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Weekly Chest CasesCases by Disease Category

Case No : 1268 Date 2022-02-07

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  • 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 Th
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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