Utility of lung ultrasound in ANCA-associated vasculitis with lung involvement
Autoři:
Natalia Buda aff001; Anna Masiak aff001; Zbigniew Zdrojewski aff001
Působiště autorů:
Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, Gdansk, Poland
aff001
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222189
Souhrn
Introduction
Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are forms of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). AAV most commonly affects the upper and lower respiratory tract as well as the kidneys. The first symptoms are often nonspecific, requiring careful differential diagnosis with infections and malignancies.
Materials and methods
We analyzed the clinical and radiological data of 38 patients (20 females and 18 males) diagnosed with ANCA-associated vasculitis. Lung involvement was observed in 29 cases. Lung ultrasound (LUS) was performed on 21 patients from the study group and compared to chest CT. For 7 patients the examination was conducted repeatedly.
Results
In total, 35 LUS and CT examinations were performed, revealing the following lesions: nodules, infiltrates with and without features of disintegration, caves (n = 17), diffuse alveolar hemorrhage (n = 3), and features of interstitial lung disease (ILD) with pulmonary fibrosis (PF) (n = 11). In 2 cases LUS and CT were negative. In 4 cases LUS was negative, despite a positive CT result.
Conclusions
Both in CT and LUS, images of pulmonary lesions were consistent though highly variable. Therefore, further studies are required for a larger group of patients.
Klíčová slova:
Research and analysis methods – Imaging techniques – Ultrasound imaging – Biology and life sciences – Neuroscience – Neuroimaging – Anatomy – Respiratory system – Medicine and health sciences – Diagnostic medicine – Diagnostic radiology – Tomography – Computed axial tomography – Signs and symptoms – Lesions – Radiology and imaging – Clinical medicine – Clinical immunology – Autoimmune diseases – Wegener granulomatosis – Immunology – Vasculitis – Inflammatory diseases – Rheumatology – Pathology and laboratory medicine – Hemorrhage – Thorax – Pleurae – Lungs – Vascular medicine
Zdroje
1. Jennette JC. Nomenclature and classification of vasculitis: lessons learned from granulomatosis with polyangiitis. Clin Exp Immunol. 2011; 1:7–10.
2. Leavitt RY, Fauci AS, Bloch DA, Michel BA, Hunder GG, Arend WP, et al. The American College of Rheumatology 1990 criteria for the classification of Wegener's granulomatosis. Arthritis Rheum. 1990; 33:1101–1107. doi: 10.1002/art.1780330807 2202308
3. Jennette C, Falk R, Andrassy K, Bacon PA, Churg J, Gross WL, et al. Nomenclature of systemic vasculitides. Proposal of an International Consensus Conference. Arthritis Rheum. 1994; 37:187–192. doi: 10.1002/art.1780370206 8129773
4. Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, et al. Wegener’s granulomatosis: an analysis of 159 patients. Ann Intern Med. 1992; 116:488–498. doi: 10.7326/0003-4819-116-6-488 1739240
5. Fauci AS, Haynes BF, Katz P, Wolff SM. Wegener’s granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med. 1983; 98:76–85. doi: 10.7326/0003-4819-98-1-76 6336643
6. Gibson A, Stamp LK, Chapman PT, O'Donnell JL. The epidemiology of Wegener’s granulomatosis and microscopic polyangiitis in a Southern Hemisphere region. Rheumatology 2006; 45:624–628. doi: 10.1093/rheumatology/kei259 16368729
7. Anderson G, Coles ET, Crane M, Douglas AC, Gibbs AR, Geddes DM, et al. Wegener’s granuloma. A series of 265 British cases seen between 1975 and 1985. A report by a sub-committee of the British Thoracic Society Research Committee. Q J Med. 1992; 83:427–438. 1448544
8. Cordier JF, Valeyre D, Guillevin L, Loire R, Brechot JM. Pulmonary Wegener's granulomatosis. A clinical and imaging study of 77 cases. Chest. 1990; 97:906–912. doi: 10.1378/chest.97.4.906 2323259
9. Brown KK. Pulmonary vasculitis. Proc Am Thorac Soc. 2006; 3:48–57. doi: 10.1513/pats.200511-120JH 16493151
10. Allen SD, Harvey CJ. Imaging of Wegener’s granulomatosis. Br J Radiol. 2007; 80:757–765. doi: 10.1259/bjr/34705892 16728414
11. Toffart A, Arbib F, Lantuejoul S, Roux JF, Bland V, Ferrettiet G, et al. Wegener granulomatosis revealed by pleural effusion. Case Report Med. 2009; 1–3.
12. Delevaux I, Khellaf M, Andre M, Michel JL, Piette JC, Aumaître O, et al. Spontaneous pneumothorax in Wegener granulomatosis. Chest. 2005; 128:3074–3075. doi: 10.1378/chest.128.4.3074 16236988
13. Reuter M, Schnabel A, Wesner F, Tetzlaff K, Risheng Y, Gross WL,et al. Pulmonary Wegener’s granulomatosis. Chest. 1998; 114:500–506. doi: 10.1378/chest.114.2.500 9726737
14. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012; 38:577–591. doi: 10.1007/s00134-012-2513-4 22392031
15. Buda N, Kosiak W, Radzikowska E, Olszewski R, Jassem E, Magdalena Grabczak E, et al. Polish recommendations for lung ultrasound in internal medicine (POLLUS-IM). J Ultrason. 2018; 18:198–206. doi: 10.15557/JoU.2018.0030 30451402
16. Masiak A, Buda N, Wojteczek A, Kujawska-Danecka H, Zdrojewski Z. Diffuse alveolar hemorrhage as an initial presentation of ANCA‑associated vasculitis in an 80‑year‑old man. Pol Arch Intern Med. 2017; 127:365–367. doi: 10.20452/pamw.4038 28581453
17. Buda N, Masiak A, Smoleńska Ż, Gałecka K, Porzezińska M, Zdrojewski Z. Serial Lung Ultrasonography to Monitor Patient With Diffuse Alveolar Hemorrhage. Ultrasound Q. 2017; 33:86–89. doi: 10.1097/RUQ.0000000000000259 27599312
18. Knight A, Askling J, Ekbom A. Cancer incidence in a population-based cohort of patients with Wegener's granulomatosis. Int J Cancer. 2002; 100:82–85. doi: 10.1002/ijc.10444 12115591
19. Mathews JD, Forsythe AV, Brady Z, Butler MW, Goergen SK, Byrnes GB, et al. Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 2013; 346:f2360. doi: 10.1136/bmj.f2360 23694687
20. Lichtenstein D, van Hooland S, Elbers P, Malbrain ML. Ten good reasons to practice ultrasound in critical care. Anaesthesiol Intensive Ther. 2014; 46:323–335. doi: 10.5603/AIT.2014.0056 25432552
21. Agricola E, Arbelot C, Blaivas M, Bouhemad B, Copetti R, Dean A, et al. Ultrasound performs better than radiographs. Thorax. 2011; 66:828–829. doi: 10.1136/thx.2010.153239 21193568
Článek vyšel v časopise
PLOS One
2019 Číslo 9
- S diagnostikou Parkinsonovy nemoci může nově pomoci AI nástroj pro hodnocení mrkacího reflexu
- Je libo čepici místo mozkového implantátu?
- Pomůže v budoucnu s triáží na pohotovostech umělá inteligence?
- AI může chirurgům poskytnout cenná data i zpětnou vazbu v reálném čase
- Nová metoda odlišení nádorové tkáně může zpřesnit resekci glioblastomů
Nejčtenější v tomto čísle
- Graviola (Annona muricata) attenuates behavioural alterations and testicular oxidative stress induced by streptozotocin in diabetic rats
- CH(II), a cerebroprotein hydrolysate, exhibits potential neuro-protective effect on Alzheimer’s disease
- Comparison between Aptima Assays (Hologic) and the Allplex STI Essential Assay (Seegene) for the diagnosis of Sexually transmitted infections
- Assessment of glucose-6-phosphate dehydrogenase activity using CareStart G6PD rapid diagnostic test and associated genetic variants in Plasmodium vivax malaria endemic setting in Mauritania
Zvyšte si kvalifikaci online z pohodlí domova
Všechny kurzy