Objective@#To summarize the clinical features,
diagnosis and
treatment of postoperative acute exacerbation of
interstitial lung disease (ILD) after
pneumonectomy.@*
Methods@#The clinical data of 4
patients with postoperative acute exacerbation of ILD after
pneumonectomy admitted in
Beijing Hospital from October 2014 to November 2015 were retrospectively analyzed and related
literatures were reviewed.@*Results@#Four
patients were
aged 60 to 74 years, including 3
males and 1
female, 2 of whom were
idiopathic pulmonary fibrosis and 2 were
connective tissue diseases related ILD.
Chest high resolution computed
tomography (HRCT) showed multiple lobular septal thickening, ground
glass opacities, reticular shadow and strip shadow in both
lungs. The
patients developed acute
dyspnea 2 to 3 days after
pneumonectomy. In 2 cases, HRCT showed new patchy ground-
glass opacities, reticular shadow and strip shadow in both
lungs on the basis of preoperative
pulmonary fibrosis. The
sputum smear and
culture showed no pulmonary
infection in all 4 cases. Three
patients were treated with
glucocorticoids and 3 received
mechanical ventilation with
endotracheal intubation. One
patient was successfully treated by early using adequate
glucocorticoids, one
patient improved
after treatment but died after re-exacerbation, and the other two
patients died
after treatment failed.@*Conclusions@#Acute exacerbation of ILD after
pneumonectomy often occurs in early
postoperative period and it is characterized by progressive
dyspnea.
Chest CT and respiratory pathogen examination are helpful for
early diagnosis. Postoperative acute exacerbation of ILD often lacks effective
treatment, requires
mechanical ventilation, and the
prognosis is poor. Although
glucocorticoids may be effective, re-exacerbation should be alert during
treatment.