Y. Cormier et al., High-resolution computed tomographic characteristics in acute farmer's lung and in its follow-up, EUR RESP J, 16(1), 2000, pp. 56-60
High resolution computed tomography (HRCT) scans are increasingly used in h
ypersensitivity pneumonitis (HP), This study looked at HRCT findings at dif
ferent phases of farmer's lung (FL), a common form of HP,
A cross sectional analysis of 95 HRCT scans of FL cases (20 acute, 75 with
a history of FL, 48 still in contact (Ex +) (dairy farm), and 27 who had ce
ased contact (Ex-)) was made, All scans were read independently by two, and
if needed by three, radiologists blinded to the category. The lungs were d
ivided into six regions (fives lobes + lingula), and read for attenuation/m
osaic, ground-glass, micronodules, fibrosis, and emphysema, A score of 0-3
was given for each region and each variable: 0 = absence, 1 =<5% of the sur
face, 2 = 25-50%, 3 =>50%, Mediastinal lymphadenopathy was also noted.
Ground glass, predominating in the lower lobes, was the most frequent featu
re in the acute and Ex+ cases. Other abnormalities had no preferential dist
ribution. Ex+ had more ground-glass than the Ex- (p=0.0025), Emphysema was
more frequently seen than interstitial fibrosis (p=0.004), Mediastinal lymp
hadenopathy was present in 26 cases (9 acute, 10 Ex+ and 7 Ex-).
In conclusion, in farmer's lung: 1) ground-glass predominates in the lower
lobes while the other abnormalities have no anatomic predilection; 2) conta
ct avoidance allows a better resolution of computed tomography abnormalitie
s than continued exposure; 3) emphysema is a more frequent finding than int
erstitial fibrosis; and 4) the presence of mediastinal lymphadenopathy has
no negative diagnostic value.