Preliminary Diagnosis: Hypersensitivity Pneumonitis
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 of hypersensitivity pneumonitis.
Advantages
- Fast and portable imaging modality
- Exposes patients to minimal ionizing radiation
Disadvantages
- Less sensitive and specific in diagnosing a primary pulmonary process or detecting a secondary complication
- Offers less detail of the lung parenchyma and surrounding vascular, osseous, and soft tissue structures compared to companion cross-sectional imaging
III. What are the contraindications for the first-line imaging technique?
- No specific contraindications to plain radiography exist. Consent may be required for pregnant patients at some institutions.
IV. What alternative imaging techniques are available?
- CT of the chest without contrast/high resolution CT of the chest without contrast
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of hypersensitivity pneumonitis.
CT of the chest without contrast/high resolution CT of the chest without contrast
Advantages
- Much more sensitive and specific in detecting a primary parenchymal or pleural process, or detecting any secondary complication than plain radiography
- May help direct and guide treatment
- CT/high resolution CT imaging offers exquisite detail of the secondary pulmonary lobule and surrounding interlobular and intralobular septa, which helps clinch a definite diagnosis
Disadvantages
- Exposes patients to ionizing radiation
- Less portable and 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 without contrast
- May be contraindicated in pregnant patients
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