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