Cellulose Granulomatosis Presenting as Centrilobular Nodules

Bendeck, Sandra E.; Leung, Ann N.; Berry, Gerald J.; Daniel, Dawn; Ruoss, Stephen J.

doi:10.2214/ajr.177.5.1771151

Cited by 36 publications

(38 citation statements)

References 6 publications

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“…When medications are injected [228], the insoluble particles, such as microcrystalline cellulose and talcum, become trapped in the pulmonary arterioles causing both thrombosis and inflammation. Over time, these particles can penetrate the arteriolar wall and provoke a giant cell granulomatous reaction.…”

Section: Particulate Materials Incidencementioning

confidence: 99%

“…Clinical symptoms associated with cellulose granulomatosis are also largely dependent on the extent of arteriolar involvement. Symptoms may range from none to exertional dyspnoea to sudden death [228]. Two out of 47 children undergoing therapeutic embolisation of cerebral arteriovenous malformation developed severe respiratory distress that required endotracheal intubation [222].…”

Section: Clinical Signsmentioning

confidence: 99%

“…BAL typically reveals lymphocytosis with a predominance of CD8 lymphocytes, and talcum crystals can occasionally be seen [238]. Cellulose granulomatosis has also been described as a cause of the tree-in-bud appearance on high-resolution CT: micronodules distributed at the termination of bronchovascular bundles [160,228]. These micronodules represent intra-arteriolar accumulation of microcrystalline cellulose with adjacent granulomatous reaction.…”

Section: Diagnosismentioning

confidence: 99%

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Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

161

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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Section: Particulate Materials Incidencementioning

confidence: 99%

Section: Clinical Signsmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

161

127

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“…In individuals with talc granulomatosis, the intravascular foreign material and the associated granulomatous reaction in vessel walls cause tree-in-bud appearance (74). Materials responsible for this disorder are insoluble particles such as microcrystalline cellulose, talc, and corn starch, which are used as fillers in tablets taken orally.…”

Section: Talc Embolismmentioning

confidence: 99%

Thrombotic and Nonthrombotic Pulmonary Arterial Embolism: Spectrum of Imaging Findings

Han

Lee

Franquet³

et al. 2003

RadioGraphics

201

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Along with clinical examination and laboratory tests, imaging plays a key role in the diagnosis of pulmonary embolism. Multi-detector row helical computed tomography (CT) is particularly helpful in the diagnosis of acute pulmonary thromboembolism (PTE) owing to its capacity to directly show emboli as intravascular filling defects. Although parenchymal abnormalities at CT are nonspecific for acute PTE, they may contribute to a correct diagnosis of chronic PTE, the characteristic helical CT features of which are similar to its angiographic features and include webs or bands, intimal irregularities, abrupt narrowing or complete obstruction of the pulmonary arteries, and "pouching defect." Nonthrombotic pulmonary embolism is an uncommon condition but is sometimes associated with specific imaging findings, including discrete nodules with cavitation (septic embolism), widespread homogeneous and heterogeneous areas of increased opacity or attenuation that typically appear 12-24 hours after trauma (fat embolism), and fine miliary nodules that subsequently coalesce into large areas of increased opacity or attenuation (talcosis). Knowledge of appropriate imaging methods and familiarity with the specific imaging features of pulmonary embolism should facilitate prompt, effective diagnosis.

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“…Multiple episodes of injection may elicit intractable pulmonary hypertension and death. [5][6][7] Although clinical information (e.g., unexplained pulmonary hypertension in a patient with suspicion of drug abuse) 8,11,12 and radiographic findings (e.g., micronodular infiltrates detected by computed tomography) 1,13 can provide clues to the presence of pulmonary vascular deposits of microcrystalline cellulose, such stigmata are fairly nonspecific and often signal the presence of extensive, irreversible changes associated with repeated injections. Definitive diagnosis requires histologic examination of pulmonary tissue samples and often is made at autopsy.…”

mentioning

confidence: 99%