Demonstration of Honeycomb Lung by Liquid-Filled Alveolography (LFA) in Cases of Cryptogenic Fibrosing Alveolitis

Abstract

Liquid-filled alveolography (LFA) was reported as a routine technique by Hideo Sawada et al. in 1969. This method was designed to investigate the structural changes of the peripheral bronchi, bronchioles and alveoli in cases of diffuse pulmonary diseases by infusing low viscosity contrast medium (60% Urografin) into the subpleural portion of the lung via a flexible bronchocatheter, the FBC-5 (Machida K.K.).
For the last three years we have performed LFA in 29 patients with cryptogenic fibrosing alveolitis. LFA revealed a high frequency of poor alveolar filling (28/29) simultaneously with numerous small cysts (18/29) in the subpleural portion of the lung, especially adjacent to the costophrenic angle. A combination of these findings suggests “honeycomb lung”, which is the only dependable roentgenological sign of “interstitial fibrosis”. Since biopsy techniques including TBLB are not necessarily successful in cryptogenic fibrosing alveolitis, LFA may be very helpful to establish a definitive diagnosis in such cases.