desquamative interstitial pneumonia


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des·qua·ma·tive in·ter·sti·tial pneu·mo·ni·a (DIP),

diffuse proliferation of alveolar epithelial cells, which desquamate into the air sacs and become filled with macrophages, accompanied by interstitial cellular infiltration and fibrosis; gradual onset of dyspnea and nonproductive cough occurs.

desquamative interstitial pneumonia

A generally mild, nonspecific interstitial pulmonary reaction that is a double misnomer—as it is neither desquamative nor interstitial—which is characterised by diffuse deposition of haemosiderotic macrophages. DIP is often idiopathic but may be associated with inhalation of inorganic dusts.

Demographics
Most patients are smokers and adults; DIP rarely occurs in children, in whom it has a worse prognosis.

Prognosis
Better prognosis and response to steroids than UIP (in adults).

Imaging
Bilateral ground-glass opacification.
 
DiffDx
Smoking (RBILD), amiodarone therapy, eosinophilic pneumonia, pulmonary alveolar proteinosis.

Management
Corticosteroids.
References in periodicals archive ?
They were asked to classify the histopathologic pattern according to the 2002 ATS/ERS statement on IIP (1) as follows: UIP, nonspecific interstitial pneumonia, organizing pneumonia, diffuse alveolar damage, respiratory bronchiolitis, desquamative interstitial pneumonia, and other specific diseases.
Given that most patients with PLCH are smokers, it is not surprising that the background lung parenchyma might show smoking-related changes including respiratory bronchiolitis, desquamative interstitial pneumonia, and/or emphysema (Figures 2, B, and 4, E).
As described and referenced in the preceding paragraphs, the histologic appearance of lung injury secondary to cigarette smoke is a constellation of findings that includes smokers' macrophages within airspaces, which may be airway centered (respiratory bronchiolitis) or diffuse (desquamative interstitial pneumonia) in distribution; emphysema; small-airway injury evidenced by submucosal and adventitial fibrosis, remodeling that results in distortion, and increased bronchus-associated lymphoid tissue; thickening of walls of small arteries and arterioles; stellate cellular and/ or fibrotic lesions of pulmonary Langerhans' cell histiocytosis; and alveolar wall fibrosis (Figure, c through g).
(4) The purpose of this short article is to suggest how RBF fits into the general category of smoking-related ILD, and particularly to compare it with two possibly related forms of accepted smoking-related ILDs: respiratory bronchiolitisinterstitial lung disease (RBILD) and desquamative interstitial pneumonia (DIP).