Lung involvement

Introduction Lung involvement was seen in 85% of patients with mixed connective tissue disease. Only 27% of them have clinical symptoms, mainly characterized by shortness of breath, chest pain and dry cough. A small number of patients have pulmonary interstitial fibrosis, pleural effusion, pleural hypertrophy or pulmonary hypertension. Pulmonary involvement is associated with pulmonary hemorrhage in 12% to 29% of patients with spinal cord involvement, and is also an important factor in morbidity and mortality. Hemoptysis is a common manifestation of lung involvement, with bloody sputum in the sputum and massive hemoptysis in the sputum. Most cases appear within 1 month of admission, but they can also persist for a long time, accompanied by dyspnea and anemia. Pulmonary hemorrhage can lead to severe hypoxemia.

Cause

There are many diseases that can cause lung involvement, such as the following:

1. Systemic lupus erythematosus

Systemic lupus erythematosus is a multi-factor-specific autoimmune disease that highlights a variety of autoantibodies and, through autoimmune complexes, causes almost any systemic system in the body to be affected. Lung involvement in systemic lupus erythematosus is much more common than other connective tissue diseases. Systemic lupus erythematosus can affect any part of the respiratory system including the pleura, lung parenchyma, pulmonary vessels, and respiratory muscles. Mainly manifested as: pulmonary infection, pleurisy, acute lupus pneumonia, alveolar hemorrhage, acute reversible hypoxemia, chronic interstitial pneumonia (fibrosis), obstructive bronchiolitis with organizing pneumonia, respiratory muscle weakness , pulmonary hypertension, pulmonary thromboembolism, obstructive pulmonary disease, upper respiratory tract dysfunction.

Systemic lupus erythematosus can occur at any stage of the disease, and the incidence rate is different, which is considered to be 60%. Another report is that 17% of patients with systemic lupus erythematosus are affected by pleural involvement, and those with lung involvement account for 3 %, the pleural involvement was up to 36% and the lung involvement was 7% throughout the course of the disease. Lighter such as pleurisy can be without any symptoms, and severe cases such as alveolar bleeding can be life-threatening. The clinical and imaging findings and even histopathological manifestations of various pulmonary lesions in systemic lupus erythematosus can overlap, and some patients may have more than one pulmonary symptom throughout the course of the disease. Lung involvement in systemic lupus erythematosus suggests a poor prognosis, with mortality rates more than two times higher than those without pulmonary involvement.

The understanding of the pulmonary manifestations of systemic lupus erythematosus is a wake-up for patients. Systemic lupus erythematosus will be difficult to cure in the later stages of development, and may even cause death, so patients should go to hospital for treatment as soon as possible.

2, spinal vascular disease

Pulmonary involvement is associated with pulmonary hemorrhage in 12% to 29% of patients with spinal cord involvement, and is also an important factor in morbidity and mortality. Hemoptysis is a common manifestation of lung involvement, with bloody sputum in the sputum and massive hemoptysis in the sputum. Most cases appear within 1 month of admission, but they can also persist for a long time, accompanied by dyspnea and anemia. Pulmonary hemorrhage can lead to severe hypoxemia. Common imaging features are alveolar shadows without pulmonary edema or infection. An increase in the carbon monoxide conversion coefficient (30%) also suggests pulmonary hemorrhage, which can be diagnosed by bronchoalveolar lavage. The clinical imaging function test of some patients with small vascular pulmonary vasculitis is consistent with the interstitial lesion process, similar to idiopathic pulmonary fibrosis.

3, primary vasculitis

Lung involvement: cough, hemoptysis / hemoptysis, severe respiratory failure due to extensive alveolar hemorrhage is life-threatening.

Mainly manifested as shortness of breath, chest pain and dry cough. A small number of patients have pulmonary interstitial fibrosis, pleural effusion, pleural hypertrophy or pulmonary hypertension. X-ray was characterized by interstitial inflammation, fibrosis, pulmonary function tests, and ventilatory function.

an examination

Related inspection

Tumor receptor imaging pulmonary ventilation imaging pulmonary ventilation

Recently, it has been reported in the literature that pulmonary involvement may be the first manifestation of pulmonary fibrosis, which is easily misdiagnosed as idiopathic pulmonary interstitial fibrosis (IPA) and other diseases. Cough, dyspnea, and chest tightness may occur in the lung. Pulmonary involvement is associated with pulmonary hemorrhage in 12% to 29% of patients with spinal cord involvement, and is also an important factor in morbidity and mortality. Hemoptysis is a common manifestation of lung involvement, with bloody sputum in the sputum and massive hemoptysis in the sputum. Most cases appear within 1 month of admission, but they can also persist for a long time, accompanied by dyspnea and anemia. Pulmonary hemorrhage can lead to severe hypoxemia. Common imaging features are alveolar shadows without pulmonary edema or infection. An increase in the carbon monoxide conversion coefficient (30%) also suggests pulmonary hemorrhage, which can be diagnosed by bronchoalveolar lavage. The clinical imaging function test of some patients with small vascular pulmonary vasculitis is consistent with the interstitial lesion process, similar to idiopathic pulmonary fibrosis.

Differential diagnosis

1, skin involvement: Skin involvement is a common early manifestation of the disease. It is characterized by diffuse swelling of the fingers and a sausage-like appearance. Some patients developed diffuse swelling of the back of the hand. Finger flattening is another characteristic manifestation of this disease. A small number of patients have erythema, purple eyelids, hair loss and photoallergies.

2, kidney involvement: the renal involvement of patients with this disease accounted for 25-65%, of which membranous glomerulonephritis is the most common. Individual cases have manifestations of nephrotic syndrome, while diffuse proliferative and interstitial nephritis are rarely seen in mixed connective tissue disease.

3, heart involvement: about 4% of patients with mixed connective tissue disease. The central inflammation is the most common, followed by myocardial lesions and arrhythmias.

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