Abstract
Non-tuberculous mycobacterial lung disease (NTMLD) is diagnosed in 3-6% of patients (pts) with predisposing chronic lung diseases such as COPD and cystic fibrosis. We reported previously the occurrence of NTMLD due to M. kansasii in 6/156 CTEPH pts (3.8%) treated in our centre from 2002 to 2008. The aim of the present study was to analyse the possible causes of NTMLD development in CTEPH pts.
Methods: Clinical data, chest CT scans and hemodynamic variables of 156 CTEPH pts were analysed. Reconstructions were obtained to allow for better visualisation of lung density on chest CT scan.
Results: Marked mosaic perfusion of grade 3-4 was significantly more frequent on CT scans in CTEPH pts who developed NTMLD in comparison to the others (100% vs 64%, p=0.024). Moreover NTMLD, described as focal consolidations with cavitation and satelite micronodules, developed in the areas of lung hypoperfusion.
Pulmonary artery diameter on chest CT scan was 40 (36-42) mm in NTMLD pts comparing to 35 (26 -62) mm in the remaining ones (p=0.015).
CTEPH patients with NTMLD were slimmer than the others: BMI were 23.4 (17.6-27.7) kg/m2 and 28.45 (15.6-55.1) kg/m2 respectively, p=0.039.
NTMLD pts had also lower cardiac indexes and lower mixed venous blood oxygen saturation in comparison to the group without mycobacteriosis.
Conclusions: Vascular pathology resulting in the areas of hypoperfusion within the lungs is probably the reason of growing susceptibility to NTMLD in CTEPH. This phenomenon might be responsible for local defence disturbances. The disease occurrence in younger and slimmer group of CTEPH pts is also observed.
- © 2013 ERS
