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Kızıloğlu HA, Beyhan M, Gökçe E. Evaluation of respiratory bronchiolitis nodules with maximum intensity projection images. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230297. [PMID: 37971118 PMCID: PMC10645165 DOI: 10.1590/1806-9282.20230297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/26/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Respiratory bronchiolitis is a disease associated with heavy smoking. Computed tomography in this disease often shows symmetrical and bilaterally ill-defined circumscribed centriacinar micronodular involvement in the upper-middle lobes. The maximum intensity projection method is a kind of image processing method and provides a better evaluation of nodules and vascular structures. Our study aimed to show whether maximum intensity projection images increase the diagnostic accuracy in the detection of micronodules in respiratory bronchiolitis. METHODS Two radiologists with different experiences (first reader: 10-year radiologist with cardiothoracic radiology experience and second reader: nonspecific radiologist with 2 years of experience) reviewed images of patients whose respiratory bronchiolitis diagnosis was supported by clinical findings. The evaluation was done independently of each other. Both conventional computed tomography images and maximum intensity projection images of the same patients were examined. The detection rates on conventional computed tomography and maximum intensity projection images were then compared. RESULTS A total of 53 patients were evaluated, of whom 48 were men and 5 were women. The first reader detected centriacinar nodules in 42 (79.2%) patients on conventional computed tomography and centriacinar nodules in all 53 (100%) patients on maximum intensity projection images. The second reader detected centriacinar nodules in 12 (22.6%) patients on conventional computed tomography images and in 48 (90.6%) patients on maximum intensity projection images. For the less experienced reader, the detection rate of micronodules in respiratory bronchiolitis in maximum intensity projection images increased statistically significantly (p<0.001). CONCLUSION Maximum intensity projection images in respiratory bronchiolitis increase the detectability of micronodules independently of the experience of the radiologist.
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Affiliation(s)
- Hüseyin Alper Kızıloğlu
- Tokat Gaziosmanpaşa University, Faculty of Medicine, Department of Radiology – Tokat, Turkey
| | - Murat Beyhan
- Tokat Gaziosmanpaşa University, Faculty of Medicine, Department of Radiology – Tokat, Turkey
| | - Erkan Gökçe
- Tokat Gaziosmanpaşa University, Faculty of Medicine, Department of Radiology – Tokat, Turkey
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Mayuga KA, Fedorowski A, Ricci F, Gopinathannair R, Dukes JW, Gibbons C, Hanna P, Sorajja D, Chung M, Benditt D, Sheldon R, Ayache MB, AbouAssi H, Shivkumar K, Grubb BP, Hamdan MH, Stavrakis S, Singh T, Goldberger JJ, Muldowney JAS, Belham M, Kem DC, Akin C, Bruce BK, Zahka NE, Fu Q, Van Iterson EH, Raj SR, Fouad-Tarazi F, Goldstein DS, Stewart J, Olshansky B. Sinus Tachycardia: a Multidisciplinary Expert Focused Review. Circ Arrhythm Electrophysiol 2022; 15:e007960. [PMID: 36074973 PMCID: PMC9523592 DOI: 10.1161/circep.121.007960] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sinus tachycardia (ST) is ubiquitous, but its presence outside of normal physiological triggers in otherwise healthy individuals remains a commonly encountered phenomenon in medical practice. In many cases, ST can be readily explained by a current medical condition that precipitates an increase in the sinus rate, but ST at rest without physiological triggers may also represent a spectrum of normal. In other cases, ST may not have an easily explainable cause but may represent serious underlying pathology and can be associated with intolerable symptoms. The classification of ST, consideration of possible etiologies, as well as the decisions of when and how to intervene can be difficult. ST can be classified as secondary to a specific, usually treatable, medical condition (eg, pulmonary embolism, anemia, infection, or hyperthyroidism) or be related to several incompletely defined conditions (eg, inappropriate ST, postural tachycardia syndrome, mast cell disorder, or post-COVID syndrome). While cardiologists and cardiac electrophysiologists often evaluate patients with symptoms associated with persistent or paroxysmal ST, an optimal approach remains uncertain. Due to the many possible conditions associated with ST, and an overlap in medical specialists who see these patients, the inclusion of experts in different fields is essential for a more comprehensive understanding. This article is unique in that it was composed by international experts in Neurology, Psychology, Autonomic Medicine, Allergy and Immunology, Exercise Physiology, Pulmonology and Critical Care Medicine, Endocrinology, Cardiology, and Cardiac Electrophysiology in the hope that it will facilitate a more complete understanding and thereby result in the better care of patients with ST.
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Affiliation(s)
- Kenneth A. Mayuga
- Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Artur Fedorowski
- Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G.d’Annunzio” University of Chieti-Pescara, Chieti Scalo, Italy
| | | | | | | | | | | | - Mina Chung
- Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, Phoenix, AZ
| | - David Benditt
- University of Minnesota Medical School, Minneapolis, MN
| | | | - Mirna B. Ayache
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Hiba AbouAssi
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC
| | | | | | | | | | - Tamanna Singh
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | | | - James A. S. Muldowney
- Vanderbilt University Medical Center &Tennessee Valley Healthcare System, Nashville Campus, Department of Veterans Affairs, Nashville, TN
| | - Mark Belham
- Cambridge University Hospitals NHS FT, Cambridge, UK
| | - David C. Kem
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Cem Akin
- University of Michigan, Ann Arbor, MI
| | | | - Nicole E. Zahka
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Qi Fu
- Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas & University of Texas Southwestern Medical Center, Dallas, TX
| | - Erik H. Van Iterson
- Section of Preventive Cardiology & Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic Cleveland, OH
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Raucherassoziierte interstitielle Lungenerkrankungen. DIE RADIOLOGIE 2022; 62:738-746. [PMID: 35736996 PMCID: PMC9433357 DOI: 10.1007/s00117-022-01025-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/07/2022]
Abstract
Klinisches Problem Raucherassoziierte interstitielle Lungenerkrankungen umfassen heterogene pulmonale Pathologien, deren korrekte Diagnostik prognostische und therapeutische Konsequenzen hat. In diesem Artikel werden die gängigsten raucherassoziierten interstitiellen Lungenerkrankungen beschrieben sowie eine strukturierte Herangehensweise präsentiert, welche den diagnostischen Arbeitsprozess erleichtern kann. Empfehlungen für die Praxis Die Computertomographie (CT) besitzt einen hohen Stellenwert in der Diagnose der raucherassoziierten interstitiellen Lungenerkrankungen und kann dazu beitragen, Lungenbiopsien zu verhindern. Um eine hohe diagnostische Genauigkeit zu erreichen, sollten standardisierte Untersuchungsprotokolle sowie eine strukturierte Herangehensweise in der Befundung zur Anwendung kommen. In den entzündlich dominierten Stadien der respiratorischen Bronchiolitis (RB), der respiratorischen Bronchiolitis mit interstitieller Lungenerkrankung (RB-ILD) sowie der desquamativen interstitiellen Pneumonie (DIP) haben die Beendigung des Rauchens sowie Steroide den größten therapeutischen Effekt. Bei fibrotischen Veränderungen (z. B. im Rahmen einer idiopathischen pulmonalen Fibrose [IPF]) können antifibrotische Therapien mit Pirfenidon und Nintedanib zum Einsatz kommen. Patienten mit dem Verdacht auf raucherassoziierte interstitielle Lungenerkrankung sollten in multidisziplinären Boards abgeklärt und behandelt werden.
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Abstract
Background Coronavirus (COVID-19) pneumonia emerged in Wuhan, China, in December 2019. It was highly contagious spreading all over the world, with a rapid increase in the number of deaths. The reported cases have reached more than 14 million with more than 600,000 deaths around the world. So, the pandemic of COVID-19 became a surpassing healthcare crisis with an intensive load on the healthcare resources. In this study, the aim was to differentiate COVID-19 pneumonia from its mimickers as atypical infection, interstitial lung diseases, and eosinophilic lung diseases based on CT, clinical, and laboratory findings. Results This retrospective study included 260 patients, of which 220 were confirmed as COVID-19 positive by two repeated RT-PCR test and 40 were classified as non-COVID by two repeated negative RT-PCR test or identification of other pathogens, other relevant histories, or clinical findings. In this study, 158 patients were male (60.7 %) and 102 patients were female (39.3%). There was 60.9% of the COVID-19 group were male and 39.1% were female. Patients in the non-COVID group were significantly older (the mean age was 46.4) than those in the confirmed COVID-19 group (35.2y). In the COVID-19 group, there was exposure history to positive cases in 84.1% while positive exposure history was 20% in the non-COVID group. Conclusion The spectrum of CT imaging findings in COVID-19 pneumonia is wide that could be contributed by many other diseases making the interpretation of chest CTs nowadays challenging to differentiate between different diseases having the same signs and act as deceiving simulators in the era of COVID-19.
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Dawod YT, Cook NE, Graham WB, Madhani-Lovely F, Thao C. Smoking-associated interstitial lung disease: update and review. Expert Rev Respir Med 2020; 14:825-834. [PMID: 32379511 DOI: 10.1080/17476348.2020.1766971] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Smoking-associated interstitial lung disease manifests as several heterogeneous disorders involving the airways, pleura, and lung parenchyma with various radiological patterns. The clinical history, radiologic, and pathologic findings are important to distinguish these more uncommon diseases. A multidisciplinary approach is recommended for diagnosis and to manage these conditions appropriately. AREAS COVERED This review provides an overview of the epidemiology, risk factors, pathogenesis, clinical features, diagnosis, and treatment of acute eosinophilic pneumonia, e-cigarettes, or vaping associated lung injury, respiratory bronchiolitis interstitial lung disease, desquamative interstitial pneumonitis, pulmonary Langerhans cell histiocytosis, idiopathic pulmonary fibrosis, and combined pulmonary fibrosis emphysema. EXPERT OPINION Cigarette smoking is associated with a variety of pathologic conditions that affect the airways and lungs. E-cigarette use and vaping present new challenges to the clinician. Consensus between the clinical, radiographic, and pathologic findings is important in identifying and differentiating between the various entities to properly diagnose smoking-related interstitial lung diseases discussed in this review.
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Affiliation(s)
- Yaser T Dawod
- Section of Pulmonary and Critical Care Medicine, Medstar Washington Hospital Center , Washington, USA
| | - Noah E Cook
- Department of Pulmonary and Critical Care Medicine, University of Nevada Las Vegas School of Medicine , Las Vegas, USA
| | - William B Graham
- Department of Pulmonary and Critical Care Medicine, Renown Health , Reno, USA
| | | | - Choua Thao
- Department of Pulmonary and Critical Care Medicine, Renown Health , Reno, USA
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Sismanlar T, Aslan AT, Turktas H, Memis L, Griese M. Respiratory Bronchiolitis-Associated Interstitial Lung Disease in Childhood: New Sequela of Smoking. Pediatrics 2015; 136:e1026-9. [PMID: 26347438 DOI: 10.1542/peds.2015-1303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/24/2022] Open
Abstract
Childhood interstitial lung diseases are rare disorders of largely unknown etiology characterized by variable types and degrees of parenchymal inflammation. Disease spectrum and prognosis considerably from those in adults. Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) is a well-described entity occurring almost exclusively in adults who are current heavy cigarette smokers. We describe an 11-year-old boy with failure to thrive, dry cough, and exertional dyspnea for 1 year who was diagnosed with RB-ILD due to heavy passive smoking exposure. Although RB-ILD is well defined in smoking adults, there are no reports in the English literature in nonactive smokers, especially in childhood.
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Affiliation(s)
| | | | | | - Leyla Memis
- Pathology Department, Gazi University Hospital, Ankara, Turkey; and
| | - Matthias Griese
- Pediatric Pneumology and Allergy, Children's Hospital, Ludwig Maximilians University, Munich, Germany
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Sieminska A, Kuziemski K. Respiratory bronchiolitis-interstitial lung disease. Orphanet J Rare Dis 2014; 9:106. [PMID: 25011486 PMCID: PMC4227129 DOI: 10.1186/s13023-014-0106-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/27/2014] [Indexed: 11/24/2022] Open
Abstract
Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) is a rare, mild inflammatory pulmonary disorder that occurs almost exclusively in current or former heavy smokers, usually between the third and sixth decades, most likely with no gender predilection. The onset is usually insidious with exertional dyspnea and persistent cough, which may be non-productive, developing over a course of weeks or months. RB-ILD may also be diagnosed in asymptomatic patients with functional impairment and chest radiograph or high-resolution computed tomography (HRCT) abnormalities. Histologically, RB-ILD is characterized by the accumulation of yellow-brown pigmented macrophages within the lumens of respiratory bronchioles and alveolar ducts, associated with a patchy submucosal and peribronchiolar chronic inflammation. Common findings also include mild bronchiolar and peribronchiolar alveolar fibrosis that expands contiguous alveolar septa and leads to architectural distortion as well as centrilobular emphysema. Chest radiographs in patients with RB-ILD typically show fine reticulonodular interstitial opacities, while on HRCT central and peripheral bronchial wall thickening, centrilobular nodules, and ground-glass opacities associated with upper lobe centrilobular emphysema are most frequently reported. Pulmonary function testing may be normal but usually demonstrates mixed, predominantly obstructive abnormalities, often combined with hyperinflation and usually associated with a mild to moderate reduction in carbon monoxide diffusion capacity (DLco). The course of RB-ILD is heterogeneous. Some patients respond favorably to corticosteroids and/or smoking cessation, but often there is no functional improvement and the disease progresses despite smoking cessation and treatment.
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Affiliation(s)
- Alicja Sieminska
- Department of Allergology and Pneumonology, Medical University of Gdansk, Debinki Str 7, Gdansk 80-211, Poland
| | - Krzysztof Kuziemski
- Department of Allergology and Pneumonology, Medical University of Gdansk, Debinki Str 7, Gdansk 80-211, Poland
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Abstract
Cigarette smoke, a toxic collection of thousands of chemicals generated from combustion of tobacco, is recognized as the primary causative agent of certain diffuse interstitial and bronchiolar lung diseases. Most patients afflicted with these disorders are cigarette smokers, and smoking cessation has been shown to be capable of inducing disease remission and should occupy a pivotal role in the management of all smokers with these diffuse lung diseases. The role of pharmacotherapy with corticosteroids or other immunomodulating agents is not well established but may be considered in patients with progressive forms of smoking-related interstitial lung diseases.
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Affiliation(s)
- Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Jhun BW, Kim DM, Park JH, Jung H, Song L, Han J, Chung MP. A Case of Non-Small Cell Lung Cancer in a Respiratory Bronchiolitis Associated Interstitial Lung Disease Patient. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.71.3.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Byung Woo Jhun
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Da Min Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hyeon Park
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunae Jung
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Limhwa Song
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Pyo Chung
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Domagała-Kulawik J. BAL in the diagnosis of smoking-related interstitial lung diseases: review of literature and analysis of our experience. Diagn Cytopathol 2009; 36:909-15. [PMID: 18855907 DOI: 10.1002/dc.20944] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The group of interstitial lung diseases (ILDs) is formed by respiratory tract disorders, whose aetiology is unknown in the majority of cases, the clinical course differs and the prognosis is generally serious. Some of the ILDs have a potential relation to tobacco smoking and are known as smoking-related ILDs (sr-ILD). Bronchoalveolar lavage fluid (BALF) examination is one of the initial procedures in the diagnosis of ILD. Despite the fact that histological confirmation is the gold standard in ILD diagnosis in many studies, the number of reported biopsies was low. In this review we present the results of BALF examinations of patients with sr-ILD and discuss their value in the differential diagnosis with other types of ILD. An extremely high total cell count (about 50 x 10(6) cells) with significant predominance of pigmented alveolar macrophages is a characteristic pattern of BALF in sr-ILD. The greatest challenge in BALF cytology interpretation is to distinguish sr-ILD and idiopathic pulmonary fibrosis (IPF). IPF is characterised by an elevated proportion and absolute count of lymphocytes and neutrophils; in addition, BALF lymphocytosis is higher in non-specific interstitial pneumonia than in usual interstitial pneumonia (UIP). The population of alveolar macrophage of patients with sr-ILD differs markedly from the foamy and vacuolated cells that predominate in IPF/UIP. Thus, the absence of pigmented cells rather excludes sr-ILD and indicates other types of ILD. To summarise, the place of BALF in the diagnosis of sr-ILD seems to be established.
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Bourke SJ. Interstitial lung disease: progress and problems. Postgrad Med J 2006; 82:494-9. [PMID: 16891438 PMCID: PMC2585700 DOI: 10.1136/pgmj.2006.046417] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Accepted: 03/16/2006] [Indexed: 01/01/2023]
Abstract
Interstitial lung disease involves all areas of medicine as it often occurs in patients with comorbidities or as a consequence of systemic diseases and their treatment. Typically the physician is faced with a breathless patient, a diffusely abnormal chest radiograph, and a wide differential diagnosis. Progress has been made in using high resolution computed tomography as the key investigation in characterising the pattern and extent of the disease. Bronchoalveolar lavage is particularly important in excluding infection as a cause of diffuse lung infiltrates. Surgical lung biopsies have led to a new classification system for the range of histopathological patterns of disease that were previously known by the collective term cryptogenic fibrosing alveolitis. Problems persist in deciding when a surgical lung biopsy is clinically justified, in understanding the pathogenesis of these diseases, and in finding more effective treatments.
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Affiliation(s)
- S J Bourke
- Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
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