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Weekly Chest CasesArchive of Old Cases

Case No : 1127 Date 2019-06-03

  • Courtesy of Chan Ho Park, Sung Shick Jou, Young Tong Kim / Soonchunhyang University Cheonan Hospital
  • Age/Sex 39 / M
  • Chief ComplaintAggravation of cough, sputum / Past Hx. : Ex-smoker (quit 6years ago, 15PY)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Desqumative interstitial pneumonia
Radiologic Findings
Fig 1. Chest PA shows bilateral reticular opacities and suspicious ground-glass opacity in both lower lung fields.
Fig 2-6. CT scans shows bilateral ground glass attenuation in peripheral lower lobe dominant distribution. Diffuse paraseptal emphysema in both lungs.

VATS biopsy specimen of the patient shows accumulation of intra-alveolar macrophages within the alveolar air spaces with mild interstitial inflammation, suggestive of DIP.
Brief Review
DIP is an uncommon form of interstitial pneumonia that occurs frequently in patients between 30 and 50 years of age. Approximately 90% of patients with DIP are cigarette smokers. Most cases of DIP are currently considered to represent a reaction to cigarette smoke. The DIP is characterized histologically by the presence of numerous macrophages within alveolar airspaces. Unlike usual interstitial pneumonia, DIP involvement is typically more or less uniform in severity within affected lobules. Interstitial inflammation and fibrosis are usually mild but may be moderate or rarely severe. Similarly, architectural distortions of lung parenchyma and traction bronchiectasis are uncommon features.
The most common radiographic appearance of DIP is bilateral basal hazy increased opacification with a reduction in lung volumes. However, the radiographs are normal in about 5% to 20% of patients who have biopsy-proven DIP. The predominant HRCT abnormality is also bilateral area of ground-glass attenuation, reflecting the filling of alveolar airspaces by macrophages. A subpleural and basal predominance is often present. Although reticular opacity may be associated with ground-glass attenuation, honeycombing is uncommon. Of cases, 32%-75% develop small cystic airspaces within areas of ground-glass attenuation. Histopathologic correlation suggests that some of these cysts represent bronchioliectasis and dilated alveolar ducts, without honeycomb fibrosis. Because of its association with cigarette smoking, centrilobular emphysema is also common present. Spontaneous improvement may occur in untreated patients. The response to corticosteroid is unclear; however, most patients report a symptomatic improvement.
References
1. Akira M, Yamamoto S, Hara H, Sakatani M, Ueda E: Serial computed tomographic evaluation in desquamative interstitial pneumonia. Thorax 1997; 52(4):333-337
2. Hartman TE, Primack SL, Kang EY, Swensen SJ, Hansell DM, McGuinness G, Muller NL: Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia. Assessment with serial CT. Chest 1996; 110(2):378-382
3. Hartman TE, Primack SL, Swensen SJ, Hansell D, McGuinness G, Muller NL: Desquamative interstitial pneumonia: thin-section CT findings in 22 patients. Radiology 1993; 187(3):787-790
4. 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 Case 615 Case 620 Case 840
Keywords
Lung, Desquamative interstitial pneumonia,

No. of Applicants : 78

▶ Correct Answer : 41/78,  52.6%
  • - , Korea (South) JANG SEONG WON
  • - Myongji Hospital , Korea (South) KI EON KWON
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Chonbuk National University Medical School , Korea (South) HYEJIN YANG
  • - Other , Korea (South) JEONGHYUN LEE
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - istanbul , Turkey AYHAN YILMAZ
  • - NIMS, Hyderabad , India AMIT DADHANIA
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - Ajou University Hospital , Korea (South) DAYOUNG KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - National cancer center hospital east , Japan SHIOTO ODA
  • - Private sector , Greece VASILIOS TZILAS
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - Ajou University Hospital , Korea (South) YONG HO JANG
▶ Correct Answer as Differential Diagnosis : 12/78,  15.4%
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) CHUNGEUN LIM
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Other , Korea (South) JUWON KIM
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Other , Korea (South) SEONGSU KANG
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
▶ Semi-Correct Answer : 5/78,  6.4%
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
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