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Hypersensitivity Pneumonitis

¹ Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
² Department of Pathology, Duke University Medical Center, Durham, NC 27710.

View larger version (187K): [in a new window]   Fig. 1A. —Microscopic features of hypersensitivity pneumonitis. Low-power photomicrograph of histopathologic specimen shows diffuse uniform expansion of pulmonary interstitium by mononuclear inflammatory cells with accentuation of distribution around small airways. (H and E, x52)

View larger version (164K): [in a new window]   Fig. 1B. —Microscopic features of hypersensitivity pneumonitis. High-power photomicrograph of histopathologic specimen shows interstitial inflammation accompanied by organizing pneumonia (thick arrow) and multinucleate giant cell (thin arrow) typical of hypersensitivity pneumonitis. (H and E, x130)

View larger version (106K): [in a new window]   Fig. 2A. —Acute hypersensitivity pneumonitis in 25-year-old man with severe dyspnea after attic renovation. Chest radiographs (not shown) were normal. Thin-section CT (1.0-mm collimation), initially interpreted as normal, shows, in retrospect, subtle centrilobular nodules (arrowhead).

View larger version (145K): [in a new window]   Fig. 2B. —Acute hypersensitivity pneumonitis in 25-year-old man with severe dyspnea after attic renovation. Chest radiographs (not shown) were normal. Cone-down view of chest CT shows centrilobular nodule in left lower lobe (arrowhead) more clearly than A. Thoracoscopic lung biopsy revealed hypersensitivity pneumonitis. Offending antigen was never identified.

View larger version (96K): [in a new window]   Fig. 3A. —Acute hypersensitivity pneumonitis (bird fancier's lung) in 34-year-old man with severe dyspnea. Chest radiograph shows bilateral homogeneous pulmonary opacities.

View larger version (164K): [in a new window]   Fig. 3B. —Acute hypersensitivity pneumonitis (bird fancier's lung) in 34-year-old man with severe dyspnea. CT scan (1.0-mm collimation) shows scattered ground-glass opacities. Radiologic and clinical findings resolved within 5 days of removal of antigen and institution of corticosteroid therapy.

View larger version (86K): [in a new window]   Fig. 4A. —Acute hypersensitivity pneumonitis in 38-year-old woman with acute dyspnea, hypoxemia, and chills. Chest radiograph shows focal area of homogeneous opacity (arrows) in right lower lung. Note subtle heterogeneous opacities in left lower lobe.

View larger version (147K): [in a new window]   Fig. 4B. —Acute hypersensitivity pneumonitis in 38-year-old woman with acute dyspnea, hypoxemia, and chills. CT scan (1.0-mm collimation) shows scattered areas of consolidation and ground-glass opacities in centrilobular and bronchovascular distribution. Thoracoscopic lung biopsy revealed hypersensitivity pneumonitis. Offending antigen was never identified. Clinical and radiographic findings resolved after institution of corticosteroid therapy.

View larger version (111K): [in a new window]   Fig. 5A. —Acute and subacute hypersensitivity pneumonitis in 36-year-old woman. (Reprinted from [10]) Chest radiograph at patient's initial presentation with severe dyspnea and hypoxemia shows bilateral scattered heterogeneous opacities with more focal homogeneous opacity in lung bases. During patient's hospitalization, all radiographic and clinical manifestations resolved in several days and patient was discharged.

View larger version (127K): [in a new window]   Fig. 5B. —Acute and subacute hypersensitivity pneumonitis in 36-year-old woman. (Reprinted from [10]) Full (B) and coned (C) chest radiographs obtained 9 months after A show diffuse small nodules (arrows) and normal lung volumes. Patient complained of mild dyspnea at this time.

View larger version (116K): [in a new window]   Fig. 5C. —Acute and subacute hypersensitivity pneumonitis in 36-year-old woman. (Reprinted from [10]) Full (B) and coned (C) chest radiographs obtained 9 months after A show diffuse small nodules (arrows) and normal lung volumes. Patient complained of mild dyspnea at this time.

View larger version (100K): [in a new window]   Fig. 5D. —Acute and subacute hypersensitivity pneumonitis in 36-year-old woman. (Reprinted from [10]) CT scan (1.5-mm collimation) obtained at same time as B and C predominantly shows poorly defined centrilobular nodules (arrows). Note peripheral well-defined nodule in right upper lobe (arrowhead). Thoracoscopic lung biopsy revealed hypersensitivity pneumonitis. Offending antigen was never identified.

View larger version (142K): [in a new window]   Fig. 6A. —Subacute hypersensitivity pneumonitis in 22-year-old woman with progressive dyspnea. Full (A) and coned (B) chest radiographs show bilateral, diffusely distributed, well-defined small lung nodules. No adenopathy or pleural fluid is seen. Thoracoscopic lung biopsy found hypersensitivity pneumonitis. Offending antigen was never identified.

View larger version (121K): [in a new window]   Fig. 6B. —Subacute hypersensitivity pneumonitis in 22-year-old woman with progressive dyspnea. Full (A) and coned (B) chest radiographs show bilateral, diffusely distributed, well-defined small lung nodules. No adenopathy or pleural fluid is seen. Thoracoscopic lung biopsy found hypersensitivity pneumonitis. Offending antigen was never identified.

View larger version (99K): [in a new window]   Fig. 7. —Subacute hypersensitivity pneumonitis in 30-year-old woman with dyspnea. Chest radiographs (not shown) were normal. CT scan (1.5-mm collimation) shows scattered ground-glass opacities. Note centrilobular distribution peripherally (arrows). Thoracoscopic lung biopsy revealed hypersensitivity pneumonitis. Offending antigen was never identified.

View larger version (107K): [in a new window]   Fig. 8. —Subacute hypersensitivity pneumonitis (bird fancier's lung) in 40-year-old woman with dyspnea. Patient kept more than 200 parakeets. Chest radiographs (not shown) were normal. CT scan (1.5-mm collimation) shows scattered ground-glass opacities. Note more well-defined centrilobular nodules in dependent right lung (arrowhead). These findings suggest diagnosis of hypersensitivity pneumonitis, which was confirmed at thoracoscopic lung biopsy.

View larger version (119K): [in a new window]   Fig. 9. —Chronic hypersensitivity pneumonitis (bird fancier's lung) in 29-year-old woman with progressive dyspnea. Chest radiograph shows coarse reticulonodular opacities and volume loss in both upper lobes. Thoracoscopic lung biopsy revealed hypersensitivity pneumonitis and fibrosis.

View larger version (144K): [in a new window]   Fig. 10A. —Chronic hypersensitivity pneumonitis in 61-year-old woman with progressive dyspnea. Chest radiograph shows bilateral reticulonodular opacities in mid lung zones and mild loss of lung volume.

View larger version (122K): [in a new window]   Fig. 10B. —Chronic hypersensitivity pneumonitis in 61-year-old woman with progressive dyspnea. CT scan (10-mm collimation) shows irregular linear opacities, architectural distortion, and traction bronchiectasis. Note centrilobular nodules in right mid lung (arrows).

View larger version (136K): [in a new window]   Fig. 10C. —Chronic hypersensitivity pneumonitis in 61-year-old woman with progressive dyspnea. CT scan (1-mm collimation) better shows traction bronchiectasis (solid arrow) and architectural distortion, particularly in left lung. Note subpleural honeycomb cyst formation (open arrows). Thoracoscopic lung biopsy revealed hypersensitivity pneumonitis and fibrosis. Offending antigen was never identified.

View larger version (124K): [in a new window]   Fig. 11A. —Chronic hypersensitivity pneumonitis (bird fancier's lung) in 70-year-old man with progressive dyspnea. Patient kept three cockatiels. Serum antibodies to avian proteins were positive at greater than 1:20,000 dilution. Chest radiograph shows bilateral coarse reticulonodular opacities, honeycombing, and volume loss. Note small right pneumothorax after transbronchial lung biopsy (arrows).

View larger version (106K): [in a new window]   Fig. 11B. —Chronic hypersensitivity pneumonitis (bird fancier's lung) in 70-year-old man with progressive dyspnea. Patient kept three cockatiels. Serum antibodies to avian proteins were positive at greater than 1:20,000 dilution. CT scan (1.5-mm collimation) with patient prone shows basal honeycombing, traction bronchiectasis, and architectural distortion. CT findings are indistinguishable from those of idiopathic pulmonary fibrosis.

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