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Chest High-resolution Computed Tomography Findings in 601 Patients with Inflammatory Bowel Diseases

Rationale and Objectives

Pulmonary involvement in inflammatory bowel disease may reflect the common embryonic origin of the gastrointestinal tract and the bronchial tree. No studies have compared pulmonary high-resolution computed tomography (HRCT) findings between ulcerative colitis (UC) and Crohn disease (CD). This study aimed to assess the relationship between pulmonary HRCT findings and inflammatory bowel disease activity and to compare HRCT findings between UC and CD.

Materials and Methods

We retrospectively identified 601 consecutive patients (350 with UC and 251 with CD) who had undergone chest HRCT examinations at our institutions between April 2004 and April 2016. Parenchymal abnormalities, enlarged lymph nodes, and pleural effusion were evaluated on HRCT.

Results

One hundred sixty-seven patients (94 men, 73 women; aged 12–86 years, mean: 47.2 years) with UC and 93 patients (61 men, 32 women; aged 12–71 years, mean: 37.9 years) with CD had abnormal findings on chest HRCT. The HRCT findings of UC and CD mainly consisted of centrilobular nodules (in 49.1% and 45.2% of cases, respectively) and bronchial wall thickening (in 31.7% and 54.8%, respectively). There was no relationship between HRCT findings and disease activity. Bronchial wall thickening was significantly more frequent in patients with CD than in those with UC ( P < .001).

Conclusion

The main chest HRCT findings in UC and CD are centrilobular nodules and bronchial wall thickening. There are differences in HRCT findings between UC and CD.

Introduction

The inflammatory bowel diseases (IBDs) (Crohn disease [CD] and ulcerative colitis [UC]) are widely recognized disorders of the gastrointestinal tract that may have a variety of extraintestinal manifestations. These manifestations include pyoderma gangrenosum, erythema nodosum, arthritis, uveitis, and various types of pulmonary disease . Colonic and respiratory epithelia share an embryonic origin from the primitive foregut. Unexplained bronchopulmonary disease was first reported in six patients with IBD in 1976 . Pulmonary involvement in IBD has since been recognized with increasing frequency in the literature.

There have been several reports of pulmonary computed tomography (CT) findings in patients with IBD. However, only nine English-language studies have used high-resolution CT (HRCT) to evaluate these findings. Tunc et al. investigated associations between chest HRCT findings and IBD activity in 52 patients with IBD . They found that 50% of patients with UC and 60% of patients with CD had abnormal chest HRCT findings and that these abnormalities were not significantly different between UC and CD. Yilmaz et al. reported that IBD activity was not correlated with chest HRCT findings in 39 patients .

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Materials and Methods

Patients

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CT Examinations

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CT Image Interpretation

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Statistical Analysis

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Results

Patients’ Characteristics

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TABLE 1

Patient Characteristics

Characteristics Ulcerative Colitis ( n = 167) Crohn Disease ( n = 93) M, F 94, 73 61, 32 Age (y) Range 12-86 13-71 Mean 47.2 37.9 Smoking Current/Exs/Never/unknown 1/11/146/9 1/9/83/0 Clinical activity Mild 64 (38.3) 25 (26.9) Moderate 94 (56.3) 65 (69.9) Severe 9 (5.4) 3 (3.2) Clinical symptoms Abdominal pain 133 (79.6) 70 (75.3) Diarrhea 77 (46.1) 49 (52.7) Weight loss 65 (38.9) 39 (41.9) Fever 91 (54.5) 40 (43.0) Cough 17 (10.2) 8 (8.6) Sputum 0 0 0 0 Breathlessness 5 (3.0) 3 (3.2)

Note: Data in parentheses are percentages.

Exs- ex-smoker.

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TABLE 2

Thoracic CT Findings in Patients with Ulcerative Colitis

Findings Activity Mild ( n = 64) Moderate ( n = 94) Severe ( n = 9)P Value Ground-glass opacity 10 (15.6) 14 (14.9) 0 (0) NS Consolidation 1 (1.6) 0 (0) 0 (0) NS Bronchial wall thickening 16 (25.0) 33 (35.1) 4 (44.4) NS Centrilobular nodules 35 (54.7) 42 (44.7) 5 (55.6) NS Crazy-paving appearance 0 (0) 0 (0) 0 (0) NS Nodules 6 (9.4) 11 (11.7) 0 (0) NS Bronchiectasis 0 (0) 4 (4.3) 0 (0) NS Interlobular septal thickening 0 (0) 4 (4.3) 0 (0) NS Cysts 2 (3.1) 0 (0) 0 (0) NS Lymph node enlargement 0 (0) 0 (0) 0 (0) NS Pleural effusion 1 (1.6) 2 (2.1) 1 (11.1) NS CT diagnostic pattern NSIP 0 (0) 3 (3.2) 0 (0) NS OP 1 (1.6) 8 (8.5) 0 (0) NS UIP 0 (0) 1 (1.1) 0 (0) NS Indeterminate 2 (3.1) 2 (2.1) 0 (0) NS

Data in parentheses are percentages.

CT, computed tomography; NS, not significant; NSIP, nonspecific interstitial pneumonia; OP, organizing pneumonia; UIP, usual interstitial pneumonia.

TABLE 3

Thoracic CT Findings in Patients with Crohn Disease

Findings Activity Mild ( n = 25) Moderate ( n = 65) Severe ( n = 3)P Value Ground-glass opacity 0 (0) 8 (12.3) 0 (0) NS Consolidation 1 (4.0) 1 (1.5) 0 (0) NS Bronchial wall thickening 14 (56.0) 35 (53.8) 2 (66.7) NS Centrilobular nodules 15 (60.0) 25 (38.5) 2 (66.7) NS Crazy-paving appearance 0 (0) 0 (0) 0 (0) NS Nodules 1 (4.0) 3 (4.6) 0 (0) NS Bronchiectasis 0 (0) 1 (1.5) 0 (0) NS Interlobular septal thickening 0 (0) 0 (0) 1 (33.3) NS Cysts 0 (0) 1 (1.5) 0 (0) NS Lymph node enlargement 1 (4.0) 1 (1.5) 0 (0) NS Pleural effusion 0 (0) 1 (1.5) 0 (0) NS CT diagnostic pattern NSIP 1 (4.0) 1 (1.5) 0 (0) NS OP 0 (0) 4 (6.2) 0 (0) NS UIP 0 (0) 0 (0) 0 (0) NS Indeterminate 0 (0) 3 (4.6) 0 (0) NS

Data in parentheses are percentages.

CT, computed tomography; NS, not significant; NSIP, nonspecific interstitial pneumonia; OP, organizing pneumonia; UIP, usual interstitial pneumonia.

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CT Patterns

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Figure 1, Twelve-year-old male patient with Crohn disease (never smoker, with no respiratory symptoms).

Figure 2, Fifty-nine-year-old male patient with ulcerative colitis (never smoker, with no respiratory symptoms).

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Figure 3, Forty-two-year-old female patient with Crohn disease (never smoker, with a cough).

Figure 4, Thirty-eight-year-old female patient with Crohn disease (never smoker, with no respiratory symptoms). ( a ) Transverse computed tomography (CT) image (1-mm thickness) at the level of the division of right B 3 shows bronchial wall thickening ( arrows ) in both lungs. ( b ) Transverse CT image (1-mm thickness) at the level of the left upper lobe (16 mm below the level in a ) shows ill-defined centrilobular nodules ( arrows ) in the left upper lobe.

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TABLE 4

Thoracic CT Findings for Each Type of Disease

Findings Ulcerative Colitis ( n = 167) Crohn Disease ( n = 93)P Value Ground-glass opacity 24 (14.4) 8 (8.6) NS Consolidation 1 (0.6) 2 (2.1) NS Bronchial wall thickening 53 (31.7) 51 (54.8) <.001 Centrilobular nodules 82 (49.1) 42 (45.2) NS Crazy-paving appearance 0 (0) 0 (0) NS Nodules 17 (10.2) 4 (4.3) NS Bronchiectasis 4 (2.4) 1 (1.1) NS Interlobular septal thickening 4 (2.4) 1 (1.1) NS Cysts 2 (1.2) 1 (1.1) NS Lymph node enlargement 0 (0) 2 (2.2) NS Pleural effusion 4 (2.4) 1 (1.1) NS CT diagnostic pattern NSIP 3 (1.8) 2 (2.2) NS OP 9 (5.4) 4 (4.3) NS UIP 1 (0.6) 0 (0) NS Indeterminate 4 (2.4) 3 (3.2) NS

Data in parentheses are percentages.

CT, computed tomography; NS, not significant; NSIP, nonspecific interstitial pneumonia; OP, organizing pneumonia; UIP, usual interstitial pneumonia.

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Disease Distribution

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Follow-up Study

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Discussion

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