Clinical,Radiological and Pathological Features of Hypersensitivity Pneumonitis: 24 Cases Analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 QiuYuying ¹ , ChenLulu ¹ , WangYongsheng ¹ , ChenHuifen ¹ , CaiHourong ¹ , XiaoYonglong ¹ , YeQing ² , MengFanqing ² , FengAnning ²

1. Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China;
2. ;

Corresponding author：

QiuYuying, Email: qiuyuying1402@sina.com

Keywords：

Hypersensitivity pneumonitis; Interstial lung disease; Diagnosis

DOI：

10.7507/1671-6205.2014010

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Objective To improve clinicians' knowledge of hypersensitivity pneumonitis (HP). Methods We retrospectively analyzed the clinical data of 24 HP patients who were diagnosed in the Affiliated Drum Tower Hospital of Nanjing University Medical School during February 2005 to February 2013. The clinical,radiological and pathological features of those patients were summarized. Results Among those 24 patients,15 were male and 9 were female,with mean age of (48±13) years. All patients had a history of environmental exposure. Two patients showed acute clinical manifestations,and there were 17 subacute and 5 chronic cases. The main clinical manifestations were dyspnea,cough,sputum,fever and weight loss with hypoxemia via blood gas analysis. Restrictive ventilatory impairment was the most frequent functional pattern,and the carbon monoxide diffusing capacity was decreased. Pulmonary function test showed restrictive ventilatory defect and gas interchange disturbance. The features of chest HRCT included diffuse ground-glass attenuation and/or patchy consolidation,centrilobular micronodules,mosaic sign,reticular and/or honeycombing lesions. Bronchoalveolar lavage fluid (BALF) demonstrated an increase of total cell counts with predominant lymphocytosis. The transbronchoscopic lung biopsy (TBLB) pathological examination revealed lymphocytic alveolitis,noncaseating granuloma,and interstial pneumonia. All patients were treated by corticosteroid and avoided antigen exposure and showed significant clinical and radiological improvement. Conclusion The diagnosis of HP is difficult. In most cases (acute and subacute HP),a diagnosis can be made by combination history of exposure,chest HRCT manifestations,cell classification of BALF and pathological examination of TBLB. For atypical cases (chronic HP),a surgery lung biopsy is needed for multi-disciplinary diagnosis including pathologist,radiologist and pulmonologists.

Citation： QiuYuying, ChenLulu, WangYongsheng, ChenHuifen, CaiHourong, XiaoYonglong, YeQing, MengFanqing, FengAnning. Clinical,Radiological and Pathological Features of Hypersensitivity Pneumonitis: 24 Cases Analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(1): 38-43. doi: 10.7507/1671-6205.2014010 Copy

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5.	Hoppin JA,Umbach DM,Kullman GJ,et al.Pesticides and other agricultural factors associated with self-reported farmer's lung among farm residents in the Agricultural Health Study.Occup Environ Med,2007,64:334-341.
6.	Sahin H,Brown KK,Curran-Everett D,et al.Chronic hypersensitivity pneumonitis:CT features comparison with pathologic evidence of fibrosis and survival.Radiology,2007,244:591-598.
7.	Morell F,Roger A,Reyes L,et al.Bird fancier'S lung:a series of 86 patients.Medicine,2008,87:110-130.
8.	Sahin H,Brown KK,Curran-Everett D,et al.Chronic hypersensitivity pneumonitis:CT features comparison with pathologic evidence of fibrosis and survival.Radiology,2007,244:591-598.
9.	Silva Cl,Churg A,Muller NL.Hypersensitivity pneumonitis:spectrum of high-resolution CT and pathologic findings.AJR,2007,188:334-344.
10.	班承钧,代华平,张曙,等.外源性过敏性肺泡炎高分辨率CT特点及其诊断价值.中华医学杂志,2010,16:1105-1108.
11.	刁小莉,金木兰,代华平,等.慢性外源性过敏性肺泡炎七例病理诊断和临床分析.中华病理学杂志,2011,40:732-735.
12.	Ohtani Y,Saiki S,Kitaiehi M,et al.Chronic bird fancier's lung:histopathological and clinical correlation.An application of the 2002 ATS/ERS consensus classificationl of the idiopathic interstitial pneumonias.Thorax,60:665-671.
13.	秦茵茵,周承志,林心情,等.复发性过敏性肺炎的误诊分析及文献复习.中国呼吸与危重监护杂志,2013,12:279-283.

1. 代华平.过敏性肺炎.见:王辰,主编.呼吸病学.北京:中国协和医科大学出版社中华医学电子音像出版社,2007,102-108.
2. Patel AM,Ryu JH,Reed CE.Hypersensitivity pneumonitis;current concepts and future questions.J Allergy Clin Immunol,2001,108:661-670.
3. Lacasse Y,Cormier Y.Hypersensitivity pneumonitis.Orphanet J Rare Dis,2006,1:25.
4. Baldwin CI,Todd A,Bourke S,et al.Pigeon fanciers' lung:effects of smoking on serum and salivary antibody responses to pigeon antigens.Clin Exp Immunol,1998,113:166-172.
5. Hoppin JA,Umbach DM,Kullman GJ,et al.Pesticides and other agricultural factors associated with self-reported farmer's lung among farm residents in the Agricultural Health Study.Occup Environ Med,2007,64:334-341.
6. Sahin H,Brown KK,Curran-Everett D,et al.Chronic hypersensitivity pneumonitis:CT features comparison with pathologic evidence of fibrosis and survival.Radiology,2007,244:591-598.
7. Morell F,Roger A,Reyes L,et al.Bird fancier'S lung:a series of 86 patients.Medicine,2008,87:110-130.
8. Sahin H,Brown KK,Curran-Everett D,et al.Chronic hypersensitivity pneumonitis:CT features comparison with pathologic evidence of fibrosis and survival.Radiology,2007,244:591-598.
9. Silva Cl,Churg A,Muller NL.Hypersensitivity pneumonitis:spectrum of high-resolution CT and pathologic findings.AJR,2007,188:334-344.
10. 班承钧,代华平,张曙,等.外源性过敏性肺泡炎高分辨率CT特点及其诊断价值.中华医学杂志,2010,16:1105-1108.
11. 刁小莉,金木兰,代华平,等.慢性外源性过敏性肺泡炎七例病理诊断和临床分析.中华病理学杂志,2011,40:732-735.
12. Ohtani Y,Saiki S,Kitaiehi M,et al.Chronic bird fancier's lung:histopathological and clinical correlation.An application of the 2002 ATS/ERS consensus classificationl of the idiopathic interstitial pneumonias.Thorax,60:665-671.
13. 秦茵茵,周承志,林心情,等.复发性过敏性肺炎的误诊分析及文献复习.中国呼吸与危重监护杂志,2013,12:279-283.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical,Radiological and Pathological Features of Hypersensitivity Pneumonitis: 24 Cases Analysis

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