CTICasesSmoking-Related Interstitial Lung Disease with Bizarre Cystic Airspaces
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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