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Nakagawa S, Ono N, Hakamata Y, Ishii T, Saito A, Yanagimoto S, Kanaya S. Quantitative evaluation model of variable diagnosis for chest X-ray images using deep learning. PLOS DIGITAL HEALTH 2024; 3:e0000460. [PMID: 38489375 PMCID: PMC10942047 DOI: 10.1371/journal.pdig.0000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/04/2024] [Indexed: 03/17/2024]
Abstract
The purpose of this study is to demonstrate the use of a deep learning model in quantitatively evaluating clinical findings typically subject to uncertain evaluations by physicians, using binary test results based on routine protocols. A chest X-ray is the most commonly used diagnostic tool for the detection of a wide range of diseases and is generally performed as a part of regular medical checkups. However, when it comes to findings that can be classified as within the normal range but are not considered disease-related, the thresholds of physicians' findings can vary to some extent, therefore it is necessary to define a new evaluation method and quantify it. The implementation of such methods is difficult and expensive in terms of time and labor. In this study, a total of 83,005 chest X-ray images were used to diagnose the common findings of pleural thickening and scoliosis. A novel method for quantitatively evaluating the probability that a physician would judge the images to have these findings was established. The proposed method successfully quantified the variation in physicians' findings using a deep learning model trained only on binary annotation data. It was also demonstrated that the developed method could be applied to both transfer learning using convolutional neural networks for general image analysis and a newly learned deep learning model based on vector quantization variational autoencoders with high correlations ranging from 0.89 to 0.97.
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Affiliation(s)
- Shota Nakagawa
- Department of Science and Technology, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Naoaki Ono
- Department of Science and Technology, Nara Institute of Science and Technology, Ikoma, Nara, Japan
- Data Science Center, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | | | - Takashi Ishii
- Division for Health Service Promotion, the University of Tokyo, Japan
| | - Akira Saito
- Division for Health Service Promotion, the University of Tokyo, Japan
| | | | - Shigehiko Kanaya
- Department of Science and Technology, Nara Institute of Science and Technology, Ikoma, Nara, Japan
- Data Science Center, Nara Institute of Science and Technology, Ikoma, Nara, Japan
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2
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Kinoshita Y, Utsunomiya T, Wada K, Nakashima S, Kushima H, Ishii H. Comparative study of the two diagnostic criteria for idiopathic pleuroparenchymal fibroelastosis. Respir Med Res 2023; 84:101046. [PMID: 37729671 DOI: 10.1016/j.resmer.2023.101046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Yoshiaki Kinoshita
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Takuhide Utsunomiya
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Kenji Wada
- 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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3
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Oh SL, Lee JW, Yoo SY, Kim JH, Kim YJ, Han J, Kim K, Kim J, Jeon TY. Pleuroparenchymal fibroelastosis after hematopoietic stem cell transplantation in children: a propensity score-matched analysis. Eur Radiol 2023; 33:2266-2276. [PMID: 36346442 DOI: 10.1007/s00330-022-09188-2] [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: 03/28/2022] [Revised: 08/07/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To investigate the incidence, risk factors, and clinical outcomes of pleuroparenchymal fibroelastosis (PPFE) in pediatric hematopoietic stem cell transplantation (HSCT) recipients. METHODS This single-center, retrospective, case-control study included 738 consecutive patients who underwent chest CT more than 3 months after HSCT. We identified patients who fulfilled the diagnostic criteria for PPFE and assessed their clinical characteristics and radiologic findings. Propensity score-matched analysis was performed using four covariates (age, sex, HSCT type, and primary disease). The risk factors and clinical outcomes of PPFE were analyzed using the Fine and Gray regression model and stratified log-rank test in the matched groups. RESULTS PPFE was identified in 4% (31/738, 8.3 ± 3.1 years, 15 males) of the pediatric HSCT recipients with a median time of 2.7 years after HSCT, and it occurred following allogeneic (5%, 15/317), autologous (4%, 15/379), or both (2%, 1/42). Matching yielded 30 and 130 cases in the PPFE and control groups, respectively. The PPFE group showed more frequent late-onset noninfectious pulmonary complications (LONIPCs) and pneumonia more than 3 months after HSCT (p < 0.05). Multivariable analysis showed a significantly higher risk of PPFE in HSCT recipients who had pneumonia more than 3 months after HSCT (hazard ratio = 10.78 [95% confidence interval: 4.29, 27.13], p < 0.001). The PPFE group showed higher mortality (73%, 22/30) and poorer median overall survival (6.8 years [95% confidence interval: 4.1, 9.5]) than the control group (p < 0.001). CONCLUSIONS PPFE represents a severe type of LONIPC after HSCT. HSCT recipients with pneumonia after HSCT may have an increased risk of PPFE. KEY POINTS • The incidence of pleuroparenchymal fibroelastosis is not negligible (4%), and it can occur after either allogeneic or autologous hematopoietic stem cell transplantation. • Pleuroparenchymal fibroelastosis after hematopoietic stem cell transplantation showed poor outcome with a high mortality rate of 73% and median overall survival of 6.8 years. • After hematopoietic stem cell transplantation, pneumonia may increase the risk of pleuroparenchymal fibroelastosis development in children. • Lung biopsy should not be indicated in patients with pleuroparenchymal fibroelastosis findings on chest CT as it can cause refractory pneumothorax without helping the diagnosis.
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Affiliation(s)
- Sae-Lin Oh
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - So-Young Yoo
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ji Hye Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Yu Jin Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Kyunga Kim
- Department of Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Jihyun Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Tae Yeon Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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4
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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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5
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Shakil F, Snijder J, Salvatore MM. Why is UIP peripheral? Expert Rev Respir Med 2022; 16:907-915. [PMID: 36066423 DOI: 10.1080/17476348.2022.2119131] [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: 11/04/2022]
Abstract
INTRODUCTION The radiology pattern associated with IPF is called UIP. It is unique because unlike any other form of fibrosis it is peripheral in its distribution. We investigated the peripheral nature of UIP and why it was a key feature of IPF the deadliest of the ILDS. AREAS COVERED It is not enough to say that UIP is peripheral but instead as scientists we must ask ourselves why it is peripheral. This review dives into the published hypothesis that includes vascular insult, tensile forces, microaspiration, and inflammation and looks at the pros and cons for each argument, and ultimately comes to its own conclusion. PubMed searches using the below keywords were used to identify papers that described pathogenesis of IPF with regard to a particular theory. EXPERT OPINION In this paper, we will review four ideas that support why UIP is peripheral and propose the most likely explanation given what is currently known about the pathophysiology of IPF.
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Affiliation(s)
- Faariah Shakil
- Department of Radiology, Columbia University Irving Medical Center, New York, USA
| | - Juan Snijder
- Department of Radiology, Columbia University Irving Medical Center, New York, USA
| | - Mary M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, USA
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6
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Nguyen HN, McBee MP, Morin CE, Sharma A, Patel KR, Silva-Carmona M, Guillerman RP. Late pulmonary complications related to cancer treatment in children. Pediatr Radiol 2022; 52:2029-2037. [PMID: 35699763 DOI: 10.1007/s00247-022-05391-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/31/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022]
Abstract
As the number of childhood cancer survivors increases, a heightened awareness and recognition of therapy-related late effects is becoming more important. Pulmonary complications are the third leading cause of late mortality in cancer survivors. Diagnosis of these complications on chest imaging helps facilitate prompt treatment to mitigate adverse outcomes. In this review, we summarize the imaging of late pulmonary complications of cancer therapy in children and highlight characteristic findings that should be recognized by radiologists.
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Affiliation(s)
- HaiThuy N Nguyen
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Houston, TX, 77030, USA. .,Department of Radiology, Baylor College of Medicine, Houston, TX, USA.
| | - Morgan P McBee
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kalyani R Patel
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Manuel Silva-Carmona
- Department of Pediatrics, Pulmonology Division, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - R Paul Guillerman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Houston, TX, 77030, USA.,Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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7
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Duhig EE. Usual interstitial pneumonia: a review of the pathogenesis and discussion of elastin fibres, type II pneumocytes and proposed roles in the pathogenesis. Pathology 2022; 54:517-525. [PMID: 35778287 DOI: 10.1016/j.pathol.2022.05.002] [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: 01/16/2022] [Revised: 05/11/2022] [Accepted: 05/22/2022] [Indexed: 10/17/2022]
Abstract
The pathogenesis of idiopathic pulmonary fibrosis (IPF) and its histological counterpart, usual interstitial pneumonia (UIP) remains debated. IPF/UIP is a disease characterised by respiratory restriction, and while there have been recent advances in treatment, mortality remains high. Genetic and environmental factors predispose to its development and aberrant alveolar repair is thought to be central. Following alveolar injury, the type II pneumocyte (AEC2) replaces the damaged thin type I pneumocytes. Despite the interstitial fibroblast being considered instrumental in formation of the fibrosis, there has been little consideration for a role for AEC2 in the repair of the septal interstitium. Elastin is a complex protein that conveys flexibility and recoil to the lung. The fibroblast is presumed to produce elastin but there is evidence that the AEC2 may have a role in production or deposition. While the lung is an elastic organ, the role of elastin in repair of lung injury and its possible role in UIP has not been explored in depth. In this paper, pathogenetic mechanisms of UIP involving AEC2 and elastin are reviewed and the possible role of AEC2 in elastin generation is proposed.
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Affiliation(s)
- Edwina E Duhig
- Sullivan Nicolaides Pathology, The John Flynn Hospital, Tugun, Qld, Australia; UQ Thoracic Research Centre, The Prince Charles Hospital, Chermside, Qld, Australia; Faculty of Medicine, The University of Queensland, Herston, Qld, Australia.
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8
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Yong G, Kwan KEL, Chuah KL, Chai GT. Clinics in diagnostic imaging (212). Singapore Med J 2022; 63:74-78. [DOI: 10.11622/smedj.2022037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Rodrigues Vieira AC, Monteiro Ferra JR, Vicente De Carvalho JS, Melo N, Mota P, E Bastos H, Pereira J, Moura C, Morais A. Pleuroparenchymal fibroelastosis as a complication of chemotherapy: A case report. Mol Clin Oncol 2022; 16:71. [DOI: 10.3892/mco.2022.2504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/29/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
| | | | | | - Natália Melo
- Pulmonology Department, Hospital Center of São João, 4200‑319 Porto, Portugal
| | - Patrícia Mota
- Pulmonology Department, Hospital Center of São João, 4200‑319 Porto, Portugal
| | - Hélder E Bastos
- Pulmonology Department, Hospital Center of São João, 4200‑319 Porto, Portugal
| | - José Pereira
- Imaging Department, Hospital Center of São João, 4200‑319 Porto, Portugal
| | - Conceição Moura
- Pathology Department, Hospital Center of São João, 4200‑319 Porto, Portugal
| | - António Morais
- Pulmonology Department, Hospital Center of São João, 4200‑319 Porto, Portugal
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10
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Abstract
Childhood interstitial lung disease (ChILD) is an umbrella term encompassing a diverse group of diffuse lung diseases affecting infants and children. Although the timely and accurate diagnosis of ChILD is often challenging, it is optimally achieved through the multidisciplinary integration of imaging findings with clinical data, genetics, and potentially lung biopsy. This article reviews the definition and classification of ChILD; the role of imaging, pathology, and genetics in ChILD diagnosis; treatment options; and future goals. In addition, a practical approach to ChILD imaging based on the latest available research and the characteristic imaging appearance of ChILD entities are presented.
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11
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Cereser L, Passarotti E, De Pellegrin A, Patruno V, Poi ED, Marchesini F, Zuiani C, Girometti R. Chest high-resolution computed tomography in patients with connective tissue disease: pulmonary conditions beyond "the usual suspects". Curr Probl Diagn Radiol 2021; 51:759-767. [PMID: 34579993 DOI: 10.1067/j.cpradiol.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/18/2021] [Indexed: 11/22/2022]
Abstract
The term "connective tissue diseases" (CTDs) refers to a heterogeneous group of autoimmune disorders, including systemic sclerosis, rheumatoid arthritis, Sjögren's syndrome, systemic lupus erythematosus, polymyositis, dermatomyositis, antisynthetase syndrome, and mixed connective tissue disease. Chest high-resolution computed tomography (HRCT) is the imaging method of choice for evaluating patients with known or suspected CTD-related interstitial lung disease (CTD-ILD), a complication accounting for substantial morbidity and mortality. While specific HRCT patterns and signs of CTD-ILD have been extensively described (hence the designation "the usual suspects"), the knowledge of various, less frequent conditions involving the lungs in patients with CTD would help the radiologist produce a clinically valuable report, thus potentially influencing patient management. This paper aims to provide an up-to-date review of various unusual pulmonary CTD-related conditions the radiologist should be aware of; namely, acute exacerbation of CTD-ILD, CTD-related interstitial lung abnormalities, lung amyloidosis, MALT lymphoma, antisynthetase syndrome, pleuroparenchymal fibroelastosis-like lesion, drug-induced ILD, combined pulmonary fibrosis and emphysema, and pulmonary hypertension. For each condition, the chest HRCT appearance and the key histopathological and clinical features are resumed, helping the radiologist participate actively in the multidisciplinary discussion of complex clinical cases.
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Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy.
| | - Emanuele Passarotti
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Alessandro De Pellegrin
- Department of Pathology, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Department, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Emma Di Poi
- Rheumatology Clinic, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Filippo Marchesini
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
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12
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Homer KL, Mandziuk J, Hirji A, Barrie J, Meyer SR, Wong EYL, Puttagunta L, Halloran KM. Progressive Dyspnea With Recurrent Pneumothoraces. Chest 2021; 160:e209-e215. [PMID: 34366047 DOI: 10.1016/j.chest.2021.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/03/2021] [Accepted: 03/20/2021] [Indexed: 10/20/2022] Open
Abstract
CASE PRESENTATION A 34-year-old previously healthy man of Korean descent (height, 174 cm; weight, 47.4 kg) demonstrated dyspnea with cough and chest tightness. The patient had no relevant occupational exposures and no history of illicit drug or tobacco use. His medical history was notable for chronic sinus tachycardia of undetermined cause, hypertension, gout, glaucoma of the right eye, and a remote history of an intracranial malignancy 24 years prior treated with unspecified chemotherapy, craniotomy, and ventriculoperitoneal shunt placement. His active medications included diltiazem, candesartan, and colchicine as needed.
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Affiliation(s)
- Kai L Homer
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada.
| | - Jake Mandziuk
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Alim Hirji
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - James Barrie
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Steven R Meyer
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Eric Y L Wong
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lakshmi Puttagunta
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
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13
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Marinescu DC, English J, Sedlic T, Kliber A, Ryerson CJ, Wong AW. Pulmonary Apical Cap as a Potential Risk Factor for Pleuroparenchymal Fibroelastosis. Chest 2021; 159:e365-e370. [PMID: 34099151 DOI: 10.1016/j.chest.2021.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/19/2020] [Accepted: 01/01/2021] [Indexed: 11/19/2022] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a progressive and frequently fatal interstitial lung disease that involves the upper lobes. Although its cause remains unknown, the histopathologic evidence underlying PPFE bears striking resemblance to that of the pulmonary apical cap (PAC), a relatively common and benign entity. We describe the case of a patient with PAC that evolved into distinctly asymmetric PPFE over 6 years after unilateral surgical lung injury. Given the histologic similarity between these two conditions, we propose that these two entities underlie common biologic pathways of abnormal response to lung injury, with the presence of a PAC increasing susceptibility to the development of PPFE in the face of ongoing inflammatory insults. This case describes the histopathologic evolution of PAC to PPFE before and after an inciting injury.
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Affiliation(s)
- Daniel-Costin Marinescu
- Department of Medicine, Thoracic Service, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - John English
- Department of Pathology, Thoracic Service, University of British Columbia, Vancouver, BC, Canada
| | - Tony Sedlic
- Department of Diagnostic Medical Imaging, Thoracic Service, University of British Columbia, Vancouver, BC, Canada
| | - Agnes Kliber
- Department of Medicine, Mount St Joseph Hospital, Vancouver, BC, Canada
| | - Christopher J Ryerson
- Department of Medicine, Thoracic Service, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Alyson W Wong
- Department of Medicine, Thoracic Service, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.
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14
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Pulmonary Fibroelastotic Remodelling Revisited. Cells 2021; 10:cells10061362. [PMID: 34205982 PMCID: PMC8227669 DOI: 10.3390/cells10061362] [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: 04/21/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/27/2022] Open
Abstract
Pulmonary fibroelastotic remodelling occurs within a broad spectrum of diseases with vastly divergent outcomes. So far, no comprehensive terminology has been established to adequately address and distinguish histomorphological and clinical entities. We aimed to describe the range of fibroelastotic changes and define stringent histological criteria. Furthermore, we wanted to clarify the corresponding terminology in order to distinguish clinically relevant variants of pulmonary fibroelastotic remodelling. We revisited pulmonary specimens with fibroelastotic remodelling sampled during the last ten years at a large European lung transplant centre. Consensus-based definitions of specific variants of fibroelastotic changes were developed on the basis of well-defined cases and applied. Systematic evaluation was performed in a steps-wise algorithm, first identifying the fulcrum of the respective lesions, and then assessing the morphological changes, their distribution and the features of the adjacent parenchyma. We defined typical alveolar fibro-elastosis as collagenous effacement of the alveolar spaces with accompanying hyper-elastosis of the remodelled and paucicellular alveolar walls, independent of the underlying disease in 45 cases. Clinically, this pattern could be seen in (idiopathic) pleuroparenchymal fibro-elastosis, interstitial lung disease with concomitant alveolar fibro-elastosis, following hematopoietic stem cell and lung transplantation, autoimmune disease, radio-/chemotherapy, and pulmonary apical caps. Novel in-transit and activity stages of fibroelastotic remodelling were identified. For the first time, we present a comprehensive definition of fibroelastotic remodelling, its anatomic distribution, and clinical associations, thereby providing a basis for stringent patient stratification and prediction of outcome.
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15
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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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16
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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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17
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Byrne D, Nador RG, English JC, Yee J, Levy R, Bergeron C, Swiston JR, Mets OM, Muller NL, Bilawich AM. Chronic Lung Allograft Dysfunction: Review of CT and Pathologic Findings. Radiol Cardiothorac Imaging 2021; 3:e200314. [PMID: 33778654 PMCID: PMC7978021 DOI: 10.1148/ryct.2021200314] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 04/14/2023]
Abstract
Chronic lung allograft dysfunction (CLAD) is the most common cause of mortality in lung transplant recipients after the 1st year of transplantation. CLAD has traditionally been classified into two distinct obstructive and restrictive forms: bronchiolitis obliterans syndrome and restrictive allograft syndrome. However, CLAD may manifest with a spectrum of imaging and pathologic findings and a combination of obstructive and restrictive physiologic abnormalities. Although the initial CT manifestations of CLAD may be nonspecific, the progression of findings at follow-up should signal the possibility of CLAD and may be present on imaging studies prior to the development of functional abnormalities of the lung allograft. This review encompasses the evolution of CT findings in CLAD, with emphasis on the underlying pathogenesis and pathologic condition, to enhance understanding of imaging findings. The purpose of this article is to familiarize the radiologist with the initial and follow-up CT findings of the obstructive, restrictive, and mixed forms of CLAD, for which early diagnosis and treatment may result in improved survival. Supplemental material is available for this article. © RSNA, 2021.
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18
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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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Transbronchial cryobiopsy for diagnosis of pleuroparenchymal fibroelastosis. Respir Med Case Rep 2020; 31:101164. [PMID: 32714826 PMCID: PMC7371979 DOI: 10.1016/j.rmcr.2020.101164] [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: 05/27/2020] [Revised: 06/24/2020] [Accepted: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
Rationale Pleuroparenchymal fibroelastosis (PPFE) is a rare subtype of idiopathic interstitial pneumonias. PPFE mostly affects the upper lung zones and is characterized radiologically by pleural and subpleural fibrotic thickening with a reticular pattern. There is no established treatment for PPFE but lung transplantation can be considered for advanced stage. The gold standard for the diagnosis of PPFE is surgical lung biopsy (SLB) but the bronchoscopic transbronchial cryobiopsy (TBCB) is a less invasive alternative. Patient concerns We report here two cases in which the diagnosis of PPFE was established with the help of TBCB. Diagnosis and interventions Bronchoscopy with TBCB was performed under sedation with spontaneous ventilation and the help of an uncuffed ET tube. Outcomes Histopathology showed intra-alveolar fibroblastic proliferation with elastosis, which confirmed the diagnosis of PPFE. Lessons The current report demonstrates that TBCB can be a useful and safe tool to confirm the diagnosis of PPFE. According to our knowledge, this is one of few reports that shows successful diagnosis of PPFE by TBCB.
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20
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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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21
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Verleden SE, Von Der Thüsen J, Van Herck A, Weynand B, Verbeken E, Verschakelen J, Dubbeldam A, Vanaudenaerde BM, Vos R, Verleden GM. Identification and characterization of chronic lung allograft dysfunction patients with mixed phenotype: A single-center study. Clin Transplant 2020; 34:e13781. [PMID: 31958356 DOI: 10.1111/ctr.13781] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE Patients can change chronic lung allograft dysfunction (CLAD) phenotype, especially from BOS to mixed phenotype. Our aim was to further characterize these patients. METHOD Mixed CLAD was defined as a restrictive physiology with persistent CT opacities, after initial bronchiolitis obliterans syndrome (BOS) diagnosis. The incidence, prognosis, pulmonary function, radiology, pathology, and airway inflammation were compared between patients with restrictive allograft syndrome (RAS) and mixed CLAD. RESULT A total of 268 (44%) patients developed CLAD of which 47 (18%) were diagnosed with RAS "ab initio," 215 (80%) with BOS, and 6 (2%) an undefined phenotype. Twenty-five patients developed a mixed CLAD phenotype (24 BOS to mixed and 1 RAS to mixed). Survival after mixed phenotype diagnosis was comparable (P = .39) to RAS. More emphysema patients developed a mixed phenotype (P = .020) compared to RAS ab initio, while mixed CLAD patients had a lower FEV1 (P < .0001) and FEV1 /FVC (P = .0002) at diagnosis compared to RAS ab initio. CT scans in patients with the mixed phenotype demonstrated apical predominance of the opacities (P = .0034) with pleuroparenchymal fibroelastosis on histopathology. CONCLUSION We further characterized patients with a mixed phenotype of CLAD. Although the survival after diagnosis was comparable to RAS ab initio patients, there was a difference in demography, pulmonary function, radiology, and pathology.
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Affiliation(s)
- Stijn E Verleden
- Lung Transplant Unit, Department of Chronic diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Jan Von Der Thüsen
- Department of Pathology, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Anke Van Herck
- Lung Transplant Unit, Department of Chronic diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | | | | | | | | | - Bart M Vanaudenaerde
- Lung Transplant Unit, Department of Chronic diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Lung Transplant Unit, Department of Chronic diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Lung Transplant Unit, Department of Chronic diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
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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: 89] [Impact Index Per Article: 17.8] [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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Abstract
Lung transplantation is an accepted therapeutic option for end-stage lung diseases. Its history starts in the 1940s, initially hampered by early deaths due to perioperative problems and acute rejection. Improvement of surgical techniques and the introduction of immunosuppressive drugs resulted in longer survival. Chronic lung allograft dysfunction (CLAD), a new complication appeared and remains the most serious complication today. CLAD, the main reason why survival after lung transplantation is impaired compared to other solid-organ transplantations is characterized by a gradually increasing shortness of breath, reflected in a deterioration of pulmonary function status, respiratory insufficiency and possibly death.
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Clinico-radiologic features of pleuroparenchymal fibroelastosis in children. Pediatr Radiol 2019; 49:1163-1170. [PMID: 31004186 DOI: 10.1007/s00247-019-04405-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/06/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pleuroparenchymal fibroelastosis (PPFE) may be underdiagnosed clinically and radiographically in children with a remote history of cancer, leading to a delay in care and unnecessary lung biopsies. OBJECTIVE To describe the characteristic clinical and radiologic findings of PPFE in a cohort of children to facilitate recognition and noninvasive diagnosis. MATERIALS AND METHODS Clinical presentation, history of chemotherapy or radiation therapy, lung or bone marrow transplantation, and lung function testing and outcome were retrospectively extracted from the electronic medical records of eight children treated at our institution's pulmonary medicine clinic with histopathology confirmation of PPFE from 2008 to 2018. Two pediatric radiologists evaluated the chest imaging studies for the presence or absence of published radiologic findings of PPFE in adults, including platythorax, pneumothorax, upper lobe predominant pleural and septal thickening, and bronchiectasis. Platythorax indices were calculated from the normal chest CT exams of eight age- and gender-matched individuals obtained via the radiology search engine. RESULTS The mean presentation age was 12.9 years (range: 7-16 years). Seven of the eight had a history of chemotherapy and radiation therapy for cancer. Three of the eight had undergone bone marrow transplantation and none had undergone lung transplantation. The mean time between chemotherapy, radiation therapy, and/or bone marrow transplantation and the presentation of PPFE was 8.4 years (range: 5.6-12.1 years). Most of the patients presented with dyspnea (63%), cough (50%) and/or pneumothorax (38%). The mean percentage of predicted FEV1 (forced expiratory volume in one second) was 14.1 (range: 7.7-27.5). All eight patients demonstrated platythorax, bronchiectasis, pleural and septal thickening (upper lobes in four, upper and lower lobes in four) and six had pneumothorax. Five underwent lung biopsies, four of whom developed pneumothoraces. CONCLUSION Clinical and radiologic findings of pediatric PPFE are similar to those in adults, although a majority of the former have a history of treated cancer. Clinical presentation of restrictive lung disease, dyspnea, cough or spontaneous pneumothorax years after treatment for childhood cancer combined with platythorax, upper lobe pleural and septal thickening and traction bronchiectasis on chest CT establishes a presumptive diagnosis of PPFE.
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25
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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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Yabuuchi Y, Goto H, Nonaka M, Tachi H, Akiyama T, Arai N, Ishikawa H, Hyodo K, Nemoto K, Miura Y, Hase I, Oh-Ishi S, Hayashihara K, Saito T, Chonan T. A case of airway aluminosis with likely secondary pleuroparenchymal fibroelastosis. Multidiscip Respir Med 2019; 14:15. [PMID: 31011423 PMCID: PMC6463652 DOI: 10.1186/s40248-019-0177-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background Excessive inhalation of aluminium powder occasionally results in upper lobe predominant lung fibrosis, which is similar to idiopathic pleuroparenchymal fibroelastosis (IPPFE) and has been suggested to be secondary PPFE. Case presentation A 67-year-old man who had worked in an aluminum-processing factory for 50 years visited our hospital complaining of exertional dyspnea. Chest computed tomography (CT) showed bilateral dense sub-pleural consolidation in the upper and middle lung fields, which was consistent with IPPFE; however, the possibility of secondary PPFE associated with aluminosis was not ruled out. Considering the patient's critical condition, trans-bronchial lung biopsy (TBLB) rather than surgical lung biopsy was performed, with elemental analysis of the biopsied specimen. Unfortunately, the specimen obtained by TBLB did not contain alveolar tissue; therefore, pathological diagnosis of PPFE was not possible. However, radiographic findings were highly suggestive of PPFE. On elemental analysis, excessive amounts of aluminum were detected in the bronchiolar walls, establishing a diagnosis of airway aluminosis with likely secondary PPFE resulting from aluminium exposure. Conclusions TBLB with elemental analysis might be useful in differentiating idiopathic PPFE from secondary causes in dust inhalation related disease, such as aluminosis. This case indicated that inhalation of aluminium might cause secondary PPFE, with attention needing to be paid to avoid further exposure.
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Affiliation(s)
- Yuki Yabuuchi
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Hitomi Goto
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Mizu Nonaka
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Hiroaki Tachi
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Tatsuya Akiyama
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Naoki Arai
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Hiroaki Ishikawa
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Kentaro Hyodo
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Kenji Nemoto
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Yukiko Miura
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Isano Hase
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Shuji Oh-Ishi
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Kenji Hayashihara
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Takefumi Saito
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Tatsuya Chonan
- 2Department of Medicine, Nikko Memorial Hospital, Ibaraki, Japan
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Maturu VN, Rajendran P, Narahari NK. Idiopathic pleuroparenchymal fibroelastosis presenting as bilateral spontaneous pneumothorax: A case report. Lung India 2019; 36:75-77. [PMID: 30604712 PMCID: PMC6330791 DOI: 10.4103/lungindia.lungindia_248_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Narendra Kumar Narahari
- Department of Pulmonary Medicine, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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28
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Sumikawa H, Johkoh T, Iwasawa T, Nakanishi K, Tomiyama N. Pleuroparenchymal fibroelastosis-like lesions on chest computed tomography in routine clinical practice. Jpn J Radiol 2019; 37:230-236. [DOI: 10.1007/s11604-018-0805-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022]
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29
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Poorer Prognosis of Idiopathic Pleuroparenchymal Fibroelastosis Compared with Idiopathic Pulmonary Fibrosis in Advanced Stage. Can Respir J 2018; 2018:6043053. [PMID: 30186537 PMCID: PMC6110001 DOI: 10.1155/2018/6043053] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/13/2018] [Accepted: 07/14/2018] [Indexed: 12/16/2022] Open
Abstract
Objective Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare disease characterized by predominant upper lobe pulmonary fibrosis of unknown etiology. However, the prognosis of IPPFE has not been discussed. We investigated the clinical characteristics and prognostic factors of IPPFE and idiopathic pulmonary fibrosis (IPF). Methods We performed a retrospective cohort study on 375 consecutive idiopathic interstitial pneumonia patients between April 2004 and December 2014. Among them, we diagnosed IPPFE and IPF patients using high-resolution computed tomography radiological criteria. Results Twenty-nine IPPFE patients (9 males, 20 females) and 67 IPF patients (54 males, 13 females) were enrolled. IPPFE patients were significantly more likely to be females and nonsmokers and had lower body mass index, lower values of predicted percentage of forced vital capacity (%FVC), and a higher residual volume-to-total lung capacity ratio than IPF patients. Survival analysis revealed that they had significantly poorer prognosis than IPF patients in GAP (gender, age, and physiology) stages II + III. %FVC and GAP index independently predict mortality in patients with IPPFE. Conclusions Patients with IPPFE showed poorer prognosis in the advanced stage than patients with IPF. %FVC and GAP index are independent predictors of survival in patients with IPPFE.
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Kronborg-White S, Ravaglia C, Dubini A, Piciucchi S, Tomassetti S, Bendstrup E, Poletti V. Cryobiopsies are diagnostic in Pleuroparenchymal and Airway-centered Fibroelastosis. Respir Res 2018; 19:135. [PMID: 30005615 PMCID: PMC6045856 DOI: 10.1186/s12931-018-0839-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 07/02/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibroelastosis (iPPFE) is a rare lung lesion characterized by pleural and subpleural parenchymal thickening due to accumulation of fibroelastotic tissue. Only recently, a few cases with a peribronchiolar distribution of fibroelastotic tissue have been reported. These lesions are more prominent in the upper lobes. Even though high resolution computed tomography (HRCT) scan features are considered characteristic, a histological confirmation is suggested, mainly when the clinical setting is not clearly defined. However, due to non-negligible complications, a surgical lung biopsy is not often recommended. The prognosis is usually poor and currently, the only effective treatment is lung transplantation. METHOD Patients with a multidisciplinary diagnosis of iPPFE or airway-centered fibroelastosis (airway-centered FE), with histological confirmation by transbronchial cryobiopsy, were identified from an ongoing interstitial lung disease registry. Data on patient demographics, HRCT patterns, size and number of biopsies, histology patterns and complications were registered. RESULTS Seven patients were diagnosed with iPPFE and one patient was diagnosed with airway-centered FE. Pneumothorax was documented in three cases, but none of them required a chest tube. No other complications during or after the procedure were observed. CONCLUSION This study suggests that using cryobiopsies in the diagnostics of PPFE and airway-centered FE is safe and effective.
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Affiliation(s)
- Sissel Kronborg-White
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
| | - Claudia Ravaglia
- Department of the Diseases of the Thorax, Ospedale Morgagni, Forli, Italy
| | | | - Sara Piciucchi
- Department of Radiology, Ospedale Morgagni, Forli, Italy
| | - Sara Tomassetti
- Department of the Diseases of the Thorax, Ospedale Morgagni, Forli, Italy
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Venerino Poletti
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.,Department of the Diseases of the Thorax, Ospedale Morgagni, Forli, Italy
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31
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Kinoshita Y, Watanabe K, Ishii H, Kushima H, Fujita M, Nabeshima K. Significant increases in the density and number of lymphatic vessels in pleuroparenchymal fibroelastosis. Histopathology 2018; 73:417-427. [PMID: 29675827 DOI: 10.1111/his.13634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/13/2018] [Indexed: 01/08/2023]
Abstract
AIMS Some investigators have detected fibrinous exudate or immature organisation in the alveolar spaces prior to the development of subpleural elastofibrosis in patients with pleuroparenchymal fibroelastosis (PPFE). We hypothesised that PPFE progress is associated with an impaired lymphatic drainage system, resulting in the failed resolution of intra-alveolar exudate. The aim of this study is to investigate the pulmonary lymphatic vessels in PPFE, histologically. METHODS AND RESULTS We retrospectively reviewed our medical records from 1995 to 2017, and selected autopsied or surgically biopsied patients with PPFE (n = 18), pulmonary apical cap (n = 18), and IPF (n = 26). We detected lymphatic endothelial cells by using immunostained specimens, calculating the percentage of lymphatic vessel area in the non-aerated area (lymphatic vessel density) and the number of lymphatic vessels per non-aerated area (per mm2 ) (lymphatic vessel number). These parameters in PPFE were compared with those in apical cap, IPF, and normal lung tissue. The lymphatic vessel density in PPFE patients [2.97%; interquartile range (IQR) 2.61-3.86] was significantly higher than that in normal lung (0.91%; IQR 0.84-1.07), pulmonary apical cap (0.67%; IQR 0.58-0.83), and IPF (0.91%; IQR 0.68-1.25) (P < 0.01 in any comparison). The lymphatic vessel number in PPFE was also significantly higher than that in normal lung, pulmonary apical cap, and IPF. Among PPFE patients, the increase in lymphatic vessel density was found to be correlated with the characteristic physiology of PPFE, such as a flattened chest cage on computed tomography and high residual volume/total lung capacity ratio on spirometry. CONCLUSIONS Significant increase in the density and number of lymphatic vessels is a supportive characteristic that enables the differentiation of PPFE from IPF and apical cap.
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Affiliation(s)
- Yoshiaki Kinoshita
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan.,Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Kentaro Watanabe
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan.,General Medical Research Centre, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Hisako Kushima
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Masaki Fujita
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
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32
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von der Thüsen JH, Vandermeulen E, Vos R, Weynand B, Verbeken EK, Verleden SE. The histomorphological spectrum of restrictive chronic lung allograft dysfunction and implications for prognosis. Mod Pathol 2018; 31:780-790. [PMID: 29327719 DOI: 10.1038/modpathol.2017.180] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/17/2017] [Accepted: 10/17/2017] [Indexed: 12/31/2022]
Abstract
Chronic lung allograft dysfunction continues to be the main contributor to poor long-term allograft survival after lung transplantation. The restrictive phenotype of chronic lung allograft dysfunction carries a particularly poor prognosis. Little is known about the pathogenetic mechanisms involved in restrictive chronic lung allograft dysfunction. In this study, we performed histomorphological and immunohistochemical analysis of restrictive chronic lung allograft dysfunction lungs. Explant lung tissue from 21 restrictive chronic lung allograft dysfunction patients was collected and histopathologic patterns of rejection, fibrosis and vascular changes were scored after routine histochemical stains and additional immunohistochemistry for endothelial markers and C4d. In all, 75% of cases showed evidence of acute cellular rejection; lymphocytic bronchiolitis was absent in most lungs, whereas in 55% there was obliterative bronchiolitis. Almost half of the cases showed a pattern consistent with pleuroparenchymal fibro-elastosis (n=10), and a subset showed nonspecific interstitial pneumonia (n=5) or irregular emphysema (n=5). Fibrinous alveolar exudates were frequently seen in association with fibrosis (n=6), but no diffuse alveolar damage was found. Evidence of microvascular damage was present in most cases. An emphysematous pattern of fibrosis was associated with a better survival (P=0.0030), whereas fibrinous exudates were associated with a worse survival (P=0.0007). In addition to the previously described nonspecific interstitial pneumonia and pleuroparenchymal fibro-elastosis patterns in restrictive chronic lung allograft dysfunction, we are the first to describe a pattern of fibrosis-induced subpleural/paraseptal emphysema. This pattern confers a better survival, whereas fibrinous exudates are associated with a worse survival. We believe that our findings offer a pathogenetic theory for pleuroparenchymal fibro-elastosis in restrictive chronic lung allograft dysfunction, and show that restrictive chronic lung allograft dysfunction is an increasingly heterogeneous disease with presumably different mechanisms of subpattern formation.
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Affiliation(s)
| | - Elly Vandermeulen
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | | | | | - Stijn E Verleden
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
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Semple TR, Ashworth MT, Owens CM. Interstitial Lung Disease in Children Made Easier…Well, Almost. Radiographics 2018; 37:1679-1703. [PMID: 29019755 DOI: 10.1148/rg.2017170006] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Interstitial lung disease (ILD) in pediatric patients is different from that in adults, with a vast array of pathologic conditions unique to childhood, varied modes of presentation, and a different range of radiologic appearances. Although rare, childhood ILD (chILD) is associated with significant morbidity and mortality, most notably in conditions of disordered surfactant function, with respiratory failure in 100% of neonates with surfactant protein B dysfunction and 100% mortality without lung transplantation. The authors present a summary of lung development and anatomy, followed by an organized approach, using the structure and nomenclature of the 2013 update to the chILD Research Network classification system, to aid radiologic diagnosis of chILD. Index radiologic cases with contemporaneous histopathologic findings illustrate a summary of recent imaging studies covering the full spectrum of chILD. chILD is best grouped by age at presentation from infancy (diffuse developmental disorders, lung growth abnormalities, specific conditions of unknown origin, surfactant dysfunction mutations) to later childhood (disorders of the normal host, disorders related to systemic disease processes, disorders related to immunocompromise). Appreciation of the temporal division of chILD into infant and later childhood onset, along with a sound understanding of pulmonary organogenesis and surfactant homeostasis, will aid in providing useful insight into this important group of pediatric conditions. Application of secondary lobular anatomy to interpretation of thin-section computed tomographic images is pivotal to understanding patterns of ILD and will aid in selecting and narrowing a differential diagnosis. ©RSNA, 2017.
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Affiliation(s)
- Thomas R Semple
- From the Department of Imaging, Royal Brompton Hospital, Sydney Street, London, England SW3 6NP (T.R.S.); and Departments of Imaging (T.R.S., C.M.O.) and Histopathology (M.T.A.), Great Ormond Street Hospital, London, England
| | - Michael T Ashworth
- From the Department of Imaging, Royal Brompton Hospital, Sydney Street, London, England SW3 6NP (T.R.S.); and Departments of Imaging (T.R.S., C.M.O.) and Histopathology (M.T.A.), Great Ormond Street Hospital, London, England
| | - Catherine M Owens
- From the Department of Imaging, Royal Brompton Hospital, Sydney Street, London, England SW3 6NP (T.R.S.); and Departments of Imaging (T.R.S., C.M.O.) and Histopathology (M.T.A.), Great Ormond Street Hospital, London, England
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34
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Lin YY, Hsu WH, Wu MH, Chou TY. Pleuroparenchymal fibroelastosis presenting with pneumothorax. SAGE Open Med Case Rep 2018; 6:2050313X18762853. [PMID: 29552343 PMCID: PMC5846918 DOI: 10.1177/2050313x18762853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/07/2018] [Indexed: 11/15/2022] Open
Abstract
A 47-year-old woman presented with spontaneous right side pneumothorax. Image studies showed consolidations and reticular opacities involving the pleural and subpleural regions of bilateral lungs. Wedge biopsy specimens of right upper, middle and lower lobes showed fibrosis of the visceral pleura and subpleural area in all three lobes, more significant in the upper lobe. Elastic Van Gieson stain showed a pattern of alveolar septal elastosis with intra-alveolar fibrosis. The clinical presentation and pathological findings are compatible with pleuroparenchymal fibroelastosis, a rare and distinct type of interstitial lung disease. This entity is different from usual interstitial pneumonia by its relationship to pleura, upper lobe predominance and temporal homogeneity. It is different from non-specific interstitial pneumonia by its pleural involvement and scanty inflammatory cell infiltration. Pleuroparenchymal fibroelastosis is a slowly progressive disease; about half of the patients die in 10 years. No curative treatment is available at present time.
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Affiliation(s)
- Yen-Yu Lin
- Division of Molecular Pathology, Pathology and Laboratory Medicine Department, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Hu Hsu
- Division of Thoracic Surgery, Surgery Department, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Han Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Teh-Ying Chou
- Division of Molecular Pathology, Pathology and Laboratory Medicine Department, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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35
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Vanaudenaerde B, Verleden S, Neyrinck A, Verleden G, Vos R. A New Step in the Marathon of Understanding Chronic Rejection after Lung Transplantation. Am J Respir Cell Mol Biol 2018; 56:683-684. [PMID: 28569594 DOI: 10.1165/rcmb.2017-0060ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bart Vanaudenaerde
- 1 Department of Clinical and Experimental Disease Katholieke Universiteit Leuven Leuven, Belgium
| | - Stijn Verleden
- 1 Department of Clinical and Experimental Disease Katholieke Universiteit Leuven Leuven, Belgium
| | - Arne Neyrinck
- 1 Department of Clinical and Experimental Disease Katholieke Universiteit Leuven Leuven, Belgium
| | - Geert Verleden
- 1 Department of Clinical and Experimental Disease Katholieke Universiteit Leuven Leuven, Belgium
| | - Robin Vos
- 1 Department of Clinical and Experimental Disease Katholieke Universiteit Leuven Leuven, Belgium
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36
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Awano N, Izumo T, Fukuda K, Tone M, Yamada D, Takemura T, Ikushima S, Kumasaka T. Is hypothyroidism in idiopathic pleuroparenchymal fibroelastosis a novel lung-thyroid syndrome? Respir Investig 2018; 56:48-56. [PMID: 29325681 DOI: 10.1016/j.resinv.2017.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/11/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare type of interstitial pneumonia characterized by fibroelastosis. Patients with IPPFE as well as idiopathic interstitial pneumonia often have autoimmune diseases, which sometimes coincide with hypothyroidism (HypoT). However, there have been no reports on the association between IPPFE and HypoT. The purpose of this study was to evaluate the correlation between IPPFE and HypoT. We also examined the pathological features of the thyroid glands from autopsied cases. METHODS Thirteen patients diagnosed with IPPFE from among 255 consecutive cases of idiopathic interstitial pneumonia were included in this study; pertinent data were obtained from our hospital's clinical library. We examined the prevalence of HypoT and compared the clinical, radiological, and pathological features between the patients with and those without HypoT. Histological analyses of the lungs and thyroid glands were performed in 4 and 3 cases, respectively. RESULTS HypoT was identified in 7 of 13 patients (53.8%). Sex, body mass index, survival time, and laboratory test results were not significantly different between patients with and those without HypoT. Radiological and pathological lung findings were similar between both groups of patients. Thyroid gland histology demonstrated perifollicular or interlobular fibrosis without inflammation in all three cases, including a euthyroid case. CONCLUSIONS Although we only analyzed a small number of IPPFE cases, HypoT was prevalent among all of them. Characteristic fibrosis in the thyroid gland was observed even in a euthyroid case. Therefore, patients with IPPFE may potentially have thyroid gland dysfunction through a common pathogenesis in both organs.
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Affiliation(s)
- Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
| | - Kensuke Fukuda
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
| | - Mari Tone
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
| | - Daisuke Yamada
- Department of Radiology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
| | - Soichiro Ikushima
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
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Clinical diagnosis of idiopathic pleuroparenchymal fibroelastosis: A retrospective multicenter study. Respir Med 2017; 133:1-5. [PMID: 29173442 DOI: 10.1016/j.rmed.2017.11.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/11/2017] [Accepted: 11/03/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although the accurate diagnosis of pleuroparenchymal fibroelastosis (PPFE) requires pathologic evaluation, this diagnosis is often suggested when the radiologic findings are consistent with typical PPFE and when pulmonary apical cap, which radiologically and pathologically mimics PPFE, can be excluded by confirming disease progression. The aim of this study was to evaluate the validity of the clinical diagnosis of idiopathic PPFE. METHODS We recruited 44 patients with idiopathic PPFE according to our modified diagnostic criteria: 1) a radiologic PPFE pattern (i.e., bilateral subpleural dense consolidation with or without pleural thickening in the upper lobes and less marked or absent involvement of the lower lobes), 2) radiologic confirmation of disease progression, and 3) exclusion of other lung diseases with identifiable etiologies. The patients' baseline characteristics and clinical course were reviewed. RESULTS The median age was 70 years, and 28 patients were males. The majority revealed emaciation, hypercapnia, and a high ratio of residual volume to total lung capacity. On chest computed tomography, 39 patients showed abnormal shadows in the lower lobes; more than half were classified as having usual interstitial pneumonia (UIP)/possible UIP pattern. Pneumothorax was the most frequent complication (33/44). The median overall survival time after diagnosis was 35.3 months. The presence of lower lobe UIP/possible UIP pattern did not show a significant prognostic impact. CONCLUSIONS Using our diagnostic criteria, we could recruit relatively many patients with similar characteristics to those of idiopathic PPFE patients in the literature. The possibility of clinical diagnosis of idiopathic PPFE should be further discussed.
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Cha YJ, Han J, Chung MP, Kim TJ, Shin S. Pleuroparenchymal fibroelastosis in heterogeneous clinical conditions: Clinicopathologic analysis of 7 cases. CLINICAL RESPIRATORY JOURNAL 2017; 12:1495-1502. [DOI: 10.1111/crj.12696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 08/14/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Yoon Jin Cha
- Department of PathologyGangnam Severance Hospital, Yonsei University College of MedicineSeoul Korea
| | - Joungho Han
- Department of PathologySamsung Medical Center, Sungkyunkwan University School of MedicineSeoul Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care MedicineSamsung Medical Center, Sungkyunkwan University School of MedicineSeoul Korea
| | - Tae Jung Kim
- Department of RadiologySamsung Medical Center, Sungkyunkwan University School of MedicineSeoul Korea
| | - Sumin Shin
- Department of Thoracic SurgerySamsung Medical Center, Sungkyunkwan University School of MedicineSeoul Korea
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Mariani F, Gatti B, Rocca A, Bonifazi F, Cavazza A, Fanti S, Tomassetti S, Piciucchi S, Poletti V, Zompatori M. Pleuroparenchymal fibroelastosis: the prevalence of secondary forms in hematopoietic stem cell and lung transplantation recipients. Diagn Interv Radiol 2017; 22:400-6. [PMID: 27460284 DOI: 10.5152/dir.2016.15516] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Pleuroparenchymal fibroelastosis (PPFE) is a rare form of interstitial pneumonia, characterized by elastotic fibrosis involving the pleura and subpleural parenchyma, predominantly in the upper lobes. PPFE can be either idiopathic or secondary and mostly occurs as a late complication of lung or hematopoietic stem cell transplantation (HSCT). The aim of this study was to evaluate the prevalence of secondary forms in transplant recipients. METHODS An expert thoracic radiologist retrospectively reviewed high-resolution computed tomography exams of 700 HSCT recipients and 53 lung transplant recipients from the database of the Radiology Department of S. Orsola-Malpighi Hospital dating back from 2007. For each case that radiologically fulfilled PPFE criteria, the following details were retrieved: clinical characteristics, laboratory and functional data, pathologic findings (obtained from one patient) and metabolic data (obtained from three patients). RESULTS Six cases clinically and radiologically consistent with PPFE were identified: two HSCT recipients (0.28%) and four lung transplant recipients (7.54%). CONCLUSION In this study, PPFE was strongly associated with lung transplants as a late complication, with a prevalence of 7.54%.
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Affiliation(s)
- Francesca Mariani
- Department of Radiology, S. Orsola-Malpighi Hospital, Bologna, Italy.
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Huang H, Feng R, Li S, Wu B, Xu K, Xu Z, Chen J. A CARE-compliant case report: Lung transplantation for a Chinese young man with idiopathic pleuroparenchymal fibroelastosis. Medicine (Baltimore) 2017; 96:e6900. [PMID: 28489801 PMCID: PMC5428635 DOI: 10.1097/md.0000000000006900] [Citation(s) in RCA: 9] [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] [Indexed: 01/30/2023] Open
Abstract
RATIONAL Pleuroparenchymal fibroelastosis (PPFE) is a rare interstitial lung disease that is characterized radiologically by apical pleural thickening and histologically by elastic fibrosis of the visceral pleura. Although PPFE cases have been reported occasionally since this disease was initially described, most such cases have involved secondary PPFE. Idiopathic PPFE (iPPFE) cases have been less thoroughly studied. There are no effective medications for patients with iPPFE. PATIENT CONCERNS A 34-year-old man with no asbestos or cigarette exposure was admitted to our ward due to worsening cough and exertional dyspnea for 10 years. He had a "flattened thoracic cage" and bibasilar inspiratory crackles without finger clubbing. A series of chest computed tomography scans during the preceding 10 years revealed the presence of gradual, exaggerated, upper lung-predominant, diffuse pleural thickening and dense subpleural opacification with traction bronchiectasis. DIAGNOSIS He was performed with video-assisted thoracic surgical (VATS) lung biopsy. The pulmonary histopathologic examination showed thickened visceral pleura and prominent subpleural fibroelastosis, confirming the diagnosis of iPPFE. INTERVENTION After the failure of treatment with prednisone plus cyclophosphamide and sequential pirfenidone administration, he was arranged with bilateral lung transplantation two years later. OUTCOMES The patient did not require supplemental oxygenation anymore after he recovered from lung transplantation. LESSONS Bilateral lung transplantation might be tried for the end-stage iPPFE cases.
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Affiliation(s)
| | - Ruie Feng
- Pathological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing
| | - Shan Li
- Department of Respiratory Medicine
| | - Bo Wu
- Department of Cardiothoracic Surgery, Lung transplant Group, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiang Su
| | - Kai Xu
- Radiological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | | | - Jingyu Chen
- Department of Cardiothoracic Surgery, Lung transplant Group, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiang Su
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41
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Abstract
Described in Japan by Amitani et al in 1992, the entity of idiopathic upper lobe fibrosis was subsequently given the name pleuroparenchymal fibroelastosis (PPFE) in the English-speaking world. Pleuroparenchymal fibroelastosis is believed to be a rare disease characterized by a fibrosing process affecting the pleura and the subpleural lung parenchyma, with a predilection for the upper lobes. Uniquely, the fibrosing process is elastotic in nature, being associated with intra-alveolar fibrosis. The etiology of PPFE is unclear at this juncture, with many cases being considered as idiopathic forms of the disease. Conditions associated with PPFE include infections, bone marrow transplantation, and autoimmunity. In this review, we explore the clinical, radiologic, and pathologic features associated with PPFE in light of current understanding of the disease. Recent studies implicated that PPFE may not be as uncommon as claimed. The various differential diagnoses and implications of diagnosing PPFE are discussed.
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Affiliation(s)
| | - Khoon Leong Chuah
- From the Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
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42
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Abstract
Purpose of the review Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare fibrosing lung disease, affecting the visceral pleura and the subpleural parenchyma with an upper lobe predilection, included as a distinct clinicopathologic entity in the latest international multidisciplinary classification of the idiopathic interstitial pneumonias (IIP). We aim to summarize the current evidence on IPPFE, in terms of clinical features and potential treatments. Recent findings Overall, there is increasing awareness of PPFE in association with a separate ILD pattern. Although an agreed consensus on diagnosis has yet to be defined, a list of radiological and histopathological criteria has been proposed. Due to the unfavorable risk-benefit profile of surgical lung biopsy in a significant proportion of patients, a potential role for transbronchial lung cryobiopsy has been suggested. At present, lung transplantation remains the only curative option. Summary The increasing awareness of this condition among specialists has led to more frequent identification of IPPFE. Large international studies are needed to better characterize pathogenesis and pheno/endotypes of disease, a key step towards the development of effective treatments.
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Affiliation(s)
- Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.,Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - M Angeles Montero
- Department of Histopathology, Imperial College, London Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, UK
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
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43
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Oliveira RC, Nogueira T, Carvalho L. Idiopathic pleuroparenchymal fibroelastosis with suggestive biopsy of pulmonary carcinoma - Case report. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 23:111-113. [PMID: 28034563 DOI: 10.1016/j.rppnen.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/05/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- R C Oliveira
- Pathology Department, Coimbra University Hospital, Portugal.
| | - T Nogueira
- Thoracic Surgery Department, Coimbra University Hospital, Portugal
| | - L Carvalho
- Pathology Department, Coimbra University Hospital, Portugal
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44
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Greer M, Riise GC, Hansson L, Perch M, Hämmäinen P, Roux A, Hirschi S, Lhuillier E, Reynaud-Gaubert M, Philit F, Claustre J, Stern M, Gottlieb J, Holm AM. Dichotomy in pulmonary graft-versus-host disease evident among allogeneic stem-cell transplant recipients undergoing lung transplantation. Eur Respir J 2016; 48:1807-1810. [DOI: 10.1183/13993003.01121-2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 08/04/2016] [Indexed: 11/05/2022]
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45
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Chronic Cough and Bilateral Pneumothoraces in a Nonsmoker. Chest 2016; 149:e49-e55. [PMID: 26867855 DOI: 10.1016/j.chest.2015.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/05/2015] [Accepted: 10/08/2015] [Indexed: 11/20/2022] Open
Abstract
An 82-year-old Japanese nonsmoking man presented with persistent dry cough and small left apical pneumothorax. High resolution CT scan of the chest demonstrated bilateral upper lobe pleuroparenchymal thickening and architectural distortion. Serial imaging revealed mild progression and development of small bilateral pneumothoraces, and pneumomediastinum. A surgical lung biopsy was required to confirm the diagnosis.
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46
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Thangakunam B, Isaac BTJ, Christopher DJ, Burad D. Idiopathic pleuroparenchymal fibroelastosis - A rare idiopathic interstitial pneumonia. Respir Med Case Rep 2016; 17:8-11. [PMID: 27141432 PMCID: PMC4821335 DOI: 10.1016/j.rmcr.2015.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 11/13/2022] Open
Abstract
Idiopathic pleuroparenchymal fibroelastosis is a rare idiopathic interstitial pneumonia. It was first described in 2004 and subsequently included in the ATS/ERS classification of idiopathic interstitial pneumonia in 2013. There have been few cases reported so far. The diagnostic criteria is still emerging and its etiology is being questioned. We report a case of pleuroparenchymal fibroelastosis probably idiopathic, the first of its kind to be reported from India, and a brief review of the literature.
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Affiliation(s)
| | - Barney T J Isaac
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | | | - Deepak Burad
- Department of General Pathology, Christian Medical College, Vellore, India
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47
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Williams K, Roman J. Studying human respiratory disease in animals--role of induced and naturally occurring models. J Pathol 2016; 238:220-32. [PMID: 26467890 DOI: 10.1002/path.4658] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 01/12/2023]
Abstract
Respiratory disorders like asthma, emphysema, and pulmonary fibrosis affect millions of Americans and many more worldwide. Despite advancements in medical research that have led to improved understanding of the pathophysiology of these conditions and sometimes to new therapeutic interventions, these disorders are for the most part chronic and progressive; current interventions are not curative and do not halt disease progression. A major obstacle to further advancements relates to the absence of animal models that exactly resemble the human condition, which delays the elucidation of relevant mechanisms of action, the unveiling of biomarkers of disease progression, and identification of new targets for intervention in patients. There are currently many induced animal models of human respiratory disease available for study, and even though they mimic features of human disease, discoveries in these models have not always translated into safe and effective treatments in humans. A major obstacle relates to the genetic, anatomical, and functional variations amongst species, which represents the major challenge to overcome when searching for appropriate models of respiratory disease. Nevertheless, rodents, in particular mice, have become the most common species used for experimentation, due to their relatively low cost, size, and adequate understanding of murine genetics, among other advantages. Less well known is the fact that domestic animals also suffer from respiratory illnesses similar to those found in humans. Asthma, bronchitis, pneumonia, and pulmonary fibrosis are among the many disorders occurring naturally in dogs, cats, and horses, among other species. These models might better resemble the human condition and are emphasized here, but further investigations are needed to determine their relevance.
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Affiliation(s)
- Kurt Williams
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Jesse Roman
- Departments of Medicine and Pharmacology & Toxicology, Division of Pulmonary, Critical Care & Sleep Medicine, University of Louisville Health Sciences Center and Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
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48
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Hurtado EJS, González MLA, Soto MDME, Rueda FJC, Nadal FJP, Cantero AR. Idiopathic pleuroparenchymal fibroelastosis, a new idiopathic interstitial pneumonia: A case report. Chron Respir Dis 2016; 13:312-6. [PMID: 26810762 DOI: 10.1177/1479972316628529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare disease, idiopathic in most of the cases described in the literature. We report the case of a 55-year-old patient, non-smoker with tuberculosis treated in his youth, starting with progressive dyspnoea and cough, with radiographic abnormalities consisting of pleural thickening, bronchiectasis and structural distortion predominantly in the upper lobes. Due to functional impairment and persistent radiographic abnormalities, biopsy by video-assisted thoracoscopic surgical was decided. The presence of striking elastosis, absence of interstitial damage and abrupt boundary of the fibrous lesion with healthy lung allowed the diagnosis of IPPFE. Currently, the patient has no specific treatment and is in follow-up in the Transplant Unit.
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49
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Kokosi MA, Nicholson AG, Hansell DM, Wells AU. Rare idiopathic interstitial pneumonias: LIP and PPFE and rare histologic patterns of interstitial pneumonias: AFOP and BPIP. Respirology 2015; 21:600-14. [DOI: 10.1111/resp.12693] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/22/2015] [Accepted: 10/24/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Maria A. Kokosi
- Interstitial Lung Disease Unit; Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - Andrew G. Nicholson
- Department of Histopathology; Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust; London UK
- National Heart and Lung Institute; Imperial College; London UK
| | - David M. Hansell
- Department of Radiology; Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust; London UK
- National Heart and Lung Institute; Imperial College; London UK
| | - Athol U. Wells
- Interstitial Lung Disease Unit; Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust; London UK
- National Heart and Lung Institute; Imperial College; London UK
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50
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The radiology of diffuse interstitial pulmonary disease in children: pearls, pitfalls and new kids on the block in 2015. Radiol Med 2015; 121:352-61. [PMID: 26589422 DOI: 10.1007/s11547-015-0599-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/27/2015] [Indexed: 12/29/2022]
Abstract
Diffuse interstitial lung disease in children differs markedly from interstitial lung disease in adults and is a distinct entity. The childhood interstitial lung disease (ChILD) classification, devised in 2010 separates conditions into those occurring in infancy, and those not specific to infants, the later group containing many conditions related to systemic diseases (including connective tissue diseases and depositional/storage disorders), and conditions occurring in immunocompromised children. In this article, we briefly review normal lung growth and development. We discuss our preferred technique for imaging the lungs with computed tomography in children, and review the recent literature regarding the radiological appearance of various ChILD. We illustrate this with cases from our institution and emphasize the more recently recognised conditions including pleuroparenchymal fibroelastosis and filamin A deficiency-related lung disease.
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