Patient Data
Age: Adult
Gender: Female
From the case:
Fibrotic hypersensitivity pneumonitis
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Fibrotic hypersensitivity pneumonitis pattern.
Case Discussion
Classic three density pattern (aka head cheese sign). Highly suggestive of fibrotic hypersensitivity pneumonitis in the presence of superimposed reticulation or other signs of pulmonary fibrosis. The three density pattern is characterized by three different levels of opacity on CT in the lungs marinated by edges of secondary pulmonary lobules: the low density areas are areas of air-trapping, the high density are areas of pulmonary infiltration, and the middle density areas are normal or near-normal lung.
Using ACCP guidelines, this is enough to label it a typical HP pattern on CT, regardless of distribution. Using ATS guidelines, you need to see a typical distribution for HP.
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