• Tuberculosis and Respiratory Diseases
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• v.48 no.6
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• pp.932-943
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• 2000

Background : Nonspecific interstitial pneumonitis (NSIP) is most likely to be confused with usual interstitial pneumonitis (UIP). Unlike patients witþ UIP, the majority of patients with NSIP have a good prognosis, with most patients improving after treatment with corticosteroids. Therefore it is clinically important to differentiate NSIP from UIP. Up to now, the only means of differentiating these two diseases was by means of surgical lung biopsy. American Thoracic Society (ATS) proposed a clinical diagnostic criteria for UIP to provide assistance to clinicians in its diagnosis without surgical lung biopsy. This study is aimed to investigate whether there were clinical and radiological differences between NSIP and UIP, and the usefulness of ATS clinical diagnostic criteria for UIP in Korea. Methods : We studied 60 patients with UIP and NSIP confirmed by surgical lung biopsy. Clinical manifestations, pulmonary function test, arterial blood gas analysis, bronchoalveolar lavage (BAL), and high resolution computed tomography (HRCT) were evaluated and analyzed by Chi-square test or t-test. The clinical criteria for UIP proposed by ATS were applied to all patients with idiopathic interstitial pneumonia. Results : Forty-two patients with UIP and 18 with NSIP were pathologically identified. Among the 18 patients with NSIP (M : F=1 : 17), the mean age was 55.2$\pm$8.4 (44~73) yr. Among the 42 patients with UIP (M : F=33 : 9), the mean age was 59.5$\pm$7.1 (45~74) yr (p=0.046). Fever was more frequent in NSIP (39%) (p=0.034), but clubbing was frequently observed in UIP (33%) (p=0.023). BAL lymphocytosis was more frequent (23%) (p=0.0001) and CD4/CD8 ratio was lower in NSIP (p=0.045). On HRCT, UIP frequently showed honeycomb appearance (36 of 42 patients) though not in NSIP (p=0.0001). Six of 42 UIP patients (14.3%) met the ATS clinical criteria for IPF, and 3 of 16 NSIP patients (18.8%) met the diagnostic criteria. Conclusion : Being a relatively young female and having short duration of illness, fever, BAL lymphocytosis, low CD4/CD8 ratio with the absence of clubbing and honeycomb appearance in HRCT increase the likelihood of the illness being NSIP. The usefulness of ATS clinical diagnostic criteria for UIP may be low in Korea.

• Tuberculosis and Respiratory Diseases
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• v.77 no.2
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• pp.81-84
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• 2014

A patient treated with venlafaxine for major depression developed an interstitial lung disease (ILD) with the characteristic clinical, radiological and pathological features of chronic hypersensitivity pneumonitis. A high resolution computed tomography scan demonstrated ground glass opacity, mosaic perfusion with air-trapping and traction bronchiectasis in both lungs. The pathological findings were consistent with a nonspecific interstitial pneumonia pattern. Clinical and radiological improvements were noted after the discontinuation of venlafaxine and the administration of a corticosteroid. This report provides further evidence that the anti-depressant venlafaxine can cause ILD.

• Tuberculosis and Respiratory Diseases
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• v.70 no.1
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• pp.43-50
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• 2011

Background: Open lung biopsy is used for diagnosis of diffuse infiltrative lung diseases (DILD), but it is invasive and relatively expensive procedure. Fluoroscopy-guided cutting needle lung biopsy (FCNLB) has merits of avoidance of admission and rapid diagnosis. But diagnostic accuracy and safety were not well known in the diagnosis of DILD. Methods: We included 52 patients (37 men, 15 women) having DILD on HRCT with dyspnea, except the patients who could be confidently diagnosed with clinical and HRCT findings. FCNLB was performed using 16G Ace cut needle (length 1.5 cm, diameter 2 mm) at the area of most active lesion on HRCT. Final diagnoses were made by the consensus. Results: The mean interval between the HRCT and FCNLB was 4.5 days. Most cases were performed one biopsy during 5~10 minutes. Specific diagnosis was obtained in 43 of 52 biopsies (83%). The most common diagnosis was nonspecific interstitial pneumonia (11 cases) and followed by cryptogenic organizing pneumonia (7 cases), diffuse alveolar hemorrhage and usual interstitial pneumonia (5 cases in each), hypersensitivity pneumonitis (3 cases), tuberculosis and drug induced interstitial pneumonitis (2 cases in each), the others are in one respectively. Mild complication was developed in 9 patients (8 pneumothorax, 1 hemoptysis). Most of complications were regressed without treatment except one case with chest tube insertion for pneumothorax. Conclusion: Fluoroscopy-guided 16 G cutting needle lung biopsy was an useful method for the diagnosis of DILD.

• Journal of the Korean Society of Radiology
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• v.82 no.4
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• pp.817-825
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• 2021

Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) characterized by an inhaled inciting antigen that leads to the inflammation of the lung parenchyma and small airway with immunologic reactions. Over the last decades, the most effective therapeutic option for HP has been limited to antigen avoidance. The differential diagnosis of HP from other ILDs is the beginning of treatment as well as diagnosis. However, the presence of several overlapping clinical and radiologic features makes differentiating HP from other ILDs particularly challenging. In 2020, a multidisciplinary committee of experts from the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax suggested a new clinical practice guideline classifying HP into nonfibrotic and fibrotic phenotypes on the basis of chest high-resolution CT (HRCT) findings. Therefore, we introduced a new diagnostic algorithm based on chest HRCT in the clinical practice guideline for the diagnosis of HP.

• Journal of Environmental Health Sciences
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• v.38 no.6
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• pp.451-459
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• 2012

Background: In Korea, a healthy 36-year-old man developed acute interstitial pneumonitis soon after inhaling a waterproofing spray which he had applied at home to his outdoor jacket. Objectives: The objectives of this study were to review cases of varying degrees of respiratory toxicity and poisoning in connection with the use of waterproofing spray and summarize major reasons for cases of poisoning. Methods: We searched articles reporting on a combination of a waterproofing agent and/or respiratory symptoms, including acute respiratory syndrome, lung injury, pneumonia, pulmonary toxicity, and respiratory disease. Results: We reviewed a number of cases of varying degrees of respiratory toxicity and poisoning resulting from inhalation of waterproofing spray containing fluorocarbon co-polymer, solvents and propellants reported in a variety of countries. The literature searches concluded that among the ingredients of waterproofing agents, fluorinated polymer may cause acute respiratory health effects. Conclusion: Environmental policy should be implemented in order to prevent consumers from using household and industrial products including waterproofing agents. In addition, a national surveillance system should be created to collect cases of poisoning caused by the use of consumer products.

• Tuberculosis and Respiratory Diseases
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• v.47 no.6
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• pp.843-849
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• 1999

The prevalence of nonspecific interstitial pneumonitis(NSIP) in HIV-positive patients with pulmonary disease has varied from 11 to 38%. But NSIP in HIV-positive patients is indistinguishable from Pneumocystis carinii pneumonia(PCP) clinically and radiologically. The number of HIV-positive patients is less in Korea than in western developed countries, so little attention has been paid to the differential diagnosis between NSIP and PCP. We report a case of NSIP in HIV-positive, 61-year-old man which mimicked PCP. He presented with cough, sputum and mild exertional dyspnea. Lung sound was clear. But, chest X-ray and HRCT demonstrated diffuse patch and bilateral ground-glass opacities in central and perihilar area of both lung. Microbial pathogens were not found on sputum, BAL fluid and tissues taken by TBLB. In transbronchial lung biopsy specimen, interstitial infiltrates with lymphocytes were distributed on peribronchiolar regions. A pathologic diagnosis of NSIP was suggested, he received symptomatic treatment. The follow-up chest X-ray showed near complete resolution.

• Tuberculosis and Respiratory Diseases
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• v.54 no.3
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• pp.338-345
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• 2003

A 65-year-old man was admitted due to low grade fever, dry coughing, and dyspnea on exertion. The chest radiograph and CT scan showed diffuse ground glass opacities and small nodules in the both lung fields resulting in a diagnosis of severe interstitial pneumonia. Conservative treatment with antibiotics and bronchodilators decreased the symptoms, but the dyspnea and cough reappeared when he returned home. An inspection of his house revealed the presence of fungi under the wallpaper. His symptoms disappeared completely after these were removed. His clinical course raised the suspicion of hypersensitivity pneumonitis and these fungi believed to be the cause of hypersensitivity pneumonitis. The histological findings of a lung specimen by video-assisted thorachoscopy were compatible with hypersensitivity pneumonitis. The fungi were identified as Alternaria.

• Tuberculosis and Respiratory Diseases
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• v.39 no.1
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• pp.89-94
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• 1992

A 16 years old girl with systemic lupus erythematosus had a high fever for 20 days. Skin and renal biopsy showed diffuse granular deposits (IgG, IgM, $C_3$, $C_{1q}$ at dermo-epideral junction and IgG, IgA, IgM, $C_3$, $C_{1q}$, fibrinogen in the renal mesangium and segmentally along the capillary walls) which were compatable with systemic lupus erythematosus. The chest X-ray revealed patchy mottled densities in whole lung field when she complained more dyspnea at 9th hospital days. Even with the parenteral administration of broad-spectrum antibiotics, the symptoms of high fever, cough, tachydyspnea and hypoxia were continued. At 24th hospital day, the clinical course was rapidly deteriorated after sudden loss of consciousness with focal seizure which suggested CNS involvement during hydrocortisone administration for 10 days. She died of respiratory failure despite the mechanical ventilatory support with PEEP. The limited necropsy showed interstitial pneumonia, alveolar hemorrhage and occlusive necrotizing vasculitis of acute lupus pneumonitis.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.602-609
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• 1993

Lymphocytic interstitial pneumonitis (LIP) is one of parenchymal pulmonary infiltrative diseases first described at 1966 by Carrington and Liebow. In LIP, there is a predominance of mature small lymphocytes in the interstitium of the lung which form germinal centers. The disease process surrounds, but dose not invade lung parenchyme, tracheobronchial tree and vascular structures. The etiology remains still unknown and the clinical features of this disorder have not been clearly defined. Therefore, the therapeutic modality is obscure. Development of LIP association with AIDS is often reported currently and possibility of progress to malignant lymphoma is emphasized. We experienced a case of primary LIP with pnemomediastinum. She was adimitted due to chest and anterior nuchal pain with chronic coughing, and diagnosed as pneumomediastinum with LIP. Medication with steroid was begun and some improvement of symptoms was observed, but an X-ray film of the chest remained same without improvement. We report above case with review of the literatures.

• Tuberculosis and Respiratory Diseases
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• v.74 no.1
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• pp.32-36
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• 2013

A 43-year-old woman with breast cancer who was on neoadjuvant chemotherapy presented with cough, sputum and mild fever. High-resolution computed tomography showed diffuse ground glass opacities in bilateral lungs and subpleural patchy consolidations. Initially, she was thought to have pneumonia or interstitial lung diseases such as drug-induced pneumonitis and treated with antibiotics and steroids. She subsequently got breast cancer surgery because of disease progression, and concurrent thoracoscopic lung biopsy revealed metastatic carcinoma of the lung from breast cancer. The diagnosis of suspected interstitial lung disease can be made without lung biopsy, but malignancy should always be considered and lung biopsy should be performed in the absence of a definitive clinical diagnosis.