Subpleural Bandlike Ground-Glass Opacity in Thoracic CT: Differential Diagnosis Value in Paraquat Poisoning Pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZhangXiujian ¹ ,  XiaoYonglong ¹ , ZhouKefeng ² , XuPeng ³ , ZhouZhengyang ² , WangJun ³ , CaiHourong ¹

1. Department of Pulmonary Medicine, The Affiliated Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210008, China;
2. ;
3. ;

Corresponding author：

XiaoYonglong, Email: yonglong11a@163.com

Keywords：

Paraquat poisoning; Interstitial pneumonia; Ground-glass opacity; Pulmonary alveolar proteinosis

DOI：

10.7507/1671-6205.2016111

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Objective To explore the differential diagnosis value of subpleural bandlike ground-glass opacity (GGO) in thoracic CT in paraquat poisoning pneumonia. Methods A retrospective study was carried out by retrieving the patients CT database from March 2013 to March 2015. The patients with paraquat poisoning pneumonia, interstitial pneumonia and pulmonary alveolar proteinosis (PAP) were recruited and their radiological characteristics of thoracic CT were analyzed. Results A total of 698 newly diagnosed interstitial pneumonia patients were finally enrolled in this study, 392 of them (56.2%) presented with GGO in thoracic CT. A total of 38 newly diagnosed PAP patients and 14 paraquat poisoning patients were enrolled, and GGO presented in thoracic CT of 100.0% and 42.9% of them respectively. Subpleural bandlike GGO was mostly commonly found in 83.3% of the paraquat poisoning pneumonia patients with GGO in thoracic CT, followed by 18.4% of the PAP patiens and 5.6% of the interstitial pneumonia patients with GGO in thoracic CT, which were significantly lower than that in the paraquat poisoning pneumonia patients (P < 05). GGO associated crazy paving pattern in thoracic CT was mostly commonly found in 94.7% of the PAP patients, followed by 0.5% of the interstitial pneumonia patients and none of the paraquat poisoning pneumonia patients. All the PAP patients with subpleural bandlike GGO were found associated with crazy paving pattern, while none of such association was found in the interstitial pneumonia or the paraquat poisoning pnuemonia patients. GGO coexisting with honeycombing and subpleural line were respectively found in 22.7% and 11.2% of the interstitial pneumonia patients, and none of such association was found in the PAP or the paraquat poisoning pneumonia patients. Conclusions Subpleural bandlike GGO is mostly commonly found in paraquat poisoning pneumonia patients and rarely in PAP and interstitial pneumonia patients. Combined with crazy paving pattern and subpleural line, subpleural bandlike GGO may be a valuable feature in the diagnosis of paraquat poisoning pneumonia patients.

Citation： Zhang Xiujian, Xiao Yonglong, Zhou Kefeng, Xu Peng, Zhou Zhengyang, Wang Jun, Cai Hourong. Subpleural Bandlike Ground-Glass Opacity in Thoracic CT: Differential Diagnosis Value in Paraquat Poisoning Pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(5): 477-483. doi: 10.7507/1671-6205.2016111 Copy

1.	Kang X, Hu DY, Li CB, et al. The volume ratio of ground glass opacity in early lung CT predicts mortality in acute paraquat poisoning. PLoS One, 2015, 10:e0121691.
2.	Delirrad M, Majidi M, Boushehri B. Clinical features and prognosis of paraquat poisoning:a review of 41 cases. Int J Clin Exp Med, 2015, 8:8122-8128.
3.	Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society statement:update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med, 2013, 188:733-748.
4.	Wells AU, Hirani N. Interstitial lung disease guideline. Thorax, 2008, 63:v1-v58.
5.	Seymour JF, Presneill JJ. Pulmonary alveolar proteinosis. Progress in the first 44 years. Am J Respir Crit Care Med, 2002, 166:7215-7235.
6.	Trapnell BC, Whitsett JA, Nakata K. Pulmonary alveolar proteinosis. N Engl J Med, 2003, 349:2527-2539.
7.	Miller WT, Shah RT. Isolated diffuse ground-glass opacity in thoracic CT:causes and clinical presentations. AJR, 2005, 184:613-622.
8.	Jacob J, Hansell DM. HRCT of fibrosing lung disease. Respirology, 2015, 20:859-872.
9.	Lee KS, Chung MP. Idiopathic interstitial pneumonias:clinical findings, pathogenesis, pathology and radiologic findings. J Korean Med Sci, 1999, 14:113-127.
10.	Silva CLS, Muller NL, Lynch DA, et al. Chronic hypersensitivity pneumonitis:differentiation from idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia by using thin-section CT. Radiology, 2008, 246:288-297.
11.	Fukushima T, Tanaka K, Lim H, et al. Mechanism of cytotoxicity of paraquat. Environ Health Prev Med, 2002, 7:89-94.
12.	Satomi Y, Sakaguchi K, Kasahara Y, et al. Novel and extensive aspects of paraquat-induced pulmonary fibrogenesis:comparative and time-course microarray analyses in fibrogenic and non-fibrogenic rats. J Toxicol Sci, 2007, 32:529-553.
13.	Otsuki T, Ishikawa T. Mouse model of paraquat-poisoned lungs and its gene expression profile. Toxicology, 2007, 231:200-209.
14.	American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med, 2002, 165:277-304.

1. Kang X, Hu DY, Li CB, et al. The volume ratio of ground glass opacity in early lung CT predicts mortality in acute paraquat poisoning. PLoS One, 2015, 10:e0121691.
2. Delirrad M, Majidi M, Boushehri B. Clinical features and prognosis of paraquat poisoning:a review of 41 cases. Int J Clin Exp Med, 2015, 8:8122-8128.
3. Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society statement:update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med, 2013, 188:733-748.
4. Wells AU, Hirani N. Interstitial lung disease guideline. Thorax, 2008, 63:v1-v58.
5. Seymour JF, Presneill JJ. Pulmonary alveolar proteinosis. Progress in the first 44 years. Am J Respir Crit Care Med, 2002, 166:7215-7235.
6. Trapnell BC, Whitsett JA, Nakata K. Pulmonary alveolar proteinosis. N Engl J Med, 2003, 349:2527-2539.
7. Miller WT, Shah RT. Isolated diffuse ground-glass opacity in thoracic CT:causes and clinical presentations. AJR, 2005, 184:613-622.
8. Jacob J, Hansell DM. HRCT of fibrosing lung disease. Respirology, 2015, 20:859-872.
9. Lee KS, Chung MP. Idiopathic interstitial pneumonias:clinical findings, pathogenesis, pathology and radiologic findings. J Korean Med Sci, 1999, 14:113-127.
10. Silva CLS, Muller NL, Lynch DA, et al. Chronic hypersensitivity pneumonitis:differentiation from idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia by using thin-section CT. Radiology, 2008, 246:288-297.
11. Fukushima T, Tanaka K, Lim H, et al. Mechanism of cytotoxicity of paraquat. Environ Health Prev Med, 2002, 7:89-94.
12. Satomi Y, Sakaguchi K, Kasahara Y, et al. Novel and extensive aspects of paraquat-induced pulmonary fibrogenesis:comparative and time-course microarray analyses in fibrogenic and non-fibrogenic rats. J Toxicol Sci, 2007, 32:529-553.
13. Otsuki T, Ishikawa T. Mouse model of paraquat-poisoned lungs and its gene expression profile. Toxicology, 2007, 231:200-209.
14. American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med, 2002, 165:277-304.

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Subpleural Bandlike Ground-Glass Opacity in Thoracic CT: Differential Diagnosis Value in Paraquat Poisoning Pneumonia

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