The diagnosis of idiopathic interstitial pneumonias (IIPs) involves a
multidisciplinary scenario in which the radiologist assumes a key role. The
latest (2013) update of the IIP classification by the American Thoracic
Society/European Respiratory Society proposed some important changes to the
original classification of 2002. The novelties include the addition of a new
disease (idiopathic pleuroparenchymal fibroelastosis) and the subdivision of the
IIPs into four main groups: chronic fibrosing IIPs (idiopathic pulmonary
fibrosis and nonspecific interstitial pneumonia); smoking-related IIPs
(desquamative interstitial pneumonia and respiratory bronchiolitis-associated
interstitial lung disease); acute or subacute IIPs (cryptogenic organizing
pneumonia and acute interstitial pneumonia); rare IIPs (lymphoid interstitial
pneumonia and idiopathic pleuroparenchymal fibroelastosis); and the so-called
“unclassifiable” IIPs. In this study, we review the main clinical, tomographic,
and pathological characteristics of each IIP.
There is significant variability on pleural space volume. However, pleural volume remains unchanged in many cases. Besides that, more than half patients with initial large space coursed with relevant reduction. Finally, patients with initial small space presented a greater chance of clinical success.
Objective:To evaluate the role of intrapleural positioning of a pleural catheter in early lung expansion and pleurodesis success in patients with recurrent malignant pleural effusion (RMPE). Methods:This was a retrospective study nested into a larger prospective cohort study including patients with RMPE recruited from a tertiary university teaching hospital between June of 2009 and September of 2014. The patients underwent pleural catheter insertion followed by bedside pleurodesis. Chest CT scans were performed twice: immediately before pleurodesis (iCT) and 30 days after pleurodesis (CT30). Catheter positioning was categorized based on iCT scans as posterolateral, anterior, fissural, and subpulmonary. We used the pleural volume on iCT scans to estimate early lung expansion and the difference between the pleural volumes on CT30 and iCT scans to evaluate radiological success of pleurodesis. Clinical pleurodesis success was defined as no need for any other pleural procedure. Results:Of the 131 eligible patients from the original study, 85 were included in this nested study (64 women; mean age: 60.74 years). Catheter tip positioning was subpulmonary in 35 patients (41%), anterior in 23 (27%), posterolateral in 17 (20%), and fissural in 10 (12%). No significant differences were found among the groups regarding early lung expansion (median residual pleural cavity = 377 mL; interquartile range: 171-722 mL; p = 0.645), radiological success of pleurodesis (median volume = 33 mL; interquartile range: −225 to 257 mL; p = 0.923), and clinical success of pleurodesis (85.8%; p = 0.676). Conclusions:Our results suggest that the position of the tip of the pleural catheter influences neither early lung expansion nor bedside pleurodesis success in patients with RMPE.
Shrinking lung refers to a rare complication of systemic lupus erythematosus and is characterized by unexplained dyspnea, a restrictive pattern in lung function tests, and elevation of the diaphragmatic hemicuples. It is postulated to have a predilection for female involvement and occurs mainly during late stages of the disease. Chest X-rays usually show small, diaphragmatic lungs. Occasional basal atelectasis may be present. Chest tomography usually shows reduced lung volumes with diaphragmatic elevation, occasional basal atelectasis, without severe pulmonary or pleuropulmonary disease. Shrinking lung can cause significant morbidity and occasional mortality. There is no definitive therapy, while corticosteroids may decrease symptoms and improve lung function in some patients. The objective of this study was to describe the main imaging findings in Shrinking Lung, an important pulmonary alteration in lupus patients. We highlight the characteristics observed on radiography and computed tomography, with an emphasis on computed tomography. It is important that every radiologist is prepared to recognize these findings and understand the possible clinical repercussions.
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