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Weekly Chest CasesArchive of Old Cases

Case No : 826 Date 2013-08-26

  • Courtesy of 1. Jae Yeon Wi, Youkyung Lee, Kwang Nam Jin / SMG-SNU Boramae Medical Center
  • Age/Sex 24 / M
  • Chief Complainthematochezia, cough, and sputum during two weeks
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Airway involvement in ulcerative colitis
Radiologic Findings
Diffuse wall thickening with nodularity from trachea to segmental bronchi, small amount of bilateral pleural effusions, ill-defined GGO infiltration in both lower lobes.
Brief Review
Actually, the patient was diagnosed with ulcerative colitis in 2006.
Inflammatory bowel disease (IBD), namely Crohn disease and ulcerative colitis, has a variety of thoracic manifestations. Respiratory manifestations may involve the large and small airways, pulmonary vasculature, lung parenchyma, or serosal surface. In contrast to other extraintestinal manifestations, pulmonary parenchymal IBD is seen more commonly with ulcerative colitis than Crohn disease, and large airway disease is strongly associated with ulcerative colitis.
Airway inflammation is the most common form of respiratory involvement in IBD patients, predominantly affecting the intermediate sized central bronchi. Bronchiectasisis, chronic bronchitis, suppurative large airway disease without airway dilation, or acute bronchitis are seen. Chest radiographs may show increased interstitial markings or a tramline pattern or may appear normal. CT findings include diffuse concentric bronchial wall thickening with or without mucoid impaction and bronchiectasis. Upper airway involvement, particularly tracheal involvement in the form of subglottic stenosis or diffuse tracheitis, is rare. Chest radiographs and CT may show narrowing of any portion of the trachea, with circumferential tracheal wall thickening on CT. IBD-related parenchymal disease is rare but, when present, it is usually due to crytogenic organizing pneumonia, eosinophilic pneumonia or nonspecific interstitial pneumonitis.
References
1.Wilcox, P., et al., Airway involvement in ulcerative colitis. CHEST Journal, 1987.92(1);18-22.
2.Morris, M.J., D.E. Cole, and P.F. Allan, Pulmonary disease associated with inflammatory bowel disease. Clinical Pulmonary Medicine, 2005.12(4);246-257.
3.Betancourt, S.L., et al., Thoracic manifestations of inflammatory bowel disease. American Journal of Roentgenology, 2011. 197(3);W452-W456.
Keywords
airway,

No. of Applicants : 82

▶ Correct Answer : 18/82,  22.0%
  • - McGill university , Canada Badriya Al-Qassabi
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - stanley medical college , India mahes waran
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Asan medical center , Korea (South) yoonyoung choi
  • - Asan medical center , Korea (South) Sang Young Oh
  • - AMC , Korea (South) park jong chun
  • - ASAN MEDICAL CENTER , Korea (South) CHONG HYUN SUH
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - CHU Poitiers , France CHAN paul
  • - Chungbuk univertisy hospital , Korea (South) Soohyun Lee
  • - Chungbuk national university hospital , Korea (South) Jisun Lee
  • - chungbuk national university hospital , Korea (South) Soo Jung, Lee
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
▶ Correct Answer as Differential Diagnosis : 5/82,  6.1%
  • - NASA SCANS , India RAKESH BHATIA
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - All India Institute of medical sciences , India Justin Moses
▶ Semi-Correct Answer : 3/82,  3.7%
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Teleradiology solutions , India harish bhambore
  • - university of montreal , Canada Andrei Gorgos I
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