Smoking-related interstitial lung disease: Radiologic-clinical-pathologic correlation
Smoking-related interstitial lung disease: Radiologic-clinical-pathologic correlation
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DOI：
10.1148/rg.285075223
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发表时间：
2008-09-01
期刊：
影响因子：
5.5
通讯作者：
Martinez, Fernando J.
中科院分区：
文献类型：
--
作者：
Attili, Anil K.;Kazerooni, Ella A.;Martinez, Fernando J.
吸烟是公认的间质性肺病（ILD）发生的危险因素。有强有力的证据支持吸烟在呼吸性细支气管炎ILD（RB-ILD）、脱屑性间质性肺炎（DIP）和肺朗格汉斯细胞组织细胞增生症（PLCH）的发生中具有因果关系。此外，既往和当前吸烟者发生特发性肺纤维化（IPF）的风险可能增加。下肺纤维化和上肺气肿的组合越来越被认为是吸烟者的一个独特的临床实体。高分辨率计算机断层扫描对ILD的检测和表征敏感，可以将吸烟相关ILD（SR-ILD）识别和分类为不同的个体实体。然而，不同的SR-ILD的临床、影像学和组织学特征重叠，并且在同一患者中经常同时存在疾病的混合模式。RB-ILD和DIP之间的重叠最为显著。在RB-ILD中，巨噬细胞聚集以细支气管为中心，产生小叶中心毛玻璃样混浊，而在DIP中，巨噬细胞聚集更为弥漫，产生广泛的毛玻璃样改变。吸烟者上肺结节和囊肿的共存使PLCH的诊断更有把握。只有在肺科医生、放射科医生和病理科医生审查了所有临床、放射学和病理学数据后，才能确定SR-ILD的最终诊断和特定实体的识别。(C)RSNA，2008.radiographics.rsnajnls.org.
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. (C) RSNA, 2008.radiographics.rsnajnls.org.