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Hypersensitivity Pneumonitis: Essential Radiologic and Pathologic Findings.

Teri J Franks1, Jeffrey R Galvin2

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Diagnosing hypersensitivity pneumonitis (HP) requires integrating imaging and biopsy findings. High-resolution computed tomography (HRCT) is crucial for identifying characteristic patterns suggestive of HP.

Keywords:
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Area of Science:

  • Pulmonology
  • Radiology
  • Pathology

Background:

  • Hypersensitivity pneumonitis (HP) is an interstitial lung disease triggered by environmental antigen exposure.
  • HP presents with variable clinical, radiologic, and histologic features, often mimicking other conditions.
  • Accurate diagnosis relies on a comprehensive assessment of multiple findings.

Purpose of the Study:

  • To review key radiologic and pathologic findings in hypersensitivity pneumonitis.
  • To discuss differential diagnoses for HP.
  • To provide an approach for evaluating lung biopsies in suspected HP cases.

Main Methods:

  • Review of high-resolution computed tomography (HRCT) findings characteristic of HP.
  • Correlation of HRCT findings with histopathologic features.
  • Discussion of diagnostic criteria and pitfalls.

Main Results:

  • HRCT findings like centrilobular nodules, ground glass opacities, and air trapping are highly suggestive of HP.
  • Specific HRCT patterns support the diagnosis when characteristic histologic features (airway-centered inflammation, granulomas, organizing pneumonia) are present.
  • HRCT aids diagnostic confidence, especially in biopsies lacking the full histologic triad.

Conclusions:

  • Integrating HRCT findings with histopathology is essential for diagnosing hypersensitivity pneumonitis.
  • Radiologic findings can guide pathologists and improve diagnostic accuracy.
  • Awareness of potential mimics, like infections, is critical when interpreting imaging and biopsy results.