Case of Late-onset Acute Lung Injury Developed as a Complication of Organophosphate Intoxication-induced Acute Pancreatitis

Organophosphate insecticides are used globally and are household items in rural areas of Korea. Their ingestion for a suicidal purpose is common in Korea. Respiratory failure is the most serious manifestation and the usual cause of death in acute organophosphate poisoning, and is usually common during acute cholinergic crisis. But, respiratory failure may appear suddenly in a patient who is recovering from a cholinergic crisis, even while receiving conventional therapy. Most of these respiratory failures are associated with intermediate syndrome or pneumonia. In several recent studies, acute pancreatitis as a complication of organophosphate poisoning has been shown to be not a rare condition and respiratory failure may also occur in acute pancreatitis. However, acute lung injury developing as a complication of organophosphate intoxication-induced pancreatitis has not been hitherto reported in Korea. We described a case of a 50-year-old woman who had acute organophosphate intoxication-induced acute pancreatitis. The patient developed acute lung injury on the eighth day hospital day, after cholinergic crisis, without intermediate syndrome and pneumonia. Exclusion of other causes indicated that the acute lung injury may have developed due to acute pancreatitis.

Change of Pulmonary Arterial and Bronchial Diameter During Respiration: HRCT Findings

PURPOSE: To evaluate the changes and normal ranges of the artery-bronchus ratio (ABR) during respiration MATERIALS AND METHODS: We analyzed HRCT of 10 healthy adults. The HRCT findings of ten healthy adults were analysed. CT scanning was performed with 1 mm collimation at 3 mm intervals during full inspiration and full expiration, with a range during inspiration from 2 cm to 4 cm above the carina and from 4 cm above to 2 cm below the right hemidiaphragm. The range during expiration was from 1 cm to 3 cm above the carina and from 4 cm above to 2 cm below the right hemidiaphragm. ABiR (defined as the diameter of pulmonary artery divided by the inner diameter of the bronchus), ABoR (defined as the diameter of pulmonary artery divided by the outer diameter of the bronchus) and BLR (defined as the inner diameter of the bronchus divided by the outer diameter of the bronchus) were measured on the display console. RESULTS: The mean inner diameter of the bronchi was 2.04+/-0.73 mm during inspiration and 1.68+/-0.51 mm during expiration, while the mean diameter of the arteries was 3.95+/-1.03 mm during inspiration and 4.37+/-1.09 mm during expiration. The diameters of the bronchi were thus seen to increase during inspiration, and the diameters of the pulmonary arteries, to decrease. The mean thickness of the bronchial wall was 1.07+/-0.19 mm during inspiration and 1.06+/-0.24mm during expiration; thus, no change in thickness was seen during respiration (p<0.05). Mean ABiR was 2.01+/-0.60 (range 1.15-4.58) during inspiration and 2.59+/-0.74(range 1.16-4.9) during expiration, and in all cases the inner diameter of the bronchus was less than that of the accompanying pulmonary artery. Mean ABoR was 0.91+/-0.19 during inspiration and 1.09+/-0.22 during expiration. while for BLR, the corresponding fingures were 0.46+/-0.06, and 0.44+/-0.09. CONCLUSION: HRCT is a useful tool for evaluating changes in the pulmonary arteries and bronchi during respiration.