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Weekly Chest CasesArchive of Old Cases

Case No : 615 Date 2009-08-09

  • Courtesy of Jin-Hwan Kim / Chungnam National University Hospital
  • Age/Sex 58 / M
  • Chief ComplaintChest discomfort for 3 months
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Desquamative interstitial pneumonia
Radiologic Findings
Chest PA shows ground-glass opacity in both mid- and lower lung zones.

HRCT showed diffuse ground glass opacity in both lung zones, predominantly involving peripheral portion of both lower lungs. The normal lung parenchymal architecture was well preserved.
Brief Review
Desquamative interstitial pneumonia (DIP) is subtype of the idiopathic interstitial pneumonia and often grouped with usual interstitial pneumonia within the spectrum of idiopathic pulmonary fibrosis. However, recent studies revealed that DIP differs from usual interstitial pneumonia in its histologic appearance, radiologic findings, and, most importantly, its natural course. Approximately 90% of patients with DIP are cigarette smokers. Most cases of DIP are currently considered to represent a reaction to cigarette smoke.
Chest radiographs are insensitive for detection of DIP and are reported to be normal in 3%?2% of biopsy-proved cases. The radiologic patterns are nonspecific and include patchy ground-glass opacities with a lower lung and peripheral predominance. The predominant abnormality at high-resolution CT in patients with DIP is ground-glass opacity, which may be peripheral, patchy, or diffuse in distribution. A peripheral subpleural and basal predominance of ground-glass opacity is most commonly seen. Honeycombing is uncommon. Coexistent emphysema may be present. At follow-up high-resolution CT of patients receiving treatment, the ground-glass opacity may show partial or complete resolution. Small cystic spaces may develop within the areas of ground-glass opacity, although progression to reticular abnormality and honeycombing is unusual. The differential diagnosis includes RB-ILD, hypersensitivity pneumonitis, NSIP, and atypical infections such as Pneumocystis carinii pneumonia.
References
1. Lee KH, Lee JS, Lynch DA, et al. The radiologic differential diagnosis of diffuse lung diseases characterized by multiple cysts or cavities. J Comput Assist Tomogr. 2002 ;26:5-12.
2. Akira M, Yamamoto S, Hara H, et al. Serial computed tomographic evaluation in desquamative interstitial pneumonia. Thorax 1997 Apr;52:333-7
3. Anil K. Attili, Ella A. Kazerooni, Barry H. Gross, et al. Smoking-related Interstitial Lung Disease: Radiologic-Clinical-Pathologic Correlation. Radiographics 2008;28:1383-1396
Please refer to
Case 4 Case 266
Keywords
Lung, Idiopathic interstitial pneumonia, DIP, smoking related, IIP,

No. of Applicants : 88

▶ Correct Answer : 15/88,  17.0%
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Osaka University , Japan Osamu Honda
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Asan Medical Center , Korea (South) Jae-Woo Song
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Samsung Medical Center , Korea (South) Hye Sun Hwang
  • - McGill University Health Center , Canada Alexandre Semionov
  • - KMC,Manipal , India satish maddukuri
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - CH Sud Rnion , Reunion jean-baptiste Noel
  • - Hopital universitaire Lausanne , Switzerland abed kourhani
  • - Asan Medical Center , Korea (South) Seong Yun Kim
  • - Hopital du SacrCoeur , Canada Abraham Bohadana
  • - chp st martin , France Mariotte benoit
▶ Correct Answer as Differential Diagnosis : 25/88,  28.4%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - hospital Sao Paulo , Brazil israel missrie
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Clinica Las Condes , Chile David LadronDeGuevara
  • - Samsung Medical Center , Korea (South) Ju Won Lee
  • - Hospital of Inha university , Korea (South) Bongwan Noh
  • - clinique de rochefort , France viviane pages
  • - Toyama University Hospital, Laboratory of Pathology , Japan TANAKA TOMONORI
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Assam medical college , India Karunakaran M
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Hanmaeum Hospital , Korea (South) Kwon Hyoung Kim
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - CHUM, Hital du SacrCoeur, Montrl , Canada Andrea Ojanguren
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - IRCCS Istituto Oncologico Bari , Italy Carlo Florio
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Hospital M de Deus , Brazil Thiago Bento da Silva
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - CHU caen , France nicolas gautier
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
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