부산대학교 도서관

Despite a growing literature, hypersensitivity pneumonitis continues to resist our best attempts to develop an accurate, reproducible case definition for this disease. Making a diagnosis of hypersensitivity pneumonitis is challenging because it is often shadowed by marginal exposure histories, borderline antigen positivity or discordant imaging patterns and treatment decisions are often based on diagnostic probability rather than certainty. As in idiopathic pulmonary fibrosis, chest high-resolution computed tomography (HRCT), plays a central role in the initial evaluation of hypersensitivity pneumonitis and involves the identification of specific CT patterns. For many years, the presence of mosaic attenuation on CT has been widely accepted as a cardinal imaging feature of hypersensitivity pneumonitis. The presence of mosaic attenuation is an often hotly debated observation in patients with fibrotic lung disease. Recent data reinforce the importance of making distinctions between different types of mosaic attenuation and provide radiologists with a specific imaging target to aim for, namely, the headcheese sign. The Fleischner Glossary of Terms for Thoracic Imaging provides radiologists with a toolbox for conveying interpretation and formulating a diagnosis. Currently there are no approved therapies for hypersensitivity pneumonitis. Management involves identifying and eradicating the antigen from the patient’s environment. Corticosteroids may be administered for acute symptomatic relief and in those patients with subacute progressive and chronic disease. While the management of acute hypersensitivity pneumonitis may be straightforward, chronic hypersensitivity pneumonitis does not always respond to corticosteroid treatment. Recent data indicate that anti-fibrotic therapy may be of benefit in patients affected by chronic hypersensitivity pneumonitis with a progressive disease course.