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Weekly Chest CasesArchive of Old Cases

Case No : 1433 Date 2025-04-07

  • Courtesy of Hye Soo Cho, Taehee Lee, Woo Hyeon Lim / Seoul National University Hospital
  • Age/Sex 64 / M
  • Chief ComplaintDyspnea
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Desquamative interstitial pneumonia
Radiologic Findings
Fig 1. Chest PA shows multifocal patchy ground-glass opacities in both lungs.
Fig 2-4. Chest CT scan shows diffuse ground-glass opacities and air cysts in both lungs, mainly distributed in the basal and peripheral lungs. A VATS biopsy specimen from this patient, who has a 40-pack-year smoking history, demonstrates the accumulation of intra-alveolar macrophages within the alveolar air spaces accompanied by interstitial fibrosis, consistent with desquamative interstitial pneumonia.
Brief Review
Desquamative interstitial pneumonia (DIP) is a rare form of idiopathic interstitial pneumonia (IIP). DIP is strongly associated with cigarette smoking (approximately 90% of patients). However, DIP also occurs in nonsmokers and has been related to a variety of conditions, including lung infections and exposure to organic dust. Chest radiographs of DIP are nonspecific and may reveal hazy opacities. At high-resolution CT, DIP is characterized by diffuse ground-glass opacities, which correlate histologically with the spatially homogeneous intraalveolar accumulation of macrophages and thickening of alveolar septa. Usually, there is a peripheral and lower lung lobe predominance. Other frequent CT findings include spatially limited irregular linear opacities and small cystic spaces, which are indicative of fibrotic changes. With smoking cessation and corticosteroid therapy, the prognosis is good. Nevertheless, progressive disease with eventual death can occur, notably in patients with continued cigarette smoking.
References
1. LynchDA, Travis WD, Muller NL, et al. Idiopathic interstitial pneumonias: CT features. Radiology2005; 236: 10–21
2. HidalgoA, Franquet T, Gimenez A, Bordes R, Pineda R, Madrid M. Smoking-related interstitial lung diseases: radiologic-pathologic correlation. Eur Radiol2006; 16: 2463–2470.
3. Mueller-Mang C, Grosse C, Schmid K, Stiebellehner L, Bankier AA. What every radiologist should know about idiopathic interstitial pneumonias. Radiographics. 2007 May-Jun;27(3):595-615.
Keywords
smoking related, IIP,

No. of Applicants : 70

▶ Correct Answer : 41/70,  58.6%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Oita university , Japan AYUMI KAMEI
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - , Korea (South) DONG-HO BANG
  • - Teikyo University Hospital , Japan CHIAKI SATO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - , China FANG YING GEN
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Osaka University , Japan AKINORI HATA
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - , Japan YOSHIKI ISHII
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Other , Korea (South) KI-NAM LEE
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Other , Korea (South) CHAEHUN LIM
  • - Inha University Hospital , Korea (South) KANG HEON LEE
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - , Korea (South) HEONSEOK LEE
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - TB centre kasaragod. , India rikhy krishnan
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - , Japan SHUHEI NORIMOTO
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - CHA University, CHA Bundang Medical Center , Korea (South) HWANGSEON JU
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - , Japan YUMI MAEHARA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - , China YU YAO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 5/70,  7.1%
  • - IUHW Narita Hospital , Japan ISSEI FUKUDA
  • - , Italy PAOLO BALDASSARI
  • - POST GRADUATE , India NALLAPATI LAKSHMI CHAITANYA
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
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