Chest radiography in desquamative interstitial pneumonitis: a review of 37 patients

Follow-up radiographs were obtained in 37 cases of desquamative interstitial pneumonitis (DIP) in order to assess the degree to which the radiographic appearance could be used to follow the course of the disease and/or predict prognosis. The films were compared to the clinical outcome in 21 patients and the histology of the original biopsy was studied in 16 cases. The radiographic appearance was most commonly nonspecific, consisting of irregular opacities especially at the bases. Only six cases had the "classic" appearance of hazy, ground-glass densities in the medial parts of the lower lung fields. Of the 21 patients, 16 showed clinical improvement, usually after corticosteroid therapy. The radiographic changes accurately reflected the clinical course in 18 of 21 patients, although specific patterns could not be associated with any specific outcome and the films became completely normal in only four of the 16 patients who improved. Histologic characteristics within the confines of those diagnostic of DIP were not useful in predicting outcome. These results confirm the utility of radiography in following the course of DIP, although specific radiographic appearances cannot be used to predict prognosis. The favorable prognosis demonstrated in DIP favors the separation of DIP and UIP (usual interstitial pneumonitis) as independent diseases.
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