Thin-section CT assessment of spontaneous pneumomediastinum in interstitial lung disease: correlation with serial changes in lung parenchymal abnormalities.
OBJECTIVE
The purpose of this study was to analyze thin-section computed tomography (CT) appearances of interstitial lung diseases before and at the time of detection of pneumomediastinum, and to evaluate the relationship between pneumomediastinum and parenchymal changes on thin-section CT.


METHODS
We reviewed CT images before and at the time of detection of pneumomediastinum in 13 patients with idiopathic pulmonary fibrosis (8 patients) and collagen vascular diseases (5 patient). The extent of the total area of reticular opacity, increased opacity (ground-glass opacity and consolidation), and honeycombing were scored, and these scores were compared before and at the time of detection of pneumomediastinum. We also divided patients into two groups according to therapy received. Patients in group 1 experienced pneumomediastinum after or during treatment with corticosteroids or immunosuppressive agents for acute or subacute exacerbation of interstitial lung disease. Patients in group 2 experienced pneumomediastinum without therapy.


RESULTS
The mean score of all patients for honeycombing significantly increased at the time of detection of pneumomediastinum (P=0.003). In group 1, the extent of increasing opacity had been decreased significantly at the time of detection of pneumomediastinum (P=0.028). In group 2, the mean CT score of reticular opacity, increasing opacity, and honeycombing significantly increased at the time of detection of pneumomediastinum (P=0.028, 0.018, and 0.018, respectively).


CONCLUSIONS
Spontaneous pneumomediastinum associated with interstitial lung disease appears to have a tendency to occur under conditions of altered of parenchymal interstitial lesions.
Matsuoka
Shin
S
Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, Kanagawa 216-8511, Japan. shinma@d9.dion.ne.jp
Kurihara
Yasuyuki
Y
Yagihashi
Kunihiro
K
Okamoto
Kyoko
K
Niimi
Hiroshi
H
Nakajima
Yasuo
Y
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging* / Q000209:etiology; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents