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Vol. 64. Issue S3.
Supplement “Pulmonary Interstitial Pathology”
Pages 277-289 (December 2022)
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Vol. 64. Issue S3.
Supplement “Pulmonary Interstitial Pathology”
Pages 277-289 (December 2022)
Update in Radiology
Smoking-related interstitial lung disease
Enfermedades pulmonares intersticiales relacionadas con el tabaco
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M.P. Serrano Gotarredonaa,
Corresponding author
mpserranogot@gmail.com

Corresponding author.
, S. Navarro Herreroa,
Corresponding author
silvianavarroherrero@gmail.com

Corresponding author.
, L. Gómez Izquierdob, J.A. Rodríguez Portalc
a Unidad de Imagen Cardiotorácica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
b Servicio de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
c Unidad de Patología Intersticial, Servicio de Neumología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Special issue
This article is part of special issue:
Vol. 64. Issue S3

Supplement “Pulmonary Interstitial Pathology”

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Abstract

Exposure to smoke is associated with the development of diseases of the airways and lung parenchyma. Apart from chronic obstructive pulmonary disease (COPD), in some individuals, tobacco smoke can also trigger mechanisms of interstitial damage that result in various pathological changes and pulmonary fibrosis. A causal relation has been established between tobacco smoke and a group of entities that includes respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), desquamative interstitial pneumonia (DIP), Langerhans cell histiocytosis (LCH), and acute eosinophilic pneumonia (AEP). Smoking is considered a risk factor for idiopathic pulmonary fibrosis (IPF); however, the role and impact of smoking in the development of this differentiated clinical entity, which has also been called combined pulmonary fibrosis and emphysema (CPFE) as well as nonspecific interstitial pneumonia (NIP), remains to be determined. The definition of smoking-related interstitial fibrosis (SRIF) is relatively recent, with differentiated histological characteristics. The likely interconnection between the mechanisms involved in inflammation and pulmonary fibrosis in all these processes often results in an overlapping of clinical, radiological, and histological features in the same patient that can sometimes lead to radiological patterns of interstitial lung disease that are impossible to classify. For this reason, a combined approach to diagnosis is recommendable. This combined approach should be based on the joint interpretation of the histological and radiological findings while taking the clinical context into consideration. This paper aims to describe the high-resolution computed tomography (HRCT) findings in this group of disease entities in correlation with the clinical manifestations and histological changes underlying the radiological pattern.

Keywords:
Smoking
Diffuse interstitial lung disease
High-resolution computed tomography (HRCT)
Fibrosis
Resumen

La exposición al tabaco guarda una relación reconocida con el desarrollo de enfermedades de la vía aérea y el parénquima pulmonar. Aparte de la enfermedad pulmonar obstructiva crónica, en algunos individuos el humo del tabaco puede desencadenar mecanismos de daño intersticial que resultan en variadas alteraciones patológicas y fibrosis pulmonar. Se ha reconocido un grupo de entidades con una relación causal establecida con el tabaco, que incluye la bronquiolitis respiratoria con enfermedad pulmonar intersticial, la neumonía intersticial descamativa, la histiocitosis de células de Langerhans y la neumonía eosinófila aguda. Aunque el tabaco se considera factor de riesgo, aún es ambiguo su papel e impacto en el desarrollo de la fibrosis pulmonar idiopática, la entidad clínica diferenciada que se ha denominado combinación fibrosis pulmonar y enfisema, y la neumonía intersticial no específica. La definición de la fibrosis intersticial asociada al tabaco es relativamente reciente, con características histológicas diferenciadas. La interconexión probable entre los mecanismos que determinan la inflamación y la fibrosis pulmonar en todos estos procesos referidos se traduce con frecuencia en superposición de rasgos histológicos, clínicos y radiológicos en el mismo paciente, que en algunos casos puede determinar patrones radiológicos de neumopatía intersticial no clasificables. Por ello es recomendable un abordaje combinado para el diagnóstico, que debe estar basado en la interpretación conjunta de las características histológicas y hallazgos radiológicos, en el contexto clínico apropiado. Nuestro objetivo se centra en la descripción de los hallazgos radiológicos en la tomografía computarizada de alta resolución, en correlación con las manifestaciones clínicas y las alteraciones histológicas subyacentes al patrón radiológico.

Palabras clave:
Tabaco
Enfermedad pulmonar intersticial difusa
Tomografía computarizada de alta resolución
Fibrosis

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