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Am. J. Respir. Crit. Care Med., Volume 158, Number 3, September 1998, 979-984

Pulmonary Infection with Mycobacterium Avium-intracellulare Leads to Air Trapping Distal to the Small Airways

KEISHI KUBO, YOSHITAKA YAMAZAKI, TAKESHI MASUBUCHI, AKEMI TAKAMIZAWA, HIROSHI YAMAMOTO, TOMONOBU KOIZUMI, KEISAKU FUJIMOTO, YUKINORI MATSUZAWA, TAKAYUKI HONDA, MINORU HASEGAWA, and SHUSUKE SONE

Departments of Medicine, Laboratory Medicine and Radiology, Shinshu University School of Medicine, Matsumoto, Japan

To clarify the structure and function of the airways in Mycobacterium avium-intracellulare (MAI) infection, we performed pulmonary function tests and high-resolution computed tomography (HRCT) of the thorax in female patients 61 ± 9 yr of age (n = 12) with pulmonary MAI infection without predisposing lung disease and compared their data with those of normal female volunteers 54 ± 8 yr of age (n = 9). We calculated the E/I ratio, i.e., the average ratio of HRCT number at full expiration to that at full inspiration, as an index for the evaluation of air trapping distal to the small airways. Patients showed significant increases in residual volume and slope of phase III (Delta N2) of the single-breath nitrogen test, and significant decreases in flow at 50 and 25% of FVC, suggesting hyperinflation and obstruction of the small airways. HRCT of patients revealed the small nodules and ectasis of bronchioles and small bronchi located mainly in segments (S) S2, S3, S4, and S5. The E/I ratio was significantly elevated in patients, and especially higher in the upper lung field than in the lower lung field, suggesting air trapping distal to the small airways. The difference of E/I ratio between the upper and lower field is probably related to the segmental distribution of CT abnormalities. These findings suggest that MAI infection can lead to air trapping distal to the small airways.




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