Diffuse smoking-related lung disease: emphysema and interstitial lung disease
弥漫性吸烟相关的肺病:肺气肿和间质性肺病 Abstract: Smoking-related illnesses contribute to a large number of deaths in the industrialized world and their treatment comprises a substantial percentage of total healthcare dollars.The most common and most well-known smoking-related illnesses include chronic obstructive pulmonary disease,bronchogenic carcinoma, and ischemic heart disease. However,the role of cigarette smoking in the pathogenesis of other lung diseases is becoming increasingly apparent. Knowledge of both the histologic and radiographic manifestations of smoking-related lung disease is important to the radiologist as imaging findings can be nonspecific. Finally, correlation of imaging and clinical information may obviate the need for open lung biopsy.肺气肿 Emphysema secondary to smoking is typically centrilobular. FIGURE 1. A 56-year-old male smoker with centrilobular emphysema. HRCT image shows multiple centrilobular lucencies and scattered peripheral bullae.肺朗格汉斯细胞增多症 Pulmonary Langerhans cell histiocytosis (PLCH)(Figs. 2–5) FIGURE 2. A 30-year-old male smoker with PLCH. HRCT image shows multiple lung nodules, one of which has cavitated (arrow). FIGURE 3. A 29-year-old male smoker with PLCH. HRCT image shows scattered lung nodules with ill-defined margins (black arrows), and irregular lung cysts (white arrows). FIGURE 4. A 30-year-old male smoker with PLCH. HRCT image demonstrates multiple bizarrely shaped cysts and scattered irregular nodules (black arrows). FIGURE 5. A 37-year-old male smoker with PLCH and emphysema. A and B, HRCT images show innumerable lucencies of varying sizes. Some small cysts have well-defined walls (arrows). 呼吸性毛细支气管炎 Respiratory bronchiolitis (RB) FIGURE 6. A 43-year-old asymptomatic male smoker with RB.HRCT image through the upper lungs demonstrates multiple ill-defined centrilobular nodules.呼吸性毛细支气管炎-间质性肺病 RB-associated interstitial lung disease (RB-ILD) FIGURE 7. A 46-year-old male smoker with RB-ILD. A and B,HRCT images demonstrate patchy ground-glass opacity and small bullae (arrows).
脱屑性间质性肺炎
desquamative interstitial pneumonia (DIP) FIGURE 8. A 65-year-old male heavy smoker with DIP. A and B, HRCT images show patchy basal and peripheral predominant ground-glass opacity with interlobular septal thickening (thin arrows) and small cysts (thick arrows). C, Hematoxylin and eosin stain of lung specimen showing multiple clusters of intra-alveolar macrophages (arrows).急性嗜酸细胞性肺炎 Unlike RB, RB-ILD, and DIP, the relationship between cigarette smoking and acute eosinophilic pneumonia (AEP) is less clear. FIGURE 9. A 19-year-old female smoker with AEP. HRCT image of the right lung shows septal thickening (arrowheads),ground-glass opacity, and nodular consoldiation (arrows).间质性纤维化 The exact role of cigarette smoking in the development of interstitial fibrosis. FIGURE 10. A 71-year-old male with emphysema and usualinterstitial pneumonia. A, HRCT image through the upper lungs demonstrates centrilobular (arrowheads) and paraseptal(arrows) emphysema. B, HRCT image through the mid lungs shows both centrilobular emphysema (arrowheads) and subpleural honeycombing (arrows). C, HRCT image through the lung bases shows subpleural honeycombing (arrows).特发性非特异性间质性肺炎 Recently, smoking has been implicated as a possible cause of idiopathic nonspecific interstitial pneumonia. FIGURE 11. A 47-year-old male heavy smoker with smoking-related nonspecific interstitial pneumonia. HRCT image through the lung bases shows cystic airspaces superimposedon a background of ground-glass opacity and faint reticular pattern. 来源：Stephanie Cheng,Tan Lucien H. Mohammed. Diffuse Smoking-Related Lung Disease: Emphysema and Interstitial Lung Disease[J]. Seminars in Roentgenology,2015,50(1).