Anterior Mediastinal Fat Changes in Idiopathic Pulmonary Fibrosis: A Preliminary Study
ABSTRACT
Background: The mediastinum is composed primarily of fatty tissue that is surrounded by the lungs bilaterally.
There is a lack in the published literature in studying changes in mediastinal fat in idiopathic pulmonary fibrosis
(IPF). The purpose of this study was to determine whether the shape and dimensions of the anterior mediastinal fat in patients with IPF are different from that of a normal control group and to correlate the changes with disease severity. Design and Setting: This prospective case control study was done at the chest department of Assiut University Hospital on IPF patients from May 2010-September 2012. A questionnaire containing questions such as age, sex, clinical findings, high resolution computerized tomography (HRCT) score and pulmonary function tests (PFTs) was filled for patients and normal controls. Results: The IPF retrosternal AP dimension was significantly shorter (p = 0.03) and the transverse dimension was longer (p = 0.001) than that in the normal control group. The convex shape of the anterior mediastinum was predictive of IPF (p = 0.001), whereas concave shape was predictive of normal controls (p = 0.001). The change in anteroposterior diameter (AP) and transverse diameters showed significant correlation with the changes in FVC, DLCO and HRCT score. Conclusions: IPF patients had reduced retrosternal AP and increased transverse dimensions than those of the controls with convex shape of their anterior mediastinal fat. Changes in anterior mediastinal fat dimensions are correlated with lower FVC, DLCO and higher HRCT score. A larger sample size, better multicenteric study is needed to confirm the results of this study.
There is a lack in the published literature in studying changes in mediastinal fat in idiopathic pulmonary fibrosis
(IPF). The purpose of this study was to determine whether the shape and dimensions of the anterior mediastinal fat in patients with IPF are different from that of a normal control group and to correlate the changes with disease severity. Design and Setting: This prospective case control study was done at the chest department of Assiut University Hospital on IPF patients from May 2010-September 2012. A questionnaire containing questions such as age, sex, clinical findings, high resolution computerized tomography (HRCT) score and pulmonary function tests (PFTs) was filled for patients and normal controls. Results: The IPF retrosternal AP dimension was significantly shorter (p = 0.03) and the transverse dimension was longer (p = 0.001) than that in the normal control group. The convex shape of the anterior mediastinum was predictive of IPF (p = 0.001), whereas concave shape was predictive of normal controls (p = 0.001). The change in anteroposterior diameter (AP) and transverse diameters showed significant correlation with the changes in FVC, DLCO and HRCT score. Conclusions: IPF patients had reduced retrosternal AP and increased transverse dimensions than those of the controls with convex shape of their anterior mediastinal fat. Changes in anterior mediastinal fat dimensions are correlated with lower FVC, DLCO and higher HRCT score. A larger sample size, better multicenteric study is needed to confirm the results of this study.
Cite this paper
W. Hassan and E. Abo-Elhamd, "Anterior Mediastinal Fat Changes in Idiopathic Pulmonary Fibrosis: A Preliminary Study," Open Journal of Respiratory Diseases, Vol. 4 No. 1, 2014, pp. 18-21. doi: 10.4236/ojrd.2014.41003.
W. Hassan and E. Abo-Elhamd, "Anterior Mediastinal Fat Changes in Idiopathic Pulmonary Fibrosis: A Preliminary Study," Open Journal of Respiratory Diseases, Vol. 4 No. 1, 2014, pp. 18-21. doi: 10.4236/ojrd.2014.41003.
References
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Vedal, W. M. Thurlbeck and D. N. Ostrow, “Disease Activity in Idiopathic Pulmonary Fibrosis: CT and Pathologic Correlation,” Radiology, Vol. 165, 1987, pp. 731-734. [14] L. Agnaldo, C. Domenico, M. Roberto, L. Pedro and J. José, “Severity Classification for Idiopathic Pulmonary Fibrosis by Using Fuzzy Logic,” Clinics (Sao Paulo), Vol. 66, No. 6, 2011, pp. 1015-1019. http://dx.doi.org/10.1590/S1807-59322011000600016 [15] L. Michele, H. Marvin, M. D. Chasen, F. Reginald and Munden, “Imaging of the Mediastinum in Oncology,” AR, Vol. 36, No. 1, 2007, pp. 1-2. [16] H. J. Koerner and D. I. Sun, “Mediastinal Lipomatosis Secondary to Steroid therapy,” American Journal of Roentgenology, Vol. 98, No. 2, 1966, pp. 461-464. http://dx.doi.org/10.2214/ajr.98.2.461 [17] H. Toei, M. Furuse, T. Shinozaki and Y. Sohara, “CT Analysis of the Anterior Mediastinal Fat: Before and after Lobectomy,” Nippon Igaku Hoshasen Gakkai Zasshi, Vol. 57, No. 8, 1997, pp. 493-498. [18] T. Johkoh, N. L. Müller, Y. Cartier, P. V. Kavanagh, T. E. Hartman, M. Akira, et al., “Idiopathic Interstitial Pneumonias: Diagnostic Accuracy of Thin-Section CT in 129 Patients,” Radiology, Vol. 211, No. 3, 1999, pp. 555-560. http://dx.doi.org/10.1148/radiology.211.2.r99ma01555 [19] S. L. MacDonald, M. B. Rubens, D. M. Hansell, S. J. Copley, S. R. Desai, R. M. du Bois, et al., “Nonspecific Interstitial Pneumonia and Usual Interstitial Pneumonia: Comparative Appearances at and Diagnostic Accuracy of Thin-Section CT,” Radiology, Vol. 221, No. 3, 2001, pp. 600-605. http://dx.doi.org/10.1148/radiol.2213010158
[1] L. Cheung, J. Gertow, O. Werngren, L. Folkersen, N. Petrovic, J. Nedergaard, A. Franco-Cereceda, P. Eriksson, and R. Fisher, “Human Mediastinal Adipose Tissue Displays Certain Characteristics of Brown Fat,” Nutrition & Diabetes, Vol. 3, No. 5, 2013, p. 66. http://dx.doi.org/10.1038/nutd.2013.6 [2] E. R. Fisher and J. D. Godwin, “Extrapleural Fat Collections: Pseudotumors and Other Confusing Manifestations,” American Journal of Roentgenology, Vol. 161, No. 1, 1993, pp. 47-52. http://dx.doi.org/10.2214/ajr.161.1.8517319 [3] P. Macchiarini and H. Ostertag, “Uncommon Primary Mediastinal Tumours,” The Lancet Oncology, Vol. 5, No. 2, 2004, pp. 107-118. http://dx.doi.org/10.1016/S1470-2045(04)01385-3 [4] C. H. Lee, H. J. Lee, K. R. Son, E. J. Chun, K. Y. Lim, J. M. Goo, J. G. Im, J. N. Heo and J. W. Song, “CT Analysis of the Anterior Mediastinum in Idiopathic Pulmonary Fibrosis and Nonspecific Interstitial Pneumonia,” Korean Journal of Radiology, Vol. 7, No. 3, 2006, pp. 173-179. http://dx.doi.org/10.3348/kjr.2006.7.3.173 [5] G. Raghu, H. R. Collard, J. J. Egan, et al., “An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-Based Guidelines for Diagnosis and Management,” American Journal of Respiratory and Critical Care Medicine, Vol. 183, No. 6, 2011, pp. 788-824. http://dx.doi.org/10.1164/rccm.2009-040GL [6] T. E. Hartman, S. J. Swensen, D. M. Hansell, T. V. Colby, J. L. Myers, H. D. Tazelaar, et al., “Nonspecific Interstitial Pneumonia: Variable Appearance at High-Resolution Chest CT,” Radiology, Vol. 217, No. 3, 2000, pp. 701-705. http://dx.doi.org/10.1148/radiology.217.3.r00nv31701 [7] S. Hiromitsu, J. Takeshi, I. Kazuya, T. Hiroyuki, et al., “Usual Interstitial Pneumonia and Chronic Idiopathic Interstitial Pneumonia: Analysis of CT Appearance in 92 Patients,” Radiology, Vol. 241, No. 1, 2006, pp. 258-266. [8] Z. D. Niil, F. C. Gilchrist, A. G. Nicholson, D. M. Hansell, J. Harris, T. V. Colby, et al., “A Histologic pattern of Nonspecific Interstitial Pneumonia Is Associated with a Better Prognosis Than Usual Interstitial Pneumonia in Patients with Cryptogenic Fibrosing Alveolitis,” American Journal of Respiratory and Critical Care Medicine, Vol. 160, No. 3, 1999, pp. 899-905. http://dx.doi.org/10.1164/ajrccm.160.3.9903021 [9] K. R. Flaherty, W. D. Travis, T. V. Colby, G. B. Toews, E. A. Kazerooni, B. H. Gross, et al., “Histologic Variability in Usual and Nonspecific Interstitial Pneumonias,” American Journal of Respiratory and Critical Care Medicine, Vol. 164, No. 9, 2001, pp. 1722-1727. http://dx.doi.org/10.1164/ajrccm.164.9.2103074 [10] W. D. Travis, K. Matsui, J. Moss and V. J. Ferrans, “Idiopathic Nonspecific Interstitial Pneumonia: Prognostic Significance of Cellular and Fibrosing Patterns: Survival Comparison with Usual Interstitial Pneumonia and Desquamative Interstitial Pneumonia,” The American Journal of Surgical Pathology, Vol. 24, 2000, pp. 19-33. http://dx.doi.org/10.1097/00000478-200001000-00003 [11] Y. J. Jeong, K. S. Lee, N. L. Müller, M. P. Chung, M. J. Chung, J. Han, et al., “Usual Interstitial Pneumonia and Non-Specific Interstitial Pneumonia: Serial Thin-Section CT Findings Correlated with Pulmonary Function,” Korean Journal of Radiology, Vol. 6, No. 3, 2005, pp. 143- 152. http://dx.doi.org/10.3348/kjr.2005.6.3.143 [12] A. C. Best, A. M. Lynch, C. M. Bozic, D. Miller, G. K. Grunwald and D. A. Lynch, “Quantitative CT Indexes in Idiopathic Pulmonary Fibrosis: Relationship with Physiologic Impairment,” Radiology, Vol. 228, No. 2, 2003, pp. 407-414. http://dx.doi.org/10.1148/radiol.2282020274 [13] N. L. Müller, C. A. Staples, R. R. Miller, S. Vedal, W. M. Thurlbeck and D. N. Ostrow, “Disease Activity in Idiopathic Pulmonary Fibrosis: CT and Pathologic Correlation,” Radiology, Vol. 165, 1987, pp. 731-734. [14] L. Agnaldo, C. Domenico, M. Roberto, L. Pedro and J. José, “Severity Classification for Idiopathic Pulmonary Fibrosis by Using Fuzzy Logic,” Clinics (Sao Paulo), Vol. 66, No. 6, 2011, pp. 1015-1019. http://dx.doi.org/10.1590/S1807-59322011000600016 [15] L. Michele, H. Marvin, M. D. Chasen, F. Reginald and Munden, “Imaging of the Mediastinum in Oncology,” AR, Vol. 36, No. 1, 2007, pp. 1-2. [16] H. J. Koerner and D. I. Sun, “Mediastinal Lipomatosis Secondary to Steroid therapy,” American Journal of Roentgenology, Vol. 98, No. 2, 1966, pp. 461-464. http://dx.doi.org/10.2214/ajr.98.2.461 [17] H. Toei, M. Furuse, T. Shinozaki and Y. Sohara, “CT Analysis of the Anterior Mediastinal Fat: Before and after Lobectomy,” Nippon Igaku Hoshasen Gakkai Zasshi, Vol. 57, No. 8, 1997, pp. 493-498. [18] T. Johkoh, N. L. Müller, Y. Cartier, P. V. Kavanagh, T. E. Hartman, M. Akira, et al., “Idiopathic Interstitial Pneumonias: Diagnostic Accuracy of Thin-Section CT in 129 Patients,” Radiology, Vol. 211, No. 3, 1999, pp. 555-560. http://dx.doi.org/10.1148/radiology.211.2.r99ma01555 [19] S. L. MacDonald, M. B. Rubens, D. M. Hansell, S. J. Copley, S. R. Desai, R. M. du Bois, et al., “Nonspecific Interstitial Pneumonia and Usual Interstitial Pneumonia: Comparative Appearances at and Diagnostic Accuracy of Thin-Section CT,” Radiology, Vol. 221, No. 3, 2001, pp. 600-605. http://dx.doi.org/10.1148/radiol.2213010158