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The Overlap Between Respiratory Bronchiolitis and Desquamative Interstitial Pneumonia: Clinical and Radiographic Characteristics

The Overlap Between Respiratory Bronchiolitis and Desquamative Interstitial Pneumonia: Clinical and Radiographic CharacteristicsThe second patient (patient 2 in Tables 1, 2) was a 48-year-old white man with a 30-pack-year smoking history referred for evaluation of progressive dyspnea. Although claiming to have quit smoking several months prior to evaluation, arterial blood gas analysis revealed a carbon monoxide concentration of 2%. The pulmonary examination revealed scattered bilateral basal crackles, and pulmonary function testing revealed a restrictive process with a plethysmographically measured TLC of 70% predicted and a Dlco of 55% predicted. HRCT of the chest demonstrated patchy areas of ground-glass attenuation in both lungs, believed to be most consistent with a diagnosis of hypersensitivity pneumonitis or RB-ILD. Link
A videothoracoscopic biopsy of the right middle lobe demonstrated PLCH with prominent features of RB. The patient was treated with prednisone, 40 mg/d, but died of unrelated causes just weeks after the diagnosis was established.
Clinical and Radiographic Characteristics of the Study Population
The study population consisted of six men and eight women, with an average age of 49.3 years (Table 1). All were either smokers at the time of diagnosis by lung biopsy or had quit smoking within the year preceding the lung biopsy (mean pack-years smoked at the time of diagnosis, 26.9; range, 1 to 70 pack-years). Results of pulmonary function testing (Table 1) were normal in three patients, revealed obstructive physiology in four patients (normal or increased TLC with an FEV1/FVC < 0.75), and restrictive physiology in seven patients (TLC < 80% of predicted). The Dlco was reduced (< 72% of predicted normal value) in seven patients (mean, 70.3%; range, 40 to 98%).
Lung nodules were the most frequent finding on HRCT (Table 2), occurring in combination with cystic abnormalities in five cases, and in the absence of cystic change in six cases.