Desquamative interstitial pneumonia: thin-section CT findings in 22 patients.

Hartman, Thomas E.; Primack, Steven L.; Swensen, Stephen J.; Hansell, David M.; McGuinness, Georgeann; Müller, Néstor L.

doi:10.1148/radiology.187.3.8497631

Cited by 215 publications

(97 citation statements)

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“…Pathological features of DIP, such as diffuse alveolar wall thickening and accumulation of macrophages in the alveolar space, were not noted in any of the biopsy specimens from the present five patients. In addition, the HRCT findings were considered to be different from those of DIP because HRCT features of DIP include mainly ground-glass opacity and scarce centrilobular nodules [13,25]. The present HRCT findings resembled those of subacute hypersensitivity pneumonitis or flock workers' lung rather than DIP, and the same characteristic HRCT features have been reported in previous articles [26,27].…”

Section: Discussionsupporting

confidence: 81%

Changes in HRCT findings in patients with respiratory bronchiolitis-associated interstitial lung disease after smoking cessation

Nakanishi¹,

Demura²,

Mizuno³

et al. 2007

European Respiratory Journal

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High-resolution computed tomography (HRCT) findings in patients with respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) are varied and nonspecific. There is no known report of changes in HRCT findings and respiratory function test results for RB-ILD patients following the cessation of smoking.Five patients with RB-ILD, confirmed by surgical lung biopsy, were retrospectively studied. Each stopped cigarette smoking and did not receive corticosteroid therapy after diagnosis. The clinical symptoms, respiratory function test results and HRCT findings obtained at the final observation were compared with those from the time of diagnosis.Ground-glass opacity and centrilobular nodules corresponding to pathological respiratory bronchiolitis, as well as intralobular fine linear-reticular opacity corresponding to fibrosis involving the subpleural alveolar septa, showed computed tomography-pathological correlations. Both clinical symptoms and the diffusing capacity of the lungs for carbon monoxide improved significantly following smoking cessation, as did ground-glass opacity and centrilobular nodules seen during the initial HRCT examination.Centrilobular nodules and ground-glass opacity, which are the main features of high-resolution computed tomography of respiratory bronchiolitis-associated interstitial lung disease patients and represent pathological respiratory bronchiolitis, can be improved by smoking cessation. The diffusing capacity of the lung for carbon monoxide in respiratory function tests can be also improved.

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Section: Discussionsupporting

confidence: 81%

Changes in HRCT findings in patients with respiratory bronchiolitis-associated interstitial lung disease after smoking cessation

Nakanishi¹,

Demura²,

Mizuno³

et al. 2007

European Respiratory Journal

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“…Chest radiographs (normal in 3-22% of DIP biopsy-proven cases) [2,4,6] is mainly characterised by patchy alveolar opacities, with a lower and middle lung zones pre-dilection, but occasionally with a peripheral predominance. Thin-section CT scans always reveal more or less extensive areas of ground-glass attenuation [7]. Irregular lines, traction bronchiectasis and cystic changes may also be seen.…”

Section: Diagnosis: Desquamative Interstitial Pneumonia (Dip)mentioning

confidence: 98%

Dry cough and dyspnoea rapidly increasing to respiratory failure in a male smoker

Sigala

Kalomenidis²,

Malagari³

et al. 2005

European Respiratory Journal

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A 65-yr-old male, current smoker of .30 cigarettes?day -1 (total smoking history 150 pack-yrs), who was working as a bus driver, presented at the Evangelismos Hospital (Athens, Greece) complaining of increasing breathlessness on exertion and dry cough during the past 2 months. He had no animal exposure and he hadn't travelled abroad during the last few years. His medical history showed arterial hypertension, for which he was receiving treatment with an angiotension-converting enzymeinhibitor (ramipril) plus hydrochlorothiazide, as well as asymptomatic cholelithiasis and prostate hypertrophy for which he was receiving tamsulosin hydrochloride. He did not mention suffering from fever in the last few months.On admission, the patient was mildly tachypnoeic (22 breaths? min -1 ), but apparently in discrete health, with a body temperature of 36.8˚C, pulse rate 85 beats?min -1 and blood pressure 130/70 mmHg. On chest auscultation, rare fine inspiratory rales were audible over both hemithoraces. He had no clubbing. The tuberculin test was negative. The routine blood analysis and chemistry was normal. Arterial blood gas analysis while breathing room air gave results as follows: arterial oxygen tension (Pa,O 2 ) 7.95 kPa; carbon dioxide arterial tension (Pa,CO 2 ) 3.94 kPa; pH: 7.45. Chest radiography on admission is shown in figure 1. Spirometry 2 days later was compatible with a moderate restrictive pattern (forced vital capacity (FVC): 1.52 L (48% predicted); forced expiratory volume in one second (FEV1): 1.28 L?sec -1 (53.6% pred); FEV1/FVC6100 ratio: 84%). Lung volumes and diffusing capacity could not be assessed because the patient was unable to cooperate. A bronchoscopy was performed on the 4th day of hospitalisation and no endobronchial abnormalities were found. Bronchoalveolar lavage (BAL) was performed during bronchoscopy and the total cell count was 26.6610, with a differential of 82% macrophages, 12% lymphocytes and 6% neutrophils. No infective agents were detected in sputum or in bronchial secretions. Serology for HIV infection was negative, as was the urinary test for Legionella pneumophila and Streptococcus pneumoniae. Serology for common virus, and mycoplasma, ricketsiae and chlamydiae were pending. No underlying immunosuppressive condition was evident.During the 2-3 days following bronchoscopy, the patient's respiratory condition rapidly deteriorated. Respiratory rate was 34 breaths?min -1 and pulse rate 130 beats?min -1 . Arterial blood gases on supplemental oxygen and fractional concentration of oxygen in inspired gas 60% were: Pa,O 2 9.24 kPa; Pa,CO 2 4.2 kPa; pH 7.44. However, he remained afebrile and the new haematology and biochemical laboratory studies, including total and differential white cell blood count, were within the normal range.Another chest radiograph obtained on the 7th day of his hospital stay, is shown in figure 2, and the chest computed tomography (CT) obtained at the same time point is shown in figure 3. During the next few hours, the patient was admitted to the intensive care unit ...

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“…It is a characterized finding in the high-resolution CT (HRCT), the presence of areas ground-glass attenuation [34] that is correlated histologically with the alveolar filling by macrophages [35] (Figure 1). DIP affects mainly peripheral lower lung areas [36].…”

Section: Desquamative Interstitial Pneumoniamentioning

confidence: 99%

“…DIP affects mainly peripheral lower lung areas [36]. Fibrosis may be present in 50-60% of the patients [34,35], but honeycombing is rare [17]. On follow-up HRCT, patients receiving treatment can show partial or complete resolution of the areas of ground-glass opacification [37].…”

Section: Desquamative Interstitial Pneumoniamentioning

confidence: 99%

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Smoking and Other Interstitial Lung Diseases

2011

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Cigarette smoking has been implicated in the development of some uncommon respiratory interstitial diseases. Desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung diseases are characterized by a diffuse alveolar and peribronchiolar filling with macrophages, respectively. Pulmonary Langerhans' cell histiocytosis is a rare interstitial lung disorder characterized by the proliferation of Langerhans' cell forming interstitial infiltrates and nodules that could progress to cavitary nodules. The treatment of these disorders involves smoking cessation and sometimes the use of steroids. High-resolution computed tomography is essential for the characterization of these smoking-related interstitial lung diseases, but frequently it is necessary to create a workgroup composed by pulmonologists, pathologists, and radiologists to diagnosis and treat patients affected with these pathologies.

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Desquamative interstitial pneumonia: thin-section CT findings in 22 patients.

Cited by 215 publications

References 0 publications

Changes in HRCT findings in patients with respiratory bronchiolitis-associated interstitial lung disease after smoking cessation

Changes in HRCT findings in patients with respiratory bronchiolitis-associated interstitial lung disease after smoking cessation

Dry cough and dyspnoea rapidly increasing to respiratory failure in a male smoker

Smoking and Other Interstitial Lung Diseases

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