Computed tomography and pathologic findings in fulminant forms of idiopathic interstitial pneumonia

This study describes the computed tomography features of various fulminant forms of idiopathic interstitial pneumonia and to clarify the usefulness of computed tomography in such patients. Computed tomography scans in 19 patients with fulminant forms of idiopathic interstitial pneumonia were reviewed. This study included patients with acute interstitial pneumonia (n = 7), an accelerated form of idiopathic pulmonary fibrosis (n = 2), and an acute exacerbation of idiopathic pulmonary fibrosis (n = 10). Pathologic confirmation of the diagnosis was obtained in all patients. Follow-up computed tomography scans were available for eight patients, and postmortem computed tomography scans were available for three patients. All patients had progressive ground-glass attenuation, consolidation, or both. In patients with an acute exacerbation of idiopathic pulmonary fibrosis, subpleural honeycombing was also seen. Follow-up computed tomography showed a change from ground-glass attenuation to consolidation with distortion. Architectural distortion, traction bronchiectasis, and ground-glass opacity were the prominent features in the initial computed tomography scans obtained more than 7 days after the onset of symptoms, and cystic lesions were seen in follow-up computed tomography obtained more than 1 month after the onset. High-resolution computed tomography was more sensitive than the plain radiographs in the early detection of these entities. Computed tomography examination at the onset of the acute symptoms is useful in classifying these fulminant forms of idiopathic interstitial pneumonia.