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Thin-Section CT Findings in Flock Worker’s Lung, a Work-related Interstitial Lung Disease¹

¹ From the Departments of Radiology of University of Colorado Health Sciences Center, 4200 E Ninth Ave, Denver, CO 80262 (D.A.W., D.A.L., S.P.J., J.D.N., D.E.M.); Brown University School of Medicine and Memorial Hospital of Rhode Island, Pawtucket (R.S.C., C.K.); and Penobscot Bay Medical Center, Rockport, Me (D.G.K.). From the 2000 RSNA scientific assembly. Received June 18, 2001; revision requested August 10; final revision received August 7, 2002; accepted August 22. Address correspondence to D.A.L. (e-mail: david.lynch@uchsc.edu).

View larger version (128K): [in a new window]   Figure 1. Transverse thin-section CT scan through the right lower lung lobe in a supine patient with FWL shows extensive ground-glass opacity (arrows).

View larger version (145K): [in a new window]   Figure 2. Transverse thin-section CT scan through the right upper lung lobe in a supine patient with FWL shows profuse micronodules (arrows).

View larger version (109K): [in a new window]   Figure 3. Transverse thin-section CT scan through the right midlung in a supine exposed worker who did not meet the diagnostic criteria for FWL shows profuse fine micronodules (arrows) with a pattern similar to that of hypersensivity pneumonitis.

View larger version (117K): [in a new window]   Figure 4. Transverse thin-section CT scan through the right lower lung lobe in a prone patient with FWL shows subpleural-predominant reticular abnormalities (arrows) associated with honeycombing and traction bronchiectasis; this pattern is similar to that of usual interstitial pneumonia.

View larger version (131K): [in a new window]   Figure 5. Transverse thin-section CT scan through the right lower lung lobe in a supine patient with FWL shows extensive basal-predominant ground-glass opacity (arrows) similar to that seen in nonspecific interstitial pneumonia or desquamative interstitial pneumonia.

View larger version (15K): [in a new window]   Figure 6a. Bar graphs show the results of quantitative analysis. The unshaded bars denote the patients with FWL, while the shaded bars denote the exposed workers. (a) Mean lung attenuation was significantly lower in workers with FWL than in exposed workers (P < .05). (b) Skewness was significantly lower in workers with FWL than in exposed workers (P < .05). (c) Kurtosis did not differ significantly between the two groups.

View larger version (11K): [in a new window]   Figure 6b. Bar graphs show the results of quantitative analysis. The unshaded bars denote the patients with FWL, while the shaded bars denote the exposed workers. (a) Mean lung attenuation was significantly lower in workers with FWL than in exposed workers (P < .05). (b) Skewness was significantly lower in workers with FWL than in exposed workers (P < .05). (c) Kurtosis did not differ significantly between the two groups.

View larger version (11K): [in a new window]   Figure 6c. Bar graphs show the results of quantitative analysis. The unshaded bars denote the patients with FWL, while the shaded bars denote the exposed workers. (a) Mean lung attenuation was significantly lower in workers with FWL than in exposed workers (P < .05). (b) Skewness was significantly lower in workers with FWL than in exposed workers (P < .05). (c) Kurtosis did not differ significantly between the two groups.

View larger version (17K): [in a new window]   Figure 7a. Graphs show results of analysis of follow-up CT data for five patients with FWL. (a) The overall visual extent of disease decreased in all but one patient (represented by the dotted line). (b) Mean lung attenuation decreased in all four patients for whom digital data were available (P < .05).

View larger version (19K): [in a new window]   Figure 7b. Graphs show results of analysis of follow-up CT data for five patients with FWL. (a) The overall visual extent of disease decreased in all but one patient (represented by the dotted line). (b) Mean lung attenuation decreased in all four patients for whom digital data were available (P < .05).

View larger version (114K): [in a new window]   Figure 8a. Transverse thin-section CT scans through the right midlung in a supine patient with FWL. (a) CT scan obtained before treatment shows patchy, peripheral areas of consolidation (arrows). Biopsy revealed organizing fibrous tissue within alveoli and widespread lymphocytic infiltrates with perivascular nodules. (b) CT scan obtained after the removal of the patient, who did not undergo steroid treatment, from work exposure shows substantial decrease in parenchymal opacity, with residual ground-glass opacity.

View larger version (112K): [in a new window]   Figure 8b. Transverse thin-section CT scans through the right midlung in a supine patient with FWL. (a) CT scan obtained before treatment shows patchy, peripheral areas of consolidation (arrows). Biopsy revealed organizing fibrous tissue within alveoli and widespread lymphocytic infiltrates with perivascular nodules. (b) CT scan obtained after the removal of the patient, who did not undergo steroid treatment, from work exposure shows substantial decrease in parenchymal opacity, with residual ground-glass opacity.

View larger version (18K): [in a new window]   Figure 9. Scatterplot with line of best fit for percent predicted DLCO versus overall extent of disease. There is an inverse correlation between extent of disease and percent predicted DLCO.

View larger version (18K): [in a new window]   Figure 10. Scatterplot with line of best fit for percent predicted TLC versus ground-glass opacity score. There is a weak inverse correlation between TLC and ground-glass opacity score.

View larger version (21K): [in a new window]   Figure 11. Scatterplot with line of best fit for percent predicted TLC versus mean lung attenuation. There is an inverse correlation between mean lung attenuation and TLC.