J Korean Med Sci.  2020 Nov;35(45):e377. 10.3346/jkms.2020.35.e377.

Comparison of Long Term Follow-up Chest CT Imaging in Adult and Pediatric Patients with Humidifier Disinfectant-related Lung Injury

• Lim S
• Leem JH
• Hong YS
• Kim J
• Park S
• Joh JS
• Kwon WJ
• Kim Y

• KMID: 2508803
• DOI: http://doi.org/10.3346/jkms.2020.35.e377

Abstract

Background
To compare the chest computed tomography (CT) images of children and adults in families with clusters of humidifier disinfectant-related lung injury (HDLI) after cessation of exposure to humidifier disinfectant (HD).
Methods
We reviewed medical records of 19 families with 43 patients (21 adults, 22 children) among families, which had at least one adult and one child with HDLI. Each family was exposed to the same HD exposure environment.
Results
In adults, centrilobular nodules were predominant (95.2%) in chronic HDLI findings after cessation of exposure to HD, however, in children, normal pattern was most prevalent on chest CT (45.5%), followed by centrilobular nodule (36.4%), bizarre lung cysts (36.4%), and reticulation (13.6%).
Conclusion
Unlike the known chronic HDLI finding of adults, centrilobular nodules were only present in 36.4% of children. The frequency of bizarre lung cysts were significantly greater in children than that in adults after cessation of similar exposure to HD. Thus, bizarre lung cysts may be useful as another novel finding of chronic HDLI in children who have no history of pulmonary infection or other perinatal disorder such as hyaline membrane disease or other interstitial lung disease.

Keyword

Humidifier Disinfectant; Lung Injury; Computed Tomography; Lung Cyst; Sequele

Figure

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  Fig. 1 Comparison of the shape of classic lung cyst and bizarre lung cyst. (A) The Fleischner Society described lung cyst as a round parenchymal lucency with a well-defined interface with normal lung. (B) A 11 years old girl with bizarre lung cysts (family No.19). Variable shaped lung cysts and relatively well-defined interface with normal lung.

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  Fig. 2 Comparison of acute and chronic HDLI image between adult and child patients (family No. 3). (A, B) Chest CT of a 50-year-old man with 15 months' HD exposure. (A) Bilateral ill-defined centrilobular nodules, patchy consolidations with subpleural sparing indicates typical acute HDLI finding. (B) Two years after HD exposure cessation. Tiny, ill-defined centrilobular nodules were noted in bilateral lungs (circle). (C, D) Chest CT of a 13-year-old boy with HDLI exposure. (C) Diffuse, ill-defined centrilobular nodules, ground-glass opacity with subpleural sparing and some consolidations involving both lungs. (D) Two years after HD exposure cessation. Previous findings disappeared and showed normal lung parenchyma.HDLI = humidifier disinfectant-related lung injury, CT = computed tomography, HD = humidifier disinfectant.

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  Fig. 3 Comparison of acute and chronic HDLI image between adult and child patients (family No. 7). (A, B) CT of a 63-year-old woman with 6 months HD exposure. (A) Bilateral ill-defined centrilobular nodules and ground-glass opacity with subpleural sparing indicates acute to subacute stage HDLI finding. (B) Two years after HD exposure cessation. Tiny, extensive centrilobular nodules were noted in bilateral lungs. (C, D) CT of a 4-year-old boy with acute HDLI exposure. (C) Bilateral, multifocal consolidations and ground-glass opacity involving both lung parenchyma. Pneumomediastinum also was noted (black arrow). (D) Two years after HD exposure cessation. Subtle, subpleural ill-defined centrilobular nodules remained in both upper lobes (circles).HDLI = humidifier disinfectant-related lung injury, CT = computed tomography, HD = humidifier disinfectant.

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  Fig. 4 Comparison of acute and chronic HDLI image between adult and child patients (family No. 6). (A, B) CT of a 35-year-old woman with 4 months HD exposure. (A) Bilateral ill-defined centrilobular nodules, consolidation and subpleural sparing indicates typical acute HDLI finding. (B) Two years after HD exposure cessation. Tiny, ill-defined centrilobular nodules were noted in the subpleural portion of the bilateral lower lobes (circles). (C, D) CT of a 2-year-old boy with HD exposure. (C) Bilateral extensive consolidation and ground-glass opacity involving both lungs. Pneumomediastinum (black arrow) and interstitial emphysema (black arrowheads). (D) Two years after HD exposure cessation. Numerous bizarre lung cysts (white arrowheads) are scattered in bilateral lungs.HDLI = humidifier disinfectant-related lung injury, CT = computed tomography, HD = humidifier disinfectant.

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  Fig. 5 Comparison of acute and chronic HDLI image between adult and child patients (family No. 10). (A, B) CT of a 47-year-old man with 20.3 months HD exposure. (A) Bilateral, extensive ground-glass opacity with subpleural sparing and irregular consolidations involving both lungs, indicates acute HDLI finding. (B) Four years after HD exposure cessation. Tiny, extensive centrilobular nodules were noted in bilateral lungs (circles). Due to previous lung damage, parenchymal distortion and bullae developed in the right upper lobe (white arrow). (C, D) CT of a 4-year-old boy with HD exposure. (C) Bilateral, extensive ground glass opacity and consolidation involve bilateral lungs. Interstitial emphysema was also noted (black arrow). (D) Four years after HD exposure cessation. Several bizarre lung cysts are noted in bilateral upper lobes (white arrowheads).HDLI = humidifier disinfectant-related lung injury, CT = computed tomography, HD = humidifier disinfectant.

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  Fig. 6 Comparison of acute and chronic HDLI image between adult and child patients (family No. 11). (A, B) CT of a 34-year-old woman with 9.8 months HD exposure. (A) Ill-defined centrilobular nodules and some consolidations were noted in bilateral lungs. (B) Three years after HD exposure cessation. Tiny, extensive centrilobular nodules were noted in bilateral lungs. (C, D) CT of a 2-year-old girl with HD exposure. (C) Bilateral, extensive ground glass opacity and ill-defined centrilobular nodules involve bilateral lungs. Interstitial emphysema was also noted (black arrow). (D) Three years after HD exposure cessation. Subtle bizarre lung cysts were noted in bilateral upper lobes (white arrowheads).HDLI = humidifier disinfectant-related lung injury, CT = computed tomography, HD = humidifier disinfectant.

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  Fig. 7 Comparison of acute and chronic HDLI image between adult and child patients (family No. 16). (A, B) CT of a 34-year-old woman with 4 months' HD exposure. (A) Extensive, ill-defined tiny centrilobular nodules were noted in bilateral lungs, presumed to be subacute stage of HDLI. (B) Two years after HD exposure cessation. Very tiny centrilobular nodules remain in lung parenchyma. (C, D) CT of a 1-year-old boy with HDLI exposure. (C) Bilateral, extensive ground glass opacity and consolidations, indicates acute HDLI finding. Pneumomediastinum (black arrows) and interstitial emphysema (black arrowheads) were also found. (D) Two years after HD exposure cessation. Distortion of bilateral lungs suggest post-inflammatory parenchymal changes. Subtle bizarre lung cysts were noted in the left upper lobe (white arrowheads).HDLI = humidifier disinfectant-related lung injury, CT = computed tomography, HD = humidifier disinfectant.

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