Limits...
Pulmonary involvement in systemic sclerosis: an imaging study from kashmir.

Hassan I, Nisa N, Hamid M - Indian J Dermatol (2015 Jan-Feb)

Bottom Line: The differences in these parameters between the two groups were statistically significant, while the differences for mean skin tethering index, mean disease duration and female/male sex ratio were statistically meaningless.Most common HRCT finding observed in the study was ground glass opacities (GGO) (9/20).Only 4 of total 9 patients who had only GGO in HRCT were symptomatic for respiratory involvement as compared to 100% (11/11) in the group who had HRCT findings other than or in addition to GGO.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, STD and Leprosy, Shri Maharaja Hari Singh Hospital, Srinagar, Jammu and Kashmir, India.

ABSTRACT

Background: Systemic sclerosis (SS) is a chronic, multisystem collagen vascular disorder of undefined etiology, whose prognosis and overall survival is determined by visceral especially the lung involvement.

Aim: To evaluate the pulmonary involvement in SS by imaging methods.

Materials and methods: Clinical examination, pulmonary function tests, chest X-ray and high resolution computed tomography (HRCT) scans were carried out in a series of 25 patients prospectively over a period of 3 years (2009-2011AD).

Results: Of the total 25 patients of the study, the group with abnormal HRCT chest (n = 20), 16 had clinical symptoms of respiratory involvement, only 7 had an abnormal chest X-ray and 15 had abnormal forced expiratory volume/forced vital capacity (FEV1/FVC) spirometric parameter. While the group with normal HRCT chest (n = 5), 1 had clinical symptoms of respiratory involvement and 4 had abnormal FEV1/FVC spirometric parameter. The differences in these parameters between the two groups were statistically significant, while the differences for mean skin tethering index, mean disease duration and female/male sex ratio were statistically meaningless. Most common HRCT finding observed in the study was ground glass opacities (GGO) (9/20). Only 4 of total 9 patients who had only GGO in HRCT were symptomatic for respiratory involvement as compared to 100% (11/11) in the group who had HRCT findings other than or in addition to GGO.

Conclusion: The HRCT outscores Chest X-ray in detecting early lung involvement in SS patients more so early in the course of the disease thereby underscoring its importance in identifying SS patients who will be potential candidates for early institution of therapy that might reverse/limit pulmonary involvement by the disease.

No MeSH data available.


Related in: MedlinePlus

Ground glass opacities in association with fine reticular pattern and bronchiectasis changes
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4318021&req=5

Figure 2: Ground glass opacities in association with fine reticular pattern and bronchiectasis changes

Mentions: Most studies show that up to two thirds of patients suffering from SS present with pulmonary disease with effort dyspnoea being the most usual respiratory symptom, many times associated with dry cough.[4] We found pulmonary involvement in 80% (20/25) of cases on HRCT as against 16% (4/25) on chest X-ray. Among patients with documentation of pulmonary involvement on HRCT, predominant patterns of involvement included ground-glass opacities (11 of total 20 abnormal scans) followed by reticular pattern and traction bronchiectasis (6 of total 20 abnormal scans) [Figure 1]. Ground-glass appearance was the most common HRCT finding, observed in total 11 scans with it being an exclusive finding in 9 scans [Figures 2 and 4]. Of the 9 patients in whom an exclusive GGO was observed in HRCT scans near 50% lack clinical symptoms of pulmonary involvement. Against any other HRCT finding GGO is the only HRCT pattern which is as commonly found in clinically asymptomatic patients as it is found in symptomatic patients. This is in remarkable contrast to chest X-ray which was normal in all asymptomatic patients. Practically such observations would mean that presence of effort dyspnoea and/or dry cough in patients with SS reflects overt pulmonary fibrosis and that HRCT evaluation of the chest should document such findings in almost all such cases. Such results are in concurrence with what has been documented in the literature. In the long run, GGO on HRCT usually progress to overt fibrosis. Furthermore, the finding of ground glass appearance of pulmonary parenchyma on HRCT in a few patients who had no pulmonary symptoms and its presence in significant number of those patients who had HRCT evidence of frank fibrosis 18% (2/11) might hint at it representing a harbinger of pulmonary fibrosis. This inference has also been suggested by various authors.[5] In view of above finding the authors believe that GGO in HRCT of SS patients can be used as a radiological marker of impending ILD.


Pulmonary involvement in systemic sclerosis: an imaging study from kashmir.

Hassan I, Nisa N, Hamid M - Indian J Dermatol (2015 Jan-Feb)

Ground glass opacities in association with fine reticular pattern and bronchiectasis changes
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318021&req=5

Figure 2: Ground glass opacities in association with fine reticular pattern and bronchiectasis changes
Mentions: Most studies show that up to two thirds of patients suffering from SS present with pulmonary disease with effort dyspnoea being the most usual respiratory symptom, many times associated with dry cough.[4] We found pulmonary involvement in 80% (20/25) of cases on HRCT as against 16% (4/25) on chest X-ray. Among patients with documentation of pulmonary involvement on HRCT, predominant patterns of involvement included ground-glass opacities (11 of total 20 abnormal scans) followed by reticular pattern and traction bronchiectasis (6 of total 20 abnormal scans) [Figure 1]. Ground-glass appearance was the most common HRCT finding, observed in total 11 scans with it being an exclusive finding in 9 scans [Figures 2 and 4]. Of the 9 patients in whom an exclusive GGO was observed in HRCT scans near 50% lack clinical symptoms of pulmonary involvement. Against any other HRCT finding GGO is the only HRCT pattern which is as commonly found in clinically asymptomatic patients as it is found in symptomatic patients. This is in remarkable contrast to chest X-ray which was normal in all asymptomatic patients. Practically such observations would mean that presence of effort dyspnoea and/or dry cough in patients with SS reflects overt pulmonary fibrosis and that HRCT evaluation of the chest should document such findings in almost all such cases. Such results are in concurrence with what has been documented in the literature. In the long run, GGO on HRCT usually progress to overt fibrosis. Furthermore, the finding of ground glass appearance of pulmonary parenchyma on HRCT in a few patients who had no pulmonary symptoms and its presence in significant number of those patients who had HRCT evidence of frank fibrosis 18% (2/11) might hint at it representing a harbinger of pulmonary fibrosis. This inference has also been suggested by various authors.[5] In view of above finding the authors believe that GGO in HRCT of SS patients can be used as a radiological marker of impending ILD.

Bottom Line: The differences in these parameters between the two groups were statistically significant, while the differences for mean skin tethering index, mean disease duration and female/male sex ratio were statistically meaningless.Most common HRCT finding observed in the study was ground glass opacities (GGO) (9/20).Only 4 of total 9 patients who had only GGO in HRCT were symptomatic for respiratory involvement as compared to 100% (11/11) in the group who had HRCT findings other than or in addition to GGO.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, STD and Leprosy, Shri Maharaja Hari Singh Hospital, Srinagar, Jammu and Kashmir, India.

ABSTRACT

Background: Systemic sclerosis (SS) is a chronic, multisystem collagen vascular disorder of undefined etiology, whose prognosis and overall survival is determined by visceral especially the lung involvement.

Aim: To evaluate the pulmonary involvement in SS by imaging methods.

Materials and methods: Clinical examination, pulmonary function tests, chest X-ray and high resolution computed tomography (HRCT) scans were carried out in a series of 25 patients prospectively over a period of 3 years (2009-2011AD).

Results: Of the total 25 patients of the study, the group with abnormal HRCT chest (n = 20), 16 had clinical symptoms of respiratory involvement, only 7 had an abnormal chest X-ray and 15 had abnormal forced expiratory volume/forced vital capacity (FEV1/FVC) spirometric parameter. While the group with normal HRCT chest (n = 5), 1 had clinical symptoms of respiratory involvement and 4 had abnormal FEV1/FVC spirometric parameter. The differences in these parameters between the two groups were statistically significant, while the differences for mean skin tethering index, mean disease duration and female/male sex ratio were statistically meaningless. Most common HRCT finding observed in the study was ground glass opacities (GGO) (9/20). Only 4 of total 9 patients who had only GGO in HRCT were symptomatic for respiratory involvement as compared to 100% (11/11) in the group who had HRCT findings other than or in addition to GGO.

Conclusion: The HRCT outscores Chest X-ray in detecting early lung involvement in SS patients more so early in the course of the disease thereby underscoring its importance in identifying SS patients who will be potential candidates for early institution of therapy that might reverse/limit pulmonary involvement by the disease.

No MeSH data available.


Related in: MedlinePlus