Cystic lung disease: probable lymphocytic interstitial pneumonitis
Shortness of breath over many months. No known significant past medical conditions. Not on any medications. The patient has declined to have bronchoscopy or an open lung biopsy.
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Both lungs show numerous cysts in all zones. These cysts are located in a perivascular location.
Changes of groung glass opacification are also present bilaterally
These changes have remained unaltered over a 16 month period.
The perivascular location of the cysts and the ground glass appearance of the lungs is suggestive of a diagnosis of lymphocytic interstitial pneumonitis.
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When viewing a HRCT study of multiple lung cysts, it is important to establish whether the findings are those of multiple pulmonary cysts or airway abnormalities, as seen in emphysema, bronchiectasis, or bullous lung disease.
Cystic lung disorders include pulmonary Langerhans cell histiocytosis (PLCH), lymphangioleiomyomatosis (LAM), and lymphocytic interstitial pneumonitis (LIP).
Rarer causes of multiple lung cysts include light chain deposition disease, amyloidosis, Birt-Hogg-Dube syndrome and neurofibromatosis.
Cavitating lung metastases can also result in multiple cysts (lacunar metastases).