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Weekly Chest CasesArchive of Old Cases

Case No : 1318 Date 2023-01-25

  • Courtesy of Sun Joosung, Seulgi You / Ajou University School of Medicine, Dept of Radiology
  • Age/Sex 30 / F
  • Chief ComplaintReferred for evaluation of ILD detected on health check-up. No particular past history and symptom
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Lymphocytic interstitial pneumonia
Radiologic Findings
Fig 1. Chest PA shows tiny nodular lesions in both lungs.
Fig 2-5. CT scans reveal multifocal peribronchiolar, centrilobular GGOs, and mild interlobular septal thickening.
Brief Review
Lymphoid interstitial pneumonia (LIP) was originally described by LIEBOW and CARRINGTON as a benign lymphoproliferative disorder limited to the lungs and LIP showed diffuse infiltration of the alveolar septa by dense collections of lymphocytes admixed with plasma cells and other cellular elements, resulting widening the alveolar septa (1). LIP has a propensity to be in the perilymphatic interstitium. LIP commonly is associated with Sjögren SD, autoimmune thyroiditis, AIDS, or Castleman disease (2). The prognosis of LIP is highly variable. Some patients may have an indolent or even an asymptomatic course while others may have complications, such as associated infections, pulmonary fibrosis. It has been considered a pre-neoplastic condition with a high likelihood of progression to lymphoma (3); however, immunohistochemical and molecular analyses indicate that malignant transformation is not common (4, 5). CT findings of LIP is characterized by the presence of GGO, poorly defined centrilobular nodules, and thickening of the interstitium along the lymphatic vessels. Combined lymph node enlargement is also common (2).
References
1. Cha SI, Fessler MB, Cool CD, Schwarz MI, Brown KK. Lymphoid interstitial pneumonia: clinical features, associations and prognosis. Eur Respir J 2006;28(2):364-369. doi: 10.1183/09031936.06.00076705
2. Johkoh T, Muller NL, Pickford HA, Hartman TE, Ichikado K, Akira M, Honda O, Nakamura H. Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients. Radiology 1999;212(2):567-572. doi: 10.1148/radiology.212.2.r99au05567
3. Koss MN. Pulmonary lymphoid disorders. Semin Diagn Pathol 1995;12(2):158-171.
4. Katzenstein AL, Myers JL. Idiopathic pulmonary fibrosis: clinical relevance of pathologic classification. Am J Respir Crit Care Med 1998;157(4 Pt 1):1301-1315. doi: 10.1164/ajrccm.157.4.9707039
5. Kradin RL, Young RH, Kradin LA, Mark EJ. Immunoblastic lymphoma arising in chronic lymphoid hyperplasia of the pulmonary interstitium. Cancer 1982;50(7):1339-1343. doi: 10.1002/1097-0142(19821001)50:7<1339::aid-cncr2820500720>3.0.co;2-d
Keywords

No. of Applicants : 98

▶ Correct Answer : 9/98,  9.2%
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - , Italy PAOLO BALDASSARI
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Ajou University Hospital , Korea (South) HYUNSEUNG LEE
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Other , Korea (South) CHAEHUN LIM
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
▶ Correct Answer as Differential Diagnosis : 14/98,  14.3%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Other , Korea (South) SEONGSU KANG
  • - The University of Tokyo Hospital , Japan WATARU GONOI
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Chonnam National University Hospital , Korea (South) SOMIN LEE
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Semi-Correct Answer : 5/98,  5.1%
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - , Japan FUMINORI MIYOSHI
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
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