Lung parenchymal changes secondary to cigarette smoking: pathologic-CT correlations.

Abstract

To determine the histopathologic basis for computed tomographic (CT) interpretation of smokers' lung and the accuracy of CT in the detection of alterations related to cigarette smoking, parenchymal lung lesions were studied from 41 heavy smokers who underwent thoracotomy for removal of a solitary pulmonary nodule. CT scanning of the resected lungs, corresponding exactly to the sections seen on preoperative CT scans, resulted in the following pathologic-CT correlations. Areas of ground-glass attenuation seen on preoperative CT scans (n = 11 [27%]) were related to three main histologic features: (a) accumulation of pigmented macrophages and mucus in the alveolar spaces, associated with mild interstitial inflammation and/or fibrosis (n = 7); (b) thickening of the alveolar walls with inflammatory cells with normal alveolar spaces (n = 3); and (c) presence of organizing alveolitis (n = 1). Parenchymal micronodules depicted presurgically (n = 4 [10%]) corresponded to bronchiolectases with peribronchiolar fibrosis (n = 4) associated with obliterative bronchiolitis in one patient. When emphysema was detected presurgically (n = 21 [51%]), it was always present at pathologic study to a higher extent than initially suspected.

Respiratory bronchiolitis-associated interstitial lung disease with fibrosis is a lesion distinct from fibrotic nonspecific interstitial pneumonia: a proposal

“…[1][2][3][4][5][6] When associated with clinical symptoms of shortness of breath and cough, pulmonary function abnormalities of mixed restrictive and obstructive lung disease and high resolution CT scanning demonstrating centrilobular micronodules, ground glass opacities and peribronchiolar thickening, a diagnosis of respiratory bronchiolitisassociated interstitial lung disease can be considered. [7][8][9][10][11][12][13][14] While the above small airway changes and airspace macrophages have been areas of primary pathologic interest, Fraig et al and others have also pointed out that very mild degrees of centrilobular alveolar septal and focal subpleural fibrosis can be present in nearly 50% of respiratory bronchiolitis cases. 6,9,15,16 This collagenous thickening of the alveolar septa can be dramatic and is the basis for this report of nine cases referred for consultation with the diagnosis of fibrotic phase of nonspecific interstitial pneumonia, but instead are interpreted as a form of respiratory bronchiolitis-associated interstitial lung disease with pronounced panlobular and subpleural alveolar septal fibrosis occurring in the presence of emphysematous change.…”

Diagnosis of Respiratory Bronchiolitis associated interstitial lung disease

“…In other words, ground-glass attenuation could reflect "smoker's alveolitis" whereas micronodules would correspond to respiratory bronchiolitis [15,16] (as can be observed in the morphologic appearance from a surgical biopsy performed on patient 3 -figure 3). Lung function tests, shown in table 3, were performed on seven patients.…”

The “dirty chest”—correlations between chest radiography, multislice CT and tobacco burden

“…It has been demonstrated that respiratory illness is associated with the degree of tobacco smoke exposure in particular [5,11]. The pathological entity of smokeinduced RB-ILD is also called ''smokers' bronchiolitis'' as it is seen almost exclusively in current or former smokers.…”

“…The common finding of ''dirty chest'', an overall increase in non-specific lung markings on chest radiography in such patients, is frequently identified in daily routine [7][8][9][10]. Remy-Jardin et al [11] found that the morphological substrate of cigarette smoking-induced changes in chest radiography were parenchymal micronodules and intralobular opacities comparable to the findings in anthracosilicosis of coal workers. Therefore, we hypothesised that it might be possible to quantify the smoking-induced changes of the lung using the International Labour Organization (ILO) classification [12].…”