Serial computed tomographic evaluation in desquamative interstitial pneumonia

Abstract

Abstracta better prognosis and a better response to treatment with corticosteroids than patients Background -Desquamative interstitial pneumonia (DIP) may represent the early with UIP. However, other observers 3 4 have suggested that DIP may represent an early stage stage and usual interstitial pneumonia (UIP) the late stage of the same disease. of idiopathic pulmonary fibrosis which subsequently progresses to UIP. The morphology The purpose of this study was to evaluate the computed tomographic (CT) features of both may appear in the same patient at the same time, and although in one study patients of DIP, to evaluate the changes in pattern and extent of disease over time, and to with DIP treated with corticosteroids were found ultimately to develop extensive fibrosis determine whether the appearances of DIP on the CT scan change to those of and honeycombing, 5 others 6 7 have suggested that DIP does not necessarily progress to UIP UIP during follow up. Methods -Sequential CT evaluation was and can relapse many years after the initial presentation with a similar histological picture. conducted on eight patients with DIP over a mean (SD) follow up period of 3.2 (1.3)Computed tomographic (CT) scanning has an established role in the evaluation of idioyears (range 1.6-6.5). The relative extents of ground glass and honeycombing were pathic pulmonary fibrosis.8 9 On the CT scan DIP is characterised by patchy areas of ground determined from serial CT scans. Changes in the extent and appearance of the disease glass opacification, predominantly on the periphery of the lung. 10 It has recently been sugwere examined in paired anatomically comparable CT sections.gested that the greater extent of ground glass attenuation and the paucity of cystic changes Results -Common features on the CT scans of patients with DIP were a homo-in patients with DIP should enable it to be distinguished from UIP. 11geneous increase in lung attenuation (n= 5), linear areas of attenuation (n=5), rel-UIP is easily distinguished from DIP by the presence of honeycomb cysts.10 However, cystic atively well preserved lung architecture (n=5), and the presence of small cysts (n= changes may also be seen but are less prominent in DIP. 11 DIP should change to UIP during 6). Uncommon features were architectural distortion (n=3) and traction bron-follow up if DIP represents the early stage and UIP the late stage of the same disease. chiectasis (n=1). In six patients with DIP with cystic spaces these did not changeThe purpose of this study was to assess the CT features of DIP, to evaluate the changes of with time in three cases, in two they regressed, and in one patient they increased. the pattern and extent of the disease with time, and to determine whether the CT appearances Open lung biopsy samples from patients with DIP with many cystic lesions showed of DIP change to those of UIP during follow up. dilated alveolar ducts and bronchioles and/ or pulmonary cysts, as well as numerous macrophage-filled air spaces and mild

Idiopathic interstitial pneumonias: imaging–pathology correlation

“…Cysts when identified are thought to correspond to dilated alveolar ducts and bronchioles with no parenchymal distortion. Minor honeycombing is seen in less than onethird of cases [44,45]. The ground-glass opacification …”

Smoking-related interstitial lung diseases: a concise review

“…When treated, patients with DIP usually receive long-term corticosteroid therapy. Most patients with DIP remain stable or improve with corticosteroid therapy and complete recovery is possible [10,11,27,28]. The response to corticosteroid therapy is not uniform and approximately one-quarter of patients may continue to worsen despite treatment for DIP [10,11,28].…”

The role of high-resolution computed tomography in the follow-up of diffuse lung disease

“…In the study by KAWABATA et al [22], 16% of DIP patients showed temporal progression of HRCT findings as evidenced by the development of honeycombing and/or thin-walled cysts (figure 1b). These thin-walled cysts demonstrated a different morphology than honeycombing, potentially representing emphysema surrounded by fibrosis [19].…”

“…In patients with predominantly inflammatory (non-fibrotic) disease, manifested by peripheral GGO on HRCT, the cessation of smoking will be associated with significant improvement or resolution of the abnormalities [19,20]. Corticosteroid therapy may be used in conjunction with smoking cessation.…”