title: Humidifier disinfectant-associated children's interstitial lung disease: Computed tomographic features, histopathologic correlation and comparison between survivors and non-survivors.
abstract: OBJECTIVE
  To report radiologic findings with histopathologic correlations of humidifier disinfectant-associated children's interstitial lung disease (HD-chILD) and to compare computed tomography (CT) findings between survivors and non-survivors.
  
  
  METHODS
  Forty-seven children with HD-chILD (27.4 ± 12.4 months old) were categorized as survivors (n = 25) and non-survivors (n = 22). The patterns, distributions, and chronological changes in lung lesions at follow-up CT were investigated. Histopathologic correlations were performed in 23 patients.
  
  
  RESULTS
  CT features were characterized by chronological changes, from consolidation to centrilobular opacities, and lesions eventually became faint centrilobular nodules. Histopathologic features were bronchocentric-distributed fibro-inflammatory lesions, which were more profound in the advanced stage than the early stage. Consolidation ≥ 30 % [hazard ratio (HR), 2.932], centrilobular opacities ≥ 60 % of the total lung volume (TLV; HR, 0.206) and spontaneous air leaks (HR, 3.457) were significant factors associated with patient survival, as per univariate analysis. Consolidation ≥ 30 % (HR, 3.519), centrilobular opacities ≥ 60 % (HR, 0.205) and diffuse ground glass opacity (GGO) ≥ 70 % of the TLV (HR, 3.521) were significant factors associated with patient survival, as determined via multivariate analysis.
  
  
  CONCLUSIONS
  Distinctive chronological CT features were observed in the HD-chILD images. Spontaneous air leaks, consolidation, GGO, and centrilobular opacities were prognostic factors.
  
  
  CONCLUSIONS
  Chemical disinfectants can induce severe inhalation lung injury. Lung injury caused by inhaled disinfectants demonstrates chronologic changes in radiologic findings. Understanding of radiological characteristics is important to predict outcomes in chemical pneumonitis. Physicians should be aware of the potential risk of environmental chemicals.
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Hee Mang
authors.initials: HM
authors.lastname: Yoon
authors.affiliation: Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Eun
authors.initials: E
authors.lastname: Lee
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Jin Seong
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Kyung-Hyun
authors.initials: KH
authors.lastname: Do
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Ah Young
authors.initials: AY
authors.lastname: Jung
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Chong Hyun
authors.initials: CH
authors.lastname: Yoon
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Seon-Ok
authors.initials: SO
authors.lastname: Kim
authors.affiliation: Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Se-Jin
authors.initials: SJ
authors.lastname: Jang
authors.affiliation: Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Soo-Jong
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea. youngbud27@daum.net.
authors.forename: Young Ah
authors.initials: YA
authors.lastname: Cho
mesh_terms: D001706:Biopsy / Q000379:methods*; D002675:Child, Preschool; D004202:Disinfectants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D000068998:Humidifiers; D007223:Infant; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000139:chemically induced / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D004202:Disinfectants
keywords: Children; Computed tomography; Environmental substances; Interstitial lung disease; Prognosis