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Jönsson ÅLM, Hilberg O, Simonsen U, Christensen JH, Bendstrup E. New insights in the genetic variant spectrum of SLC34A2 in pulmonary alveolar microlithiasis; a systematic review. Orphanet J Rare Dis 2023; 18:130. [PMID: 37259144 DOI: 10.1186/s13023-023-02712-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/30/2023] [Indexed: 06/02/2023] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive lung disease caused by variants in the SLC34A2 gene encoding the sodium-dependent phosphate transport protein 2B, NaPi-2b. PAM is characterized by deposition of calcium phosphate crystals in the alveoli. Onset and clinical course vary considerably; some patients remain asymptomatic while others develop severe respiratory failure with a significant symptom burden and compromised survival. It is likely that PAM is under-reported due to lack of recognition, misdiagnosis, and mild clinical presentation. Most patients are genetically uncharacterized as the diagnostic confirmation of PAM has traditionally not included a genetic analysis. Genetic testing may in the future be the preferred tool for diagnostics instead of invasive methods. This systematic review aims to provide an overview of the growing knowledge of PAM genetics. Rare variants in SLC34A2 are found in almost all genetically tested patients. So far, 34 allelic variants have been identified in at least 68 patients. A majority of these are present in the homozygous state; however, a few are found in the compound heterozygous form. Most of the allelic variants involve only a single nucleotide. Half of the variants are either nonsense or frameshifts, resulting in premature termination of the protein or decay of the mRNA. There is currently no cure for PAM, and the only effective treatment is lung transplantation. Management is mainly symptomatic, but an improved understanding of the underlying pathophysiology will hopefully result in development of targeted treatment options. More standardized data on PAM patients, including a genetic diagnosis covering larger international populations, would support the design and implementation of clinical studies to the benefit of patients. Further genetic characterization and understanding of how the molecular changes influence disease phenotype will hopefully allow earlier diagnosis and treatment of the disease in the future.
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Affiliation(s)
- Åsa Lina M Jönsson
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.
| | - Ole Hilberg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark.
| | - Ulf Simonsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Elisabeth Bendstrup
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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2
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Sarkar M, Sharma SK, Jhobta A, Gulati A. A case report of pulmonary alveolar microlithiasis with pulmonary tuberculosis. Lung India 2023; 40:161-164. [PMID: 37006101 PMCID: PMC10174655 DOI: 10.4103/lungindia.lungindia_276_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/09/2023] [Indexed: 03/05/2023] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disease characterised by the deposition of calcium phosphate microliths in the alveoli. PAM has been reported in all continents and there is often a familial history. There is clinical-radiological dissociation as there is often a paucity of symptoms in contrast to the imaging findings. Patients often remain asymptomatic until the third or fourth decade of life, and dyspnea is the most common symptom. PAM is caused by a mutation within the solute carrier family 34 member 2 gene (the SLC34A2 gene) located on chromosome 4p15.2, which encodes a sodium/phosphate co-transporter. The imaging appearance of the disease is quite pathognomic with the high-resolution computed tomography (HRCT) demonstrating a diffuse micronodular appearance. Transbronchial lung biopsy also confirms the diagnosis. There is no effective therapy at present except lung transplantation. We herein, present a case of PAM along with clinical history, imaging study, histopathological study and genetic study of a 43-year-old female adult patient along with genetic analysis.
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Affiliation(s)
- Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sudarshan K. Sharma
- Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Jhobta
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anchana Gulati
- Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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3
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Novel deletion of SLC34A2 in Chinese patients of PAM shares mutation hot spot with fusion gene SLC34A2–ROS1 in lung cancer. J Genet 2018. [DOI: 10.1007/s12041-018-0977-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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4
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Microlitiasis alveolar y su peculiar disociación clínico-radiológica. Arch Bronconeumol 2018; 54:493-494. [DOI: 10.1016/j.arbres.2017.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/10/2017] [Indexed: 12/26/2022]
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5
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Oliveira DS, Araújo Filho JDA, Paiva AFL, Ikari ES, Chate RC, Nomura CH. Idiopathic interstitial pneumonias: review of the latest American Thoracic Society/European Respiratory Society classification. Radiol Bras 2018; 51:321-327. [PMID: 30369660 PMCID: PMC6198836 DOI: 10.1590/0100-3984.2016.0134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 01/05/2017] [Indexed: 12/17/2022] Open
Abstract
The diagnosis of idiopathic interstitial pneumonias (IIPs) involves a multidisciplinary scenario in which the radiologist assumes a key role. The latest (2013) update of the IIP classification by the American Thoracic Society/European Respiratory Society proposed some important changes to the original classification of 2002. The novelties include the addition of a new disease (idiopathic pleuroparenchymal fibroelastosis) and the subdivision of the IIPs into four main groups: chronic fibrosing IIPs (idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia); smoking-related IIPs (desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung disease); acute or subacute IIPs (cryptogenic organizing pneumonia and acute interstitial pneumonia); rare IIPs (lymphoid interstitial pneumonia and idiopathic pleuroparenchymal fibroelastosis); and the so-called "unclassifiable" IIPs. In this study, we review the main clinical, tomographic, and pathological characteristics of each IIP.
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Affiliation(s)
- Daniel Simões Oliveira
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - José de Arimatéia Araújo Filho
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - Antonio Fernando Lins Paiva
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - Eduardo Seigo Ikari
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - Rodrigo Caruso Chate
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - César Higa Nomura
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
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6
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Dandan S, Yuqin C, Wei L, Ziheng P, Dapeng Z, Jianzhu Y, Xin X, Yonghong L, Fengjun T. Novel deletion of SLC34A2 in Chinese patients of PAM shares mutation hot spot with fusion gene SLC34A2-ROS1 in lung cancer. J Genet 2018; 97:939-944. [PMID: 30262706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pulmonary alveolar microlithiasis (PAM) is an autosomal recessive disorder with distinctive deposition of calcium phosphate microliths in the lungs. Mutation of the SLC34A2 gene was proved to be responsible for PAM. Here, we report the study of a family affected by PAM in China. Two daughters of an inbred family whose parents are cousins and are affected by PAM. Mutation analysis of the SLC34A2 gene by polymerase chain reaction (PCR) amplification and direct sequencing in both patients revealed that exon 5 was deleted on both alleles. Both parents of the patients are proved to be carriers of the mutated allele. Gap-PCR was performed to determine the breakpoints and a homologous deletion of 1152 bp encompassing exon 5 of the SLC34A2 gene (c.IVS4+1452_IVS5+660del) was confirmed. A 4-bp fragment of TGGG was located on the edge of both upstream and downstream breakpoints. The upstream breakpoint lies in the same region as the breakpoint of a fused gene SLC34A2-ROS1, which encodes a constitutive kinase in the lung cancer cell line HCC78 and nonsmall-cell lung cancer (NSCLC), suggesting that the deletion in this family is a hot spot for recombination, not only in cancer samples with somatic mutation, but also in PAM patients with germline genetic defects of SLC34A2.
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Affiliation(s)
- Shang Dandan
- Department of Biochemistry and Molecular Biology, Hebei Medical University, Shijiazhuang 050017, Hebei, People's Republic of China.
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7
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Delic JA, Fuhrman CR, Trejo Bittar HE. Pulmonary Alveolar Microlithiasis: AIRP Best Cases in Radiologic-Pathologic Correlation. Radiographics 2017; 36:1334-8. [PMID: 27618319 DOI: 10.1148/rg.2016150259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Editor's Note.-RadioGraphics continues to publish radiologic-pathologic case material selected from the American Institute for Radiologic Pathology (AIRP) "best case" presentations. The AIRP conducts a 4-week Radiologic Pathology Correlation Course, which is offered five times per year. On the penultimate day of the course, the best case presentation is held at the American Film Institute Silver Theater and Cultural Center in Silver Spring, Md. The AIRP faculty identifies the best cases, from each organ system, brought by the resident attendees. One or more of the best cases from each of the five courses are then solicited for publication in RadioGraphics. These cases emphasize the importance of radiologic-pathologic correlation in the imaging evaluation and diagnosis of diseases encountered at the institute and its predecessor, the Armed Forces Institute of Pathology (AFIP).
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Affiliation(s)
- Joseph A Delic
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Suite 174 E, Pittsburgh, PA 15213
| | - Carl R Fuhrman
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Suite 174 E, Pittsburgh, PA 15213
| | - Humberto E Trejo Bittar
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Suite 174 E, Pittsburgh, PA 15213
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Belém LC, Souza CA, Souza AS, Escuissato DL, Hochhegger B, Nobre LF, Rodrigues RS, Gomes ACP, Silva CS, Guimarães MD, Zanetti G, Marchiori E. Metastatic pulmonary calcification: high-resolution computed tomography findings in 23 cases. Radiol Bras 2017; 50:231-236. [PMID: 28894330 PMCID: PMC5586513 DOI: 10.1590/0100-3984.2016-0123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective The aim of this study was to evaluate the high-resolution computed tomography
(HRCT) findings in patients diagnosed with metastatic pulmonary
calcification (MPC). Materials and Methods We retrospectively reviewed the HRCT findings from 23
cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89) years]. The
patients were examined between 2000 and 2014 in nine tertiary hospitals in
Brazil, Chile, and Canada. Diagnoses were established by histopathologic
study in 18 patients and clinical-radiological correlation in 5 patients.
Two chest radiologists analyzed the images and reached decisions by
consensus. Results The predominant HRCT findings were centrilobular ground-glass nodules
(n = 14; 60.9%), consolidation with high attenuation
(n = 10; 43.5%), small dense nodules
(n = 9; 39.1%), peripheral reticular opacities
associated with small calcified nodules (n = 5; 21.7%), and
ground-glass opacities without centrilobular ground-glass nodular opacity
(n = 5; 21.7%). Vascular calcification within the chest
wall was found in four cases and pleural effusion was observed in five
cases. The abnormalities were bilateral in 21 cases. Conclusion MPC manifested with three main patterns on HRCT, most commonly centrilobular
ground-glass nodules, often containing calcifications, followed by dense
consolidation and small solid nodules, most of which were calcified. We also
described another pattern of peripheral reticular opacities associated with
small calcified nodules. These findings should suggest the diagnosis of MPC
in the setting of hypercalcemia.
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Affiliation(s)
| | - Carolina A Souza
- MD, PhD, Ottawa Hospital Research Institute, University of Ottawa, Canada
| | - Arthur Soares Souza
- MD, PhD, Faculdade de Medicina de São José do Rio Preto (Famerp) and Ultra X, São José do Rio Preto, SP, Brazil
| | | | - Bruno Hochhegger
- MD, PhD, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Luiz Felipe Nobre
- MD, PhD, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Rosana Souza Rodrigues
- MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ) and Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil
| | | | - Claudio S Silva
- MD, MSc, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Marcos Duarte Guimarães
- MD, PhD, A.C.Camargo Cancer Center, São Paulo, SP, and Universidade Federal do Vale do São Francisco (Univasf), Petrolina, PE, Brazil
| | - Gláucia Zanetti
- MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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9
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Torres PPTES, Rabahi M, Pinto SA, Curado KCDMA, Rabahi MF. Primary tracheobronchial amyloidosis. Radiol Bras 2017; 50:267-268. [PMID: 28894337 PMCID: PMC5586520 DOI: 10.1590/0100-3984.2015.0177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Matheus Rabahi
- Pontifícia Universidade Católica de Goiás (PUC Goiás), Goiânia, GO, Brazil
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10
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Hochhegger B, Baldisserotto M. Chest computed tomography in bronchiolitis obliterans after bone marrow transplantation. Radiol Bras 2017; 50:IX. [PMID: 28670041 PMCID: PMC5487226 DOI: 10.1590/0100-3984.2017.50.3e3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Bruno Hochhegger
- Adjunct Professor of Radiology at the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil. E-mail:
| | - Matteo Baldisserotto
- Professor in the Graduate Program of the Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil. E-mail:
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11
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Togni Filho PH, Casagrande JLM, Lederman HM. Utility of the inspiratory phase in high-resolution computed tomography evaluations of pediatric patients with bronchiolitis obliterans after allogeneic bone marrow transplant: reducing patient radiation exposure. Radiol Bras 2017; 50:90-96. [PMID: 28428651 PMCID: PMC5396998 DOI: 10.1590/0100-3984.2015.0181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/26/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the utility of the inspiratory phase in high-resolution computed tomography (HRCT) of the chest for the diagnosis of post-bone marrow transplantation bronchiolitis obliterans. MATERIALS AND METHODS This was a retrospective, observational, cross-sectional study. We selected patients of either gender who underwent bone marrow transplantation and chest HRCT between March 1, 2002 and December 12, 2014. Ages ranged from 3 months to 20.7 years. We included all examinations in which the HRCT was performed appropriately. The examinations were read by two radiologists, one with extensive experience in pediatric radiology and another in the third year of residency, who determined the presence or absence of the following imaging features: air trapping, bronchiectasis, alveolar opacities, nodules, and atelectasis. RESULTS A total of 222 examinations were evaluated (mean, 5.4 ± 4.5 examinations per patient). The expiratory phase findings were comparable to those obtained in the inspiratory phase, except in one patient, in whom a small uncharacteristic nodule was identified only in the inspiratory phase. Air trapping was identified in a larger number of scans in the expiratory phase than in the inspiratory phase, as was atelectasis, although the difference was statistically significant only for air trapping. CONCLUSION In children being evaluated for post-bone marrow transplantation bronchiolitis obliterans, the inspiratory phase can be excluded from the chest HRCT protocol, thus reducing by half the radiation exposure in this population.
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Affiliation(s)
- Paulo Henrique Togni Filho
- MD, MSc, Attending Physician, Department of Diagnostic Imaging,
Escola Paulista de Medicina da Universidade Federal de São Paulo
(EPM-Unifesp), São Paulo, SP, Brazil
| | - João Luiz Marin Casagrande
- Radiologist, Fellow in Musculoskeletal Imaging, Instituto de
Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade
de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Henrique Manoel Lederman
- Tenured Full Professor, Department of Diagnostic Imaging, Escola
Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp),
São Paulo, SP, Brazil
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12
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de Brito MCB, Ota MK, Leitão Filho FSS, Meirelles GDSP. Radiologist agreement on the quantification of bronchiectasis by high-resolution computed tomography. Radiol Bras 2017; 50:26-31. [PMID: 28298729 PMCID: PMC5347500 DOI: 10.1590/0100-3984.2015.0146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To evaluate radiologist agreement on the quantification of bronchiectasis by
high-resolution computed tomography (HRCT). Materials and Methods The HRCT scans of 43 patients with bronchiectasis were analyzed by two
radiologists, who used a scoring system to grade the findings. Kappa
(κ) values and overall agreement were calculated. Results For the measurement and appearance of bronchiectasis, the interobserver
agreement was moderate (κ = 0.45 and κ = 0.43, respectively),
as was the intraobserver agreement (κ = 0.54 and κ = 0.47,
respectively). Agreement on the presence of mucous plugging was fair, for
central distribution (overall interobserver agreement of 68.3% and κ
= 0.39 for intraobserver agreement) and for peripheral distribution
(κ = 0.34 and κ = 0.35 for interobserver and intraobserver
agreement, respectively). The agreement was also fair for peribronchial
thickening (κ = 0.21 and κ = 0.30 for interobserver and
intraobserver agreement, respectively). There was fair interobserver and
intraobserver agreement on the detection of opacities (κ = 0.39 and
71.9%, respectively), ground-glass attenuation (64.3% and κ = 0.24,
respectively), and cysts/bullae (κ = 0.47 and κ = 0.44,
respectively). Qualitative analysis of the HRCT findings of bronchiectasis
and the resulting individual patient scores showed that there was an
excellent correlation between the observers (intraclass correlation
coefficient of 0.85 and 0.81 for interobserver and intraobserver agreement,
respectively). Conclusion In the interpretation of HRCT findings of bronchiectasis, radiologist
agreement appears to be fair. In our final analysis of the findings using
the proposed score, we observed excellent interobserver and intraobserver
agreement.
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Affiliation(s)
| | - Maurício Kenji Ota
- MD, Radiologist for the Fundação Instituto de Pesquisa e Estudos de Diagnóstico por Imagem (FIDI), São Paulo, SP, Brazil
| | | | - Gustavo de Souza Portes Meirelles
- PhD, Coordinator of the Thoracic Imaging Team of the Grupo Fleury, São Paulo, SP, Professor and Advisor for the Graduate Course in Clinical Radiology at the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Affiliation(s)
| | | | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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14
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Barbosa AGDJ, Penha D, Zanetti G, Marchiori E. Foreign body in the bronchus of a child: the importance of making the correct diagnosis. Radiol Bras 2016; 49:340-342. [PMID: 27818551 PMCID: PMC5094826 DOI: 10.1590/0100-3984.2015.0169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Diana Penha
- Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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15
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Feng Y, Zhao J, Yang Q, Xiong W, Zhen G, Xu Y, Zhang Z, Zhang H. Pulmonary melanoma and "crazy paving" patterns in chest images: a case report and literature review. BMC Cancer 2016; 16:592. [PMID: 27488496 PMCID: PMC4973081 DOI: 10.1186/s12885-016-2630-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/26/2016] [Indexed: 12/19/2022] Open
Abstract
Background In the lung, melanoma is mostly arranged as patterns of multiple nodules, solitary nodules, or miliary invasions. Very rarely, it also displays a “crazy paving” pattern (also described as a “paving stone,” “flagstone,” or “slabstone” pattern), which is rarer still in discrete bilateral nodules. This pattern is considered to be caused by pulmonary alveolar proteinosis, but its association with various diseases is unclear. Case presentation A 60-year-old man was diagnosed with pulmonary melanoma. Computed tomography revealed discrete bilateral nodules surrounded by a “paving” pattern. A literature review found more than 40 types of diseases that have presented with “paving” patterns in the lung—predominantly pulmonary alveolar proteinosis, viral pneumonia, exogenous lipoid pneumonia, bacterial pneumonia, pulmonary alveolar microlithiasis, interstitial pneumonia, ARDS, squalene aspiration pneumonia, radiation pneumonitis, drug-induced pneumonitis, pulmonary leptospirosis, pulmonary hemorrhage, and pulmonary nocardiosis. Conclusions We describe the first case of pulmonary melanoma in the form of discrete bilateral nodules accompanied with a computed tomography paving pattern. Although pulmonary paving patterns are rare, more than 40 diseases reportedly display them; clinicians should consider melanoma of the lung in differential diagnoses for patients who show such a pattern.
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Affiliation(s)
- Yikuan Feng
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jianping Zhao
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qun Yang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Weining Xiong
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Guohua Zhen
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yongjian Xu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhenxiang Zhang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Huilan Zhang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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16
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Alves UD, Lopes AJ, Maioli MCP, Soares AR, de Melo PL, Mogami R. Changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease. Radiol Bras 2016; 49:214-219. [PMID: 27777473 PMCID: PMC5073386 DOI: 10.1590/0100-3984.2015.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To describe and quantify the main changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease, as well as to evaluate the radiologist accuracy in determining the type of hemoglobinopathy. MATERIALS AND METHODS A prospective study involving 44 adult patients with sickle cell disease who underwent inspiration and expiration computed tomography of the chest. The frequency of tomography findings and the extent of involvement are reported. We also calculated radiologist accuracy in determining the type of hemoglobinopathy by analyzing the pulmonary alterations and morphology of the spleen. RESULTS The changes found on computed tomography scans, in descending order of frequency, were as follows: fibrotic opacities (81.8%); mosaic attenuation (56.8%); architectural distortion (31.8%); cardiomegaly (25.0%); lobar volume reduction (18.2%); and increased caliber of peripheral pulmonary arteries (9.1%). For most of the findings, the involvement was considered mild, five or fewer lung segments being affected. The accuracy in determining the type of hemoglobinopathy (HbSS group versus not HbSS group) was 72.7%. CONCLUSION In adult patients with sickle cell disease, the main tomography findings reflect fibrotic changes. In addition, computed tomography can be helpful in differentiating among hemoglobinopathies.
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Affiliation(s)
- Ursula David Alves
- MD, Radiologist at the Hospital Universitário Pedro Ernesto (HUPE), Student in the Graduate Program in Medical Sciences at the Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Agnaldo José Lopes
- PhD, Adjunct Professor of Pulmonology at the Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Maria Christina Paixão Maioli
- PhD, Adjunct Professor of Hematology at the Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Andrea Ribeiro Soares
- PhD, Adjunct Professor of Hematology at the Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Pedro Lopes de Melo
- PhD, Associate Professor, Head of the Biomedical Instrumentation Laboratory, Head of the Laboratory for Clinical and Experimental Research in Vascular Biology, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Roberto Mogami
- PhD, Adjunct Professor of Radiology at the Universidade do Estado do Rio de Janeiro (UERJ), Head of the Radiology Department of the Hospital Universitário Pedro Ernesto (HUPE), Rio de Janeiro, RJ, Brazil
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17
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Ribeiro BNDF, Ribeiro RN, Zanetti G, Marchiori E. Hughes-Stovin syndrome: an unusual cause of pulmonary artery aneurysms. Radiol Bras 2016; 49:202-3. [PMID: 27403026 PMCID: PMC4938456 DOI: 10.1590/0100-3984.2015.0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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18
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Abstract
Pulmonary alveolar microlithiasis (PAM) is a genetic lung disorder that is characterized by the accumulation of calcium phosphate deposits in the alveolar spaces of the lung. Mutations in the type II sodium phosphate cotransporter, NPT2b, have been reported in patients with PAM. PAM progresses gradually, often producing incremental dyspnea on exertion, desaturation in young adulthood, and respiratory insufficiency by late middle age. Treatment remains supportive, including supplemental oxygen therapy. For patients with end-stage disease, lung transplantation is available as a last resort. The recent development of a laboratory animal model has revealed several promising treatment approaches for future trials.
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19
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Affiliation(s)
- Juliana Pessoa
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | | | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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20
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Qian X, Wu X, Liu X. Pulmonary alveolar microlithiasis with finger clubbing: A case report and literature review. Exp Ther Med 2016; 11:1381-1384. [PMID: 27073453 DOI: 10.3892/etm.2016.3075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/08/2015] [Indexed: 12/27/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive and slowly progressive disease. Mutations of the solute carrier family 34, member 2 gene are considered to be the cause of the disease. The present study reported the case of a 35-year-old female patient who was diagnosed with PAM. The parents of the patient were reported to be blood-related (cousins). The clinical manifestations and radiological and pathological characteristics of the patient are reported. A pulmonary function examination detected restrictive ventilatory and diffusion defects, and a high-resolution computed tomography scan showed multiple bilateral diffuse ground-glass opacifications and subpleural linear calcifications. A bronchoalveolar lavage fluid (BALF) examination detected a calcified body in the lavage fluid and a transbronchial biopsy showed numerous calcified bodies, concentrically laminated with an onion skin-like appearance in the alveolar spaces. Based on the aforementioned observations, the patient was diagnosed with PAM. Following administration of inhaled corticosteroid treatment, the symptoms were improved and the patient was discharged. After 1 year, the patient was lost to follow-up. The present study presents and reviews the typical radiological appearance, clinical presentation, pathological characteristics and treatments of PAM, and suggests that, often, the parents of the patients are blood-related and typically cousins. In addition, the present study proposes that a BALF examination may be considered an alternative method for the pathological diagnosis of PAM.
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Affiliation(s)
- Xin Qian
- Department of Respiratory Medicine, Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Xiaofeng Wu
- Department of Respiratory Medicine, Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Xianjun Liu
- Department of Respiratory Medicine, Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
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21
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Affiliation(s)
- Marcel Koenigkam Santos
- Attending Physician at Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HCFMRP-USP), MD, Radiologist at MED - Medicina Diagnóstica, Ribeirão Preto, SP, Brazil. E-mail:
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