An autopsy study of combined pulmonary fibrosis and emphysema: correlations among clinical, radiological, and pathological features
| Autor: | Yuji Kusunoki, Hiroyuki Kamiya, Nobuyasu Awano, Masahiro Masuo, Tamiko Takemura, Noriyo Yanagawa, Atsuko Moriya, Takashi Ogura, Keisuke Kondoh, Kohta Satake, Toshio Kumasaka, Arata Azuma, Soichiro Ikushima, Fumikazu Sakai, Akihiko Gemma, Minoru Inomata, Tsunehiro Ando |
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| Rok vydání: | 2013 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male Fibroblastic foci medicine.medical_specialty Pathology Exacerbation Pulmonary Fibrosis Vital Capacity Autopsy Idiopathic pulmonary fibrosis Combined pulmonary fibrosis and emphysema Forced Expiratory Volume Pulmonary fibrosis medicine Humans Pathological Aged Retrospective Studies Aged 80 and over Emphysema Carbon Monoxide business.industry Cysts Retrospective cohort study respiratory system Middle Aged medicine.disease respiratory tract diseases Pulmonary Emphysema Radiological weapon Thick-walled cystic lesion Pulmonary Diffusing Capacity Female Radiology business Tomography X-Ray Computed Research Article |
| Zdroj: | BMC Pulmonary Medicine |
| ISSN: | 1471-2466 |
| Popis: | Background Clinical evaluation to differentiate the characteristic features of pulmonary fibrosis and emphysema is often difficult in patients with combined pulmonary fibrosis and emphysema (CPFE), but diagnosis of pulmonary fibrosis is important for evaluating treatment options and the risk of acute exacerbation of interstitial pneumonia of such patients. As far as we know, it is the first report describing a correlation among clinical, radiological, and whole-lung pathological features in an autopsy cases of CPFE patients. Methods Experts retrospectively reviewed the clinical charts and examined chest computed tomography (CT) images and pathological findings of an autopsy series of 22 CPFE patients, and compared these with findings from 8 idiopathic pulmonary fibrosis (IPF) patients and 17 emphysema-alone patients. Results All patients had a history of heavy smoking. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC%) was significantly lower in the emphysema-alone group than the CPFE and IPF-alone groups. The percent predicted diffusing capacity of the lung for carbon monoxide (DLCO%) was significantly lower in the CPFE group than the IPF- and emphysema-alone groups. Usual interstitial pneumonia (UIP) pattern was observed radiologically in 15 (68.2%) CPFE and 8 (100%) IPF-alone patients and was pathologically observed in all patients from both groups. Pathologically thick-cystic lesions involving one or more acini with dense wall fibrosis and occasional fibroblastic foci surrounded by honeycombing and normal alveoli were confirmed by post-mortem observation as thick-walled cystic lesions (TWCLs). Emphysematous destruction and enlargement of membranous and respiratory bronchioles with fibrosis were observed in the TWCLs. The cystic lesions were always larger than the cysts of honeycombing. The prevalence of both radiological and pathological TWCLs was 72.7% among CPFE patients, but no such lesions were observed in patients with IPF or emphysema alone (p = 0.001). The extent of emphysema in CPFE patients with TWCLs was greater than that in patients without such lesions. Honeycombing with emphysema was also observed in 11 CPFE patients. Conclusions TWCLs were only observed in the CPFE patients. They were classified as lesions with coexistent fibrosing interstitial pneumonia and emphysema, and should be considered an important pathological and radiological feature of CPFE. |
| Databáze: | OpenAIRE |
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