CTICasesCombined Smoking-Related Lung Disease with Overlapping LCH and RB-ILD/DIP Features
Imaging findings
Chest radiographs and CT in a smoker show fine reticulation with small holes/cysts, dense gray-appearing lung parenchyma from a heavy burden of pigmented macrophages, and a distinctive well-defined thin-walled cyst above the right hemidiaphragm; the upper lobes show more bizarre, irregularly shaped cystic spaces alongside centrilobular ground-glass nodules.
Key takeaways
This case illustrates that the various smoking-related diffuse lung diseases -- Langerhans cell histiocytosis, respiratory bronchiolitis/desquamative-interstitial-pneumonia-pattern change, and emphysema -- frequently coexist in the same patient, with different processes dominating in different regions of the lung (LCH-type bizarre cysts in the upper lobes here, versus a more typical thin-walled cyst pattern near the diaphragm); the combination is often best labeled together as smoking-related diffuse lung disease rather than forcing a single unifying diagnosis.
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