Abstract
Purpose
This paper describes chest X-ray (CXR) and computed tomography (CT) findings of diffuse alveolar haemorrhage (DAH).
Materials and methods
We retrospectively reviewed 23 episodes of DAH in 20 patients, 17 of known aetiology and three of unknown aetiology. All cases were studied by CXR and 15 also by CT. Parenchymal consolidations and ground-glass opacities were evaluated after dividing each lung into three regions (upper, middle, lower) for a total of six zones.
Results
Consolidations or ground-glass opacities were identified on CXR in 16/20 patients, mainly in the middle fields (73%). In 4/20 patients, all with Wegener’s granulomatosis, CXR was negative or demonstrated only nodular opacities; in two of these cases, CT revealed ground-glass opacities. A complete follow-up was available for ten patients: initially, they showed consolidation opacities in 36/60 zones, which persisted in 16/60 after 7 days and in 11/60 after 15 days. Conversely, ground-glass opacities increased after 7 days owing to the partial regression of consolidation opacities, and they markedly diminished after 15 days.
Conclusions
DAH is radiologically characterised by a nonspecific alveolar-filling pattern. Diagnosis or suspicion of DAH needs to be supported by the evidence of haemoptysis and/or rapid-onset anaemia. CT is superior in detecting ground-glass opacities and is required in cases of suspected DAH with normal CXR findings.
Riassunto
Obiettivo
Descrivere i reperti Rx e TC della emorragia alveolare diffusa (EAD).
Materiali e metodi
Studio retrospettivo di 23 episodi di EAD in 20 pazienti, 17 con eziologia identificata, 3 senza causa specifica, studiati tutti con Rx torace e 15 con TC. È stata valutata la presenza di opacità consolidative e ground glass dividendo arbitrariamente in sei zone (superiore, media ed inferiore) sia il polmone destro, sia il polmone sinistro.
Risultati
Opacità consolidative o ground glass erano dimostrate all’Rx, prevalentemente nei campi medi (73%), in 16/20 pazienti. In 4/20, tutti con Wegener, il radiogramma risultava negativo o dimostrava solo lesioni nodulari mentre la TC in 2/4 evidenziava opacità ground glass. Dieci pazienti di cui era disponibile follow-up completo esordivano con opacità consolidative in 36/60 zone, persistenti in 16/60 dopo 7 giorni e in 11/60 dopo 15. Le opacità ground glass aumentavano dopo 7 giorni per l’attenuazione delle consolidazioni, riducendosi nettamente 15 giorni.
Conclusioni
L’EAD presenta aspetti radiologici aspecifici di occupazione alveolare. Per la diagnosi o il semplice sospetto di EAD è indispensabile la correlazione con i dati clinico-anamnestici di emottisi o di anemia insorta rapidamente. La TC, più sensibile dell’Rx nel riconoscere opacità ground-glass, è indispensabile in pazienti con possibile EAD e quadro Rx negativo.
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Cortese, G., Nicali, R., Placido, R. et al. Radiological aspects of diffuse alveolar haemorrhage. Radiol med 113, 16–28 (2008). https://doi.org/10.1007/s11547-008-0229-x
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DOI: https://doi.org/10.1007/s11547-008-0229-x