Learning objectives
To describe the spectrum of radiologic findings in diffuse smoking-related lung disease and how the pathologic manifestations lead to specific findings on high-resolution computerized tomography (HRCT).
Background
Tobacco smoke is a toxic and carcinogenic mixture containing an estimated 5.000 chemicals,
and is probably the most significant source of toxic chemical exposure and chemically mediated disease in humans.
The direct toxicity of cigarette smoke in the lung cells and the body’s inflammatory response to this injury induce both reversible and irreversible damage to the large airways,
small airways,
alveolar walls,
and alveolar spaces.
Although all smokers have some degree of inflammation in the airways,
only a minority develop clinically significant diffuse lung disease....
Findings and procedure details
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
COPD,
defined on the basis of spirometric evidence of airway obstruction,
encompasses several distinct but overlapping obstructive syndromes not entirely reversible,
including emphysema,
chronic bronchitis,
and reduction in the caliber and number of small airways in the lung.
Bronchiolitis is the earliest lesion in COPD.
Emphysema is formed distal to surviving bronchioles,
supported by collateral ventilation of acini within the same lobule that lost terminal bronchioles.
Bronchitis or inflammation of the large airways is secondary to an innate immune response to...
Conclusion
Smoking-related lung diseases represent a wide clinicopathologic manifestation due to the same process of lung injury.
Some or all of these histologic findings can overlap and be seen in a single patient,
and although key findings can be recognized,
mixed patterns of disease associated with cigarette smoking may be confusing at HRCT.
An integrated radiologic and pathologic approach is useful for best comprehension and distinction of these entities.
Personal information
- Célia Sousa,
Radiology Resident,
Centro Hospitalar de São João,
Porto,
Portugal
- André Carvalho,
Radiology Resident,
Centro Hospitalar de São João,
Porto,
Portugal
- Márcio Rodrigues,
Radiology Resident,
Centro Hospitalar de São João,
Porto,
Portugal
- João Rebelo,
Radiology Resident,
Centro Hospitalar de São João,
Porto,
Portugal
- Susana Guimarães,
MD,
MSc,
Pathology Department,Centro Hospitalar de São João,
Porto,
Portugal
- Rui Cunha,
Radiologist,
Centro Hospitalar de São João,
Porto,
Portugal
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