Skip to main content
SpringerLink
Log in

Noninvasive diagnosis of bronchiolitis obliterans due to sulfur mustard exposure: could high-resolution computed tomography give us a clue?

Diagnosi non-invasiva di bronchiolite obliterante dovuta alla esposizione a mostarde azotate (iprite): può la tomografia computerizzata ad alta risoluzione fornire una soluzione?

  • Chest Radiology/Radiologia Toracica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

Previous pathological investigations have reported bronchiolitis obliterans (BO) as the major long-term sequela of exposure to sulfur mustard. In this study, we investigated whether high-resolution computed tomography (HRCT) could be used as a noninvasive imaging modality to differentiate between mustard lung (as a subtype of BO) and other respiratory disorders.

Materials and methods

Three groups of patients with sulfur-mustard-induced lung injury (BO), severe chronic asthma (resistant asthma) and smoking habit, respectively, were recruited. Also 30 nonsmoking participants were recruited randomly as the control group. Pulmonary function tests (PFT) and HRCT were performed. Images were viewed with a window level of −450 and window width of 1,400 HU. All images were evaluated by an expert radiologist who was blinded regarding the patients’ diagnoses and clinical situations.

Results

Airway involvement was higher and more frequent than parenchymal involvement in the groups with chemical-induced injury and asthma in comparison with smokers. On the other hand, parenchymal involvement was more frequent than airway involvement in the smokers’ group in comparison with the other groups.

Conclusions

HRCT can be a very useful method for differentiating between mustard lung, resistant asthma and lung injuries due to cigarette smoking.

Abstract

Obiettivo

Numerosi precedenti studi di anatomia patologica hanno dimostrato come la bronchiolite obliterante (BO) sia la conseguenza a lungo termine più frequente all’esposizione alle mostarde azotate (iprite). In questo studio abbiamo valutato se la tomografia computerizzata ad alta risoluzione (HRCT) possa essere impiegata come modalità di imaging non invasivo per la diagnosi differenziale tra il danno polmonare indotto da mostarde azotate (sottotipo di BO) ed altre patologie respiratorie.

Materiali e metodi

Sono stati reclutati tre gruppi di pazienti, rispettivamente affetti da bronchiolite obliterante indotta da mostarde azotate (BO), affetti da asma cronica (asma refrattaria) e fumatori. Sono stati scelti casualmente ulteriori 30 soggetti non fumatori come gruppo di controllo.Tutti i pazienti sono stati tutti sottoposti a test di funzionalità respiratoria (PFT) e HRCT. Le immagini sono state visualizzate con un livello di finestra di −450 UH ed un’ampiezza di finestra di 1,400 UH. Tutte le immagini sono state visionate da un radiologo esperto all’insaputa della diagnosi e della situazione clinica dei pazienti.

Risultati

Il coinvolgimento delle vie aeree è risultato maggiore e più frequente del coinvolgimento parenchimale nei gruppi di pazienti con danno polmonare chimicamente indotto e asmatici rispetto ai fumatori. D’altra parte il coinvolgimento parenchimale è risultato più frequente del coinvolgimento delle vie aeree nel gruppo di fumatori rispetto agli altri gruppi.

Conclusioni

L’ HRCT risulta essere un metodo utile per la diagnosi differenziale tra il danno polmonare da mostarde azotate, l’asma refrattaria ed il danno polmonare indotto dal fumo.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References/Bibliografia

  1. Ghanei M, Tazelaar HD, Chilosi M et al (2008) An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients. Respir Med 102:825–830

    Article  PubMed  Google Scholar 

  2. Saglani S, Papaioannou G, Khoo L et al (2006) Can HRCT be used as a marker of airway remodelling in children with difficult asthma? Respir Res 7:46

    Article  CAS  PubMed  Google Scholar 

  3. Teel GS, Engeler CE, Tashijian JH, duCret RP (1996) Imaging of small airways diseases. Radiographics 16:27–413

    CAS  PubMed  Google Scholar 

  4. Yilmaz S, Ekici A, Ekici M, Keles H (2006) High-resolution computed tomography findings in elderly patients with asthma. Eur J Radiol 59:238–243

    Article  PubMed  Google Scholar 

  5. SA, Park CS, Kim JS, Müller NL (1997) Bronchiolitis obliterans after lung transplantation: high-resolution CT findings in 15 patients. Worthy AJR 169:673–677

    Google Scholar 

  6. Gupta PP, Yadav R, Verma M et al (2009) High-resolution computed tomography features in patients with chronic obstructive pulmonary disease. Singapore Med J 50:193–200

    CAS  PubMed  Google Scholar 

  7. Boskabady MH, Kolahdooz GH (2002) Prevalence of asthma symptoms among the adult population in the city of Mashhad (north-east of Iran). Respirology 7:267–272

    Article  PubMed  Google Scholar 

  8. Niimi A, Matsumoto H, Amitani R et al (2000) Airway wall thickness in asthma assessed by computed tomography. Relation to clinical indices. Am J Respir Crit Care Med 162:1518–1523

    CAS  PubMed  Google Scholar 

  9. Jensen SP, Lynch DA, Brown KK et al (2002) High-resolution CT features of severe asthma and bronchiolitis obliterans. Clin Radiol 57:1078–1085

    Article  CAS  PubMed  Google Scholar 

  10. Cho SH, Seo JY, Choi DC et al (1996) Pathological changes according to the severity of asthma. Clin Exp Allergy 26:1210–1219

    Article  CAS  PubMed  Google Scholar 

  11. Clark KD, Wardrobe-Wong N, Elliott JJ et al (2001) Patterns of lung disease in a “normal” smoking population: are emphysema and airflow obstruction found together? Chest 120:743–747

    Article  CAS  PubMed  Google Scholar 

  12. Ghanei M, Fathi H, Mohammad MM et al (2004) Long-term respiratory disorders of claimers with subclinical exposure to chemical warfare agents. Inhal Toxicol 16:491–495

    Article  CAS  PubMed  Google Scholar 

  13. Ghanei M, Mokhtari M, Mohammad MM, Aslani J (2004) Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography. Eur J Radiol 52:164–169

    Article  PubMed  Google Scholar 

  14. Hefazi M, Attaran D, Mahmoudi M, Balali-Mood M (2005) Late respiratory complications of mustard gas poisoning in Iranian veterans. Inhal Toxicol 17:587–592

    Article  CAS  PubMed  Google Scholar 

  15. Bagheri MH, Hosseini SK, Mostafavi SH, Alavi SA (2003) High resolution CT in chronic pulmonary changes after mustard gas exposure. Acta Radiol 44:241–245

    CAS  PubMed  Google Scholar 

  16. Paganin F, Séneterre E, Chanez P et al (1996) Computed tomography of the lungs in asthma: influence of disease severity and etiology. Am J Respir Crit Care Med 153:110–114

    CAS  PubMed  Google Scholar 

  17. Carr DH, Hibon S, Rubens M, Chung KF (1998) Peripheral airways obstruction on high-resolution computed tomography in chronic severe asthma. Respir Med 92:448–453

    Article  CAS  PubMed  Google Scholar 

  18. Vignola AM, Paganin F, Capieu L et al (2004) Airway remodelling assessed by sputum and high-resolution computed tomography in asthma and COPD. Eur Respir J 24:910–917

    Article  CAS  PubMed  Google Scholar 

  19. Lynch DA, Newell JD, Tschomper BA et al (1993) Uncomplicated asthma in adults: comparison of CT appearance of the lungs in asthmatic and healthy subjects. Radiology 188:829–833

    CAS  PubMed  Google Scholar 

  20. Harmanci E, Kebapci M, Metintas M, Ozkan R (2002) High-resolution computed tomography findings are correlated with disease severity in asthma. Respiration 69:420–426

    Article  PubMed  Google Scholar 

  21. Deveci F, Murat A, Turgut T et al (2004) Airway wall thickness in patients with COPD and healthy current smokers and healthy non-smokers: assessment with high resolution computed tomographic scanning. Respiration 71:602–610

    Article  PubMed  Google Scholar 

  22. Webb R, Muller N (2001) High-resolution CT of the lung, 3rd edn. Lippincott Williams & Wilkins, New York

    Google Scholar 

  23. Bankier AA, Van Muylem A, Scillia P et al (2003) Air trapping in heart-lung transplant recipients: variability of anatomic distribution and extent at sequential expiratory thin-section CT. Radiology 229:737–742

    Article  PubMed  Google Scholar 

  24. Yorgancio lu A, Sakar A, Tarhan S et al (2003) High resolution CT findings in patients with asthma. Tuberk Turaks 51:5–10

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chemical Injuries Research Center, Baqiyatallah University of Medical Science, Mollasadra Ave, 14359-16471, Tehran, Iran

    M. Ghanei, M. Ghayumi, M. Jafari, A. Ani & J. Aslani

  2. Department of Radiology, Baqiyatallah University of Medical Sciences, Tehran, Iran

    N. Ahakzani

  3. Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

    O. Rezvani

Authors
  1. M. Ghanei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Ghayumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Ahakzani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O. Rezvani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Jafari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Ani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Aslani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Ghanei.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ghanei, M., Ghayumi, M., Ahakzani, N. et al. Noninvasive diagnosis of bronchiolitis obliterans due to sulfur mustard exposure: could high-resolution computed tomography give us a clue?. Radiol med 115, 413–420 (2010). https://doi.org/10.1007/s11547-010-0503-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-010-0503-6

Keywords

Parole chiave

Search

Navigation