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Humidifier disinfectant-associated children’s interstitial lung disease: Computed tomographic features, histopathologic correlation and comparison between survivors and non-survivors

  • Paediatric
  • Published:
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Abstract

Objectives

To report radiologic findings with histopathologic correlations of humidifier disinfectant-associated children’s interstitial lung disease (HD-chILD) and to compare computed tomography (CT) findings between survivors and non-survivors.

Methods

Forty-seven children with HD-chILD (27.4 ± 12.4 months old) were categorized as survivors (n = 25) and non-survivors (n = 22). The patterns, distributions, and chronological changes in lung lesions at follow-up CT were investigated. Histopathologic correlations were performed in 23 patients.

Results

CT features were characterized by chronological changes, from consolidation to centrilobular opacities, and lesions eventually became faint centrilobular nodules. Histopathologic features were bronchocentric-distributed fibro-inflammatory lesions, which were more profound in the advanced stage than the early stage. Consolidation ≥30 % [hazard ratio (HR), 2.932], centrilobular opacities ≥60 % of the total lung volume (TLV; HR, 0.206) and spontaneous air leaks (HR, 3.457) were significant factors associated with patient survival, as per univariate analysis. Consolidation ≥30 % (HR, 3.519), centrilobular opacities ≥60 % (HR, 0.205) and diffuse ground glass opacity (GGO) ≥70 % of the TLV (HR, 3.521) were significant factors associated with patient survival, as determined via multivariate analysis.

Conclusion

Distinctive chronological CT features were observed in the HD-chILD images. Spontaneous air leaks, consolidation, GGO, and centrilobular opacities were prognostic factors.

Key Points

• Chemical disinfectants can induce severe inhalation lung injury

• Lung injury caused by inhaled disinfectants demonstrates chronologic changes in radiologic findings

• Understanding of radiological characteristics is important to predict outcomes in chemical pneumonitis

• Physicians should be aware of the potential risk of environmental chemicals

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Abbreviations

HD-chILD:

Humidifier disinfectant-associated children’s interstitial lung disease

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Acknowledgments

The scientific guarantor of this publication is Jin Seong Lee.

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by the National Institute of Environment Research (2014-0677) and the Korea Environmental Industry & Technology Institute (2014-0784), Republic of Korea. One of the authors (Seon-Ok Kim) has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Some study subjects have been previously reported in the Journal of Korean medical science by Lee et al. [3], in PloS One by Yang et al. [7] and in the American Journal of Respiratory and Critical Care Medicine by Kim et al. [8].

Methodology: retrospective, observational, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Hee Mang Yoon, Jin Seong Lee, Kyung-Hyun Do, Ah Young Jung, Chong Hyun Yoon & Young Ah Cho

  2. Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Eun Lee & Soo-Jong Hong

  3. Department of Clinical Epidemiology & Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Seon-Ok Kim

  4. Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Se-Jin Jang

Authors
  1. Hee Mang Yoon
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  2. Eun Lee
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  3. Jin Seong Lee
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  4. Kyung-Hyun Do
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  5. Ah Young Jung
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  6. Chong Hyun Yoon
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  7. Seon-Ok Kim
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  8. Se-Jin Jang
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  9. Soo-Jong Hong
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  10. Young Ah Cho
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Corresponding author

Correspondence to Young Ah Cho.

Appendix

Appendix

Table 3 Symptoms and underlying patient diseases
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Table 4 Radiologic-pathologic correlation
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Table 5 Cox proportional hazard model (of the combined variable) for patient survival
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Yoon, H.M., Lee, E., Lee, J.S. et al. Humidifier disinfectant-associated children’s interstitial lung disease: Computed tomographic features, histopathologic correlation and comparison between survivors and non-survivors. Eur Radiol 26, 235–243 (2016). https://doi.org/10.1007/s00330-015-3813-1

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  • DOI: https://doi.org/10.1007/s00330-015-3813-1

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