Acute interstitial pneumonia in elderly patients after thoracic surgery: a report of 5 cases and literature review / 中华老年医学杂志

ABSTRACT

Objective:To analyze the clinical characteristics of elderly patients with acute interstitial pneumonia after thoracic surgery, and to provide evidence for the diagnosis and treatment of acute interstitial pneumonia after surgery.Methods:Data from 2578 elderly patients who had undergonethoracic surgery at Beijing Hospital from October 2014 to October 2021were collected.Five patients developed acute interstitial pneumonia after thoracic surgery.The diagnosis and treatment of the patients were analyzed and major relevant issues were discussed in combination with the literature.Results:Of the 5 patients aged from 60 to 74 years, including 4 men and 1 woman, 3 had idiopathic pulmonary interstitial fibrosis and 2 had Sjogren's syndrome with secondary pulmonary interstitial fibrosis.Preoperative chest CT images were characterized by sporadic interlobular septal thickening and ground-glass, reticular and linear opacities in both lungs.After surgery, all 5 patients presented unexplained and progressively aggravating dyspnea in 1~3 days and chest imaging showed newly emerged and more diffuse ground-glass, reticular and linear opacities in both lungs, in addition toprevious pulmonary interstitial fibrosis.Four patients were treated with glucocorticoids, and four underwent endotracheal intubation and mechanical ventilation.Two cases were treated successfully, 1 case improved after treatment but died after re-aggravation, and 2 cases died after treatment failure.Conclusions:Patients with pulmonary interstitial fibrosis after thoracic surgery may have progressive and aggravated dyspnea in the early postoperative period.Early CT imaging and pathogenic examinations will be helpful in differential diagnosis.Acute interstitial pneumonia often involves both lungs, with rapid progression and high mortality.Once the disease has progressed to respiratory failure, mechanical ventilation should be initiated as early as possible to improve organ function.Glucocorticoids should be used early with sufficient doses and lengths to prevent re-aggravation.