대한흉부영상의학회 Weekly Chest Cases

Courtesy of Won Gi Jeong, Hyun-Ju Lim, Kun Young Lim, Hyae Young Kim / National Cancer Center
Age/Sex 61 / F
Chief ComplaintIncidentally detected pulmonary nodules on chest CT

Diagnosis: Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH)
Radiologic Findings: Axial high-resolution CT images reveal multiple small well-defined nodules, predominantly located in the peripheral and lower lung regions of both lungs. Additionally, mosaic attenuation is observed in the lung parenchyma.
Brief Review: DIPNECH (Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia) is a rare pulmonary condition characterized by the proliferation of neuroendocrine cells in the lungs. On CT imaging, it often presents with multiple, well-defined, small nodules, typically located in the peripheral and subpleural areas of both lungs. These nodules may be associated with mosaic attenuation, reflecting areas of abnormal ventilation or perfusion, and can sometimes lead to the development of a ground-glass appearance. The condition may be asymptomatic or present with mild respiratory symptoms, and while it can resemble other pulmonary diseases such as carcinoid tumors, a careful evaluation of clinical history, imaging findings, and histopathological results is necessary for a definitive diagnosis.
References: 1. Little BP, Junn JC, Zheng KS, Sanchez FW, Henry TS, Veeraraghavan S, Berkowitz EA. Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia: Imaging and Clinical Features of a Frequently Delayed Diagnosis. AJR Am J Roentgenol. 2020;215(6):1312-1320.
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대한흉부영상의학회 Korean Society of Thoracic Radiology