Cellulose granulomatosis of the lungs

Diaz-Ruiz, Maria Jesus; Gallardo, Xavier; Castañer, Eva; Mata, Josep M.; Català, J.; Ferreres, Joan Carles

doi:10.1007/s003300050817

Cited by 22 publications

(35 citation statements)

References 3 publications

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“…Initially, imaging reveals several small (1-mm) nodular and reticular opacities or interstitial nodules, some of which occur in a centrilobular distribution throughout the lungs after talcum or cellulose granulomatosis [236]. Later, homogeneous upper lobe opacities resembling massive fibrosis may be identified.…”

Section: Diagnosismentioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

Eur Respir J

162

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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Section: Diagnosismentioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

Eur Respir J

162

127

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“…It is not typically on the initial differential diagnosis, unless the patient's history indicates IV drug abuse. 3,6 As is the circumstance in the current case, oftentimes patients do not divulge a history of substance abuse even when questioned. The diagnosis of foreign body granulomatosis is often made after other common conditions have been excluded.…”

Section: Discussionmentioning

confidence: 95%

“…The chest X-ray showed no acute cardiopulmonary process. An electrocardiogram (ECG) demonstrated inverted T waves in leads V 1 -V 6 and lead III and the appearance of an S1, Q3, T3 pattern consistent with right ventricular strain ( Figure 1). …”

Section: Introductionmentioning

confidence: 99%

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Illicit narcotic injection masquerading as acute pulmonary embolism

et al. 2013

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A 23-year-old male presented from a nursing home with hypotension, tachycardia, diaphoresis and electrocardiographic evidence of right ventricular strain that was confirmed by echocardiography. His differential diagnosis included sepsis and pulmonary embolism. A high-resolution computed tomography scan demonstrated no pulmonary emboli but did demonstrate multiple bilateral pulmonary nodules. Upon questioning he admitted to injecting a long-acting narcotic that had been manually macerated, dissolved in saline, and injected through an indwelling intravenous line. Lung biopsy findings were consistent with cellulose-induced perivascular granulomatosis. Cellulose granulomatosis can be seen in patients who inject medications designed for oral use and should be considered in patients who present with acute pulmonary hypertension.

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“…The following vegetable substances have been mentioned in recent literature: cellulose, vegetable particles of oat, fruits with spiny surface, rests of parasite echinococcal cystic membranes. Some granulomas represent treatment consequences of pneumocystic pneumonias with dystrophic process of calcification in AIDS 12,13,14,15,16 .…”

Section: Introductionmentioning

confidence: 99%