102
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Watanabe S, Waseda Y, Takato H, Matsunuma R, Johkoh T, Egashira R, Kawabata Y, Ikeda H, Yasui M, Fujimura M, Kasahara K. Pleuroparenchymal fibroelastosis: Distinct pulmonary physiological features in nine patients. Respir Investig 2015; 53:149-155. [PMID: 26100174 DOI: 10.1016/j.resinv.2015.02.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/16/2015] [Accepted: 02/08/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Pleuroparenchymal fibroelastosis (PPFE) is a rare idiopathic interstitial pneumonia defined by pleural and subpleural parenchymal fibrosis predominantly in the upper lobes. Although the radiological and pathological characteristics of PPFE have become increasingly recognized, its pulmonary physiological features are not well understood. METHODS We reviewed nine patients with radiologically and histologically proven PPFE, and evaluated pulmonary physiological data. RESULTS Of the nine patients, six were male and three were female. The median age at presentation was 61 years. Common symptoms were dyspnea on exertion, weight loss, and nonproductive cough. Recurrent pneumothorax was found in eight patients and pneumonia in four. Median pulmonary function test results were as follows: forced vital capacity, 55.4% predicted; total lung capacity (TLC), 67.1% predicted; residual volume (RV), 102.3% predicted; and RV/TLC, 143.6% predicted. RV/TLC was increased without evidence of small airway disease according to clinico-radiologic-pathologic evaluation. The median partial pressure of oxygen in arterial blood and the alveolar-arterial gradient of oxygen were within normal limits, although there was a slightly elevated partial pressure of carbon dioxide in arterial blood (PaCO2). PPFE progressed in all patients despite treatment with pirfenidone, corticosteroids, and immunosuppressive agents. Seven patients died during the follow-up, five because of hypercapnic respiratory failure. CONCLUSIONS PPFE is characterized by severe mechanical restriction with high RV/TLC, causing increased PaCO2 and eventual hypercapnic respiratory failure. These physiological findings may be useful as an adjunct in the diagnosis of PPFE.
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Affiliation(s)
- Satoshi Watanabe
- Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Yuko Waseda
- Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan; Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090 Austria.
| | - Hazuki Takato
- Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Ryo Matsunuma
- Department of Respiratory Medicine, Komatsu Municipal Hospital, Ho-60, Mukaimoto-ori-machi, Komatsu 923-8560, Japan.
| | - Takeshi Johkoh
- Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, 3-1 Kurumazuka, Itami, Hyogo 664-8533, Japan.
| | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan.
| | - Yoshinori Kawabata
- Division of Diagnostic Pathology, Saitama Prefectural Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya City, Saitama 360-0105, Japan.
| | - Hiroko Ikeda
- Section of Diagnostic Pathology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Masahide Yasui
- Department of Respiratory Medicine, Kanazawa Municipal Hospital, 3-7-3, Heiwa-machi, Kanazawa, Ishikawa 921-8105, Japan.
| | - Masaki Fujimura
- Department of Respiratory Medicine, National Hospital Organization Nanao Hospital, 3-1, Mattoumachi-hachibu, Nanao, Ishikawa, Japan.
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
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Neurohr C, Behr J. Changes in the current classification of IIP: A critical review. Respirology 2015; 20:699-704. [PMID: 26011188 DOI: 10.1111/resp.12553] [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: 12/31/2014] [Revised: 02/17/2015] [Accepted: 04/12/2015] [Indexed: 12/19/2022]
Abstract
Idiopathic interstitial pneumonias (IIP) are a heterogeneous group characterized by unknown aetiology. Establishment of a correct diagnosis of a distinct IIP requires a multidisciplinary approach integrating clinical presentation, physiological data, radiological appearance and histological findings. The 2013 update of the American Thoracic Society/European Respiratory Society classification summarises progress in the field of IIP and outlines potential areas for future research. The main entities defined by the 2002 statement on IIP are preserved, but major IIP are now distinguished from rare IIP and the new category of unclassifiable IIP is introduced. In addition, the existence of idiopathic non-specific interstitial pneumonia as a separate chronic fibrosing IIP and idiopathic pleuroparenchymal fibroelastosis as a specific rare entity are acknowledged. Moreover, the major IIP are categorized according to the features chronic fibrosing, smoking-related and acute/subacute clinical course. Furthermore, a clinical classification of IIP according to disease behaviour with suggestions for treatment goals and monitoring strategies is provided. The goal of this review is to discuss the areas of uncertainty in the updated multidisciplinary classification of IIP and point out potential consequences for clinical management.
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Affiliation(s)
- Claus Neurohr
- Department of Internal Medicine V, University of Munich, Munich, Germany
| | - Juergen Behr
- Department of Internal Medicine V, University of Munich, Munich, Germany
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104
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Kusagaya H, Fujisawa T, Enomoto N, Inui N, Nakamura Y, Suda T. Co-occurrence of Pneumoperitoneum and Pneumothorax in a Patient with Pleuroparenchymal Fibroelastosis. Am J Respir Crit Care Med 2015; 191:1200-1. [DOI: 10.1164/rccm.201501-0200im] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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105
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Nakatani T, Arai T, Kitaichi M, Akira M, Tachibana K, Sugimoto C, Hirooka A, Tsuji T, Minomo S, Hayashi S, Inoue Y. Pleuroparenchymal fibroelastosis from a consecutive database: a rare disease entity? Eur Respir J 2015; 45:1183-6. [PMID: 25700380 DOI: 10.1183/09031936.00214714] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Takeshi Nakatani
- Dept of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
| | - Toru Arai
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
| | - Masanori Kitaichi
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan Dept of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
| | - Masanori Akira
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan Dept of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
| | - Kazunobu Tachibana
- Dept of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
| | - Chikatoshi Sugimoto
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
| | - Aya Hirooka
- Dept of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
| | - Taisuke Tsuji
- Dept of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
| | - Shojiro Minomo
- Dept of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
| | - Seiji Hayashi
- Dept of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Japan
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