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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = Desquamative interstitial pneumonia -- intermed mag.jpg | ||
| Width = | | Width = | ||
| Caption = | | Caption = Desquamative interstitial pneumonia. [[H&E stain]]. (WC/Nephron) | ||
| Synonyms = | | Synonyms = | ||
| Micro = abundant brown pigmented airspace macrophages (smoker's macrophages), architecture preserved ("linear fibrosis") | | Micro = abundant brown pigmented airspace macrophages (smoker's macrophages), architecture preserved ("linear fibrosis") | ||
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| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = | ||
| Prevalence = | | Prevalence = rare | ||
| Bloodwork = | | Bloodwork = | ||
| Rads = | | Rads = ground glass airspaces changes - usu. all lobes but peripheral predominant and in lower lobe predominant | ||
| Endoscopy = | | Endoscopy = | ||
| Prognosis = | | Prognosis = | ||
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}} | }} | ||
'''Desquamative interstitial pneumonia''', abbreviated '''DIP''', is a [[diffuse lung diseases|diffuse lung disease]] that is strongly associated with [[smoking]]. | '''Desquamative interstitial pneumonia''', abbreviated '''DIP''', is a [[diffuse lung diseases|diffuse lung disease]] that is strongly associated with [[smoking]]. | ||
The term ''desquamative interstitial pneumonia'' is a [[misnomer]]. The airspace cells that characterize the condition were once thought to represent desquamated epithelial cells, but they are now know to represent macrophages.<ref name=pmid18794314>{{Cite journal | last1 = Attili | first1 = AK. | last2 = Kazerooni | first2 = EA. | last3 = Gross | first3 = BH. | last4 = Flaherty | first4 = KR. | last5 = Myers | first5 = JL. | last6 = Martinez | first6 = FJ. | title = Smoking-related interstitial lung disease: radiologic-clinical-pathologic correlation. | journal = Radiographics | volume = 28 | issue = 5 | pages = 1383-96; discussion 1396-8 | month = | year = | doi = 10.1148/rg.285075223 | PMID = 18794314 | url=http://pubs.rsna.org/doi/full/10.1148/rg.285075223}}</ref> | |||
==General== | ==General== | ||
* | *Rare.<ref name=pmid20854463/> | ||
*Strong association with smoking.<ref name=Ref_WMSP93>{{Ref WMSP|93}}</ref><ref name=pmid26324804>{{Cite journal | last1 = Margaritopoulos | first1 = GA. | last2 = Vasarmidi | first2 = E. | last3 = Jacob | first3 = J. | last4 = Wells | first4 = AU. | last5 = Antoniou | first5 = KM. | title = Smoking and interstitial lung diseases. | journal = Eur Respir Rev | volume = 24 | issue = 137 | pages = 428-35 | month = Sep | year = 2015 | doi = 10.1183/16000617.0050-2015 | PMID = 26324804 }}</ref> | *Strong association with smoking.<ref name=Ref_WMSP93>{{Ref WMSP|93}}</ref><ref name=pmid26324804>{{Cite journal | last1 = Margaritopoulos | first1 = GA. | last2 = Vasarmidi | first2 = E. | last3 = Jacob | first3 = J. | last4 = Wells | first4 = AU. | last5 = Antoniou | first5 = KM. | title = Smoking and interstitial lung diseases. | journal = Eur Respir Rev | volume = 24 | issue = 137 | pages = 428-35 | month = Sep | year = 2015 | doi = 10.1183/16000617.0050-2015 | PMID = 26324804 }}</ref> | ||
**Thought to be advanced ''[[RBILD]]''. | **Thought to be advanced ''[[RBILD]]''. | ||
*May be seen in non-smokers (up to ~40% of cases) due to occupational exposures, drugs, viral illnesses and autoimmune diseases.<ref name=pmid23728865>{{Cite journal | last1 = Godbert | first1 = B. | last2 = Wissler | first2 = MP. | last3 = Vignaud | first3 = JM. | title = Desquamative interstitial pneumonia: an analytic review with an emphasis on aetiology. | journal = Eur Respir Rev | volume = 22 | issue = 128 | pages = 117-23 | month = Jun | year = 2013 | doi = 10.1183/09059180.00005812 | PMID = 23728865 }}</ref> | *May be seen in non-smokers (up to ~40% of cases) due to occupational exposures, drugs, viral illnesses and autoimmune diseases.<ref name=pmid23728865>{{Cite journal | last1 = Godbert | first1 = B. | last2 = Wissler | first2 = MP. | last3 = Vignaud | first3 = JM. | title = Desquamative interstitial pneumonia: an analytic review with an emphasis on aetiology. | journal = Eur Respir Rev | volume = 22 | issue = 128 | pages = 117-23 | month = Jun | year = 2013 | doi = 10.1183/09059180.00005812 | PMID = 23728865 }}</ref> | ||
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Treatment: | Treatment: | ||
*Stop smoking/remove or manage underlying cause. | *Stop smoking/remove or manage underlying cause. | ||
==Gross/Radiology== | |||
Features:<ref name=pmid8497631>{{Cite journal | last1 = Hartman | first1 = TE. | last2 = Primack | first2 = SL. | last3 = Swensen | first3 = SJ. | last4 = Hansell | first4 = D. | last5 = McGuinness | first5 = G. | last6 = Müller | first6 = NL. | title = Desquamative interstitial pneumonia: thin-section CT findings in 22 patients. | journal = Radiology | volume = 187 | issue = 3 | pages = 787-90 | month = Jun | year = 1993 | doi = 10.1148/radiology.187.3.8497631 | PMID = 8497631 }}</ref> | |||
*Ground glass (airspace changes). | |||
**Usually peripheral predominant (~60% of cases) and lower lobe predominant (~70-75% of cases). | |||
**Typically all lobes are involved - though upper lobe spared in ~20% of cases. | |||
*Fibrotic (radiologic) changes ~50% of cases. | |||
==Microscopic== | ==Microscopic== | ||
Features:<ref name=pmid20854463>{{Cite journal | last1 = Tazelaar | first1 = HD. | last2 = Wright | first2 = JL. | last3 = Churg | first3 = A. | title = Desquamative interstitial pneumonia. | journal = Histopathology | volume = 58 | issue = 4 | pages = 509-16 | month = Mar | year = 2011 | doi = 10.1111/j.1365-2559.2010.03649.x | PMID = 20854463 }}</ref> | Features:<ref name=pmid20854463>{{Cite journal | last1 = Tazelaar | first1 = HD. | last2 = Wright | first2 = JL. | last3 = Churg | first3 = A. | title = Desquamative interstitial pneumonia. | journal = Histopathology | volume = 58 | issue = 4 | pages = 509-16 | month = Mar | year = 2011 | doi = 10.1111/j.1365-2559.2010.03649.x | PMID = 20854463 }}</ref> | ||
*Abundant | *Abundant airspace macrophages - usually with brown pigment (so called ''smoker's macrophages'') - '''key feature'''. | ||
*Interstitial inflammation ''or'' interstitial fibrosis with preserved architecture | *Interstitial inflammation ''or'' interstitial fibrosis with a preserved architecture - so called "linear fibrosis". | ||
Notes: | Notes: | ||
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===Images=== | ===Images=== | ||
<gallery> | |||
Image: Desquamative interstitial pneumonia -- low mag.jpg | DIP - low mag. | |||
Image: Desquamative interstitial pneumonia -- intermed mag.jpg | DIP - intermed. mag. | |||
Image: Desquamative interstitial pneumonia -- high mag.jpg | DIP - high mag. | |||
Image: Desquamative interstitial pneumonia -- very high mag.jpg | DIP - very high mag. | |||
Image: Desquamative interstitial pneumonia - alt -- low mag.jpg | DIP - low mag. | |||
Image: Desquamative interstitial pneumonia - alt -- intermed mag.jpg | DIP - intermed. mag. | |||
Image: Desquamative interstitial pneumonia - alt -- high mag.jpg | DIP - high mag. | |||
Image: Desquamative interstitial pneumonia - alt 2 -- intermed mag.jpg | DIP - intermed mag. | |||
</gallery> | |||
====www==== | |||
*[http://pathhsw5m54.ucsf.edu/case27/dip27.html DIP (ucsf.edu)]. | *[http://pathhsw5m54.ucsf.edu/case27/dip27.html DIP (ucsf.edu)]. | ||
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==See also== | ==See also== | ||
*[[Diffuse lung diseases]]. | *[[Diffuse lung diseases]]. | ||
*[[Smoking]]. | |||
*[[Smoking-related interstitial fibrosis]]. | |||
==References== | ==References== |
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