Pulmonary involvement in adult Gaucher's disease: high resolution CT appearance

Uncommon Causes of Interlobular Septal Thickening on CT Images and Their Distinguishing Features

Interlobular septa thickening (ILST) is a common and easily recognized feature on computed tomography (CT) images in many lung disorders. ILST thickening can be smooth (most common), nodular, or irregular. Smooth ILST can be seen in pulmonary edema, pulmonary alveolar proteinosis, and lymphangitic spread of tumors. Nodular ILST can be seen in the lymphangitic spread of tumors, sarcoidosis, and silicosis. Irregular ILST is a finding suggestive of interstitial fibrosis, which is a common finding in fibrotic lung diseases, including sarcoidosis and usual interstitial pneumonia. Pulmonary edema and lymphangitic spread of tumors are the commonly encountered causes of ILST. It is important to narrow down the differential diagnosis as much as possible by assessing the appearance and distribution of ILST, as well as other pulmonary and extrapulmonary findings. This review will focus on the CT characterization of the secondary pulmonary lobule and ILST. Various uncommon causes of ILST will be discussed, including infections, interstitial pneumonia, depositional/infiltrative conditions, inhalational disorders, malignancies, congenital/inherited conditions, and iatrogenic causes. Awareness of the imaging appearance and various causes of ILST allows for a systematic approach, which is important for a timely diagnosis. This study highlights the importance of a structured approach to CT scan analysis that considers ILST characteristics, associated findings, and differential diagnostic considerations to facilitate accurate diagnoses.

Fever, pulmonary interstitial fibrosis, and hepatomegaly in a 15-year-old boy with Gaucher disease: a case report

BACKGROUND

Gaucher disease is an autosomal recessive disorder resulting from the accumulation of glucocerebroside in the cells of the macrophage-monocyte system caused by deficiency in lysosomal glucocerebrosidase. Intravenously administered enzyme replacement therapy is the first-line therapy for Gaucher disease type 1 and substrate reduction therapy represents an alternative oral treatment. Here is a rare case report of Gaucher disease in South China.

CASE PRESENTATION

Our patient was a 15-year-old Han Chinese boy presenting with fever, edema, and gradually increasing abdominal girth. A physical examination revealed obvious hypoevolutism and hepatomegaly, and laboratory tests and imaging examinations showed severe pulmonary interstitial fibrosis, infection, and moderate anemia. A final diagnosis of Gaucher disease was confirmed after examining the splenic pathological section derived from a splenectomy performed 6 years ago. His recovery improved after receiving anti-infection, diuresis, blood transfusion, and hepatoprotection and so on. However, enzyme replacement therapy was not adopted by our patient because his family could not afford it.

CONCLUSION

A rare case of Gaucher disease is reported here to emphasize the importance of early recognition by clinical manifestation and histological findings. Gaucher disease should be considered in the differential diagnosis of children with unexplained symptoms of multiple systems.

Imaging of Gaucher disease

Gaucher disease is the prototypical lysosomal storage disease. It results from the accumulation of undegraded glucosylceramide in the reticuloendothelial system of the bone marrow, spleen and liver due to deficiency of the enzyme glucocerebrosidase. This leads to hematologic, visceral and skeletal maifestions. Build up of glucosylceramide in the liver and spleen results in hepatosplenomegaly. The normal bone marrow is replaced by the accumulating substrate leading to many of the hematologic signs including anemia. The visceral and skeletal manifestations can be visualized with various imaging modalities including radiography, computed tomography, magnetic resonance imaging (MRI) and radionuclide scanning. Prior to the development of enzyme replacement therapy, treatment was only supportive. However, once intravenous enzyme replacement therapy became available in the 1990s it quickly became the standard of care. Enzyme replacement therapy leads to improvement in all manifestations. The visceral and hematologic manifestations respond more quickly usually within a few months or years. The skeletal manifestations take much longer, usually several years, to show improvement. In recent years newer treatment strategies, such as substrate reduction therapy, have been under investigation. Imaging plays a key role in both initial diagnosis and routine monitoring of patient on treatment particularly volumetric MRI of the liver and spleen and MRI of the femora for evaluating bone marrow disease burden.

Hydrolysis of phosphatidylcholine by cerium(IV) releases significant amounts of choline and inorganic phosphate at lysosomal pH

Niemann-Pick disease and drug-induced phospholipidosis are examples of lysosomal storage disorders in which serious respiratory infections are brought on by high levels of the phospholipid phosphatidylcholine in the acidic lamellar bodies and lysosomes of pulmonary cells. One approach to developing an effective therapeutic agent could involve the use of a metal to preferentially hydrolyze phospholipid phosphate ester bonds at mildly acidic, lysosomal pH values (~pH 4.8). Towards this end, here we have investigated phosphatidylcholine hydrolysis by twelve metal ion salts at 60°C. Using a malachite green/molybdate-based colorimetric assay to detect inorganic phosphate released upon metal-assisted phosphate ester bond hydrolysis, Ce(IV) was shown to possess outstanding reactivity in comparison to the eleven other metals. We then utilized cerium(IV) to hydrolyze phosphatidylcholine at normal, core body temperature (37°C). The malachite green/molybdate assay was used to quantitate free phosphate and an Amplex® Red-based colorimetric assay and matrix-assisted laser desorption ionization time-of-flight mass spectrometry were employed to detect choline. Ce(IV) hydrolyzed phosphatidylcholine more efficiently at lysosomal pH: i.e., at a Triton X-100:phosphatidylcholine molar mixing ratio of 1.57, yields of choline and phosphate were 51±4% and 40±4% at ~pH 4.8, compared to 28±4% and 27±5% at ~pH 7.2.

An unusual form of Gaucher’s disease: pulmonary and cardiovascular involvement and cholelitiasis

Gaucher’s disease is an inherited storage disease caused by a deficiency of the enzyme glucocerebrosidase. Although the hepatic manifestations are seen frequently, pulmonary and cardiovascular involvements are known to be very rare in Gaucher’s disease. This report presents these rare findings made by conventional radiography, computerized tomography (CT), and High-resolution CT (HRCT) of a 16-year-old female patient with fatal Gaucher’s disease.

Imaging of macrophage-related lung diseases

Macrophage-related pulmonary diseases are a heterogeneous group of disorders characterized by macrophage accumulation, activation or dysfunction. These conditions include smoking-related interstitial lung diseases, metabolic disorders such as Niemann-Pick or Gaucher disease, and rare primary lung tumors. High-resolution computed tomography abnormalities include pulmonary ground-glass opacification secondary to infiltration by macrophages, centrilobular nodules or interlobular septal thickening reflecting peribronchiolar or septal macrophage accumulation, respectively, emphysema caused by macrophage dysfunction, and honeycombing following macrophage-related lung matrix remodeling.

Manifestações esqueléticas da doença de gaucher

A doença de Gaucher é manifestação genética causada pela deficiência da enzima glicocerebrosidase, resultando no acúmulo secundário de glicocerebrosídeos nos órgãos do sistema reticuloendotelial. Apresenta-se sob três formas clínicas distintas, podendo ser rapidamente fatal ou crônica com poucos sintomas. O presente trabalho tem o objetivo de analisar os achados da radiografia simples do esqueleto em 32 pacientes comprovadamente portadores da doença, de ambos os sexos e em diferentes faixas etárias. Foram observadas as seguintes alterações: osteopenia difusa em todos os casos, deformidade em "frasco de Erlenmeyer" em 93,7%, alterações articulares em 40,6%, necrose da cabeça do fêmur e lesões líticas em 28,1%, respectivamente, fratura patológica em 9,3% e necrose da cabeça do úmero em 6,2% dos casos. Estes resultados encontram-se de acordo com as descrições da literatura, demonstrando a importância da radiologia convencional como método complementar no diagnóstico desta enfermidade.

CT determination of bone mineral density and structural investigations on the axial skeleton for estimating the osteoporosis-related fracture risk by means of a risk score

In addition to the pure measurement of bone mineral density (BMD) in osteodensitometry, the investigation of bone structure is becoming increasingly important for estimating fracture risk. In a clinical study, a risk score was proposed which separately assesses BMD and structural parameters for spongious and cortical bone and aggregates them into a single diagnostic parameter. In 120 lumbar vertebrae from 40 patients, BMD was determined separately for spongious and cortical bone by means of quantitative CT using a single energy procedure (SE-QCT/85 kV). In addition, structural parameters based on high resolution CT were calculated for the spongiosa and cortical bone. For all patients the number of osteoporosis-related fractures was determined on the entire skeletal system. According to WHO criteria, the patients were subdivided into four groups: 1, normal; 2, osteopenic; 3, osteoporotic without fractures; 4, severely osteoporotic. Weighting factors were determined by means of multivariate least-squares analysis and used to calculate a risk score of all parameters. The ability of the individual parameters and of the sum of discriminate between the individual groups was tested. If one considers the individual parameters (BMD and the fractal structural values for spongious and cortical bone), they allow a statistically significant separation of the four groups, although there is overlapping in the value ranges. In patients with fractures, there was a significant reduction in the cortical mineral density, accompanied by a deterioration in structural properties. The following individual values were obtained (minimum-mean-maximum): spongiosa BMD (mg ml-1), unfractured: 62-112-163, fractured: 9-48-77; cortical BMD (mg ml-1), unfractured: 190-287-405, fractured: 133-191-269; spongiosa structural parameter, unfractured: 0.35-0.73-1.01, fractured: 0.95-1.24-1.58; cortical structural parameter, unfractured: 18-31-65, fractured: 21-44-66. Above 77 mg ml-1 CaHA in the spongiosa and 270 mg ml-1 CaHA in cortical bone, no fractures were observed. By appropriately selecting the weighting factors, the score is free of overlapping between the groups with and without fractures (values: unfractured 1-9-15, fractured 16-21-29). With higher score values, the fracture risk is increasing.

High-resolution CT pulmonary findings in adults with Gaucher's disease

The purpose of this study was to illustrate high-resolution computed tomography (HRCT) findings in symptomatic adult Gaucher's disease patients. Five adult patients with Gaucher's disease experienced dyspnea. These patient were first evaluated by chest X-ray (CXR) followed by HRCT. The chest X-ray on one patient demonstrated a calcified granuloma. Two patients had interstitial disease only seen on HRCT, and two patients had a combination of interstitial and alveolar disease giving a mosaic pattern better illustrated on HRCT. HRCT can be used following CXR to evaluate lung pathology in symptomatic adult Gaucher's disease patients.