Objective To summarize the clinical characteristics of patients with diffuse parenchymal lung disease (DPLD) combined with hematological diseases in order to improve the clinicians’ knowledge of these diseases. Methods The clinical data of 46 patients was collected, who were hospitalized in Nanjing Drum Tower Hospital from January 2010 to October 2020 for DPLD combined with hematological diseases. Their clinical manifestations, laboratory tests, imaging features, diagnostic methods, treatment and prognosis were analyzed retrospectively. Results Among the 46 patients, there were 26 males and 20 females, with an average age of 60±13 years old. The main symptoms were cough and sputum, dyspnea, fever, chest tightness, and so on. Laboratory tests showed that some patients had pancytopenia or two-line cytopenia, and increase in lactate dehydrogenase, C-reactive protein, erythrocyte sedimentation rate and β2-microglobulin. Bilateral ground glass opacity, consolidations, big or small nodules, reticular shadows, and traction bronchiectasis were showed on chest high-resolution computed tomography. Among the 13 patients who were diagnosed clearly by pathology, they had 5 cases of organizing pneumonia, 4 cases of pulmonary alveolar proteinosis, 2 cases of acute fibrinous and organizing pneumonia, 1 case of diffuse alveolar hemorrhage, and 1 case of lung amyloidosis. Thirty-three patients were clinically diagnosed, including 3-case drug-induced interstitial lung disease, and 1-case exogenous allergic alveolitis. The patients with diffuse pulmonary lesions as the first manifestation and subsequently diagnosed with hematological diseases accounted for 65.2% (30/46). Among these patients, 2 of them had two kinds of hematological diseases at the same time. In the rest of the 16 cases, hematological diseases were diagnosed before DPLD. Among the 46 cases, 26 patients improved after treatment, 18 of them were treated with glucocorticoid, 8 with N-acetylcysteine and pirfenidone, 4 with granulocyte-macrophage colony stimulating factor inhaling and/ or whole lung alveolar lavage, and 2 with clarithromycin for immune regulation, etc. Fifteen patients refused treatment and transferred back to local hospital after the diagnosis of hematological diseases. Five patients died, 2 of them died of respiratory failure and 3 of them died of diseases progression. Conclusions DPLD includes many kinds of diseases, with known or unknown etiology and lack of specificity in clinical manifestations. Therefore, diagnosis for them is quite difficult. Hematological diseases themselves can be the causes of DPLD. At the same time, the treatment for hematological diseases and the related immunosuppression after treatment can also cause DPLD. In the clinical practice, careful screening and systematic differentiation are urgently needed in order to treat different causes precisely, control the conditions and improve the prognosis.
ObjectiveTo improve clinicians' awareness of cryptogenic organizing pneumonia (COP).MethodsThirty-three inpatients with COP, who had been diagnosed by pathology in Nanjing Drum Tower Hospital during January 2013 to December 2016 were collected. Their clinical manifestations, laboratory tests and imaging data were reviewed and analyzed retrospectively.ResultsThirty-three cases consisted of 18 males and 15 females, and the mean age was (58.7±13.5) years old. Most patients had subacute or insidious onset. The common symptoms were cough, fever, shortness of breath and chest tightness. About half of patients revealed inspiratory crackles or velcroes. Autoantibodies and anti-neutrophil cytoplasmic antibodies were negative. High-resolution computerized tomography findings of COP included bilateral patchy areas of air-space consolidation that showed predominantly subpleural or peri-bronchovascular distribution, focal nodules, enlarged hilar or mediastinal lymph nodes and pleural effusion. 25 patients were treated with glucocorticoid, 6 with macrolid, and 2 were only followed up without drug treatment.ConclusionsClinical manifestations, laboratory tests and imaging features are important clues to diagnose COP. Diagnosis depends on pathology. Meanwhile, definite pathogen and potential underlying diseases must be excluded.
ObjectivesTo compare the clinical features of combined pulmonary fibrosis and emphysema (CPFE) and idiopathic pulmonary fibrosis (IPF).MethodsEighty-three patients diagnosed as CPFE or IPF for the first time were retrospectively analyzed from June 2014 to July 2018 in Nanjing Drum Tower Hospital, including 47 patients in the CPFE group and 36 in the IPF group. The demographic characteristics, clinical manifestations, pulmonary function, cardiac ultrasound, blood gas analysis and prognosis of the two groups were compared.ResultsThe proportion of smokers in the CPFE group was higher than IPF group (P<0.05), but dyspnea was lower (P<0.05). The FVC, FVC%pred, FEV1, FEV1%pred and VC% of the CPFE group were higher than IPF group (P<0.05), while FEV1/FVC%pred in the IPF group was higher than CPFE group (P<0.05). DLCO/VA%pred of CPFE group decreased more significantly than IPF group (P<0.05), RV/TLC%pred of CPFE group increased annually, while decreased annually in IPF group (P<0.01). The RV%pred of CPFE increased annually, while that of IPF group decreased annually (P<0.05). There was no significant difference in arterial oxygen pressure and pulmonary artery pressure between the two groups. As for prognosis, the 1- and 3-year survival rate of the CPFE group were 87.9% and 73.8% respectively, those of the IPF group were 84.1% and 65.8% respectively, and no significantly difference was observed between two groups (P=0.95).ConclusionsCompared with IPF, patients with CPFE usually have more smokers, less proportion of dyspnea, almost normal lung volume, more rapidly decreased DLCO/VA%pred, and no significant difference in prognosis.
ObjectiveTo investigate the clinical, radiological and pathological features of pulmonary lymphangitic carcinomatosis (PLC) from gastric signet ring cell carcinoma.MethodsThe data of 3 cases of PLC from gastric signet ring cell carcinoma were analyzed and relevant literature was reviewed. The electronic databases of Wanfang, VIP, CNKI and PubMed were searched by using the keywords " pulmonary lymphangitic carcinomatosis” and " gastric signet ring cell carcinoma”.ResultsThe average age of three patients was 34 years (ranging from 20 to 50 years). There were 2 males and 1 female. The three patients presented with non-specific respiratory complaints of cough and shortness of breath. Thickening of interlobular septa was the major radiographical abnormality. Mediastinal lymphadenopathy was seen in 1 patient. Bilateral pleural effusion was seen in 2 patients. However, gastroscopy revealed metastatic gastric signet ring cell carcinoma with the presence of lymphagitic carcinomatosis. One patient survived more than seven months with systemic chemotherapy began on day 7 of hospitalization based on the follow-up information available. Literature review found 2 cases of PLC from gastric signet ring cell carcinoma. Two cases were female aged 45 and 59 years. The chief complaints were dry cough and shortness of breath. The survival time was less than 1 month from diagnosis.ConclusionsPLC from gastric signet ring cell carcinoma is easily misdiagnosed as primary pulmonary diseases. Early identification, diagnosis and treatment are crucial to improve the survival of PLC patients.
ObjectiveThree cases of pulmonary tuberculosis misdiagnosed as pulmonary alveolar proteinosis were reported and analyzed in combination with literatures, so as to improve the ability of differential diagnosis of these two diseases. MethodsThe clinical data of 3 cases of pulmonary tuberculosis patients which were diagnosed by pathology whose imaging manifestations were similar to those of pulmonary alveolar proteinosis were collected and reviewed in combination with relevant literature. ResultsAll the 3 patients were male, with a chronic course , no typical clinical manifestations of pulmonary tuberculosis, CT imaging showed diffuse glass grinding shadow, thickened pulmonary lobular septa ,showed "Crazy-paving pattern". ALL the three patients were considered as " pulmonary alveolar proteinosis" initially, and finally confirmed by lung biopsy or acid-resistant bacilli found by bronchoalveolar lavage. Reviewing 8 literature reports with similar imaging findings, 1 case was misdiagnosed as pulmonary alveolar proteinosis, 3 cases were pulmonary alveolar proteinosis combined with pulmonary tuberculosis, and 4 cases were secondary pulmonary alveolar proteinosis. It was found that most patients had systemic or respiratory symptoms of pulmonary tuberculosis. CT images mainly showed diffuse ground glass shadows in bilateral lungs with thickening of lobular septa, and 3 patients also showed clustered small nodulars. Most patients improved after anti-tuberculosis treatment, with only one patient dying. ConclusionsThe imaging manifestations of atypical pulmonary tuberculosis are various, which are easy to be misdiagnosed when they are similar to " pulmonary alveolar proteinosis". Clinicians should raise their awareness of tuberculosis with this imaging characteristic.