Toma Claudia Lucia, Danteş Elena, Leonte Diana Gabriela, Fildan Ariadna Petronela
Department of Pulmonology, Faculty of Medicine, "Ovidius" University of Constanta, Clinical Hospital of Pulmonology, Constanta, Romania;
Rom J Morphol Embryol. 2017;58(1):261-265.
Cigarette smoking is the most frequently encountered risk factor for chronic obstructive pulmonary disease and lung cancer. The latest American Thoracic Society÷European Respiratory Society classification of idiopathic interstitial pneumonia includes two entities related to smoking habits: respiratory bronchiolitis-associated interstitial lung disease and desquamative interstitial pneumonia. The new approach to diagnosis is to combine pathological pattern with clinical and radiological data. Lung biopsy is no longer considered the "gold standard" for diagnosis, but as a part of the diagnosis, which shall be set only after the pulmonologist, radiologist and pathologist reviewed all clinical, imaging and pathological aspects. We report a case of a young male, who complained of respiratory symptoms, had normal volumes and flows on lung function tests, moderately reduced transfer factor for carbon monoxide and "ground glass" attenuation on high-resolution computed tomography. Because the patient had exposure to contact with parrots, hypersensitivity pneumonitis was considered, but the broncho-alveolar lavage was without lymphocytosis. Open lung biopsy confirmed the diagnosis of respiratory bronchiolitis-associated interstitial lung disease, a rarely described entity in the medical literature. The patient had a good clinical outcome after smoking cessation.
吸烟是慢性阻塞性肺疾病和肺癌最常见的危险因素。美国胸科学会和欧洲呼吸学会对特发性间质性肺炎的最新分类包括两种与吸烟习惯相关的疾病：呼吸性细支气管炎相关间质性肺疾病和脱屑性间质性肺炎。新的诊断方法是将病理模式与临床和放射学数据相结合。肺活检不再被视为诊断的“金标准”，而是作为诊断的一部分，只有在肺科医生、放射科医生和病理科医生对所有临床、影像学和病理学方面进行评估后才能确定。我们报告一例年轻男性病例，该患者主诉有呼吸道症状，肺功能测试中肺容积和气流正常，一氧化碳转运因子中度降低，高分辨率计算机断层扫描显示“磨玻璃”样衰减。由于患者接触过鹦鹉，曾考虑过敏性肺炎，但支气管肺泡灌洗未见淋巴细胞增多。开胸肺活检确诊为呼吸性细支气管炎相关间质性肺疾病，这是医学文献中很少描述的一种疾病。患者戒烟后临床预后良好。
