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Smoking-related Interstitial Lung Disease: Radiologic-Clinical-Pathologic Correlation¹

¹ From the Department of Radiology, Division of Cardiothoracic Radiology (A.K.A., E.A.K., B.H.G.), Division of Pulmonary and Critical Care Medicine (K.R.F., F.J.M.), and Department of Pathology (J.L.M.), University of Michigan Medical Center, Ann Arbor, Mich. Presented as an education exhibit at the 2006 RSNA Annual Meeting. Received December 12, 2007; revision requested January 18, 2008, and received May 6; accepted June 9. E.A.K. consults for General Electric and Vital Images; K.R.F. belongs to the speakers bureaus of Pfizer, Boehringer Ingelheim, GlaxoSmithKline, and Johnson & Johnson (Ortho-McNeil-Janssen Pharmaceuticals), receives research support from InterMune and Genzyme, and is a research consultant for Genzyme and Gilead Sciences; all other authors have no financial relationships to disclose. Address correspondence to A.K.A., Department of Radiology, University of Michigan, East Ann Arbor Medical Center, 4260 Plymouth Rd, Ann Arbor, MI 48109-2713 (e-mail: aattili{at}umich.edu).

Cigarette smoking is a recognized risk factor for development of interstitial lung disease (ILD). There is strong evidence supporting a causal role for cigarette smoking in development of respiratory bronchiolitis ILD (RB-ILD), desquamative interstitial pneumonitis (DIP), and pulmonary Langerhans cell histiocytosis (PLCH). In addition, former and current smokers may be at increased risk for developing idiopathic pulmonary fibrosis (IPF). The combination of lower lung fibrosis and upper lung emphysema is being increasingly recognized as a distinct clinical entity in smokers. High-resolution computed tomography is sensitive for detection and characterization of ILD and may allow recognition and classification of the smoking-related ILDs (SR-ILDs) into distinct individual entities. However, the clinical, radiologic, and histologic features overlap among the different SR-ILDs, and mixed patterns of disease frequently coexist in the same patient. The overlap is most significant between RB-ILD and DIP. Macrophage accumulation is bronchiolocentric in RB-ILD, producing centrilobular ground-glass opacity, and more diffuse in DIP, producing widespread ground-glass changes. The coexistence of upper lung nodules and cysts in a smoker allows confident diagnosis of PLCH. Final diagnosis of an SR-ILD and identification of the specific entity can be achieved with certainty only after the pulmonologist, radiologist, and pathologist have reviewed all of the clinical, radiologic, and pathologic data.

© RSNA, 2008

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Invited Commentary • Authors’ Response

Loren Ketai, Anil K. Attili, Ella A. Kazerooni, Barry H. Gross, Kevin R. Flaherty, Jeffrey L. Myers, and Fernando J. Martinez
RadioGraphics 2008 28: 1396-1398. [Full Text] [PDF]

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				L. Ketai, A. K. Attili, E. A. Kazerooni, B. H. Gross, K. R. Flaherty, J. L. Myers, and F. J. Martinez Invited Commentary * Authors' Response RadioGraphics, September 1, 2008; 28(5): 1396 - 1398. [Full Text] [PDF]