Michael E. Halkos, MD, Anthony A. Gal, MD, Faraz Kerendi, MD, Daniel L

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Role of Thoracic Surgeons in the Diagnosis of Idiopathic Interstitial Lung Disease Michael E. Halkos, MD, Anthony A. Gal, MD, Faraz Kerendi, MD, Daniel L. Miller, MD, Joseph I. Miller, MD The Annals of Thoracic Surgery Volume 79, Issue 6, Pages 2172-2179 (June 2005) DOI: 10.1016/j.athoracsur.2004.06.103 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Diffuse parenchymal lung disease (DPLD) represents a spectrum of disorders including those associated with known and unknown etiology. The latter includes the idiopathic interstitial pneumonias (IIP), granulomatous disorders, and rare diffuse parenchymal diseases such as lymphangioleiomyomatosis (LAM), Langerhans’ cell histiocytosis, and eosinophilic pneumonia. The IIPs can be divided into the more common idiopathic pulmonary fibrosis (IPF) and the non-IPF interstitial pneumonias. (UIP = usual interstitial pneumonia.) (Adapted from Travis WD, et al, Am J Respir Crit Care Med; 2002;165;277–304 [2], with permission.) The Annals of Thoracic Surgery 2005 79, 2172-2179DOI: (10.1016/j.athoracsur.2004.06.103) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 With idiopathic pulmonary fibrosis, high-resolution computed tomography shows bibasilar and peripheral predominant reticular abnormalities, with traction bronchiectasis and honeycombing associated with more advanced fibrosis. The Annals of Thoracic Surgery 2005 79, 2172-2179DOI: (10.1016/j.athoracsur.2004.06.103) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) The typical histologic pattern of usual interstitial pneumonia/idiopathic pulmonary fibrosis is one of fibrosis with honeycombing, architectural distortion, and patchy peripheral distribution (5× magnification). (B) Key features of usual interstitial pneumonia (UIP) include the presence of fibroblastic foci (arrow) which represent areas of active inflammation adjacent to areas of established fibrosis characterized by acellular dense collagen accumulation. This pattern of temporal heterogeneity distinguishes UIP from the other idiopathic interstitial pneumonias (25× magnification). The Annals of Thoracic Surgery 2005 79, 2172-2179DOI: (10.1016/j.athoracsur.2004.06.103) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Nonspecific interstitial pneumonia can be distinguished by a temporally uniform organized pattern of fibrosis, with minimal honeycombing and absent fibroblastic foci (5× magnification). The Annals of Thoracic Surgery 2005 79, 2172-2179DOI: (10.1016/j.athoracsur.2004.06.103) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions