CASE 108

HRCT (lung window) (Figs. 108.1A, 108.1B) demonstrates extensive bilateral areas of ground glass attenuation, irregular juxtapleural linear opacities consistent with mild fibrosis, and traction bronchiectasis.

Diagnosis

Desquamative Interstitial Pneumonia (DIP)

Differential Diagnosis

• Chronic Hypersensitivity Pneumonitis

• Pulmonary Drug Toxicity

• Pulmonary Hemorrhage

• Eosinophilic Pneumonia

Discussion

Background

Desquamative interstitial pneumonia (DIP) is a rare idiopathic interstitial pneumonia that occurs almost exclusively in current or former smokers and is characterized histologically by diffuse, marked intra-alveolar accumulation of macrophages and minimal interstitial fibrosis. It is considered part of a histopathologic spectrum of smoking-related interstitial lung diseases that includes pulmonary Langerhans’ cell histiocytosis and respiratory bronchiolitis–associated interstitial lung disease (RB-ILD). The term desquamative is a misnomer based on the previous but erroneous concept that the intra-alveolar cells represent desquamated pneumocytes. Some authors have suggested that a more technically correct terminology for DIP would be alveolar macrophage pneumonia. The incidence of DIP is much lower than that of usual interstitial pneumonia (UIP). The diagnosis of DIP requires open or thoracoscopic lung biopsy.

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