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Palafox-Flores JG, Valencia-Ledezma OE, Vargas-López G, Jamaica-Balderas L, Acevedo-Silva N, Castro-Fuentes CA. Systemic lupus erythematosus in pediatric patients: Pulmonary manifestations. Respir Med 2023; 220:107456. [PMID: 37926179 DOI: 10.1016/j.rmed.2023.107456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
The pulmonary manifestations of Systemic Lupus Erythematosus (SLE) in pediatric patients are poorly understood and the pulmonary manifestations reported from the adult population are generally extrapolated to the pediatric population. In the present work, the review of 228 files was carried out, in which the pulmonary manifestations, symptoms and antibody levels of the patients treated at the Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI), State of Mexico, Mexico, were identified. Statistical significance between groups was estimated using the Chi-square and Mann-Whitney U test. The main pulmonary manifestations identified were pleurisy (14 %), pulmonary hemorrhage (3.9 %), pulmonary thromboembolism (0.9 %), acute lupus pneumonitis (0.4 %), pulmonary arterial hypertension (0.4 %), and small lung syndrome (0.4 %). While the initial symptomatology was dyspnea with an incidence of 9.6 %, the mean oxygen saturation in the population was 96.87 %. Pleural effusion was identified as the most frequent pulmonary manifestation in radiographic changes. No statistically significant difference was found in antibody levels when comparing the groups. The most common pulmonary manifestation associated with SLE is pleurisy, however, the range of pulmonary manifestations in this type of patient can be very varied, as well as the presentation of each of them.
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Affiliation(s)
| | | | | | | | - Nydia Acevedo-Silva
- Pediatric Rheumatology Unit, Hospital Regional de Alta Especialidad de Ixtapaluca, Mexico
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Martini K, Loubet A, Bankier A, Bouam S, Morand P, Cassagnes L, Revel MP, Chassagnon G. Nodular reverse halo sign in active pulmonary tuberculosis: A rare CT feature? Diagn Interv Imaging 2020; 101:281-287. [PMID: 32057699 DOI: 10.1016/j.diii.2020.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to investigate the prevalence of the nodular reverse halo sign (NRHS) in chest computed tomography (CT) in patients with active pulmonary tuberculosis. MATERIALS AND METHODS From March 2018 to March 2019, 29 consecutive patients with a culture-confirmed active pulmonary tuberculosis and who underwent chest CT examination during hospital-admission were retrospectively included in the study. There were 24 men and 5 women with a mean age of 40.9±16.7 (SD) years (range: 18-80years). Chest CT examinations of included patients were evaluated for the presence of NRHS and other tuberculosis-related CT signs. RESULTS CT revealed the NRHS in 5 patients (5/29; 17%). The other CT signs of tuberculosis included consolidations in 18 patients (18/29; 62%), tree-in-bud pattern in 14 patients (14/29; 48%), cavitation in 12 patients (12/29; 41%), sparse nodules in 10 patients (10/29; 34%), and pleural effusion in 8 patients (8/29; 28%). CONCLUSION CT shows NRHS in 17% of patients with active pulmonary tuberculosis, indicating that the sign is not as rare as previously thought in patients with this condition.
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Affiliation(s)
- K Martini
- Department of Radiology, Cochin Hospital, 75014 Paris, France; Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zürich, Switzerland
| | - A Loubet
- Department of Radiology, Cochin Hospital, 75014 Paris, France
| | - A Bankier
- Department of Radiology, Beth Israel Deaconess Medical Center, MA 02215, USA
| | - S Bouam
- Department of Medical informatics, Cochin Hospital, 75014 Paris, France
| | - P Morand
- Microbiology Department, Cochin Hospital, 75014 Paris, France
| | - L Cassagnes
- Department of Radiology, CHU Gabriel-Montpied, Institut Pascal, UMR6602 CNRS SIGMA, 63000 Clermont-Ferrand, France
| | - M-P Revel
- Department of Radiology, Cochin Hospital, 75014 Paris, France; Université de Paris, 75006 Paris, France.
| | - G Chassagnon
- Department of Radiology, Cochin Hospital, 75014 Paris, France; Université de Paris, 75006 Paris, France
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Abstract
Pulmonary manifestations of inflammatory bowel disease are increasingly recognized in patients with ulcerative colitis and Crohn's disease. Most commonly, incidental abnormalities are noted on chest imaging or pulmonary function tests. Although clinically significant pulmonary disease is less common, it can carry significant morbidity for patients. We review the presenting symptoms, workup, and management for several of the more common forms of inflammatory bowel disease-related pulmonary disease. Increased awareness of the spectrum of extraintestinal inflammatory bowel disease will help providers more readily recognize this phenomenon in their own patients and more comprehensively address the protean sequelae of inflammatory bowel disease.
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Horváth Á, Végh E, Pusztai A, Pethő Z, Hamar A, Czókolyová M, Bhattoa HP, Nagy G, Juhász B, Hodosi K, Domján A, Szekanecz Z, Szücs G, Szamosi S. Complex assessment of bone mineral density, fracture risk, vitamin D status, and bone metabolism in Hungarian systemic sclerosis patients. Arthritis Res Ther 2019; 21:274. [PMID: 31823821 PMCID: PMC6905018 DOI: 10.1186/s13075-019-2072-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/27/2019] [Indexed: 12/22/2022] Open
Abstract
Objective We wished to determine bone alterations in systemic sclerosis (SSc) patients by conventional densitometry (DXA), peripheral quantitative computed tomography (pQCT), and bone biomarkers. Methods We included 44 SSc patients and 33 age-matched healthy controls. Lumbar spine and femoral neck bone mineral density (BMD) was assessed by DXA. Volumetric BMD was measured by pQCT at the radius. FRAX, 25-hydroxyvitamin-D3 (25-OH-D3), parathyroid hormone, osteocalcin, C-terminal collagen telopeptide, and procollagen type I amino-terminal propeptide were also assessed. Results SSc patients had lower L2–4 BMD (0.880 ± 0.108 vs. 0.996 ± 0.181 g/cm2; p = 0.019) and femoral neck (FN) BMD (0.786 ± 0.134 vs. 0.910 ± 0.090 g/cm2; p = 0.007) by DXA. In SSc vs. controls, pQCT indicated lower mean cortical (328.03 ± 103.32 vs. 487.06 ± 42.45 mg/cm3; p < 0.001) and trabecular density (150.93 ± 61.91 vs. 184.76 ± 33.03 mg/cm3; p = 0.037). Vitamin D3 deficiency was more common in SSc vs. controls (60.0% vs. 39.3%; p = 0.003). L2–4 (p = 0.002) and FN BMD (p = 0.015) positively correlated with BMI. pQCT assessments confirmed an inverse correlation between pulmonary manifestation and total (p = 0.024), trabecular (p = 0.035), and cortical density (p = 0.015). Anti-Scl70 positivity inversely correlated with pQCT total density (p = 0.015) and the presence of digital ulcers with cortical density (p = 0.001). We also found that vertebral and FN BMD as determined by DXA significantly correlated with pQCT total, trabecular, and cortical density (p < 0.05). Conclusion The results of our study suggest that bone loss in SSc patients may be associated with lower BMI, anti-Scl70 positivity, and the presence of pulmonary manifestations and digital ulcers. Both DXA and pQCT are appropriate tools to evaluate the bone alterations in SSc patients.
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Affiliation(s)
- Ágnes Horváth
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Edit Végh
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anita Pusztai
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsófia Pethő
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Hamar
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Monika Czókolyová
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Harjit Pal Bhattoa
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gábor Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Balázs Juhász
- Department of Oncology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin Hodosi
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andrea Domján
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szekanecz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary. .,Faculty of Medicine, Department of Rheumatology, University of Debrecen, Nagyerdei str 98, Debrecen, 4032, Hungary.
| | - Gabriella Szücs
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Szilvia Szamosi
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Abstract
The incidence of pulmonary manifestations of inflammatory bowel disease (IBD) appears to be much higher than previously assumed. In prospective studies, subclinical pulmonary interstitial infiltrates or pathological lung function were found in 40%-60% of IBD patients, both in children and adults. Pulmonary disorders can affect any part of the respiratory system, the most frequent pattern being inflammation of the large airways often associated with bronchiectasis. The differential diagnosis should include drug-related pulmonary disease and infectious causes when receiving immunosuppressive therapy. The diagnostic approach consists of a thorough history and clinical status as well as lung function tests including body plethysmography and high-resolution computed tomography of the thorax. Bronchoscopy with broncheoalveolar lavage and sample collection for histology as well as exclusion of pulmonary embolism may be indicated. Pulmonary disease in association with IBD can develop at any time during the course of IBD: in rare cases, symptoms can evolve even before gastrointestinal symptoms appear. On the other hand, there are frequent reports on the occurrence of pulmonary inflammation after proctocolectomy in patients with ulcerative colitis. The pathophysiologic background is largely unknown, but there seems to be an interaction between gastrointestinal and pulmonary inflammation. The mainstay of therapy are inhaled or systemic corticosteroids. Most patterns of pulmonary involvement in IBD respond well to corticosteroid therapy. Rarely, serious and persisting complications occur, such as strictures or stenosis of the large airways.
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Affiliation(s)
- A Moeser
- Institut für Infektionsmedizin und Krankenhaushygiene, Klinik für Innere Medizin/FB Pneumologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - M Lerche
- Abteilung für Pneumologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - H Wirtz
- Abteilung für Pneumologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, Jena, Deutschland
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Tadyanemhandu C, Mupanda C, Dambi J, Chiwaridzo M, Chikwasha V, Chengetanai S. Human immunodeficiency virus associated pulmonary conditions leading to hospital admission and the pulmonary rehabilitation services received by patients at two central hospitals in Harare. BMC Res Notes 2018; 11:407. [PMID: 29941015 PMCID: PMC6019525 DOI: 10.1186/s13104-018-3525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/20/2018] [Indexed: 11/10/2022] Open
Abstract
Objective Use of highly active antiretroviral therapy has led to marked reductions in the incidence of HIV-associated opportunistic infections but has had comparatively less impact on the incidence of some pulmonary diseases. This study was done to determine the pulmonary conditions leading to hospital admissions in people living with HIV/AIDS at two central hospitals in Zimbabwe and the pulmonary rehabilitation intervention received. Results A total of 92 participants were recruited of which 60 (65.2%) were females. The mean age of the participants was 41.3 years (SD = 9.1). The most common pulmonary condition leading to hospital admission was tuberculosis in 53 (57.6%). About 52 (56.6%) of the participants suffered from pulmonary complications in the last 6 months, 48 (92.3%) were admitted and 26 (50.0%) of the participants received physiotherapy treatment during their admission. None of the participants indicated that they once attended an outpatient pulmonary rehabilitation clinic. Respiratory complication is one of the leading causes of morbidity associated with HIV but no pulmonary rehabilitation services are being offered to these patients. There is need for introduction of pulmonary rehabilitation programs for people living with HIV/AIDS in the current setting.
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Affiliation(s)
- C Tadyanemhandu
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Avondale, PO Box AV 178, Harare, Zimbabwe.
| | - C Mupanda
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Avondale, PO Box AV 178, Harare, Zimbabwe
| | - J Dambi
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Avondale, PO Box AV 178, Harare, Zimbabwe
| | - M Chiwaridzo
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Avondale, PO Box AV 178, Harare, Zimbabwe
| | - V Chikwasha
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Avondale, PO Box AV 178, Harare, Zimbabwe
| | - S Chengetanai
- Division of Basic Medical Sciences, Faculty of Medicine, National University of Science and Technology, Ascot, PO Box AC 939, Bulawayo, Zimbabwe
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Medlin JL, Hansen KE, McCoy SS, Bartels CM. Pulmonary manifestations in late versus early systemic lupus erythematosus: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48:198-204. [PMID: 29550111 DOI: 10.1016/j.semarthrit.2018.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Phenotypes differ between late- and early-onset systemic lupus erythematosus (SLE). Prior studies suggested that there may be more pulmonary disease among late-onset patients. Our objective was to perform a systematic review and meta-analysis to evaluate the differences in pulmonary manifestations in late- versus early-onset SLE. METHODS We searched the literature using PubMed, CINAHL, Web of Science, Cochrane Library, and EMBASE. We excluded studies that did not include American College of Rheumatology SLE classification criteria, an early-onset SLE comparison group, or those that defined late-onset SLE as <50 years of age. We rated study quality using the Newcastle-Ottawa Quality Scale. We used Forest plots to compare odds ratios (95% confidence intervals) of pulmonary manifestations by age. Study heterogeneity was assessed using I2. RESULTS Thirty-nine studies, representing 10,963 early-onset and 1656 late-onset patients with SLE, met eligibility criteria. The odds of developing several pulmonary manifestations were higher in the late-onset group. Interstitial lung disease (ILD) was nearly three times more common (OR = 2.56 (1.27, 5.16)). Pleuritis (OR = 1.53 (1.19, 1.96)) and serositis (OR = 1.31 (1.05, 1.65)) were also more common in the late-onset group. The mean Newcastle-Ottawa Quality Scale score for study quality was moderate (6.3 ± 0.7, scale 0-9). CONCLUSIONS Pulmonary manifestations of SLE were more common in late-onset SLE patients compared to their younger peers, in particular ILD and serositis. Age-related changes of the immune system, tobacco exposure, race, and possible overlap with Sjögren's syndrome should be examined in future studies.
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Affiliation(s)
| | - Karen E Hansen
- Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, Rm 4132, Madison, WI
| | - Sara S McCoy
- Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, Rm 4132, Madison, WI
| | - Christie M Bartels
- Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, Rm 4132, Madison, WI.
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Agrawal A, Sahni S, Vulisha AK, Gumpeni R, Shah R, Talwar A. Pulmonary manifestations of urothelial carcinoma of the bladder. Respir Med 2017; 128:65-69. [PMID: 28610671 DOI: 10.1016/j.rmed.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/12/2017] [Accepted: 05/13/2017] [Indexed: 01/30/2023]
Abstract
Urothelial carcinoma (Transitional cell carcinoma) of the bladder is the pre-dominant histological type of bladder cancer in the United States and Europe. Patients with bladder cancer usually present with painless hematuria. The diagnosis is often delayed, as the symptoms are similar to various other benign conditions such as urinary tract infection, prostatitis or renal calculi. In some patients, the metastatic lesions will cause the initial presenting symptoms. We conducted a MedLine/PubMED search identifying all relevant articles with "pulmonary manifestations", "urothelial bladder cancer", "manifestations of bladder cancer" or a combination of these terms in the title. The pulmonary manifestations of urothelial carcinoma of the bladder include metastatic disease including cavitary lesions, endobronchial, pleural, or lymph node metastasis pleural effusion and chylothorax. Pulmonary embolism and tumor embolism is another manifestation of this cancer. Intravesical Bacillus Calmette-Gurin therapy for bladder cancer has been associated with a range of adverse effects including the systemic spread of Bacilli Calmette-Guérin immunotherapy affecting the lungs. Other drugs used to treat bladder cancer can be associated with drug-related pneumonitis. Other rare manifestations include a sarcoid like reaction and systemic granulomatous disease to Bacilli Calmette-Guérin therapy. In this review we discuss the various pulmonary manifestations of urothelial carcinoma of the bladder. A high index of suspicion with these presentations can lead to an early diagnosis and assist in instituting an appropriate intervention.
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Affiliation(s)
- Abhinav Agrawal
- Monmouth Medical Center, Department of Medicine, 300 Second Avenue Long Branch, NJ 07740, United States; Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States
| | - Sonu Sahni
- Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States; Touro College of Osteopathic Medicine, Department of Primary Care, New York, NY 10027, United States
| | - Abhinav K Vulisha
- Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States
| | - Rammohan Gumpeni
- New York Presbyterian Hospital Queens, Department of Pulmonary Critical Care Medicine, 56-45 Main Street Flushing, NY 11355, United States
| | - Rakesh Shah
- Northwell Health, Department of Radiology, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States
| | - Arunabh Talwar
- Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States.
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Abstract
Elevated serum IgE has many etiologies including parasitic infection, allergy and asthma, malignancy, and immune dysregulation. The hyper-IgE syndromes caused by mutations in STAT3, DOCK8, and PGM3 are monogenic primary immunodeficiencies associated with high IgE, eczema, and recurrent infections. These primary immunodeficiencies are associated with recurrent pneumonias leading to bronchiectasis; however, each has unique features and genetic diagnosis is essential in guiding therapy, discussing family planning, and defining prognosis. This article discusses the clinical features of these primary immunodeficiencies with a particular focus on the pulmonary manifestations and discussion of the genetics, pathogenesis, and approaches to therapy.
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Affiliation(s)
- Alexandra F Freeman
- Laboratory of Clinical Infectious Diseases, NIAID, NHLBI, National Institutes of Health, Bethesda, MD, USA.
| | - Kenneth N Olivier
- Laboratory of Clinical Infectious Diseases, NIAID, NHLBI, National Institutes of Health, Bethesda, MD, USA
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Agrawal A, Sahni S, Iftikhar A, Talwar A. Pulmonary manifestations of renal cell carcinoma. Respir Med 2015; 109:1505-8. [PMID: 26525375 DOI: 10.1016/j.rmed.2015.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/22/2015] [Accepted: 10/05/2015] [Indexed: 12/15/2022]
Abstract
Renal cell carcinoma (RCC) accounts for majority of all primary renal neoplasms. Classic manifestations of RCC include the triad of flank pain, hematuria and a palpable renal mass. Patients with RCC can develop various extra renal manifestations including involvements of the lungs, inferior vena cava, liver and the bones. The pulmonary manifestations of renal cell carcinoma include metastatic disease including endobronchial, pleural, parenchymal or lymph node metastasis, pleural effusion or hemothorax. Pulmonary embolism and tumor embolism is another common manifestation of renal cell carcinoma. RCC is a highly vascular tumor and can cause pulmonary arterio-venous fistulas leading to high output failure. Rarely, RCC can also present with paraneoplastic presentations including cough or bilateral diaphragm paralysis. Drugs used to treat RCC have been associated with drug related pneumonitis and form an important differential diagnosis in patients with RCC on therapy presenting with shortness of breath. In this review we discuss the various pulmonary manifestations of RCC. A high index of suspicion with these presentations can lead to an early diagnosis and assist in instituting an appropriate intervention.
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Affiliation(s)
- Abhinav Agrawal
- Monmouth Medical Center, Department of Medicine, 300 Second Avenue Long Branch, NJ 07740, United States.
| | - Sonu Sahni
- North Shore-Long Island Jewish Health System, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States; Feinstein Institute for Medical Research, Center for Heart and Lung Research, 350 Community Drive Manhasset, NY 11030, United States.
| | - Asma Iftikhar
- North Shore-Long Island Jewish Health System, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States; Feinstein Institute for Medical Research, Center for Heart and Lung Research, 350 Community Drive Manhasset, NY 11030, United States.
| | - Arunabh Talwar
- North Shore-Long Island Jewish Health System, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States; Feinstein Institute for Medical Research, Center for Heart and Lung Research, 350 Community Drive Manhasset, NY 11030, United States.
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