Advertisement

Pleuroparenchymal fibroelastosis-like lesions on chest computed tomography in routine clinical practice

  • Hiromitsu SumikawaEmail author
  • Takeshi Johkoh
  • Tae Iwasawa
  • Katsuyuki Nakanishi
  • Noriyuki Tomiyama
Original Article
  • 15 Downloads

Abstract

Purpose

To evaluate the incidence and changes in the pleuroparenchymal fibroelastosis (PPFE)-like lesions on chest CT in routine clinical practice.

Materials and methods

This study included 1284 patients who underwent chest CT in 2011 at a hospital. The incidence of PPFE-like lesions and their correlation with age, body mass index, and concomitant pulmonary findings were assessed. Moreover, predictors of lesion progression were evaluated on follow-up. The ethical review board waived the requirement of informed consent for the retrospective review of patient records.

Results

In total, 397 (30.9%) of the 1284 patients presented with PPFE-like lesions. The presence of PPFE-like lesions was correlated with older age (mean 72.2 vs. 69.9 years, p = 0.002); lower BMI (mean 21.0 vs. 23.2, p < 0.001); and interstitial pneumonia (64.8%, p < 0.001), emphysema (40.4%, p < 0.001), chronic airway disease (64.8%, p < 0.001), and old tuberculosis (56.5%, p < 0.001). Multivariate analysis of the follow-up CT findings revealed that interstitial pneumonia, nodular opacity, and lesion thickness affected progression (odds ratio: 3.81, 3.78 and 1.21), respectively.

Conclusion

Pleuroparenchymal fibroelastosis-like lesions were not rare and correlated with interstitial pneumonia, emphysema, chronic airway disease, and old tuberculosis. On follow-up, PPFE-like lesions in some patients with concomitant interstitial pneumonia exhibited progression.

Keywords

Computed tomography Lung Pleuroparenchymal fibroelastosis Apical cap Interstitial pneumonia 

Notes

Funding

There is no funding to declare.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The ethical review board at our institution waived the requirement of patients’ approval or informed consent for the retrospective review of their records and images.

References

  1. 1.
    Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch DA, Nicholson AG, 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(6):733–48.CrossRefGoogle Scholar
  2. 2.
    Amitani R, Niimi A, Kuze F. Idiopathic pulmonary upper lobe fibrosis (IPUF). Kokyu. 1992;11:693–9.Google Scholar
  3. 3.
    Frankel SK, Cool CD, Lynch DA, Brown KK. Idiopathic pleuroparenchymal fibroelastosis: description of a novel clinicopathologic entity. Chest. 2004;126(6):2007–13.CrossRefGoogle Scholar
  4. 4.
    Piciucchi S, Tomassetti S, Casoni G, Sverzellati N, Carloni A, Dubini A, et al. High resolution CT and histological findings in idiopathic pleuroparenchymal fibroelastosis: features and differential diagnosis. Respir Res. 2011;12:111.CrossRefGoogle Scholar
  5. 5.
    Kusagaya H, Nakamura Y, Kono M, Kaida Y, Kuroishi S, Enomoto N, et al. Idiopathic pleuroparenchymal fibroelastosis: consideration of a clinicopathological entity in a series of Japanese patients. BMC Pulm Med. 2012;12:72.CrossRefGoogle Scholar
  6. 6.
    Watanabe K, Nagata N, Kitasato Y, Wakamatsu K, Nabeshima K, Harada T, et al. Rapid decrease in forced vital capacity in patients with idiopathic pulmonary upper lobe fibrosis. Respir Investig. 2012;50(3):88–97.CrossRefGoogle Scholar
  7. 7.
    Renner RR, Markarian B, Pernice NJ, Heitzman ER. The apical cap. Radiology. 1974;110(3):569–73.CrossRefGoogle Scholar
  8. 8.
    Oda T, Ogura T, Kitamura H, Hagiwara E, Baba T, Enomoto Y, et al. Distinct characteristics of pleuroparenchymal fibroelastosis with usual interstitial pneumonia compared with idiopathic pulmonary fibrosis. Chest. 2014;146(5):1248–55.CrossRefGoogle Scholar
  9. 9.
    Nakatani T, Arai T, Kitaichi M, Akira M, Tachibana K, Sugimoto C, et al. Pleuroparenchymal fibroelastosis from a consecutive database: a rare disease entity? Eur Respir J. 2015;45(4):1183–6.CrossRefGoogle Scholar
  10. 10.
    Yoshida Y, Nagata N, Tsuruta N, Kitasato Y, Wakamatsu K, Yoshimi M, et al. Heterogeneous clinical features in patients with pulmonary fibrosis showing histology of pleuroparenchymal fibroelastosis. Respir Investig. 2016;54(3):162–9.CrossRefGoogle Scholar
  11. 11.
    Cheng SKH, Chuah KL. Pleuroparenchymal fibroelastosis of the lung: a review. Arch Pathol Lab Med. 2016;140(8):849–53.CrossRefGoogle Scholar
  12. 12.
    Yousem SA. Pulmonary apical cap: a distinctive but poorly recognized lesion in pulmonary surgical pathology. The American journal of surgical pathology. 2001;25(5):679–83.CrossRefGoogle Scholar
  13. 13.
    Lagstein A. Pulmonary apical cap-what’s old is new again. Arch Pathol Lab Med. 2015;139(10):1258–62.CrossRefGoogle Scholar
  14. 14.
    McLoud TC, Isler RJ, Novelline RA, Putman CE, Simeone J, Stark P. The apical cap. AJR Am J Roentgenol. 1981;137(2):299–306.CrossRefGoogle Scholar
  15. 15.
    Im JG, Webb WR, Han MC, Park JH. Apical opacity associated with pulmonary tuberculosis: high-resolution CT findings. Radiology. 1991;178(3):727–31.CrossRefGoogle Scholar
  16. 16.
    Reddy TL, Tominaga M, Hansell DM, von der Thusen J, Rassl D, Parfrey H, et al. Pleuroparenchymal fibroelastosis: a spectrum of histopathological and imaging phenotypes. Eur Respir. 2012;40(2):377–85.CrossRefGoogle Scholar
  17. 17.
    Watanabe K. Pleuroparenchymal fibroelastosis: its clinical characteristics. Curr Respir Med Rev. 2013;9:229–37.CrossRefGoogle Scholar
  18. 18.
    von der Thusen JH. Pleuroparenchymal fibroelastosis: its pathological characteristics. Curr Respir Med Rev. 2013;9(4):238–47.CrossRefGoogle Scholar
  19. 19.
    Kokosi MA, Nicholson AG, Hansell DM, Wells AU. Rare idiopathic interstitial pneumonias: LIP and PPFE and rare histologic patterns of interstitial pneumonias: AFOP and BPIP. Respirology (Carlton, Vic). 2016;21(4):600–14.CrossRefGoogle Scholar
  20. 20.
    Enomoto Y, Nakamura Y, Colby TV, Johkoh T, Sumikawa H, Nishimoto K, et al. Radiologic pleuroparenchymal fibroelastosis-like lesion in connective tissue disease-related interstitial lung disease. PLoS One. 2017;12(6):e0180283.CrossRefGoogle Scholar

Copyright information

© Japan Radiological Society 2019

Authors and Affiliations

  1. 1.Department of RadiologyOsaka International Cancer InstituteOsakaJapan
  2. 2.Department of Diagnostic RadiologySakai City Medical CenterSakaiJapan
  3. 3.Department of RadiologyKinki Central HospitalItamiJapan
  4. 4.Department of RadiologyKanagawa Cardiovascular and Respiratory CenterYokohamaJapan
  5. 5.Department of RadiologyOsaka Graduate School of MedicineOsakaJapan

Personalised recommendations