of different multidisciplinary diagnoses within this pattern are unknown.

Methods: Patients with a typical fHP pattern on chest computed tomography (CT) were identified from a prospective registry. Multidisciplinary diagnoses were established by consensus during a research-dedicated standardized multidisciplinary discussion of all available data. Pre-specified diagnostic categories of interest included fHP with an exposure identified, fHP without an exposure identified, and connective tissue disease-associated interstitial lung disease (CTD-ILD), with each diagnosis defined by >50% likelihood after this structured multidisciplinary discussion. Clinical and radiological features and outcomes were compared across multidisciplinary diagnoses.

Results: Of 164 patients with a CT pattern of typical fHP, 49 had a multidisciplinary diagnosis of fHP with a probable or possible exposure identified (30%), 56 had fHP without an exposure (34%), 36 had a CTD-ILD (22%), and 23 had another multidisciplinary diagnosis (14%). Clinical and CT features differed across multidisciplinary diagnoses. Lung function decline and time to death or transplant were worse in fHP without a probable or possible exposure. Positive autoimmune serologies or a new rheumatologist-confirmed CTD diagnosis developed in 14% of patients with fHP without an exposure identified during follow-up.

Conclusion: Patients with a typical fHP pattern on chest CT frequently have non-HP diagnoses (most often CTD-ILD), have differences in baseline characteristics and disease behavior across multidisciplinary diagnoses, and more frequently develop features of CTD during follow-up when an initial HP exposure is not identified.

Keywords: bronchiolocentric interstitial pneumonia; computed tomography; hypersensitivity pneumonitis; outcomes; pulmonary fibrosis.

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Outcomes of a Typical Fibrotic Hypersensitivity Pneumonitis Pattern on Chest Computed Tomography

Affiliations

Outcomes of a Typical Fibrotic Hypersensitivity Pneumonitis Pattern on Chest Computed Tomography

Authors

Affiliations

Abstract

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous