Kang Hyung Koo, Choi Sun Mi, Shin Hong-Joon, Jung Hae In, An Uiri, Yang Sei Hoon
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Tuberc Respir Dis (Seoul). 2025 Jul;88(3):454-476. doi: 10.4046/trd.2024.0181. Epub 2025 Mar 13.
Rare forms of interstitial lung diseases (ILDs) present with unique clinical features and require different treatment strategies. Respiratory bronchiolitis-associated ILD mainly affects smokers, showing ground-glass opacities on chest computed tomography (CT) scans and pigmented macrophages in the bronchoalveolar lavage fluid. Smoking cessation is essential for treatment, with corticosteroids used for severe cases. Desquamative interstitial pneumonia, also related to smoking, is characterized by exertional dyspnea, dry cough, restrictive lung function, and ground-glass opacities on high-resolution CT. Lymphoid interstitial pneumonia involves lymphocytic proliferation and is associated with autoimmune diseases or infections, treated with corticosteroids. Acute interstitial pneumonia resembles acute respiratory distress syndrome but occurs without a clear cause and is managed with supportive care. Idiopathic pleuroparenchymal fibroelastosis results in fibrosis in the upper lobes, primarily in nonsmokers, and is diagnosed through clinical and imaging findings, with no effective treatment to improve survival. Each condition has distinct pathological features, clinical presentations, and treatment approaches, along with variable prognoses.
罕见类型的间质性肺疾病(ILDs)具有独特的临床特征,需要不同的治疗策略。呼吸性细支气管炎相关的ILD主要影响吸烟者,胸部计算机断层扫描(CT)显示磨玻璃影,支气管肺泡灌洗液中有色素沉着的巨噬细胞。戒烟是治疗的关键,严重病例使用皮质类固醇。脱屑性间质性肺炎也与吸烟有关,其特征为劳力性呼吸困难、干咳、限制性肺功能以及高分辨率CT上的磨玻璃影。淋巴细胞间质性肺炎涉及淋巴细胞增殖,与自身免疫性疾病或感染有关,采用皮质类固醇治疗。急性间质性肺炎类似于急性呼吸窘迫综合征,但无明确病因,采用支持治疗。特发性胸膜肺实质纤维弹性组织增生症导致上叶纤维化,主要见于非吸烟者,通过临床和影像学检查确诊,尚无改善生存的有效治疗方法。每种疾病都有独特的病理特征、临床表现、治疗方法以及不同的预后。