Rationale and Objectives
To evaluate pulmonary findings on computed tomography (CT) scans in carriers of human T-lymphotropic virus type 1 (HTLV-1).
Materials and Methods
This retrospective study was approved by the Institutional Review Board at each institution, and informed consent was waived. Patients who were diagnosed with adult T-cell lymphoma/leukemia or collagen vascular disease were excluded from the study. Chest CT of 106 HTLV-1 carriers (54 females and 52 males; age range 44–94 years) were initially evaluated by two chest radiologists. Assessed CT findings included centrilobular nodules, thickening of bronchovascular bundles, ground-glass opacity, bronchiectasis, interlobular septal thickening, consolidation, honeycombing, crazy-paving appearance, enlarged lymph nodes, pleural effusion, and pericardial effusion. Three chest radiologists secondarily evaluated the CT scans with the abnormal findings to judge the presence of interstitial pneumonia patterns or a bronchiolitis/bronchitis pattern.
Results
Abnormal CT findings were found in 65 (61.3%) patients, including ground-glass opacity ( n = 33), bronchiectasis ( n = 28), centrilobular nodules ( n = 25), and interlobular septal thickening ( n = 19). Honeycombing ( n = 5) and crazy-paving appearance ( n = 3) were also observed. Based on the CT findings, 10 subjects were diagnosed with interstitial pneumonia (usual interstitial pneumonia pattern, n = 3; nonspecific interstitial pneumonia pattern, n = 5; organizing pneumonia pattern, n = 2; respectively). Twenty subjects were diagnosed with the bronchitis/bronchiolitis pattern.
Conclusion
Although the bronchiolitis/bronchitis pattern is predominant on chest CT in HTLV-1 carriers, the HTLV-1 infection is associated with various interstitial pneumonias.
Introduction
Human T-lymphotropic virus type 1 (HTLV-1) is a unique retrovirus that causes adult T-cell leukemia/lymphoma (ATL) . The prevalence of HTLV-1 varies among countries and/or continents; Japan, the Caribbean, South America, and Africa have proven to be pandemic areas of the virus. Although the prevalence of the virus is relatively low in the United States or Europe, it has also been acknowledged that a certain percentage of HTLV-1 carriers has been detected in these countries, and that HTLV-1 infection is not deemed to be negligible from the perspective of public health .
Several symptoms/diseases associated with the virus can appear in HTLV-1 carriers, yet not necessarily as manifestations of ATL, which are important for the management of the carriers. Previous studies, focusing on HTLV-1–associated myelopathy or tropical spastic paraparesis, HTLV-1–associated uveitis, and HTLV-1–associated arthropathy, have clarified the connection of HTLV-1 to these disorders . Further, it has been acknowledged that HTLV-1 infection can cause bronchopulmonary abnormalities, such as T-lymphocytic alveolitis, lymphocytic interstitial pneumonia (LIP), and bronchiolitis resembling diffuse panbronchiolitis (DPB) , which can be explained by the peculiar tropism of HTLV-1 to the lymphatic systems in the lung .
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Materials and methods
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Subjects
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CT
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Image Interpretation
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Table 1
CT Findings of Interstitial Lung Diseases and Airway Diseases
Diseases CT Findings Reference Numbers Usual interstitial pneumonia Honeycombing and irregular linear opacities that predominantly involve basal and subpleural lung regions; may show traction bronchiectasis, architectural distortion, and GGO Nonspecific interstitial pneumonia GGO, usually bilateral with some predominance of subpleural and basal regions; may show fine reticulation or traction bronchiectasis, airspace consolidation, and minor honeycombing Organizing pneumonia Patchy and multiple airspace consolidation usually with subpleural or peribronchial distribution associated with GGO; may show centrilobular nodules or masses Lymphoid interstitial pneumonia Poorly defined centrilobular nodules and GGO that accompany thickening of interlobular septa and/or bronchovascular bundle; may show cystic airspaces and lymph node enlargement Bronchiolitis/bronchitis Multiple centrilobular nodules and/or bronchiectasis; may show branching linear structures, peribronchial nodules, and bronchial wall thickening
CT, computed tomography; GGO, ground-glass opacity.
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Results
CT Findings
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Table 2
Summary of CT Findings and CT-based Diagnoses in the 106 HTLV-1 Carriers
CT Findings Total ( n = 106) Usual Interstitial Pneumonia Pattern ( n = 3) Nonspecific Interstitial Pneumonia Pattern ( n = 5) Organizing Pneumonia Pattern ( n = 2) Bronchitis/Bronchiolitis Pattern ( n = 20) Others ( n = 76) κ Value ∗ Centrilobular nodules 25 1 1 2 14 7 0.746 Thickening of bronchovascular bundles 9 1 0 1 7 0 0.642 Ground-glass opacity 33 3 5 2 8 15 0.648 Bronchiectasis (Traction bronchiectasis) 28 (4) 2 (2) 4 (2) 0 (0) 17 (0) 5 (0) 0.774 Interlobular septal thickening 19 2 5 2 7 3 0.836 Consolidation 13 0 0 2 7 4 0.788 Honeycombing 5 3 2 0 0 0 0.904 Crazy-paving appearance 3 1 1 1 0 0 0.852 Enlarged lymph nodes 7 0 3 0 3 1 0.754 Pleural effusion 19 0 0 1 3 15 0.969 Pericardial effusion 10 0 0 0 2 8 0.942
CT, computed tomography; HTLV-1, human T-lymphotropic virus type 1.
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CT-based Diagnoses
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Discussion
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Acknowledgment
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