RADIOLOGICAL DIAGNOSIS
We ask: what is the diagnosis?
57 year old Caucasian man
Weakness and dyspnea to moderate effort for two years, with 20 kg weight loss during this period
Smoker for 15 years, 1/3 of a pack per day. Quit smoking four years ago.
Jorge KavakamaI; Nestor MüllerII
IRadiologist of the Imaging Diagnosis of the Heart Institute InCor of the HCFMUSP, São Paulo, SP
IISt. Pauls Hospital, Vancouver, BC, Canada
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Diagnosis of the case of the previous issue
J Pneumol 2003;29(2):116
Lymphocytic Interstitial Pneumonia (LIP)
HIGH RESOLUTION CT (HRCT)
Predominant damage of the lower pulmonary fields, characterized by: opacity in dim glass, cystic formations, ill-defined center-lobular nodes, small sub-pleural nodes, and septal thickening.
Comments
LIP is considered a benign lymphoproliferative disease, characterized by diffuse interstitial infiltration, with predominance of lymphocytes and plasma cells.
It is usually associated with other diseases, especially Sjögrens Disease and AIDS. Other associations include primary biliar cirrhosis, multicentric Castlemans disease, chronic active hepatitis, renal tubular acidosis, miastenia gravis, systemic lupus erythematosus, auto-immune thyroiditis, and bone marrow allogeinic transplant.
It generally affects adults in their 50´s, predominantly women, except in the case of AIDS, in which the damage is higher for children.
At the thoracic X-ray, the most frequent aspect is the reticular or reticular-nodular pattern, damaging the lower fields. Further alterations include bilateral consolidation, nodules and hilar lymphonodusmegaly, the latter being more usual in AIDS.
At HRCT, the predominant alterations are bilateral opacity on dim glass and ill-defined center-lobular nodes. Other findings: cysts, sub-pleural nodes, thickening of the peribronchovascular interstice and of the interlobular septum. More seldom: nodes of 1 to 2 cm in diameter, consolidation of the airway, bronchiectasis and faveolating.
In the Sjögrens Syndrome the predominant findings of LIP at the HRCT are opacities on dim glass and cysts.
Benedito Francisco Cabral Junior Brasília University Hospital (HUB) Brasília, DF
José Antonio Baddini Martinez Ribeirão Preto School of Medicine (USP), Ribeirão Preto, SP
Karina Tavares Oliveira Escola Paulista de Medicina (EPM), São Paulo, SP
Lucia Ande Santos Universidade Federal de São Paulo, São Paulo, SP
Marcelo Alcântara Holanda Universidade Federal do Ceará, Fortaleza, CE
Marcelo Bicalho de Fuccio Escola Paulista de Medicina, Universidade Federal de São Paulo, (EPM/UNIFESP), São Paulo, SP
Marcelo Coelho Machado Itamaraty Medical Center, Vitória da Conquista, BA
Marlon B.M. Molina HAGF, Ponte Nova, MG
Nassir José Jabour Khoury Albert Sabin Hospital, Juiz de Fora, MG
Richard Volpato Heliópolis Hospital, São Paulo, SP
Roberto Rodrigues Junior ABC School of Medicine, São Paulo, SP
Simone Castelo Branco Fortaleza Messejana Hospital, Fortaleza, CE
Publication Dates
-
Publication in this collection
24 Sept 2003 -
Date of issue
June 2003