Imaging

Idiopathic pulmonary fibrosis

Preliminary Diagnosis: Idiopathic Pulmonary Fibrosis

I. What imaging technique is first-line for this diagnosis

  • Chest x-ray, PA and lateral view

II. Describe the advantages and disadvantages of this technique for diagnosis

Advantages

  • Highly portable and relatively inexpensive imaging modality

  • Exposes patients to minimal ionizing radiation

Disadvantages

  • Less sensitive and specific in diagnosing a primary parenchymal and/or pleural abnormality or detecting any secondary complications compared to cross-sectional imaging

  • Unable to evaluate the secondary pulmonary lobule, which would be helpful in generating a differential diagnosis

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant patients.

IV. What alternative imaging techniques are available?

  • CT of the chest without contrast/high resolution CT of the chest

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis

CT of the chest without contrast/high resolution CT of the chest

Advantages

  • The gold standard in evaluating and characterizing idiopathic pulmonary fibrosis

  • Highly sensitive and specific in evaluating for a primary parenchymal and/or pleural abnormality, and detailing and characterizing a secondary complication

  • Offers exquisite visualization and evaluation of the secondary pulmonary lobule and interlobular and intralobular septae.

Disadvantages

  • Exposes patients to ionizing radiation

  • More expensive compared to plain radiography

VI. What are the contraindications for the alternative imaging techniques?

CT of the chest without contrast/high resolution CT of the chest

  • CT imaging may be contraindicated in pregnant patients.

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