Chronic hypersensitivity pneumonitis (CHP) refers to hypersensitivity pneumonitis where there is radiological evidence of fibrosis and represents the end-stage of repeated or persistent pneumonitis 7.
High-resolution CT of the chest typically reveals indistinct centrilobular peribronchiolar nodular opacities - micronodules) of varying numbers 5. Other features include:
- ground-glass opacities
- lobular areas of hyperlucency (mosaic perfusion) caused by bronchiole obstruction
- areas of pulmonary fibrosis and honeycombing
There is often a middle or upper zone predominance of CT findings with sparing of the lung bases, unlike non-specific interstitial pneumonia (NSIP) or usual interstitial pneumonia (UIP), which show a lower zone predominance.
The presence of an extensive reticular pattern, traction bronchiectasis, and honeycombing have been shown to closely correlate with the presence of histologic fibrosis in chronic hypersensitivity pneumonitis 6.
Treatment and prognosis
The presence of fibrotic changes confers a poor prognosis.
In some cases, it may be difficult to differentiate from idiopathic pulmonary fibrosis - UIP cases are also thought to have honeycombing and peripheral or lower lung zone predominance of disease, and less likely to have micronodules 4.
Sometimes some forms of advanced-stage sarcoidosis may carry some imaging overlap 8.
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- 6. Sahin H, Brown KK, Curran-everett D et-al. Chronic hypersensitivity pneumonitis: CT features comparison with pathologic evidence of fibrosis and survival. Radiology. 2007;244 (2): 591-8. doi:10.1148/radiol.2442060640 - Pubmed citation
- 7. From the European respiratory monograph http://erm.ersjournals.com/content/ermpl/1/SEC12.body
- 8. Jeong YJ, Lee KS, Chung MP, Han J, Johkoh T, Ichikado K. Chronic hypersensitivity pneumonitis and pulmonary sarcoidosis: differentiation from usual interstitial pneumonia using high-resolution computed tomography. Seminars in ultrasound, CT, and MR. 35 (1): 47-58. doi:10.1053/j.sult.2013.10.006 - Pubmed