HRCT and alveoloscopic assessment of diffuse lung disease

A modern approach to the diagnosis of diffuse pulmonary diseases (DPDs) is based on a multidisciplinary discussion (MDD) among clinicians, pathologists, and radiologists. Many rare pulmonary diseases have very clear and specific HRCT signs, and there is often no need for invasive diagnostic approaches to obtain histological material. For example, in cases of idiopathic pulmonary fibrosis, lymphangioleiomyomatosis, alveolar microlithiasis, and alveolar proteinosis as well as others, chest HRCT can be a definitive diagnostic method; in other cases, it can narrow the range of possible diagnoses so that additional laboratory tests or patient history can conclude the diagnostic quest satisfactorily. Thus knowledge of the basic interpretation of HRCT signs of DPDs is a prerequisite for the professional competence of a chest physician. In this chapter, we will overview the main HRCT signs of DPDs, which will be discussed in more detail in subsequent chapters that describe the radiological picture of individual DPDs. In addition, we provide basic information on probe-based confocal laser endomicroscopy (pCLE) of the lower respiratory tract, a relatively new method, which, similar to HRCT, is aimed at structural assessment of the lung tissue; however, unlike HRCT, pCLE does not utilize X-ray radiation but analyzes reflected laser beam from intraacinar structures and inclusions that have taking autofluorescence properties. In this monograph, we also present our own data and conclusions regarding the prospects for the use of this technology based on our accumulating experience in pCLE for patients with DPDs.