Tracheobronchomalacia and air trapping after mustard gas exposure.
BACKGROUND
Mustard gas primarily affects the eyes, skin, and particularly the respiratory tract. Tracheobronchomalacia (TBM) and air trapping are often observed in high-resolution computerized tomography (HRCT) scans of the chest of mustard gas-exposed patients.


OBJECTIVE
To examine the frequency and severity of TBM in a group of Iranian wartime mustard gas-exposed victims, and to investigate the correlation between TBM and air trapping in these cases.


METHODS
Chest HRCT films obtained from 300 randomly selected subjects who had been exposed to mustard gas 15.5 yr previously were reviewed to determine the existence of TBM and air trapping. The HRCT films of a healthy control group were also analyzed for comparison.


RESULTS
Out of 300 reviewed cases, 13 had TBM. From these 13 TBM cases, 11 (85%) showed air trapping with mean score of 5.5. In the control group, 5 (25%) of 20 subjects showed air trapping, with mean score of 0.6. The total air trapping was significantly higher in the TBM group (p < 0.001). There was an association between the severity of tracheomalacia and air trapping in the TBM group (p = 0.01, r = 0.69), but no association was observed between severity of bronchomalacia and air trapping.


CONCLUSIONS
The results show that air trapping and TBM are correlated, both as long-term sequelae in mustard gas-exposed cases. Because air trapping is highly suggestive of bronchiolitis obliterans, we conclude that both bronchiolitis obliterans and TBM are caused by a single underlying process affecting small and large airways, respectively, in this group of patients.
Ghanei
Mostafa
M
Research Center of Chemical Injuries, Baqiyatallah Medical Science University, Mollasadra Street, Tehran, 14359151371, Iran. m.ghanei@bmsu.ac.ir
Akbari Moqadam
Farhad
F
Mohammad
Mehdi Mir
MM
Aslani
Jafar
J
D000328:Adult; D000402:Airway Obstruction / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001982:Bronchial Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002357:Cartilage Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000503:physiopathology; D016022:Case-Control Studies; D002618:Chemical Warfare; D002619:Chemical Warfare Agents / Q000633:toxicity*; D005260:Female; D006801:Humans; D019570:Inhalation Exposure; D007492:Iran; D008297:Male; D008875:Middle Aged; D009151:Mustard Gas / Q000633:toxicity*; D011859:Radiography; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D014133:Tracheal Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology
D002619:Chemical Warfare Agents; D009151:Mustard Gas