NSIP is a very inhomogeneous group. Galzerano D Tuccillo B Lama D Paolisso G Mirra G Giasi M. Park JH Park SW Kim JY Kim SK Jeoung B Lee MHet al. In two cases with mild interstitial lung disease, the everolimus therapy was successfully continued. Respiratory bronchiolitis (RB), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), and desquamative interstitial pneumonia (DIP) represent different degrees of severity of small airway and parenchymal reaction to cigarette smoke (8). On HRCT, numerous clearly visible septal lines usually indicates the presence of some interstitial abnormality. *P < 0.05. However, CFAE area and CFAE area index in RA showed significant positive correlation (r = 0.494, P = 0.012 and r = 0.480, P = 0.015, respectively) with IAST. Solvent-dependent termination, size and stability in polyynes synthesized. Scroll through the images. Scroll through the images. Alveolar Sarcoidosis (2) Lesions may show pleural tags or spiculae and give the impression of volume loss and slight retraction of the surrounding parenchyma (DD bronchogenic carcinoma). TB: Tree-in-bud appearance in a patient with active TB. There is subtle opacity in the centre of the secondary lobules (arrows) with sparing of the subpleural region. This study demonstrates that IAST measured by cardiac CT is significantly associated with the extent of LA CFAEs and CFAE area index irrespective of LA size or body mass index in persistent AF patients. The term RB-ILD was proposed to describe the bronchocentric (or centrilobular) lung disease in these patients and the term DIP was used to describe the more diffuse disorder. Significance of Interlobular Septal Thickening. Secondary TB: Sarcoidosis, Silicosis, Pneumoconiosis, Endobronchial spread of TB: Bronchopneumonia, Hypersensitivity pneumonitis. There is a mosaic pattern. He doesn't think it is infection. Perihilar and gravitational distribution predominatly in the dependent lung. All patients initially underwent circumferential antral ablation with the endpoint being the electrical PV exit and entrance block or dissociation. Prognosis has improved since the advent of treatment using bronchoalveolar lavage. On the left a patient with stage I disease. Depending on filling with fluid or with tumor cells, septal thickening is irregular or smooth. Patients respond promptly to treatment with steroids. Interatrial septal thickness was measured at a single site 1 cm inferior to the fossa ovalis. Progressive fibrosis in sarcoidosis may lead to peribronchovascular (perihilar) conglomerate masses of fibrous tissue. The crazy paving pattern is a rather non-specific finding. In the cystic stage bronchiolar obliteration causes alveolar wall fibrosis and cyst formation. Bronchial wall thickening and dilatation are seen in most patients and are usually restricted to areas of consolidation or ground glass opacifications. Paracrine interactions of these cytokines and mediators contribute to perivascular inflammation.14,17 Thus, such proinflammatory cytokines produced by epicardial adipose tissue may directly or systemically produce myocardial remodelling. Radiol Clin North Am 2001:39: 1115-35, by Zampatori M, Sverzellati N, Poletti V et al. A control HRCT ten days later (right) demonstrated, that the findings had resolved without any treatment. In 25 to 30% of cases the radiologic findings are atypical. A quadripolar catheter was also placed in the superior vena cava. Knowing the common and also uncommon HRCT-presentations of these frequently encountered diffuse lung diseases is extremely important. Pulmonary interstitial high-resolution computed tomography abnormality. This is the reactivation of the original infection. The diagnosis of drug-induced pulmonary disease is usually one of exclusion. Nakagawa H Scherlag BJ Patterson E Ikeda A Lockwood D Jackman WM. Patients were monitored overnight and anticoagulation was continued for at least 2 months after the procedure. The key findings in the subacute hypersensitivity pneumonitis are: Here two examples of subacute hypersensitivity pneumonitis. On the left another case of stage IV sarcoidosis. Representative examples of IAST and CFAE measurements are shown. Additionally there is septal and intralobular reticular thickening, indicating already existing irreversible fibrosis. Many other diseases may present with this finding and are listed in the differential diagnosis. The high right atrium (RA), low RA, and coronary sinus were mapped with a decapolar catheter (Bard Electrophysiology, Inc., Lowell, MA, USA) and steerable duo-decapolar catheter (St. Jude Medical, Inc., Minnetonka, MN, USA) inserted through the left femoral vein. One third have continuing disease leading to clinically significant organ impairment. Langerhans cell histiocytosis: early nodular stage before the typical cysts appear. Pearson's correlation method was used to calculate the relationship between the IAST and the extent of CFAEs and CFAE index. On the left a contrast enhanced CT in a patient with chronic eosinophilic pneumonia. The HRCT of this patient with scleroderma and NSIP shows a fine subpleural reticular pattern in the upper lobes and more extensive abnormalities in the lower lung zones. It is important to realize that these diseases are rare compared to sarcoidosis. One nodule contains calcification (arrow). Radiofrequency ablation was delivered at a target temperature of 48°C and power in the range of 25–35 W (Stockert generator, Biosense Webster, Inc., Diamond Bar, CA, USA or IBI 1500T11, St. Jude Medical, Inc., MN, USA) using a 4 mm open irrigated-tip catheter (Thermocool, Biosense Webster, Inc., Diamond Bar, CA, USA or Cool Path Duo, St. Jude Medical, Inc., MN, USA). The major diagnostic problem is, that it may present with a large variety of radiologic patterns. The images on the left suggest the diagnosis hypersensitivity pneumonitis. The HRCT characteristics are diffuse or patchy consolidation, often with a crazy paving appearance like in the case on the left. Small nodules in a perilymphatic distribution (i.e. Ground glass opacities, referring to findings on computed tomography (CT) scans of COVID-19 patients, can diagnose coronavirus infections—but what exactly are 'ground glass opacities' in lung scans? Fortunately only about 10 of these account for about 90% of all diffuse lung diseases, that are assessed by open lung biopsy. Emphysema, when it is severe, can mimick Langerhans cell histiosytosis. In the presence of a surgical biopsy showing a UIP pattern the diagnosis of IPF requires exclusion of other known causes of UIP including drug toxicities, environmental exposures (asbest), and collagen vascular diseases like RA, SLE, polyarteritis nodosa and sclerodermia. All patients underwent cardiac CT within 24 h prior to ablation. Interlobular septal thickening is commonly seen in patients with interstitial lung disease. Most lung diseases cause an increase in the radiodensity of the lung, and if this is due to a relative thickening of the interstitium- this will be manifest as increased prominance of the interstitial markings on the CXR. Symptoms are nonspecific and often those of the patient's underlying disease. There are many causes of interlobular septal thickening, and this should be distinguished from intralobular septal thickening. Patients resumed the anti-arrhythmic medications they had been taking before the catheter ablation. Frequently biopsy is needed for final proof. They represent fundamental responses of the lung to injury and do not represent 'diseases' per se. Usual Interstitial Pneumonitis (UIP) is a histologic diagnosis. We would also like to thank Dr. Richard Webb who produced such a fabulous educational CD (1). Rupture of necrotic lymph nodes into the bronchi can also result in endobronchial dissemination. This is termed progressive primary tuberculosis. All statistical analyses were performed using SPSS 12.0 software (SPSS Inc., Chicago, IL, USA). Patients die within 10 years of the onset of symptoms. Chronic eosinophilic pneumonia is an idiopathic condition characterized by filling of the alveoli with eosinophils. An HRCT scan of the chest revealed nodular interlobular septal thickening (ILST) at the right lung base . It has a fatal outcome in many cases. Procedural characteristics of the study population by IAST tertile. There were several limitations to our study. Computed tomography (CT) imaging of case 1 pre‐ and post‐immunosuppression. These cysts start as round structures but finally coalesce to become the typical bizarre shaped cysts of LCH. Patients with the lowest tertile of IAST group showed (A) significant higher rates of acute procedural success by means of AF termination, either converting to SR or AT during catheter ablation (87.5% vs. 73.9% vs. 62.5%) (P = 0.048) and (B) tendency of higher proportion of converting to sinus rhythm (P = 0.145). The predominant finding is ground glass opacity (GGO). NSIP is the prevalent lung pattern in systemic sclerosis and polymyosisits/dermatomyositis (more than 90%), but also may occur in RA, SLE, Sj?gren's and MCTD. So these smoking-related diseases do not represent discrete entities. In addition there is bilateral pleural fluid. Cavitation in TB There is also hyperinflation. Those septal CFAEs were preferentially targeted during ablation procedure in patients who had thick IAST and septal CFAEs. It is one of the best educational CD's ever made. Representative examples of CFAE measurement in LA are shown in Figure 1. Success was defined as the absence of any documented arrhythmia or symptoms suggestive of arrhythmia recurrence without anti-arrhythmic drugs. If this patient was coughing up blood, this probably would be pulmonary hemorrhage (although we would expect more pulmonary densities in these patients). Interstitial lung disease can vary from person to person and depending on what caused it. Crazy paving pattern: reticular pattern superimposed on ground glass opacification. Measurements were made using electronic callipers at the point of maximum thickness of the interatrial septum, 1 cm inferior to the fossa ovalis. These abnormalities developed in several days and this rapid progression of disease combined with these imaging findings are very suggestive of the diagnosis AIP. All forms of interstitial lung disease cause the interstitium to thicken. All tests were two tailed and a P-value of <0.05 was considered significant. Characterized by progressive proliferation of atypical muscle cells along the bronchioles leading to air trapping and the development of thin-walled cysts, that replace normal lung parenchyma. In turn, the degree of IAST may serve a predictive marker for the acute intraprocedural success of AF ablation. There is also lymphadenopathy. On the left another example of cardiogenic pulmonary edema. The first (top left) shows a very subtle GGO. The presence of pleural plaques helps for the differentiation between IPF and asbestosis. The close anatomical relationship of epicardial adipose tissue to the adjacent myocardium allows for local interactions that may provoke electrical or structural remodelling in the atrium.13 Inflammatory mediators such as adipocytokines and proinflammatory cytokines produced by epicardial adipose tissue can directly or systemically produce myocardial remodelling and enhance inflammation in addition to the effects of direct interactions between adipocytes and neighbouring atrial cardiomyocytes.14–16 Epicardial fat is also a source of several inflammatory mediators, including interleukin-1β, interleukin-6, tumour necrosis factor-α, and monocyte chemoattractant protein-1. Elayi CS Verma A Di Biase L Ching CK Patel D Barrett Cet al. Cumulative arrhythmia-free survival (any recurrence of atrial arrhythmia) was estimated using the Kaplan–Meier method and arrhythmia-free survival among groups was compared using a Wilcoxon log-rank test. On the left a patient with Sjogren's syndrome with LIP. LCH is probably an allergic reaction to cigarette smoke since more than 90% of patients are active smokers. Interatrial septal thickness measured by cardiac CT is associated with the extent of CFAE area within the LA and is related to acute procedural success of catheter ablation. © The Author 2015. The CFAE area in the RA was not evaluated in all patients. This could be the result of an idiopathic form of fibrosis like idiopathic pulmonary fibrosis and non-specific interstitial pneumonitis or fibrosis in chronic hypersensitivity pneumonitis and longstanding sarcoid. In this case there is distribution in both lungs. Complex fractionated atrial electrogram areas and CFAE area index in the RA were measured with the same method among available patients. Lymphocytic interstitial pneumonitis or LIP is uncommon, being seen mainly in patients with autoimmune disease, particularly Sj?gren's syndrome, and in patients with AIDS. The histologic pattern aswell as the HRCT findings in AIP are indistinguishable from acute respiratory distress syndrome (ARDS). On the left a patient who developed ARSD as a result of pneumonia (i.e. The interatrial septal thickness (IAST) reflects the changes of the atrial wall in patients with atrial fibrillation (AF). CFAE, complex fractionated atrial electrogram; CT, computed tomography; IAST, interatrial septal thickness. In most subjects, the primary infection is localized and clinically inapparent. There are multiple areas of consolidation. RB-ILD: seen in smokers, upper lobe predilection, usually associated with centrilobular emphysema. In patients with LCH, the pathologist may find LCH, but also areas of emphysema, respiratory bronchiolitis and even fibrosis. The radiologic findings are the same as in other forms of NSIP. We sought to characterize the relationship between IAST and LA CFAE area, as well as the acute procedural and clinical outcomes of catheter ablation in persistent AF patients. The dominant pattern is ground glass opacification. During a mean follow-up of 27.7 ± 8.2 months after a single ablation procedure, 29 patients (40.8%) maintained sinus rhythm without anti-arrhythmic drugs. Hypersensitivity pneumonitis: ill defined centrilobular nodules. Batal O Schoenhagen P Shao M Ayyad AE Van Wagoner DR Halliburton SSet al. A detailed history of any symptoms suggesting potential AF or AT recurrence was taken. All three patients were suffering from connective tissue disease, all cases were biopsy proven. In the images on your left you can appreciate again the spectrum of findings seen in NSIP. The mean CFAE area (6.7 ± 13.6 mm2 vs. 30.8 ± 40.9 mm2 vs. 38.8 ± 52.4 mm2, P = 0.164) and CFAE area index (4.2 ± 9.3 vs. 16.2 ± 20.5 vs. 17.3 ± 21.8, P = 0.204) in RA were not significantly different among groups. The mean duration of AF before catheter ablation was 7.1 ± 5.5 years. Patients were grouped into tertiles according to IAST value. At a lobar level, 69% (514 of 748) of lobes with bronchiectasis had septal thickening. 4. These abnormalities are usually reversible and will disappear upon cessation of smoking. Some types of autoimmune diseases, such as rheumatoid … Prior work demonstrated that CFAEs were mostly observed in areas of slow conduction and/or at pivot points of wavelets turnaround at the end of functional block arcs. The HRCT shows a mosaic pattern with hyperaerated secondary nodules and secondry nodules of increased attenuation. Knowledge of both, the radiological and clinical appearance of these more common interstitial lung diseases, is therefore important for recognizing them in the daily practice and including them in the differential diagnosis. Hypersensitivity pneumonitis (HP) is also known as extrinsic allergic alveolitis (EAA). Complex fractionated atrial electrograms were found to be critical sites for AF perpetuation and can therefore serve as target sites for AF ablation. Respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia: different entities or part of the spectrum of the same disease process? Epicardial adipose tissue can provoke chronic inflammation of the left atrium (LA), which may contribute to the genesis or perpetuation of atrial fibrillation (AF).1,2 We previously demonstrated that interatrial septal thickness (IAST) was significantly correlated with total epicardial adipose tissue and independently associated with structural remodelling of the LA in patients with persistent AF.3 Several reports have shown that atrial arrhythmias are related to thickening of IAST with fibrosis or fatty infiltration of the int… Extra-pulmonary ARDS On the left a patient with Lymphangitic Carcinomatosis. Sarcoidosis is a more likely diagnosis if the fibrosis is located in the posterior parts of the upper lobes or in the perihilar area and if there are also nodules in a perilymphatic distribution or if there is extensive mediastinal lymphadenopathy. As a result we find cystic destruction ventrally and residual fibrosis mostly in the ventral lung areas. Notice the lack of honeycombing in all three cases, excluding UIP as diagnosis. Calkins H Kuck KH Cappato R Brugada J Camm AJ Chen SAet al. Histology revealed alveolar sarcoid. This is caused by the fact that the proteinacious material, which is removed from the alveolar space by macrophages is transported to the interstitium and thus leads to thickening of septa. Fibrotic conditions, including interstitial fibrosis of any cause, which present with irregular septal thickening and marked distortion of the lung. Drug-induced lung disease is a major source of iatrogenic lung injury. Interatrial septal thickness showed significant positive correlation with (A) LA CFAE area and (B) CFAE area index. Nonspecific interstitial pneumonia (NSIP) is by some considered as a specific entity, with specific histologic characteristics, but by others as a 'wastebasket' diagnosis, representing cases of idiopathic interstitial pneumonia that cannot be classified as UIP, DIP, or OP. The proportion of patients who showed CFAEs in the LA septal area was significantly higher as IAST getting thicker [45.8% (11/24) vs. 56.5% (13/23), 75.0% (18/24), P = 0.041]. Effect of ablation behavior on the matrix effect in nanosecond laser ablation inductively coupled plasma mass spectrometry. It can be caused by many things. It is important to note that we do not see the classic distribution of UIP, from which NSIP has to be differentiated. In some of them the old names are used and in some the newer ones. NSIP was characterized by temporally homogenous septal inflammatory thickening and minimal organizing fibrosis (score 3), N = 20 cases (Figure 1E). Depending on filling with fluid or with tumor cells, septal thickening is irregular or smooth. The chest film on the left shows diffuse areas with nodular air space opacifications. OP presents with a several-month history of nonproductive cough, low-grade fever, malaise and shortness of breath. More patients in the highest IAST tertile did not terminate AF during catheter ablation (12.5% vs. 26.1% vs. 37.5%, P = 0.048). The reconstructed image slice thickness measured 0.76 mm and the field of view was 20 cm. Does location of epicardial adipose tissue correspond to endocardial high dominant frequency or complex fractionated atrial electrogram sites during atrial fibrillation? RB-ILD (3) The second (top right) is a more obvious example of GGO with a superimposed fine reticular densities as a result of thickening of the intralobular septa. On the left an immunocompromised patient with PCP. This study demonstrates that IAST measured by cardiac CT is significantly associated with the extent of LA CFAEs and CFAE area index irrespective of LA size or body mass index in persistent AF patients. FIGURE 23-25 Pulmonary hemorrhage with intralobular interstitial thickening and intralobular lines. Pleural effusion due to pleuritic carcinomatosis ( > 50% of patients). 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