대한흉부영상의학회 Weekly Chest Cases

Case No : 1386 Date 2024-05-14

Courtesy of Sung Ho Hwang / Korea University Anam Hospital
Age/Sex 52 / F
Chief ComplaintDyspnea IgG anti-cardiolipin: Positive Anti-Neutrophil Cytoplasmic Antibody (ANCA): Positive

Figure 1
Figure 2

Diagnosis With Brief Discussion

Diagnosis: Lymphocytic interstitial pneumonia
Radiologic Findings: Right middle lobe (RML) wedge resection
Peribronchiolar prominent lymphoid follicles, patchy interstitial thickening, and chronic inflammation are noted in the histology result.

Fig. 1 The chest posteroanterior radiograph shows increased opacities and haziness in the right lower lung zone.

Fig. 2 A transverse image (A) of HRCT shows small ground-glass lesions and dilated bronchi in the middle lobe and lower lobe of the right lung.
A six-month follow-up HRCT (B) shows multiple small cysts replacing the previous ground-glass lesions in the right lung.
Brief Review: Lymphocytic interstitial pneumonia (LIP) has been considered part of a spectrum of pulmonary lymphoproliferative disorders that range in severity from benign airway-centered cellular aggregates (lymphoid hyperplasia) to malignant lymphomas.
Most cases of LIP occur in patients with underlying autoimmune disease or immunodeficiency, most commonly Sjögren syndrome, autoimmune disorders, dysproteinemia, and AIDS.

Radiographic findings include a reticular or reticulonodular pattern involving mainly the lower lung zones. The main findings on high-resolution CT consist of extensive bilateral ground-glass opacities and poorly defined centrilobular nodules; other common manifestations include subpleural nodules, thickening of the bronchovascular bundles, and a few cystic airspaces. The cystic changes in LIP are usually mild and are associated with ground-glass opacities. Occasionally, the cysts may be an isolated finding or may be extensive.

Most patients with LIP initially respond to corticosteroids cytotoxic drugs or both. In some patients, however, the disease progresses despite treatment. The median survival is approximately 11 years.
References: 1) Silva CI, Flint JD, Levy RD, et al. Diffuse lung cysts in lymphoid interstitial pneumonia: high-resolution CT and pathologic findings. J Thorac Imaging. 2006;21:241–244.
2) Johkoh T, Ichikado K, Akira M, et al. Lymphocytic interstitial pneumonia: follow-up CT findings in 14 patients. J Thorac Imaging. 2000;15:162–167
Keywords

No. of Applicants : 73

▶ Correct Answer : 7/73, 9.6%

- , Korea (South) DONG-HO BANG
- Other , Korea (South) SEONGSU KANG
- , China FANG YING GEN
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- , Japan YOSHIKI ISHII
- , Korea (South) HEONSEOK LEE
- Mie university , Japan MIYUKO FUJITA

▶ Correct Answer as Differential Diagnosis : 9/73, 12.3%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
- , Japan SHUNJIRO NOGUCHI
- Ome Medical Center , Japan MIKIYA FUJII
- GHICL , France MANUEL TOLEDANO
- Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- , Japan YUMI MAEHARA
- Toyota Kosei Hospital , Japan YUKI HAYASHI

▶ Semi-Correct Answer : 6/73, 8.2%

- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- Other , Korea (South) SEOL A LEE
- Kyoto University , Japan SHO KOYASU
- The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- , Korea (South) JIN WOO YOON

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1386 Date 2024-05-14

Discussion

No. of Applicants : 73