A 61-year-old man was discharged from our hospital after recovering from bilateral fractures in the neck of each femur. However, a productive cough, dyspnea, and a high grade fever occurred eight hours after returning home. He was thus admitted once more. At rehospitalization, there was radiographic evidence of bilateral infiltrates and hypoxemia. Hypersensitivity pneumonitis was strongly suggested by radiographic evidence, by the fact that no new drugs had been administered, and by a positive result after an environmental provocation test. A diagnosis of humidifier lung was confirmed by a positive precipitins test for humidifier water. Several microorganisms were isolated from humidifier water, and precipitins tests for the isolated microorganisms were mostly positive. Microscopic examination revealed focal alveolitis, bronchiolitis, and perivasculitis. Perivascular leucocytic infiltrations around venules suggested that inhaled antigens might have also caused humidifier lung via a vascular route. Humidifier lung may be due in part to soluble factors, such as endotoxin, present in humidifier water.
CT findings following pneumonectomy were studied in 28 cases with lung cancer. A total of 53 CT images were evaluated in 13 right pneumonectomy cases and 15 left pneumonectomy patients. The postpneumonectomy pleural space (PS), thoracic space of the operated site (TS) and the thoracic space of the non-operated site (CTS) were measured at 3 slice levels of the brachiocephalic level, subcarinal level and lower pulmonary vein level, using a digital planimeter. There was no significant difference in the TS/CTS ratio, between the right pneumonectomy group and the left pneumonectomy group, but the PS/TS ratio in the left pneumonectomy group was smaller than that in the right pneumonectomy group (p less than 0.01). The PS/TS ratio in both groups and the TS/CTS ratio in the right pneumonectomy group were decreased with time. In the left pneumonectomy group, the TS/CTS ratio was greater in the median sternotomy group that of the posterolateral thoracotomy group (p less than 0.01). Residual pleural effusion was accompanied with a thin circulating lesion along the outer surface. This lesion had been reported as thickening of the parietal pleura, but it could be detected in the case of panpleuropneumonectomized state. Additionally, in some cases, the parietal pleural imaging could be separated from the circulating lesion. So, this structure was thought to be mainly composed of organized effusion. CT images could detect some parts of the episodes in post operated thorax, because of the lack of the information with the sagittal direction. However, the recognition of the common changes and images on CT after the operation might be helpful for the follow-up of the patients.
Despite the relatively high cost and complicated procedures, Gallium-67 (67Ga) scanning and bronchoalveolar lavage (BAL) are increasingly advocated as more sensitive indicators of disease activity in sarcoidosis than chest X-ray and serum angiotensin-converting enzyme activity (SACE). To evaluate the clinical usefulness of 67Ga scanning and BAL, we followed 31 patients with pulmonary sarcoidosis, using these four parameters, at 9- to 24-month intervals over periods of 9 to 48 months. We obtained 68 complete evaluations. Close correlations were observed among chest X-ray, 67Ga scanning, SACE, and the percentage of lymphocytes in BAL fluid (p less than 0.1 to 0.001). Longitudinal changes were also well correlated in these four parameters (p less than 0.001) and paralleled the changes in vital capacity (p less than 0.01 to 0.001). However, we were unable to predict the patients' outcome from the initial evaluation of these four parameters. These results suggest that, in terms of their usefulness for estimating disease activity, the differences among these four indicators are negligible. We therefore conclude that chest X-ray and SACE sufficiently reflect disease activity and that, at present, routine evaluation by 67Ga scanning and BAL are not necessarily indicated in the long-term management of pulmonary sarcoidosis.
An increased incidence of lung cancer and epithelial metaplasia or hyperplasia which is felt to be as a precursor of cancer, has been reported in patients with idiopathic pulmonary fibrosis (IPF). In this study, carcinoembryonic antigen (CEA) in bronchoalveolar lavage (BAL) fluid was measured in 53 control patients, 31 patients with sarcoidosis, 10 patients with hypersensitivity pneumonitis, 16 patients with primary lung cancer and 26 patients with histologically confirmed IPF. High ratio of CEA to albumin (Alb), exceeding mean + 2SD of nonsmoking control patients, were found in 8 (25%) out of 32 smoking control patients, 4 (44%) out of 9 nonsmoking patients with IPF, 8 (62%) out of 13 smoking patients with IPF, 3 (75%) out of 4 smoking patients with IPF and lung cancer and 13 (81%) out of 16 patients with primary lung cancer, although BAL was performed at the noncancerous parts of the lung in the cases of lung cancer. Furthermore, it was confirmed that CEA increased in BAL fluid in these subjects were different from nonspecific cross-reacting antigen (NCA) which was detectable in the normal lung. Thus we consider that the increase of CEA/Alb ratio in BAL fluid is a possible marker of these early histological disorders in the lung, and also suggests a greater risk of malignant change in the clinical course of IPF.
