Interstitielle Lungenerkrankungen bei Rauchern

Zusammenfassung

Zentraler Gesichtspunkt der radiologischen Diagnostik interstitieller Lungenerkrankungen bei Rauchern ist die Tatsache, dass es sich hierbei um ein Spektrum von Erkrankungen mit häufiger Koexistenz bzw. Transformation der einzelnen Entitäten handelt. respiratorische bronchiolitisassoziierte interstitielle Lungenerkrankung (RBILD) und desquamative interstitielle Pneumonie (DIP) unterscheiden sich v. a. in der Lokalisation und der Ausprägung der akkumulierenden Alveolarmakrophagen sowie hinsichtlich des Grads der interstitiellen Veränderungen; ihre histopathologische Differenzierung (und daher auch die radiologische Differenzialdiagnose) ist im Einzelfall schwierig bzw. nicht möglich. Beide Entitäten kommen häufig als „Begleitbefund” bei Patienten mit pulmonale Langerhanszellhistiozytose (PLCH) vor. Einige Raucher können zusätzlich, möglicherweise als Folge einer DIP, eine Lungenfibrose entwickeln, die bildmorphologisch und histopathologisch einer NSIP entspricht - ein Zusammenhang, der im Rahmen zukünftiger Studien näher untersucht werden wird.

Abstract

The most important smoking-related interstitial lung diseases (ILD) are respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, desquamative interstitial pneumonia, and Langerhans’ cell histiocytosis. Although traditionally considered to be discrete entities, smoking-related ILDs often coexist, thus accounting for the sometimes complex patterns encountered on high-resolution computed tomography (HRCT). Further studies are needed to elucidate the causative role of smoking in the development of pulmonary fibrosis.

Key words

smoking - interstitial lung disease - high-resolution CT

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