The Role of Multislice in Assessment of Resistant and Atypical Asthmatic Cases
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- Category: Vol. 80, December 2012
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The Role of Multislice in Assessment of Resistant and Atypical Asthmatic Cases,YOUSSRIAH Y. SABRI, MARIAN F. FARID and SARA M.K. ALI
Abstract
Background: Bronchial asthma is considered one of the most common chest diseases causing recurrent wheezes. With the new advances in computed tomography machines, it is now possible to understand the underlying pathophysiologic changes affecting the airways of the asthmatic patients. Multislice computed tomography (MSCT) plays an important role in assessing the patient’s response to treatment. MSCT is used also for identification of causes of failure to respond to asthma medications which include complicated asthma and presence of conditions that may be confused with asthma.
Aim of the Work: The aim of our review study is to evaluate the role of multislice CT in detecting and characterizing lung findings in resistant cases of bronchial asthma, complicated and atypical cases.
Patients and Methods: This study involved 20 patients; 10 males and 10 females, age range 16-80 (average of 42.21years) from June 2010 till November 2011. All patients were known or clinically suspected cases of bronchial asthma. One of the cases was known to be Churg-Strauss. All cases were not responding to therapy. Cases were referred to radi-ology department in kasr El- Ainy for MSCT. They all pre-sented with persistent or recurrent attacks of chronic productive cough and dyspnea. Wheeze was the main complaint in 12 patients. Three patients also had fever. They were all subjected to Thorough clinical examination with history taking, general and chest examination, Pulmonary function tests (PFT), laboratory tests mostly complete blood picture, the other tests were considered according to case e.g. Assessment of serum immunoglobulin, sputum culture..etc. MSCT was done to all patients.
Results: In this study, we provide evidence that multislice computed tomography (MSCT) especially using the HRCT technique is useful in patients with chronic or recurring symptoms of asthma especially those who are resistant to treatment. We found that MSCT can demonstrate a number of findings that support the diagnosis of asthma (18 out of 20 patients) or suggest an alternative diagnosis which may mimic asthma clinically, which in our study was hypersensitivity pneumonitis (1 case) and congestive heart failure (1 case). In those patients who are radiologically proved to be asthmatics, the MSCT was helpful in detecting the cause of non response to treatment which is the presence of irreversible airway changes or the presence of complications (allergic broncho-pulmonary asperigillosis) ABPA in our study in 4 out of 18 patients, including the treatment (steroid) complications. We found that peribronchial thickening and hyperinflation are the most common MSCT findings (14 out of 20 patients) and (13 out of 20 patients), respectively. Other findings are mucus plugging, bronchiectasis and bronchial narrowing.