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Narrowing the Differential Diagnosis of Cystic Lesions in Smokers with Expiratory CT Acquisition Using the Cyst-Airway Communication Hypothesis

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Abstract

The aim of this study was to assess percentage respiratory changes (δ) in the size of pulmonary cysts of different smoking-related etiologies. Retrospectively, we measured the cystic lesions due to histopathological-confirmed honeycombing from interstitial pulmonary fibrosis, pulmonary Langerhans cell histiocytosis (PLCH), and paraseptal emphysema, using paired inspiratory and expiratory CT scans. In a sample of 72 patients and 216 lesions, the mean diameter of PLCH and honeycombing decreased during expiration (PLCH, δ = 60.9%; p = 0.001; honeycombing, δ = 47.5%; p = 0.014). Conversely, paraseptal emphysema did not show any changes (δ = 5.2%; p = 0.34). In summary, our results demonstrated that cysts in smokers with PLCH and honeycombing fibrosis get smaller during expiratory CT scans, whereas the size of cystic-like lesions due to paraseptal emphysema and bullae tend to remain constant during respiratory cycles. These results support the hypothesis of cyst-airway communication in some cystic diseases, which could assist in the differential diagnosis in smoking-related lung diseases.

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Acknowledgements

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiology, College of Medicine, University of Florida, 1600 SW Archer Rd m509, Gainesville, FL, 32610, USA

    Bruno Hochhegger, Pratik P. Patel, Daniela Quinto dos Reis Hochhegger & Klaus Irion

  2. Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619-900, Brazil

    Bruno Hochhegger, Matheus Zanon, Enrico Müller & Liana Ferreira Correa

  3. Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil

    Bruno Hochhegger, Matheus Zanon, Nupur Verma, Tan-Lucien Mohammed & Daniela Quinto dos Reis Hochhegger

  4. Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust - Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Oxford Road, Manchester, M139WL, UK

    Klaus Irion

  5. Department of Radiology, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Rio de Janeiro, 21941-902, Brazil

    Edson Marchiori

Authors
  1. Bruno Hochhegger
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  2. Pratik P. Patel
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  3. Matheus Zanon
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  4. Enrico Müller
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  5. Liana Ferreira Correa
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  6. Nupur Verma
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  7. Tan-Lucien Mohammed
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  8. Daniela Quinto dos Reis Hochhegger
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  9. Klaus Irion
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  10. Edson Marchiori
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Contributions

All authors contributed to the study conception and design, material preparation, data collection, and analysis. The first draft of the manuscript was written by BH, PPP, MZ, and EM2 and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bruno Hochhegger.

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There are no conflicts of interest from the author.

Ethical Approval

This is an observational and retrospective study. Written consent was waived by our institutional review board, but subjects’ data was treated following the principles of the Declaration of Helsinki.

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Hochhegger, B., Patel, P.P., Zanon, M. et al. Narrowing the Differential Diagnosis of Cystic Lesions in Smokers with Expiratory CT Acquisition Using the Cyst-Airway Communication Hypothesis. Lung 200, 817–820 (2022). https://doi.org/10.1007/s00408-022-00576-5

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  • DOI: https://doi.org/10.1007/s00408-022-00576-5

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