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European Radiology
Published in: European Radiology 1/2016

01-01-2016 | Paediatric

Humidifier disinfectant-associated children’s interstitial lung disease: Computed tomographic features, histopathologic correlation and comparison between survivors and non-survivors

Authors: Hee Mang Yoon, Eun Lee, Jin Seong Lee, Kyung-Hyun Do, Ah Young Jung, Chong Hyun Yoon, Seon-Ok Kim, Se-Jin Jang, Soo-Jong Hong, Young Ah Cho

Published in: European Radiology | Issue 1/2016

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Abstract

Objectives

To report radiologic findings with histopathologic correlations of humidifier disinfectant-associated children’s interstitial lung disease (HD-chILD) and to compare computed tomography (CT) findings between survivors and non-survivors.

Methods

Forty-seven children with HD-chILD (27.4 ± 12.4 months old) were categorized as survivors (n = 25) and non-survivors (n = 22). The patterns, distributions, and chronological changes in lung lesions at follow-up CT were investigated. Histopathologic correlations were performed in 23 patients.

Results

CT features were characterized by chronological changes, from consolidation to centrilobular opacities, and lesions eventually became faint centrilobular nodules. Histopathologic features were bronchocentric-distributed fibro-inflammatory lesions, which were more profound in the advanced stage than the early stage. Consolidation ≥30 % [hazard ratio (HR), 2.932], centrilobular opacities ≥60 % of the total lung volume (TLV; HR, 0.206) and spontaneous air leaks (HR, 3.457) were significant factors associated with patient survival, as per univariate analysis. Consolidation ≥30 % (HR, 3.519), centrilobular opacities ≥60 % (HR, 0.205) and diffuse ground glass opacity (GGO) ≥70 % of the TLV (HR, 3.521) were significant factors associated with patient survival, as determined via multivariate analysis.

Conclusion

Distinctive chronological CT features were observed in the HD-chILD images. Spontaneous air leaks, consolidation, GGO, and centrilobular opacities were prognostic factors.

Key Points

• Chemical disinfectants can induce severe inhalation lung injury
• Lung injury caused by inhaled disinfectants demonstrates chronologic changes in radiologic findings
• Understanding of radiological characteristics is important to predict outcomes in chemical pneumonitis
• Physicians should be aware of the potential risk of environmental chemicals
Appendix
Available only for authorised users
Literature
1.
Cheon CK, Jin H-S, Kang EK, Kim HB, Kim B-J, Yu J et al (2008) Epidemic acute interstitial pneumonia in children occurred during the early 2006s. Korean J Pediatr 51:383CrossRef
2.
Kim B-J, Kim HA, Song Y-H, Yu J, Kim S, Park SJ et al (2009) Nationwide surveillance of acute interstitial pneumonia in Korea. Korean J Pediatr 52:324CrossRef
3.
Lee E, Seo JH, Kim HY, Yu J, Jhang WK, Park SJ et al (2013) Toxic inhalational injury-associated interstitial lung disease in children. J Korean Med Sci 28:915–923PubMedCentralCrossRefPubMed
4.
Lee JH, Kim YH, Kwon JH (2012) Fatal misuse of humidifier disinfectants in Korea: importance of screening risk assessment and implications for management of chemicals in consumer products. Environ Sci Technol 46:2498–2500CrossRefPubMed
5.
Lee E, Seo JH, Kim HY, Yu J, Song JW, Park YS et al (2012) Two series of familial cases with unclassified interstitial pneumonia with fibrosis. Allergy Asthma Immunol Res 4:240–244PubMedCentralCrossRefPubMed
6.
Hong SB, Kim HJ, Huh JW, Do KH, Jang SJ, Song JS et al (2014) A cluster of lung injury associated with home humidifier use: clinical, radiological and pathological description of a new syndrome. Thorax 69:694–702CrossRefPubMed
7.
Yang HJ, Kim HJ, Yu J, Lee E, Jung YH, Kim HY et al (2013) Inhalation toxicity of humidifier disinfectants as a risk factor of children's interstitial lung disease in Korea: a case-control study. PLoS One 8, e64430PubMedCentralCrossRefPubMed
8.
Kim KW, Ahn K, Yang HJ, Lee S, Park JD, Kim WK et al (2014) Humidifier disinfectant-associated children's interstitial lung disease. Am J Respir Crit Care Med 189:48–56PubMed
9.
Kim HJ, Lee MS, Hong SB, Huh JW, Do KH, Jang SJ et al (2014) A cluster of lung injury cases associated with home humidifier use: an epidemiological investigation. Thorax 69:703–708CrossRefPubMed
10.
Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246:697–722CrossRefPubMed
11.
Lester SC (2006) Manual of surgical pathology, 2nd edn. Elsevier Churchill Livingstones, New York, NY
12.
Ichikado K, Suga M, Gushima Y, Johkoh T, Iyonaga K, Yokoyama T et al (2000) Hyperoxia-induced diffuse alveolar damage in pigs: correlation between thin-section CT and histopathologic findings. Radiology 216:531–538CrossRefPubMed
13.
Gattinoni L, Caironi P, Pelosi P, Goodman LR (2001) What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 164:1701–1711CrossRefPubMed
14.
Ichikado K, Suga M, Muller NL, Taniguchi H, Kondoh Y, Akira M et al (2002) Acute interstitial pneumonia: comparison of high-resolution computed tomography findings between survivors and nonsurvivors. Am J Respir Crit Care Med 165:1551–1556CrossRefPubMed
15.
Selman M, Pardo A, King TE Jr (2012) Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med 186:314–324CrossRefPubMed
16.
Primack SL, Hartman TE, Ikezoe J, Akira M, Sakatani M, Muller NL (1993) Acute interstitial pneumonia: radiographic and CT findings in nine patients. Radiology 188:817–820CrossRefPubMed
Metadata
Title
Humidifier disinfectant-associated children’s interstitial lung disease: Computed tomographic features, histopathologic correlation and comparison between survivors and non-survivors
Authors
Hee Mang Yoon
Eun Lee
Jin Seong Lee
Kyung-Hyun Do
Ah Young Jung
Chong Hyun Yoon
Seon-Ok Kim
Se-Jin Jang
Soo-Jong Hong
Young Ah Cho
Publication date
01-01-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3813-1

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