Hypersensitivity pneumonitis: a historical, clinical, and radiologic review

Abstract

Most cases of hypersensitivity pneumonitis develop only after many years of inhaling allergens, which include microbes, animal or plant proteins, and certain chemicals that form haptens. The initial clinical presentation is either episodes of acute illness with dyspnea and prominent constitutional symptoms, such as fever, or an insidious onset of dyspnea, coughing, and weight loss, sometimes with superimposed acute episodes. The histopathologic process consists of The linked image cannot be displayed. The file may have been moved, renamed, or deleted. Verify that the link points to the correct file and location. chronic inflammation of the bronchi and peribronchiolar tissue, often with poorly defined granulomas and giant cells in the interstitium or alveoli. Fibrosis and emphysema may develop. The radiologic findings include diffuse ground-glass opacification, centrilobular ground-glass opacities, air trapping, fibrosis, lung cysts, and emphysema. The histologic and radiologic features in some cases may resemble those of usual interstitial pneumonia or nonspecific interstitial pneumonia. The diagnosis usually rests on a variable combination of findings from history, serology, radiography, lung biopsy, and bronchoalveolar lavage, which characteristically reveals a lymphocyte content of more than 30%, often with an increased CD4-to-CD8 ratio of T cells. Treatment includes avoiding the allergen, if possible, and, in severe cases, systemic corticosteroids. The long-term prognosis is usually good, but some patients develop severe respiratory insufficiency, and a few die of the disease. • © RSNA, 2009 Previous SectionNext Section LEARNING OBJECTIVES FOR TEST 2 After reading this article and taking the test, the reader will be able to: • Describe the most common clinical manifestations of hypersensitivity pneumonitis. • Correlate the histologic features of hypersensitivity pneumonitis with the radiologic findings. • Identify the most important abnormalities indicative of hypersensitivity pneumonitis at chest radiography and CT. Previous SectionNext Section

Key Biomarkers

Symptom Clusters