Original Article
Postoperative acute exacerbation of interstitial lung disease after pneumonectomy: clinical analysis of four cases
Chuan Huang, Chao Ma, Qingjun Wu, Peng Jiao, Wenxin Tian, Yaoguang Sun, Hongfeng Tong
Published 2020-01-04
Cite as Chin J Gen Pract, 2020, 19(1): 44-48. DOI: 10.3760/cma.j.issn.1671-7368.2020.01.008
Abstract
ObjectiveTo summarize the clinical features, diagnosis and treatment of postoperative acute exacerbation of interstitial lung disease (ILD) after pneumonectomy.
MethodsThe 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.
ResultsFour 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.
ConclusionsAcute 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.
Key words:
Lung diseases, interstitial; Idiopathic pulmonary fibrosis; Pneumonectomy; Acute exacerbation
Contributor Information
Chuan Huang
Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Chao Ma
Qingjun Wu
Peng Jiao
Wenxin Tian
Yaoguang Sun
Hongfeng Tong