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Weekly Chest CasesArchive of Old Cases

Case No : 729 Date 2011-10-18

  • Courtesy of Young-Hoon Cho, MD, Eun-Young Kim, MD, Mi-Young Kim, MD / University of Ulsan College of Medicine, Asan Medical Center
  • Age/Sex 63 / F
  • Chief Complaintchronic cough for 5 month
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Lymphocytic Interstitial Pneumonia
Radiologic Findings
HRCT images shows (Figure 1-3) show diffuse reticulation, diffuse GGO, and traction bronchiectasis with both lower lobe dominancy. Chest radiograph (Figure 4) shows both lower lung dominant reticular opacity and diffuse ground-glass opacity (GGO). We can see a 5.5cm sized bulla in retrocardiac area of the left lower lobe.
Brief Review
The lymphocytic interstitial pneumonia (LIP) is a rare disease characterized by diffuse infiltration of lymphocytes and plasma cells within the lung parenchyma. It is usually associated with various conditions, including HIV or EBV infection, Sj�ren's syndrome, pernicious anemia, and autoimmune hemolytic anemia. Especially, 25% of all LIP cares are associated with Sj�ren's disease.
Reflecting diffuse infiltration of lymphocytes and plasma cells, HRCT usually reveals thickening of perilymphatic interstitium, ground-glass opacity, and poorly defined centrilobular nodules. Furthermore, multiple variable sized thin-walled cystic airspaces are common finding, and should be good differential point from other idiopathic interstitial pneumonias. Other findings include lymphnode enlargement (in about 50% of cases) and bronchiectasis.
Definite diagnosis can be made with lung biopsy. Although there is no standard treatment for LIP, steroid therapy is commonly used and other immunosuppressive drugs may be combined.
Prognosis is variable, and can be grave. Therefore, keen radiologic suspicion and early diagnosis is crucial.
References
1. T Johkoh, N Muller, H Pickford, et al. Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients. Radiology 1999;212:567
Keywords
lung, lymphoproliferative disease, Interstitial lung disease, ILD,

No. of Applicants : 90

▶ Correct Answer : 17/90,  18.9%
  • - UWO , Canada S Lee
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - SMC , Korea (South) Yi Kyung Kim
  • - Asan medical center , Korea (South) Cherry Kim
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Kashgar, East Turkistan , China Mahmud Uyghur
  • - Az Osp Santa Maria Terni , Italy angelo carloni
  • - CHRU lille , France manuel toledano
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - Japanese Red Cross Society Himeji Hospital , Japan Yuichiro Kanie
  • - marmara universitesi , Turkey ozlem elibol
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - university of Iowa , United States leandro leite
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - All India Institute of medical sciences , India Justin Moses
▶ Correct Answer as Differential Diagnosis : 18/90,  20.0%
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - Radiologie Brabois adultes , France ROPION helene
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - National Cancer Center , Japan rintaro hashimoto
  • - University of British Columbia , Canada Amr Ajlan
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - McGill , Canada ilan azuelos
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Jaseng Oriental Hospital , Korea (South) Byung-June Jo
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
▶ Semi-Correct Answer : 1/90,  1.1%
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
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