, Francesca Pennati, Caterina Salito, Bruno Guedes Baldi, Marcio Sawamura, Rodrigo Caruso Chate, Carlos Roberto Ribeiro de Carvalho, André Albuquerque, Andrea Aliverti, Jeferson Ferreir Mosaic attenuation is a commonly encountered pattern on computed tomography that is defined as heterogeneous areas of differing lung attenuation. This heterogeneous pattern of attenuation is the result of diverse causes that include diseases of the small airways, pulmonary vasculature, alveoli, and interstitium, alone or in combination Mosaic attenuation has previously been described as an important CT parameter in diagnostic models of hypersensitivity pneumonitis [ 1, 2 ] Survival time of chronic hypersensitivity pneumonitis cohort for those with pulmonary fibrosis and unknown inciting antigen based on the presence or absence of high-resolution computed tomography air trapping (AT)/mosaic attenuation (MA) and adjusted to mean 15 pack-year history of smoking (n = 45, number of events = 17; log-rank P = 0.003)
Hypersensitivity pneumonitis (HP) is a complex lung disease that results from a subject's immunologic response to various inhaled antigens. Its clinical presentation and natural course can be quite variable, with its chest imaging appearance on high-resolution computed tomography (HRCT) commonly determined by the duration of the disease Mosaic attenuation is most commonly observed in Pneumocystis jiroveci pneumonia, hypersensitivity pneumonitis, and pyogenic pneumonia. It is a rare manifestation of nonspecific and desquamative interstitial pneumonitis. Expiratory CT scans typically show a uniform decrease in lung volume and increase in attenuation of the affected lung parenchyma Background: Mosaic attenuation on CT has been identified in international guidelines as an important diagnostic feature of fibrotic hypersensitivity pneumonitis (FHP) as opposed to idiopathic pulmonary fibrosis (IPF) . Vascular causes resulting in mosaic attenuation are typically chronic thromboembolic pulmonary hypertension, which is characterize
Hypersensitivity pneumonitis, previously known as extrinsic allergic alveolitis, represents a group of immune-mediated pulmonary disorders characterized by an inflammatory and/or fibrotic reaction affecting the lung parenchyma and small airways Mosaic attenuation is a descriptive term used in describing a patchwork of regions of differing pulmonary attenuation on CT imaging.It is a non-specific finding, although is associated with the following: obstructive small airways disease: low attenuation regions are abnormal and reflect two phenomena occurring at the same time: 1. air-trapping in lung areas with obstructive small airways.
Typical hypersensitivity pneumonitis (HP) and compatible-with-HP high-resolution computed tomography patterns. The nonfibrotic typical HP pattern is characterized by (A) centrilobular nodules, (B) mosaic attenuation on an inspiratory scan, and (C) air trapping on an expiratory scan (A) Inspiratory and (B) expiratory high-resolution computed tomography images of a patient with hypersensitivity pneumonitis (HP). In A, arrows mark mosaic attenuation, defined by patchwork regions of differing attenuation, and in B arrows mark air trapping, suggested by the lack of normal increase in lung attenuation during expiration We are concerned that mosaic attenuation (although less specific for hypersensitivity pneumonitis compared with the three-density pattern) is included in the abnormalities indicative of small airways disease in the typical hypersensitivity pneumonitis but not in the compatible with hypersensitivity pneumonitis pattern Suggested Novel Classiﬁcation of Hypersensitivity Pneumonitis Clinical Behavior Typical HRCT Image Patterns* Histopathology Patterns Acute HP†‡: symptom duration usually few weeks/months (,6motoz24 wk) d Mostly reversible Upper- and middle-lobe predominant ground-glass opacities, poorly deﬁned centrilobular nodules; mosaic attenuation. Hypersensitivity pneumonitis (HP) is a remarkably diverse clinical condition. Although it is defined by the presence of inflammation and/or fibrosis incited by a wide array of potential organic and inorganic antigens, an inciting antigen is not identified in about 50% of patients with chronic HP
Hypersensitivity Pneumonitis: Pigeons, Farmers and Hot Tubs, Oh My Rachel S. Knipe, MD (GGO, mosaic attenuation) and 1 pattern of small airway disease (centrilobular nodules, air trapping) Compatible with HP Nonspecific patterns that have been described in HP Indeterminate for HP N/ of fibrotic hypersensitivity pneumonitis albeit with a lower sensitivity (0·49). We are concerned that mosaic attenuation (although less specific for hypersensitivity pneumonitis compared with the three-density pattern) is included in the abnormalities indicative of small airways disease in the typical hypersensitivity pneumonitis bu
Chronic hypersensitivity pneumonitis (CHP) is a clinical diagnosis that requires exposure to an identifiable antigen [1,2].The classic histopathologic description, which is the result of antigen inhalation, is airway-centered cellular bronchiolitis, interstitial pneumonia, poorly formed granulomas, and multinucleated giant cells INTRODUCTION — Hypersensitivity pneumonitis (HP), also called extrinsic allergic alveolitis, is a complex syndrome of varying intensity, clinical presentation, Air trapping (mosaic attenuation) can be demonstrated by comparison of inspiratory and expiratory images Hypersensitivity pneumonitis is an immune-mediated interstitial lung disease caused by an aberrant response to an inhaled exposure, which results in mostly T cell-mediated inflammation, granuloma formation, and fibrosis in some cases. and mosaic attenuation, with traction bronchiectasis and honeycombing in fibrotic cases. Additional. Mosaic attenuation a-d) Chronic hypersensitivity pneumonitis (CHP) at its clinical acute presentation in a 65 year-old woman living in the countryside and presenting acute respiratory failure, dry.
. The name HP defines the disease more appropriately than the previous term extrinsic allergic alveolitis, as the inflammation involves not only the alveoli but the bronchioles as well Mosaic attenuation. The term 'mosaic attenuation' is used to describe density differences between affected and non-affected lung areas. · Hypersensitivity pneumonitis (HP) is an allergic lung disease caused by the inhalation of antigens contained in a variety of organic dusts Mosaic attenuation represents coexisting pneumonitis-affected lobules interspersed with regular or slightly decreased attenuation lobules which is due to bronchiolar obstruction. 17 Ground glass opacities; a radiological term that clearly suggests a region of hazy increased lung opacity that can still be found through vessels and bronchial.
Hypersensitivity pneumonitis is a syndrome of cough, dyspnea, and fatigue caused by sensitization and subsequent hypersensitivity to environmental (frequently occupational) antigens. Acute, subacute, and chronic forms exist; all are characterized by acute interstitial inflammation and development of granulomas and fibrosis with long-term exposure Hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, is an immune-mediated interstitial lung disease (ILD) triggered by repeated inhalational exposure and sensitization to one or more environmental antigens in genetically susceptible individuals [1••].Despite our awareness of the disease for decades, substantial gaps remain in our understanding of the.
Abstract Hypersensitivity pneumonitis is an immune mediated interstitial lung disease caused by an aberrant response to an inhaled exposure, HP is diagnosed by exposure identification, HRCT findings of ground glass opacities, centrilobular nodules and mosaic attenuation, with traction bronchiectasis and honeycombing in fibrotic cases. Though the HRCT pattern is variable depending on the stage of HP, characteristic findings include centrilobular ground-glass nodular opacities, diffuse ground-glass abnormality, and mosaic attenuation with expiratory air-trapping (Fig. 12, hypersensitivity pneumonitis showing features of ground glass opacity, traction bronchiectasis, and mosaic.
Chronic hypersensitivity pneumonitis (cHP) is a heterogeneous condition, where both small airway involvement and fibrosis may simultaneously occur. Computer-aided analysis of CT lung imaging is increasingly used to improve tissue characterization in interstitial lung diseases (ILD), quantifying disease extension, and progression Hypersensitivity pneumonitis (HP) is caused by exaggerated immune response, either in the form of immune-complex hypersensitivity (acute HP) or Th2 immune response (subacute, chronic HP), to inhalation of different organic antigens: fungi, yeasts, mycobacteria, bacteria, animal proteins or chemicals [1-3]. Mosaic attenuation pattern with. Chung JH, Zhan X, Cao M, et al. Presence of Air Trapping and Mosaic Attenuation on Chest Computed Tomography Predicts Survival in Chronic Hypersensitivity Pneumonitis. Ann Am Thorac Soc 2017; 14:1533
Chronic hypersensitivity pneumonitis HRCT • Micronodules • Mosaic attenuation • Sparing of lung periphery **tend to favor HP as a diagnosis over other interstitial diseases** • Pleural disease is uncommon JO A. DOUGLASS .et al .Middleton's allergy ; 8th edition 2013:1000-13 46 Therefore, the presence of to mosaic attenuation, namely hypersensitivity airtrapping is just one finding and should be used pneumonitis, will demonstrate airtrapping on ex- in conjunction with other imaging findings such 1378 September-October 2015 radiographics.rsna.org Figure 22 The term mosaic is used because the lung attenuation varies rapidly across a relatively lin- ear interface and may produce a polygonal or quiltlike appearance. Hyperlucency is the result of decreased attenuation or density in the areas of mosaic perfusion. Mosaic perfusion and hyperlucency apply to HRCT images that are obtained at TLC . chronic HP, arts and crafts, solvent and sprays\. Hypersensitivity Pneumonitis, Chronic Hypersensitivity Pneumonitis, CHP. Nutshell Buzz. Airway Thickening. May be Basilar. Reticulation. Heterogeneous. lobular sparing air trapping mosaic attenuation. Signs and Findings of Mosaic Attenuation Pattern; Signs and Findingsof Atelectasis; Signs for Localizing Mass; Signs in Radiology.
Hypersensitivity pneumonitis is a syndrome of cough, dyspnea, and fatigue caused by sensitization and subsequent hypersensitivity to environmental (frequently occupational) antigens. may be a prominent feature in some patients (eg, mosaic attenuation with air trapping on expiratory HRCT). In chronic hypersensitivity pneumonitis, there are. Hypersensitivity pneumonitis (HP) is a T H 1 lymphocyte-biased fibrosing alveolitis caused by antigens ranging from avian excreta, fungi, thermophilic bacteria, and protozoa to reactive chemicals found in the workplace. Mimicking a viral syndrome, acute exposures to inciting antigens cause abrupt onset of nonproductive cough, dyspnea, and chills with arthralgias or malaise usually from 4 to. To the Editor:. We commend the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax for the publication of the first hypersensitivity pneumonitis (HP) clinical practice guidelines ().The guidelines propose two distinctive subtypes of HP: nonfibrotic and fibrotic, as determined by the presence of radiological and/or histopathological fibrosis Hypersensitivity pneumonitis is an inflammation of the alveoli and distal bronchioles caused by an immune response to inhaled allergens. Occupational exposure to organic dust is the key epidemiological factor - most commonly including bacteria, animal proteins, or reactive chemicals. Diagnosis. Hypersensitivity pneumonitis (HP) is a complex syndrome resulting from repeated exposure to a variety of organic particles. The syndrome was first described in 1713 by the Italian scientist Bernardino Ramazzini in subjects belonging to 52 different professions. It involves the lung parenchyma and specifically the alveoli, terminal bronchioli, and alveolar interstitium. Repeated exposure to.
glass opacities, mosaic attenuation pattern, and normal lung tissue. This sign is highly specific for hypersensitivity pneumonitis, although it can also be seen in other mixed infiltrative and obstructive processes. • Several other metaphoric chest CT scan signs have been described linking abnormal imaging patterns to lung diseases mosaic attenuation, ground-glass and normal lung, or a combination of mosaic attenuation and signs of brosis were present . Usual interstitial pneumonia (UIP) and HP hypersensitivity pneumonitis, IPF idiopathic pulmonary brosis; UIP usual interstitial pneumonia Table 1 Baseline characteristics by MDD diagnose Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) which varies in prevalence across the world, depending on disease definition, diagnostic methods, exposure type and intensity, geographical environments, agricultural and industrial practices, and host risk factors. This study aimed to deepen knowledge about HP's clinical characteristics, diagnosis and functional and. What is hypersensitivity pneumonitis. Hypersensitivity pneumonitis also known as extrinsic allergic alveolitis, bird fancier's lung, farmer's lung, hot tub lung or humidifier lung, is a disease of your lungs caused by an allergy to certain dust (allergens) that you breathe in
Hypersensitivity Pneumonitis. (GGO), poorly defined centrilobular nodules, and occasionally mosaic attenuation reflective of air trapping. Henry and team observed improvement after cessation. Chest CT revealed a mosaic attenuation pattern (MAP; Figure 1). Chest CT scans basically show the MAP. By definition, mosaic attenuation is a CT pattern in which areas of differing attenuation are found diffusely distributed throughout the lung parenchyma. Chate RC, Sawamura MVY, et al. Computed tomography in hypersensitivity pneumonitis. BACKGROUND: Mosaic attenuation on CT has been identified in international guidelines as an important diagnostic feature of fibrotic hypersensitivity pneumonitis (FHP) as opposed to idiopathic pulmonary fibrosis (IPF)
Similar model performance is seen with population restriction to those reporting no exposure (score >2: specificity 91%).When radiological mosaic attenuation or air trapping are more extensive than reticulation and disease has diffuse axial distribution, hypersensitivity pneumonitis specificity is high and false diagnosis risk low (<10%), but. lymphocytosis >20%) and 24 patients with mosaic attenuation, most (n=16) with head and cheese sign (n=6 with BAL lymphocytosis >20%). IPF: idiopathic pulmonary fibrosis; HP: hypersensitivity pneumonitis Hypersensitivity pneumonitis:  Worthy SA, Muller NL, Hartman TE, et al. Mosaic attenuation pattern on thin-section CT scans of the lung: differentiation among infiltrative lung, airway, and vascular diseases as a cause. Radiology 1997; 205: 465 -47 Hypersensitivity pneumonitis (HP) develops after inhalation of many different environmental antigens, causing variable clinical symptoms that often make diagnosis uncertain. These include mosaic attenuation (29), expiratory air trapping (29), cysts (37), and emphysema (30, 33, 38, 39). Several studies have found that emphysema occurs more.
—Areas of mosaic lung attenuation on inspiratory image are confirmed to be air trapping on expiratory images —Peripheral reticulation; no honeycombing —Ground glass opacity present Treated for chronic hypersensitivity pneumonitis (cHP) with removal of exposur The mosaic pattern of lung attenuation refers to a patchwork of regions of differing attenuation. The term is descriptive and nonspecific. It can be seen with: especially in patients with hypersensitivity pneumonitis. Causes include: Hypersensitivity pneumonitis Desquamative interstitial pneumonitis Alveolar proteinosis Cryptogenic.
A ground glass lung result from a CT scan is a non-specific finding that describes an area characterized by a small increase in lung density, explains the National Institutes of Health. Patients with early diffuse pulmonary infiltrative diseases are more likely to present with an area of ground glass opacity in the lung Fig. 8. Coronal CT reformats (A, B) in 2 separate patients with HP show upper-lung zone predominant reticular fibrosis, subpleural honeycombing, and traction bronchiectasis. The second image (B) shows mosaic attenuation with concomitant air-trapping. - Imaging of Hypersensitivity Pneumonitis Interstitial lung diseases (ILD) lead to significant symptoms, physical impairment, and early mortality [1, 2].Fibrotic hypersensitivity pneumonitis (HP) is an ILD subtype caused by an ongoing or repetitive exposure to an inhaled antigen in sensitised and susceptible individuals .The identification of patients with HP is crucial, particularly to prevent ongoing exposure to the causative antigen Hypersensitivity pneumonitis is an inflammatory syndrome of the lung characterized by repetitive inhalation of antigenic agents in a susceptible host.  Hypersensitivity pneumonitis has been traditionally classified into acute, subacute, and chronic phases. However, there are only 2 clinical phases or syndromes: acute and subacute/chronic An international modified Delphi survey identified 18 items as important in the diagnosis of chronic hypersensitivity pneumonitis (cHP), according to an article published in the American Journal of Respiratory and Critical Care Medicine.. cHP is a fibrotic interstitial lung disease (ILD) that results from exposure to a sensitizing antigen over time
Hypersensitivity pneumonitis: Smoking-related lung disease Alpha-1 antitrypsin deficiency: Mosaic attenuation/air trapping: Bronchiolitis from toxic fume or chemical inhalation (eg, flavoring chemicals) Obliterative bronchiolitis related to collagen vascular disease, previous infection, etc Chronic hypersensitivity pneumonitis (cHP) is an immunologically mediated lung disease caused by a persistent or repeated exposure to inhaled environmental or occupational antigens resulting in bronchoalveolar inflammation and progressive fibrosis [1, 2].While previously characterized as acute, subacute, and chronic, recent literature has transitioned to classifying HP as acute or inflammatory. Correlation of lung function parameters and presence or absence mosaic attenuation in chronic hypersensitivity pneumonitis. Table 4. Comparison of oscillometric data in patients with chronic hypersensitivity pneumonitis according to the presence of mosaic attenuation Hypersensitivity pneumonitis (HP) is an immunologically mediated form of lung disease resulting from inhalational exposure to a large variety of antigens. Presence of air trapping and mosaic attenuation on chest computed tomography predicts survival in chronic hypersensitivity pneumonitis
Patients presented to the First and Second Affiliated Hospital of Wenzhou Medical University and Wenzhou Yueqing People's Hospital from Jan. 17 to Feb. 13, 2020, for COVID-19 and over a longer. Background Fibrotic hypersensitivity pneumonitis (f-HP) can exhibit a progressive course similar to idiopathic pulmonary fibrosis (IPF). The lack of diagnostic guidelines and randomised controlled trials in this population represent a significant unmet need. Objectives To describe our clinical experience with antifibrotics in patients with f-HP Mosaic attenuation. The term mosaic attenuation is used to describe density differences between affected and non-affected lung areas. Hypersensitivity pneumonitis (HP) is an allergic lung disease caused by the inhalation of antigens contained in a variety of organic dusts Hypersensitivity pneumonitis (HP) formerly recognized as extrinsic allergic alveolitis is the consequence of immunologi- tion, and mosaic attenuation predominantly in upper and middle lobes21. The HRCT findings specific to chronic HP included fibro-sis, namely reticulation, architectural distortion, and traction.
The differential diagnosis includes: · Chronic hypersensitivity pneumonitis · Advanced-stage sarcoidosis Drug-related lung toxicity . HP is an immune-mediated inflammatory disease of the lung parenchyma/airways in response to repeated inhalation of organic or inorganic antigens Rationale: Current diagnosis of chronic hypersensitivity pneumonitis (cHP) involves considering a combination of clinical, radiological, and pathological information in multidisciplinary team discussions. However, this approach is highly variable with poor agreement between centers. mosaic attenuation on chest imaging, and poorly formed. Hello Everyone, Im 46 years old and have been recently diagnosed with Hypersensitivity Pneumonitis. Not sure yet but the doctors are leading to Chronic as am I. Had every test/biopsy under the sun. All negative. Found mold in my house and had it removed. The same mold that is known to cause HP., although my blood test for it shows up negative Chronic hypersensitivity pneumonitis . Collagen vascular disease . IPF and NSIP . Occupation - related lung diseases . Chronic Symptoms . Signs & Symptoms: Chronic, non-productive cough . Mosaic attenuation . Common Radiologic Abnormalities: CXR or Chest CT in ILD . 10 to 15 % Symptomatic patients with proven infiltrative lung disease
Hypersensitivity pneumonitis has been described as a complication of electronic cigarette use.1 3 Hypersensitivity pneumonitis is a complex pulmonary syndrome mediated by an already sensitised immune system reacting to inhaled antigens.6 There are both acute and chronic manifestations of the disease, whereby the characteristic bronchiolocentric. Fig. 14: Bilateral patchy mosaic attenuation in a case of hypersensitivity pneumonitis. Low attenuation areas represent air trapping with attenuated vessels. The air trapping and mosaic attenuation pattern is more pronounced, on scans obtained at end-exhalation instead of the more conventional end-inspiration technique 20. Air trapping is. Hypersensitivity Pneumonitis (HP) one of the most common interstitial lung diseases (ILDs) is characterized by exposure to an inhaled inciting antigen that leads to a host immunologic reaction determining interstitial inflammation and architectural distortion. 38, is exemplified by the headcheese sign and mosaic attenuation (MA). HRCT is.
Mosaic attenuation Lung density and attenuation depends partially on amount of blood in lung tissue. May be due to vascular obstruction, abnormal ventilation or airway disease 32 19. Mosaic pattern in a patient with hypersensitivity pneumonitis 20. Mosaic pattern in a patient with chronic thromboemboli 21 The diagnosis of chronic hypersensitivity pneumonitis (CHP) is often based on the pathology, but evidence is scarce that a pathological diagnosis of CHP may mislead the multidisciplinary diagnosis. and a lack of nodular shadow or mosaic attenuation on computed tomography. CONCLUSIONS. Cases of suspected CHP on pathology may be determined to. Hypersensitivity Pneumonitis (HP) one of the most common interstitial lung diseases (ILDs) is characterized by exposure to an inhaled inciting antigen that leads to a host immunologic reaction determining interstitial inflammation and architectural distortion. The underlying pathogenetic mechanisms are unclear Background: Hypersensitivity pneumonitis (HP) is the third, according to frequency, interstitial lung disease, with the estimated incidence rate of 1-2/100,000.In HP patients, the extensive inflammatory lesions encompassing both small airways and lung parenchyma, as well as subsequent development of lung fibrosis, may result in respiratory insufficiency and secondary pulmonary hypertension (PH) -hypersensitivity pneumonitis. Unknown Causes of DPLDs-idiopathic interstitial pneumonias-idiopathic pulmonary fibrosis-acute interstitial pneumonia-cryptogenic organizing pneumonia Mosaic Attenuation pattern. patchy regions of differing attenuation-on expiratory images, decreased areas of attenuation represent bronchial or bronchiolar.
DiscussionJapanese summer-type relapsing fever accounts for 74% of hypersensitivity pneumonitis in Japan. 1 It is caused by hypersensitivity to seasonal moulds which grow in damp, poorly ventilated, shady houses. Fig. 2 .2High resolution CT scan of the thorax showing diffuse ground glass shadowing with mosaic attenuation and peripheral. A 48-year-old woman from the Scottish Borders presented to her general practitioner with exertional dyspnoea. There was a delay in diagnosis of the underlying respiratory condition, due to initial investigations being suggestive of cardiac disease. Subsequently, the patient developed clinical symptoms and signs of pneumomediastinum, which was discovered on radiological imaging Development and validation of a radiological diagnosis model for hypersensitivity pneumonitis. Margaret L. Salisbury, Barry H. Gross, Aamer Chughtai, Mohamed Sayyouh, Ella A. Kazerooni,.
hypersensitivity pneumonitis (acute or subacute) bronchiolitis CF sarcoidosis Asthma mosaic attenuation from patchy lung disease. Mosaic Perfusion (lucent attenuation+small vessels) mimic? Swyer James (diffuse bronchiectasis, small pulmonary arterial tree) Unilateral lucent lung. Solid pneumoconiosis Infection-TB-invasive aspergillosi The pulmonary disease caused by this response has been called extrinsic allergic alveolitis (EAA) or hypersensitivity pneumonitis. The clinical phases associated with this process have been termed acute, subacute, and chronic. The subacute phase is characterized by centrilobular nodules, areas of ground-glass attenuation, a mosaic perfusion. Presence of Air-Trapping and Mosaic Attenuation on Chest CT Predicts Survival in Chronic Hypersensitivity Pneumonitis. Ann Am Thorac Soc. 2017 Mannina A, Chung JH, Swigris JJ, Solomon JJ, Huie TJ, Yunt ZX, Truong TQ, Brown KK, Achcar RD, Olson AL, Cox CW, Kligerman SJ, Curran-Everett D, Fernández Pérez ER In chronic hypersensitivity pneumonitis, several patterns may be observed, including multiple centrilobular nodules with some ground-glass attenuation, radiolucency or air trapping, extensive.
The objective of this pictorial essay is to highlight the key role of computed tomography scanning (CT scan), particularly minimum intensity projection (MinIP) reformation, with regards to the diagnosis of hypersensitivity pneumonitis (HP) and its contribution to patients' management. MinIP enhances detecting the characteristic CT scan features of HP, particularly air trapping and ground. PURPOSE. To retrospectively compare in patients with chronic hypersensitivity pneumonitis (HP) the computed tomographic (CT) imaging features suggestive of fibrosis with pathologic evidence of fibrosis at surgical lung biopsy and to compare a usual interstitial pneumonia (UIP) pattern at CT with survival