scholarly journals Clinico-pathologic presentation of hypersensitivity pneumonitis in Egyptian patients: a multidisciplinary study

2017 ◽  
Vol 12 ◽  
Author(s):  
Dalia Abd El-Kareem ◽  
Yosri M. Akl ◽  
Gina A. Nakhla ◽  
Ali A. Elhindawi ◽  
Mahmoud A. Eltorky
Keyword(s):  
Hypersensitivity Pneumonitis ◽  
Ground Glass Opacity ◽  
Giant Cells ◽  
Cane Sugar ◽  
High Resolution Computed Tomography ◽  
Multidisciplinary Study ◽  
Diffuse Parenchymal Lung Disease ◽  
Egyptian Patients ◽  
Exhaust Fumes ◽  
Exposure History

Background: Hypersensitivity pneumonitis (HP) is a common diffuse parenchymal lung disease in Egypt which can be difficult to recognize due to the dynamic symptoms & associated environmental factors. Methods: Forty-three Egyptian patients were enrolled in this study, presenting with dyspnea and cough, predominant ground-glass opacity (GGO) in high-resolution computed tomography (HRCT) where lung biopsy was needed to establish the diagnosis. Results: The age range was 15 to 60 years. Females represented 90.7% (39 patients) while 9.3% (4 patients) of our patients were males. History of contact with birds was detected in 9 (20.9%) patients. Most of our patients (60.5%) didn’t have exposure history, and only 8 patients (18.6%) were living in geographic areas in Egypt that are known for the exposure to environmental etiologic factors (cane sugar exhaust fumes). The most common HRCT pattern was GGO with mosaic parenchyma in 18 patients (41.86%), followed by GGO with centrilobular nodules in 9 patients (20.93%), then isolated diffuse GGO in 5 patients (11.62%), GGO with traction bronchiectasis in 4 patients (9.3%), GGO with consolidation in 3 patients (6.97%), GGO with reticulations in 2 patients (4.65%), and GGO with cysts in 2 patients (4.65%). The most common histologic finding was isolated multinucleated giant cells in 38 patients (88.3%) commonly found in airspaces (24 patients) and less commonly in the interstitium (14 patients), followed by interstitial pneumonia and cellular bronchiolitis in 36 patients (83.7% each), interstitial ill-formed non-necrotizing granulomas in 12 patients (27.9%), fibrosis in 10 patients (23.2%), and organizing pneumonia pattern in 4 patients (9.3%). Conclusion: The diagnosis of HP presenting with predominant GGO pattern in HRCT requires a close interaction among clinicians, radiologists, and pathologists. Some environmental and household factors may be underestimated as etiologic factors. Further environmental and genetic studies are needed especially in patients with negative exposure history.

scholarly journals Using PaCO2 values to grade obesity-hypoventilation syndrome severity: a retrospective study

2017 ◽  
Vol 12 ◽  
Author(s):  
Mario Francesco Damiani ◽  
Vito Antonio Falcone ◽  
Pierluigi Carratù ◽  
Cristina Scoditti ◽  
Elioda Bega ◽  
...  
Keyword(s):  
Ground Glass Opacity ◽  
Giant Cells ◽  
Cane Sugar ◽  
High Resolution Computed Tomography ◽  
Diffuse Parenchymal Lung Disease ◽  
Exhaust Fumes ◽  
History Of ◽  
Exposure History ◽  
Hypoventilation Syndrome ◽  
Age Range

Background Hypersensitivity pneumonitis (HP) is a common diffuse parenchymal lung disease in Egypt which can be difficult to recognize due to the dynamic symptoms & associated environmental factors. Methods Forty-three Egyptian patients were enrolled in this study, presenting with dyspnea and cough, predominant ground-glass opacity (GGO) in high-resolution computed tomography (HRCT) where lung biopsy was needed to establish the diagnosis. Results The age range was 15 to 60 years. Females represented 90.7% (39 patients) while 9.3% (4 patients) of our patients were males. History of contact with birds was detected in 9 (20.9%) patients. Most of our patients (60.5%) didn’t have exposure history, and only 8 patients (18.6%) were living in geographic areas in Egypt that are known for the exposure to environmental etiologic factors (cane sugar exhaust fumes). The most common HRCT pattern was GGO with mosaic parenchyma in 18 patients (41.86%), followed by GGO with centrilobular nodules in 9 patients (20.93%), then isolated diffuse GGO in 5 patients (11.62%), GGO with traction bronchiectasis in 4 patients (9.3%), GGO with consolidation in 3 patients (6.97%), GGO with reticulations in 2 patients (4.65%), and GGO with cysts in 2 patients (4.65%). The most common histologic finding was isolated multinucleated giant cells in 38 patients (88.3%) commonly found in airspaces (24 patients) and less commonly in the interstitium (14 patients), followed by interstitial pneumonia and cellular bronchiolitis in 36 patients (83.7% each), interstitial ill-formed non-necrotizing granulomas in 12 patients (27.9%), fibrosis in 10 patients (23.2%), and organizing pneumonia pattern in 4 patients (9.3%). Conclusion. The diagnosis of HP presenting with predominant GGO pattern in HRCT requires a close interaction among clinicians, radiologists, and pathologists. Some environmental and household factors may be underestimated as etiologic factors. Further environmental and genetic studies are needed especially in patients with negative exposure history.

scholarly journals Hypersensitivity Pneumonitis High-resolution Computed Tomography Findings, and Their Correlation with the Etiology and the Disease Duration

2020 ◽  
Vol 121 (3) ◽  
pp. 133-141
Author(s):  
Farzaneh Shobeirian ◽  
Payam Mehrian ◽  
Abtin Doroudinia
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Hypersensitivity Pneumonitis ◽  
Care Center ◽  
Tertiary Care ◽  
Ground Glass Opacity ◽  
Final Diagnosis ◽  
Ground Glass ◽  
High Resolution Computed Tomography ◽  
Diffuse Parenchymal Lung Disease

Hypersensitivity pneumonitis (HP) is an immune-mediated diffuse parenchymal lung disease induced by inhaled antigens. High-resolution computed tomography (HRCT) is widely used in the diagnosis and follow-up of patients and determining the progression and prognosis of the disease. In this retrospective study, 45 consecutive patients with the final diagnosis of HP, seen at a large tertiary care center during a period of 4 years, were included and their HRCT findings were evaluated. The most common HRCT findings were ground glass opacity and reticulation. Some HRCT patterns were detected more severely in bird fanciers in comparison with other etiologies. There is no “gold standard” for the diagnosis of HP. HRCT findings play an important role in hypersensitivity pneumonitis diagnosis and CT scan also help to define the severity of hypersensitivity pneumonitis injuries. In our study, reticulation and ground glass opacity were the most common findings in HRCT of patients with HP. We also find that patients with avian contacts had a significantly higher rate of fibrosis.

scholarly journals High-resolution computed tomography and histopathological findings in hypersensitivity pneumonitis: a pictorial essay

2016 ◽  
Vol 49 (2) ◽  
pp. 112-116 ◽  
Author(s):  
Pedro Paulo Teixeira e Silva Torres ◽  
Marise Amaral Rebouças Moreira ◽  
Daniela Graner Schuwartz Tannus Silva ◽  
Roberta Rodrigues Monteiro da Gama ◽  
Denis Masashi Sugita ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Lung Biopsy ◽  
Hypersensitivity Pneumonitis ◽  
Giant Cells ◽  
Clinical Findings ◽  
High Resolution Computed Tomography ◽  
Histopathological Findings ◽  
Pictorial Essay ◽  
Inflammatory Infiltrates

Abstract Hypersensitivity pneumonitis is a diffuse interstitial and granulomatous lung disease caused by the inhalation of any one of a number of antigens. The objective of this study was to illustrate the spectrum of abnormalities in high-resolution computed tomography and histopathological findings related to hypersensitivity pneumonitis. We retrospectively evaluated patients who had been diagnosed with hypersensitivity pneumonitis (on the basis of clinical-radiological or clinical-radiological-pathological correlations) and had undergone lung biopsy. Hypersensitivity pneumonitis is clinically divided into acute, subacute, and chronic forms; high-resolution computed tomography findings correlate with the time of exposure; and the two occasionally overlap. In the subacute form, centrilobular micronodules, ground-glass opacities, and air trapping are characteristic high-resolution computed tomography findings, whereas histopathology shows lymphocytic inflammatory infiltrates, bronchiolitis, variable degrees of organizing pneumonia, and giant cells. In the chronic form, high-resolution computed tomography shows traction bronchiectasis, honeycombing, and lung fibrosis, the last also being seen in the biopsy sample. A definitive diagnosis of hypersensitivity pneumonitis can be made only through a multidisciplinary approach, by correlating clinical findings, exposure history, high-resolution computed tomography findings, and lung biopsy findings.

scholarly journals Clinico- pathologic presentation of hypersensitivity pneumonitis in Egyptian patients: a multidisciplinary study

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Dalia Abd El-Kareem ◽  
Yosri M. Akl ◽  
Gina A. Nakhla ◽  
Ali A. Elhindawi ◽  
Mahmoud A. Eltorky
Keyword(s):  
Hypersensitivity Pneumonitis ◽  
Multidisciplinary Study ◽  
Egyptian Patients

scholarly journals The New Useful High-Resolution Computed Tomography Finding for Diagnosing Fibrotic Hypersensitivity Pneumonitis: “Hexagonal Pattern”: A Single-Center Retrospective Study

2021 ◽  
Author(s):  
Hiroko Okabayashi ◽  
Taiki Fukuda ◽  
Tae Iwasawa ◽  
Tsuneyuki Oda ◽  
Hideya Kitamura ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Hypersensitivity Pneumonitis ◽  
Ground Glass Opacity ◽  
High Resolution Computed Tomography ◽  
Air Trapping ◽  
Hexagonal Pattern ◽  
Significant Difference ◽  
Tomography Finding ◽  
Density Pattern

Abstract Background Centrilobular nodules, ground-glass opacity (GGO), mosaic attenuation, air trapping, and three-density pattern were reported as high-resolution computed tomography (HRCT) findings characteristic of fibrotic hypersensitivity pneumonitis (HP). However, it is often difficult to differentiate fibrotic HP from idiopathic pulmonary fibrosis (IPF). In fibrotic HP, the HRCT sometimes shows tortoiseshell-like interlobular septal thickening that extends from the subpleural lesion to the inner layers. This finding is called “hexagonal pattern,” and this study is focused on the possibility that such finding is useful for differentiating fibrotic HP from IPF. Methods This study included patients with multidisciplinary discussion (MDD) diagnosis of fibrotic HP or IPF undergoing surgical lung biopsy between January 2015 and December 2017 in Kanagawa Cardiovascular and Respiratory Center. Two radiologists have evaluated the HRCT findings without clinical and pathological information. Results A total of 23 patients were diagnosed with fibrotic HP by MDD and 48 with IPF. Extensive GGO, centrilobular nodules, and hexagonal pattern were more frequent findings in fibrotic HP than in IPF. No significant difference was observed between the two groups in the presence or absence of mosaic attenuation, air trapping, or three-density pattern. In the multivariate logistic regression, the presence of extensive GGO and hexagonal pattern was associated with increased odds ratio of fibrotic HP. The sensitivity and specificity of the diagnosis of fibrotic HP in the presence of the hexagonal pattern were 69.6% and 87.5%, respectively. Conclusion Hexagonal pattern is a useful finding for differentiating fibrotic HP from IPF.

scholarly journals Clinical, radiologic, and morphological diagnosis of hypersensitivity pneumonitis

2022 ◽  
Vol 20 (4) ◽  
pp. 93-102
Author(s):  
A. L. Cherniaev ◽  
E. V. Kusraeva ◽  
M. V. Samsonova ◽  
S. N. Avdeev ◽  
N. V. Trushenko ◽  
...  
Keyword(s):  
Hypersensitivity Pneumonitis ◽  
Clinical Symptoms ◽  
Usual Interstitial Pneumonia ◽  
Giant Cells ◽  
External Respiration ◽  
High Resolution Computed Tomography ◽  
Morphological Diagnosis ◽  
Classical Triad ◽  
Clinical Error ◽  
The Relationship

Aim. To study the relationship between clinical, radiologic, and morphological features in nonfibrotic and fibrotic hypersensitivity pneumonitis.Materials and methods. Clinical symptoms, data of high-resolution computed tomography, parameters of external respiration, and histological changes in the lung tissue obtained via open and transbronchial biopsies were studied retrospectively in 175 patients with hypersensitivity pneumonitis (HP). Statistical analysis was performed using the Statistica software.Results. We found that the clinical error rate in the diagnosis of HP was 84.5%, among pathologists – 92%. Among all the variants of HP, the most common was fibrotic HP. It was shown that non-necrotizing granulomas and giant cells in the cavities of the alveoli, microcells, and interalveolar septa were more typical of nonfibrotic HP. In fibrotic HP, peribronchial fibrosis, smooth muscle metaplasia in fibrotic areas, and the presence of fibroblastic foci in the walls of terminal bronchioles are signs of differential diagnosis with usual interstitial pneumonia. The classical triad of histological signs was observed in 19.2% of patients with nonfibrotic HP and in 5.6% of patients with fibrotic HP.Conclusion. Diagnosis of HP is complex and should be based on a multidisciplinary approach involving clinicians (pulmonologists), radiologists, functional diagnostics specialists, and pathologists. In this case, it is imperative to take into account and identify factors causing development of the disease, as well as the age of patients. 

scholarly journals Hypersensitivity pneumonitis complicated by acute respiratory viral infection

2020 ◽  
Vol 9 (3) ◽  
pp. 68-73
Author(s):  
A.S. Kontorshchikov ◽  
A.L. Chernyaev ◽  
O.A. Vasyukova ◽  
Zh.R. Omarova
Keyword(s):  
Viral Infection ◽  
Hypersensitivity Pneumonitis ◽  
Interstitial Fibrosis ◽  
Clinical Manifestations ◽  
Giant Cells ◽  
Lung Damage ◽  
Allergic Alveolitis ◽  
Multinucleated Cells ◽  
Lung Scan ◽  
Exogenous Allergic Alveolitis

The article presents a clinical case of hypersensitivity pneumonitis complicated by a viral infection in a 72-year-old woman. The introductory part provides a concise literature review on the etiology, classification, frequency, and possible complications of hypersensitivity pneumonitis. The patient’s computed tomography (CT) lung scan showed bilateral interstitial lesions. The patient was diagnosed with idiopathic pulmonary fibrosis based on the clinical manifestations and radiological findings. The autopsy revealed morphological signs of hypersensitivity pneumonitis (obliterative bronchiolitis, moderate interstitial fibrosis with honey-combing, nonspecific interstitial pneumonia, giant multinucleated cells) and viral lung damage (exudative stage of acute respiratory distress syndrome with interalveolar edema, hyaline membranes lining the alveoli, pneumocyte desquamation, and ugly giant cells). Keywords: hypersensitivity pneumonitis, exogenous allergic alveolitis, viral infection, lungs

scholarly journals Hypersensitivity pneumonitis – acceptance of the diagnosis

Pneumologia ◽  
2021 ◽  
Vol 69 (3) ◽  
pp. 186-189
Author(s):  
Patricia Hogea ◽  
Emanuela Tudorache ◽  
Zsolt Vastag ◽  
Andrada Gârjoabă ◽  
Cristian Oancea
Keyword(s):  
Hypersensitivity Pneumonitis ◽  
High Resolution Computed Tomography ◽  
Serological Tests ◽  
Exertional Dyspnea ◽  
The Past ◽  
Repetitive Exposure ◽  
Etiological Agents ◽  
Pigeon Breeder ◽  
Organic Particles ◽  
Hypersensitivity Pneumonia

Abstract Hypersensitivity pneumonia (HP) is an inflammatory lung syndrome due to repetitive exposure to small organic particles. The etiological agents of the disease are diverse and can be represented by fungi, bacteria, small molecule chemical compounds, as well as proteins from animals or insects. We present the case of a 25-year-old male, who was admitted to our Pulmonology Clinic for the following symptoms: morning cough with mucosal sputum for about 2 years, moderate exertional dyspnea (mMRC 3) started for 2 months, weight loss of about 6 kg in the past 5 months and fatigue. Clinical examination revealed bilateral mid- basal crackling rales. Chest high-resolution computed tomography (HRCT) (multiple micronodular opacities, diffuse contoured, bilaterally disseminated), lung function tests (restrictive ventilatory dysfunction with decreased carbon monoxide diffusing capacity), bronchoalveolar lavage (BAL) (lymphocyte alveolitis) and serological tests (positive antibodies for pigeon heathers and dejections) pointed to the diagnosis of hypersensitivity pneumonitis. It was recommended to avoid exposure to pigeons, as the patient was a pigeon breeder. Prednisone treatment was initiated. The general condition of the patient 1 month after diagnosis had improved, the evolution being good under treatment.

Hypersensitivity pneumonitis

2021 ◽  
Vol 31 (1) ◽  
pp. 88-99
Author(s):  
S. N. Avdeev
Keyword(s):  
Immune Response ◽  
Clinical Picture ◽  
Lung Biopsy ◽  
Hypersensitivity Pneumonitis ◽  
Common Finding ◽  
High Resolution Computed Tomography ◽  
Air Trapping ◽  
Wide Range ◽  
Inflammatory Immune Response ◽  
Lungs And Airways

Hypersensitivity pneumonitis (HP) is an inflammatory disease of the lungs and airways that develops in response to repeated inhalation of a wide range of aerosol antigens. The clinical picture and course of HP are highly variable and depend on such factors as the nature of the antigen, the intensity and duration of exposure to the antigen, as well as on the characteristics of the patient's immune response. The annual incidence of HAP is 1.28 -1.94 cases per 100 000. Currently, the diagnosis of HP is usually based on the characteristic clinical picture, high-resolution computed tomography (HRCT) data, bronchoscopy, lung biopsy, and evidence on the antigen. HRCT plays a central role in the diagnosis of HP. The most common finding on HRCT in HP is ground-glass opacities, which can be associated with centrilobular nodules and air trapping. In some cases, the fibrotic HP signs are very similar to those of idiopathic pulmonary fibrosis (IPF), and most changes are found in the lower regions and subpleurally. Therapy for HP usually includes avoiding exposure to the antigen, considering corticosteroids (CS) and/or immunosuppressive therapy to suppress the active inflammatory/immune response, and treating comorbidities. Nintedanib therapy in patients with progressive fibrotic HP results in a slower decline of lung function compared to placebo.

scholarly journals Hypersensitivity Pneumonitis Associated with Red-Vented Bulbul: A New Encounter of Bird Related Hypersensitivity Pneumonitis

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
W. D. N. L. Amarasinghe ◽  
R. Jayasekara ◽  
B. D. W. Jayamanne ◽  
T. D. K. Nalaka ◽  
W. A. D. L. Amarasiri ◽  
...  
Keyword(s):  
Urban Areas ◽  
Lung Biopsy ◽  
Hypersensitivity Pneumonitis ◽  
Close Contact ◽  
High Resolution Computed Tomography ◽  
Female Case ◽  
Severe Reduction ◽  
Chest Clinic ◽  
Oral Corticosteroids ◽  
Good Improvement

Bird related hypersensitivity pneumonitis (HP) is becoming more common than other forms of HP around the world. We present two cases of HP, associated with exposure to visiting birds which had nested within their homes in semi urban areas of Colombo, Sri Lanka. A 65-year-old female (case 1) and a 61-year-old male (case 2) presented to the chest clinic complaining of gradually progressive and persistent chronic dry cough and dyspnoea during the year 2018. Both were found to have close contact with red-vented bulbuls (Konda kurulla) in their homes for more than 6 months prior to onset of symptoms and denied any other risk exposures in detail history taking. In both patients, high-resolution computed tomography chest (HRCT) showed centrilobular nodules of ground glass density with significant lobular air trapping. Video-assisted thoracoscopic (VATs) lung biopsy of case 1 showed patchy and focal interstitial thickening with lymphocytic infiltrate, minimal fibrosis, and few noncaseating granulomata within the interstitium. Transbronchial lung biopsy of case 2 showed thickened alveolar septae with lympho-histiocytic infiltrate and occasional neutrophils and eosinopils. Both showed severe reduction in forced vital capacity (FVC) at presentation. Multidisciplinary diagnosis of HP associated with red-vented bulbuls was made. Both achieved good improvement in clinical, lung function, and radiological assessment following removal of offending antigen exposure and treatment with oral corticosteroids.

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