Discussion
Diagnosis With Brief Discussion
- Diagnosis
- desquamative interstitial pneumonia
- Radiologic Findings
- Fig. 1. Chest radiograph showing patchy increased opacity in both lower lung zones.
Fig. 2-5. Chest computed tomography scans showing bilateral areas of ground-glass opacity with peripheral basal predominance. Traction bronchiectasis and small cystic lesions are seen within the ground-glass opacity area.
- Brief Review
- The patient was a smoker with a smoking history of 60 pack-years. Surgical lung biopsy was performed in the left upper lobe and left lower lobe. The biopsied lung showed diffuse intra-alveolar macrophage accumulation and mild interstitial thickening. The architecture of the lung was relatively well preserved. The histopathologic findings suggested desquamative interstitial pneumonia (DIP).
DIP is an uncommon form of idiopathic interstitial pneumonia that primarily affects cigarette smokers in their fourth or fifth decade. Approximately 90% of patients with DIP are smokers. DIP can occasionally be seen in nonsmokers in association with systemic disorders, infections, and exposure to occupational or environmental agents or drugs. DIP is characterized by the accumulation of numerous pigmented macrophages within most of the distal airspaces of the lung and, occasionally, the presence of giant cells.
Chest radiography has a low sensitivity in the detection of DIP and is reported to yield normal findings in 3%–22% of biopsy-proven cases. The radiologic patterns are nonspecific and include patchy ground-glass opacities with a lower lung and peripheral predominance.
The common computed tomographic findings of DIP include bilateral areas of ground-glass opacity with peripheral basal predominance, which may reflect the filling of alveolar airspaces by macrophages. Irregular and linear opacities and reticular patterns are frequently observed in the base of the lung (59%); however, honeycombing is uncommon. Coexistent emphysema may be present. Traction bronchiectasis and small cystic spaces may develop within the areas of ground-glass opacity, which may suggest dilated bronchioles and alveolar ducts.
- Please refer to
Case 4, Case 266, Case 615, Case 620, Case 840, Case 1127, Case 1149, Case 1157, Case 1214, -
- References
- 1. Godbert B., Wissler M. P., Vignaud J. M. Desquamative interstitial pneumonia: an analytic review with an emphasis on aetiology, European Respiratory Review. 2013 22(128),117-23.
2. Attili, A. K., Kazerooni, E. A., Gross, B. H., Flaherty, K. R., Myers, J. L., Martinez, F. J. Smoking-related interstitial lung disease: radiologic-clinical-pathologic correlation. Radiographics. 2008 28(5), 1383-1396.
3. Iwasawa, T., Takemura, T., Ogura, T. Smoking-related lung abnormalities on computed tomography images: comparison with pathological findings. Japanese Journal of Radiology. 2018 36(3), 165-180.
- Keywords