Pulmonary complications are known to occur in over half of the patients exposed to sulfur mustard (HD). Chemical weapon agents including HD were used by Iraq during Iran-Iraq war between 1983 and 1989. Chest high resolution computed tomography (HRCT) of a group of patients with documented exposure to HD during the war with development of respiratory symptoms, were reviewed to examine delayed HRCT features of HD exposure.
The field emergency cards and medical records of 155 patients exposed to HD during Iran-Iraq war, suffered chronic respiratory complications and had chest HRCT were reviewed. Fifty chest HRCTs were then randomly selected and examined by a panel of pulmonologists and radiologist for analysis.
Forty-five (90%) with mean age of 37.4. The most frequent findings were; air trapping 38 (76%), bronchiectasis 37 (74%), mosaic parenchymal attenuation (MPA) 36 (72%), irregular and dilated major airways 33 (66%) and interlobular septal thickening (SWT) 13 (26%) respectively. LLL and ML were the most and the least frequent lobes involved with total lesions 119 and 18 respectively. Table 1
Chest HRCT findings of bronchiectasis, air trapping, MPA and SWT were seen in patients exposed to HD fifteen years ago. These findings are highly suggestive of obliterative bronchiolitis (OB). We did not encounter significant HRCT findings consistent with pulmonary fibrosis. Major airways dilatation and irregularity seen in two thirds of patients is not a common feature of OB.
Chronic respiratory complications have been the major contributor of mortality and morbidity in these patients. HRCT features fifteen years after exposure to HD is highly suggestive of OB with significant major air ways abnormalities. Further studies are designed to determine the followings in this population; clinical, PFT and pathological correlation with the HRCT, direct toxic effect of HD on major airways and possibility of more favorable clinical outcome with early intervention considering the apparent indolent course of this form of the disease.
M. Mokhtari, None.