Akira Masanori
Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan.
Ann Am Thorac Soc. 2017 Mar;14(3):432-440. doi: 10.1513/AnnalsATS.201611-883PS.
The concept of end-stage lung disease suggests a final common pathway for most diffuse parenchymal lung diseases. In accordance with this concept, end-stage disease is characterized radiographically and pathologically by the presence of extensive honeycombing. However, sequential computed tomographic (CT) scans obtained from patients with chronic diffuse lung disease evolve over time to show various advanced lung disease patterns other than honeycombing. In addition, several radiographically distinct honeycomb patterns, including microcystic, macrocystic, mixed, and combined emphysema and honeycombing, differentiate one advanced lung disease from another. For example, usual interstitial pneumonia (IP) usually shows mixed microcystic and macrocystic honeycombing. In contrast, CT images of long-standing fibrotic nonspecific IP typically show only small, scattered foci of honeycombing; instead, most enlarged airspaces observed in the advanced stage of this disease represent dilatation of bronchioles. In desquamative IP and pulmonary Langerhans cell histiocytosis, focal opacities typically evolve into emphysema-like lesions seen on CT imaging. In combined pulmonary fibrosis and emphysema and sarcoidosis, the cysts tend to be larger than those observed in usual IP. Sequential CT scans in other chronic, diffuse lung diseases also show various distinctive changes. This article highlights radiographic patterns of lung destruction that belie a single common pathway to end-stage lung disease. Recognition of distinct radiographic patterns of lung destruction can help differentiate diffuse parenchymal lung diseases, even in advanced stages of disease evolution.
终末期肺病的概念提示了大多数弥漫性实质性肺病的最终共同路径。根据这一概念，终末期疾病在影像学和病理学上的特征是存在广泛的蜂窝状改变。然而，对慢性弥漫性肺病患者进行的连续计算机断层扫描（CT）显示，随着时间的推移，会出现除蜂窝状改变以外的各种晚期肺病模式。此外，几种在影像学上不同的蜂窝状模式，包括微囊状、大囊状、混合型以及合并肺气肿和蜂窝状改变的模式，可用于区分不同的晚期肺病。例如，寻常型间质性肺炎（IP）通常表现为微囊状和大囊状蜂窝状改变混合存在。相比之下，长期纤维化非特异性IP的CT图像通常仅显示小的、散在的蜂窝状病灶；相反，在该疾病晚期观察到的大多数扩大的气腔代表细支气管扩张。在脱屑性IP和肺朗格汉斯细胞组织细胞增多症中，局灶性混浊通常会演变为CT成像上可见的肺气肿样病变。在合并肺纤维化和肺气肿以及结节病中，囊肿往往比寻常型IP中观察到的囊肿更大。其他慢性弥漫性肺病的连续CT扫描也显示出各种独特的变化。本文强调了肺部破坏的影像学模式，这些模式表明终末期肺病并非只有单一的共同路径。认识到不同的肺部破坏影像学模式有助于区分弥漫性实质性肺病，即使在疾病进展的晚期也是如此。
