Lymphocytic interstitial pneumonitis
Lymphocytic interstitial pneumonitis (LIP) is a benign lymphoproliferative disorder characterised by lymphocyte predominant infiltration of the lungs 1,5. It is classified as a subtype of interstitial lung disease. It also falls under the umbrella of non lymphomatous pulmonary lymphoid disorders 7.
Demographics and clinical presentation
There is a recognised female predilection.
There is generally diffuse infiltration of the interstitium and alveolar spaces by lymphocytes and plasma cells.
- Sjogren syndrome: can occur in up to 25% of those with LIP 6
- AIDS: particularly if it occurs in the young
- rheumatoid arthritis
- auto immune thyroid disease
- systemic lupus erythematosus (SLE)
- Castleman disease
- features can be non specific, but may include
The following features may be seen with LIP on HRCT, but the findings are not exclusive to its diagnosis.
- features generally tend to be diffuse
- mediastinal lymphadenopathy
- ground-glass change
- scattered thin walled cysts - usually deep within the lung parenhyma and range from 1-30 mm (useful for differentiation between lymphoma or the lung 1)
- intersitital thickening along lymph channels 2
- thickening of bronchovascular bundles
- small but variably sized pulmonary nodules (can be centrilobular or subpleural, and often ill defined)
Treatment and prognosis
The natural history is variable, from near complete resolution to progressive disease. Corticosteroids have been successfully trialled 1.
General imaging differential considerations include
- 1.Honda O, Johkoh T, Ichikado K et-al. Differential diagnosis of lymphocytic interstitial pneumonia and malignant lymphoma on high-resolution CT. AJR Am J Roentgenol. 1999;173 (1): 71-4. AJR Am J Roentgenol (abstract) - Pubmed citation
- 2. Johkoh T, Müller NL, Pickford HA et-al. Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients. Radiology. 1999;212 (2): 567-72. Radiology (full text) - Pubmed citation
- 3. Silva CI, Churg A, Müller NL. Hypersensitivity pneumonitis: spectrum of high-resolution CT and pathologic findings. AJR Am J Roentgenol. 2007;188 (2): 334-44. doi:10.2214/AJR.05.1826 - Pubmed citation
- 4. T Fischer et.al, The idiopathic interstitial pneumonias: a beginner's guide, Imaging (2004) 16, 37-49
- 5. Kim TS, Lee KS, Chung MP et-al. Nonspecific interstitial pneumonia with fibrosis: high-resolution CT and pathologic findings. AJR Am J Roentgenol. 1998;171 (6): 1645-50. AJR Am J Roentgenol (abstract) - Pubmed citation
- 6. Najjar N, El gamal A, Halabi S et-al. A 38-year-old man with HIV infection and subacute onset of cough and dyspnea. Chest. 2005;128 (6): 4008-12. doi:10.1378/chest.128.6.4008 - Pubmed citation
- 7. Glickstein M, Kornstein MJ, Pietra GG et-al. Nonlymphomatous lymphoid disorders of the lung. AJR Am J Roentgenol. 1986;147 (2): 227-37. AJR Am J Roentgenol (abstract) - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Lymphoid interstitial pneumonia||✓|
|Lymphocytic interstitial pneumonitis||✗|
|Lymphocytic interstitial pneumonia (LIP)||✗|
|Lymphocytic interstitial pneumonia||✗|
|Lymphoid interstitial pneumonia (LIP)||✗|
|Lymphocytic interstitial pneumonitis (LIP)||✗|