CTICasesSmoking-Related Bronchiolitis/DIP Mimicking Hypersensitivity Pneumonitis
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Imaging findings
Mosaic attenuation with ground glass and lobular areas of lower attenuation indicating air trapping (on expiration). Small ground-glass centrilobular nodules and some centrilobular emphysema in the upper lobes were also noted.
Key takeaways
This case highlights the diagnostic challenge in distinguishing smoking-related lung disease (respiratory bronchiolitis interstitial lung disease (RB-ILD) / desquamative interstitial pneumonia (DIP)) from hypersensitivity pneumonitis solely based on imaging. Pathological biopsy confirmed smoking-related macrophages consistent with RB/DIP, emphasizing the importance of clinical history and, if necessary, biopsy for definitive diagnosis.
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