Isolated anthracosis: benign but neglected cause of bronchial stenosis and obstruction

Transcription

1 Isolated anthracosis: benign but neglected cause of bronchial stenosis and obstruction Poster No.: C-0143 Congress: ECR 2013 Type: Scientific Exhibit Authors: S. Kahkouee, R. Pourghorban, M. Bitarafan, K. Najafizadeh, S. S. Mohammad Makki; Tehran/IR Keywords: DOI: Lung, CT, Diagnostic procedure, Occupational / Environmental hazards /ecr2013/C-0143 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 9

2 Purpose Anthracosis has been regarded as black pigmentation in bronchial mucosa visible on bronchoscopy, or based on histological findings and it is characteristically related to the presence of pneumoconiosis or heavy exposure to atmospheric carbon or soot particles. The authors use the term "isolated anthracosis" to describe bronchial dark tattoos found in bronchoscopic assessment or black pigmentation within macrophages of bronchial mucosa in patients whose pulmonary evaluation for tuberculosis, neoplasm or other apparent lung pathologies was negative. Given the prevalence of anthracosis in elderly patients and some common imaging features between lung cancer and anthracosis, familiarity with computed tomography (CT) findings of anthracosis will be useful in improving the diagnostic accuracy. In this poster, we investigated CT features of patients with proved isolated anthracosis. Methods and Materials In this study, 111 patients with proved anthracosis, based on bronchial biopsy results at bronchoscopy, were enrolled. After excluding those with tuberculosis, malignancy, smoking-related lung diseases and chronic bronchitis, 58 patients (male, 29; female, 29; mean age, 70.2; smoker, 12); designated as isolated anthracosis, were enrolled and their imaging features were reviewed by two radiologists, expert in chest imaging with consensus. The CT analysis included central peribronchial soft tissue, intraparenchymal peribronchial cuffing, bronchial narrowing or obstruction, atelectasis, air trapping, mosaicism, lymph nodes involvement and other visible imaging findings as well as the location of the lesions. Results We highlighted central peribronchial soft tissue thickening (figure 1) (63.8%) and intraparenchymal peribronchial cuffing (figure 2) (62%) as important imaging findings, causing bronchial narrowing (63.8%) or obstruction (19%). Bronchial narrowing affected multiple bronchi in some cases (two bronchi, 12 patients; three bronchi, 9 patients; five bronchi, 2 patients). As a result, segmental atelectasis (46.6%), lobar (22.4%) or multilobar (3.4%) collapses were ensued. The mentioned findings mostly occurred in the right lung, with a predominance of right middle lobe (RML) (figure 3). Interestingly, the most common extraparanchymal imaging findings in patients with isolated anthracosis were mediastinal and peribronchial lymphadenopathies, detected in 56 (96.5%) and 46 (79.3%) patients, 47 (84%) and 39 (85%) of whom were calcified, respectively. Pressure effect on adjacent bronchi by calcified lymph nodes was detected in 21 (36.2%) cases Page 2 of 9

3 while suspicious calcified lymph nodes protrusion (figure 4) into the lumen of adjacent bronchi occurred in 10 subjects. Thirty-two (55.2%) patients showed consolidation; among them, 12 (20.7%) patients revealed multilobar involvement. Solitary and multiple pulmonary nodules were detected in 11 (19%) and 18 (31%) patients, respectively and nodular infiltration was seen in 27 (46.6%) patients. Other findings included fibrotic bands (53.4%), mosaicism (36.2%), pleural effusion (29.3%), pleural thickening (24.1%) and reticular infiltration (22.4%). Prevalence of various CT findings is illustrated in figure 5. Images for this section: Fig. 1: 60-year-old female with cough. Post-contrast chest CT at the level of main pulmonary artery shows bilateral central peribronchial soft tissue thickening (arrows) with associated stenosis of adjacent bronchi. Page 3 of 9

4 Fig. 2: 64-year-old female with cough and dyspnea. CT with lung window demonstrates intraparenchymal peribronchial cuffing (arrows). Page 4 of 9

5 Fig. 3: 64-year-old female with cough and dyspnea. Chest CT with lung window reveals stenosis of RML bronchus (arrow) with central peribronchial soft tissue. LUL and LLL bronchi were also involved (not shown). Page 5 of 9

6 Fig. 4: 64-year-old female with cough and dyspnea. Chest CT shows calcified lymph node with intraluminal suspicious protrusion into LUL bronchus (arrow). Page 6 of 9

7 Fig. 5: Prevalence of different CT findings in 58 patients with anthracosis (LN, Lymph Node). Page 7 of 9

8 Conclusion Central peribronchial soft tissue thickening and intraparenchymal peribronchial cuffing in patients with anthracosis might lead to bronchial narrowing or obliteration and consequently, lobar, segmental or subsegmental atelectasis. Although these findings may raise the suspicion of malignancy in elderly patients; the diagnosis of anthracosis may also be considered, with regard to its multiple sites of involvement with a predominance of right side, especially RML and other associated mentioned findings. References 1. Chung MP, Lee KS, Han J, et al. Bronchial stenosis due to anthracofibrosis. Chest. 1998;113: Kim HY, Im JG, Goo JM, et al. Bronchial anthracofibrosis (inflammatory bronchial stenosis with anthracotic pigmentation): CT findings. AJR. 2000;174: Long R, Wong E, Barrie J. Bronchial anthracofibrosis and tuberculosis: CT features before and after treatment. AJR. 2005;184:[suppl]S33-S Park HJ, Park SH, Im SA, Kim YK, Lee K. CT differentiation of anthracofibrosis from endobronchial tuberculosis. AJR. 2008;191: Wynn GJ, Turkington PM, O'Driscoll BR. Anthracofibrosis, bronchial stenosis with overlying anthracotic mucosa: possibly a new occupational lung disorder; a series of seven cases from one UK hospital. Chest. 2008;134: Naccache JM, Monnet I, Nunes H, et al. Anthracofibrosis attributed to mixed mineral dust exposure: report of three cases. Thorax. 2008;63: Kim JY, Park JS, Kang MJ, et al. Endobronchial anthracofibrosis is causally associated with tuberculosis. Korean J Intern Med. 1996;51: Najafizadeh K, Zahirifard S, Mohammadi F, et al. Bronchial anthracofibrosis or anthracotic bronchitis. Tanaffos. 2003;2:7-11. Personal Information Shahram Kahkouee, MD, Department of Radiology, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Page 8 of 9

9 Ramin Pourghorban, MD (presenter and submitter), Department of Radiology, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Zip code: Tel: Fax: Mahdi Bitarafan, MD, Department of Radiology, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Katayoun Najafizadeh, MD, Department of Pulmonary Medicine, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyed Shahabeddin Mohammad Makki, MD, Department of Pulmonary Medicine, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Page 9 of 9