Skip to main content
SpringerLink
Log in

Natural history of honeycombing: follow-up of patients with idiopathic pulmonary fibrosis treated with single-lung transplantation

Storia naturale dell’honeycombing: follow-up di pazienti con fibrosi polmonare idiopatica sottoposti a trapianto mono-polmonare

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

Abstract

Purpose

Although honeycombing is one of the key features for the diagnosis of idiopathic pulmonary fibrosis (IPF), its origin and evolution are still poorly understood. The aim of our study was to analyse the natural history of honeycombing in patients treated with single-lung transplantation.

Materials and methods

We considered seven patients who underwent single-lung transplantation; two of them (28.6%) were excluded from our analysis because they died in the posttransplantation period, whereas the remaining five (71.4%) were evaluated with computed tomography (CT) over 67.6±38.56 months. Each CT scan was assessed for disease extension and cyst size (visual score and size of target cysts); CT scans acquired after 2006 were also assessed for native lung volume.

Results

All patients showed disease progression (with a concurrent reduction in lung volume in two, 40%) and a progression of honeycombing, with increased number and size of cysts in four (80%). We observed dimensional changes in all target cysts (enlargement or reduction); three patients (60%) also had radiological evidence of complications, such as spontaneous rupture with pneumothorax and development of mycetomas within the cysts.

Conclusions

Honeycombing is a dynamic process in which the overall trend is represented by a dimensional increase in cystic pattern; however, single cysts may have a different evolution (enlargement, reduction or complications). This behaviour could be explained by the variety of the pathogenetic processes underlying honeycombing, with cysts that may present abnormal communication with the airway, including the development of a check-valve mechanism.

Riassunto

Obiettivo

L’honeycombing rappresenta un reperto chiave per la diagnosi di fibrosi polmonare idiopatica; nonostante questo, la sua patogenesi ed evolutività restano ancora poco conosciuti. Scopo del nostro studio è stato quello di analizzarne il comportamento evolutivo attraverso il follow-up di pazienti sottoposti a trapianto monopolmonare.

Materiali e metodi

Sette pazienti sottoposti a trapianto mono-polmonare sono stati studiati evolutivamente; di questi 2 (28,6%) sono stati esclusi dalla nostra analisi perché deceduti nel post-trapianto, mentre i restanti 5 (71,4%) sono stati valutati mediante tomografia computerizzata (TC) per 67,6±38,56 mesi. Per ogni TC sono stati analizzati: estensione della malattia, dimensioni delle cisti (score visivo medio e dimensioni di cisti target) e, per le TC acquisite dopo l’anno 2006, volume del polmone nativo.

Risultati

Tutti i pazienti (5/5, 100%) hanno evidenziato un progressione della malattia (con riduzione consensuale dei volumi polmonari in 2/5, 40%) e una evoluzione dell’honeycombing (con incremento numerico e dimensionale delle cisti in 4/5, 80%). Tutte le cisti target sono andate incontro a modificazioni dimensionali (ingrandimento o riduzione) con evidenza di complicanze in 3/5 pazienti (60%), quali rottura spontanea con pneumotorace e sviluppo di inclusi (micetomi).

Conclusioni

I nostri dati dimostrano che l’honeycombing è un processo dinamico ed evolutivo durante il quale la tendenza globale del pattern cistico è quella dell’incremento dimensionale; le singole cisti, possono però subire un diverso destino, potendo andare incontro ad ingrandimento, riduzione o complicanze. Ciò si spiega in considerazione dell’eterogeneità dei processi patogenetici alla base dell’honeycombing, con cisti che possono presentare anomale comunicazioni con le vie aeree come lo sviluppo di un meccanismo a valvola.

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. Muller-Mang C, Grosse C, Schmid K et al (2007) What every radiologist should know about idiopathic interstitial pneumonias. Radiographics 27:595–615

    Article  Google Scholar 

  2. American Thoracic Society/European Respiratory Society (2002) American Thoracic Society/European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 165:277–304

    Google Scholar 

  3. Sverzellati N, De Filippo M, Bartalena T et al (2010) High-resolution computed tomography in the diagnosis and follow-up of idiopathic pulmonary fibrosis. Radiol Med 115:526–538

    Article  PubMed  CAS  Google Scholar 

  4. Elicker BM, Golden JA, Ordovas KG et al (2010) Progression of native lung fibrosis in lung transplant recipients with idiopathic pulmonary fibrosis. Respir Med 104:426–433

    Article  PubMed  Google Scholar 

  5. Arakawa H, Honma K (2011) Honeycomb lung: history and current concepts. AJR Am J Roentgenol 196:773–782

    Article  PubMed  Google Scholar 

  6. Akira M, Sakatani M, Ueda E (1993) Idiopathic pulmonary fibrosis: progression of honeycombing at thinsection CT. Radiology 189:687–691

    PubMed  CAS  Google Scholar 

  7. Mino M, Noma S, Kobashi Y et al (1995) Serial changes of cystic air spaces in fibrosing alveolitis: a CT-pathological study. Clin Radiol 50:357–363

    Article  PubMed  CAS  Google Scholar 

  8. Krishnam MS, Suh RD, Tomasian A et al (2007) Postoperative complications of lung transplantation: radiologic findings along a time continuum. Radiographics 27:957–974

    Article  PubMed  Google Scholar 

  9. Verleden GM, Fisher AJ (2011) Lung transplantation and lung cancer: is there a link? Respiration 81:441–445

    Article  PubMed  Google Scholar 

  10. Dalpiaz G, Cancellieri A, Stasi G (2010) Fibrosi polmonare idiopatica. Radiol Med 115(Suppl):S130–S138

    Google Scholar 

  11. Zompatori M, Sverzellati N (2010) La polmonite interstiziale non specifica (NSIP). Radiol Med 115(Suppl):S139–S143

    Google Scholar 

  12. Lynch DA, Travis WD, Müller NL et al (2005) Idiopathic interstitial pneumonias: CT features. Radiology 236:10–21

    Article  PubMed  Google Scholar 

  13. Maffesanti M. (2004) Malattie infiltrative diffuse: clinica, anatomia patologica, HRTC. Springer Italia, Milano

    Google Scholar 

  14. Hansell DM, Bankier AA, MacMahon H et al (2008) Fleischner society: glossary terms for thoracic imaging. Radiology 246:697–722

    Article  PubMed  Google Scholar 

  15. Genereux GP (1975) The end-stage lung. Radiology 116:279–285

    PubMed  CAS  Google Scholar 

  16. Johkoh T, Müller NL, Ichikado K et al (1999) Respiratory change in size of honeycombing: inspiratory and expiratory spiral volumetric CT analysis of 97 cases. J Comput Assist Tomogr 23:174–180

    Article  PubMed  CAS  Google Scholar 

  17. Heppleston AG (1956) The pathology of honeycomb lung. Thorax 11:77–93

    Article  PubMed  CAS  Google Scholar 

  18. Lee KN, Yoon SK, Choi SJ et al (2000) Cystic lung disease: a comparison of cystic size, as seen on expiratory and inspiratory HRCT scans. Korean J Radiol 1:84–90

    Article  PubMed  CAS  Google Scholar 

  19. Worthy SA, Brown MJ, Müller NL (1998) Technical report: cystic air spaces in the lung: change in size on expiratory high-resolution CT in 23 patients. Clin Radiol 53:515–519

    Article  PubMed  CAS  Google Scholar 

  20. Aquino SL, Webb WR, Zaloudek CJ et al (1994) Lung cysts associated with honeycombing: change in size on expiratory CT scans. AJR Am J Roentgenol 162:583–584

    PubMed  CAS  Google Scholar 

  21. Neurohr C, Huppmann P, Thum D et al (2010) Potential functional and survival benefit of double over single lung transplantation for selected patients with idiopathic pulmonary fibrosis. Transpl Int 23:887–896

    PubMed  Google Scholar 

  22. Mal H, Brugière O, Dauriat G et al (2005) Lung transplantation in patients with pulmonary fibrosis. Rev Pneumol Clin 61:232–238

    Article  PubMed  Google Scholar 

  23. Christie JD, Edwards LB, Kucheryavaya AY et al (2010) The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult lung and heart-lung transplant report—2010. J Heart Lung Transplant 29:1104–1118

    Article  PubMed  Google Scholar 

  24. Nagao T, Nagai S, Hiramoto Y et al (2002) Serial evaluation of high-resolution computed tomography findings in patients with idiopathic pulmonary fibrosis in usual interstitial pneumonia. Respiration 69:413–419

    Article  PubMed  Google Scholar 

  25. Wahidi MM, Ravenel J, Palmer SM et al (2002) Progression of idiopathic pulmonary fibrosis in native lungs after single lung transplantation. Chest 121:2072–2076

    Article  PubMed  Google Scholar 

  26. Grgic A, Lausberg H, Heinrich M et al (2008) Progression of fibrosis in usual interstitial pneumonia: serial evaluation of the native lung after single transplantation. Respiration 76:136–145

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiologia Cardio-Toracica, Policlinico S. Orsola-Malpighi, Bologna, Italy

    G. Mineo, F. Ciccarese, D. Attinà, V. Di Scioscio, N. Sciascia, L. Bono & M. Zompatori

  2. U.O. Pneumologia e Terapia Intensiva, Policlinico S. Orsola-Malpighi, Bologna, Italy

    A. Rocca

  3. U.O. Chirurgia Toracica, Policlinico S. Orsola-Malpighi, Bologna, Italy

    F. Stella

Authors
  1. G. Mineo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Ciccarese
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Attinà
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Di Scioscio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Sciascia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Bono
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Rocca
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F. Stella
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Zompatori
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Mineo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mineo, G., Ciccarese, F., Attinà, D. et al. Natural history of honeycombing: follow-up of patients with idiopathic pulmonary fibrosis treated with single-lung transplantation. Radiol med 118, 40–50 (2013). https://doi.org/10.1007/s11547-012-0810-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-012-0810-4

Keywords

Parole chiave

Search

Navigation