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Cassius De Linval Q, Barat M, Aissaoui M, Talabard MP, Martin C, Malamut G, Canniff E, Soyer P, Revel MP, Chassagnon G. Imaging findings of thoracic manifestations of Crohn's disease and ulcerative colitis. Insights Imaging 2024; 15:197. [PMID: 39112694 PMCID: PMC11306860 DOI: 10.1186/s13244-024-01742-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/16/2024] [Indexed: 08/10/2024] Open
Abstract
Thoracic manifestations of inflammatory bowel disease (IBD) are rare, occurring in less than 1% of patients. Unlike most other extra-intestinal manifestations, they predominate in patients with ulcerative colitis rather than in Crohn's disease. In most patients, thoracic involvement follows the onset of IBD by several years. However, thoracic involvement may also occur synchronously or even precede the onset of digestive symptoms. The thoracic manifestations of IBD include airway involvement and parenchymal lung abnormalities. Airways are the most frequent anatomical site for thoracic involvement in IBD. Airway manifestations usually develop several years after the onset of intestinal manifestations, preferentially when the latter are stable or in remission. Airway manifestations include bronchial wall thickening, bronchiectasis, small airway disease, and tracheal wall thickening. Parenchymal lung abnormalities are less prevalent in IBD and include organizing pneumonia, necrobiotic nodules, noncaseating granulomatous nodules, drug-induced pneumonia, and rarely interstitial lung diseases. The differential diagnosis between organizing pneumonia, necrobiotic nodules, and noncaseating granulomatous nodules is difficult and usually requires histopathological analysis for a definite diagnosis. Radiologists play a key role in the detection of thoracic manifestations of Crohn's disease and ulcerative colitis and, therefore, need to be familiar with their imaging findings. This article aims to offer an overview of the imaging findings of thoracic manifestations in patients with Crohn's disease or ulcerative colitis. CRITICAL RELEVANCE STATEMENT: Thoracic manifestations of Crohn's disease and ulcerative colitis include tracheal involvement, bronchiectasis, small airway disease, and parenchymal lung abnormalities such as organizing pneumonia and necrobiotic nodules. These rare manifestations (< 1% of patients) more often affect patients with ulcerative colitis. KEY POINTS: Thoracic manifestations of inflammatory bowel disease are rare, occurring in less than 1% of patients. Thoracic manifestations are more frequent in patients with ulcerative colitis than Crohn's disease. Bronchial disease is the most frequent thoracic manifestation of Crohn's disease and ulcerative colitis.
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Affiliation(s)
- Quentin Cassius De Linval
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Maxime Barat
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Mathilde Aissaoui
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Marie-Pauline Talabard
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Clémence Martin
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Georgia Malamut
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
- Department of Gastroenterology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Emma Canniff
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Marie-Pierre Revel
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Guillaume Chassagnon
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France.
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Kinoshita Y, Takenaka S, Takata K, Utsunomiya T, Koide Y, Wada K, Yoshida Y, Nakashima S, Kushima H, Ishii H. Platythorax increases residual volume/total lung capacity in idiopathic pleuroparenchymal fibroelastosis. ERJ Open Res 2024; 10:00996-2023. [PMID: 38978546 PMCID: PMC11228601 DOI: 10.1183/23120541.00996-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/25/2024] [Indexed: 07/10/2024] Open
Abstract
Platythorax significantly contributes to the increase in residual volume/total lung capacity ratio in patients with idiopathic pleuroparenchymal fibroelastosis https://bit.ly/3uZ0rmP.
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Affiliation(s)
- Yoshiaki Kinoshita
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Shota Takenaka
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Kengo Takata
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Takuhide Utsunomiya
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Yohei Koide
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Kenji Wada
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Yuji Yoshida
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Shota Nakashima
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Hisako Kushima
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
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Yamakawa H, Oda T, Sugino K, Hirama T, Komatsu M, Katano T, Fukuda T, Takemura T, Kubota Y, Kishaba T, Norisue Y, Araya J, Ogura T. Proposed Clinical Algorithm for Pleuroparenchymal Fibroelastosis (PPFE). J Clin Med 2024; 13:3675. [PMID: 38999241 PMCID: PMC11242275 DOI: 10.3390/jcm13133675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is characterized by fibrosis involving the pleura and subpleural lung parenchyma, predominantly in the upper lobes. As PPFE appears to occur in patients with heterogeneous etiologies, the disease course is thus also heterogenous, with some patients showing rapid progression while others have slow progression. Therefore, it is very difficult to predict prognosis with PPFE. Needless to say, this problematic matter has influenced the treatment strategy of PPFE patients. In fact, until now no evidence has been shown for use in creating an appropriate management algorithm for PPFE. We speculate that "uncoordinated breathing" is the most important reason for dyspnea in PPFE patients. Because monitoring of physique and not just pulmonary function and radiological evaluation is also very important, particularly in PPFE patients, this review focused on the characteristics of PPFE through an overview of previous studies in this field, and we proposed an algorithm as precision medicine based on the current evidence. Multiple views by the pulmonologist are needed to standardize a clinical algorithm that is necessary to correctly assess PPFE patients under the premise of maintenance of physique by providing appropriate nutritional care and pulmonary rehabilitation.
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Affiliation(s)
- Hideaki Yamakawa
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama 330-8553, Japan
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Tokyo 105-8461, Japan
| | - Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama 236-0051, Japan
| | - Keishi Sugino
- Department of Respiratory Medicine, Tsuboi Hospital, Fukushima 963-0197, Japan
| | - Takashi Hirama
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan
- Division of Organ Transplantation, Tohoku University, Sendai 980-8574, Japan
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
| | - Takuma Katano
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Taiki Fukuda
- Department of Radiology, The Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama 236-0051, Japan
| | - Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-0022, Japan
| | - Tomoo Kishaba
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa 904-2293, Japan
| | - Yasuhiro Norisue
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba 279-0001, Japan
| | - Jun Araya
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Tokyo 105-8461, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama 236-0051, Japan
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Shiraishi M, Higashimoto Y, Nishiyama O, Yamazaki R, Sugiya R, Mizusawa H, Takeda Y, Noguchi M, Kanki K, Kuwano M, Kimura T, Matsumoto H. Improvement of diaphragmatic excursion in the supine position in a patient with idiopathic pleuroparenchymal fibroelastosis: A case report. Respir Med Case Rep 2024; 51:102078. [PMID: 39027817 PMCID: PMC11255951 DOI: 10.1016/j.rmcr.2024.102078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/03/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is a rare form of idiopathic interstitial pneumonia. We report a case of a patient with iPPFE in whom postural changes improved diaphragmatic excursion (DE) and exercise tolerance. Chest radiography showed a greater elevation of the diaphragm at maximum expiration in the supine position than the standing position. DE measured by ultrasonography was higher in the supine position than the standing position. The findings may suggest greater diaphragm movement in the supine position, leading to successful rehabilitation and improved exercise endurance. There is no effective treatment for iPPFE; therefore, an innovative treatment strategy is warranted.
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Affiliation(s)
- Masashi Shiraishi
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yuji Higashimoto
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Osamu Nishiyama
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Japan, Osaka, Japan
| | - Ryo Yamazaki
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Japan, Osaka, Japan
| | - Ryuji Sugiya
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroki Mizusawa
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yu Takeda
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masaya Noguchi
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kengo Kanki
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Mitsuo Kuwano
- Department of Radiology Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tamotsu Kimura
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Japan, Osaka, Japan
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Clermidy H, Mercier O, Brioude G, Mordant P, Fadel G, Picard C, Chatron E, Le Pavec J, Roux A, Reynaud-Gaubert M, Messika J, Olland A, Demant X, Degot T, Lavrut PM, Jougon J, Sage E, Fadel E, Thomas P, Cottin V, Tronc F. Outcomes of lung transplantation for pleuroparenchymal fibroelastosis: A French multicentric retrospective study. J Heart Lung Transplant 2024:S1053-2498(24)01701-7. [PMID: 38909712 DOI: 10.1016/j.healun.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Pleuroparenchymal fibroelastosis (PPFE) has no currently available specific treatment. Benefits of lung transplantation (LT) for PPFE are poorly documented. METHODS We conducted a nation-wide multicentric retrospective study in patients who underwent lung or heart-lung transplantation for chronic end-stage lung disease secondary to PPFE between 2012 and 2022 in France. RESULTS Thirty-one patients were included. At transplantation, median age was 48 years [IQR 35-55]. About 64.5% were women. Twenty-one (67.7%) had idiopathic PFFE. Sixteen (52%) had bilateral LT, 10 (32%) had single LT, 4 (13%) had lobar transplantation and one (3%) had heart-lung transplantation. Operative mortality was 3.2%. Early mortality (<90 days or during the first hospitalization) was 32%. Eleven patients (35.5%) underwent reoperation for hemostasis. Eight (30.8%) experienced bronchial complications. Mechanical ventilation time was 10 days [IQR 2-55]. Length of stay in intensive care unit and hospital were 34 [IQR 18-73] and 64 [IQR 36-103] days, respectively. Median survival was 21 months. Post-transplant survival rates after 1, 2, and 5 years were 57.9%, 42.6% and 38.3% respectively. Low albuminemia (p = 0.046), FVC (p = 0.021), FEV1 (p = 0.009) and high emergency lung transplantation (p = 0.04) were associated with increased early mortality. Oversized graft tended to be correlated to a higher mortality (p = 0.07). CONCLUSION LT for PPFE is associated with high post-operative morbi-mortality rates. Patients requiring high emergency lung transplantation with advanced disease, malnutrition, or critical clinical status experienced worse outcomes. CLINICALTRIALS GOV IDENTIFIER NCT05044390.
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Affiliation(s)
- H Clermidy
- Department of Thoracic Surgery and Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.
| | - O Mercier
- Department of Thoracic Surgery and Heart-Lung transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - G Brioude
- Department of Thoracic Surgery, North Hospital, Marseille, France
| | - P Mordant
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, Paris, France
| | - G Fadel
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, Paris, France
| | - C Picard
- Pneumology, Adult Cystic Fibrosis Center and Lung Transplantation Dept, Foch Hospital, Suresnes, France
| | - E Chatron
- Department of Pneumology, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - J Le Pavec
- Department of Thoracic Surgery and Heart-Lung transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - A Roux
- Pneumology, Adult Cystic Fibrosis Center and Lung Transplantation Dept, Foch Hospital, Suresnes, France
| | - M Reynaud-Gaubert
- Service de Pneumologie, Équipe de Transplantation Pulmonaire, Centre de Compétences des Maladies Pulmonaires Rares, North Hospital, Marseille, France
| | - J Messika
- Service de Pneumologie B et Transplantation Pulmonaire, Bichat Hospital, Paris, France
| | - A Olland
- Pneumology Unit and Strasbourg Lung Transplant Program, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - X Demant
- Service des Maladies Respiratoires, Hôpital Haut Leveque, CHU Bordeaux, Bordeaux, France
| | - T Degot
- Pneumology Unit and Strasbourg Lung Transplant Program, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - P M Lavrut
- Department of Pathology, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - J Jougon
- Service de Chirurgie Thoracique, Hôpital Haut Leveque, CHU Bordeaux, Bordeaux, France
| | - E Sage
- Department of Thoracic Surgery and Lung Transplantation, Foch Hospital, Suresnes, France
| | - E Fadel
- Department of Thoracic Surgery and Heart-Lung transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - P Thomas
- Department of Thoracic Surgery, North Hospital, Marseille, France
| | - V Cottin
- Department of Pneumology, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; National Reference Centre for Rare Pulmonary Diseases, OrphaLung, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, Claude Bernard University Lyon 1, Lyon, France
| | - F Tronc
- Department of Thoracic Surgery and Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
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Lucà S, Pagliuca F, Perrotta F, Ronchi A, Mariniello DF, Natale G, Bianco A, Fiorelli A, Accardo M, Franco R. Multidisciplinary Approach to the Diagnosis of Idiopathic Interstitial Pneumonias: Focus on the Pathologist's Key Role. Int J Mol Sci 2024; 25:3618. [PMID: 38612431 PMCID: PMC11011777 DOI: 10.3390/ijms25073618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Idiopathic Interstitial Pneumonias (IIPs) are a heterogeneous group of the broader category of Interstitial Lung Diseases (ILDs), pathologically characterized by the distortion of lung parenchyma by interstitial inflammation and/or fibrosis. The American Thoracic Society (ATS)/European Respiratory Society (ERS) international multidisciplinary consensus classification of the IIPs was published in 2002 and then updated in 2013, with the authors emphasizing the need for a multidisciplinary approach to the diagnosis of IIPs. The histological evaluation of IIPs is challenging, and different types of IIPs are classically associated with specific histopathological patterns. However, morphological overlaps can be observed, and the same histopathological features can be seen in totally different clinical settings. Therefore, the pathologist's aim is to recognize the pathologic-morphologic pattern of disease in this clinical setting, and only after multi-disciplinary evaluation, if there is concordance between clinical and radiological findings, a definitive diagnosis of specific IIP can be established, allowing the optimal clinical-therapeutic management of the patient.
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Affiliation(s)
- Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Francesca Pagliuca
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Fabio Perrotta
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Domenica Francesca Mariniello
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Giovanni Natale
- Division of Thoracic Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia, 2, 80138 Naples, Italy; (G.N.); (A.F.)
| | - Andrea Bianco
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Alfonso Fiorelli
- Division of Thoracic Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia, 2, 80138 Naples, Italy; (G.N.); (A.F.)
| | - Marina Accardo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
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Fujisaki M, Higuchi T, Konda N, Hirahara S, Watanabe K, Yamada R, Motoyama R, Yamaguchi R, Katsumata Y, Kawaguchi Y, Harigai M. Development of microscopic polyangiitis following idiopathic pleuroparenchymal l fibroelastosis: A case report. Mod Rheumatol Case Rep 2023; 8:141-144. [PMID: 37307430 DOI: 10.1093/mrcr/rxad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/27/2023] [Accepted: 06/08/2023] [Indexed: 06/14/2023]
Abstract
Idiopathic pleuroparenchymal fibroelastosis (PPFE) is a rare type of idiopathic interstitial pneumonia, which is characterised by pleural fibrosis and subjacent parenchymal fibroelastosis of the upper lobes. Herein, we present a case of microscopic polyangiitis (MPA) following PPFE. The patient had abnormal shadows on chest radiographs 15 years before the onset of MPA, and the patient was diagnosed with PPFE. Four years after the PPFE diagnosis, the patient was diagnosed with MPA based on persistent fever, purpura, mononeuritis multiplex, myeloperoxidase-antineutrophil cytoplasmic antibody positivity, and pathological findings of peritubular capillaritis on kidney biopsy. The patient was treated with glucocorticoids, including methylprednisolone pulse therapy and rituximab, followed by maintenance therapy with rituximab. One year after treatment, the PPFE had not worsened. PPFE occasionally occurs secondary to connective tissue disease, including MPA; however, to the best of our knowledge, this is the first report of PPFE preceding MPA. Our case suggests that PPFE, as other interstitial lung diseases, may be associated with MPA and precede the onset of MPA. The accumulation of more cases is needed to clarify the characteristics of MPA-associated PPFE.
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Affiliation(s)
- Mayuko Fujisaki
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
- Department of Rheumatology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Tomoaki Higuchi
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Naoko Konda
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Shinya Hirahara
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kotaro Watanabe
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Risa Yamada
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Ryo Motoyama
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Rei Yamaguchi
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuhiro Katsumata
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasushi Kawaguchi
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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8
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Capaccione KM, Fan W, Saqi A, Padilla M, Salvatore MM. Establishing quantitative radiographic criteria for the diagnosis of pleuroparenchymal fibroelastosis. Clin Imaging 2023; 103:109982. [PMID: 37717512 DOI: 10.1016/j.clinimag.2023.109982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE Pleuroparenchymal Fibroelastosis (PPFE) is a type of pulmonary fibrosis most commonly occurring at the apices. Patients with PPFE have an increased risk of adverse effects from lung biopsy and in the post-surgical setting. Here, we investigated simple and reproducible measurements on chest CT to evaluate their predictive value in diagnosing PPFE. METHODS We analyzed a cohort of patients with histologically-proven PPFE and compared them to a cohort of patients diagnosed with "biapical scarring" (BAS) on chest CT. We measured plueuroparenchymal thickness using several independent parameters on chest CT. We also assessed other radiologic and clinical characteristics to identify if any were predictive of PPFF. RESULTS Our analysis demonstrated the average greatest apical thickness with a cut off of 4.5 mm yielded a sensitivity of 94.4% and a specificity of 88.9%, and an area under the curve of 97.2%. Single greatest apical thickness with a cut off of 7.5 mm had a sensitivity of 100% and a specificity of 88.9%, with the area under the curve of 97.8%. Average greatest upper lobe thickness with a cut off of 8.0 mm had a sensitivity of 88.9% and a specificity of 100%, with an area under the curve of 98.2%. Single greatest upper lobe thickness with a cut off of 8.5 yielded both a sensitivity and specificity of 94.4% and an area under the curve of 94.3%. CONCLUSION Measurements described above are highly sensitive and specific for the diagnosis of PPFE and warrant investigation with a larger cohort of patients.
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Affiliation(s)
- Kathleen M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, United States of America.
| | - Weijia Fan
- Department of Biostatistics, Irving Institute for Translational Research, Columbia University, New York, NY 10032, United States of America
| | - Anjali Saqi
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Maria Padilla
- National Jewish Respiratory Institute, The Mount Sinai Hospital, New York, NY 10029, United States of America
| | - Mary M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, United States of America
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Iwasaki K, Watanabe S, Okazaki A, Yano S. Home high-flow nasal therapy in a patient with pleuroparenchymal fibroelastosis: A case report. Respir Investig 2023; 61:729-732. [PMID: 37708638 DOI: 10.1016/j.resinv.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/10/2023] [Accepted: 08/16/2023] [Indexed: 09/16/2023]
Abstract
A 62-year-old man with pleuroparenchymal fibroelastosis (PPFE), who had been under observation for 19 years, was admitted due to headache, fatigue, and dyspnea. Although no acute findings were detected, his symptoms were attributed to hypercapnia and exertional hypoxemia. He had a history of pneumothorax, but chose not to undergo positive airway pressure ventilation. Consequently, home high-flow nasal therapy (HFNT) was initiated, and 4 months later, he observed an improvement in his quality of life, body weight gain, and relief from hypercapnia. These outcomes suggested that home HFNT holds potential for improving the quality of life for patients with PPFE.
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Affiliation(s)
- Kazuhiko Iwasaki
- Department of Internal Medicine, Kaga Medical Center, Kaga, Ishikawa, Japan; Department of Respiratory Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan.
| | - Satoshi Watanabe
- Department of Respiratory Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Akihito Okazaki
- Department of Internal Medicine, Kaga Medical Center, Kaga, Ishikawa, Japan
| | - Seiji Yano
- Department of Respiratory Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
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10
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Buschulte K, Cottin V, Wijsenbeek M, Kreuter M, Diesler R. The world of rare interstitial lung diseases. Eur Respir Rev 2023; 32:32/167/220161. [PMID: 36754433 PMCID: PMC9910344 DOI: 10.1183/16000617.0161-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023] Open
Abstract
The world of rare interstitial lung diseases (ILDs) is diverse and complex. Diagnosis and therapy usually pose challenges. This review describes a selection of rare and ultrarare ILDs including pulmonary alveolar proteinosis, pulmonary alveolar microlithiasis and pleuroparenchymal fibroelastosis. In addition, monogenic ILDs or ILDs in congenital syndromes and various multiple cystic lung diseases will be discussed. All these conditions are part of the scope of the European Reference Network on rare respiratory diseases (ERN-LUNG). Epidemiology, pathogenesis, diagnostics and treatment of each disease are presented.
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Affiliation(s)
- Katharina Buschulte
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), ERN-LUNG, Heidelberg, Germany
| | - Vincent Cottin
- National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, Claude Bernard University Lyon 1, ERN-LUNG, Lyon, France
| | - Marlies Wijsenbeek
- Center for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC-University Medical Center, ERN-LUNG, Rotterdam, The Netherlands
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), ERN-LUNG, Heidelberg, Germany
| | - Rémi Diesler
- National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, Claude Bernard University Lyon 1, ERN-LUNG, Lyon, France
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11
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Pleuroparenchymal Fibroelastosis: A Review with a Focus on a Non-Infectious Complications after Hematopoietic Stem Cell Transplant. Biomedicines 2023; 11:biomedicines11030924. [PMID: 36979903 PMCID: PMC10046474 DOI: 10.3390/biomedicines11030924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a rare disease that is currently classified as an idiopathic interstitial pneumonia. Although originally described as an idiopathic disease, PPFE has now been identified as a rare complication following hematopoietic stem cell transplant (HSCT). Unlike other pulmonary complications after HSCT, PPFE occurs very late after transplant. Etiologies for PPFE after HSCT remain to be fully established. Infections and adverse effects to alkylating chemotherapy have been suggested as possible causes. In several cases, there is an association of PPFE with bronchiolitis obliterans syndrome after HSCT, suggesting that PPFE may be another manifestation of pulmonary chronic graft versus host disease after HSCT. Algorithms have been designed to assist in confirming a diagnosis of PPFE without the need for a surgical lung biopsy, however at present, no biomarker is established for the diagnosis or to predict the progression of disease. Presently, there is no current therapy for PPFE, but fortunately the disease progresses slowly in most patients.
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12
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Clinical features of idiopathic pleuroparenchymal fibroelastosis with progressive phenotype showing a decline in forced vital capacity. Respir Investig 2023; 61:210-219. [PMID: 36773509 DOI: 10.1016/j.resinv.2023.01.003] [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: 10/14/2022] [Revised: 12/12/2022] [Accepted: 01/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is heterogeneous, with some patients showing a progressive decline in forced vital capacity (FVC). However, the clinical features of these cases with progressive phenotypes remain unknown. METHODS This retrospective study included 48 patients diagnosed with IPPFE who underwent longitudinal pulmonary function tests at our institution from 2005 to 2021. The progressive phenotype was defined as a relative decline of ≥10% in %FVC within two years from diagnosis of IPPFE, and its clinical features were evaluated. RESULTS Of the 48 patients, 23 (47.9%) were classified as progressive IPPFE. They were significantly older with a higher rate of dyspnea, fine crackles on chest auscultation, lower-lobe usual interstitial pneumonia (UIP) pattern on high-resolution computed tomography, and lower %FVC at diagnosis than non-progressive IPPFE. Additionally, progressive IPPFE had a significantly higher rate of long-term oxygen therapy requirement, the incidence of pneumothorax, and weight loss after diagnosis, which showed worse survival than non-progressive IPPFE. The relative decline in %FVC and weight loss showed a significant positive correlation. Multivariate analysis revealed that lower body mass index tended to predict early progression, and the coexistence of lower-lobe UIP pattern was significantly associated with early progression. A decline in %FVC was an independent poor prognostic factor in IPPFE. CONCLUSIONS With a progressive decline in %FVC, IPPFE often has an advanced stage at diagnosis and lower-lobe UIP pattern and is associated with weight loss and worse survival.
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Franquet T, Giménez Palleiro A. Idiopathic pleuroparenchymal fibroelastosis. RADIOLOGIA 2022; 64 Suppl 3:301-307. [PMID: 36737168 DOI: 10.1016/j.rxeng.2022.12.002] [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: 09/23/2022] [Accepted: 10/12/2022] [Indexed: 02/05/2023]
Abstract
The term idiopathic pleuroparenchymal fibroelastosis refers to a rare interstitial lung disease that predominantly involves the upper lobes. It has been considered a rare subtype of interstitial lung disease since 2013, when it was included in the joint consensus statement on the diagnosis of interstitial lung diseases published by the American Thoracic Society (ATS) and the European Respiratory Society (ERS). Currently, two distinct types of pleuroparenchymal fibroelastosis are recognized: the idiopathic type for cases in which it has not been possible to establish a specific etiology and a secondary type associated with a variety of different causes. The diagnosis of pleuroparenchymal fibroelastosis must be managed from a combined clinical and radiological perspective. High-resolution computed tomography (HRCT) is the imaging method of choice for the evaluation and diagnosis of pleuroparenchymal fibroelastosis. In many cases, the diagnosis will be based exclusively on the HRCT findings and histologic confirmation will be unnecessary. This article describes the clinical, radiological, and histological characteristics of pleuroparenchymal fibroelastosis, discussing the different associations with this entity and its differential diagnosis.
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Affiliation(s)
- T Franquet
- Servicio de Radiodiagnóstico, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - A Giménez Palleiro
- Servicio de Radiodiagnóstico, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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14
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Bonniaud P, Cottin V, Beltramo G. Pleuroparenchymal fibroelastosis: so many unmet needs. Eur Respir J 2022; 60:2201798. [PMID: 36549690 DOI: 10.1183/13993003.01798-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/02/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Philippe Bonniaud
- Constitutive Reference Center for Rare Pulmonary Diseases, OrphaLung, Department of Pulmonary Medicine and Intensive Care Unit, Dijon-Bourgogne Universitary Hospital, Inserm U1231, University of Bourgogne-Franche Comté, Dijon, France
| | - Vincent Cottin
- National Reference Centre for Rare Pulmonary Diseases, OrphaLung, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, Claude Bernard University Lyon 1, Lyon, France
| | - Guillaume Beltramo
- Constitutive Reference Center for Rare Pulmonary Diseases, OrphaLung, Department of Pulmonary Medicine and Intensive Care Unit, Dijon-Bourgogne Universitary Hospital, Inserm U1231, University of Bourgogne-Franche Comté, Dijon, France
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15
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Changes in body weight reflect disease progression in pleuroparenchymal fibroelastosis. Respir Med Res 2022; 83:100980. [PMID: 36563546 DOI: 10.1016/j.resmer.2022.100980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
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Fibroelastosis pleuroparenquimatosa idiopática (FEPPI). RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Tetikkurt C, Ozturk BC, Gungordu N. Diagnosis of pleuroparenchymal fibroelastosis: A review. Monaldi Arch Chest Dis 2022. [PMID: 36269206 DOI: 10.4081/monaldi.2022.2363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a rare lung disease with unprecedented features characterized by fibroelastotic changes in the subpleural lung parenchyma affecting the upper lobes. PPFE is usually idiopathic, but it can be caused by infection, autoimmunity, bone marrow or lung transplantation, or a genetic predisposition. Histopathologic examination of lung biopsy samples reveals homogenous subpleural fibrosis and abundant elastic fibers, allowing for a definitive diagnosis. As PPFE mimics many interstitial lung diseases, clinicians face significant difficulties in making a definitive final diagnosis. Since most disease-related comorbid conditions manifest at an advanced stage, invasive tissue sampling for histopathologic evaluation is consistently impossible. Such a patient presentation highlights the importance of an analysis based solely on clinical findings, which would provide a definitive diagnosis without the need for a biopsy. Because of its exceptional and inconceivable presentation, PPFE creates a diagnostic dilemma. In light of our two cases and the literature data, we present a diagnostic assessment score assay that relies solely on clinical manifestations without histopathological tissue verification to shed light on the diagnosis of PPFE. This review focuses on PPFE identification through the use of a diagnostic assessment analysis to improve early disease recognition without the use of invasive diagnostic interventions to obtain biopsy samples for histopathologic evaluation. This analytic approach, while not diagnostic in and of itself, may provide a useful pathway for differential diagnosis and may preclude redundant initiatives.
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Affiliation(s)
- Cuneyt Tetikkurt
- Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul Cerrahpasa University, Istanbul.
| | - Buket Caliskaner Ozturk
- Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul Cerrahpasa University, Istanbul.
| | - Nejdiye Gungordu
- Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul Cerrahpasa University, Istanbul.
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18
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Sato N, Iwanami Y, Ebihara K, Nakao K, Miyagi M, Nakamura Y, Kishi K, Homma S, Ebihara S. Determinants of Six-Minute Walk Distance in Idiopathic Pulmonary Fibrosis and Idiopathic Pleuroparenchymal Fibroelastosis. Biomedicines 2022; 10:biomedicines10102556. [PMID: 36289817 PMCID: PMC9599550 DOI: 10.3390/biomedicines10102556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 12/01/2022] Open
Abstract
Background: In idiopathic pulmonary fibrosis (IPF), 6-minute walking distance (6MWD) is an independent factor for mortality. Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare disease with physical features such as emaciation, but the relationship between IPPFE and 6MWD is unclear. In this study, we investigated the factors that cause a decrease in the percent of the predicted value of a 6-minute walk distance (%6MWD), including the disease entities, IPF and IPPFE. Methods: This study included 100 patients (IPF: 75 patients, IPPFE: 25 patients, age: 73.5 ± 7.2 years, sex: 73 males) who visited the rehabilitation department. Patients with a %6MWD ≥ 80% were assigned to the normal group (n = 54), and patients with a %6MWD < 80% were assigned to the decreased group (n = 46). The items showing a significant difference between groups were used as independent variables, after the consideration of multicollinearity, for a logistic analysis where %6MWD < 80% was used as the dependent variable. Results: The 6MWD results show that there was no significant difference between IPF and IPPFE in the absolute value of 6MWD and in the number of people with 6MWD ≥ 250 m, but when 6MWD was compared with %6MWD, the IPPFE group showed a significantly lower value than the IPF group (p = 0.013). Logistic regression analysis showed that only BMI (p = 0.032), GAP index (p = 0.043), and mMRC (p = 0.026) were factors that caused a decrease in %6MWD in 100 patients. Conclusion: The results suggest that leanness, shortness of breath and severity of illness are the most important factors that determine exercise tolerance, regardless of disease entity in IPF and IPPFE.
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Affiliation(s)
- Naofumi Sato
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Yuji Iwanami
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Kento Ebihara
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Keiko Nakao
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Midori Miyagi
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Yasuhiko Nakamura
- Department of Respiratory Medicine, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Kazuma Kishi
- Department of Respiratory Medicine, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Sakae Homma
- Department of Advanced and Integrated Interstitial Lung Diseases Research, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-5874, Japan
- Correspondence:
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19
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Cottin V, Si-Mohamed S, Diesler R, Bonniaud P, Valenzuela C. Pleuroparenchymal fibroelastosis. Curr Opin Pulm Med 2022; 28:432-440. [PMID: 35855575 DOI: 10.1097/mcp.0000000000000907] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Pleuroparenchymal fibroelastosis (PPFE) is a clinico-radiologic-pathologic interstitial lung disease (ILD) characterized by fibrosis that has upper lobe and subpleural predominance, involving both the visceral pleura and the subjacent subpleural lung parenchyma, and comprises dense fibroelastic changes with prominent elastosis of the alveolar walls together with fibrous thickening of the visceral pleura. The goal of this review is to summarize the state-of-the-art understanding in PPFE. RECENT FINDINGS PPFE was described in an increasing number of conditions. The course of disease is heterogeneous. Idiopathic PPFE, cases associated with telomerase-related gene mutations, cases related to a history of chemotherapy, and cases combining PPFE with a pattern of usual interstitial pneumonia, may have a particularly poor prognosis. Well-conducted retrospective studies identified marked PPFE features in approximately 10% of patients with idiopathic pulmonary fibrosis, 11% of patients with systemic sclerosis-associated ILD, 6.5% of patients with rheumatoid arthritis-associated ILD, and 23% of patients with hypersensitivity pneumonitis. Drug therapy has not been evaluated prospectively. A small retrospective study suggests that nintedanib may slow disease progression. However, whether the efficacy of antifibrotics is comparable in PPFE and in other forms of progressive pulmonary fibrosis warrants further evaluation. SUMMARY Accumulating data indicate that PPFE features are associated with poor prognosis in fibrosing ILDs. Further research on the management of PPFE is warranted.
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Affiliation(s)
- Vincent Cottin
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases
| | - Salim Si-Mohamed
- Department of Thoracic Imaging, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, Claude Bernard University Lyon 1, Lyon
| | - Rémi Diesler
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases
| | - Philippe Bonniaud
- Constitutive Reference Center for Rare Pulmonary Diseases, Department of Pulmonary Medicine and Intensive Care Unit, Inserm U1231, University of Bourgogne-Franche Comté, Dijon, France
| | - Claudia Valenzuela
- Department of Respiratory Medicine, Hospital universitario de la Princesa, Universitad autónoma de Madrid, Madrid, Spain
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20
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Muto Y, Sekine A, Hagiwara E, Komatsu S, Baba T, Oda T, Tabata E, Sakayori M, Fukui K, Iwasawa T, Takemura T, Misumi T, Ogura T. Clinical characteristics of pulmonary hypertension in patients with pleuroparenchymal fibroelastosis. Respir Investig 2022; 60:543-550. [PMID: 35387760 DOI: 10.1016/j.resinv.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study aimed to investigate the clinical characteristics and prognosis of patients with pleuroparenchymal fibroelastosis (PPFE) and pulmonary hypertension (PH). METHODS We retrospectively analyzed the data of patients who were diagnosed with PPFE and underwent transthoracic echocardiography (TTE) for the evaluation of their right heart systems within 3 months of their first visit between 2011 and 2018. Patients were divided into the PH and non-PH groups based on their peak tricuspid regurgitation velocity (TRV) on TTE (cutoff, 2.8 m/s). The clinical characteristics of PH and association between PH and survival among patients with PPFE were investigated. RESULTS In total, 83 patients were enrolled. Sixteen (19.3%) patients were included in the PH group. The PH group had a lower body mass index, percent predicted forced vital capacity (FVC), 6-min walk distance, and partial pressure of arterial oxygen than the non-PH group. There was no significant difference in the presence of usual interstitial pneumonia patterns in the lower lobes between the two groups. The survival period was significantly shorter in the PH group than in the non-PH group (median survival 16.3 versus 50.2 months, log-rank p < 0.001). The multivariate Cox proportional hazard model showed that male sex (hazard ratio [HR] = 4.83, p < 0.001), Krebs von den Lungen-6 (KL-6) > 550 U/mL (HR = 3.48, p = 0.005), %FVC < 50% (HR = 3.04, p = 0.028), and peak TRV > 2.8 m/s (HR = 3.26, p = 0.038) were independently associated with poor survival. CONCLUSIONS PH was not rare in patients with PPFE. Male sex, increased KL-6, lower FVC, and PH were independently associated with poor survival in patients with PPFE.
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Affiliation(s)
- Yutaka Muto
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan.
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Shigeru Komatsu
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Erina Tabata
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Masashi Sakayori
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, 236-0051, Japan
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21
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Lin L, Zhao Y, Li Z, Li Y, Wang W, Kang J, Wang Q. Expression of S100A9 and KL-6 in common interstitial lung diseases. Medicine (Baltimore) 2022; 101:e29198. [PMID: 35512076 PMCID: PMC9276110 DOI: 10.1097/md.0000000000029198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/10/2022] [Indexed: 01/04/2023] Open
Abstract
By evaluating S100 calcium binding protein A9 (S100A9) and Klebs von den Lungen-6 (KL-6) expression in patients with 4 common interstitial lung diseases (ILDs), we aimed to investigate whether S100A9 or KL-6 can be of any value in the differential diagnosis of these ILDs and simultaneously signal the disease progression.We collected the data of patients diagnosed with the 4 ILDs and underwent fiber-optic bronchoscopy and BAL in the First Affiliated Hospital, China Medical University from January 2012 to December 2020. The data related to BGA, C-reactive protein, pulmonary function test, total number and fraction of cells, T lymphocyte subsets in bronchoalveolar lavage fluid (BALF), and the expression of S100A9 and KL-6 in BALF and serum were collected. We analyzed, whether S100A9 or KL-6 could serve as a biomarker for differential diagnosis between the 4 common ILDs; whether the levels of S100A9 and KL-6 correlated with each other; whether they were correlated with other clinical parameters and disease severity.This study included 98 patients, 37 patients with idiopathic pulmonary fibrosis (IPF), 12 with hypersensitivity pneumonitis, 13 with connective tissue disease-associated ILD, and 36 with sarcoidosis (SAR): stage I (18), stage II (9), stage III (5), and stage IV (4). The expression of KL-6 in BALF was significantly higher in IPF patients than other 3 groups (all P-value < .05). However, there was no significant difference in the levels of S100A9 in BALF and serum between the 4 groups (P-value > .05). The levels of S100A9 in BALF of IPF patients was positively and significantly correlated with KL-6 expression and the percentage of neutrophils in BALF (P-value < .05). Along with the stage increase of SAR patients, the level of S100A9 in BALF gradually increased, which was negatively and significantly correlated with the forced vital capacity/predicted, carbon monoxide diffusing capacity/predicted%, and PaO2 (all P-value < .05).The expression of KL-6 in BALF can be used as a biomarker to differentiate IPF from the other 3 common ILDs. While, this was not the case with expression of S100A9 in BALF and serum. However, the expression S100A9 in BALF is useful to indicate the progression of SAR. Thus, simultaneous measurement of KL-6 and S100A9 levels in BALF makes more sense in differential diagnosing of the 4 common ILDS.
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Affiliation(s)
- Li Lin
- Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Yabin Zhao
- Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Zhenhua Li
- Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Yun Li
- Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
- Department of Geriatric Respiratory, The First Hospital of Kunming Medical University, Kunming, China
| | - Wei Wang
- Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Jian Kang
- Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Qiuyue Wang
- Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
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Limited efficacy of nintedanib for idiopathic pleuroparenchymal fibroelastosis. Respir Investig 2022; 60:562-569. [PMID: 35398003 DOI: 10.1016/j.resinv.2022.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The antifibrotic agent nintedanib has been reported to effectively prevent the decline in forced vital capacity (FVC) in a broad range of interstitial lung diseases. However, the efficacy of nintedanib against idiopathic pleuroparenchymal fibroelastosis (iPPFE) remains unclear. METHODS We retrospectively examined patients with idiopathic PPFE or idiopathic pulmonary fibrosis (IPF) who received nintedanib for more than 6 months. We evaluated annual changes in %FVC, radiological PPFE lesions, and body weight before and during nintedanib treatment. To investigate radiological PPFE lesions, we examined the fibrosis score, which was defined as the mean percentage of the high attenuation area in the whole lung parenchyma using three axial computed tomography images. RESULTS Overall, 15 patients with iPPFE and 27 patients with IPF were included in the present study. In patients with IPF, the annual rate of decline in %FVC was significantly lower during nintedanib treatment than that before treatment (-2.01%/year [-7.64 to 3.21] versus -7.64%/year [-10.8 to -4.44], p = 0.031). Meanwhile, in patients with iPPFE, the annual rate of decline in %FVC during nintedanib treatment was higher than that before treatment (-18.0%/year [-21.6 to -12.7] versus -9.40%/year [-12.3 to -8.23], p = 0.109). In addition, nintedanib treatment failed to inhibit the annual rate of increase in fibrosis score in patients with iPPFE (6.53/year [1.18-15.3] during treatment versus 2.70/year [0.27-12.2] before treatment, p = 0.175). CONCLUSIONS Nintedanib efficacy may be limited in patients with iPPFE.
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Miyamura T, Kinoshita Y, Kushima H, Mukae H, Ishii H. Lung involvement during the prediagnostic phase of idiopathic pleuroparenchymal fibroelastosis. ERJ Open Res 2022; 8:00548-2021. [PMID: 35539440 PMCID: PMC9081544 DOI: 10.1183/23120541.00548-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/28/2021] [Indexed: 11/05/2022] Open
Abstract
Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare interstitial pneumonia that predominantly affects the upper lung fields [1, 2]. A pulmonary apical cap (PAC) is an imaging finding resembling that for PPFE that does not show symptoms or progression [3, 4]. Some patients with PPFE have recognised lung involvement at the lung apex long before the diagnosis is actually made, findings that are indistinguishable from PAC based on temporal imaging data [5]. Clinically, it takes months to years from the first recognition of lung involvement to the diagnosis of PPFE [6, 7]. However, no study has yet focused on the progression of lung involvement or the clinical course before the diagnosis of IPPFE. The present study evaluated the prediagnostic clinical course in patients with IPPFE. Patients with PPFE sometimes have lung involvement at the lung apex long before the diagnosis. The prediagnostic phase with apical fibrosis is much longer than the postdiagnostic phase in patients with PPFE.https://bit.ly/32X1iXi
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Ikegami N, Nakajima N, Yoshizawa A, Handa T, Chen-Yoshikawa T, Kubo T, Tanizawa K, Ohsumi A, Yamada Y, Hamaji M, Nakajima D, Yutaka Y, Tanaka S, Watanabe K, Nakatsuka Y, Murase Y, Nakanishi T, Niwamoto T, Chin K, Date H, Hirai T. Clinical, radiological, and pathological features of idiopathic and secondary interstitial pneumonia cases with pleuroparenchymal fibroelastosis undergoing lung transplantation. Histopathology 2021; 80:665-676. [PMID: 34747513 DOI: 10.1111/his.14595] [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: 06/23/2021] [Revised: 10/27/2021] [Accepted: 11/06/2021] [Indexed: 11/28/2022]
Abstract
AIMS Idiopathic pleuroparenchymal fibroelastosis (PPFE) is a rare type of idiopathic interstitial pneumonia, and pathological PPFE is also observed in secondary interstitial pneumonia. This study aimed to evaluate the pathological findings associated with radiological PPFE-like lesions and the clinical and morphological features of patients with pathological PPFE. METHODS AND RESULTS We retrospectively reviewed the pathology of the explanted lungs from 59 lung transplant recipients with radiological PPFE-like lesions. Pathological PPFE lesions were identified in 14 patients with idiopathic cases and 12 patients with secondary cases. Pathological PPFE was associated with previous pneumothorax, a volume loss in the upper lobes and a flattened chest. Patients with idiopathic and secondary cases with pathological PPFE had similar clinical, radiological, and pathological findings, while fibroblastic foci were more common in patients with idiopathic cases, and patients with secondary cases more frequently showed alveolar septal thickening with elastosis or fibrosis. Post-transplantation survival did not differ between patients with idiopathic and secondary cases with pathological PPFE (log-rank; P=0.57) and was similar between patients with idiopathic cases with pathological PPFE and patients with idiopathic pulmonary fibrosis (IPF) (log-rank; P = 0.62). CONCLUSIONS Not all patients with interstitial pneumonia with radiological PPFE-like lesions have pathological PPFE. Characteristic clinical features can suggest the presence of pathological PPFE, and idiopathic and secondary cases with pathological PPFE are similar except for fibroblastic foci in idiopathic cases and alveolar septal thickening with elastosis or fibrosis in secondary cases. Patients with pathological PPFE have a similar prognosis to those with IPF after transplantation.
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Affiliation(s)
- Naoya Ikegami
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoki Nakajima
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toyofumi Chen-Yoshikawa
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Thoracic Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Radiology, Tenri Hospital, Tenri, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshito Yamada
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yojiro Yutaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satona Tanaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kizuku Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Respiratory Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yoshinari Nakatsuka
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuko Murase
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoko Nakanishi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,McGill International Collaborative School in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takafumi Niwamoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Hobbs SB, Chung JH, Walker CM, Bang TJ, Carter BW, Christensen JD, Danoff SK, Kandathil A, Madan R, Moore WH, Shah SD, Kanne JP. ACR Appropriateness Criteria® Diffuse Lung Disease. J Am Coll Radiol 2021; 18:S320-S329. [PMID: 34794591 DOI: 10.1016/j.jacr.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Abstract
Diffuse lung disease, frequently referred to as interstitial lung disease, encompasses numerous disorders affecting the lung parenchyma. The potential etiologies of diffuse lung disease are broad with several hundred established clinical syndromes and pathologies currently identified. Imaging plays a critical role in diagnosis and follow-up of many of these diseases, although multidisciplinary discussion is the current standard for diagnosis of several DLDs. This document aims to establish guidelines for evaluation of diffuse lung diseases for 1) initial imaging of suspected diffuse lung disease, 2) initial imaging of suspected acute exacerbation or acute deterioration in cases of confirmed diffuse lung disease, and 3) clinically indicated routine follow-up of confirmed diffuse lung disease without acute deterioration. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Stephen B Hobbs
- Vice-Chair, Informatics and Integrated Clinical Operations and Division Chief, Cardiovascular and Thoracic Radiology, University of Kentucky, Lexington, Kentucky.
| | - Jonathan H Chung
- Panel Chair; and Vice-Chair of Quality, and Section Chief, Chest Imaging, Department of Radiology, University of Chicago, Chicago, Illinois
| | | | - Tami J Bang
- Co-Director, Cardiothoracic Imaging Fellowship Committee, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; Co-Chair, membership committee, NASCI; and Membership committee, ad-hoc online content committee, STR
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jared D Christensen
- Vice-Chair, Department of Radiology, Duke University Medical Center, Durham, North Carolina; and Chair, ACR Lungs-RADS
| | - Sonye K Danoff
- Johns Hopkins Medicine, Baltimore, Maryland; Board of Directors, American Thoracic Society; Senior Medical Advisor, Pulmonary Fibrosis Foundation; and Medical Advisory Board Member, The Myositis Association
| | | | - Rachna Madan
- Associate Fellowship Director, Division of Thoracic Imaging, Brigham & Women's Hospital, Boston, Massachusetts
| | - William H Moore
- Associate Chair, Clinical Informatics and Chief, Thoracic Imaging, New York University Langone Medical Center, New York, New York
| | - Sachin D Shah
- Associate Chief and Medical Information Officer, University of Chicago, Chicago, Illinois; and Primary care physician
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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26
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Ikeda T, Kinoshita Y, Miyamura T, Ueda Y, Yoshida Y, Kushima H, Ishii H. Platythorax progresses with lung involvement in pleuroparenchymal fibroelastosis. Respir Investig 2021; 60:293-299. [PMID: 34732291 DOI: 10.1016/j.resinv.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Patients diagnosed with pleuroparenchymal fibroelastosis (PPFE) exhibit unique clinical features, including upper lobe-dominant lung involvement and platythorax (or flattened thoracic cage). Although platythorax have been shown to be a sign of disease progression, the temporal relationship between the progression of platythorax and the extent of lung involvement has not been closely investigated. METHODS We retrospectively investigated patients diagnosed with PPFE, who did not exhibit fibrotic lesions other than PPFE in the lower lobes. We estimated the fibrosis score, which is a visual score indicating the percentage of lung parenchyma occupied by the disease on computed tomography images selected every 2 cm from the lung apex to the lung base, and the flat chest index (the ratio of the anteroposterior diameter of the thoracic cage to the transverse diameter of the thoracic cage). Additionally, we investigated serial changes in the flat chest index and fibrosis score. RESULTS A total of 29 patients were included in this study. The fibrosis score was found to be weakly and inversely correlated with forced vital capacity %predicted at the diagnosis (r = -0.40, p = 0.038). Furthermore, the annual changes in the flat chest index and fibrosis score was found to be moderately and inversely correlated (r = -0.663, p = 0.0037). CONCLUSIONS These results indicate that there is a causal relationship between the progression of fibroelastosis and that of platythorax in patients with PPFE.
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Affiliation(s)
- Takato Ikeda
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yoshiaki Kinoshita
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Takuto Miyamura
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yusuke Ueda
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yuji Yoshida
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Hisako Kushima
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
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Mori Y, Yamano Y, Kataoka K, Yokoyama T, Matsuda T, Kimura T, Ogawa T, Watanabe F, Kondoh Y. Pulmonary rehabilitation for idiopathic pleuroparenchymal fibroelastosis: A retrospective study on its efficacy, feasibility, and safety. Respir Investig 2021; 59:849-858. [PMID: 34561207 DOI: 10.1016/j.resinv.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/23/2021] [Accepted: 08/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The beneficial effects of pulmonary rehabilitation (PR) for patients with idiopathic pleuroparenchymal fibroelastosis (IPPFE) remain unknown. This study aimed to examine the efficacy, feasibility, and safety of PR for IPPFE. METHODS We retrospectively investigated 25 patients with IPPFE referred for PR between April 2007 and March 2017. The PR mainly consisted of a 10-week exercise training program. The primary outcome was a change in 6-min walk distance (6MWD). Secondary outcomes included changes in dyspnea (transition dyspnea index [TDI]), anxiety and depression (hospital anxiety and depression scale [HADS]), and health-related quality of life (HRQoL) (St George's respiratory questionnaire [SGRQ]). RESULTS Thirteen patients participated in the PR program (PRP). Recurrent pneumothorax was the most common reason for patients not participating in the PRP. Four patients discontinued the PRP due to the recurrence of pneumothorax, new onset of pneumomediastinum, stroke, and another reason, respectively. Nine patients completed the PRP. Significant improvement was observed in 6MWD (median [interquartile range], 90 m [55-116 m]; P = 0.033). Clinically important improvements in the 6MWD, and TDI, HADS-anxiety, HADS-depression, and SGRQ total domain scores were observed in seven (78%), five (56%), four (44%), four (44%), and five (56%) of the nine patients, respectively. CONCLUSIONS Patients with IPPFE benefited from PR in terms of exercise capacity, dyspnea, anxiety, depression, and HRQoL. Pneumothorax and pneumomediastinum may impede the implementation of a PRP for patients with IPPFE. While careful patient selection is required, PR may be an efficacious non-pharmacological approach for managing disabilities in patients with IPPFE.
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Affiliation(s)
- Yuta Mori
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan; Department of Respiratory Medicine, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Toshiki Yokoyama
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Toshiaki Matsuda
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Tomoya Ogawa
- Department of Rehabilitation, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Fumiko Watanabe
- Department of Rehabilitation, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan.
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Kinoshita Y, Ikeda T, Miyamura T, Ueda Y, Yoshida Y, Kushima H, Fujita M, Ogura T, Watanabe K, Ishii H. A proposed prognostic prediction score for pleuroparenchymal fibroelastosis. Respir Res 2021; 22:215. [PMID: 34330287 PMCID: PMC8400711 DOI: 10.1186/s12931-021-01810-z] [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: 05/29/2021] [Accepted: 07/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical course of pleuroparenchymal fibroelastosis (PPFE) shows considerable variation among patients, but there is no established prognostic prediction model for PPFE. METHODS The prediction model was developed using retrospective data from two cohorts: our single-center cohort and a nationwide multicenter cohort involving 21 institutions. Cox regression analyses were used to identify prognostic factors. The total score was defined as the weighted sum of values for the selected variables. The performance of the prediction models was evaluated by Harrell's concordance index (C-index). We also examined the usefulness of the gender-age-physiology (GAP) model for predicting the prognosis of PPFE patients. RESULTS We examined 104 patients with PPFE (52 cases from each cohort). In a multivariate Cox analysis, a lower forced vital capacity (FVC [defined as FVC < 65%]; hazard ratio [HR], 2.23), a history of pneumothorax (HR, 3.27), the presence of a lower lobe interstitial lung disease (ILD) (HR, 2.31), and higher serum Krebs von den Lungen-6 (KL-6) levels (> 550 U/mL, HR, 2.56) were significantly associated with a poor prognosis. The total score was calculated as 1 × (FVC, < 65%) + 1 × (history of pneumothorax) + 1 × (presence of lower lobe ILD) + 1 × (KL-6, > 550 U/mL). PPFE patients were divided into three groups based on the prognostic score: stage I (0-1 points), stage II (2 points), and stage III (3-4 points). The survival rates were significantly different in each stage. The GAP stage was significantly associated with the prognosis of PPFE, but no difference was found between moderate (stage II) and severe (stage III) disease. Our new model for PPFE patients (PPFE Prognosis Score) showed better performance in the prediction of mortality in comparison to the GAP model (C-index of 0.713 vs. 0.649). CONCLUSIONS Our new model for PPFE patients could be useful for predicting their prognosis.
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Affiliation(s)
- Yoshiaki Kinoshita
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka, 818-8502, Japan
| | - Takato Ikeda
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka, 818-8502, Japan
| | - Takuto Miyamura
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka, 818-8502, Japan
| | - Yusuke Ueda
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka, 818-8502, Japan
| | - Yuji Yoshida
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka, 818-8502, Japan
| | - Hisako Kushima
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka, 818-8502, Japan
| | - Masaki Fujita
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan
| | - Kentaro Watanabe
- Department of Respiratory Medicine, Nishi Fukuoka Hospital, Fukuoka, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka, 818-8502, Japan.
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Ricoy J, Suárez-Antelo J, Antúnez J, Martínez de Alegría A, Ferreiro L, Toubes ME, Casal A, Valdés L. Pleuroparenchymal fibroelastosis: Clinical, radiological and histopathological features. Respir Med 2021; 191:106437. [PMID: 33992495 DOI: 10.1016/j.rmed.2021.106437] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/10/2021] [Accepted: 04/21/2021] [Indexed: 01/24/2023]
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a rare, generally idiopathic form of interstitial pneumonia with unique clinical, radiological and histopathological features. It is named after the presence of upper lobe pleural and subjacent parenchymal fibrosis, with accompanying elastic fibers. Although it is usually an idiopathic disease, it has been linked to other co-existent diseases. Diagnostic suspicion of PPFE is based on the identification of typical abnormalities on chest CT scan, which are prevailingly located in the upper lobes, adjacent to the apex of the lungs. Diagnosis can be confirmed by histological analysis, although biopsy is not always feasible. The disease is generally progressive, but not uniformly. The course of the disease is frequently slow and involves a progressive loss of upper lobe volume, which results in platythorax, associated with a significant reduction of body mass. PPFE concomitant to other interstitial lung diseases is associated with a poorer prognosis. The disease occasionally progresses rapidly causing irreversible respiratory insufficiency, which leads to death. Currently, there is no effective pharmacological therapy available, and lung transplantation is the best therapeutic option. The purpose of this review is to draw the attention to PPFE, describe its clinical, radiological and histopathological features, analyze its diagnostic criteria, and provide an update on the management of the disease.
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Affiliation(s)
- Jorge Ricoy
- Department of Pulmonology, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Juan Suárez-Antelo
- Department of Pulmonology, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - José Antúnez
- Department of Pathology, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Anxo Martínez de Alegría
- Department of of Radiology, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Lucía Ferreiro
- Department of Pulmonology, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain; Multidisciplinary Research Group on Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - María Elena Toubes
- Department of Pulmonology, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Ana Casal
- Department of Pulmonology, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Luis Valdés
- Department of Pulmonology, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain; Multidisciplinary Research Group on Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
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Miyahara S, Waseda R, Tokuishi K, Sato T, Iwasaki A, Shiraishi T. Elucidation of prognostic factors and the effect of anti-fibrotic therapy on waitlist mortality in lung transplant candidates with idiopathic interstitial pneumonias. Respir Investig 2021; 59:428-435. [PMID: 33888448 DOI: 10.1016/j.resinv.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lung transplantation (LTx) is the last resort for patients who fail to respond to drug therapy and progress to advanced idiopathic interstitial pneumonias (IIPs). However, more than one-third of patients registered for LTx face despair because of rapid disease progression and donor shortage. This study aimed to identify the risk factors of waitlist mortality in LTx candidates with IIPs and investigate the association of anti-fibrotic therapy with waitlist mortality. METHODS We retrospectively investigated 56 patients with IIPs, including 29 patients with idiopathic pulmonary fibrosis (51.7%) and 11 patients with idiopathic pleuroparenchymal fibroelastosis (19.6%), registered for LTx at Fukuoka University Hospital between January 2006 and June 2020. The risk factors affecting transplantation-censored survival were evaluated. RESULTS The waitlist mortality rate of patients with nonspecific interstitial pneumonia was significantly lower than that of others. Multivariate survival analysis using Cox's model identified a history of pneumothorax (P = 0.029) and short 6-min walk distance (6MWD) (P = 0.012) to be significant variables affecting waitlist mortality. Patients receiving anti-fibrotic therapy (n = 27, 48.2%) had a lower risk of pneumothorax (P = 0.017) and their 6MWD was longer than that of non-therapy patients (P < 0.001). The waitlist mortality rate of patients on anti-fibrotic therapy was significantly lower (P = 0.012). CONCLUSIONS History of pneumothorax and short 6MWD were independent predictors of waitlist mortality in LTx candidates with IIPs. The anti-fibrotic therapy may potentially reduce mortality in patients with IIPs on the waiting list for LTx.
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Affiliation(s)
- So Miyahara
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan.
| | - Ryuichi Waseda
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Keita Tokuishi
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Toshihiko Sato
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Akinori Iwasaki
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Takeshi Shiraishi
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
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Hamada R, Oshima Y, Sato S, Yoshioka Y, Sato T, Nankaku M, Kondo T, Chen-Yoshikawa TF, Ikeguchi R, Nakajima D, Date H, Matsuda S. Physical function after lung transplantation for late-onset noninfectious pulmonary complications after allogeneic hematopoietic stem cell transplantation. Support Care Cancer 2021; 29:5447-5454. [PMID: 33709187 DOI: 10.1007/s00520-021-06118-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/26/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Late-onset noninfectious pulmonary complications (LONIPCs) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) are fatal, and lung transplantation is the only curative treatment. Although lung transplantation for LONIPCs may confer good survival rates, it is unclear whether or how impaired physical functioning is restored. Thus, this study aimed to investigate the long-term course and associated changes in physical functions after lung transplantation in patients with LONIPCs after allo-HSCT. METHODS This prospective cohort study enrolled 15 patients who received lung transplantation for LONIPCs after allo-HSCT between 2012 and 2018. Dyspnea scores, performance status, physical function, and exercise tolerance were assessed before lung transplantation and up to 2 years after transplantation. RESULTS Two years after lung transplantation, the dyspnea scores and performance status improved, but did not recover completely. Physical function was assessed using the knee extensor strength (KES) and 6-min walk test (6MWT); the results were poor until 3 months after transplantation but improved over 2 years. The 6MWT distance showed improvement to a nearly healthy level (562.7 m). Recovery of exercise tolerance was associated with recovery in % vital capacity (%VC; r=0.5) and KES (r=0.4) from 3 months to 2 years after lung transplantation. Furthermore, a flat thorax, which is a characteristic of patients with LONIPCs, affected the %VC at 2 years after transplantation (r=0.8). CONCLUSION Lung transplantation for LONIPCs may restore impaired physical function. A multifaceted rehabilitation program should be considered, especially to improve muscle weakness and pulmonary function.
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Affiliation(s)
- Ryota Hamada
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yohei Oshima
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Susumu Sato
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuji Yoshioka
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tatsuya Sato
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Graduate of School of Medicine, Kyoto University, Shogoin, 54 Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toyofumi F Chen-Yoshikawa
- Department of Thoracic Surgery, Graduate of School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Graduate of School of Medicine, Kyoto University, Shogoin, 54 Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate of School of Medicine, Kyoto University, Shogoin, 54 Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Lee JH, Chae EJ, Song JS, Kim M, Song JW. Pleuroparenchymal fibroelastosis in Korean patients: clinico-radiologic-pathologic features and 2-year follow-up. Korean J Intern Med 2021; 36:S132-S141. [PMID: 32088939 PMCID: PMC8009146 DOI: 10.3904/kjim.2019.303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS Pleuroparenchymal fibroelastosis (PPFE) is a type of rare idiopathic interstitial pneumonia that is characterized by predominantly upper lobe involvement with pleural fibrosis and subjacent parenchymal fibrosis. This study aimed to determine the clinico-radiologic-pathologic features and prognosis of Korean patients with PPFE. METHODS A total of 26 patients who were confirmed to have PPFE by lung biopsy, were included, and their clinico-radiologic-pathologic findings were retrospectively analyzed. RESULTS The mean follow-up period was 23.8 months, and the mean age of the patients was 62.5 years; 61.5% were men and 50% were smokers. Cough and dyspnea were the most frequent presenting symptoms, and restrictive pattern was the most common observation in lung function. In 84.6% of the subjects, lower lobe involvement was found on chest computed tomography, and the usual interstitial pneumonia (UIP) pattern was the most common (59.1%). Among patients whose lower lobe was biopsied (n = 13), the UIP pattern was the most common (46.2%). Patients with lower lobe involvement were older and walked a shorter distance during the 6-minute walk test, compared to those without. Spontaneous pneumothorax was a common complication (26.9%), and 15.4% of the patients died mostly due to pneumonia (100%). The 1- and 3-year survival rates were 90.2% and 84.5%, respectively. CONCLUSION Clinical features of Korean patients with PPFE were similar to those reported previously; however, lower lobe involvement was more frequent. During follow-up, one-fourth of the patients experienced pneumothorax and one-fifth died from pneumonia.
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Affiliation(s)
- Jae Ha Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Inje niversity Haeundae Paik Hospital, Busan, Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miae Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Jin Woo Song, M.D. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3993 Fax: +82-2-3010-6968 E-mail:
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Comparison of Clinical Characteristics and Outcomes between Idiopathic and Secondary Pleuroparenchymal Fibroelastosis. J Clin Med 2021; 10:jcm10040846. [PMID: 33670776 PMCID: PMC7922642 DOI: 10.3390/jcm10040846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Pleuroparenchymal fibroelastosis (PPFE) is a unique clinical, radiologic, and histopathologic entity for which several potential etiologies have been reported recently. However, there has been no comprehensive study of secondary PPFE. Objective: Assessment of the clinical characteristics, outcomes, and prognostic factors of secondary and idiopathic PPFE. Methods: We retrospectively reviewed the medical records of consecutive PPFE patients between January 1999 and December 2018. We identified 132 idiopathic PPFE patients and 32 secondary PPFE patients. Results: The incidence of interstitial lung disease (ILD) pattern different from the usual interstitial pneumonia (UIP) pattern in the lower lobes was higher in secondary PPFE patients (38.5%) than in idiopathic PPFE patients (61.5%, p = 0.02). The idiopathic and secondary PPFE groups did not differ significantly in terms of laboratory data, respiratory complications, and survival (median: 5.0 years vs. 4.1 years, p = 0.95). The presence of UIP pattern was independently associated with increased mortality in multivariate analyses in idiopathic PPFE patients, but not in secondary PPFE patients. Conclusions: The frequency and prognostic impact of UIP-pattern ILD differed between idiopathic and secondary PPFE patients. Lung transplantation should be considered in secondary PPFE patients with low diffusing capacity of the lungs for carbon monoxide (DLCO) regardless of lower-lobe ILD pattern.
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Kono M, Nakamura Y, Enomoto Y, Yasui H, Hozumi H, Karayama M, Suzuki Y, Furuhashi K, Miki Y, Hashimoto D, Fujisawa T, Enomoto N, Inui N, Kaida Y, Yokomura K, Koshimizu N, Toyoshima M, Imokawa S, Yamada T, Shirai T, Hayakawa H, Nakamura H, Suda T. Pneumothorax in Patients with Idiopathic Pleuroparenchymal Fibroelastosis: Incidence, Clinical Features, and Risk Factors. Respiration 2021; 100:19-26. [PMID: 33401281 DOI: 10.1159/000511965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Idiopathic pleuroparenchymal fibroelastosis (PPFE) is a rare form of idiopathic interstitial pneumonia that is characterized by predominantly upper lobe pleural and subpleural lung parenchymal fibrosis. Pneumothorax is one of the major respiratory complications in PPFE patients; however, its clinical features are poorly understood. OBJECTIVE We aimed to investigate the complication of pneumothorax in patients with idiopathic PPFE. METHODS A retrospective multicenter study involving 89 patients who had been diagnosed with idiopathic PPFE was conducted. We investigated the cumulative incidence, clinical features, and risk factors of pneumothorax after the diagnosis of idiopathic PPFE. RESULTS Pneumothorax developed in 53 patients (59.6%) with 120 events during the observation period (41.8 ± 35.0 months). The cumulative incidence of pneumothorax was 24.8, 44.9, and 53.9% at 1, 2, and 3 years, respectively. Most events of pneumothorax were asymptomatic (n = 85; 70.8%) and small in size (n = 92; 76.7%); 30 patients (56.6%) had recurrent pneumothorax. Chest drainage was required in 23 pneumothorax events (19.2%), and a persistent air leak was observed in 13 (56.5%). Patients with pneumothorax were predominantly male and frequently had pathological diagnoses of PPFE and prior history of pneumothorax and corticosteroid use; they also had significantly poorer survival than those without pneumothorax (log-rank test; p = 0.001). Multivariate analysis revealed that a higher residual volume/total lung capacity ratio was significantly associated with the development of pneumothorax after the diagnosis. CONCLUSION Pneumothorax is often asymptomatic and recurrent in patients with idiopathic PPFE, leading to poor outcomes in some cases.
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Affiliation(s)
- Masato Kono
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan, .,Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan,
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasunori Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshihiro Miki
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Dai Hashimoto
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yusuke Kaida
- Department of Respiratory Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Koshi Yokomura
- Department of Respiratory Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Naoki Koshimizu
- Department of Respiratory Medicine, Fujieda Municipal General Hospital, Fujieda, Japan
| | - Mikio Toyoshima
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Shiro Imokawa
- Department of Respiratory Medicine, Iwata City Hospital, Iwata, Japan
| | - Takashi Yamada
- Department of Respiratory Medicine, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Toshihiro Shirai
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroshi Hayakawa
- Department of Respiratory Medicine, Tenryu Hospital, National Hospital Organization, Hamamatsu, Japan
| | - Hidenori Nakamura
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Kinoshita Y, Ishii H, Nabeshima K, Watanabe K. The pathogenesis and pathology of idiopathic pleuroparenchymal fibroelastosis. Histol Histopathol 2020; 36:291-303. [PMID: 33315234 DOI: 10.14670/hh-18-289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare subtype of idiopathic interstitial pneumonias that consists of elastofibrosis involving the lung parenchyma and pleural collagenous fibrosis predominantly located in the upper lobes. IPPFE has various distinct clinical and physiological characteristics, including platythorax and a marked decrease of forced vital capacity with an increased residual volume on a respiratory function test. The concept of IPPFE is now widely recognized and some diagnostic criteria have been proposed. In addition, the accumulation of cases has revealed the pathological features of IPPFE. However, little is known about the pathogenesis or the process of disease formation in IPPFE. This review article will provide a summary of the pathological features and previously reported hypotheses on disease formation in IPPFE, to discuss the potential etiologies and pathogenesis of IPPFE.
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Affiliation(s)
- Yoshiaki Kinoshita
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Kentato Watanabe
- Department of Respiratory Medicine, Nishi Fukuoka Hospital, Fukuoka, Japan
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Ikeda T, Kinoshita Y, Ueda Y, Sasaki T, Kushima H, Ishii H. Physiological Criteria Are Useful for the Diagnosis of Idiopathic Pleuroparenchymal Fibroelastosis. J Clin Med 2020; 9:jcm9113761. [PMID: 33266381 PMCID: PMC7700592 DOI: 10.3390/jcm9113761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diagnostic criteria of idiopathic pleuroparenchymal fibroelastosis (IPPFE) were recently proposed, including physiological criteria of the body mass index (BMI) and percentage of the predicted values of residual volume (RV)/total lung capacity (TLC) (RV/TLC %pred.). The aim of this study was to evaluate (i) whether the physiologic criteria are useful for the diagnosis and (ii) whether the flat chest index, defined as the ratio of the anteroposterior diameter to the transverse diameter of the thoracic cage, could be an alternative parameter to RV/TLC %pred. METHODS We selected consecutive IPPFE patients and idiopathic pulmonary fibrosis (IPF) patients. We examined the diagnostic sensitivity and specificity of the physiological criteria and flat chest index for differentiating IPPFE patients from IPF patients. RESULTS This study included 37 IPPFE patients and 89 IPF patients. The physiological criteria distinguished IPPFE patients from IPF patients with a sensitivity of 78.6% and specificity of 88.0%. The combination of the flat chest index and BMI was also effective for differentiation (sensitivity of 82.1% and specificity of 89.3%). CONCLUSION We verified the good performance of the physiologic criteria in a different cohort. When the RV/TLC is not measured, using the flat chest index instead of RV/TLC %pred. may be reasonable.
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Namba M, Masuda T, Takao S, Terada H, Yamaguchi K, Sakamoto S, Horimasu Y, Miyamoto S, Nakashima T, Iwamoto H, Ohshimo S, Fujitaka K, Hamada H, Awai K, Hattori N. Extent of pulmonary fibrosis on high-resolution computed tomography is a prognostic factor in patients with pleuroparenchymal fibroelastosis. Respir Investig 2020; 58:465-472. [PMID: 32762953 DOI: 10.1016/j.resinv.2020.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Several prognostic factors for pleuroparenchymal fibroelastosis (PPFE) have recently been reported. However, detailed high-resolution computed tomography (HRCT) findings have not yet been evaluated as prognostic factors. This study retrospectively investigated whether HRCT findings are prognostic factors in patients with PPFE compared to those with idiopathic pulmonary fibrosis (IPF). METHODS Patients with PPFE and IPF diagnosed at our hospital between January 2008 and December 2016 were enrolled. Clinical and HRCT characteristics were obtained. In addition to our patients, we also analyzed data of PPFE patients whose cause of death had been identified in previous studies. RESULTS We enrolled 15 patients with PPFE and 75 patients with IPF. Consolidation and maximum pleural thickening were significantly higher in patients with PPFE than in those with IPF (both P < .001). Fibrosis score, honeycomb area, and traction bronchiectasis were not significantly different between these patient groups but were significant prognostic factors in patients with PPFE in univariate analysis (P = .021, P = .017, and P = .014, respectively). The proportions of deaths by acute exacerbation or lung cancer were significantly lower in patients with PPFE than in those with IPF (P < .001 and P = .001, respectively), whereas death by respiratory failure was significantly more frequent in PPFE patients (P < .001). CONCLUSIONS HRCT findings, such as fibrosis score, honeycomb area, and traction bronchiectasis, were independent prognostic factors in patients with PPFE. Respiratory failure, but not acute exacerbation and lung cancer, was the main cause of death in patients with PPFE.
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Affiliation(s)
- Masashi Namba
- Department of Clinical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan.
| | - Shun Takao
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroaki Terada
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kakuhiro Yamaguchi
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinjiro Sakamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Yasushi Horimasu
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Shintaro Miyamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Taku Nakashima
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hironobu Hamada
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Murakami Y, Sakamoto K, Okumura Y, Suzuki A, Mii S, Sato M, Yokoi T, Hashimoto N, Hasegawa Y. Acute Exacerbation of Pleuroparenchymal Fibroelastosis Secondary to Allogenic Hematopoietic Stem Cell Transplantation. Intern Med 2020; 59:2737-2743. [PMID: 32669500 PMCID: PMC7691016 DOI: 10.2169/internalmedicine.4995-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In this article, we report a case with pleuroparenchymal fibroelastosis (PPFE) following hematopoietic stem cell transplantation (HSCT) that developed acute respiratory failure with new bilateral ground glass opacity, which could not be explained by either a pulmonary infection, drug toxicity or extraparenchymal causes. Although combination therapy with multiple immunosuppressants was transiently effective, the patient died from a recurrent exacerbation. Autopsied lungs demonstrated diffuse alveolar damage superimposed on PPFE. There was no evidence of any coexisting interstitial pneumonia with the usual interstitial pneumonia (UIP) pattern. Our case suggests that acute exacerbation can occur in patients with post-HSCT PPFE, even when a coexisting UIP pattern is absent.
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Affiliation(s)
- Yasushi Murakami
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Koji Sakamoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Yuki Okumura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Japan
| | - Atsushi Suzuki
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Shinji Mii
- Department of Pathology, Nagoya University Graduate School of Medicine, Japan
| | - Mitsuo Sato
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
- Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Japan
| | | | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, National Hospital Organization, Nagoya Medical Center, Japan
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Lee JH, Jang HJ, Park JH, Kim HK, Lee S, Kim JY, Kim SH. Unilateral pleuroparenchymal fibroelastosis as a rare form of idiopathic interstitial pneumonia: A case report. World J Clin Cases 2020; 8:4186-4192. [PMID: 33024777 PMCID: PMC7520781 DOI: 10.12998/wjcc.v8.i18.4186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/15/2020] [Accepted: 08/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pleuroparenchymal fibroelastosis (PPFE) is a rare idiopathic interstitial pneumonia characterized by predominantly upper lobe involvement with pleural fibrosis and subjacent parenchymal fibrosis. Recently, there have been increasing reports of PPFE, and PPFE might coexist with other interstitial lung diseases in the lower lobe and upper lobe. However, cases of unilateral PPFE are scarce.
CASE SUMMARY A 75-year-old Korean male presented to our hospital with chronic dry cough and exertional dyspnea. The patient’s symptoms started 6 mo previously and had been gradually worsening. At the time of presentation, he felt dyspnea when walking at his own pace. Radiologic findings suggested PPFE, but the lesion was localized in the upper lobe of the right lung. After multidisciplinary discussion, a transbronchial lung biopsy in the right upper lobe revealed collapsed alveoli with parenchymal fibroelastosis, and elastic van Gieson staining demonstrated septal elastosis with intra-alveolar collagenosis, which met the histopathologic criteria of definite PPFE. After multidisciplinary discussion in an experienced interstitial lung disease center, we confirmed the diagnosis of unilateral PPFE. Furthermore, we confirmed the progression of PPFE on radiologic findings during the follow-up period.
CONCLUSION Clinicians should consider PPFE, even in cases with unilateral, predominantly upper lung involvement in interstitial lung disease patients through multidisciplinary discussion.
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Affiliation(s)
- Jae-Ha Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
| | - Hang-Jea Jang
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
| | - Jin-Han Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
| | - Hyun-Kuk Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
| | - Sunggun Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
| | - Ji-Yeon Kim
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
| | - Seong-Ho Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
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Ishii H, Kinoshita Y, Kushima H, Nagata N, Watanabe K. The similarities and differences between pleuroparenchymal fibroelastosis and idiopathic pulmonary fibrosis. Chron Respir Dis 2020; 16:1479973119867945. [PMID: 31387379 PMCID: PMC6685112 DOI: 10.1177/1479973119867945] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The idiopathic form of pleuroparenchymal fibroelastosis (PPFE) is categorized as
a rare idiopathic interstitial pneumonia in the current classification. The
majority of PPFE cases are idiopathic, but many predisposing factors or
comorbidities have been reported. Although histological PPFE is predominantly
located in the upper lobes, which are less often affected by fibrosis in
patients with idiopathic pulmonary fibrosis (IPF), the clinical course of PPFE
is seemingly similar to that of IPF. However, upper lobe fibroelastosis has
various clinical and physiological characteristics that differ from those of
IPF, including a flattened thoracic cage and a marked decrease in the forced
vital capacity (FVC) but with a preserved residual volume. Compared with IPF,
the decrease in the walking distance is mild despite the markedly decreased FVC
in PPFE, and chest radiograph more frequently shows the elevation of bilateral
hilar opacities with or without tracheal deviation. The prognosis may be related
to the development of fibrosing interstitial pneumonia in the lower lobes with
elevated levels of serum Krebs von den Lungen-6; however, there is marked
variation in the pathogenesis and clinical features in PPFE. A proposal of the
diagnostic criteria for idiopathic PPFE with and without surgical lung biopsy,
which has recently been published, may be useful.
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Affiliation(s)
- Hiroshi Ishii
- 1 Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | | | - Hisako Kushima
- 3 Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Nobuhiko Nagata
- 1 Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kentaro Watanabe
- 4 Department of Respiratory Medicine, Nishi Fukuoka Hospital, Fukuoka, Japan
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Disease course and prognosis of pleuroparenchymal fibroelastosis compared with idiopathic pulmonary fibrosis. Respir Med 2020; 171:106078. [PMID: 32917352 DOI: 10.1016/j.rmed.2020.106078] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is a rare interstitial lung disease characterized by unique radiological and pathological findings. However, pathological evaluations are available only in a limited number of patients. Therefore, several clinical diagnostic criteria have been proposed. Nevertheless, the applicability of these criteria has not yet been validated. Moreover, the clinical course of iPPFE and its prognosis have not yet been completely elucidated. METHODS The present study assessed previously proposed clinical diagnostic criteria by comparing the clinical features between pathologically diagnosed iPPFE (p-iPPFE) and clinically diagnosed iPPFE (c-iPPFE). Subsequently, the clinical features of iPPFE were characterized and compared with those of idiopathic pulmonary fibrosis (IPF, n = 323). RESULTS Clinical characteristics of c-iPPFE (n = 27) and p-iPPFE (n = 35) were similar. No significant difference was observed in terms of prognosis between c-iPPFE and p-iPPFE. The number of patients with iPPFE (both c-iPPFE and p-iPPFE) who developed lung cancer was significantly lower than that of patients with IPF. However, acute exacerbation (AE) showed similar incidence in patients with iPPFE and IPF. Survival of patients with iPPFE was significantly worse than that of patients with IPF (5-year survival rate: 38.5% vs. 63.5%, p < 0.0001), and the most common cause of death was chronic respiratory failure (73.8%), followed by AE (14.3%). Male gender was the only poor prognostic factor of iPPFE. CONCLUSION The present study demonstrated efficiency of clinical diagnosis and also revealed clinically important characteristics of iPPFE that should be considered for management of iPPFE.
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Sekine A, Satoh H, Takemura T, Matsumura M, Okudela K, Iwasawa T, Okabayashi H, Ikeda S, Yamakawa H, Oda T, Okuda R, Kitamura H, Baba T, Komatsu S, Hagiwara E, Ogura T. Unilateral upper lung-field pulmonary fibrosis radiologically consistent with pleuroparenchymal fibroelastosis after thoracic surgery: Clinical and radiological courses with autopsy findings. Respir Investig 2020; 58:448-456. [PMID: 32660899 DOI: 10.1016/j.resinv.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/17/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pleuroparenchymal fibroelastosis (PPFE) is a rare idiopathic interstitial pneumonia characterized by pleural and parenchymal involvements predominantly in the upper lobes. Unilateral upper-lung field pulmonary fibrosis (upper-PF) radiologically consistent with PPFE was recently reported in patients with a history of open thoracotomy and presented with impaired thoracic movements in the operated side with unknown mechanisms. This retrospective study aimed to elucidate the clinical and radiological courses and pathological findings of unilateral upper-PF. METHODS All the consecutive patients diagnosed as having unilateral upper-PF between March 2012 and April 2018 were included. Radiological images and clinical courses before and after the diagnosis were thoroughly reviewed. RESULTS Fourteen patients were included. Unilateral upper-PF was diagnosed after a median of 4.8 years from the open thoracotomy or video-assisted thoracic surgery for treating lung or esophageal cancer, or bronchiectasis. Before or at diagnosis, 12 (85.7%) of 14 patients developed aberrant intrathoracic/extrathoracic air suggestive of pleural fistula, although the degree was slight. Of note, the upper-PF lesion apparently deteriorated once aberrant air emerged in all the patients. After diagnosis, the upper-PF lesion transformed into cystic lesion in 9 patients, 4 of whom eventually developed pulmonary aspergillosis. The prognosis was poor, with a median overall survival of 49.3 months. The autopsy in one patient demonstrated findings consistent with PPFE and chronic pleuritis. CONCLUSIONS Unilateral upper-PF developed after thoracic surgeries and had many clinical, radiological, and pathological characteristics in common with idiopathic PPFE. Our results indicate that the commonly observed aberrant air may be correlated with disease development and progression.
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Affiliation(s)
- Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
| | - Hiroaki Satoh
- Department of Internal Medicine, Mito Medical Center, University of Tsukuba, Mito, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Mai Matsumura
- Department of Pathology, Graduate School of Medicine, Yokohama-City University, Yokohama, Japan
| | - Koji Okudela
- Department of Pathology, Graduate School of Medicine, Yokohama-City University, Yokohama, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Hiroko Okabayashi
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Hideaki Yamakawa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Ryo Okuda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Hideya Kitamura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Shigeru Komatsu
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
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Futatsuya C, Minato H, Okayama Y, Katayanagi K, Kurumaya H, Yuasa M, Nishi K. An Autopsy Case of Idiopathic Pleuroparenchymal Fibroelastosis with Left Vocal Cord Paralysis and a Rapid Deterioration without an Acute Exacerbation. Intern Med 2020; 59:1541-1547. [PMID: 32188804 PMCID: PMC7364249 DOI: 10.2169/internalmedicine.3892-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a generally slow-progressing rare disorder of unknown etiology. The direct cause of death in cases of IPPFE is rarely investigated. We experienced an autopsy case of a Japanese man with IPPFE and found aspiration pneumonia to be the major trigger of death. The individual had left vocal cord paralysis at admission, which may have contributed to aspiration pneumonia, and which probably was affected by the fibrous adhesion of the left apex of the chest wall resulting from IPPFE. The prevention of aspiration pneumonia is important for maintaining the respiratory function, especially in IPPFE patients with repeated pneumothorax.
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Affiliation(s)
- Chizuru Futatsuya
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Japan
| | - Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Japan
| | - Yurie Okayama
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Japan
| | - Kazuyoshi Katayanagi
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Japan
| | - Hiroshi Kurumaya
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Japan
| | - Mizuki Yuasa
- Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, Japan
| | - Koichi Nishi
- Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, Japan
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44
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Minomo S, Arai T, Tachibana K, Matsui H, Kasai T, Akira M, Inoue Y. Airway-centered Fibroelastosis Accompanied by Subpleural Lesions of Unknown Cause in a Young Man Who Later Developed Pulmonary Hypertension. Intern Med 2020; 59:695-700. [PMID: 31588081 PMCID: PMC7086328 DOI: 10.2169/internalmedicine.3256-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 26-year-old man with a history of bronchial asthma was found to have high-density shadows along the bronchovascular bundle and in the subpleural area on computed tomography of the chest. Surgical lung biopsy specimens from the right S5 showed fibroelastosis in the subpleural and central airway area with alveolar destruction. He was diagnosed with airway-centered fibroelastosis of unknown cause after multidisciplinary discussions. The patient developed pulmonary hypertension and died 6 years later. The patient was younger in comparison to patients in earlier reports and had more obvious subpleural fibroelastic lesions in the upper lobes than in previously described cases.
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Affiliation(s)
- Shojiro Minomo
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Toru Arai
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Kazunobu Tachibana
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Hideo Matsui
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Takahiko Kasai
- Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Masanori Akira
- Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Yoshikazu Inoue
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
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Abstract
This review discusses diagnostic pathology in idiopathic interstitial pneumonias (IIPs). Accurate understanding of basic structure of lung lobules is critical because the location of abnormalities inside the lobule is an important effector of pathology diagnosis. Depending on the method of obtaining tissue, recognition of the location may be difficult or impossible. Cryobiopsy is a new technology and its coverage of lung lobules is limited. This article discusses fundamental anatomy and approach to interstitial pneumonia. In addition, most histologic types of IIPs are covered, but the focus is on diagnosis of usual interstitial pneumonia because of its clinical importance.
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Affiliation(s)
- Yoshiaki Zaizen
- Department of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki 852-8501, Japan; Department of Pathology, Kameda Medical Center, 929 Higashi-machi, Kamogawa, Chiba 296-8602, Japan.
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46
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Chua F, Desai SR, Nicholson AG, Devaraj A, Renzoni E, Rice A, Wells AU. Pleuroparenchymal Fibroelastosis. A Review of Clinical, Radiological, and Pathological Characteristics. Ann Am Thorac Soc 2019; 16:1351-1359. [PMID: 31425665 PMCID: PMC6945468 DOI: 10.1513/annalsats.201902-181cme] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is an unusual pulmonary disease with unique clinical, radiological, and pathological characteristics. Designated a rare idiopathic interstitial pneumonia in 2013, its name refers to a combination of fibrosis involving the visceral pleura and fibroelastotic changes predominating in the subpleural lung parenchyma. Although a number of disease associations have been described, no single cause of PPFE has been unequivocally identified. A diagnosis of PPFE is most commonly achieved by identifying characteristic abnormalities on computed tomographic scans. The earliest changes are consistently located in the upper lobes close to the lung apices, the same locations where subsequent disease progression is also most conspicuous. When sufficiently severe, the disease leads to progressive volume loss of the upper lobes, which, in combination with decreased body mass, produces platythorax. Once regarded as a slowly progressing entity, it is now acknowledged that some patients with PPFE follow an inexorably progressive course that culminates in irreversible respiratory failure and early death. In the absence of effective medical drug treatment, lung transplant remains the only therapeutic option for this disorder. This review focuses on improving early disease recognition and evaluating its pathophysiological impact and discusses working approaches for its management.
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Affiliation(s)
| | | | | | | | | | - Alexandra Rice
- Department of Pathology, Royal Brompton Hospital, London, United Kingdom
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47
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Tsubosaka A, Matsushima J, Ota M, Suzuki M, Yonemori Y, Ota S, Yoshino I, Tsushima K, Tatsumi K, Nakatani Y. Whole-lung pathology of pleuroparenchymal fibroelastosis (PPFE) in an explanted lung: Significance of elastic fiber-rich, non-specific interstitial pneumonia-like change in chemotherapy-related PPFE. Pathol Int 2019; 69:547-555. [PMID: 31290582 DOI: 10.1111/pin.12833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 06/04/2019] [Indexed: 01/03/2023]
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is characterized by upper lobe-predominant subpleural fibroelastosis. Despite its characteristic uneven distribution, detailed whole-lung pathological features of PPFE have rarely been studied. We investigated PPFE in the explanted lungs from a 19-year-old male patient with a history of chemotherapy. Grossly, the explanted lungs showed upper lobe-predominant shrinkage with subpleural and central consolidation. Histologically, fibroelastosis was prominent in the perilobular areas and along the bronchovascular bundles. The other areas of the lung showed diffuse, non-specific interstitial pneumonia (NSIP)-like change with a characteristic increase of septal elastic fibers. In the digital image analysis, the ratio of elastic fibers to whole fibrosis (EF score) was lower in the subpleural areas than in the NSIP-like lesions, but the EF scores of the latter showed no significant difference between upper and middle/lower lobes. In the present case, the diffusely distributed elastic fiber-rich NSIP-like change, probably caused by the earlier chemotherapy, may have been conducive to the development of PPFE. This suggests that some unknown vulnerability of the upper lobe may exist, various primary lesions converging to the upper lobe predominance of PPFE.
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Affiliation(s)
- Ayumu Tsubosaka
- Department of Pathology, Chiba University Hospital, Chiba, Japan.,Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Jun Matsushima
- Department of Pathology, Chiba University Hospital, Chiba, Japan.,Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masayuki Ota
- Department of Pathology, Chiba University Hospital, Chiba, Japan.,Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masaki Suzuki
- Department of Pathology, Chiba University Hospital, Chiba, Japan
| | - Yoko Yonemori
- Department of Pathology, Chiba University Hospital, Chiba, Japan.,Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Satoshi Ota
- Department of Pathology, Chiba University Hospital, Chiba, Japan
| | - Ichiro Yoshino
- Department of Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kenji Tsushima
- Department of Respiratory Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koichiro Tatsumi
- Department of Respiratory Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yukio Nakatani
- Department of Pathology, Chiba University Hospital, Chiba, Japan.,Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Chiba, Japan
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48
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Kinoshita Y, Watanabe K, Ishii H, Kushima H, Nabeshima K. Lower‐lobe predominant pleuroparenchymal fibroelastosis. Pathol Int 2019; 69:536-540. [DOI: 10.1111/pin.12827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/22/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Yoshiaki Kinoshita
- Department of Respiratory MedicineFukuoka University Hospital Fukuoka Japan
- Department of PathologyFukuoka University School of Medicine and Hospital Fukuoka Japan
| | - Kentaro Watanabe
- Department of Respiratory MedicineFukuoka University Hospital Fukuoka Japan
- General Medical Research CenterFukuoka University School of Medicine Fukuoka Japan
| | - Hiroshi Ishii
- Department of Respiratory MedicineFukuoka University Hospital Fukuoka Japan
| | - Hisako Kushima
- Department of Respiratory MedicineFukuoka University Hospital Fukuoka Japan
| | - Kazuki Nabeshima
- Department of PathologyFukuoka University School of Medicine and Hospital Fukuoka Japan
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Watanabe K, Ishii H, Kiyomi F, Terasaki Y, Hebisawa A, Kawabata Y, Johkoh T, Sakai F, Kondoh Y, Inoue Y, Azuma A, Suda T, Ogura T, Inase N, Homma S. Criteria for the diagnosis of idiopathic pleuroparenchymal fibroelastosis: A proposal. Respir Investig 2019; 57:312-320. [PMID: 30981683 DOI: 10.1016/j.resinv.2019.02.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/07/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Physicians have few opportunities to perform surgical lung biopsy (SLB) to diagnose idiopathic pleuroparenchymal fibroelastosis (IPPFE). Therefore, diagnostic criteria for IPPFE that do not require SLB must be established. Herein, we propose diagnostic criteria for IPPFE with and without SLB. METHODS AND RESULTS The diagnostic criteria for IPPFE with SLB are histological, based on computed tomography (CT) lesions compatible with PPFE, predominantly in the upper lobes. The three diagnostic criteria for IPPFE without SLB are as follows: (1) radiologically possible IPPFE (a radiological criterion confirming CT lesions in both lung apexes, regardless of the lower lobe lesions); (2) radiologically probable IPPFE (also a radiological criterion, but mandatory to confirm chest radiograph findings of bilateral upward shift of the hilar structures and/or CT findings of volume loss of the upper lobes); (3) radiologically and physiologically probable IPPFE. Our data from 41 patients with IPPFE and 97 with idiopathic pulmonary fibrosis (IPF) showed that the percentage of the predicted values of the ratio of residual volume to total lung capacity (RV/TLC %pred.) ≥115% and body mass index (BMI) ≤20 kg/m2 plus RV/TLC %pred. ≥80% performed well for discriminating IPPFE from IPF. These parameters were thus added to criterion (3). CONCLUSIONS We have proposed diagnostic criteria for IPPFE in patients with and without SLB. Both imaging criteria and physiological criteria using RV/TLC and BMI successfully discriminate IPPFE from chronic IIPs when SLB cannot be performed.
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Affiliation(s)
- Kentaro Watanabe
- General Medical Research Center, Fukuoka University School of Medicine, 814-0180 Fukuoka, Japan.
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | | | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Akira Hebisawa
- Department of Clinical Research, National Hospital Organization Tokyo National Hospital, Japan
| | - Yoshinori Kawabata
- Division of Diagnostic Pathology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Arata Azuma
- Department of Pulmonary Medicine, Nippon Medical School, Tokyo, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan
| | - Naohiko Inase
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Sakae Homma
- Department of Respiratory Medicine, Toho University Omori Medical Center, Japan
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50
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Kono M, Fujita Y, Takeda K, Miyashita K, Tsutsumi A, Kobayashi T, Miki Y, Hashimoto D, Enomoto N, Nakamura Y, Suda T, Nakamura H. Clinical significance of lower-lobe interstitial lung disease on high-resolution computed tomography in patients with idiopathic pleuroparenchymal fibroelastosis. Respir Med 2019; 154:122-126. [PMID: 31238182 DOI: 10.1016/j.rmed.2019.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/21/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare form of idiopathic interstitial pneumonias (IIP) and may have other patterns of interstitial lung disease (ILD) in the lower lobe, such as usual interstitial pneumonia (UIP). However, the clinical significance of lower-lobe ILD in patients with IPPFE is unclear. METHODS A retrospective review of 40 consecutive patients with clinically diagnosed IPPFE in our institution from 2005 to 2016 was conducted. The presence of lower-lobe ILD on high-resolution computed tomography (HRCT) was assessed and classified into UIP or non-UIP pattern according to a modification of diagnostic criteria for idiopathic pulmonary fibrosis. Clinical characteristics and prognostic factors were evaluated. RESULTS Among the 40 patients with IPPFE, 21 (53%) had lower-lobe ILD, including 13 with UIP pattern and 8 with non-UIP pattern. Patients with IPPFE who had lower-lobe ILD had significantly older age, higher frequency of fine crackles, higher serum KL-6 level, lower residual volume (RV), and lower total lung capacity (TLC) than those without lower-lobe ILD. In addition, those with lower-lobe ILD, especially UIP pattern, had a significantly poorer survival than those without lower-lobe ILD (log-rank test; p = 0.014, p < 0.001, respectively). Multivariate Cox proportional hazards regression analysis revealed that low %forced vital capacity (%FVC) at baseline and coexistence of UIP pattern were significantly associated with poor prognosis in patients with IPPFE. CONCLUSIONS The coexistence of lower-lobe ILD on HRCT, especially the UIP pattern, may predict poor survival in patients with IPPFE.
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Affiliation(s)
- Masato Kono
- Seirei Hamamatsu General Hospital, Department of Pulmonary Medicine, Japan.
| | - Yuiko Fujita
- Seirei Hamamatsu General Hospital, Department of Pulmonary Medicine, Japan
| | - Kenichiro Takeda
- Seirei Hamamatsu General Hospital, Department of Pulmonary Medicine, Japan
| | - Koichi Miyashita
- Seirei Hamamatsu General Hospital, Department of Pulmonary Medicine, Japan
| | - Akari Tsutsumi
- Seirei Hamamatsu General Hospital, Department of Pulmonary Medicine, Japan
| | - Takeshi Kobayashi
- Seirei Hamamatsu General Hospital, Department of Pulmonary Medicine, Japan
| | - Yoshihiro Miki
- Seirei Hamamatsu General Hospital, Department of Pulmonary Medicine, Japan
| | - Dai Hashimoto
- Seirei Hamamatsu General Hospital, Department of Pulmonary Medicine, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hidenori Nakamura
- Seirei Hamamatsu General Hospital, Department of Pulmonary Medicine, Japan
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