Affiliations: South Hills Pulmonary Associates
New York Methodist Hospital and Weill Medical College of Cornell University
New York, NY
Correspondence to: C. Vaughn Strimlam, MD, FCCP, South Hills Pulmonary Associates, Roesch-Taylor Medical Building, 2100 Jane St, North-Suite 601, Pittsburgh, PA 15203
To the Editor:
I read with interest the Roentgenogram of the Month by Thai et
al (December 2000).1This is an excellent example of a
patient with ankylosing spondylitis and apical fibrobullous disease. In
the discussion, the author states that “…the true incidence of
fibrobullous lung disease… is not known, but reports range from 1
to 30%.” This statement is incorrect. Our previous comprehensive and
thorough review of 2,080 patients clarified the incidence of apical
fibrobullous disease.2 A total of 28 patients (an
incidence of 1.3%) had pleuropulmonary manifestations of ankylosing
spondylitis. This is the definitive report in the English-language
literature. We clearly established an incidence figure between 1% and
2%. Hopefully, this figure has now been corrected and future reports
will reflect the true incidence of this uncommon disorder.
We welcome the comments of Dr. Strimlan in response to our
Roentgenogram of the Month article (December 2000) regarding apical
fibrocavitary disease in a patient with ankylosing
spondylitis.1In their article2as well as in
other review articles,3–4 a range of reported incidence of
pleuropulmonary manifestations in ankylosing spondylitis quoted is 0 to
30%. However, in several original articles, the pathology was
nonspecific fibrosis rather than apical fibrocavitary disease related
to ankylosing spondylitis. In a review of 42 patients with ankylosing
spondylitis, Chakera et al5found upper-lobe fibrosis in 6
patients (14.3%) in addition to focal pulmonary changes in 13 patients
(30.9%). Interestingly, none of their patients developed cavities.
Wolson and Rohwedder6found unexplained upper-zone
fibrosis in 2 of the 52 patients with typical skeletal radiologic
features of ankylosing spondylitis. In their follow-up, one patient
developed a mycetoma in the area of fibrosis and the other patient
showed no progression of fibrosis. Crompton et al7 found
unexplained pleuropulmonary abnormalities in 14 of 225 patients (12%).
Upper-lobe fibrosis was found in 12 of these 14 patients. In only one
patient was there evidence of cavitation. We concur with Dr. Strimlan
that apical fibrobullous disease is indeed an uncommon entity in
patients with ankylosing spondylitis, as has been established in their
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