7
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
7-11
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
ABSTRACT
The retrospective analysis of case histories of 82 patients with nonspecific interstitial pneumonia, treated as inpatients
at the Pulmonology Department of Samarkand City Medical Association during the period from 2010 to 2020 has been
carried out. All patients were examined by means of X-ray and computed tomography with high resolution. In the
cellular subtype predominance of "frosted glass" and absence of "honeycomb lung" and in fibrous or mixed subtype
all four main X-ray syndromes as well as the sign of "honeycomb lung" were noted to a different extent [1]
KEYWORDS
Nonspecific interstitial pneumonia, diagnosis, radiological characteristics, computed tomography, signs.
INTRODUCTION
Currently, about two hundred diseases with signs of
interstitial lung disease have been identified, which is
about 20% of all lung diseases, with half of them being
of unclear nature [9]. Diagnostic errors in these
patients have been found to be 75-80%, and the
necessary specialist care is usually provided 1.5-2 years
after the first signs of the disease, with a direct impact
on
the
effectiveness
of
treatment
[2].
Research Article
RADIOLOGICAL SIGNS NON-SPECIFIC INTERSTITIAL PNEUMONIA
Submission Date:
February 10, 2022,
Accepted Date:
February 20, 2022,
Published Date:
February 28, 2022 |
Crossref doi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue02-03
Makhmatmuradova Nargiza Negmatullaevna
Department of Internal Medicine No.4 Samarkand State Medical Institute, Uzbekistan
Journal
Website:
https://theamericanjou
rnals.com/index.php/ta
jmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
8
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
7-11
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
Misinterpretation
of the diagnosis leads to
inappropriate treatment, with the use of powerful
drugs: glucocorticoids, cytostatics, antibiotics. The
absence of an immediate therapeutic effect 1-2 weeks
after the start of wrongly prescribed treatment can be
regarded as a manifestation of insufficient intensity of
therapy and lead to an increase in the doses of wrongly
prescribed drugs. This results in the development of
'second' - iatrogenic diseases, which significantly alter
the clinical picture of the disease, complicating the
diagnostic search and often worsening the prognosis
[6].
Mortality rate in interstitial diseases is much higher
than in most other lung diseases. Factors of high
mortality rate are determined by low awareness of
physicians, insufficient technical equipment of medical
centres, difficulties of differential diagnostics due to
the absence of pathognomonic signs, fatal character of
some pathologies [4,5]. All this determines the need to
optimise diagnostic work-up in interstitial lung disease,
especially in patients with nonspecific interstitial
pneumonia [3,7].
Modern diagnostic medicine cannot be imagined
without the use of high-resolution computed
tomography technologies. In particular, multislice
("multispiral", "multislice" computed tomography -
MSCT) was first introduced by Elscint Co. in 1992. The
fundamental difference between MSCTs and spiral CT
scanners of previous generations is that there are not
one but two or more rows of detectors on the gantry
circumference. In order to allow X-rays to be
simultaneously received by detectors located on
different rows, a new - volumetric geometric beam
shape was developed. In 1992, the first twin-slice
(double-helix) MSCT tomographs with two rows of
detectors were introduced, and in 1998, four-slice
(quadruple-helix) tomographs with four rows of
detectors,
respectively.
In
addition
to
the
aforementioned features, the number of X-ray tube
rotations was increased from one to two per second.
Thus,
fifth-generation
quadruple
spiral
MSCT
tomography scanners are now eight times faster than
conventional fourth-generation spiral CT scanners. In
2004-2005, 32-, 64- and 128-slice MSCTs, including
those with two X-ray tubes, were introduced. Today,
some hospitals already have 320-slice CT scanners. First
introduced in 2007 by Toshiba, these CT scanners are a
new round in the evolution of X-ray computed
tomography. Not only can they produce images, but
they can also observe physiological processes such as
those occurring in the brain and heart in almost "real"
time. The distinctive feature of this system is that an
entire organ (heart, joints, brain, etc.) can be scanned
in one revolution of the radiation tube, which
significantly reduces the time of the examination, and
it is also possible to scan the heart even in patients with
arrhythmia [8].
PURPOSE OF THE STUDY
To study radiological changes in non-specific interstitial
pneumonia
MATERIAL AND METHODS OF INVESTIGATION
As a material we carried out a retrospective analysis of
case histories of 200 patients with nonspecific
interstitial pneumonia (NIP), who were hospitalized at
the Pulmonology Department of Samarkand City
Medical Association in 2010-2020. All patients
underwent general clinical examination standards
according to ICD-10, and all had high-resolution X-rays
and CT scans.
RESULTS AND DISCUSSION
9
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
7-11
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
The results obtained show that in about 26 patients X-
ray examination revealed lung roots aggravation on
both sides, heaviness, decreased transparency of local
character. In 30 patients, together with strengthening
of roots, decreased transparency of both lungs was
revealed as bilateral pneumonia. In 27 patients general
radiological signs characteristic of chronic obstructive
bronchitis were revealed. High resolution CT scanning
was carried out in all patients for differential
diagnostics. Typical signs of nonspecific interstitial
pneumonia were revealed, including decreased
transparency of lung tissue as "frosted glass",
tractional bronchiectasis and bronchioloectasis,
thickening of interlobular septa, reduced volume of
lower lobes (Fig. 1).
It is generally believed that the "frosted glass"
symptom dominates all other signs in this pathology.
However, W.D.Travis et al[10] examined a large div
of material and found this phenomenon in only 44% of
patients with NIP, whereas bronchiectasis was found in
82%, reticular pattern in 96%, and shrinkage of the
lower lobes in 77% of cases. Cellular lung areas are
generally atypical for this pathology. According to
various researchers, they occur in 5-30% of patients,
with prevalence not exceeding 10% of the total lung
surface.
Figure1. Overview radiograph of the lungs in nonspecific interstitial pneumonia
The radiological picture generally reflects the
morphological pattern of non-specific interstitial
pneumonia. The inflammatory (cellular) subtype is
characterised by a predominance of 'frosted glass' and
the absence of a 'honeycomb lung' (Fig. 2). Fibrotic and
mixed subtypes have a more varied symptomatology,
with all four major radiological syndromes presenting
simultaneously in varying degrees of severity, as well
as (often, but not always) a 'honeycomb' lung.
10
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
7-11
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
Figure2. CT scan of the lungs. MRI slice - subpleural consolidations are visible, 'frosted glass' fields and
reticular patterns are identified.
It should be noted that possible findings in patients
with NIP are consolidation foci. This symptom may
reflect the concomitant presence of organising
pneumonia, with which NIP was crossed in 50% of
patients in one study. It has been established that the
course of the pathology can be accompanied by
periods of increasing clinical symptoms, usually
accepted as an exacerbation of NIP. The exact causes
of exacerbation of NIP have not been conclusively
established, but infectious factors or sudden
destabilizing events, such as pulmonary embolism,
pneumothorax, acute heart failure, etc., are
considered most likely. Inadequate therapy or
withdrawal of baseline treatment can also lead to
exacerbation of NIP. On a CT scan during this period,
"frosted glass" areas are enlarged and new areas of
consolidation appear.
The observed mediastinal lymph node enlargement is
quite typical in this, although this symptom is also
found in other interstitial pneumonias. According to
C.A. Souza et al [10], among 206 patients with
interstitial pneumonia, intrathoracic lymphadenopathy
occurred in 81% of patients with NIP, in 71% of patients
with respiratory bronchiolitis associated with
interstitial lung disease, and in 66% of cases with
pulmonary fibrosis.
Another rather typical symptom of NIP was the
presence of symmetrical thin subpleural bands of
preserved lung tissue (subpleural sparing), followed by
reticular and inflammatory changes.
CONCLUSIONS
Thus, the conducted X-ray investigations with CTWR
technologies testify to the fact that in patients with
nonspecific interstitial pneumonia the prevalence of
11
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
7-11
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
"frosted glass" and absence of "honeycomb lung" is
typical for cellular subtype, and in fibrous or mixed
subtype all four main X-ray syndromes are
simultaneously expressed in different degree, as well
as (often, but not always) "honeycomb lung". The
presence of symmetrical thin subpleural strips of
preserved lung tissue followed by reticular and
inflammatory changes is also characteristic.
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