Lymphocytic Interstitial Pneumonia Presenting as hilar mass with Obstructive Atelectasis: A Case Report and Literature Review

Lymphocytic Interstitial Pneumonia Presenting as hilar mass with Obstructive Atelectasis: A Case Report and Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Lymphocytic Interstitial Pneumonia Presenting as hilar mass with Obstructive Atelectasis: A Case Report and Literature Review Man Wu, Zhangyan Zhao, Haicheng Tang, Qingguo Wu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6880756/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 16 You are reading this latest preprint version Abstract Background Lymphocytic Interstitial Pneumonia (LIP) is a rare benign lymphoproliferative disorder characterized by diffuse infiltration of lymphocytes and plasma cells in the pulmonary parenchyma. It is commonly associated with autoimmune diseases. Chest CT showed multiple bronchial cysts and diffuse interstitial infiltration in most cases. Due to its nonspecific clinical manifestations, it is often misdiagnosed or overlooked. Definitive diagnosis requires pathological biopsy. Case presentation A 65-year-old male was admitted due to cough for one month. Chest CT revealed left hilar mass with left upper lung lingular segment consolidation and atelectasis (measuring approximately 3.5 cm). the pathological showed hyperplasia of alveolar epithelium with extensive interstitial infiltration of lymphocytes and plasma cells, along with histiocyte proliferation in alveolar spaces, suggestive of LIP. After treatment with corticosteroids, the patient's symptoms improved, and follow-up imaging showed radiographic resolution of the lesions. Conclusions To our knowledge, our case may be the first reported case of LIP presenting as a hilar mass on chest CT. This atypical radiological manifestation underscores the importance of differentiating LIP from malignant tumors in clinical practice. Lymphocytic Interstitial Pneumonia Hilar mass Imaging presentation Figures Figure 1 Background Lymphocytic interstitial pneumonia (LIP) is a rare form of interstitial lung disease, characterized by diffuse infiltration of lymphocytes and plasma cells in the pulmonary parenchyma[ 1 ]. Most cases are secondary to autoimmune disorders (particularly Sjögren's syndrome (SS), rheumatoid arthritis, and systemic lupus erythematosus), dysproteinemia, infections (HIV and EBV), or genetic predisposition. LIP lacks typical clinical manifestations[ 2 , 3 ]. High-resolution computed tomography (HRCT) findings include multiple bronchial cysts and diffuse interstitial infiltrates, along with ground-glass opacities, centrilobular or subpleural nodules, bronchovascular bundle thickening, interlobular septal thickening, and cystic changes. LIP is frequently misdiagnosed or overlooked in clinical practice, therefore, definitive diagnosis requires lung biopsy[ 4 ]. We present a diagnostically challenging case of LIP manifesting as hilar mass with obstructive atelectasis on HRCT. Through comprehensive analysis of this patient's clinical data and systematic literature review, we aim to enhance the understanding of LIP's diverse radiological presentations and enhance awareness of LIP. Case report A 65-year-old male patient was admitted to the hospital due to “cough for one month". One month prior, the patient developed a cough without fever, sputum production, chest tightness, or dyspnea. A chest CT at an external hospital indicated left-sided obstructive pneumonia. After 14 days of intravenous antibiotic therapy, the cough showed no improvement, and a follow-up chest CT revealed no resolution of the lesion. Past medical history included hypertension for 20 years and diabetes mellitus for 10 years. Seven years ago, the patient underwent "resection of a right femoral hemangioma with internal fixation for a right femoral fracture" and 14 years ago, a "cholecystectomy" was performed. Physical examination upon admission showed no positive findings. As for laboratory tests, Hepatitis B surface antigen, hepatitis C antibody, HIV, and syphilis-specific antibodies were negative. Eosinophil percentage (18.00%) and absolute eosinophil count (1.24×10⁹/L) were elevated. Urinalysis, stool routine, liver function, renal function, coagulation function, and cardiac markers were normal. Procalcitonin (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and serum amyloid A (SAA) were normal. Tumor markers were normal. Glycated hemoglobin (HbA1c): 10.70%. Autoimmune markers and serum protein electrophoresis were negative. EBV IgG was positive, while IgM was negative. Rubella virus and cytomegalovirus tests were negative. The electrocardiogram suggested sinus tachycardia and T-wave changes (I, aVL, V5, V6 flattened). Abdominal color Doppler ultrasound and cardiac ultrasound did not show any obvious abnormalities. Pulmonary function was normal. FeNO was 31.0 ppb. Bronchoscopy was performed, and no special pathogens were found in the bronchoalveolar lavage fluid. Chest CT showed left hilar mass with left upper lung lingular segment consolidation and atelectasis, measuring approximately 3.5 cm (Fig. 1 .A). Left lung lesion CT-guided percutaneous lung biopsy was performed, and the pathological showed hyperplasia of alveolar epithelium with extensive interstitial infiltration of lymphocytes and plasma cells, along with histiocyte proliferation in alveolar spaces, suggestive of LIP. Subsequently, obtaining the patient's informed consent, methylprednisolone 40 mg was administered for anti-inflammatory therapy for one week. A follow-up chest CT showed partial resolution of the left lung lesions (Fig. 1 .B), along with improvement in cough symptoms. The treatment was transitioned to oral prednisone as maintenance therapy. One month later, A reexamination of chest CT showed significant regression of the lesions (Fig. 1 .C). Currently, the patient is in good overall condition and remains under regular follow-up. Discussion LIP represents a rare benign lymphoproliferative disorder of the lung and frequently associated with connective tissue diseases or infections. Idiopathic LIP is exceedingly uncommon and when LIP is diagnosed, every effort must be made to diagnose potential conditions[ 3 ]. LIP is most frequently associated with Sjögren's syndrome[ 5 ], followed by infectious etiologies, primarily human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV)[ 6 , 7 ]. Approximately 25% of LIP cases are associated with SS. However, to date, approximately 20 cases of EBV-associated LIP have been reported in the literature[ 8 ]. The connective tissue disease-related indicators of our patient were all negative, while the EBV antigen lgG was found to be positive, considering that our patient may be caused by EBV virus infection. The possible mechanism is that EBV infection allows cells to proliferate in the case of dysregulation of the host immune system[ 9 ]. The onset of LIP is hidden and there is a lack of distinctive clinical manifestations. LIP may also be diagnosed by chance. Most patients present with exertional dyspnea or dry cough, while a few have chest pain or systemic symptoms such as fever, fatigue, night sweats, etc[ 3 ]. It may also have symptoms of primary diseases such as dry mouth, dry eyes, and joint pain. On physical examination, crackles are commonly detected upon pulmonary auscultation. Extrapulmonary manifestations such as peripheral lymph node lesions, hepatic enlargement or splenomegaly are not common and further examination should be given for possible lymphoma or other diagnosis. In this case, the patient's chief complaint was cough. Upon admission, comprehensive ancillary tests, including pulmonary function tests, complete blood count, and laboratory results, yielded largely normal results. High-resolution chest CT is the imaging modality of choice for evaluating pulmonary manifestations of LIP. The most characteristic CT findings in LIP patients include multiple cysts, small nodules, and ground-glass opacities[ 10 ]. Additional radiographic features comprise thickened bronchovascular bundles and interlobular septa. Less common manifestations include large nodules, lymphadenopathy, calcified nodules, emphysema, consolidation, cavitary lesions, bronchiectasis, honeycombing, and pleural thickening[ 11 ]. The pathognomonic cysts are typically bilateral, random and diffuse distribution in the lung parenchyma, measuring 5–10 mm in diameter with smooth margins and thin walls. The pathogenesis of these thin-walled cystic spaces may involve progressive airway obstruction and dilation secondary to peribronchiolar lymphocytic infiltration, and ischemia caused by vascular obstruction[ 3 ]. The small nodules typically manifest as poorly defined centrilobular nodules and subpleural nodules. A review of LIP literature, Honda et al showed that large nodules (11–30 mm in diameter) were significantly more prevalent in patients with malignant lymphoma (41%) compared to those with LIP (6%)[ 12 ]. In the present case, the CT findings of a left hilar mass accompanied by consolidation and atelectasis in the lingular segment of the left upper lobe represent atypical imaging features for LIP (3.5cm in diameter), necessitating thorough differentiation from malignant neoplasms. Enhanced recognition of these characteristic LIP imaging manifestations may help reduce diagnostic errors. Bronchoalveolar lavage (BAL) may be employed to exclude underlying infections, but demonstrates no diagnostic specificity for LIP, as evidenced by the absence of significant abnormalities in the BAL fluid of our patient. The definitive diagnosis of LIP requires lung biopsy. The histopathological hallmark of LIP is characterized by dense interstitial lymphocytic infiltration that expands and widens both interlobular and alveolar septa[ 13 ]. This infiltrate typically exhibits a polymorphous composition, consisting predominantly of small lymphocytes admixed with variable proportions of plasma cells, immunoblasts, macrophages, and occasional histiocytes. While granulomas and giant cells may occasionally be observed, they are not commonly present. Immunophenotypically, CD3-positive T cells represent the predominant population within the interstitial infiltrate, whereas CD20-positive B lymphocytes form nodular lymphoid aggregates containing well-defined germinal centers[ 3 ]. Recent studies suggest not all cases require biopsy—early diagnosis of Sjögren's syndrome-associated LIP may be established via HRCT[ 7 , 14 ]. Management of LIP is primarily based on case series and reports. Since a small subset of LIP patients (5%) may progress to lymphoma, periodic imaging surveillance should be considered every 3–5 years. If atypical or enlarging ground-glass or nodular lesions are detected, PET scan or biopsy should be considered[ 15 ]. As for treatment, systemic glucocorticoids remain the mainstay therapy for LIP. The corticosteroid regimen should be tailored according to extrapulmonary autoimmune manifestations. Other immunosuppressants, such as cyclophosphamide or azathioprine, have shown variable efficacy[ 9 ]. As a benign lymphoproliferative disorder, most patients have a favorable prognosis, with few patients experiencing spontaneous remission. However, some (1/3) may progress to end-stage fibrosis and respiratory failure[ 16 ]. In this case, monotherapy with glucocorticoids led to significant radiographic improvement after one month. Additionally, emerging biologic agents—particularly B-cell-targeted therapies—have recently demonstrated clinical efficacy in Sjögren’s syndrome[ 17 ]. The impact of these therapeutic interventions on the natural disease progression of pulmonary involvement requires further investigation, while offering promising potential for managing patients with advanced or progressive pulmonary disease. Conclusion Our case represents an exceptionally rare presentation, potentially the first reported instance of LIP manifesting as hilar mass with distal obstructive atelectasis on chest CT. This atypical radiographic pattern underscores the critical importance of differentiating LIP from malignant neoplasms in clinical practice. Abbreviations LIP Lymphocytic interstitial pneumonia HRCT High-resolution computed tomography PCT Procalcitonin CRP C-reactive protein ESR Erythrocyte sedimentation rate SAA Serum amyloid A HbA1c Glycated hemoglobin BAL Bronchoalveolar lavage HIV human immunodeficiency virus EBV Epstein-Barr virus BAL Bronchoalveolar lavage. Declarations Acknowledgments The authors are very grateful to the patient. Authors' contributions Qingguo Wu designed the study. Man Wu and Zhangyan Zhao collected clinical data, created the figure, and wrote the manuscript. Haicheng Tang revised the manuscript, which all authors revised and approved. Funding This study was supported by the Scientific Research Startup Project of Shanghai Public Health Clinical Center(KY-GW-2025-26). Data availability All data generated or analysed during this study are included in this published article. Ethics approval and consent to participate Ethical approval to report this case was not required due to its retrospective nature. Consent for publication Written informed consent was obtained from the patient for publication of this case presentation and any accompanying images. Competing interests The authors declare that they have no competing interests. References Roszkowska M, Nowakowska-Płaza A, Wroński J, et al. Lymphocytic interstitial pneumonia as an extremely rare manifestation of systemic lupus erythematosus. Pol Arch Intern Med. 2021; 131 (12). Tian X, Yi ES, Ryu JH. Lymphocytic interstitial pneumonia and other benign lymphoid disorders. Semin Respir Crit Care Med. 2012; 33 (5): p. 450-61. Panchabhai TS, Farver C, Highland KB. Lymphocytic Interstitial Pneumonia. Clin Chest Med. 2016; 37 (3): p. 463-74. Johkoh T, Ichikado K, Akira M, et al. Lymphocytic interstitial pneumonia: follow-up CT findings in 14 patients. J Thorac Imaging. 2000; 15 (3): p. 162-7. Cha SI, Fessler MB, Cool CD, et al. Lymphoid interstitial pneumonia: clinical features, associations and prognosis. Eur Respir J. 2006; 28 (2): p. 364-9. Houghton KM, Cabral DA, Petty RE, et al. Primary Sjögren's syndrome in dizygotic adolescent twins: one case with lymphocytic interstitial pneumonia. J Rheumatol. 2005; 32 (8): p. 1603-6. Gonçalves CM, Cordeiro LR, de Andrade CAF, et al. Lymphocytic Interstitial Pneumonia Associated with Sjögren Syndrome: Case-Based Review. Curr Rheumatol Rev. 2023; 19 (1): p. 1-6. Prasoppokakorn T, Assanasen T, Chantranuwatana P, et al. EBV-associated lymphoid interstitial pneumonia in IBD patient: Case report and literature review. Respir Med Case Rep. 2020; 30 : p. 101059. Swigris JJ, Berry GJ, Raffin TA, et al. Lymphoid interstitial pneumonia: a narrative review. Chest. 2002; 122 (6): p. 2150-64. Louza GF, Nobre LF. Lymphocytic interstitial pneumonia: computed tomography findings in 36 patients. 2020; 53 (5): p. 287-292. Johkoh T, Müller NL, Pickford HA, et al. Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients. Radiology. 1999; 212 (2): p. 567-72. Honda O, Johkoh T, Ichikado K, et al. Differential diagnosis of lymphocytic interstitial pneumonia and malignant lymphoma on high-resolution CT. AJR Am J Roentgenol. 1999; 173 (1): p. 71-4. Infante M, Lutman RF, Imparato S, et al. Differential diagnosis and management of focal ground-glass opacities. Eur Respir J. 2009; 33 (4): p. 821-7. Obaidat B, Yazdani D, Wikenheiser-Brokamp KA, et al. Diffuse Cystic Lung Diseases. Respir Care. 2020; 65 (1): p. 111-126. Franciosi AN, Gupta N, Murphy DJ, et al. Diffuse Cystic Lung Disease: A Clinical Guide to Recognition and Management. Chest. 2025; 167 (2): p. 529-547. Chitnis A, Vyas PK, Chaudhary P, et al. Case-based discussion: Lymphocytic interstitial pneumonia a rare presentation in an immunocompetent adult male. Lung India. 2015; 32 (5): p. 500-4. Bowman SJ, Fox R, Dörner T, et al. Safety and efficacy of subcutaneous ianalumab (VAY736) in patients with primary Sjögren's syndrome: a randomised, double-blind, placebo-controlled, phase 2b dose-finding trial. Lancet. 2022; 399 (10320): p. 161-171. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 18 May, 2026 Reviews received at journal 18 May, 2026 Reviewers agreed at journal 18 May, 2026 Reviews received at journal 12 May, 2026 Reviewers agreed at journal 29 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviews received at journal 10 Mar, 2026 Reviews received at journal 14 Aug, 2025 Reviewers agreed at journal 04 Aug, 2025 Reviewers agreed at journal 27 Jul, 2025 Reviewers agreed at journal 17 Jul, 2025 Reviewers invited by journal 15 Jul, 2025 Editor invited by journal 20 Jun, 2025 Editor assigned by journal 19 Jun, 2025 Submission checks completed at journal 19 Jun, 2025 First submitted to journal 12 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6880756","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":485688536,"identity":"c6638449-6461-4a76-9193-327491714f40","order_by":0,"name":"Man Wu","email":"","orcid":"","institution":"Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center Affiliated to Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Man","middleName":"","lastName":"Wu","suffix":""},{"id":485688537,"identity":"910964d6-16de-4e91-9a3f-b4025e84d737","order_by":1,"name":"Zhangyan Zhao","email":"","orcid":"","institution":"Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center Affiliated to Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Zhangyan","middleName":"","lastName":"Zhao","suffix":""},{"id":485688538,"identity":"d7b0e9ad-9d89-41e2-b880-8db0a91ebd67","order_by":2,"name":"Haicheng Tang","email":"","orcid":"","institution":"Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center Affiliated to Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Haicheng","middleName":"","lastName":"Tang","suffix":""},{"id":485688539,"identity":"1d037685-06d1-4f23-bfbe-785401f383c0","order_by":3,"name":"Qingguo Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYJCCA2CSvYENziZSC88BErRAgEQCkVoMbiRvPFzwqzaxX/L5swc/d9yRZ2DvffwCv5a0gsMz+44nzpydY27Ye+aZYQPPcTMLfFrMbuQYHObtOZa44XYOmwRv2+EEBok0NgPitNw8/kzyL9FaeH7UJG64wWAmDbWF+QE+LfZnnhUc5m04YDyzJ8dMWvbMYcM2nmNs+HQwSLYnb/7M86dOtp8d6LC3Ow7L87O3MX/AqwcYaAyMbYchTMYGBgagFWwSBLUw/KlDaAECgraMglEwCkbByAIAyFFUyv9VU8IAAAAASUVORK5CYII=","orcid":"","institution":"Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center Affiliated to Fudan University","correspondingAuthor":true,"prefix":"","firstName":"Qingguo","middleName":"","lastName":"Wu","suffix":""}],"badges":[],"createdAt":"2025-06-12 13:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6880756/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6880756/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87047563,"identity":"b960386a-a2af-47d4-928d-bcc4fab6347b","added_by":"auto","created_at":"2025-07-18 14:43:39","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":83779,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Chest CT showed: a left hilar mass with consolidation and atelectasis in the lingular segment of the left upper lobe (measuring approximately 3.5 cm); (B) After one week, chest CT showed: the left hilar lesion had decreased in size compared to the previous scan (now measuring 2.8 cm); (C) After one month, chest CT demonstrated significant resolution of the left pulmonary lesion compared to prior imaging.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6880756/v1/0283e3eec535fb50d59f7631.jpg"},{"id":87048601,"identity":"070cafe6-bb05-463b-9dd1-1c12a97dd7f2","added_by":"auto","created_at":"2025-07-18 14:51:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":478735,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6880756/v1/aa50925e-b6c9-4910-8c2b-4e5f7c66c8a7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Lymphocytic Interstitial Pneumonia Presenting as hilar mass with Obstructive Atelectasis: A Case Report and Literature Review","fulltext":[{"header":"Background","content":"\u003cp\u003eLymphocytic interstitial pneumonia (LIP) is a rare form of interstitial lung disease, characterized by diffuse infiltration of lymphocytes and plasma cells in the pulmonary parenchyma[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Most cases are secondary to autoimmune disorders (particularly Sj\u0026ouml;gren's syndrome (SS), rheumatoid arthritis, and systemic lupus erythematosus), dysproteinemia, infections (HIV and EBV), or genetic predisposition. LIP lacks typical clinical manifestations[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. High-resolution computed tomography (HRCT) findings include multiple bronchial cysts and diffuse interstitial infiltrates, along with ground-glass opacities, centrilobular or subpleural nodules, bronchovascular bundle thickening, interlobular septal thickening, and cystic changes. LIP is frequently misdiagnosed or overlooked in clinical practice, therefore, definitive diagnosis requires lung biopsy[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWe present a diagnostically challenging case of LIP manifesting as hilar mass with obstructive atelectasis on HRCT. Through comprehensive analysis of this patient's clinical data and systematic literature review, we aim to enhance the understanding of LIP's diverse radiological presentations and enhance awareness of LIP.\u003c/p\u003e"},{"header":"Case report","content":"\u003cp\u003eA 65-year-old male patient was admitted to the hospital due to \u0026ldquo;cough for one month\". One month prior, the patient developed a cough without fever, sputum production, chest tightness, or dyspnea. A chest CT at an external hospital indicated left-sided obstructive pneumonia. After 14 days of intravenous antibiotic therapy, the cough showed no improvement, and a follow-up chest CT revealed no resolution of the lesion. Past medical history included hypertension for 20 years and diabetes mellitus for 10 years. Seven years ago, the patient underwent \"resection of a right femoral hemangioma with internal fixation for a right femoral fracture\" and 14 years ago, a \"cholecystectomy\" was performed. Physical examination upon admission showed no positive findings. As for laboratory tests, Hepatitis B surface antigen, hepatitis C antibody, HIV, and syphilis-specific antibodies were negative. Eosinophil percentage (18.00%) and absolute eosinophil count (1.24\u0026times;10⁹/L) were elevated. Urinalysis, stool routine, liver function, renal function, coagulation function, and cardiac markers were normal. Procalcitonin (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and serum amyloid A (SAA) were normal. Tumor markers were normal. Glycated hemoglobin (HbA1c): 10.70%. Autoimmune markers and serum protein electrophoresis were negative. EBV IgG was positive, while IgM was negative. Rubella virus and cytomegalovirus tests were negative. The electrocardiogram suggested sinus tachycardia and T-wave changes (I, aVL, V5, V6 flattened). Abdominal color Doppler ultrasound and cardiac ultrasound did not show any obvious abnormalities. Pulmonary function was normal. FeNO was 31.0 ppb. Bronchoscopy was performed, and no special pathogens were found in the bronchoalveolar lavage fluid. Chest CT showed left hilar mass with left upper lung lingular segment consolidation and atelectasis, measuring approximately 3.5 cm (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.A). Left lung lesion CT-guided percutaneous lung biopsy was performed, and the pathological showed hyperplasia of alveolar epithelium with extensive interstitial infiltration of lymphocytes and plasma cells, along with histiocyte proliferation in alveolar spaces, suggestive of LIP. Subsequently, obtaining the patient's informed consent, methylprednisolone 40 mg was administered for anti-inflammatory therapy for one week. A follow-up chest CT showed partial resolution of the left lung lesions (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.B), along with improvement in cough symptoms. The treatment was transitioned to oral prednisone as maintenance therapy. One month later, A reexamination of chest CT showed significant regression of the lesions (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.C). Currently, the patient is in good overall condition and remains under regular follow-up.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eLIP represents a rare benign lymphoproliferative disorder of the lung and frequently associated with connective tissue diseases or infections. Idiopathic LIP is exceedingly uncommon and when LIP is diagnosed, every effort must be made to diagnose potential conditions[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. LIP is most frequently associated with Sj\u0026ouml;gren's syndrome[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], followed by infectious etiologies, primarily human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV)[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Approximately 25% of LIP cases are associated with SS. However, to date, approximately 20 cases of EBV-associated LIP have been reported in the literature[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The connective tissue disease-related indicators of our patient were all negative, while the EBV antigen lgG was found to be positive, considering that our patient may be caused by EBV virus infection. The possible mechanism is that EBV infection allows cells to proliferate in the case of dysregulation of the host immune system[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe onset of LIP is hidden and there is a lack of distinctive clinical manifestations. LIP may also be diagnosed by chance. Most patients present with exertional dyspnea or dry cough, while a few have chest pain or systemic symptoms such as fever, fatigue, night sweats, etc[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It may also have symptoms of primary diseases such as dry mouth, dry eyes, and joint pain. On physical examination, crackles are commonly detected upon pulmonary auscultation. Extrapulmonary manifestations such as peripheral lymph node lesions, hepatic enlargement or splenomegaly are not common and further examination should be given for possible lymphoma or other diagnosis. In this case, the patient's chief complaint was cough. Upon admission, comprehensive ancillary tests, including pulmonary function tests, complete blood count, and laboratory results, yielded largely normal results.\u003c/p\u003e\u003cp\u003eHigh-resolution chest CT is the imaging modality of choice for evaluating pulmonary manifestations of LIP. The most characteristic CT findings in LIP patients include multiple cysts, small nodules, and ground-glass opacities[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Additional radiographic features comprise thickened bronchovascular bundles and interlobular septa. Less common manifestations include large nodules, lymphadenopathy, calcified nodules, emphysema, consolidation, cavitary lesions, bronchiectasis, honeycombing, and pleural thickening[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The pathognomonic cysts are typically bilateral, random and diffuse distribution in the lung parenchyma, measuring 5\u0026ndash;10 mm in diameter with smooth margins and thin walls. The pathogenesis of these thin-walled cystic spaces may involve progressive airway obstruction and dilation secondary to peribronchiolar lymphocytic infiltration, and ischemia caused by vascular obstruction[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The small nodules typically manifest as poorly defined centrilobular nodules and subpleural nodules. A review of LIP literature, Honda et al showed that large nodules (11\u0026ndash;30 mm in diameter) were significantly more prevalent in patients with malignant lymphoma (41%) compared to those with LIP (6%)[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In the present case, the CT findings of a left hilar mass accompanied by consolidation and atelectasis in the lingular segment of the left upper lobe represent atypical imaging features for LIP (3.5cm in diameter), necessitating thorough differentiation from malignant neoplasms. Enhanced recognition of these characteristic LIP imaging manifestations may help reduce diagnostic errors.\u003c/p\u003e\u003cp\u003eBronchoalveolar lavage (BAL) may be employed to exclude underlying infections, but demonstrates no diagnostic specificity for LIP, as evidenced by the absence of significant abnormalities in the BAL fluid of our patient. The definitive diagnosis of LIP requires lung biopsy. The histopathological hallmark of LIP is characterized by dense interstitial lymphocytic infiltration that expands and widens both interlobular and alveolar septa[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This infiltrate typically exhibits a polymorphous composition, consisting predominantly of small lymphocytes admixed with variable proportions of plasma cells, immunoblasts, macrophages, and occasional histiocytes. While granulomas and giant cells may occasionally be observed, they are not commonly present. Immunophenotypically, CD3-positive T cells represent the predominant population within the interstitial infiltrate, whereas CD20-positive B lymphocytes form nodular lymphoid aggregates containing well-defined germinal centers[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Recent studies suggest not all cases require biopsy\u0026mdash;early diagnosis of Sj\u0026ouml;gren's syndrome-associated LIP may be established via HRCT[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eManagement of LIP is primarily based on case series and reports. Since a small subset of LIP patients (5%) may progress to lymphoma, periodic imaging surveillance should be considered every 3\u0026ndash;5 years. If atypical or enlarging ground-glass or nodular lesions are detected, PET scan or biopsy should be considered[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. As for treatment, systemic glucocorticoids remain the mainstay therapy for LIP. The corticosteroid regimen should be tailored according to extrapulmonary autoimmune manifestations. Other immunosuppressants, such as cyclophosphamide or azathioprine, have shown variable efficacy[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. As a benign lymphoproliferative disorder, most patients have a favorable prognosis, with few patients experiencing spontaneous remission. However, some (1/3) may progress to end-stage fibrosis and respiratory failure[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In this case, monotherapy with glucocorticoids led to significant radiographic improvement after one month. Additionally, emerging biologic agents\u0026mdash;particularly B-cell-targeted therapies\u0026mdash;have recently demonstrated clinical efficacy in Sj\u0026ouml;gren\u0026rsquo;s syndrome[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The impact of these therapeutic interventions on the natural disease progression of pulmonary involvement requires further investigation, while offering promising potential for managing patients with advanced or progressive pulmonary disease.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur case represents an exceptionally rare presentation, potentially the first reported instance of LIP manifesting as hilar mass with distal obstructive atelectasis on chest CT. This atypical radiographic pattern underscores the critical importance of differentiating LIP from malignant neoplasms in clinical practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLIP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLymphocytic interstitial pneumonia\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHRCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHigh-resolution computed tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eProcalcitonin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCRP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eC-reactive protein\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eESR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eErythrocyte sedimentation rate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSAA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSerum amyloid A\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHbA1c\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGlycated hemoglobin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBAL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBronchoalveolar lavage\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ehuman immunodeficiency virus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEBV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEpstein-Barr virus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBAL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBronchoalveolar lavage.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are very grateful to the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQingguo Wu designed the study. Man Wu and Zhangyan Zhao collected clinical data, created the figure, and wrote the manuscript. Haicheng Tang revised the manuscript, which all authors revised and approved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Scientific Research Startup Project of Shanghai Public Health Clinical Center(KY-GW-2025-26).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval to report this case was not required due to its retrospective nature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case presentation and any accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRoszkowska M, Nowakowska-Płaza A, Wroński J, et al. Lymphocytic interstitial pneumonia as an extremely rare manifestation of systemic lupus erythematosus. Pol Arch Intern Med. 2021; \u003cstrong\u003e131\u003c/strong\u003e(12).\u003c/li\u003e\n\u003cli\u003eTian X, Yi ES, Ryu JH. Lymphocytic interstitial pneumonia and other benign lymphoid disorders. Semin Respir Crit Care Med. 2012; \u003cstrong\u003e33\u003c/strong\u003e(5): p. 450-61.\u003c/li\u003e\n\u003cli\u003ePanchabhai TS, Farver C, Highland KB. Lymphocytic Interstitial Pneumonia. Clin Chest Med. 2016; \u003cstrong\u003e37\u003c/strong\u003e(3): p. 463-74.\u003c/li\u003e\n\u003cli\u003eJohkoh T, Ichikado K, Akira M, et al. Lymphocytic interstitial pneumonia: follow-up CT findings in 14 patients. J Thorac Imaging. 2000; \u003cstrong\u003e15\u003c/strong\u003e(3): p. 162-7.\u003c/li\u003e\n\u003cli\u003eCha SI, Fessler MB, Cool CD, et al. Lymphoid interstitial pneumonia: clinical features, associations and prognosis. Eur Respir J. 2006; \u003cstrong\u003e28\u003c/strong\u003e(2): p. 364-9.\u003c/li\u003e\n\u003cli\u003eHoughton KM, Cabral DA, Petty RE, et al. Primary Sj\u0026ouml;gren\u0026apos;s syndrome in dizygotic adolescent twins: one case with lymphocytic interstitial pneumonia. J Rheumatol. 2005; \u003cstrong\u003e32\u003c/strong\u003e(8): p. 1603-6.\u003c/li\u003e\n\u003cli\u003eGon\u0026ccedil;alves CM, Cordeiro LR, de Andrade CAF, et al. Lymphocytic Interstitial Pneumonia Associated with Sj\u0026ouml;gren Syndrome: Case-Based Review. Curr Rheumatol Rev. 2023; \u003cstrong\u003e19\u003c/strong\u003e(1): p. 1-6.\u003c/li\u003e\n\u003cli\u003ePrasoppokakorn T, Assanasen T, Chantranuwatana P, et al. EBV-associated lymphoid interstitial pneumonia in IBD patient: Case report and literature review. Respir Med Case Rep. 2020; \u003cstrong\u003e30\u003c/strong\u003e: p. 101059.\u003c/li\u003e\n\u003cli\u003eSwigris JJ, Berry GJ, Raffin TA, et al. Lymphoid interstitial pneumonia: a narrative review. Chest. 2002; \u003cstrong\u003e122\u003c/strong\u003e(6): p. 2150-64.\u003c/li\u003e\n\u003cli\u003eLouza GF, Nobre LF. Lymphocytic interstitial pneumonia: computed tomography findings in 36 patients. 2020; \u003cstrong\u003e53\u003c/strong\u003e(5): p. 287-292.\u003c/li\u003e\n\u003cli\u003eJohkoh T, M\u0026uuml;ller NL, Pickford HA, et al. Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients. Radiology. 1999; \u003cstrong\u003e212\u003c/strong\u003e(2): p. 567-72.\u003c/li\u003e\n\u003cli\u003eHonda O, Johkoh T, Ichikado K, et al. Differential diagnosis of lymphocytic interstitial pneumonia and malignant lymphoma on high-resolution CT. AJR Am J Roentgenol. 1999; \u003cstrong\u003e173\u003c/strong\u003e(1): p. 71-4.\u003c/li\u003e\n\u003cli\u003eInfante M, Lutman RF, Imparato S, et al. Differential diagnosis and management of focal ground-glass opacities. Eur Respir J. 2009; \u003cstrong\u003e33\u003c/strong\u003e(4): p. 821-7.\u003c/li\u003e\n\u003cli\u003eObaidat B, Yazdani D, Wikenheiser-Brokamp KA, et al. Diffuse Cystic Lung Diseases. Respir Care. 2020; \u003cstrong\u003e65\u003c/strong\u003e(1): p. 111-126.\u003c/li\u003e\n\u003cli\u003eFranciosi AN, Gupta N, Murphy DJ, et al. Diffuse Cystic Lung Disease: A Clinical Guide to Recognition and Management. Chest. 2025; \u003cstrong\u003e167\u003c/strong\u003e(2): p. 529-547.\u003c/li\u003e\n\u003cli\u003eChitnis A, Vyas PK, Chaudhary P, et al. Case-based discussion: Lymphocytic interstitial pneumonia a rare presentation in an immunocompetent adult male. Lung India. 2015; \u003cstrong\u003e32\u003c/strong\u003e(5): p. 500-4.\u003c/li\u003e\n\u003cli\u003eBowman SJ, Fox R, D\u0026ouml;rner T, et al. Safety and efficacy of subcutaneous ianalumab (VAY736) in patients with primary Sj\u0026ouml;gren\u0026apos;s syndrome: a randomised, double-blind, placebo-controlled, phase 2b dose-finding trial. Lancet. 2022; \u003cstrong\u003e399\u003c/strong\u003e(10320): p. 161-171.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Lymphocytic Interstitial Pneumonia, Hilar mass, Imaging presentation","lastPublishedDoi":"10.21203/rs.3.rs-6880756/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6880756/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e Lymphocytic Interstitial Pneumonia (LIP) is a rare benign lymphoproliferative disorder characterized by diffuse infiltration of lymphocytes and plasma cells in the pulmonary parenchyma. It is commonly associated with autoimmune diseases. Chest CT showed multiple bronchial cysts and diffuse interstitial infiltration in most cases. Due to its nonspecific clinical manifestations, it is often misdiagnosed or overlooked. Definitive diagnosis requires pathological biopsy.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCase presentation\u003c/b\u003e A 65-year-old male was admitted due to cough for one month. Chest CT revealed left hilar mass with left upper lung lingular segment consolidation and atelectasis (measuring approximately 3.5 cm). the pathological showed hyperplasia of alveolar epithelium with extensive interstitial infiltration of lymphocytes and plasma cells, along with histiocyte proliferation in alveolar spaces, suggestive of LIP. After treatment with corticosteroids, the patient's symptoms improved, and follow-up imaging showed radiographic resolution of the lesions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e To our knowledge, our case may be the first reported case of LIP presenting as a hilar mass on chest CT. This atypical radiological manifestation underscores the importance of differentiating LIP from malignant tumors in clinical practice.\u003c/p\u003e","manuscriptTitle":"Lymphocytic Interstitial Pneumonia Presenting as hilar mass with Obstructive Atelectasis: A Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 14:43:34","doi":"10.21203/rs.3.rs-6880756/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-18T14:04:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-18T11:25:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"99706547144492448686739951382581230540","date":"2026-05-18T11:18:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-12T17:26:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115383274938727397703746395353759352175","date":"2026-04-29T12:45:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227819124407346834559489146106475216795","date":"2026-04-07T09:04:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-10T13:48:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-14T17:02:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"329687230868993481934855529820639877981","date":"2025-08-04T06:44:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328535750252610770086909778274756446927","date":"2025-07-27T08:54:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243458279044408462791604890385919792999","date":"2025-07-17T13:59:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-15T08:15:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-20T17:03:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-19T04:48:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-19T04:46:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-06-12T13:10:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ca52f6b-e94c-456f-8833-8b702d842d91","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-18T14:04:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-18T11:25:17+00:00","index":101,"fulltext":""},{"type":"reviewerAgreed","content":"99706547144492448686739951382581230540","date":"2026-05-18T11:18:26+00:00","index":100,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-12T17:26:22+00:00","index":91,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T14:10:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 14:43:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6880756","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6880756","identity":"rs-6880756","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}