Hee Mang Yoon MD, Presenter: Nothing to Disclose

Eun Lee, Abstract Co-Author: Nothing to Disclose

Jin Seong Lee MD, Abstract Co-Author: Nothing to Disclose

Kyung-Hyun Do MD, Abstract Co-Author: Nothing to Disclose

Se Jin Jang, Abstract Co-Author: Nothing to Disclose

Soo-Jong Hong, Abstract Co-Author: Nothing to Disclose

Young Ah Cho, Abstract Co-Author: Nothing to Disclose

From 2006, epidemics of a fatal lung injury by inhalation of humidifier disinfectant (DI) in children were observed. The aim of this study was to report radiologic findings with pathologic correlation of the disease and to compare the CT findings between survivors and non-survivors. 

Forty seven children were hospitalized with acute lung injury associated with DI inhalation (mean age=27.4±12.4 months) and divided into two groups: survivors (n=25) and non-survivors (n=22). CT findings including the presence and extent of consolidation and centrilobular ground-glass opacity (cGGO) were evaluated for hazard ratio (HR) in each group. Histopathologic correlation was performed in 25 patients.

CT scans showed the characteristic features according to the stage of disease progression. The early stage was characterized by patchy consolidation in bilateral basal lungs. In advanced stage, it evolved into cGGO involving the entire lung. In resolving stage, cGGO was resolved and slowly changed into the faint centrilobular nodules. Pathologic review revealed, in early stage, predominant denuded bronchiolar epithelium with bronchocentirc fibroblast proliferation and intra-alveolar exudate. In advanced state, bronchial damage with fibroblastic proliferation was more profound. CT showing resolving stage does not exist in non-survivors. The time interval between the presentation of initial symptom and CT scan showing early stage was significantly shorter in non-survivors than in survivors (9days and 14days respectively, p=0.021). Consolidation over 30% of lung volume was the predictor of poor prognosis (p=0.014, HR=2.932) while cGGO over 30% of the lung was that of good prognosis (p<0.001, HR=0.124). 

The distinctive CT feature was chronological changes from early consolidation to cGGO. In survivors, lesions eventually changed into the faint centrilobular nodules. It was correlated with histopathology. Wide area of consolidation in early stage results in the poor prognosis of disease.

This series of patients showed the inhalation injury caused by one kind of chemicals. Radiological understanding plays a pivotal role in management and prediction of outcome in chemical pneumonitis.

Yoon, H, Lee, E, Lee, J, Do, K, Jang, S, Hong, S, Cho, Y, Humidifier Disinfectant-associated Children’s Interstitial Lung Disease: CT Features, Histopathologic Correlation and Comparison between Survivor and Non-survivor .  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005550.html