Lymphocytic interstitial pneumonitis

Lymphocytic interstitial pneumonitis (LIP) is a benign lymphoproliferative disorder characterised by lymphocyte predominant infiltration of the lungs. It is classified as a subtype of interstitial lung disease. It also falls under the umbrella of non-lymphomatous pulmonary lymphoid disorders.

LIP can occur at any age. However, most of the patients are adults with a mean age of 50 years. If a child presents with LIP, can be indicative of AIDS.

There is a recognised female predilection most likely attributable to the fact that LIP occurs in patients with autoimmune disease such as Sjogren syndrome, which is by far more common in women 8.

The main clinical symptoms are a gradual onset of dyspnea and cough with approximately six months duration. Less frequently, patients may have systemic symptoms such as fever, night sweat, arthralgia, and weight loss. If the disease progresses to the end-stage respiratory failure cyanosis and clubbing may develop. Hypertrophy of the salivary glands observed in 20% of patients 11

There is diffuse infiltration of the interstitium and alveolar spaces by lymphocytes and plasma cells.

Associations
Markers

In about 80% of patients polyclonal or IgM monoclonal gammopathy is found 8.

Plain radiograph

Features can be non-specific, but may include:

CT

The following features may be seen with LIP on HRCT, but the findings are not exclusive to its diagnosis:

The natural history is variable, from near complete resolution to progressive disease. More than 30% of patients will develop the end-stage disease and honeycombing despite treatment.

Transformation to lymphoma can occur particularly in a patient with monoclonal gammopathy or hypogammaglobulinemia 8. Corticosteroids have been successfully trialled 1.

General imaging differential considerations include:

Share article

Article Information

rID: 8000
System: Chest
Section: Pathology
Synonyms or Alternate Spellings:
  • Lymphoid interstitial pneumonia
  • Lymphocytic interstitial pneumonitis
  • Lymphocytic interstitial pneumonia (LIP)
  • LIP
  • Lymphocytic interstitial pneumonia
  • Lymphoid interstitial pneumonia (LIP)
  • Lymphocytic interstitial pneumonitis (LIP)

Support Radiopaedia and see fewer ads

Cases and Figures

  • Drag
    LIP
    Case 1: radiograph - background Sjogren syndrome
    Drag here to reorder.
  • Drag
    Case 1: CT - showing thin walled cysts
    Drag here to reorder.
  • Drag
    Extensive ground-...
    Case 2: with predominantly ground glass changes
    Drag here to reorder.
  • Drag
    Case 3
    Drag here to reorder.
  • Drag
    Case 4
    Drag here to reorder.
  • Drag
    Case 5: SLE
    Drag here to reorder.
  • Drag
    Multiple, thinned...
    Case 6: multiple pulmonary cysts
    Drag here to reorder.
  • Drag
    Case 6: radiograph
    Drag here to reorder.
  • Drag
    Case 7
    Drag here to reorder.
  • Drag
    Case 8: in Sjogren's syndrome
    Drag here to reorder.
  • Drag
    Case 9
    Drag here to reorder.
  • Drag
    Case 10
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.