Respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia: different entities or part of the spectrum of the same disease process?

Heyneman, Laura E.; Ward, Suzanne; Lynch, David A.; Rémy‐Jardin, Martine; Johkoh, Takeshi; Müller, Néstor L.

doi:10.2214/ajr.173.6.10584810

Cited by 281 publications

(192 citation statements)

References 14 publications

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“…The only features that may differentiate these two IIPs are the distribution and the extent of the lesions. This observation may again raise the question of whether RB-ILD and DIP represent different points along the spectrum of the same disease [1,9,36], although RB, RB-ILD, and DIP representing various degrees of severity of the same process caused by long-time tobacco smoking is not commonly considered.…”

Section: Etiology and Pathogenesismentioning

confidence: 99%

“…However, separating RB and RB-ILD by sole histopathological criteria remains controversial; moreover, the two entities can also rarely be distinguished solely by the nature and extent of HRCT findings, because there is no arbitrary cut-off point for which the extent of disease at HRCT evolves from RB to RB-ILD [5][6][7][8][9]. Therefore, it has been proposed that the distinction between RB and RB-ILD should be based not on histological or radiological appearance alone, but on all markers of disease severity taken together, including clinical symptoms, pulmonary function tests results, and HRCT findings.…”

Section: Differential Diagnosismentioning

confidence: 99%

“…Contrary to RB alone, RB-ILD is an uncommon disorder found in a far smaller proportion of smokers [4,6]. Some authors have regarded RB-ILD as an exaggerated RB with more extensive peribronchiolar interstitial fibrosis [7][8][9], while others [4,6] have considered the histologic features of RB and RB-ILD indistinguishable and have separated the two based on the presence of clinical evidence of ILD.…”

mentioning

confidence: 99%

“…In spite of the substantial clinical heterogeneity of these studies, it has been consistently reported that patients with RB-ILD are usually ever cigarette smokers with at least 30 pack-years at the time of diagnosis [6][7][8][9]12,13]. Only incidental single cases of RB-ILD in non-smokers have been reported, including patients exposed to second-hand smoke [8,16].…”

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confidence: 99%

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Respiratory Bronchiolitis with Interstitial Lung Disease

Galanski¹

2010

Thoracic Imaging

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Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) is a rare, mild inflammatory pulmonary disorder that occurs almost exclusively in current or former heavy smokers, usually between the third and sixth decades, most likely with no gender predilection. The onset is usually insidious with exertional dyspnea and persistent cough, which may be non-productive, developing over a course of weeks or months. RB-ILD may also be diagnosed in asymptomatic patients with functional impairment and chest radiograph or high-resolution computed tomography (HRCT) abnormalities. Histologically, RB-ILD is characterized by the accumulation of yellow-brown pigmented macrophages within the lumens of respiratory bronchioles and alveolar ducts, associated with a patchy submucosal and peribronchiolar chronic inflammation. Common findings also include mild bronchiolar and peribronchiolar alveolar fibrosis that expands contiguous alveolar septa and leads to architectural distortion as well as centrilobular emphysema. Chest radiographs in patients with RB-ILD typically show fine reticulonodular interstitial opacities, while on HRCT central and peripheral bronchial wall thickening, centrilobular nodules, and ground-glass opacities associated with upper lobe centrilobular emphysema are most frequently reported. Pulmonary function testing may be normal but usually demonstrates mixed, predominantly obstructive abnormalities, often combined with hyperinflation and usually associated with a mild to moderate reduction in carbon monoxide diffusion capacity (DLco). The course of RB-ILD is heterogeneous. Some patients respond favorably to corticosteroids and/or smoking cessation, but often there is no functional improvement and the disease progresses despite smoking cessation and treatment.

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Section: Etiology and Pathogenesismentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Respiratory Bronchiolitis with Interstitial Lung Disease

Galanski¹

2010

Thoracic Imaging

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“…The most common causes of the bilateral symmetric centrilobular nodular pattern are HP, RB, and respiratory bronchiolitis-interstitial lung disease [23,24].…”

Section: Diagnosis Of Bronchiectasismentioning

confidence: 99%

Computed tomography and magnetic resonance imaging: past, present and future

Nl¹

2002

Eur Respir J

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The aims of this paper are to summarize the current recommendations for the use of computed tomography (CT) and magnetic resonance imaging (MRI) in the chest and to suggest some possible future developments.The main developments of CT in the chest have been the introduction of highresolution CT (HRCT), spiral CT and, more recently, multidetector spiral CT.HRCT is defined as thin-section CT (1-to 2-mm collimation scans), optimized by using a high-spatial resolution (edge-enhancing) algorithm. Several studies have shown that HRCT closely reflects macroscopic (gross) pathological findings. HRCT currently has the best sensitivity and specificity of any imaging method used for the assessment of focal and diffuse lung diseases.The advent of spiral CT and, more recently, multidetector CT scanners, has allowed for major improvements in the imaging of airways, pulmonary and systemic vessels, and lung nodules. Spiral CT facilitates multiplanar and three-dimensional display of structures and visualization of pulmonary and systemic vessels, with a level of detail that is comparable to that of conventional angiography. With the use of graphics-based software programs, spiral CT enables depiction of the luminal surface of the airways with images that resemble those of bronchoscopy (virtual bronchoscopy) or bronchography (virtual bronchography). Several studies have shown a high sensitivity and specificity for spiral CT in the diagnosis of acute pulmonary embolism. Therefore, spiral CT is rapidly becoming the imaging modality of choice in the diagnosis of pulmonary embolism.Like the radiograph, signal intensity on computed tomography is mainly due to a single parameter: electron density. The signal intensity of the magnetic resonance image depends on four parameters: nuclear density, two relaxation times called T1 and T2, and motion of the nuclei within the imaged lung volume. Abnormal soft tissue can be identified more easily through measurement of these four parameters than through use of computed tomography. Furthermore, because the spatial orientation of the image is determined by manipulation of magnetic fields, scans can be performed in any plane. The main indications for magnetic resonance in the chest have been in the evaluation of the heart, major vessels, mediastinum, and hilar structures because of the natural contrast provided by flowing blood. Of particular interest for the respirologist has been the recent development of magnetic resonance angiography. This technique consists of three-dimensional single breath-hold images obtained using gadolinium-based contrast agents. This is a promising technique for the diagnosis of acute and chronic pulmonary embolism. Eur Respir J 2002; 19: Suppl. 35, 3s- For many years, the plain chest radiograph was the only imaging modality used in the diagnosis of lung disease. With the advent of computed tomography (CT) came the first opportunity to assess gross lung structure. Conventional 8-to 10-mm collimation scans allowed better assessment of the lung parenchyma than was...

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High Resolution Computed Tomography in Idiopathic Interstitial Pneumonias

Argiriadi¹,

Mendelson²

2009

Mount Sinai J Medicine

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In June 2001, using an "international multidisciplinary consensus," the American Thoracic Society and European Respiratory Society classified the idiopathic interstitial pneumonias (Am J Respir Crit Care Med 2002;165:277-304). The American Thoracic Society and European Respiratory Society coined the term idiopathic interstitial pneumonias because the diseases in question have both unknown etiologies and various combinations of inflammation and fibrosis within the lung parenchyma. The consensus included the development of a classification standard of the interstitial pneumonias and discussed the role of surgical lung biopsy and bronchoalveolar lavage evaluation. The classification of idiopathic interstitial pneumonias is based on histologic criteria, which correlate to imaging patterns on high-resolution computed tomography. The group of lung diseases under the umbrella of idiopathic interstitial pneumonias includes the following: usual interstitial pneumonia, nonspecific interstitial pneumonia, desquamative interstitial pneumonia, respiratory bronchiolitis interstitial lung disease, acute interstitial pneumonia, cryptogenic organizing pneumonia, and lymphoid interstitial pneumonia.

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Respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia: different entities or part of the spectrum of the same disease process?

Cited by 281 publications

References 14 publications

Respiratory Bronchiolitis with Interstitial Lung Disease

Respiratory Bronchiolitis with Interstitial Lung Disease

Computed tomography and magnetic resonance imaging: past, present and future

High Resolution Computed Tomography in Idiopathic Interstitial Pneumonias

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