Imaging

Rheumatologic ILD

Preliminary Diagnosis: Rheumatologic ILD

I. What imaging technique is first-line for this diagnosis?

Chest x-ray, PA, and lateral.

II. Describe the advantages and disadvantages of this technique for diagnosing rheumatologic ILD.

Advantages

  • Relatively inexpensive and faster imaging modality compared to cross sectional imaging.

  • Exposes patients to minimal ionizing radiation.

  • Highly portable.

Disadvantages

  • Less sensitive and specific in detailing any primary parenchymal/pleural process or secondary complications.

  • Less adept in detecting subtle pleural effusions and pulmonary nodules often seen in patients with rheumatologic ILD.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant patients.

IV. What alternative imaging techniques are available?

High resolution CT of the chest without contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing rheumatologic ILD.

Advantages

  • CT/high resolution CT of the chest is the gold standard imaging modality for evaluating for rheumatologic ILD.

  • Highly sensitive and specific in detecting and characterizing an underlying primary pulmonary process or detailing any secondary complications.

Disadvantages

  • Exposes patients to ionizing radiation.

  • More expensive and less portable than plain radiography.

VI. What are the contraindications for the alternative imaging techniques?

May be contraindicated in pregnant patients.

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