0:01

Now let's talk about LIP.

0:02

So just to get everyone on the same page, the LIP

0:06

that radiologists talk about, especially in the setting

0:09

of diffuse cystic lung disease,

0:11

is likely not the same disease

0:14

as pathologists talk about when they talk about LIP.

0:17

And this has caused much confusion.

0:20

And so I predict in the future something will change.

0:24

And so most of these cases of patients who are adult

0:27

with diffuse cystic lung disease

0:30

and LIP lymphocytic interstitial pneumonitis,

0:33

they will actually have underlying Sjogren's syndrome

0:35

or some other connective tissue disease or immunodeficiency.

0:38

And so I, I think in the future maybe it'll

0:41

be more disease specific.

0:42

It'll be say, SJOGREN related cystic lung

0:45

disease or something like that.

0:46

But um, for now I think most radiologists are still using

0:50

this label of LIP.

0:52

So for the purpose of this talk, we'll still use LIP

0:55

as the label for this pattern.

0:56

But just remember if a pathologist comes to you

0:59

and talks about LIP, it's probably different from the LIP

1:01

that we're talking about right now.

1:03

So LIP, when it is in its inflammatory phase,

1:08

it often will present with ground lab opacity,

1:10

often bilateral, but as the inflammation goes away,

1:14

very commonly you're left with these cysts,

1:17

diffuse cystic lung disease.

1:19

The cysts tend to be variable in terms of their number

1:22

and will be para bronchovascular

1:24

or subpleural in their distribution.

1:27

As we see here, I talked about the ground lass opacity.

1:30

So even when you see the diff cystic lung disease,

1:32

you can see some residual ground LA opacity

1:35

or sometimes central lobular nodules,

1:37

but they're usually not the main pattern

1:40

when you see the diffuse cystic lung disease.

1:42

And sometimes you will see some reticulation as well.

1:45

Most of the cases I've seen diffuse cystic lung disease,

1:48

though they don't have much ground LA opacity

1:49

at all or nodules.

1:50

It's just, it's not that common.

1:52

Usually it's more of a diffuse cystic lung disease which has

1:55

a basler concentration.

1:57

So if we go back to our diagnostic schema for this, right,

2:01

that publication that was published by Escalon

2:05

and the National Jewish Group, remember the lamb cases,

2:08

they tend to be more diffuse.

2:09

And if it's more basal predominant,

2:11

we start thinking about bird hug debate

2:13

and lymphocytic interstitial pneumonitis.

2:15

So here's an example of someone with Sjogren's syndrome,

2:17

with lymphocytic interstitial pneumonitis.

2:19

We see para bronchovascular sub cysts in there.

2:23

Clearly this is baso predominant based

2:24

on the coronal reformation.

2:26

We count 1, 2, 3, at least there's at least 10 small cysts

2:29

in this lung so we can pretty sure this is a

2:31

diffuse cystic lung disease.

2:32

And the kicker is the patient had Sjogren's syndrome.

2:34

So this is pretty typical of someone

2:36

with LIP with Sjogren's.

2:39

Another example of Sjogren's syndrome with LIP,

2:41

this patient does have some areas

2:43

of Apache round loss capacity and residual nodules.

2:46

And then on top of it we have these basar predominant cyst,

2:49

which are in Subpleural

2:51

and para bronchovascular distribution.

2:53

And again, this patient also has Sjo syndrome,

2:55

which helps in terms of achieving this diagnosis

2:59

Very commonly in Sjogren's syndrome.

3:00

And LIP you get these peri cystic dot say there's a little

3:04

vessel here, which is quite specific for LIP,

3:08

especially if you have someone with Sjogrens syndrome.

3:10

This is just telling you this has a perivascular

3:13

distribution in terms of where the cyst are.