Human infection with a novel avian-origin influenza A (H7N9) virus: serial chest radiographic and CT findings / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Rapidly progressive pneumonia infection with H7N9 virus is a novel disease, and limited information is available concerning serial chest radiographic and computed tomography (CT) findings. The aim of this study was to evaluate the changes in serial radiologic findings in patients with H7N9 pneumonia.</p><p><b>METHODS</b>The two institutional ethics review boards approved this retrospective study. This study included 10 patients with H7N9 pneumonia. All patients underwent chest radiologic examinations at different time points. Serial radiologic images were systematically analyzed.</p><p><b>RESULTS</b>All patients showed abnormal results on initial chest radiography and CT. The initial radiographic abnormalities were unilateral (n = 9) and bilateral (n = 1), including ground-glass opacities (GGOs) (n = 5) and consolidation (n = 5). The initial CT findings consisted of unilateral (n = 6) and bilateral (n = 4), including consolidation (n = 10), GGOs (n = 10), reticular opacities (n = 2), and pleural effusion (n = 3). Follow-up radiologic findings showed rapid development of consolidation or GGOs within two weeks after illness onset. Pneumomediastinum with secondary subcutaneous emphysema and pneumothorax were noted in two patients. Follow-up high resolution computed tomography (HRCT) after two weeks showed slow improvement in both size and opacity of the lesions. On HRCT after discharge, patients had substantial residual lesions such as irregular linear opacities, reticular opacities, parenchymal bands, traction bronchiectasis, and cystic lesions.</p><p><b>CONCLUSIONS</b>The most common radiologic findings at presentation are multifocal or diffuse areas of consolidation and GGOs in H7N9 pneumonia. HRCT in sequence can show more changes in rapid progression of disease and a slow decrease of both size and opacity of the lesions plays an important role in the evaluation of H7N9 pneumonia.</p>

Giant cell interstitial pneumonia: unusual lung disorder and an update / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Giant cell interstitial pneumonia (GIP) was a rare form of pneumoconiosis, associated with exposure to hard metals, which had been reported mostly as isolated case reports. We described eight cases of GIP diagnosed in our hospital during the past seven years, with particular reference to new findings.</p><p><b>METHODS</b>Eight patients with GIP confirmed by biopsy in the Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University from 2005 to 2011 were retrospectively analyzed. For each patient, the occupy histories and medical records were thoroughly reviewed and clinic data were extracted. Two radiologists, without knowledge of any of the clinical and functional findings, independently reviewed the HRCT scans of all patients. Follow-up data were collected.</p><p><b>RESULTS</b>Among the eight patients, seven had a history of exposure to hard metal dusts, one denied an exposure history. The most common manifestations were cough and dyspnea. One patient initiated with pneumothorax and another pleural effusion, both of which were uncommon to GIP. The main pathologic appearances were the presence of macrophages and multinucleated giant cells in the alveolar space. The clinical symptoms and radiographic abnormalities were obviously improved after cessation of exposure and receiving corticosteroid treatments, recurrences were observed in two patients when they resumed work. In spite of exposure cessation and corticosteroid treatment, one patient developed pulmonary fibrosis at seven years follow-up.</p><p><b>CONCLUSIONS</b>Awareness of the patients' occupational history often provided clues to the diagnosis of GIP. Histopathologic examinations were necessary to establish the right diagnosis. Exposure cessation was of benefit to most patients; however, pulmonary fibrosis was possible in spite of exposure cessation and corticosteroid treatment. Better ways should be found out to improve the outcome and quality of life.</p>

Clinicoradiologic Features of Acute Exacerbation of Idiopathic Pulmonary Fibrosis: Two Cases Report and Literature Review / 中国呼吸与危重监护杂志

Objective To analyze the clinical presentations and radiological characteristics of acute exacerbation of idiopathic pulmonary fibrosis (IPF).Methods Clinical and radiological data of 2 patients with acute exacerbation of IPF from April 2006 to July 2008 were retrospectively analyzed and literatures were reviewed.Results Both patients were senior male patients over 60 years old.Dyspnea, cough and inspiratory crackles were the major symptoms and signs.Two patients were experiencing an exacerbation of dyspnea for one week and half of month,respectively.PaO2/FiO2 of both patients was less than 225 mm Hg.In both patients, high-resolution computed tomography (HRCT) scans at the exacerbation showed typical signs of IPF including peripheral predominant, basal predominant reticular abnormality, with honeycombing and traction bronchiectasis and bronchiolectasis,and newly developing alveolar opacity.HRCT scan showed peripheral area of ground-glass attenuation adjacent to subpleural honeycombing in one patient,and diffusely distributed ground-glass opacity in another patient.Two patients had received cortieosteroid treatment.For one patient, the symptoms improved, and ground-glass attenuation adjacent to subpleural honeycombing had almostly resolved.The other patient died of respiratory failure.Conclusions Some acute exacerbation in idiopatic pulmonary fibrosis can be idiopathic.The chnical presentations mainly include the worsening of dyspnea within short time.HRCT generally demonstrates new bilateral ground-glass abnormality with or without areas of consolidation, superimposed on typical changes of IPF.