Weekly Chest CasesArchive of Old Cases

Case No : 1157 Date 2019-12-30

  • Courtesy of Young Hun Jeon, Yeong Tae Park, Jin Young Yoo / Chungbuk National University Hospital
  • Age/Sex 39 / M
  • Chief ComplaintDyspnea (onset: 3 weeks ago), dry cough / Current smoker (20 pack years)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Desquamative Interstitial Pneumonia (DIP)
Radiologic Findings
Fig 1. Chest PA shows suspicious diffuse patchy ground-glass opacity in both lungs.
Fig 2-4. CT scans reveals diffuse symmetric ground-glass opacity in both lungs.
Fig 5. [1 year later] CT scan shows no change of diffuse ground-glass opacity and newly appeared multiple small air cysts in both lungs.
Fig 6. [4 years later] CT scan shows ground-glass opacity with aggravating multiple small air cysts, reticulation, and linear opacities in both lungs.
Brief Review
Desquamative interstitial pneumonia (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. DIP is usually associated with tobacco smoke. However, the association between smoking and DIP is less robust than that with respiratory bronchiolitis with interstitial lung disease or pulmonary Langerhans’ cell histiocytosis; approximately 10–42% of patients with DIP are nonsmokers. DIP can also occur in patients following exposure to certain inhaled toxins (occupational exposure) and drugs, and may occur in the context of certain viral illnesses and autoimmune diseases. In the context of DIP, occupational exposure should be systematically investigated.
Chest radiographs are insensitive for detection of DIP and are reported to be normal in 3%–22% of biopsy-proved cases. The radiologic patterns are nonspecific and include patchy ground-glass opacities with a lower lung and peripheral predominance. On high-resolution CT, 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. In follow-up CT findings of histologically proven DIP, GGOs were reported to have disappeared, with only the emphysema remaining; this suggests that some of the cysts serve as foci of emphysema.
The differential diagnosis includes RB-ILD, hypersensitivity pneumonitis, NSIP, and atypical infections such as Pneumocystis carinii pneumonia.
Please refer to
Case 4, Case 266, Case 615, Case 620, Case 840, Case 1127, Case 1149,
KSTR Imaging Conference 2004 Spring  Case 8 ,
KSTR Imaging conference 2010 Summer  Case 19 ,
KSTR Imaging Conference 2011 Spring  Case 6,
References
1. Godbert B, Wissler MP, Vignaud JM. Desquamative interstitial pneumonia: an analytic review with an emphasis on aetiology, Eur Respir Rev. 2013 Jun 1;22(128):117-23.
2. Attili AK, Kazerooni EA, Gross BH, et al. Smoking-related Interstitial Lung Disease: Radiologic-Clinical-Pathologic Correlation. Radiographics. 2008 Sep-Oct;28(5):1383-96.
3. Iwasawa T, Takemura T, Ogura T. Smoking-related lung abnormalities on computed tomography images: comparison with pathological findings. Jpn J Radiol. 2018 Mar;36(3):165-180.
Please refer to
Keywords
lung, interstitial pneumonia, smoking related ILD, desquamative interstitial pneumonia,

No. of Applicants : 73

▶ Correct Answer : 48/73,  65.8%
  • - , Japan YUMI MAEHARA
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Seoul Veterans Hospital , Korea (South) JANG SEONG WON
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - McGill University Health Center , Canada Alexandre Semionov
  • - , Korea (South) HYEONJUN JANG
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Lille , France BENOIST CAPON
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - FREE LANCER , India ABHIJEET YOGESHKUMAR ITAI
  • - Kyeongpook National University Hospital , Korea (South) MIRAN KIM
  • - Myongji Hospital , Korea (South) KI EON KWON
  • - Other , Korea (South) HONG SANG HYUP
  • - NIMS, HYDERABAD , India BHASKAR K
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Prince Sattam ibn Abdulaziz University hospital , Saudi Arabia ELBAGIR MOHAMED NASSIR
  • - Other , Korea (South) SEONGSU KANG
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - , Korea (South) SUNHYANG LEE
  • - , Japan KAZUMA TERAUCHI
  • - TB centre kasaragod. , India rikhy krishnan
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Chungbuk National University Hospital , Korea (South) YOUNGHUN JEON
  • - Private sector , Greece VASILIOS TZILAS
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - The Jikei university , Japan TAKU GOMI
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - , Korea (South) JAEHEUNG BAE
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Gifu University Hospital , Japan Yo Kaneko
▶ Correct Answer as Differential Diagnosis : 9/73,  12.3%
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - McGill , Canada ADRIANA SOFIA MORALES
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - , Korea (South) HYEYOUNG CHOI
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
▶ Semi-Correct Answer : 2/73,  2.7%
  • - chp st martin , France BENOIT HENR MARIOTTE
  • - Kashan University of Medical Sciences, kashan , Iran EBRAHIM RAZI
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