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RADIOLOGIC PATTERN OF PULMONARY DISEASE ASSOCIATED WITH MYCOBACTERIUM INTRACELLULARE-AVIUM IN HOT TUB USERS (HOT TUB LUNG)
October 2005, Vol 128, No. 4_MeetingAbstracts Abstract: Poster Presentations | October 2005
RADIOLOGIC PATTERN OF PULMONARY DISEASE ASSOCIATED WITH MYCOBACTERIUM INTRACELLULARE-AVIUM IN HOT TUB USERS (HOT TUB LUNG) Viktor Hanak, MD*; Jay Ryu, MD; Thomas Hartman, MD Mayo Clinic Foundation, Rochester, MN Chest. 2005;128(4_MeetingAbstracts):347S. doi:10.1378/chest.128.4_MeetingAbstracts.347S-b
Abstract PURPOSE: The purpose of this study was to evaluate the radiologic features of Hot Tub Lung disease. METHODS: The CT scans of 15 patients (13 high resolution and 2 conventional CT scans) were evaluated for the distribution and extent of nodules, irregular lines and ground glass attenuation. RESULTS: Nodules were present in 11/15 cases. They were bilateral and symmetric in 9 and bilateral and asymmetric in 2. In 9 cases there was a diffuse distribution of the nodules in the cephalocaudal plane with a centrilobular distribution in the transaxial plane. In the other 2 cases, the nodules had an upper lung distribution in the cephalocaudal plane and a random distribution in the transaxial plane. In 5 cases the nodules were well-defined and in 6 cases poorly defined. Ground glass attenuation was seen in 11/15 cases, and was bilateral and symmetric when present. The ground glass attenuation was diffuse in the cephalocaudal plane with a random distribution in the transaxial plane in 10/11 cases. In the other 1 case the areas of ground glass attenuation had lower lung predominance with a random distribution in the transaxial plane. In 6 cases the areas of ground glass attenuation involved >40% of the lungs and in 5 involved < 40% of the lungs. Both the nodules and ground glass attenuation were present in 7 cases (nodules only were present in 3 patients; ground glass only present in 3 patients). One patient had nodules, areas of ground glass attenuation and irregular linear opacities. Irregular linear opacities were present in only 1 case. They were bilateral and asymmetric with a subpleural and lower lung predominance and involved <10% of the lungs. In 7 cases expiratory images were obtained and all showed evidence of air trapping.
CONCLUSION: The patterns of centrilobular nodules, ground glass attenuation and air trapping are very similar to findings of subacute hypersensitivity pneumonitis. CLINICAL IMPLICATIONS: In cases where the CT findings suggest hypersensitivity pneumonitis, hot tub lung should also be a diagnostic consideration. DISCLOSURE: Viktor Hanak, None. Wednesday, November 2, 2005 12:30 PM - 2:00 PM
RADIOLOGIC PATTERN OF PULMONARY DISEASE ASSOCIATED WITH MYCOBACTERIUM INTRACELLULARE-AVIUM IN HOT TUB USERS (HOT TUB LUNG) Viktor Hanak, MD*; Jay Ryu, MD; Thomas Hartman, MD Mayo Clinic Foundation, Rochester, MN Chest. 2005;128(4_MeetingAbstracts):347S. doi:10.1378/chest.128.4_MeetingAbstracts.347S-b
Abstract PURPOSE: The purpose of this study was to evaluate the radiologic features of Hot Tub Lung disease. METHODS: The CT scans of 15 patients (13 high resolution and 2 conventional CT scans) were evaluated for the distribution and extent of nodules, irregular lines and ground glass attenuation. RESULTS: Nodules were present in 11/15 cases. They were bilateral and symmetric in 9 and bilateral and asymmetric in 2. In 9 cases there was a diffuse distribution of the nodules in the cephalocaudal plane with a centrilobular distribution in the transaxial plane. In the other 2 cases, the nodules had an upper lung distribution in the cephalocaudal plane and a random distribution in the transaxial plane. In 5 cases the nodules were well-defined and in 6 cases poorly defined. Ground glass attenuation was seen in 11/15 cases, and was bilateral and symmetric when present. The ground glass attenuation was diffuse in the cephalocaudal plane with a random distribution in the transaxial plane in 10/11 cases. In the other 1 case the areas of ground glass attenuation had lower lung predominance with a random distribution in the transaxial plane. In 6 cases the areas of ground glass attenuation involved >40% of the lungs and in 5 involved < 40% of the lungs. Both the nodules and ground glass attenuation were present in 7 cases (nodules only were present in 3 patients; ground glass only present in 3 patients). One patient had nodules, areas of ground glass attenuation and irregular linear opacities. Irregular linear opacities were present in only 1 case. They were bilateral and asymmetric with a subpleural and lower lung predominance and involved <10% of the lungs. In 7 cases expiratory images were obtained and all showed evidence of air trapping.
CONCLUSION: The patterns of centrilobular nodules, ground glass attenuation and air trapping are very similar to findings of subacute hypersensitivity pneumonitis. CLINICAL IMPLICATIONS: In cases where the CT findings suggest hypersensitivity pneumonitis, hot tub lung should also be a diagnostic consideration. DISCLOSURE: Viktor Hanak, None. Wednesday, November 2, 2005 12:30 PM - 2:00 PM