Objective To analyze the clinical presentations and radiological characteristics of pathologically proved cases of cryptogenic organizing pneumonia(COP).Methods The clinical and radiological features of 8 patients with COP confirmed by open lung biopsy were analyzed.Treatment and follow-up data were also recorded.Results There were 5 male an 3 female patients aged 37 to 68 years.Dyspnea，cough and inspiratory crackles were the most common symptoms and signs.Various computed tomography findings including ground glass opacities,pathy consolidation with air bronchograms，nodules and reticulation were simultaneously observed in the same patient.The diagnostic imaging features of COP were patchy or lobar consolidation，often by a predominantly subpleural distribution，and irregular band-like opacities distributed along the bronchovascular bundle or located in the subpleural area.All patients were treated with corticosteroids and yielded significant improvement in seven cases.Conclusions COP could be diagnosed by clinical and radiological findings and histopathological examination was needed for confirmed diagnosis.In general，COP responds well to glucocorticoid therapy and has a benign prognosis.
Objective To highlight the characteristics of giant cell interstitial pneumonia ( GIP) . Methods The clinical, radiological, and pathological data of two patients with GIP pathologically proven by open lung and TBLB biopsy were presented respectively, and relevant literatures were reviewed. Results Patients with GIP usually had a history of exposure to metal dust. Clinical presentations included cough and dyspnea on exertion, and pulmonary function testing showed a restrictive abnormality. On chest radiography and high-resolution CT scans, it presented as bilateral areas of ground-glass attenuation, areas of consolidation, diffuse small nodules, extensive reticular opacities, and traction bronchiectasis. The main pathological findings included a desquamative interstitial pneumonia ( DIP) -like reaction with intra alveolar macrophages and numerous large multinucleated histiocytes that ingested inflammatory cells were admixed with macrophages. The finding of GIP was almost pathognomonic for hard metal pneumoconiosis. Conclusions GIP is a very rare chronic interstitial pneumonia, and has no characteristic clinical manifestations. Radiographic findings are similar to other idiopathic interstitial pneumonias. Careful collection of the occupational history can help to minimize misdiagnosis.
ObjectiveTo highlight the characteristics of pulmonary MALT lymphoma with diffuse lung disease. MethodsThe clinical,radiological and pathological data of two patients with pulmonary MALT lymphoma were analyzed,and relevant literature was reviewed. ResultsOne patient was a 59-year-old male with cough for five years while antibiotic treatment was ineffective. The chest CT scan demonstrated diffuse lung disease,bilateral multiple consolidation and ground-glass opacities,small nodules and bronchiectasis. Thoracoscopy biopsy was performed and the pathology study confirmed the diagnosis of MALT lymphoma. Another case was a 50-year-old female,who suffered from fever,cough and dyspnea. The chest CT scan revealed bilateral multiple patchy consolidation,with air bronchogram. The eosinophils count in blood was high. Diagnosed initially as eosinophilic pneumonia,she was treated with corticosteroids. The clinical symptoms were improved,but the CT scan revealed no change. After the computed tomography guided percutaneous lung biopsy,pathological examination confirmed the diagnosis of MALT lymphoma. ConclusionMALT lymphoma with diffuse lung disease is rare and easy to be misdiagnosed. The positive rate of bronchoscopy is low and percutaneous lung biopsy or thoracoscopy biopsy is more useful for diagnosis.
ObjectiveTo summarize the clinical, radiological and pathological characteristics of acquired immune deficiency syndrome (AIDS) combined with Pneumocystis carinii pneumonia (PCP), so as to improve the clinicians' understanding of the disease. MethodsThe clinical data of 50 AIDS patients combined with PCP admitted between February 2006 and May 2015 were retrospectively analyzed, including medical history, physical signs, laboratory examination, chest high resolution CT (HRCT), pathological characteristics, treatment and prognosis, etc. ResultsThe clinical features of AIDS patients combined with PCP included cough, dyspnea and fever, without obvious positive signs in the lung.The patients were divided as a mild group, a moderate group and a severe group according to the levels of PaO2.There was significant difference among three groups in serum albumin level [(23±3) g/L vs. (30±5) g/L and (28±6) g/L, P < 0.01].There were no significant differences among three groups in CD4+ T lymphocyte and lactate dehydrogenase (LDH) (P > 0.05).The typical chest radiograph feature of HRCT was ground-glass shadows in both lungs, and may be associated with reticular shadows or "gravel sign" and cyst.Of 50 patients, 16 patients were diagnosed via pathology of transbronchial lung biopsy(TBLB) and only 5 patients were diagnosed via silver staining of the bronchoalveolar lavage fluid (BALF).The other patients were clinically diagnosed.100% of the patients were treated with sulfamethoxazole (SMZco), 64%with caspofungin, and 72% with glucocorticoid.All the patients relieved with no death in hospital. ConclusionWhen a patient got cough, dyspnea and fever, especially ground glass on HRCT in both lungs, AIDS combined with PCP should be highly considered, and diagnostic treatment with SMZco and CD4+ T lymphocyte measurement should be conducted as soon as possible, so as to reduce misdiagnosis and mortality.
ObjectiveTo improve clinicians' knowledge of hypersensitivity pneumonitis (HP). MethodsWe retrospectively analyzed the clinical data of 24 HP patients who were diagnosed in the Affiliated Drum Tower Hospital of Nanjing University Medical School during February 2005 to February 2013. The clinical,radiological and pathological features of those patients were summarized. ResultsAmong those 24 patients,15 were male and 9 were female,with mean age of (48±13) years. All patients had a history of environmental exposure. Two patients showed acute clinical manifestations,and there were 17 subacute and 5 chronic cases. The main clinical manifestations were dyspnea,cough,sputum,fever and weight loss with hypoxemia via blood gas analysis. Restrictive ventilatory impairment was the most frequent functional pattern,and the carbon monoxide diffusing capacity was decreased. Pulmonary function test showed restrictive ventilatory defect and gas interchange disturbance. The features of chest HRCT included diffuse ground-glass attenuation and/or patchy consolidation,centrilobular micronodules,mosaic sign,reticular and/or honeycombing lesions. Bronchoalveolar lavage fluid (BALF) demonstrated an increase of total cell counts with predominant lymphocytosis. The transbronchoscopic lung biopsy (TBLB) pathological examination revealed lymphocytic alveolitis,noncaseating granuloma,and interstial pneumonia. All patients were treated by corticosteroid and avoided antigen exposure and showed significant clinical and radiological improvement. ConclusionThe diagnosis of HP is difficult. In most cases (acute and subacute HP),a diagnosis can be made by combination history of exposure,chest HRCT manifestations,cell classification of BALF and pathological examination of TBLB. For atypical cases (chronic HP),a surgery lung biopsy is needed for multi-disciplinary diagnosis including pathologist,radiologist and pulmonologists.
ObjectiveTo analyze the clinical characteristics and survival of pulmonary fibrosis (PF) patients complicated with lung cancer (LC) (PL-LC). MethodsFifty-three patients with PF diagnosed as LC from January 2008 to March 2014 in Nanjing Drum Tower Hospital were included in this study. Univariate analysis and Cox regression analysis were used to detect the effects of clinical variables on survival. Kaplan-Meier method was used to calculate the median survival time (MST) and overall survival (OS). ResultsMale patients (n=48, 90.6%) and patients with a history of smoking (n=42, 79.2%) were more easily suffered from PF-LC. The average age was 68.6±9.5 years. Cox multivariate analysis revealed that Velcro crackles (P=0.009) and clinical stage (P=0.013) were the independent risk factors of survival in the patients with PF-LC. The MST of 53 patients was 6.0 months.The survival rates of 1-year and 2-year were 34.1% and 22.0%, respectively. Forty-two (79.2%) patients were idiopathic pulmonary fibrosis (IPF) complicated with LC, and 11 (20.8%) patients were secondary pulmonary fibrosis (SPF) complicated with LC. OS difference between two groups was not significant (P=0.610). OS of NSCLC group (n=37) was significantly prolonged than that of SCLC group (n=6) and unclassified pathological pattern group (n=10) (P=0.035). OS of Ⅰ and Ⅱstage patients (n=13) was significantly longer than that of Ⅲ and Ⅳ stage patients (n=40) (P=0.002). MST and OS of patients with LC treated (n=31) were significantly better than those of untreated patients (n=22) (P < 0.001) and OS of patients treated by comprehensive therapy (n=11) was significantly prolonged than that of patients treated by mono-therapy (n=20) (P=0.036). ConclusionsVelcro crackles and clinical stages are the independent risk factors of prognosis in PF-LC patients. It is beneficial to survival if the PF patients with LC were treated by comprehensive therapy.