“Smoking Related Interstitial Lung Disease: Pattern Really Does Matter”

Despite overwhelming data detailing the harm of cigarette use, nearly 1.25 billion people worldwide continue to smoke. Amongst the myriad afflictions associated with cigarette use, smoking related interstitial lung disease is a common and likely underrecognized entity given the overlap and lack of consensus in clinical, pathological, and radiological diagnosis. Many characteristic patterns of disease have been identified on diagnostic chest imaging, and using a pattern-based approach to radiologic diagnosis can improve diagnostic accuracy. Several discrete disease processes are categorized as smoking related interstitial lung disease and range from a potentially reversible desquamative interstitial pneumonia/alveolar macrophage pneumonia, to chronic and insidious onset idiopathic pulmonary fibrosis with high morbidity and mortality. This article reviews the common clinical findings and demographics associated with patient presentation, histopathological findings for each of the smoking related interstitial lung diseases upon tissue sampling or biopsy and suggests a pattern-based approach to radiologic diagnosis.