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Weekly Chest CasesArchive of Old Cases

Case No : 1000 Date 2016-12-26

  • Courtesy of Hyun Jung Koo, En Jin Chae, Kyung-Hyun Do, Jae Woo Song / Asan Medical Center
  • Age/Sex 31 / F
  • Chief ComplaintDyspnea for two weeks
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Humidifier disinfectant-associated lung injury
Radiologic Findings
Fig 1. The chest radiograph shows multiple ill-defined patchy ground-glass opacities in both the lungs.
Fig 2. Axial chest computed tomography images show diffuse ill-defined faint centrilobular nodules and irregular patchy consolidations in the subpleural areas of both lungs.
Fig 3. The chest radiograph shows pneumomediastinum, subcutaneous emphysema in the neck, and increased multiple ill-defined patchy consolidation and ground-glass opacities in both lungs.
Fig 4. Axial chest computed tomography images show pneumomediastinum, pulmonary interstitial emphysema, increased the density of ill-defined centrilobular nodules and irregular patchy consolidations in both lungs.

Pathologic findings were an organizing pneumonia pattern with proliferation of intra-alveolar fibroblastic polyps and obliterating bronchioles. Variable degrees of fibroblastic proliferation resulted in bronchiolar obliteration and peribronchiolar fibrosis.

This patient was a 31-year-old peripartum woman. Her daughters also suffered from a similar inhalation lung injury (CT and chest radiographs). She and one of her daughter finally underwent lung transplantation, and the younger daughter expired despite of intensive care.
Brief Review
Humidifier disinfectant-associated lung injury may develop as a result of inhalation of humidifier disinfectants have been reported recently. Inhalation injury of the lung from exposure to humidifier disinfectant has a severe clinical course with 47.5 % of patients requiring ICU admission and a mortality rate of 28.8 %. Young age, peripartum status, low O2 saturation, and GGO or consolidation (>30 %) on initial chest radiographs were risk factors associated with ICU admission. The role of radiologists in suspecting this inhalation lung injury is very important. The main findings in the acute stage of humidifier disinfectant-associated lung injury were centrilobular nodules and patchy consolidation. In the subacute stage, spontaneous air leaks, including pneumomediastinum, pulmonary interstitial emphysema and pneumothorax were noted in addition increased centrilobular nodules. After 3 months, fibrosis and bronchiectasis were observed along with decreased density of persistent centrilobular nodules. Radiologists should be aware of the possibility of encountering the unrecognized inhalation lung injury caused by environmental chemicals.
References
1. http://time.com/4338272/oxy-dehumidifier-disinfectant-reckitt-benckiser-korea/
2. Hong SB, Kim HJ, Huh JW, et al. A cluster of lung injury associated with home humidifier use: clinical, radiological and pathological description of a new syndrome. Thorax 2014;69:694–702.
3. Koo HJ, Do K-H, Chae EJ, et al. Humidifier disinfectant-associated lung injury in adults: Prognostic factors in predicting short-term outcome. Eur Radiol 2017;27:203-211.
4. Kim KW, Ahn K, Yang HJ, et al. Humidifier disinfectant-associated children's interstitial lung disease. Am J Respir Crit Care Med 2014;189:48–56.
5. Huh JW, Hong SB, Do KH, et al. Inhalation Lung Injury Associated with Humidifier Disinfectants in Adults. J Korean Med Sci. 2016;31:1857-1862.
Keywords
lung, Inhalation and aspiration disease,

No. of Applicants : 98

▶ Correct Answer : 18/98,  18.4%
  • - Ulsan University Hospital , Korea (South) Soyeoun Lim
  • - Korea University Guro Hospital , Korea (South) Bit Na Park
  • - Kyungpook national university , Korea (South) Chungeun Lim
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Han Na Lee
  • - Korea University Guro Hospital , Korea (South) Jae Wook Lee
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Asan Medical Center , Korea (South) SANG YOUNG OH
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Seoul national university hospital , Korea (South) Kumju Chae
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Korea University Guro Hospital , Korea (South) Sun Hong
  • - Korea University Guro Hospital , Korea (South) Hwanseok Yong
  • - Korea University Guro Hospital , Korea (South) Yoonmi Choi
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - Asan medical center , Korea (South) Cherry Kim
▶ Semi-Correct Answer : 4/98,  4.1%
  • - Yokohama-asahi-chuo-general hospital , Japan KYOKO NAGAI
  • - Private SECTOR - ITALY , Italy CARLO FLORIO
  • - IRSA La Rochelle , France Denis Chabassiere
  • - DMC - SA , Saudi Arabia Hanan m Alkahtib
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