Dr. Daria Manos: Boehringer Ingelheim CSL Behring HIT Global. Dr. Horatiu Muller: No conflicts of interest

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2 Dr. Daria Manos: Boehringer Ingelheim CSL Behring HIT Global Dr. Horatiu Muller: No conflicts of interest

3 Honeycombing Centrilobular emphysema (CLE) Paraseptal emphysema (PSE) Panlobular emphysema Cystic lung disease

4 Unusual lucency pattern, not characteristic for any of the established types: Well-demarcated Involving peripheral 1/3 of lung Basal-predominant Features of honeycombing Features of emphysema

5 Does this represent Respiratory bronchiolitis with fibrosis Smoking-related interstitial fibrosis Respiratory bronchiolitis interstitial lung disease (ILD) with fibrosis Airspace enlargement with fibrosis?

6 From Reddy et al., 2013

7 Uncommon pulmonary lucency pattern, for which: 1) The radiological appearance only has limited description in the literature = > Propose standardized criteria for defining the radiological appearance 2) The frequency in the target population has not been determined => Sample the frequency of occurrence in the target population (heavy smokers)

8 Cohort: 320 asymptomatic smokers/ex smokers enrolled in the Pan Canadian Lung Cancer Detection Study (PCLCDS) at Queen Elizabeth II Health Sciences Centre Current / former smokers, years of age Without history of lung cancer With a smoking history of at least 30 pack-years 3 year lung cancer risk 2% Multidetector-row CT scanner Settings:120 kvp, ma, tube rotation time < 1 s Contiguous images reconstructed in transaxial plane at up to 1.25-mm thickness Reconstructed with high-spatial-frequency algorithm

9 Baseline CTs were assessed for presence of CLE PSE Panlobular emphysema Each CT was reviewed By a fellowship-trained chest radiologist By a radiology resident Both blinded to demographic information Results were correlated with smoking history

10 POSITIVE FEATURES 1. Well defined lucencies 2. Subpleural 3. Basal-predominant 4. Stacked ( 3 layers)

11 NEGATIVE FEATURES 1. Not associated with honeycombing 2. Not associated with traction bronchiectasis 3. Appearance atypical for well-established emphysema

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14 BSE pattern identified in 7 patients (3, 4 ) BSE represented 2.1% of total cases assessed Smoking: pack-years (average 48.9) BSE: Average cranio-caudal extent : 115 mm Average axial depth : 45 mm Size of individual lucencies : 4-25 mm Almost all patients with BSE also demonstrated upper-lobe predominant PSE and CLE

15 Basal Subpleural Emphysema (BSE): rare but can be encountered in asymptomatic smokers Radiologists should be aware of this entity so that it is not misinterpreted as honeycombing / other forms of fibrosis The CT appearance and frequency of the pattern we have termed BSE has not been described previously but may represent a subtype of airspace enlargement with fibrosis The clinical significance of BSE might differ from that of honeycombing /common types of emphysema however unexplored at this time

16 CLE

17 Honeycombing

18 Traction bronchiectasis

19 1. Cottin, V., Nunes, H., Brillet, P.Y., Delaval, P., Devouassoux, G., Tillie-Leblonde, I., Israel-Biet, D., Court-Fortune, I., Valeyre, D., Cordier, J. F. Combined pulmonary fibrosis and emphysema: a distinct underrecognised entity. Eur Respir J. 2005; 26: Cottin,V., Nunes, H., Mouthon, L., Gamondes, D., Lazor,R., Hachulla,E., Revel,D., Valeyre,D., Cordier, J. F. Combined Pulmonary Fibrosis and Emphysema Syndrome in Connective Tissue Disease. Arthritis & Rheumatism 2011; 63: Inomata, M., Ikushima, S., Awano, N., Kondoh, K., Satake, K., Masuo, M., Kusunoki, Y., Moriya, A., Kamiya, H., Ando, T., Yanagawa, N., Kumasaka, T., Ogura, T., Sakai, F., Azuma, A., Gemma, A. Takemura, T. An autopsy study of combined pulmonary fibrosis and emphysema: correlations among clinical, radiological, and pathological features. BMC Pulmonary Medicine 2014;14: Jankowich, M.D., Rounds, S.I.S. Combined Pulmonary Fibrosis and Emphysema Syndrome. Chest 2012; 141(1): Jen, R., Ryerson, C. J. Combined pulmonary fibrosis and emphysema. Curr Respir Care Rep (2013) 2: Katzenstein, A.L.A., Mukhopadhyay, S., Zanardi, C., Dexter, E. Clinically occult interstitial fibrosis in smokers: classification and significance of a surprisingly common finding in lobectomy specimens. Human Pathology 2010; 41, Mejía, M., Carrillo, G., Rojas-Serrano, J., Estrada, A., Suarez, T., Alonso, D., Barrientos, E., Gaxiola, M., Navarro, C., Selman, M. Idiopathic Pulmonary Fibrosis and Emphysema. Chest 2009; 136: Palmucci, S., Roccasalva, F., Puglisi, S., Torrisi, S. E., Vindigni, V., Mauro, L. A., Ettorre, G. C., Piccoli, M., Vancheri, C. Clinical and radiological features of idiopathic interstitial pneumonias (IIPs): a pictorial review. Insights Imaging 2014; 5: Palmucci, S., Roccasalva, F., Puglisi, S., Torrisi, S. E., Vindigni, V., Mauro, L. A., Ettorre, G. C., Piccoli, M., Vancheri, C. Clinical and radiological features of idiopathic interstitial pneumonias (IIPs): a pictorial review. Insights Imaging 2014; 5: Reddy, T. R., Mayo, J., Churg, A. Respiratory Bronchiolitis with Fibrosis: High-Resolution Computed Tomography Findings and Correlation with Pathology. Ann Am Thorac Soc 2013; 10 (6): Sabri, Y.Y., Farid, M. F. Smoking Related Interstitial Lung Disease High Resolution Computed Tomography (HRCT) findings in 40 smokers. The Egyptian Journal of Radiology and Nuclear Medicine 2014; 45, Takahashi, M., Fukuoka, J., Nitta, N., Takazakura, R., Nagatani, Y., Murakami, Y., Otani, H., Murata, K. Imaging of pulmonary emphysema: A pictorial review. International Journal of COPD 2008; 3(2): Wright, J. L., Tazelaar, H. D., Churg, A. Fibrosis with emphysema. Histopathology 2011; 58: Yamada,T., Nakanishi,Y., Homma,T., Uehara,K., Mizutani,T., Hoshi,E., Shimizu,Y., Kawabata,Y., Colby, T.V. Airspace enlargement with fibrosis shows characteristic histology and immunohistology different from usual interstitial pneumonia, nonspecific interstitial pneumonia and centrilobular emphysema. Pathology International 2013; 63: