CTICasesReversible Smoking-Related Respiratory Bronchiolitis
Imaging findings
High-resolution chest CT of a smoker with emphysema shows upper-lung-predominant, peripheral, and centrilobular ground-glass opacities, as well as lower lobe ground-glass opacities admixed with emphysema. Following right lower lobectomy for lung cancer and subsequent smoking cessation, a repeat CT scan obtained six to seven months later demonstrates near-complete resolution of the extensive bilateral ground-glass opacities. Histopathology from the resected lobe confirmed respiratory bronchiolitis and mild fibrosis.
Key takeaways
Smoking-related lung diseases, such as respiratory bronchiolitis (RB) and respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), can show dramatic and rapid radiologic improvement or complete resolution within months of smoking cessation. Although some elements of smoking-induced fibrosis are permanent, the active inflammatory component (macrophage-rich alveolar and bronchiolar alveolitis) is highly reversible.
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