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Hamzaoui A, Louhaichi S, Hamdi B. [Lung manifestations of sickle-cell disease]. Rev Mal Respir 2023:S0761-8425(23)00107-9. [PMID: 37059617 DOI: 10.1016/j.rmr.2023.03.002] [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: 07/23/2022] [Accepted: 03/04/2023] [Indexed: 04/16/2023]
Abstract
Sickle-cell disease is an autosomal recessive genetic disorder of hemoglobin that causes systemic damage. Hypoxia is the main actor of sickle-cell disease. It initiates acutely the pathogenic cascade leading to tissue damages that in turn induce chronic hypoxia. Lung lesions represent the major risk of morbidity and mortality. Management of sickle-cell disease requires a tight collaboration between hematologists, intensivists and chest physicians. Recurrent episodes of thrombosis and hemolysis characterize the disease. New therapeutic protocols, associating hydroxyurea, transfusion program and stem cell transplantation in severe cases allow a prolonged survival until the fifth decade. However, recurrent pain, crisis, frequent hospital admissions due to infection, anemia or acute chest syndrome and chronic complications leading to organ deficiencies degrade the patients' quality of life. In low-income countries where the majority of sickle-cell patients are living, the disease is still associated with a high mortality in childhood. This paper focuses on acute chest syndrome and chronic lung manifestations.
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Affiliation(s)
- A Hamzaoui
- Pavillon B/LR19SP02, hôpital Abderrahmen-Mami, 2080 Ariana, Tunisie; Faculté de médecine de Tunis, 1006 Tunis, Tunisie.
| | - S Louhaichi
- Pavillon B/LR19SP02, hôpital Abderrahmen-Mami, 2080 Ariana, Tunisie; Faculté de médecine de Tunis, 1006 Tunis, Tunisie
| | - B Hamdi
- Pavillon B/LR19SP02, hôpital Abderrahmen-Mami, 2080 Ariana, Tunisie; Faculté de médecine de Tunis, 1006 Tunis, Tunisie
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2
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Zeitoune R, Mogami R, Koifman ACB, Lopes AJ, Soares AR, Martins RAG, Maioli MCP. Diaphragm ultrasonography in adults with sickle cell anemia: evaluation of morphological and functional aspects. ACTA ACUST UNITED AC 2020; 25:372-382. [PMID: 33095119 DOI: 10.1080/16078454.2020.1833506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess morphological and functional aspects of the diaphragm by ultrasonography (US) in adults with sickle cell anemia (SCA) and evaluate if the diaphragmatic musculature can play a role in changes found in pulmonary function tests (PFTs) of these patients. METHODS This is a cross-sectional observational and single-center study involving 40 adults with SCA who underwent diaphragm US and PFTs with a maximum of 1 month between the two tests. Diaphragm US was performed in B and M modes, and echogenicity, thickness and movement of the muscle was assessed in different respiratory maneuvers. RESULTS Diaphragms had preserved echogenicity and the thickness was not significantly different between the groups. The SCA group exhibited significantly higher movement of the right hemidiaphragm during deep breathing (p = 0.004) and the sniff test (p = 0.0008) and lower movement of the left hemidiaphragm during quiet breathing (p = 0.009). There was a predominance of restrictive pattern (65%) and a global reduction in respiratory muscle strength (RMS) (70%). CONCLUSIONS This study shows that adults with SCA had normal morphostructural aspects and absence of diaphragm dysfunction. Otherwise, they presented greater movement of the right hemidiaphragm during deep breathing and sniff test maneuvers. Despite the restrictive pattern and the reduction in RMS found in PFTs, the diaphragm of young adults with SCA did not have weakness or paralysis.
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Affiliation(s)
- Rachel Zeitoune
- Marinha do Brasil, São Paulo, Brazil.,Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Roberto Mogami
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Ana Celia Baptista Koifman
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Agnaldo Jose Lopes
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
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3
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Oliveira DS, Araújo Filho JDA, Paiva AFL, Ikari ES, Chate RC, Nomura CH. Idiopathic interstitial pneumonias: review of the latest American Thoracic Society/European Respiratory Society classification. Radiol Bras 2018; 51:321-327. [PMID: 30369660 PMCID: PMC6198836 DOI: 10.1590/0100-3984.2016.0134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 01/05/2017] [Indexed: 12/17/2022] Open
Abstract
The diagnosis of idiopathic interstitial pneumonias (IIPs) involves a multidisciplinary scenario in which the radiologist assumes a key role. The latest (2013) update of the IIP classification by the American Thoracic Society/European Respiratory Society proposed some important changes to the original classification of 2002. The novelties include the addition of a new disease (idiopathic pleuroparenchymal fibroelastosis) and the subdivision of the IIPs into four main groups: chronic fibrosing IIPs (idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia); smoking-related IIPs (desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung disease); acute or subacute IIPs (cryptogenic organizing pneumonia and acute interstitial pneumonia); rare IIPs (lymphoid interstitial pneumonia and idiopathic pleuroparenchymal fibroelastosis); and the so-called "unclassifiable" IIPs. In this study, we review the main clinical, tomographic, and pathological characteristics of each IIP.
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Affiliation(s)
- Daniel Simões Oliveira
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - José de Arimatéia Araújo Filho
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - Antonio Fernando Lins Paiva
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - Eduardo Seigo Ikari
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - Rodrigo Caruso Chate
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
| | - César Higa Nomura
- Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP),
São Paulo, SP, Brazil
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4
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Lopes AJ, Marinho CL, Alves UD, Gonçalves CEA, Silva PO, Botelho EC, Bedirian R, Soares AR, Maioli MCP. Relationship between ventilation heterogeneity and exercise intolerance in adults with sickle cell anemia. ACTA ACUST UNITED AC 2017; 50:e6512. [PMID: 28746470 PMCID: PMC5520223 DOI: 10.1590/1414-431x20176512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/09/2017] [Indexed: 12/18/2022]
Abstract
Sickle cell anemia (SCA) causes dysfunction of multiple organs, with pulmonary involvement as a major cause of mortality. Recently, there has been growing interest in the nitrogen single-breath washout (N2SBW) test, which is able to detect ventilation heterogeneity and small airway disease when the results of other pulmonary function tests (PFTs) are still normal. Thus, the objectives of the present study were to assess the heterogeneity in the ventilation distribution in adults with SCA and to determine the association between the ventilation distribution and the clinical, cardiovascular, and radiological findings. This cross-sectional study included 38 adults with SCA who underwent PFTs, echocardiography, computed tomography (CT), and 6-min walk test. To evaluate the ventilation heterogeneity, the patients were categorized according to the phase III slope of the N2SBW (SIIIN2). Compared with adults with lower SIIIN2 values, adults with higher SIIIN2 values showed lower hemoglobin levels (P=0.048), a history of acute chest syndrome (P=0.001), an elevated tricuspid regurgitation velocity (P=0.039), predominance of a reticular pattern in the CT (P=0.002), a shorter 6-min walking distance (6MWD) (P=0.002), and lower peripheral oxygen saturation (SpO2) after exercise (P=0.03). SIIIN2 values correlated significantly with hemoglobin (rs=-0.344; P=0.034), forced vital capacity (rs=-0.671; P<0.0001), diffusing capacity for carbon monoxide (rs=-0.376; P=0.019), 6MWD (rs=-0.554; P=0.0003), and SpO2 after exercise (P=0.040). Heterogeneity in the ventilation distribution is one of the most common pulmonary dysfunctions in adults with SCA. Moreover, relationships exist between ventilation heterogeneity, worsening of pulmonary structural damage, and reduced tolerance for exercise.
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Affiliation(s)
- A J Lopes
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil.,Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - C L Marinho
- Programa de Pós-Graduação em Fisiopatologia Clínica e Experimental, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - U D Alves
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - C E A Gonçalves
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - P O Silva
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - E C Botelho
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - R Bedirian
- Disciplina de Clínica Médica, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - A R Soares
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Disciplina de Hematologia e Hemoterapia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - M C P Maioli
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Disciplina de Hematologia e Hemoterapia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Togni Filho PH, Casagrande JLM, Lederman HM. Utility of the inspiratory phase in high-resolution computed tomography evaluations of pediatric patients with bronchiolitis obliterans after allogeneic bone marrow transplant: reducing patient radiation exposure. Radiol Bras 2017; 50:90-96. [PMID: 28428651 PMCID: PMC5396998 DOI: 10.1590/0100-3984.2015.0181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/26/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the utility of the inspiratory phase in high-resolution computed tomography (HRCT) of the chest for the diagnosis of post-bone marrow transplantation bronchiolitis obliterans. MATERIALS AND METHODS This was a retrospective, observational, cross-sectional study. We selected patients of either gender who underwent bone marrow transplantation and chest HRCT between March 1, 2002 and December 12, 2014. Ages ranged from 3 months to 20.7 years. We included all examinations in which the HRCT was performed appropriately. The examinations were read by two radiologists, one with extensive experience in pediatric radiology and another in the third year of residency, who determined the presence or absence of the following imaging features: air trapping, bronchiectasis, alveolar opacities, nodules, and atelectasis. RESULTS A total of 222 examinations were evaluated (mean, 5.4 ± 4.5 examinations per patient). The expiratory phase findings were comparable to those obtained in the inspiratory phase, except in one patient, in whom a small uncharacteristic nodule was identified only in the inspiratory phase. Air trapping was identified in a larger number of scans in the expiratory phase than in the inspiratory phase, as was atelectasis, although the difference was statistically significant only for air trapping. CONCLUSION In children being evaluated for post-bone marrow transplantation bronchiolitis obliterans, the inspiratory phase can be excluded from the chest HRCT protocol, thus reducing by half the radiation exposure in this population.
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Affiliation(s)
- Paulo Henrique Togni Filho
- MD, MSc, Attending Physician, Department of Diagnostic Imaging,
Escola Paulista de Medicina da Universidade Federal de São Paulo
(EPM-Unifesp), São Paulo, SP, Brazil
| | - João Luiz Marin Casagrande
- Radiologist, Fellow in Musculoskeletal Imaging, Instituto de
Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade
de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Henrique Manoel Lederman
- Tenured Full Professor, Department of Diagnostic Imaging, Escola
Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp),
São Paulo, SP, Brazil
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de Brito MCB, Ota MK, Leitão Filho FSS, Meirelles GDSP. Radiologist agreement on the quantification of bronchiectasis by high-resolution computed tomography. Radiol Bras 2017; 50:26-31. [PMID: 28298729 PMCID: PMC5347500 DOI: 10.1590/0100-3984.2015.0146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To evaluate radiologist agreement on the quantification of bronchiectasis by
high-resolution computed tomography (HRCT). Materials and Methods The HRCT scans of 43 patients with bronchiectasis were analyzed by two
radiologists, who used a scoring system to grade the findings. Kappa
(κ) values and overall agreement were calculated. Results For the measurement and appearance of bronchiectasis, the interobserver
agreement was moderate (κ = 0.45 and κ = 0.43, respectively),
as was the intraobserver agreement (κ = 0.54 and κ = 0.47,
respectively). Agreement on the presence of mucous plugging was fair, for
central distribution (overall interobserver agreement of 68.3% and κ
= 0.39 for intraobserver agreement) and for peripheral distribution
(κ = 0.34 and κ = 0.35 for interobserver and intraobserver
agreement, respectively). The agreement was also fair for peribronchial
thickening (κ = 0.21 and κ = 0.30 for interobserver and
intraobserver agreement, respectively). There was fair interobserver and
intraobserver agreement on the detection of opacities (κ = 0.39 and
71.9%, respectively), ground-glass attenuation (64.3% and κ = 0.24,
respectively), and cysts/bullae (κ = 0.47 and κ = 0.44,
respectively). Qualitative analysis of the HRCT findings of bronchiectasis
and the resulting individual patient scores showed that there was an
excellent correlation between the observers (intraclass correlation
coefficient of 0.85 and 0.81 for interobserver and intraobserver agreement,
respectively). Conclusion In the interpretation of HRCT findings of bronchiectasis, radiologist
agreement appears to be fair. In our final analysis of the findings using
the proposed score, we observed excellent interobserver and intraobserver
agreement.
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Affiliation(s)
| | - Maurício Kenji Ota
- MD, Radiologist for the Fundação Instituto de Pesquisa e Estudos de Diagnóstico por Imagem (FIDI), São Paulo, SP, Brazil
| | | | - Gustavo de Souza Portes Meirelles
- PhD, Coordinator of the Thoracic Imaging Team of the Grupo Fleury, São Paulo, SP, Professor and Advisor for the Graduate Course in Clinical Radiology at the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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