Pulmonary Apical Cap as a Potential Risk Factor for Pleuroparenchymal Fibroelastosis

Marinescu, D; English, John; Sedlic, T.; Kliber, A.; Ryerson, Christopher J.; Wong, Alyson W.

doi:10.1016/j.chest.2021.01.011

Cited by 8 publications

(2 citation statements)

References 19 publications

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“…With regard to low %VC and a preoperative pulmonary apical cap, patients with PPFE commonly have low %VC [ 1 , 3 , 4 , 18 ], and a pulmonary apical cap has the same histological characteristics as PPFE despite being an anatomically localized, non-progressive lesion [ 1 , 10 , 19 ]. In addition, a pulmonary apical cap has been reported to be potentially caused by ischaemia in the upper lobes and low-grade inflammation in the lung parenchyma [ 1 , 18 ] and is considered a potential risk factor for PPFE [ 20 ]. Therefore, we suppose that patients with low %VC and a pulmonary apical cap have some potential pathophysiological factors in common with those with PPFE.…”

Section: Discussionmentioning

confidence: 99%

Radiological unilateral pleuroparenchymal fibroelastosis as a notable late complication after lung cancer surgery: incidence and perioperative associated factors

Inafuku

Sekine

Arai

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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Objectives Pleuroparenchymal fibroelastosis (PPFE) is a rare idiopathic interstitial pneumonia characterized by pleural-parenchymal involvements predominantly in the upper lobes. Unilateral upper lung field pulmonary fibrosis (upper-PF) radiologically consistent with PPFE reportedly develops after lung cancer surgery in the operated side and presents many clinical characteristics in common with PPFE. However, the incidence and perioperative associated factors remain unclear. Methods All consecutive patients with lung cancer completely resected from 2008 to 2016 were retrospectively investigated. Pre-/postoperative characteristics were compared between patients with and without unilateral upper-PF. Cumulative incidence curves were estimated by using competing risk analysis. Results Among 587 included patients, 25 patients (4.3%) were diagnosed as unilateral upper-PF. The 3-, 5- and 10-year cumulative incidence of unilateral upper-PF was 2.3%, 3.3% and 5.3%, respectively. In multivariable analysis, male sex, presence of pulmonary apical cap, lobar resection and low % vital capacity (%VC < 80%) were independent perioperative associated factors. The 10-year cumulative incidence was 6.3% in patients treated with lobar resection, 8.0% in male patients, 10.3% in patients with pulmonary apical cap and 14.5% in patients with low %VC. Postoperative pleural effusion at 6 months after surgery was much more common in the patients who later developed unilateral upper-PF (96.0% vs 24.2%). This pleural effusion persisted and was accompanied by pleural thickening and subpleural pulmonary fibrosis thereafter. During the clinical courses of 25 patients with unilateral upper-PF, 18 patients presented symptoms related upper-PF and 6 patients died. Conclusion Unilateral upper-PF is not a rare but under-recognized late complication after lung cancer surgery.

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Section: Discussionmentioning

confidence: 99%

Radiological unilateral pleuroparenchymal fibroelastosis as a notable late complication after lung cancer surgery: incidence and perioperative associated factors

Inafuku

Sekine

Arai

et al. 2022

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…Marinescu et al . [ 10 ] recently described a patient with PAC that evolved into PPFE after lung surgery and speculated that the presence of PAC predisposes patients to PPFE development when faced with ongoing inflammatory injury. Although the insults were unidentified in patients with IPPFE and whether this apical fibrosis should be recognised as PAC or an early phase of PPFE was an intrinsic problem, we showed that half of the patients with IPPFE had apical fibrosis that did not progress long before the diagnosis.…”

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confidence: 99%