CTICasesSmoking-Related Interstitial Lung Disease with Bizarre Cystic Airspaces
[...]. Smoking-Related Interstitial Lung Disease with Bizarre Cystic Airspaces. CTICases. Published April 19, 2018. https://cticases.com/c/2tj8z
Imaging findings
Chest radiograph shows apical cystic spaces with coarse reticular opacities in the upper lung zones and poorly defined opacities in the lower zones. Thin-section CT shows bizarre, irregularly shaped cystic spaces embedded in abnormal parenchyma in the upper lobes -- distinctly larger and more irregular than typical centrilobular emphysema -- together with extensive ground-glass opacity and a few small cystic spaces in the lower lobes.
Key takeaways
Bizarre, irregularly shaped cystic airspaces in the upper lobes together with basal ground-glass opacity in a smoker represent the spectrum of smoking-related diffuse lung disease and can be diagnosed with confidence from imaging alone, without biopsy, in the absence of features suggesting connective tissue disease; biopsy in this case confirmed classic findings of pigmented smoker's macrophages with cystic spaces lined by respiratory epithelium, and notably little centrilobular emphysema, supporting that the cysts themselves -- not simple emphysema -- account for the bulk of the abnormality.
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