Fibrotic Hypersensitivity pneumonitis.pptx

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1. Fibrotic Hypersensitivity pneumonitis Typical fibrotic chronic HP is characterized by peribronchial fibrosis with various degrees of ground-glass and marked mosaic attenuation due to sparing of secondary lobules.  Expiratory air trapping due to small airways obstruction is a hallmark finding. Centrilobular ground-glass nodules may be present, but are more often and dominantly seen in the subacute (non-fibrotic) stages of the disease.  The fibrosis may show a random or diffuse distribution, or a mid- or upper lung predominance with relative sparing of the bases. 

2. Axial and non dependent .Diffuse non-basal dominant (A), peribronchial orientated ground-glass and mild fibrotic changes with mosaicism (A and B), and expiratory air trapping (C).

3. Fibrotic NSIP Pure ground-glass without fibrotic changes is the hallmark feature of cellular NSIP, separated from fibrotic NSIP pattern in which there is reticulation, traction bronchiectasis, and architectural distortion due to fibrosis.  NSIP is typically basal dominant with marked ground-glass, reticulation and traction bronchiolectasis . Subpleural sparing of the dorsal regions of the lower lobes is present in (only) approximately 40% of cases and may be a helpful feature in making the diagnosis .