Chronic Hypersensitivity Pneumonitis: CT Features—Comparison with Pathologic Evidence of Fibrosis and Survival

Purpose: To retrospectively compare in patients with chronic hypersensitivity pneumonitis (HP) the computed tomographic (CT) imaging features suggestive of fibrosis with pathologic evidence of fibrosis at surgical lung biopsy and to compare a usual interstitial pneumonia (UIP) pattern at CT with survival.

Materials and Methods: Institutional review board approval and informed consent were obtained for this study, which was HIPAA compliant. Twenty-six patients (15 women, 11 men; age range, 37–76 years) with chronic HP had their surgical lung biopsy results reviewed by two pathologists for the presence of fibrosis. Two radiologists systematically reviewed the CT scans. The two radiologists were blinded to all clinical information, including pathologic diagnosis, patient information, and outcomes. The combination of a subpleural reticular pattern and lower zone predominance was considered a UIP pattern. CT findings were compared with the histopathologic presence of fibrosis, physiologic parameters, symptoms, and survival. The χ2 or Fisher exact test (each two-tailed) was used to compare nominal and ordinal variables. A t test (with unequal variances) was used to compare continuous variables. The log-rank procedure was used to compare Kaplan-Meier survival curves.

Results: Fifteen patients had fibrotic HP at biopsy, and 11 had nonfibrotic HP. Patients with fibrotic HP had more extensive reticular pattern and were more likely to have traction bronchiectasis, honeycombing, and a UIP pattern than those with nonfibrotic HP (P = .015, P = .007, P = .007, respectively). Although the presence of histologic fibrosis was associated with decreased survival (P = .003), the CT features were not associated with decreased survival.

Conclusion: CT findings of extensive reticular pattern, traction bronchiectasis, and honeycombing are closely related to the presence of histologic fibrosis in chronic HP.

© RSNA, 2007


  • 1 Patel RA, Sellami D, Gotway MB, Golden JA, Webb WR. Hypersensitivity pneumonitis: patterns on high-resolution CT. J Comput Assist Tomogr 2000; 24: 965–970. Crossref, MedlineGoogle Scholar
  • 2 Ando M, Suga M, Kohrogi H. A new look at hypersensitivity pneumonitis. Curr Opin Pulm Med 1999;5:299–304. Crossref, MedlineGoogle Scholar
  • 3 Buschman DL, Gamsu G, Waldron JA Jr, Klein JS, King TE Jr. Chronic hypersensitivity pneumonitis: use of CT in diagnosis. AJR Am J Roentgenol 1992;159:957–960. Crossref, MedlineGoogle Scholar
  • 4 Glazer CS, Rose CS, Lynch DA. Clinical and radiologic manifestations of hypersensitivity pneumonitis. J Thorac Imaging 2002;17:261–272. Crossref, MedlineGoogle Scholar
  • 5 Hansell DM, Moskovic E. High resolution computed tomography in extrinsic allergic alveolitis. Clin Radiol 1991;43:8–12. Crossref, MedlineGoogle Scholar
  • 6 Adler BD, Padley SP, Muller NL, Remy-Jardin M, Remy J. Chronic hypersensitivity pneumonitis: high-resolution CT and radiographic features in 16 patients. Radiology 1992;185:91–95. LinkGoogle Scholar
  • 7 Hansell DM, Wells AU, Padley SP, Muller NL. Hypersensitivity pneumonitis: correlation of individual CT patterns with functional abnormalities. Radiology 1996;199:123–128. LinkGoogle Scholar
  • 8 Monkare S, Haahtela T. Farmer's lung: a 5-year follow-up of eighty-six patients. Clin Allergy 1987;17:143–151. Crossref, MedlineGoogle Scholar
  • 9 Bourke SJ, Banham SW, Carter R, Lynch P, Boyd G. Longitudinal course of extrinsic allergic alveolitis in pigeon breeders. Thorax 1989;44:415–418. Crossref, MedlineGoogle Scholar
  • 10 Lalancette M, Carrier G, Laviolette M, et al. Farmer's lung: long-term outcome and lack of predictive value of bronchoalveolar lavage fibrosing factors. Am Rev Respir Dis 1993;148:216–221. Crossref, MedlineGoogle Scholar
  • 11 Erkinjuntti-Pekkanen R, Rytkonen H, Kokkarinen JI, Tukiainen HO, Partanen K, Terho EO. Long-term risk of emphysema in patients with farmer's lung and matched control farmers. Am J Respir Crit Care Med 1998;158:662–665. Crossref, MedlineGoogle Scholar
  • 12 Emanuel DA, Wenzel FJ, Bowerman CI, Lawton BR. Farmer's lung: clinical, pathologic and immunologic study of twenty-four patients. Am J Med 1964;37:392–401. Crossref, MedlineGoogle Scholar
  • 13 Barbee RA, Callies Q, Dickie HA, Rankin J. The long-term prognosis in farmer's lung. Am Rev Respir Dis 1968;97:223–231. MedlineGoogle Scholar
  • 14 Braun SR, doPico GA, Tsiatis A, Horvath E, Dickie HA, Rankin J. Farmer's lung disease: long-term clinical and physiologic outcome. Am Rev Respir Dis 1979;119:185–191. MedlineGoogle Scholar
  • 15 Perez-Padilla R, Salas J, Chapela R, et al. Mortality in Mexican patients with chronic pigeon breeder's lung compared with those with usual interstitial pneumonia. Am Rev Respir Dis 1993;148:49–53. Crossref, MedlineGoogle Scholar
  • 16 Vourlekis JS, Schwarz MI, Cherniack RM, et al. The effect of pulmonary fibrosis on survival in patients with hypersensitivity pneumonitis. Am J Med 2004;116:662–668. Crossref, MedlineGoogle Scholar
  • 17 Zompatori M, Calabro E, Poletti V, Rabaiotti E, Piazza N, Viani S. Hypersensitivity pneumonitis: high resolution CT findings with pathological correlations—a pictorial essay. Radiol Med (Torino) 2003;106:44–50. MedlineGoogle Scholar
  • 18 Akira M, Kita N, Higashihara T, Sakatani M, Kozuka T. Summer-type hypersensitivity pneumonitis: comparison of high-resolution CT and plain radiographic findings. AJR Am J Roentgenol 1992;158:1223–1228. Crossref, MedlineGoogle Scholar
  • 19 Grenier P, Chevret S, Beigelman C, Brauner MW, Chastang C, Valeyre D. Chronic diffuse infiltrative lung disease: determination of the diagnostic value of clinical data, chest radiography, and CT and Bayesian analysis. Radiology 1994;191:383–390. LinkGoogle Scholar
  • 20 Lynch DA, Newell JD, Logan PM, King TE Jr, Muller NL. Can CT distinguish hypersensitivity pneumonitis from idiopathic pulmonary fibrosis? AJR Am J Roentgenol 1995;165:807–811. Crossref, MedlineGoogle Scholar
  • 21 Remy-Jardin M, Remy J, Wallaert B, Muller NL. Subacute and chronic bird breeder hypersensitivity pneumonitis: sequential evaluation with CT and correlation with lung function tests and bronchoalveolar lavage. Radiology 1993;189:111–118. LinkGoogle Scholar
  • 22 Johnson MS, Gonzales MN, Bizila S. Responsible conduct of radiology research. V. The Health Insurance Portability and Accountability Act and research. Radiology 2005;237:757–764. Google Scholar
  • 23 Watters LC, King TE, Schwarz MI, Waldron JA, Stanford RE, Cherniack RM. A clinical, radiographic, and physiologic scoring system for the longitudinal assessment of patients with idiopathic pulmonary fibrosis. Am Rev Respir Dis 1986;133:97–103. Crossref, MedlineGoogle Scholar
  • 24 Cherniack RM, Colby TV, Flint A, et al. Correlation of structure and function in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 1995;151:1180–1188. MedlineGoogle Scholar
  • 25 Goldman HI, Becklake MR. Respiratory function tests: normal values at medium altitudes and the prediction of normal results. Am Rev Tuberc 1959;79:457–467. MedlineGoogle Scholar
  • 26 Dubois AB, Botelho SY, Comroe JJ. A new method for measuring airway resistance in man using a body plethysmograph: values in normal subjects and in patients with respiratory disease. J Clin Invest 1956;35:327–335. Crossref, MedlineGoogle Scholar
  • 27 Blakemore WS, Forster RE, Morton JW, Ogilvie CM. A standardized breath holding technique for the clinical measurement of the diffusing capacity of the lung for carbon monoxide. J Clin Invest 1957;36:1–17. CrossrefGoogle Scholar
  • 28 Crapo RO, Morris AH. Standardized single breath normal values for carbon monoxide diffusing capacity. Am Rev Respir Dis 1981;123:185–189. MedlineGoogle Scholar
  • 29 Rossiter CE, Weil H. Ethnic differences in lung function: evidence for proportional differences. Int J Epidemiol 1974;3:55–61. Crossref, MedlineGoogle Scholar
  • 30 Riley RL, Cournand A. Ideal alveolar air and the analysis of ventilation-perfusion relationships in the lungs. J Appl Physiol 1949;1:825–847. Crossref, MedlineGoogle Scholar
  • 31 Coleman A, Colby TV. Histologic diagnosis of extrinsic allergic alveolitis. Am J Surg Pathol 1988;12:514–518. Crossref, MedlineGoogle Scholar
  • 32 Silver SF, Muller NL, Miller RR, Lefcoe MS. Hypersensitivity pneumonitis: evaluation with CT. Radiology 1989;173:441–445. LinkGoogle Scholar
  • 33 Markopoulo KD, Cool CD, Elliot TL, et al. Obliterative bronchiolitis: varying presentations and clinicopathological correlation. Eur Respir J 2002;19:20–30. Crossref, MedlineGoogle Scholar
  • 34 Perez-Padilla R, Gaxiola M, Salas J, Mejia M, Ramos C, Selman M. Bronchiolitis in chronic pigeon breeder's disease: morphologic evidence of a spectrum of small airway lesions in hypersensitivity pneumonitis induced by avian antigens. Chest 1996;110:371–377. Crossref, MedlineGoogle Scholar
  • 35 Ando M, Arima K, Yoneda R, Tamura M. Japanese summer-type hypersensitivity pneumonitis: geographic distribution, home environment, and clinical characteristics of 621 cases. Am Rev Respir Dis 1991;144:765–769. Crossref, MedlineGoogle Scholar
  • 36 Seal RM, Hapke EJ, Thomas GO, Meek JC, Hayes M. The pathology of the acute and chronic stages of farmer's lung. Thorax 1968;23:469–489. Crossref, MedlineGoogle Scholar
  • 37 Schenker MB, Christiani D, Cormier Y, et al. Respiratory health hazards in agriculture. Am J Respir Crit Care Med 1998;158(suppl):S1–S76. Crossref, MedlineGoogle Scholar
  • 38 Kokkarinen J, Tukiainen H, Terho EO. Mortality due to farmer's lung in Finland. Chest 1994;106:509–512. Crossref, MedlineGoogle Scholar

Article History

Published in print: 2007