Published ahead of print on October 27, 2005, doi:10.1164/rccm.200502-247OC Am. J. Respir. Crit. Care Med., Volume 173, Number 3, February 2006, 304-309 A more recent version of this article appeared on February 1, 2006
Submitted on February 16, 2005 Tracheobronchomalacia and Air Trapping following Mustard Gas ExposureMostafa Ghanei1*,1 Research Center of Chemical Injuries, Baqiyatallah Medical Sciences University (BMSU), Tehran, Iran (Islamic Republic of ), 2 Department of Radiology and Department of Pulmonology, Baqiyatallah Medical Sciences University (BMSU), Tehran, Iran (Islamic Republic of) * To whom correspondence should be addressed. E-mail: m.ghanei{at}bmsu.ac.ir.
Rationale: Mustard gas primarily affects the eyes, skin, and particularly the respiratory tract. Tracheobronchomalacia (TBM) and air-trapping are often observed in High-Resolution Computerized Tomography (HRCT) scans of the chest of mustard gas exposed patients. Objectives: To examine the frequency and severity of TBM in a group of Iranian war-time mustard gas exposed victims, and to investigate the correlation between TBM and air-trapping in these cases. Materials and Methods: Chest HRCT films obtained from 300 randomly selected subjects who had been exposed to mustard gas 15.5 years previously, were reviewed to determine the existence of TBM and air-trapping. The HRCT films of a healthy control group were also analyzed for comparison. Results: Out of 300 reviewed cases, 13 had TBM. From these 13 TBM cases, 11 (85%) showed air-trapping with mean score of 5.5. In the control group, 5 (20%) of 20 subjects showed air-trapping, with mean score of 0.6. The total air-trapping was significantly higher in the TBM group (p<0.001). There was an association between the severity of tracheomalacia and air-trapping in the TBM group (P=0.01, R=0.69), but no association was observed between severity of bronchomalacia and air-trapping. Conclusion: The results show that air-trapping and TBM are correlated, both as long-term sequelae in mustard gas exposed cases. Since air-trapping is highly suggestive of Bronchiolitis Obliterans (BO), we conclude that both BO and TBM are caused by a single underlying process affecting both small and large airways, respectively, in this group of patients. Key words: High-resolution CT, Air trapping, Tracheobronchomalacia (TBM), Bronchiolitis obliterans (BO), Chemical Warfare, Mustard Gas
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