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Simmonds NJ, Southern KW, De Wachter E, De Boeck K, Bodewes F, Mainz JG, Middleton PG, Schwarz C, Vloeberghs V, Wilschanski M, Bourrat E, Chalmers JD, Ooi CY, Debray D, Downey DG, Eschenhagen P, Girodon E, Hickman G, Koitschev A, Nazareth D, Nick JA, Peckham D, VanDevanter D, Raynal C, Scheers I, Waller MD, Sermet-Gaudelus I, Castellani C. ECFS standards of care on CFTR-related disorders: Identification and care of the disorders. J Cyst Fibros 2024:S1569-1993(24)00037-7. [PMID: 38508949 DOI: 10.1016/j.jcf.2024.03.008] [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: 11/21/2023] [Revised: 02/06/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
This is the third paper in the series providing updated information and recommendations for people with cystic fibrosis transmembrane conductance regulator (CFTR)-related disorder (CFTR-RD). This paper covers the individual disorders, including the established conditions - congenital absence of the vas deferens (CAVD), diffuse bronchiectasis and chronic or acute recurrent pancreatitis - and also other conditions which might be considered a CFTR-RD, including allergic bronchopulmonary aspergillosis, chronic rhinosinusitis, primary sclerosing cholangitis and aquagenic wrinkling. The CFTR functional and genetic evidence in support of the condition being a CFTR-RD are discussed and guidance for reaching the diagnosis, including alternative conditions to consider and management recommendations, is provided. Gaps in our knowledge, particularly of the emerging conditions, and future areas of research, including the role of CFTR modulators, are highlighted.
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Affiliation(s)
- N J Simmonds
- Adult Cystic Fibrosis Centre, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, UK.
| | - K W Southern
- Department of Women's and Children's Health, University of Liverpool, University of Liverpool, Alder Hey Children's Hospital, Liverpool, UK
| | - E De Wachter
- Cystic Fibrosis Center, Pediatric Pulmonology department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - K De Boeck
- Department of Pediatrics, University of Leuven, Leuven, Belgium
| | - F Bodewes
- Pediatric Gastroenterology and Hepatology, Department of Pediatrics, University of Groningen Medical Center, Groningen, the Netherlands
| | - J G Mainz
- Cystic Fibrosis Center, Brandenburg Medical School (MHB), University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - P G Middleton
- Cystic Fibrosis and Bronchiectasis Service, Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, News South Wales, Australia
| | - C Schwarz
- HMU-Health and Medical University Potsdam, CF Center Westbrandenburg, Campus Potsdam, Germany
| | - V Vloeberghs
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - M Wilschanski
- CF Center, Department of Pediatrics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - E Bourrat
- APHP, Service de Dermatologie, CRMR MAGEC Nord St Louis, Hôpital-Saint Louis, Paris, France
| | - J D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - C Y Ooi
- a) School of Clinical Medicine, Discipline of Paediatrics and Child Health, Medicine & Health, University of New South Wales, Level 8, Centre for Child Health Research & Innovation Bright Alliance Building Cnr Avoca & High Streets, Randwick, Sydney, NSW, Australia, 2031; b) Sydney Children's Hospital, Gastroenterology Department, High Street, Randwick, Sydney, NSW, Australia, 2031
| | - D Debray
- Pediatric Hepatology unit, Centre de Référence Maladies Rares (CRMR) de l'atrésie des voies biliaires et cholestases génétiques (AVB-CG), National network for rare liver diseases (Filfoie), ERN rare liver, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - D G Downey
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | | | - E Girodon
- Service de Médecine Génomique des Maladies de Système et d'Organe, APHP.Centre - Université de Paris Cité, Hôpital Cochin, Paris, France
| | - G Hickman
- APHP, Service de Dermatologie, CRMR MAGEC Nord St Louis, Hôpital-Saint Louis, Paris, France
| | - A Koitschev
- Klinikum Stuttgart, Pediatric Otorhinolaryngology, Stuttgart, Germany
| | - D Nazareth
- a) Adult CF Unit, Liverpool Heart and Chest Hospital NHS Foundation Trust, U.K; b) Clinical Infection, Microbiology and Immunology, University of Liverpool, UK
| | - J A Nick
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - D Peckham
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - D VanDevanter
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - C Raynal
- Laboratory of molecular genetics, University Hospital of Montpellier and INSERM U1046 PHYMEDEXP, Montpellier, France
| | - I Scheers
- Department of Pediatrics, Pediatric Gastroenterology and Hepatology Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - M D Waller
- Adult Cystic Fibrosis and Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; Honorary Senior Lecturer, King's College London, London, United Kingdom
| | - I Sermet-Gaudelus
- INSERM U1151, Institut Necker Enfants Malades, Paris, France; Université de Paris, Paris, France; Centre de référence Maladies Rares, Mucoviscidose et maladies apparentées, Hôpital Necker Enfants malades, Paris, France
| | - C Castellani
- IRCCS Istituto Giannina Gaslini, Cystic Fibrosis Center, Genoa, Italy
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Agarwal R, Muthu V, Sehgal IS. Clinical Manifestation and Treatment of Allergic Bronchopulmonary Aspergillosis. Semin Respir Crit Care Med 2024; 45:114-127. [PMID: 38154470 DOI: 10.1055/s-0043-1776912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to airway colonization by Aspergillus fumigatus in patients with asthma and cystic fibrosis. The pathophysiology of ABPA involves a complex interplay between the fungus and the host immune response, which causes persistent inflammation and tissue damage. Patients present with chronic cough, wheezing, and dyspnea due to uncontrolled asthma. Characteristic symptoms include the expectoration of brownish mucus plugs. Radiographic findings often reveal fleeting pulmonary infiltrates, bronchiectasis, and mucus impaction. However, the definitive diagnosis of ABPA requires a combination of clinical, radiological, and immunological findings. The management of ABPA aims to reduce symptoms, prevent disease progression, and minimize the future risk of exacerbations. The treatment approach involves systemic glucocorticoids or antifungal agents to suppress the inflammatory response or fungal growth and prevent exacerbations. Biological agents may be used in patients with severe disease or glucocorticoid dependence. This review provides an overview of the clinical manifestations and current treatment options for ABPA.
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Affiliation(s)
- Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul S Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ledda RE, Balbi M, Milone F, Ciuni A, Silva M, Sverzellati N, Milanese G. Imaging in non-cystic fibrosis bronchiectasis and current limitations. BJR Open 2021; 3:20210026. [PMID: 34381953 PMCID: PMC8328081 DOI: 10.1259/bjro.20210026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/21/2023] Open
Abstract
Non-cystic fibrosis bronchiectasis represents a heterogenous spectrum of disorders characterised by an abnormal and permanent dilatation of the bronchial tree associated with respiratory symptoms. To date, diagnosis relies on computed tomography (CT) evidence of dilated airways. Nevertheless, definite radiological criteria and standardised CT protocols are still to be defined. Although largely used, current radiological scoring systems have shown substantial drawbacks, mostly failing to correlate morphological abnormalities with clinical and prognostic data. In limited cases, bronchiectasis morphology and distribution, along with associated CT features, enable radiologists to confidently suggest an underlying cause. Quantitative imaging analyses have shown a potential to overcome the limitations of the current radiological criteria, but their application is still limited to a research setting. In the present review, we discuss the role of imaging and its current limitations in non-cystic fibrosis bronchiectasis. The potential of automatic quantitative approaches and artificial intelligence in such a context will be also mentioned.
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Affiliation(s)
- Roberta Eufrasia Ledda
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Maurizio Balbi
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Francesca Milone
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Andrea Ciuni
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
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Fendoğlu TZ, Köktürk N, Yapar D, Kılıç P, Kılıç K, Erbaş G. The effect of bronchiectasis on the exacerbation and mortality of chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2021; 15:1113-1120. [PMID: 34224649 DOI: 10.1111/crj.13417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/11/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Coexistence of bronchiectasis with chronic obstructive pulmonary disease (COPD) may lead to the worsening of the functional parameters in exacerbations and may negatively affect the outcomes. METHODS This study is a retrospective cross-sectional study that aims to investigate the relationships between bronchiectasis with COPD exacerbation and all-cause of mortality. We retrospectively enrolled 122 cases hospitalized for COPD exacerbation from 2010 to 2016. Patients who underwent thoracic tomography in the previous year of the index exacerbation were included in the study. Patients who admitted to the intensive care unit and patients with infected bronchiectasis and with conditions that mimic COPD exacerbation were excluded from the study. Demographic, clinical, and laboratory findings, comorbidities and the number of exacerbations in the previous year and the presence of bronchiectasis were recorded using hospital electronic registry. The radiological evaluation of bronchiectasis was made by the modified Reiff score (MRS). RESULTS Bronchiectasis was found in 66 (54%) of 122 patients included in the study. The mean age was 67.5 ± 10.3 in the whole group, 108 (88.5%) of the patients were male, and 14 (11.5%) were female. When patients were stratified according to the presence of bronchiectasis, no statistically significant difference was found in terms of comorbidity scores, respiratory functions, exacerbation parameters, laboratory values and all cause of mortality between the groups (p > 0.05). There was no statistical relation between the presence of bronchiectasis and long-term survival (log-rank test p = 0.83). CONCLUSIONS This study shows that patients with bronchiectasis did not cause a poor outcome in patients with COPD exacerbation.
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Affiliation(s)
| | - Nurdan Köktürk
- Department of Pulmonary Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Dilek Yapar
- Department of Public Health, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Pınar Kılıç
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Koray Kılıç
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Gonca Erbaş
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
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Dettmer S, Ringshausen FC, Fuge J, Maske HL, Welte T, Wacker F, Rademacher J. Computed Tomography in Adults with Bronchiectasis and Nontuberculous Mycobacterial Pulmonary Disease: Typical Imaging Findings. J Clin Med 2021; 10:jcm10122736. [PMID: 34205759 PMCID: PMC8235195 DOI: 10.3390/jcm10122736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/10/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022] Open
Abstract
Among patients with bronchiectasis, nontuberculous mycobacterial pulmonary disease (NTM-PD) ranged between 1 and 6% and it is suspected that its prevalence is underestimated. Our aim was to evaluate differences in computed tomography (CT) features in patients with bronchiectasis, with and without NTM-PD, in order to facilitate earlier diagnosis in the future. In addition, we evaluated longitudinal changes after successful NTM-PD treatment. One hundred and twenty-eight CTs performed in adults with bronchiectasis were scored for the involvement, type, and lobar distribution of bronchiectasis, bronchial dilatation, and bronchial wall thickening according to Reiff. In addition, associated findings, such as mucus plugging, tree-in-bud, consolidations, ground-glass opacities, interlobular thickening, intralobular lines, cavities, and atelectasis, were registered. Patients with NTM-PD (n = 36), as defined by ATS/IDSA diagnostic criteria, were compared to bronchiectasis patients without NTM-PD (n = 92). In twelve patients with an available consecutive CT scan after microbiological cure of NTM-PD imaging findings were also scored according to Kim and compared in the course. In patients with NTM-PD, there was a higher prevalence of bronchiectasis in the middle lobes (p < 0.001), extended bronchiolitis (p = 0.032) and more small and large nodules (p < 0.001). Furthermore, cavities turned out to be larger (p = 0.038), and walls thickened (p = 0.019) and extended (p = 0.016). Patients without NTM more often showed peripheral ground-glass opacities (0.003) and interstitial changes (p = 0.001). CT findings decreased after successful NTM-PD treatment in the follow-up CT; however, without statistical significance for most features (p = 0.056), but bronchiolitis was the only significantly reduced score item (p = 0.043). CT patterns in patients with bronchiectasis and NTM-PD differ from those of patients with bronchiectasis without NTM-PD, although the findings are non-specific radiological features. Follow-up CT findings after microbiological cure differed interindividual regarding the decline in imaging features. Our findings may help practitioners to identify NTM-PD in patients with bronchiectasis. Further research is needed regarding the use of CT as a potential imaging biomarker for the evaluation of treatment response.
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Affiliation(s)
- Sabine Dettmer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (S.D.); (H.L.M.); (F.W.)
| | - Felix C. Ringshausen
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (F.C.R.); (J.F.); (T.W.)
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (F.C.R.); (J.F.); (T.W.)
| | - Hannah Louise Maske
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (S.D.); (H.L.M.); (F.W.)
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (F.C.R.); (J.F.); (T.W.)
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (S.D.); (H.L.M.); (F.W.)
| | - Jessica Rademacher
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (F.C.R.); (J.F.); (T.W.)
- Correspondence: ; Tel.: +49-511-532-9735
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Lima E, Nakamura MAM, Genta PR, Rodrigues AJ, Athanazio RA, Rached S, Costa ELV, Stelmach R. Improving Airways Patency and Ventilation Through Optimal Positive Pressure Identified by Noninvasive Mechanical Ventilation Titration in Mounier-Kuhn Syndrome: Protocol for an Interventional, Open-Label, Single-Arm Clinical Trial. JMIR Res Protoc 2020; 9:e14786. [PMID: 32795996 PMCID: PMC7455860 DOI: 10.2196/14786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 04/28/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mounier-Kuhn syndrome or congenital tracheobronchomegaly is a rare disease characterized by dilation of the trachea and the main bronchi within the thoracic cavity. The predominant signs and symptoms of the disease include coughing, purulent and abundant expectoration, dyspnea, snoring, wheezing, and recurrent respiratory infection. Symptoms of the disease in some patients are believed to be pathological manifestations arising due to resident tracheobronchomalacia. Although treatment options used for the management of this disease include inhaled bronchodilators, corticosteroids, and hypertonic solution, there is no consensus on the treatment. The use of continuous positive airway pressure (CPAP) has been reported as a potential therapeutic option for tracheobronchomalacia, but no prospective studies have demonstrated its efficacy in this condition. OBJECTIVE The purpose of this is to identify the presence of tracheobronchomalacia and an optimal CPAP pressure that reduces the tracheobronchial collapse in patients with Mounier-Kuhn syndrome and to analyze the repercussion in pulmonary ventilation. In parallel, we aim to evaluate the prevalence of obstructive sleep apnea/hypopnea syndrome. METHODS This interventional, open-label, single-arm clinical trial will enroll patients who are diagnosed Mounier-Kuhn syndrome. Patient evaluation will be conducted in an outpatient clinic and involve 3 visits. Visit 1 will involve the collection and registration of social demographic, clinical, and functional data. Visit 2 will entail polysomnography, bronchoscopy for the evaluation of tracheobronchomalacia, titration of the optimal pressure that reduces the degree of collapse of the airway, and electrical impedance tomography. In visit 3, patients exhibiting a reduction in collapse areas will be requested to undergo chest computed tomography during inspiration and forced expiration with and without positive pressure (titrated to determine optimal CPAP pressure). RESULTS This protocol is a doctorate project. The project was submitted to the institutional review board on January 24, 2017, and approval was granted on February 2, 2017 (Brazilian Research database number CAAE 64001317.4.000.0068). Patient evaluations started in April 2018. Planned recruitment is based on volunteers' availability and clinical stability, and interventions will be conducted at least once a month to finish the project at the end of 2020. A preliminary analysis of each case will be performed after each intervention, but detailed results are expected to be reported in the first quarter of 2021. CONCLUSIONS There is no consensus on the best treatment options for managing Mounier-Kuhn syndrome. The use of positive pressure could maintain patency of the collapsed airways, functioning as a "pneumatic stent" to reduce the degree of airflow obstruction. This, in turn, could promote mobilization of thoracic secretion and improve pulmonary ventilation. TRIAL REGISTRATION ClinicalTrails.gov NCT03101059; https://clinicaltrials.gov/ct2/show/NCT03101059. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14786.
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Affiliation(s)
- Evelise Lima
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | | | - Pedro Rodrigues Genta
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Ascedio José Rodrigues
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Rodrigo Abensur Athanazio
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Samia Rached
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Eduardo Leite Vieira Costa
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
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Singh A, Bhalla AS, Jana M. Bronchiectasis Revisited: Imaging-Based Pattern Approach to Diagnosis. Curr Probl Diagn Radiol 2019. [DOI: 10.1067/j.cpradiol.2017.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Contarini M, Finch S, Chalmers JD. Bronchiectasis: a case-based approach to investigation and management. Eur Respir Rev 2018; 27:27/149/180016. [PMID: 29997246 DOI: 10.1183/16000617.0016-2018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/04/2018] [Indexed: 01/06/2023] Open
Abstract
Bronchiectasis is a chronic respiratory disease characterised by a syndrome of productive cough and recurrent respiratory infections due to permanent dilatation of the bronchi. Bronchiectasis represents the final common pathway of different disorders, some of which may require specific treatment. Therefore, promptly identifying the aetiology of bronchiectasis is recommended by the European Respiratory Society guidelines. The clinical history and high-resolution computed tomography (HRCT) features can be useful to detect the underlying causes. Despite a strong focus on this aspect of treatment a high proportion of patients remain classified as "idiopathic". Important underlying conditions that are treatable are frequently not identified for prolonged periods of time.The European Respiratory Society guidelines for bronchiectasis recommend a minimal bundle of tests for diagnosing the cause of bronchiectasis, consisting of immunoglobulins, testing for allergic bronchopulmonary aspergillosis and full blood count. Other testing is recommended to be conducted based on the clinical history, radiological features and severity of disease. Therefore it is essential to teach clinicians how to recognise the "clinical phenotypes" of bronchiectasis that require specific testing.This article will present the initial investigation and management of bronchiectasis focussing particularly on the HRCT features and clinical features that allow recognition of specific causes.
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Affiliation(s)
- Martina Contarini
- Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Internal Medicine Dept, Respiratory unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simon Finch
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Dettmer S, Ringshausen F, Vogel-Claussen J, Fuge J, Faschkami A, Shin HO, Schwerk N, Welte T, Wacker F, Rademacher J. Computed tomography in adult patients with primary ciliary dyskinesia: Typical imaging findings. PLoS One 2018; 13:e0191457. [PMID: 29408869 PMCID: PMC5800555 DOI: 10.1371/journal.pone.0191457] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/07/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives Among patients with non-cystic fibrosis bronchiectasis, 1–18% have an underlying diagnosis of primary ciliary dyskinesia (PCD) and it is suspected that there is under-recognition of this disease. Our intention was to evaluate the specific features of PCD seen on computed tomography (CT) in the cohort of bronchiectasis in order to facilitate the diagnosis. Materials and methods One hundred and twenty-one CTs performed in patients with bronchiectasis were scored for the involvement, type, and lobar distribution of bronchiectasis, bronchial dilatation, and bronchial wall thickening. Later, associated findings such as mucus plugging, tree in bud, consolidations, ground glass opacities, interlobular thickening, intralobular lines, situs inversus, emphysema, mosaic attenuation, and atelectasis were registered. Patients with PCD (n = 46) were compared to patients with other underlying diseases (n = 75). Results In patients with PCD, the extent and severity of the bronchiectasis and bronchial wall thickness were significantly lower in the upper lung lobes (p<0.001-p = 0.011). The lobar distribution differed significantly with a predominance in the middle and lower lobes in patients with PCD (<0.001). Significantly more common in patients with PCD were mucous plugging (p = 0.001), tree in bud (p <0.001), atelectasis (p = 0.009), and a history of resection of a middle or lower lobe (p = 0.047). Less common were emphysematous (p = 0.003) and fibrotic (p<0.001) changes. A situs inversus (Kartagener’s Syndrome) was only seen in patients with PCD (17%, p <0.001). Conclusion Typical imaging features in PCD include a predominance of bronchiectasis in the middle and lower lobes, severe tree in bud pattern, mucous plugging, and atelectasis. These findings may help practitioners to identify patients with bronchiectasis in whom further work-up for PCD is called for.
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Affiliation(s)
- Sabine Dettmer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- * E-mail:
| | - Felix Ringshausen
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Amir Faschkami
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Hoen-oh Shin
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Nicolaus Schwerk
- Department of Pediatric Pneumology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jessica Rademacher
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
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Al-Jahdali H, Alshimemeri A, Mobeireek A, Albanna AS, Al Shirawi NN, Wali S, Alkattan K, Alrajhi AA, Mobaireek K, Alorainy HS, Al-Hajjaj MS, Chang AB, Aliberti S. The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis. Ann Thorac Med 2017; 12:135-161. [PMID: 28808486 PMCID: PMC5541962 DOI: 10.4103/atm.atm_171_17] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 12/14/2022] Open
Abstract
This is the first guideline developed by the Saudi Thoracic Society for the diagnosis and management of noncystic fibrosis bronchiectasis. Local experts including pulmonologists, infectious disease specialists, thoracic surgeons, respiratory therapists, and others from adult and pediatric departments provided the best practice evidence recommendations based on the available international and local literature. The main objective of this guideline is to utilize the current published evidence to develop recommendations about management of bronchiectasis suitable to our local health-care system and available resources. We aim to provide clinicians with tools to standardize the diagnosis and management of bronchiectasis. This guideline targets primary care physicians, family medicine practitioners, practicing internists and respiratory physicians, and all other health-care providers involved in the care of the patients with bronchiectasis.
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Affiliation(s)
- Hamdan Al-Jahdali
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Pulmonary Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alshimemeri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Pulmonary Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Mobeireek
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- King Faisal Specialist Hospital and Research Centre, Department of Medicine, Pulmonary Division, Riyadh, Saudi Arabia
| | - Amr S. Albanna
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Pulmonary Division, King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | - Siraj Wali
- College of Medicine, King Abdulaziz University, Respiratory Unit, Department of Medicine, Jeddah, Saudi Arabia
| | - Khaled Alkattan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdulrahman A. Alrajhi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- King Faisal Specialist Hospital and Research Centre, Department of Medicine, Infectious Disease Division, Riyadh, Saudi Arabia
| | - Khalid Mobaireek
- College of Medicine, King Saud University, King Khalid University Hospital, Pediatric Pulmonology Division, Riyadh, Saudi Arabia
| | - Hassan S. Alorainy
- King Faisal Specialist Hospital and Research Centre, Respiratory Therapy Services, Riyadh, Saudi Arabia
| | - Mohamed S. Al-Hajjaj
- Department of Clinical Sciences, College of Medicine. University of Sharjah, Sharjah, UAE
| | - Anne B. Chang
- International Reviewer, Children's Centre of Health Research Queensland University of Technology, Queensland
- International Reviewer, Brisbane and Child Health Division, Menzies School of Health Research, Darwin, Australia
| | - Stefano Aliberti
- International Reviewer, Department of Pathophysiology and Transplantation, University of MilanInternal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Via Francesco Sforza 35, 20122, Milan, Italy
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11
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Raju S, Ghosh S, Mehta AC. Chest CT Signs in Pulmonary Disease. Chest 2017; 151:1356-1374. [DOI: 10.1016/j.chest.2016.12.033] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/08/2016] [Accepted: 12/05/2016] [Indexed: 12/29/2022] Open
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Little BP, Duong PAT. Imaging of Diseases of the Large Airways. Radiol Clin North Am 2016; 54:1183-1203. [PMID: 27719983 DOI: 10.1016/j.rcl.2016.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Imaging of the large airways is key to the diagnosis and management of a wide variety of congenital, infectious, malignant, and inflammatory diseases. Involvement can be focal, regional, or diffuse, and abnormalities can take the form of masses, thickening, narrowing, enlargement, or a combination of patterns. Recognition of the typical morphologies, locations, and distributions of large airways disease is central to an accurate imaging differential diagnosis.
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Affiliation(s)
- Brent P Little
- Department of Radiology and Imaging Sciences, Emory University Hospital, Emory University School of Medicine, Clinic Building A, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA.
| | - Phuong-Anh T Duong
- Department of Radiology and Imaging Sciences, Emory University Hospital, Emory University School of Medicine, Clinic Building A, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA
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13
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Buscot M, Pottier H, Marquette CH, Leroy S. Phenotyping Adults with Non-Cystic Fibrosis Bronchiectasis: A 10-Year Cohort Study in a French Regional University Hospital Center. Respiration 2016; 92:1-8. [PMID: 27336790 DOI: 10.1159/000446923] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/09/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Data concerning phenotypes in bronchiectasis are scarce. OBJECTIVE The aim of this study was to describe the clinical, functional and microbiological phenotypes of patients with bronchiectasis. METHODS A monocentric retrospective study in a university hospital in France was conducted over 10 years (2002-2012). Non-cystic fibrosis patients with tomographic confirmation of bronchiectasis were included. The clinical, functional and microbiological data of patients were analyzed relying on the underlying etiology. RESULTS Of the 311 included patients, an etiology was found for 245 of them. At the time of diagnosis, the median age was 61 years and the mean FEV1 was 63% of predicted. The main causes of bronchiectasis were post-infectious (50%, mostly related to tuberculosis), chronic obstructive pulmonary disease (COPD; 13%) and idiopathic (11%). Other causes were immune deficiency (6%), asthma (4%), autoimmunity (3%), tumor (2%) and other causes (4%). The comparison of phenotypic traits shows significant differences between COPD, congenital and idiopathic groups in term of sex (p = 0.0175), tobacco status (p < 0.0001), FEV1 (p = 0.0412) and age at diagnosis (p < 0.001), Pseudomonas aeruginosa (PA) colonization (p = 0.0276) and lobectomy (0.0093). Functional follow-up was available in 30% of patients with a median duration of 2.7 years. Presence of PA was associated with a lower median FEV1 at diagnosis (43% p < 0.003) but not with a faster rate of decline in FEV1. CONCLUSION Distinctive clinical, functional and microbiological features were found for idiopathic, congenital and COPD-related bronchiectasis. A prospective follow-up of these subgroups is necessary to validate their relevance in the management of bacterial colonization and specific complications of these bronchiectases.
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Affiliation(s)
- Matthieu Buscot
- Service de Pneumologie, Centre Hospitalier Universitaire de Nice, Nice, France
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Honoré I, Burgel PR. Primary ciliary dyskinesia in adults. Rev Mal Respir 2015; 33:165-89. [PMID: 26654126 DOI: 10.1016/j.rmr.2015.10.743] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/08/2015] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Primary ciliary dyskinesia is an autosomal recessive genetic disorder leading to structural and/or functional abnormalities of motor cilia. Impaired mucociliary clearance is responsible for the development of a multi-organ disease, which particularly affects the upper and lower airways. STATE OF THE ART In adults, primary ciliary dyskinesia is mainly characterized by bronchiectasis and chronic ear and sinus disorders. Situs inversus is found in half of patients and fertility disorders are commonly associated. Diagnosis is based on specialized tests: reduced level of nasal nitric oxide concentrations is suggestive of primary ciliary dyskinesia, but only a nasal or bronchial biopsy/brushing with analysis of beat pattern by videomicroscopy and/or analysis of cilia morphology by electronic microscopy can confirm the diagnosis. However, the diagnosis is difficult to achieve due to the limited access to these specialized tests and to difficulties in interpreting them. Genetic tests are under development and may provide new diagnostic tools. Treatment is symptomatic, based on airway clearance techniques (e.g., physiotherapy) and systemic and/or inhaled antibiotics. Prognosis is related to the severity of the respiratory impairment, which can be moderate or severe. PERSPECTIVES AND CONCLUSIONS Diagnosis and management of primary ciliary dyskinesia remain poorly defined and should be supported by specialized centers to standardize the diagnosis, improve the treatment and promote research.
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Affiliation(s)
- I Honoré
- Department of respiratory medicine, Cochin hospital, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
| | - P-R Burgel
- Department of respiratory medicine, Cochin hospital, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Paris Descartes university, Sorbonne Paris Cité, 75005 Paris, France.
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Noriega Aldave AP, William Saliski DO. The clinical manifestations, diagnosis and management of williams-campbell syndrome. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 6:429-32. [PMID: 25317385 PMCID: PMC4193147 DOI: 10.4103/1947-2714.141620] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Williams-Campbell syndrome is a rare congenital syndrome characterized by the absence of cartilage in subsegmental bronchi leading to formation of bronchiectasis distal to the affected bronchi. The differential diagnosis of bronchiectasis is broad and the rarity of the disease poses a diagnostic and management challenge for clinicians. This present review aims to help the understanding of the clinical manifestations, pathophysiological features, diagnostic modalities, management and differential diagnosis of Williams-Campbell syndrome. A MedLine/PubMed search was performed identifying all relevant articles. No restrictions were used for publication dates. The author used the keywords “Williams-Campbell syndrome,” “non-cystic fibrosis bronchiectasis” and “congenital bronchiectasis” finding 503, 195 and 489 articles, respectively.
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Affiliation(s)
- Adrian Pedro Noriega Aldave
- Department of Internal Medicine, University of Alabama at Birmingham Health Center Montgomery, Montgomery, Alabama, USA
| | - DO William Saliski
- Pulmonary-Critical Care Medicine, Baptisti South Medical Center Hospital, Pulmonary Montgomery Consultants, Montgomery, Alabama, USA
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Milliron B, Henry TS, Veeraraghavan S, Little BP. Bronchiectasis: Mechanisms and Imaging Clues of Associated Common and Uncommon Diseases. Radiographics 2015; 35:1011-30. [PMID: 26024063 DOI: 10.1148/rg.2015140214] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bronchiectasis is permanent irreversible dilatation of the airways and occurs in a variety of pathologic processes. Recurrent infection and inflammation and the resulting chemical and cellular cascade lead to permanent architectural changes in the airways. Bronchiectasis can confer substantial potential morbidity, usually secondary to recurrent infection. In severe cases of bronchiectasis, massive hemoptysis can lead to death. Thin-section computed tomography is the most sensitive imaging modality for the detection of bronchiectasis; findings include bronchial diameter exceeding that of the adjacent pulmonary artery and lack of normal tapering of terminal bronchioles as they course toward the lung periphery. The authors will review various causes of bronchiectasis, including common causes, such as recurrent infection or aspiration, and uncommon causes, such as congenital immunodeficiencies and disorders of cartilage development. The authors will also present an approach emphasizing the distribution (apical versus basal and central versus peripheral) and concomitant findings, such as nodules, cavities, and/or lymphadenopathy, that can assist in narrowing the differential diagnosis. Although an adequate understanding of these underlying causes in conjunction with their specific imaging appearances will allow radiologists to more confidently determine the process causing this common radiologic finding, clinical history and patient demographic characteristics play an integral role in determining a pertinent and concise differential diagnosis.
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Affiliation(s)
- Bethany Milliron
- From the Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging (B.M., T.S.H., B.P.L.), and Division of Pulmonary, Allergy, and Critical Care Medicine (S.V.), Emory University School of Medicine, 1364 Clifton Rd NE, Room D125A, Atlanta, GA 30322
| | - Travis S Henry
- From the Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging (B.M., T.S.H., B.P.L.), and Division of Pulmonary, Allergy, and Critical Care Medicine (S.V.), Emory University School of Medicine, 1364 Clifton Rd NE, Room D125A, Atlanta, GA 30322
| | - Srihari Veeraraghavan
- From the Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging (B.M., T.S.H., B.P.L.), and Division of Pulmonary, Allergy, and Critical Care Medicine (S.V.), Emory University School of Medicine, 1364 Clifton Rd NE, Room D125A, Atlanta, GA 30322
| | - Brent P Little
- From the Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging (B.M., T.S.H., B.P.L.), and Division of Pulmonary, Allergy, and Critical Care Medicine (S.V.), Emory University School of Medicine, 1364 Clifton Rd NE, Room D125A, Atlanta, GA 30322
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18
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Bennett WD, Xie M, Zeman K, Hurd H, Donaldson S. Heterogeneity of Particle Deposition by Pixel Analysis of 2D Gamma Scintigraphy Images. J Aerosol Med Pulm Drug Deliv 2014; 28:211-8. [PMID: 25393109 DOI: 10.1089/jamp.2013.1095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Heterogeneity of inhaled particle deposition in airways disease may be a sensitive indicator of physiologic changes in the lungs. Using planar gamma scintigraphy, we developed new methods to locate and quantify regions of high (hot) and low (cold) particle deposition in the lungs. METHODS Initial deposition and 24 hour retention images were obtained from healthy (n=31) adult subjects and patients with mild cystic fibrosis lung disease (CF) (n=14) following inhalation of radiolabeled particles (Tc99m-sulfur colloid, 5.4 μm MMAD) under controlled breathing conditions. The initial deposition image of the right lung was normalized to (i.e., same median pixel value), and then divided by, a transmission (Tc99m) image in the same individual to obtain a pixel-by-pixel ratio image. Hot spots were defined where pixel values in the deposition image were greater than 2X those of the transmission, and cold spots as pixels where the deposition image was less than 0.5X of the transmission. The number ratio (NR) of the hot and cold pixels to total lung pixels, and the sum ratio (SR) of total counts in hot pixels to total lung counts were compared between healthy and CF subjects. Other traditional measures of regional particle deposition, nC/P and skew of the pixel count histogram distribution, were also compared. RESULTS The NR of cold spots was greater in mild CF, 0.221±0.047(CF) vs. 0.186±0.038 (healthy) (p<0.005) and was significantly correlated with FEV1 %pred in the patients (R=-0.70). nC/P (central to peripheral count ratio), skew of the count histogram, and hot NR or SR were not different between the healthy and mild CF patients. CONCLUSIONS These methods may provide more sensitive measures of airway function and localization of deposition that might be useful for assessing treatment efficacy in these patients.
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Affiliation(s)
- William D Bennett
- 1Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina, Chapel Hill, North Carolina.,2Pulmonary Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Miao Xie
- 3Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, North Carolina
| | - Kirby Zeman
- 1Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina, Chapel Hill, North Carolina
| | - Harry Hurd
- 3Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, North Carolina
| | - Scott Donaldson
- 2Pulmonary Medicine, University of North Carolina, Chapel Hill, North Carolina
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Verhagen LM, Maes M, Villalba JA, d'Alessandro A, Rodriguez LP, España MF, Hermans PWM, de Waard JH. Agreement between QuantiFERON®-TB Gold In-Tube and the tuberculin skin test and predictors of positive test results in Warao Amerindian pediatric tuberculosis contacts. BMC Infect Dis 2014; 14:383. [PMID: 25012075 PMCID: PMC4227090 DOI: 10.1186/1471-2334-14-383] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 06/30/2014] [Indexed: 01/14/2023] Open
Abstract
Background Interferon-gamma release assays have emerged as a more specific alternative to the tuberculin skin test (TST) for detection of tuberculosis (TB) infection, especially in Bacille Calmette-Guérin (BCG) vaccinated people. We determined the prevalence of Mycobacterium tuberculosis infection by TST and QuantiFERON®-TB Gold In-Tube (QFT-GIT) and assessed agreement between the two test methods and factors associated with positivity in either test in Warao Amerindian children in Venezuela. Furthermore, progression to active TB disease was evaluated for up to 12 months. Methods 163 HIV-negative childhood household contacts under 16 years of age were enrolled for TST, QFT-GIT and chest X-ray (CXR). Follow-up was performed at six and 12 months. Factors associated with TST and QFT-GIT positivity were studied using generalized estimation equations logistic regression models. Results At baseline, the proportion of TST positive children was similar to the proportion of children with a positive QFT-GIT (47% vs. 42%, p = 0.12). Overall concordance between QFT-GIT and TST was substantial (kappa 0.76, 95% CI 0.46-1.06). Previous BCG vaccination was not associated with significantly increased positivity in either test (OR 0.68, 95% CI 0.32-1.5 for TST and OR 0.51, 95% CI 0.14-1.9 for QFT-GIT). Eleven children were diagnosed with active TB at baseline. QFT-GIT had a higher sensitivity for active TB (88%, 95% CI 47-98%) than TST (55%, 95% CI 24-83%) while specificities were similar (respectively 58% and 55%). Five initially asymptomatic childhood contacts progressed to active TB disease during follow-up. Conclusion Replacement of TST by the QFT-GIT for detection of M. tuberculosis infection is not recommended in this resource-constrained setting as test results showed substantial concordance and TST positivity was not affected by previous BCG vaccination. The QFT-GIT had a higher sensitivity than the TST for the detection of TB disease. However, the value of the QFT-GIT as an adjunct in diagnosing TB disease is limited by a high variability in QFT-GIT results over time.
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Affiliation(s)
- Lilly M Verhagen
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela.
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Abstract
BACKGROUND Bronchiectasis in tuberculosis (TB) is usually considered chronic traction bronchiectasis associated with healed scars. However, bronchiectasis can occasionally be seen in active TB. PURPOSE To evaluate prevalence, appearance, and changes of bronchiectasis associated with active TB on computed tomography (CT). MATERIAL AND METHODS A total of 391 patients with active TB who had undergone CT scans at the time of diagnosis were included in the study. Active TB was diagnosed when the sputum or the sample obtained by bronchoalveolar lavage tested positive using an acid-fast bacillus (AFB) smear test, polymerase chain reaction (PCR) test, or an AFB culture. The CT scans were reviewed focusing on bronchiectasis within consolidations or nodules. Cases with bronchiectasis beyond the consolidation or nodules were excluded from the study to exclude pre-existing traction bronchiectasis. The prevalence and appearance (cylindrical, varicose, cystic, and presence of focal erosion) of bronchiectasis and its time-dependent changes were analyzed. In addition, the presence of the feeding bronchus sign was checked. Here, the feeding bronchus sign was defined as a CT finding where the cavity communicates with the dilated airway. RESULTS In 100 (25%) of the 391 patients, bronchiectasis was present within consolidations or nodules on CT. The shape of the bronchiectasis was cylindrical in all patients and focal erosions were revealed in 75 patients (75%). Nine patients had both cylindrical and varicose forms of the bronchiectasis. The feeding bronchus sign was observed in 42 patients (42%). Follow-up CT was performed on 19 of 100 patients. The bronchiectasis had progressed in 11 patients (58%), improved in four patients (21%), remained unchanged in one patient (5%), and could not be determined in the remaining three patients (16%). In nine patients, CT images prior to diagnosis were available, and in all these cases, bronchiectasis was newly developed. CONCLUSION Bronchiectasis can be seen within active inflammation in one-fourth of active TB on CT. In association with active inflammation, bronchiectasis is mostly cylindrical with focal erosions, occasionally accompanied by the feeding bronchus sign.
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Affiliation(s)
- Jeong Min Ko
- Department of Radiology, St Vincent's Hospital, The Catholic University of Korea
| | - Ki Jun Kim
- Department of Radiology, Incheon St Mary's Hospital, The Catholic University of Korea
| | - Seog Hee Park
- Department of Radiology, Seoul St Mary's Hospital, The Catholic University of Korea, Kyeonggi-do, South Korea
| | - Hyun Jin Park
- Department of Radiology, St Vincent's Hospital, The Catholic University of Korea
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Cannon MS, Johnson LR, Pesavento PA, Kass PH, Wisner ER. Quantitative and qualitative computed tomographic characteristics of bronchiectasis in 12 dogs. Vet Radiol Ultrasound 2013; 54:351-357. [PMID: 23578226 DOI: 10.1111/vru.12036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 02/24/2013] [Indexed: 11/30/2022] Open
Abstract
Bronchiectasis is an irreversible dilatation of the bronchi resulting from chronic airway inflammation. In people, computed tomography (CT) has been described as the noninvasive gold standard for diagnosing bronchiectasis. In dogs, normal CT bronchoarterial ratios have been described as <2.0. The purpose of this retrospective study was to describe quantitative and qualitative CT characteristics of bronchiectasis in a cohort of dogs with confirmed disease. Inclusion criteria for the study were thoracic radiography, thoracic CT, and a diagnosis of bronchiectasis based on bronchoscopy and/or histopathology. For each included dog, a single observer measured CT bronchoarterial ratios at 6 lobar locations. Qualitative thoracic radiography and CT characteristics were recorded by consensus opinion of two board-certified veterinary radiologists. Twelve dogs met inclusion criteria. The mean bronchoarterial ratio from 28 bronchiectatic lung lobes was 2.71 ± 0.80 (range 1.4 to 4.33), and 23/28 measurements were >2.0. Averaged bronchoarterial ratios from bronchiectatic lung lobes were significantly larger (P < 0.01) than averaged ratios from nonbronchiectatic lung lobes. Qualitative CT characteristics of bronchiectasis included lack of peripheral airway tapering (12/12), lobar consolidation (11/12), bronchial wall thickening (7/12), and bronchial lumen occlusion (4/12). Radiographs detected lack of airway tapering in 7/12 dogs. In conclusion, the most common CT characteristics of bronchiectasis were dilatation, a lack of peripheral airway tapering, and lobar consolidation. Lack of peripheral airway tapering was not visible in thoracic radiographs for some dogs. For some affected dogs, bronchoarterial ratios were less than published normal values.
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Affiliation(s)
- Matthew S Cannon
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, 1 Shields Ave., University of California, Davis, CA, 95616
| | - Lynelle R Johnson
- Department of Medicine and Epidemiology, School of Veterinary Medicine, 1 Shields Ave, University of California, Davis, CA, 95616
| | - Patricia A Pesavento
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, 1 Shields Ave, University of California, Davis, CA, 95616
| | - Philip H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, 1 Shields Ave, University of California, Davis, CA, 95616
| | - Erik R Wisner
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, 1 Shields Ave, University of California, Davis, CA, 95616
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Hwang EH, Kim HY, Ryu M, Kim SH, Son SK, Kim YM, Park HJ. Clinical characteristics and cause of bronchiectasis in children: review in a center. ALLERGY ASTHMA & RESPIRATORY DISEASE 2013. [DOI: 10.4168/aard.2013.1.4.383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Eun Ha Hwang
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Hye-Young Kim
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Min Ryu
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Seong Heon Kim
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Seung Kook Son
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Young Mi Kim
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Hee Ju Park
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
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Agarwal R, Khan A, Garg M, Aggarwal AN, Gupta D. Pictorial essay: Allergic bronchopulmonary aspergillosis. Indian J Radiol Imaging 2012; 21:242-52. [PMID: 22223932 PMCID: PMC3249935 DOI: 10.4103/0971-3026.90680] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is the best-known allergic manifestation of Aspergillus-related hypersensitivity pulmonary disorders. Most patients present with poorly controlled asthma, and the diagnosis can be made on the basis of a combination of clinical, immunological, and radiological findings. The chest radiographic findings are generally nonspecific, although the manifestations of mucoid impaction of the bronchi suggest a diagnosis of ABPA. High-resolution CT scan (HRCT) of the chest has replaced bronchography as the initial investigation of choice in ABPA. HRCT of the chest can be normal in almost one-third of the patients, and at this stage it is referred to as serologic ABPA (ABPA-S). The importance of central bronchiectasis (CB) as a specific finding in ABPA is debatable, as almost 40% of the lobes are involved by peripheral bronchiectasis. High-attenuation mucus (HAM), encountered in 20% of patients with ABPA, is pathognomonic of ABPA. ABPA should be classified based on the presence or absence of HAM as ABPA-S (mild), ABPA-CB (moderate), and ABPA-CB-HAM (severe), as this classification not only reflects immunological severity but also predicts the risk of recurrent relapses.
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Affiliation(s)
- Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh - 160 012, India
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Abstract
Non-cystic fibrosis (CF) bronchiectasis is said to be a declining problem in developed countries, although its prevalence in indigenous communities in Australia and New Zealand is among the highest reported in the world. Early childhood pneumonia and underlying conditions such as immunodeficiency and primary ciliary dyskinesia need to be considered in the aetiology. A high-resolution computerised tomography scan is the key investigation in children with a chronic wet cough in whom bronchiectasis is suspected. Regardless of the cause, the treatment of bronchiectasis is centred upon facilitating the clearance of airway secretions and the treatment of pulmonary exacerbations. This review aims to provide general paediatricians with an update on the presenting features, investigation and management of non-cystic fibrosis bronchiectasis.
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Affiliation(s)
- Haya Al Subie
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Kim HY, Kwon JW, Seo J, Song YH, Kim BJ, Yu J, Hong SJ. Bronchiectasis in children: 10-year experience at a single institution. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2010; 3:39-45. [PMID: 21217924 PMCID: PMC3005318 DOI: 10.4168/aair.2011.3.1.39] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 09/09/2010] [Indexed: 01/02/2023]
Abstract
Purpose Bronchiectasis in children is still one of the most common causes of childhood mortality in developing countries. The aim of this study was to investigate the epidemiological characteristics, clinical features, underlying etiologic factors, and distinct change in the management of patients with bronchiectasis at Asan Medical Center Children's Hospital of Seoul. Methods A retrospective study of children diagnosed with bronchiectasis was conducted between January 1999 and December 2008. All patients underwent a comprehensive examination to identify etiologic factors. Data analysis in terms of age at onset, initial presenting symptoms, underlying etiology, distinct change in treatment, distribution of pulmonary involvement on computed tomography (CT), and causative microbiological flora triggering secondary infections was performed. Results The median age at the time of the diagnosis of bronchiectasis was 7.6 years (range, 2 months to 18 years). Persistent coughing was the most common symptom. The underlying etiologies identified in 79 patients (85.8%) included bronchiolitis obliterans (32.6%), childhood respiratory infection (20.6%), interstitial lung disease (17.3%), immunodeficiency (8.6%), and primary ciliary dyskinesia (4.3%). In 53 children (67%), the identified cause led to a distinct and individualized change in management. The distribution of CT abnormalities had no correlation with the underlying cause of bronchiectasis. Conclusions Selected Korean children with bronchiectasis were reviewed to identify diverse underlying etiologies. All children with bronchiectasis should be comprehensively investigated because identifying underlying causes may have a major impact on their management and prognosis.
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Affiliation(s)
- Hyoung-Young Kim
- Department of Pediatrics, Childhood Asthma & Atopy Center, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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Odry BL, Kiraly AP, Godoy MCB, Ko J, Naidich DP, Novak CL, Lerallut JF. Automated CT scoring of airway diseases: preliminary results. Acad Radiol 2010; 17:1136-45. [PMID: 20576450 DOI: 10.1016/j.acra.2010.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 04/27/2010] [Accepted: 04/28/2010] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to retrospectively evaluate an automated global scoring system for evaluating the extent and severity of disease in a known cohort of patients with documented bronchiectasis. On the basis of a combination of validated three-dimensional automated algorithms for bronchial tree extraction and quantitative airway measurements, global scoring combines the evaluation of bronchial lumen-to-artery ratios and bronchial wall-to-artery ratios, as well as the detection of mucoid-impacted airways. The result is an automatically generated global computed tomographic (CT) score designed to simplify and standardize the interpretation of scans in patients with chronic airway infections. MATERIALS AND METHODS Twenty high-resolution CT data sets were used to evaluate an automated CT scoring method that combines algorithms for airway quantitative analysis that have been individually tested and validated. Patients with clinically documented atypical mycobacterial infections with visually assessed CT evidence of bronchiectasis varying from mild to severe were retrospectively selected. These data sets were evaluated by two independent experienced radiologists and by computer scoring, with the results compared statistically, including Spearman's rank correlation. RESULTS Computer evaluation required 3 to 5 minutes per data set, compared to 12 to 15 minutes for manual scoring. Initial Spearman's rank tests showed positive correlations between automated and readers' global scores (r = 0.609, P = .01), extent of bronchiectasis (r = 0.69, P = .0004), and severity of bronchiectasis (r = 0.61, P = .01), while mucus plug detection showed a lesser extent of positive correlation between the scoring methods (r = 0.42, P = .07) and wall thickness a negative weak correlation (r = -0.10, P = .40). Further retrospective review of 24 lobes in which wall thickness scores showed the highest discrepancy between manual and automated methods was then performed, using electronic calipers and perpendicular cross-sections to reassess airway measurements. This resulted in an improved Spearman's rank correlation to r = 0.62 (P = .009), for a global score of r = 0.67 (P = .001). CONCLUSION Automated computerized scoring shows considerable promise for providing a standardized, quantitative method, demonstrating overall good correlation with the results of experienced readers' evaluation of the extent and severity of bronchiectasis. It is speculated that this technique may also be applicable to a wide range of other conditions associated with chronic bronchial inflammation, as well as of potential value for monitoring response to therapy in these same populations.
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Affiliation(s)
- Benjamin L Odry
- Imaging and Visualization Department, Siemens Corporate Research, Inc, Princeton, NJ 08540, USA.
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Abstract
Multidetector row computed tomography (MDCT) is the imaging modality of reference for the diagnosis of bronchiectasis. MDCT may also detect a focal stenosis, a tumor or multiple morphologic abnormalities of the bronchial tree. It may orient the endoscopist towards the abnormal bronchi, and in all cases assess the extent of the bronchial lesions. The CT findings of bronchial abnormalities include anomalies of bronchial division and origin, bronchial stenosis, bronchial wall thickening, lumen dilatation, and mucoid impaction. The main CT features of bronchiectasis are increased bronchoarterial ratio, lack of bronchial tapering, and visibility of peripheral airways. Other bronchial abnormalities include excessive bronchial collapse at expiration, outpouchings and diverticula, dehiscence, fistulas, and calcifications.
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Kennedy MP, Noone PG, Leigh MW, Zariwala MA, Minnix SL, Knowles MR, Molina PL. High-Resolution CT of Patients with Primary Ciliary Dyskinesia. AJR Am J Roentgenol 2007; 188:1232-8. [PMID: 17449765 DOI: 10.2214/ajr.06.0965] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE High-resolution CT is an important tool in the detection and management of bronchiectasis, but there is little information about high-resolution CT findings in primary ciliary dyskinesia (PCD). We analyzed all high-resolution CT studies of the chest available for a cohort of PCD patients to identify an associated pattern of high-resolution CT changes. MATERIALS AND METHODS High-resolution CT studies were available for 45 PCD patients from 42 families with ranges of age and disease severity. The images were assessed for severity and distribution of bronchiectasis, peribronchial thickening, mucous plugging, and other findings. A bronchiectasis severity score was calculated. CT findings were correlated with phenotypic findings, including situs type, ciliary ultrastructural defect, nasal level of nitric oxide, forced expiratory volume in 1 second, and microbiologic findings in the airways. RESULTS Twenty-nine adults (mean age, 42 +/- 15 years; age range, 21-73 years) and 16 children (mean age, 8 +/- 4 years; age range, 1-14 years) were included; 26 (58%) of the patients were women or girls. Situs inversus totalis (38%) or heterotaxy (18%) was identified in 56% of the patients. A high (9%) prevalence of pectus excavatum was identified. High-resolution CT of all of the adult and 56% of the pediatric patients showed bronchiectasis in a predominantly middle and lower lobe distribution. The right middle lobe was most commonly involved. Bronchiectasis severity score correlated with older age and worse pulmonary function. CONCLUSION High-resolution CT shows that pulmonary disease related to PCD predominantly involves the middle and lower lobes of the lungs. In adults, high-resolution CT findings negative for bronchiectasis may have a role in excluding the diagnosis of PCD. Correlation of severity of disease on high-resolution CT with patient phenotype gives further insight into the diversity and natural history of PCD.
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Affiliation(s)
- Marcus P Kennedy
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, NC, USA.
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Eshed I, Minski I, Katz R, Jones PW, Priel IE. Bronchiectasis: correlation of high-resolution CT findings with health-related quality of life. Clin Radiol 2007; 62:152-9. [PMID: 17207698 DOI: 10.1016/j.crad.2006.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 07/24/2006] [Accepted: 08/17/2006] [Indexed: 11/23/2022]
Abstract
AIM To evaluate the relationship between the severity of bronchiectatic diseases, as evident on high-resolution computed tomography (HRCT) and the patient's quality of life measured using the St George's Respiratory Questionnaire (SGRQ). METHODS AND MATERIALS Forty-six patients (25 women, 21 men, mean age: 63 years) with bronchiectatic disease as evident on recent HRCT examinations were recruited. Each patient completed the SGRQ and underwent respiratory function tests. HRCT findings were blindly and independently scored by two radiologists, using the modified Bhalla scoring system. The relationships between HRCT scores, SGRQ scores and pulmonary function tests were evaluated. RESULTS The patients' total CT score did not correlate with the SGRQ scores. However, patients with more advanced disease on HRCT, significantly differed in their SGRQ scores from patients with milder bronchiectatic disease. A significant correlation was found between the CT scores for the middle and distal lung zones and the activity, impacts and total SGRQ scores. No correlation was found between CT scores and respiratory function test indices. However, a significant correlation was found between the SGRQ scores and most of the respiratory function test indices. CONCLUSION A correlation between the severity of bronchiectatic disease as expressed in HRCT and the health-related quality of life exists in patients with a more severe bronchiectatic disease but not in patients with mild disease. Such correlation depends on the location of the bronchiectasis in the pulmonary tree.
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Affiliation(s)
- I Eshed
- Department of Diagnostic Radiology, The E. Wolfson Medical Center, Holon, Israel.
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Bayramoglu S, Cimilli T, Aksoy S, Yildiz S, Salihoglu B, Hatipoglu S, Celiker FB. The role of HRCT versus CXR in children with recurrent pulmonary infections. Clin Imaging 2005; 29:317-24. [PMID: 16153537 DOI: 10.1016/j.clinimag.2005.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Accepted: 01/15/2005] [Indexed: 11/28/2022]
Abstract
The purpose of this study is to evaluate the role of high-resolution computed tomography (HRCT) versus chest radiography (CXR) in children with recurrent respiratory infections. Fifty-one cases, aged 2 months-13 years, who had a history of recurrent respiratory infections, were examined with CXR and HRCT. HRCT showed that 16/51 of the cases had bronchiectasis. CXR revealed findings of bronchiectasis only in 5 of the 16 cases. HRCT showed peribronchial thickening in 18 cases, whereas CXR showed the same finding in 5 patients. Overall, HRCT showed the underlying pathology and sequel of pulmonary lesions in 22 out of 51 cases, and linear densities in 12. Compared with the CXR, HRCT gives much more information.
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Affiliation(s)
- Sibel Bayramoglu
- Department of Radiology, Istanbul Dr. Sadi Konuk Hospital, Istanbul, Turkey.
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Gotway MB, Reddy GP, Webb WR, Elicker BM, Leung JWT. High-resolution CT of the lung: patterns of disease and differential diagnoses. Radiol Clin North Am 2005; 43:513-42, viii. [PMID: 15847814 DOI: 10.1016/j.rcl.2005.01.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
High-resolution CT (HRCT) of the lung is a powerful tool for the investigation of patients with acute or chronic respiratory symptoms or diffuse parenchymal lung disease. Detailed knowledge of normal pulmonary anatomy and an understanding of how normal anatomy is altered in disease states are required to appreciate fully HRCT findings in patients with pulmonary disease. Detailed knowledge of the technical aspects of HRCT examinations is required for optimal image quality. With the proper foundation, a pattern approach to HRCT interpretation may then be used successfully to provide accurate and reproducible interpretation.
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Affiliation(s)
- Michael B Gotway
- Department of Radiology, San Francisco General Hospital, University of California at San Francisco, 1001 Potrero Avenue, Room 1X 55, Box 1325, San Francisco, CA 94110, USA.
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Brown JS, Bennett WD. Deposition of coarse particles in cystic fibrosis: model predictions versus experimental results. ACTA ACUST UNITED AC 2005; 17:239-48. [PMID: 15625816 DOI: 10.1089/jam.2004.17.239] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In patients with cystic fibrosis (CF), the lung regions most affected by infection are presumed to be poorly ventilated and, hence, difficult to treat with inhaled therapeutic aerosols. Current dosimetric models do not adequately describe regional particle deposition in CF. We have developed a multiple-path particle deposition model and compared model predictions with the observed pattern of coarse particle (5 microm, mass median aerodynamic diameter) deposition in ten CF patients and eight healthy volunteers. Our model divides the lung into quadrants, separated at lobar bronchi, representing apical and basal lung regions. The volume and ventilation of quadrants were experimentally determined from a xenon equilibrium and multi-breath washout, respectively. Regional ventilation in the healthy lung was assumed to be determined largely by regional compliance. In CF patients, the deviations in regional ventilation from that observed in the healthy subjects were assumed to be due to regional resistance. A "custom" lung morphology was calculated for each subject based on their lung volume (functional residual capacity plus one-half tidal volume) and ventilation to each quadrant. Input parameters for particle deposition calculations were "custom" lung morphology, breathing pattern, and inhaled particle size. Relative to healthy subjects, the CF patients had reduced ventilation to the apices and increased ventilation to the bases of the lung. In healthy subjects, the general pattern of particle deposition followed ventilation. However, in the CF patients, the model predicted increased particle deposition in the large airways of the apices (an obstructed and poorly ventilated region) and to a lesser extent in the basal lung (relatively healthier and better-ventilated region), whereas particle deposition in the parenchyma was only increased in the basal lung and was decreased or absent in the apical lung. Our modeling strategy improves estimates of regional aerosol deposition and may be useful for predicting breathing conditions and particle size for optimal drug delivery in a given CF patient.
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Affiliation(s)
- James S Brown
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, USA.
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Abstract
Search for an etiology of bronchiectasis consists in identifying constitutional or acquired defense mechanisms of the respiratory mucosa. The question is timely because causes change. In developing countries, presumed sequelae of infection account for about 30% of the cases despite vaccination campaigns, control of endemic tuberculosis, and widespread use of antibiotics. Genetic diseases account for 20% of the causes when identified by high-performance prospective diagnostic tests (CFTR mutation). Computed tomography enables the identification of frequent associations between bronchiectasis and rheumatoid disease or ulcerative colitis. Recent diseases such as HIV infection or GVHD can also lead to bronchiectasis. Nevertheless, the cause remains unknown in 30-50% of patients. After a detailed analysis of the clinical presentation and diagnostic criteria specific for each etiology, we propose a two-phase diagnostic procedure. The first step, used for all patients (careful history taking, physical examination, imaging, bronchofibroscopy, limited blood tests) enables detecting localized bronchial obstacles and obvious etiologies (situs inversus of primary ciliary dyskinesia, known systemic disease, HIV...). If the first step is negative, the second phase is oriented by the clinical context. Sequelae of infection (tuberculosis...) in older subjects or migrants, a genetic cause in younger subjects, particularly if there is a familial history and/or infertility, a systemic disease or allergic bronchopulmonary aspergillosis if there is an extra-respiratory context. This etiological search should help improve patient management and provide a better prognosis and prevention of bronchiectasis.
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Affiliation(s)
- H Lioté
- Service de Pneumologie, Hôpital Tenon, 4 rue de la Chine, 75020 Paris.
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Patel IS, Vlahos I, Wilkinson TMA, Lloyd-Owen SJ, Donaldson GC, Wilks M, Reznek RH, Wedzicha JA. Bronchiectasis, Exacerbation Indices, and Inflammation in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2004; 170:400-7. [PMID: 15130905 DOI: 10.1164/rccm.200305-648oc] [Citation(s) in RCA: 299] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Relationships between high-resolution computed tomography (HRCT) findings in chronic obstructive pulmonary disease (COPD) and bacterial colonization, airway inflammation, or exacerbation indices are unknown. Fifty-four patients with COPD (mean [SD]: age, 69 [7] years; FEV(1), 0.96 [0.33] L; FEV(1) [percent predicted], 38.1 [13.9]%; FEV(1)/forced vital capacity [percent predicted], 40.9 [11.8]%; arterial partial pressure of oxygen, 8.77 [1.11] kPa; history of smoking, 50.5 [33.5] smoking pack-years) underwent HRCT scans of the chest to quantify the presence and extent of bronchiectasis or emphysema. Exacerbation indices were determined from diary cards over 2 years. Quantitative sputum bacteriology and cytokine measurements were performed. Twenty-seven of 54 patients (50%) had bronchiectasis on HRCT, most frequently in the lower lobes (18 of 54, 33.3%). Patients with bronchiectasis had higher levels of airway inflammatory cytokines (p = 0.001). Lower lobe bronchiectasis was associated with lower airway bacterial colonization (p = 0.004), higher sputum interleukin-8 levels (p = 0.001), and longer symptom recovery time at exacerbation (p = 0.001). No relationship was seen between exacerbation frequency and HRCT changes. Evidence of moderate lower lobe bronchiectasis on HRCT is common in COPD and is associated with more severe COPD exacerbations, lower airway bacterial colonization, and increased sputum inflammatory markers.
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Affiliation(s)
- Irem S Patel
- Academic Unit of Respiratory Medicine, Dominion House, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
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Dupont M, Gacouin A, Lena H, Lavoué S, Brinchault G, Delaval P, Thomas R. Survival of patients with bronchiectasis after the first ICU stay for respiratory failure. Chest 2004; 125:1815-20. [PMID: 15136395 DOI: 10.1378/chest.125.5.1815] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Respiratory failure (RF) is a frequent cause of death among patients with bilateral bronchiectasis. An ICU admission is commonly required, and neither short-term or long-term outcomes have been studied. DESIGN We performed a retrospective study over a 10-year period (January 1990 to March 2000). All patients with bilateral bronchiectasis admitted for the first time in the medical ICU for RF were reviewed. Patients with cystic fibrosis were excluded. MEASUREMENTS AND RESULTS Forty-eight patients (mean age +/- SD, 63 +/- 11 years; mean simplified acute physiology score [SAPS] II, 32 +/- 12) of whom 25% received long-term oxygen therapy (LTOT) were identified. All the patients were treated with intensive medical care, associated with noninvasive ventilation in 13 patients (27%), and 26 patients (54%) required intubation. Nine patients (19%) died in the ICU. The 1-year mortality rate was 40%. Among the variables recorded at ICU admission, age > 65 years (p = 0.002), SAPS II score > 32 (p = 0.012), use of LTOT (p = 0.047), and intubation (p = 0.027) were associated with reduced survival in univariate analysis by Cox regression. Multivariate analysis by Cox proportional hazard model showed that age > 65 years (relative risk [RR], 2.70; 95% confidence interval [CI], 1.15 to 6.29) and use of LTOT (RR, 2.52; 95% CI, 1.15 to 5.54) were independently associated with reduced survival. CONCLUSIONS We performed the first study providing information related to the impact of the first ICU stay for RF on long-term outcomes for patients with bilateral bronchiectasis. Age > 65 years and prior use of LTOT were associated with reduced survival.
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Affiliation(s)
- Mathieu Dupont
- Service de Réanimation Médicale et Maladies Infectieuses, Service de Pneumologie, Centre Hospitalier Universitaire de Rennes, Rennes, France.
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Madkour MM, Abusabaah Y, Mousa AB, Al Masoud A. Post-primary Pulmonary Tuberculosis. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Unsinn KM, Freund MC, Rieger M, Jaschke WR. [High-resolution computed tomography (HRCT) of the pediatric lung]. Radiologe 2003; 43:1069-74. [PMID: 14668995 DOI: 10.1007/s00117-003-0986-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
High-resolution computed tomography (HRCT) of the lung is a very valuable method in the evaluation of children with acute and chronic lung disease due to the high spatial resolution and precise display of anatomy and pathology without superposition. The following publication will describe an optimized HRCT technique in order to reduce dose, explain various HRCT pattern and explain typical pediatric lung diseases.
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Affiliation(s)
- K M Unsinn
- Kinderradiologie, Univ.- Klinik für Kinder- und Jugendheilkunde, Innsbruck, Austria.
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Moreira JDS, Porto NDS, Camargo JDJP, Felicetti JC, Cardoso PFG, Moreira ALS, Andrade CF. Bronquiectasias: aspectos diagnósticos e terapêuticos Estudo de 170 pacientes. ACTA ACUST UNITED AC 2003. [DOI: 10.1590/s0102-35862003000500003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUÇÃO: Bronquiectasias são freqüentemente encontradas na prática médica no Brasil, levando a significativa morbidez e comprometimento da qualidade de vida de seus portadores. OBJETIVOS: Analisar aspectos diagnósticos e terapêuticos em uma série de pacientes com bronquiectasias atendidos em um serviço de doenças pulmonares. MÉTODO: Sinais, sintomas, achados radiográficos e microbiológicos, e resultados terapêuticos foram estudados em 170 pacientes portadores de bronquiectasias hospitalizados no período de 1978 a 2001 - 62,4% do sexo feminino, 37,6% do masculino, com idade média de 37 anos, variando entre 12 e 88 anos. RESULTADOS: Antecedente de pneumonia na infância foi detectado em 52,5% dos pacientes, de tratamento tisiológico em 19,8%; 8,8% tinham asma brônquica, e dois tinham síndrome de Kartagener. Os sintomas mais comuns foram tosse (100%), expectoração (96%) e estertores pulmonares (66%). As lesões eram unilaterais em 46,5% dos casos. Pneumococo, H. influenzae ou flora mista estiveram presentes em 85% das amostras de escarro examinadas. Os 170 pacientes receberam inicialmente tratamento clínico à base de antibióticos e fisioterapia respiratória; 88 deles (52%) mais jovens, com lesões menores e boa reserva funcional foram submetidos à cirurgia de ressecção pulmonar (82 unilaterais e seis bilaterais). Ocorreram dois óbitos hospitalares entre os pacientes que receberam tratamento exclusivamente clínico. Os pacientes tratados cirurgicamente tiveram acentuada melhora dos sintomas, raramente necessitando ser reinternados. CONCLUSÕES: Os prolongados sintomas broncopulmonares foram permanentemente aliviados na maioria dos pacientes com bronquiectasias que puderam ir à cirurgia de ressecção pulmonar, diferentemente dos que seguiram com o tratamento clínico.
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Eggesbø HB, Søvik S, Dølvik S, Eiklid K, Kolmannskog F. Proposal of a CT scoring system of the paranasal sinuses in diagnosing cystic fibrosis. Eur Radiol 2003; 13:1451-60. [PMID: 12682781 DOI: 10.1007/s00330-003-1825-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2002] [Revised: 12/03/2002] [Accepted: 12/23/2002] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to develop a paranasal sinus CT scoring system that could be used as a diagnostic tool to discriminate cystic fibrosis (CF) patients from control patients examined for sinonasal disease. The model should include as few and easily applicable criteria as possible, supported by statistical analyses and clinical judgement. We used data from 116 CF and 136 control patients. The CF patients were grouped according to the number of confirmed CF mutations: genetically verified (CF-2), or based on sweat testing and clinical findings alone (CF-1, CF-0). Nine paranasal sinus CT criteria, including development, pneumatisation variants and inflammatory patterns, were evaluated. The final model included three criteria: (a) frontal and (b) sphenoid sinus development, and (c) absence of three pneumatisation variants. This model discriminated CF-2 from controls with overlap of summed scores in only 8 of 206 patients. When this model was applied in the CF-1 and CF-0 groups, two populations seemed to exist. A larger group with summed scores overlapping that of the CF-2 group and a smaller group with summed scores overlapping that of the control group. We conclude that this CT scoring system may support, as well as exclude, a CF diagnosis in cases of diagnostic uncertainty.
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Affiliation(s)
- H B Eggesbø
- Department of Radiology, Aker University Hospital, 0514, Oslo, Norway.
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Affiliation(s)
- Alan F Barker
- Pulmonary and Critical Care Division, Department of Medicine, Oregon Health and Science University, Portland 97201, USA.
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Greenstone M. Changing paradigms in the diagnosis and management of bronchiectasis. AMERICAN JOURNAL OF RESPIRATORY MEDICINE : DRUGS, DEVICES, AND OTHER INTERVENTIONS 2002; 1:339-47. [PMID: 14720036 DOI: 10.1007/bf03256627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The face of bronchiectasis may have changed in recent years but individual cases continue to pose difficult challenges. As childhood infection becomes less of a problem, alternative causes of bronchiectasis are increasingly recognized which themselves offer new problems of diagnosis and management. Evolving concepts of pathogenesis suggest alternative strategies for treatment but as yet the evidence base on which to make firm decisions is lacking. Antibacterial regimens are not universally applicable and individualized protocols with parenteral, nebulized or continuous antibacterial therapy are increasingly used in the treatment of patients with bronchiectasis. Despite the theoretical appeal of using mucolytic or anti-inflammatory drugs their roles are still uncertain and have yet to be examined in adequate clinical trials. The factors determining disease progression are still poorly understood but in some patients worsening airflow obstruction heralds the onset of ventilatory failure. The management of the latter requires bronchodilators and controlled oxygen therapy, and strategies including non-invasive ventilation are increasingly an option. Changing indications for surgery are evident with fewer palliative resections but a developing role for transplantation.
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Affiliation(s)
- Michael Greenstone
- Medical Chest Unit, Castle Hill Hospital, Cottingham, East Yorkshire, UK
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46
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Abstract
High-resolution CT is accepted as an accurate noninvasive means of diagnosing bronchiectasis. A wide spectrum of abnormalities may be identified at HRCT in patients with airway disease, including various distinctive patterns of bronchiectasis in specific clinical settings, such as ABPA, MAC infection, AIDS, and CF. Characteristic CT findings occasionally suggest a specific diagnosis that may not have been under clinical consideration. HRCT also provides significant clinical use in assessing the degree and extent of airway disease, and allows noninvasive monitoring of disease progression, regression, or response to therapy.
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Affiliation(s)
- Georgeann McGuinness
- Department of Radiology, New York University Medical Center, New York 10016, USA
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Abstract
Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder that occurs in 10% to 15% of people who smoke, an estimated 16 million Americans. Asthma is also common. Spirometry is generally used to detect early COPD in smokers and to evaluate patients with respiratory symptoms. Although COPD and asthma account for most obstructive lung diseases, a broad spectrum of other disorders, including bronchiectasis, upper airway lesions, bronchiolar diseases, and some interstitial lung diseases, are associated with airflow obstruction. These less common forms of obstructive lung diseases are often misdiagnosed because of their uncommon occurrence and poor recognition. We describe the heterogeneous spectrum of disorders that can present with evidence of airflow obstruction and outline a diagnostic approach to obstructive lung disease.
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Affiliation(s)
- J H Ryu
- Division of Pulmonary and Critical Care Medicine and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA
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48
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Abstract
Bronchial diseases are common in children, and are usually associated with disturbances of aeration. This article briefly summarizes the embryological development and respiratory physiology pertinent to pediatric bronchial diseases. Current diagnostic imaging tools are discussed, with an emphasis on CT, which can demonstrate bronchial pathology such as bronchial obstruction and bronchiectasis in larger bronchi, as well as indirectly show the peripheral physiologic consequences of bronchial disease, such as alterations in aeration. Computed tomography measurements of lung attenuation may aid in diagnosis in problematic cases. Diseases that affect the pediatric airways at different ages are reviewed. Knowledge of these entities is important for accurate interpretation of imaging studies.
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Affiliation(s)
- N A Kothari
- Department of Radiology The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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49
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SANTOS JOSÉWELLINGTONALVESDOS, WALDOW ALAND, FIGUEIREDO CLAUDIUSWLADIMIRCORNELIUSDE, KLEINUBING DIEGOROSSI, BARROS SEVEROSALLESDE. Discinesia ciliar primária. ACTA ACUST UNITED AC 2001. [DOI: 10.1590/s0102-35862001000500006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Discinesia ciliar primária é uma doença autossômica recessiva caracterizada pela história de infecções repetidas do trato respiratório superior e inferior, otite média, bronquite e rinossinusite, associada a situs inversus na metade dos casos. O diagnóstico é estabelecido pela análise ciliar ultra-estrutural de espécimes respiratórios, após a exclusão inicial de outras doenças, como fibrose cística, deficiência de alfa-1-antitripsina, imunodeficiências (IgG, neutrófilos e complemento) e síndrome de Young. O propósito deste artigo é revisar os achados clínicos, o diagnóstico e o manejo da discinesia ciliar primária, incluindo um fluxograma diagnóstico.
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50
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Abstract
The prevalence of bronchiectasis (BR) has decreased significantly in industrialized countries, but is still commonplace in developing countries. We evaluated the causes and clinical features of BR in 23 children (13 boys (57%) and 10 girls (43%), with a mean age of 8.45 +/- 4.02 years). Infection was the major cause of BR in our region. In 8 patients, BR developed after tuberculosis or pneumonia, was associated with immune deficiency syndromes in 4 children, and with asthma in 4. Cystic fibrosis was diagnosed in 4 cases and ciliary dyskinesia in 3. In 10 patients, only one lobe was involved. Bronchiectatic lesions were most commonly found in the left lower lobe and were observed in 7 patients. Multilobar involvement was found in 13 patients. The initial treatment was primarily medical, but in 2 patients whose medical therapy failed, pulmonary resection was carried out. Three patients died from severe pulmonary infection and respiratory failure.
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Affiliation(s)
- G B Karakoc
- Pediatric Allergy-Immunology Division, Faculty of Medicine, Cukurova University, Adana, Turkey.
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