대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1247 Date 2021-09-13

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  • Courtesy of Min Jae Cha / Chung-Ang University Seoul hospital
  • Age/Sex 68 / M
  • Chief Complaintcough, sputum, and dyspnea for one month
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

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%
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

No. of Applicants : 92

▶ Correct Answer : 43/92,  46.7%
  • - , Japan HIROAKI ARAKAWA
  • - Korea University Guro Hospital , Korea (South) SEOKYOUNG LEE
  • - , Japan JUN KANZAWA
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Other , Korea (South) HYEJIN YANG
  • - NIMS, HYDERABAD , India BHASKAR K
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - , Canada CARL CHARTRAND-LEFEBVRE
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - The Jikei university , Japan TAKU GOMI
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Osaka University , Japan AKINORI HATA
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) HYEWON CHOI
  • - Seoul National University Bundang Hospital , Korea (South) SUNG HYUN YOON
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Gifu University Hospital , Japan Yo Kaneko
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Other , Korea (South) MINSU KIM
  • - Seoul Veterans Hospital , Korea (South) SEONG WON JANG
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Holy Family Hopsital , India RAJESH GOTHI
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUKI HAYASHI
  • - , Korea (South) WONJU HONG
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 10/92,  10.9%
  • - Other , Korea (South) MINGI SHIN
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Other , Korea (South) SEONGSU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - , Japan KANAE TAKAHASHI
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
  • - National Center for Global Health and Medicine , Japan TOMOKI IMOKAWA
  • - iran university , Iran MOHAMAD REZA AYOUBPOUR
▶ Semi-Correct Answer : 3/92,  3.3%
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - Samsung Medical Center , Korea (South) SUHO KIM
  • - , China YU YAO
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