Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Diagnosis of Hypersensitivity Pneumonitis: 2020 Clinical Practice Guideline

2020년 개정 진료 치침에 따른 과민성폐렴의 진단

  • Soojung Park (Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University) ;
  • Yu-Whan Oh (Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University) ;
  • Eun-Young Kang (Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University) ;
  • Hwan Seok Yong (Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University) ;
  • Cherry Kim (Department of Radiology, Korea University Ansan Hospital, College of Medicine, Korea University) ;
  • Ki Yeol Lee (Department of Radiology, Korea University Ansan Hospital, College of Medicine, Korea University) ;
  • Sung Ho Hwang (Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University)
  • 박수정 (고려대학교 의과대학 안암병원 영상의학과) ;
  • 오유환 (고려대학교 의과대학 안암병원 영상의학과) ;
  • 강은영 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 용환석 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 김채리 (고려대학교 의과대학 안산병원 영상의학과) ;
  • 이기열 (고려대학교 의과대학 안산병원 영상의학과) ;
  • 황성호 (고려대학교 의과대학 안암병원 영상의학과)
  • Received : 2021.04.30
  • Accepted : 2021.06.29
  • Published : 2021.07.01
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Abstract

Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) characterized by an inhaled inciting antigen that leads to the inflammation of the lung parenchyma and small airway with immunologic reactions. Over the last decades, the most effective therapeutic option for HP has been limited to antigen avoidance. The differential diagnosis of HP from other ILDs is the beginning of treatment as well as diagnosis. However, the presence of several overlapping clinical and radiologic features makes differentiating HP from other ILDs particularly challenging. In 2020, a multidisciplinary committee of experts from the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax suggested a new clinical practice guideline classifying HP into nonfibrotic and fibrotic phenotypes on the basis of chest high-resolution CT (HRCT) findings. Therefore, we introduced a new diagnostic algorithm based on chest HRCT in the clinical practice guideline for the diagnosis of HP.

과민성폐렴(hypersensitivity pneumonitis)은 기도를 통해 흡입된 항원물질이 세기관지와 폐포에 면역매개 염증병변을 일으켜 발생하는 간질성폐질환(interstitial lung disease)이다. 다양한 유기물질이 발생원인으로 작용할 수 있기에 환자의 흉부영상검사와 임상증상을 통해 과민성폐렴을 의심하고 직업 또는 주변 환경을 통해 노출되는 항원을 파악하는 것이 과민성폐렴 진단의 핵심이다. 하지만 다양한 임상증상과 진행 형태로 인해 간질성폐질환 환자의 진단에서 과민성폐렴을 정확히 감별할 수 있느냐는 풀기 쉽지 않은 주제이다. 이에 2020년 미국흉부학회, 일본호흡기학회 그리고 라틴아메리카흉부학회는 과민성폐렴 진단에 대한 새로운 임상진료지침을 발표하였다. 이번 임상진료지침은 과민성폐렴 진단에 있어서 흉부 고해상도 전산화단층촬영(high-resolution CT; 이하 HRCT)의 역할을 강조하며 과민성폐렴에 대한 새로운 분류 기준도 제시하고 있다. 본 종설은 흉부 HRCT 내용을 포함해 새롭게 소개된 과민성폐렴 진단에 대한 전반을 살펴보고자 한다.

Keywords

Acknowledgement

This research was technically supported by the Korea University Anam Imaging Data Bank.

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