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Weekly Chest CasesArchive of Old Cases

Case No : 1268 Date 2022-02-07

  • Courtesy of Hye Young Choi, Yoo Kyung Kim / Ewha Womans University Mokdong Hospital
  • Age/Sex 75 / M
  • Chief ComplaintIncidental finding
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Desquamative interstitial pneumonia
Radiologic Findings
Fig 1. Chest PA shows diffuse reticular opacities and ground-glass opacity in both lungs.
Fig 2,3. CT scans show bilateral ground-glass opacity, multiple cysts, and emphysema within the subpleural areas of ground-glass opacity in both lungs.
VATS biopsy specimen of the patient shows loose fibrosis and foamy macrophage accumulation in air space.
Fig 4,5. [after 3 months] In 3 months follow-up CT scan, ground-glass opacity has partially resolved after steroid therapy.

after 3 months

after 3 months

Brief Review
Desquamative interstitial pneumonia (DIP) is a rare form of idiopathic interstitial pneumonia (IIP). It is associated with heavy smoking. A diagnosis of DIP cannot be reliably established based on clinical and radiological features alone and ideally requires a lung biopsy. The histomorphology is characterized by the diffuse accumulation of numerous pigmented macrophages within most of the distal airspace of the lung and, sometimes, an admixture of eosinophils and/or giant cells.
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. Merel E. Hellemons1,8,9, Catharina C. Moor1,8,9, Jan von der Thüsen et al., Desquamative interstitial pneumonia: a systematic review of its features and outcomes, Eur Respir Rev 2020; 29: 190181
2. Attili AK, Kazerooni EA, Gross BH, et al. Smoking-related Interstitial Lung Disease: Radiologic-Clinical-Pathologic Correlation. Radiographics. 2008;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;36(3):165-180.
4. Ryu JH, Myers JL, Capizzi SA et-al. Desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung disease. Chest. 2005;127 (1): 178-84.
Please refer to
Case 1247 Case 1214 Case 1157 Case 1149 Case 1127 Case 840 Case 620 Case 615 Case 266 Case 4
Keywords

No. of Applicants : 95

▶ Correct Answer : 64/95,  67.4%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - , Japan JUN KANZAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - CHCB , France LE GUEN RAPHAEL
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Japan CHIAKI SATO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Other , Korea (South) HWANGHEE JO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Manipal HealthMap , India SHASHANK SOOD
  • - , Korea (South) JIN YOUNG LEE
  • - , China FANG YING GEN
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Osaka University , Japan AKINORI HATA
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) SUNHYANG LEE
  • - , Korea (South) HYEWON CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - HHS , Canada S LEE
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chonnam National University Hwasun Hospital , Korea (South) MYUNG WON SONG
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - , Korea (South) YEONG UK HWANG
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Other , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Osaka city university Hospital , Japan TATSUSHI OURA
  • - Other , Korea (South) SEONG WON JANG
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Columbia asia hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - DECRH, Fredericton , Canada RAM P GALWA
  • - TB centre kasaragod. , India rikhy krishnan
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Samsung Medical Center , Korea (South) SUHO KIM
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Apollo Hospitals , India SHRUTHI P
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - , Japan YUKI HAYASHI
  • - , Korea (South) WONJU HONG
  • - , Korea (South) HM PARK
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - , China YU YAO
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 11/95,  11.6%
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - , Italy PAOLO BALDASSARI
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - Other , Korea (South) JOO HEE KIM
  • - , Korea (South) CHAEHUN LIM
  • - , United States HIROAKI TAKAHASHI
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - , Qatar NABIL SHERIF MAHMOOD
  • - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
▶ Semi-Correct Answer : 4/95,  4.2%
  • - Japanese Red Cross Medical Center , Japan YASUSHI AOYAGI
  • - , Argentina MARCOS MESTAS NUEZ
  • - , Korea (South) NAEUN OH
  • - algeria , Algeria ZAKARIA CHERAGA
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