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Weekly Chest CasesArchive of Old Cases

Case No : 1214 Date 2021-01-26

  • Courtesy of Wonju Hong, Jongsoo Park, Jong Hyuk Lee, Eui Jin Hwang / Seoul National University Hospital
  • Age/Sex 63 / M
  • Chief ComplaintDyspnea, 1YA
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Desquamative interstitial pneumonia
Radiologic Findings
Fig 1. Chest radiograph shows diffuse increased opacities of both lungs, mainly involving bilateral lower and peripheral lungs.
Figs 2-4 Chest CT shows diffuse, relatively symmetric ground-glass opacities with internal cysts at both lungs. The ground glass opacities predominantly involves bilateral basal and subpleural lungs. Unlike emphysematous bullae, the cysts are exclusively located in the area of ground-glass opacities.
Brief Review
The patient was a heavy-smoker with 40 pack-year smoking history. Surgical lung biopsy was performed at the right upper lobe and right lower lobe. The biopsied lung revealed marked alveolar macrophage accumulation with interstitial fibrosis, suggesting desquamative interstitial pneumonia.

Desquamative interstitial pneumonia (DIP) is an uncommon form of idiopathic interstitial pneumonia that primarily affects cigarette smokers in their 4th or 5th decades. Approximately 90% of patients with DIP are smokers. It 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 airspace of the lung and, sometimes, the presence of giant cells.
Chest radiographs are insensitive for detection of DIP and are reported to be normal 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.
Common CT findings of DIP are characterized as 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 frequent usually in the base of the lung (59%), but 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,
KSTR Imaging Conference 2011 Spring  Case 6 ,
KSTR Imaging conference 2010 Summer  Case 19 ,
KSTR Imaging Conference 2004 Spring  Case 8,
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
idiopathic interstitial lung disease,

No. of Applicants : 99

▶ Correct Answer : 59/99,  59.6%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Other , Korea (South) HYEJIN YANG
  • - , Korea (South) HYEYOUNG CHOI
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Korea (South) SUYON CHANG
  • - Chonnam National University Hospital , Korea (South) MOON GYEONG IL
  • - , Chile DANIEL OCTAVIO CAMPOS
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Inje University Pusan Paik Hospital , Korea (South) DA SOM KIM
  • - , Greece EVANGELIA KOUKAKI
  • - , Korea (South) JIN YOUNG LEE
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - , Korea (South) HYEWON CHOI
  • - Seoul National University Bundang Hospital , Korea (South) SUNG HYUN YOON
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - , Korea (South) PARK JONGMIN
  • - Kyeongpook National University Hospital , Korea (South) HYEONJUN JANG
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan KANAE TAKAHASHI
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - , Korea (South) EUNJIN LEE
  • - Soonchunhyang University Hospital Bucheon , Korea (South) SEONGHWAN BYUN
  • - , United States HIROAKI TAKAHASHI
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Other , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - , Japan HIROAKI ARAKAWA
  • - Kyeongpook National University Hospital , Korea (South) PARK BYUNG GEON
  • - TB centre kasaragod. , India rikhy krishnan
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kitano Hospital , Japan SATOSHI IKEDA
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - Tokyo Metropolitan Bokutoh Hospital , Japan TOMOKI WADA
  • - Private sector , Greece VASILIOS TZILAS
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - , Korea (South) WONJU HONG
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 11/99,  11.1%
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - NIMS, HYDERABAD , India BHASKAR K
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - Other , Korea (South) SEONGSU KANG
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - GEMS, Srikakulam, Andhra Pradesh , India RAMU C
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - , Japan TOMOKI IMOKAWA
▶ Semi-Correct Answer : 1/99,  1.0%
  • - The University of Tokyo Hospital , Japan MOTO NAKAYA
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