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Cancer Screening (Lung) — SCE Respiratory MCQ

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HardRespiratory MedicineCancer Screening (Lung)SCE Respiratory

A current smoker has exertional dyspnoea, diffuse lower-zone ground-glass opacity and a restrictive defect. Lung biopsy shows widespread alveolar accumulation of pigmented macrophages with only mild interstitial inflammation. Which smoking-related ILD pattern is most likely?

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Correct answer: D — Desquamative interstitial pneumonia

Desquamative interstitial pneumonia is a smoking-related alveolar-filling pattern with diffuse intra-alveolar pigmented macrophages and lower-zone ground-glass opacity. RB-ILD is more bronchiolocentric with centrilobular nodules and patchy ground glass; PLCH favours upper-zone nodules and cysts.

Reference: ERS integrated approach to smoking-related interstitial lung disease (Published 2012): https://publications.ersnet.org/index.php/content/errev/21/125/207; ERS and ATS update of the idiopathic interstitial-pneumonia classification (Published 2025): https://publications.ersnet.org/lookup/pmid/40774805