PDF(Pubmed)
Abstract：
Usual interstitial pneumonia (UIP) refers to a combination of radiologic and histologic findings, which include patchy interstitial fibrosis with fibroblastic foci and dense acellular collagen that causes architectural distortion due to scarring and honeycomb change with alternating areas of normal lungs. The UIP pattern is not a synonymous term with idiopathic pulmonary fibrosis (IPF). IPF is diagnosed when an etiologic workup has been performed, deemed to be unrevealing, with a radiologic or histologic UIP pattern. While the 2018 American Thoracic Society (ATS)/European Respiratory Society (ERS) guideline categories of UIP help eliminate the need for surgical lung biopsy (SLB) in two categories, i.e., \"definite UIP\" and \"probable UIP,\" when characterizing a patient in the other categories, clinicians should wary about prolonging SLB in patients to determine the fibrosis pattern. Changes in the treatment and overall prognosis of patients can occur due to SLB confirming a UIP pattern on histology. Here, we report the case of a patient with an indeterminate UIP pattern on high-resolution computed tomography (HRCT) with histopathologic diagnosis of UIP on SLB. With no underlying identifiable cause for the UIP pattern, the patient was diagnosed and managed as IPF, ultimately requiring lung transplantation. This case highlights the importance of pursuing surgical lung biopsy in patients with indeterminate UIP on HRCT scanning to facilitate prompt treatment and guide further management.
摘要：
通常的间质性肺炎（UIP）是指放射学和组织学发现的组合，其中包括斑片状间质纤维化与成纤维细胞灶和致密的无细胞胶原，导致结构扭曲由于瘢痕和蜂窝改变与正常肺的交替区域。UIP模式不是特发性肺纤维化(IPF)的同义词。IPF在进行病因学检查时被诊断，被认为是不泄露的，具有放射学或组织学UIP模式。虽然2018年美国胸科学会（ATS）/欧洲呼吸学会（ERS）指南类别的UIP有助于消除两个类别的外科肺活检（SLB）的需要，即，\"确定的UIP\"和\"可能的UIP,“在描述其他类别的患者时，临床医生应警惕延长患者的SLB,以确定纤维化模式.由于SLB确认组织学上的UIP模式，可能会发生患者治疗和总体预后的变化。这里,我们报道了一例在高分辨率计算机断层扫描(HRCT)上出现不确定UIP模式并在SLB上进行组织病理学诊断的患者.由于UIP模式没有潜在的可识别原因，患者被诊断和管理为IPF，最终需要肺移植。此病例强调了在HRCT扫描中对UIP不确定的患者进行外科肺活检的重要性，以促进及时治疗并指导进一步治疗。
