Journal of the Louisiana State Medical Society
ologists in particular, to better correlate diagnostic features at any stage of the patient’s presentation and thus reduce the time-to-diagnosis of an entity that can mimick several other autoimmune conditions. Early diagnosis results in implementation of the best available current therapy and saves the patient’s and physician’s time. REFERENCES 1. Compton N., Buckner J.H, Harp K.I, Raugi G.J. Polychondritis <http://emedicine.medscape.com/article/331475-overview> (accessed 14 April, 2013). 2. Damiani, J M. Relapsing polychondritis-report of ten cases. The Laryngoscope 1979;89(6):929. 3. Mcadam L.P, BluestoneR, Pearson C.M et al. Relapsing Polychondritis: Prospective Study of 23 Patients and a Review of the Literature. Medicine 1976;55(3):193-215. 4. Tillie-Leblond I, Wallaert B, Leblond D, et al. Respiratory Involvement in Relapsing Polychondritis. Clinical, Functional, Endoscopic, and Radiographic Evaluations. Medicine 1998; 77(3):168-176. 5. Prince JS, Duhamel DR, Levin DL, et al. Nonneoplastic lesions of the tracheobronchial wall: Radiologic findings with bronchoscopic correlation. Radiographics 2002;22:S215-S230. 6. Lee KS, Ernst A, Trentham DE, Lunn W et al. Relapsing polychondritis: prevalence of expiratory CT airway abnormalities. Radiology . Aug 2006;240(2):565-73. 7. Michet CJ Jr, McKenna CH, Luthra HS, O’Fallon WM. Relapsing polychondritis. Survival and predictive role of early disease manifestations. Ann Intern Med 1986 Jan;104(1):74-8. 8. Ernst A, Rafeq S, Boiselle P, et al. Relapsing polychondritis and airway involvement. Chest 2009 Apr;135(4):1024-30. 9. TrenthamD.E, Le C.H. Relapsing polychondritis. Ann Intern Med Figure 6: AP chest radiograph showing a complete collapse of the left lung with ipsilateral pleural effusion. There is a pneumonic consolidation in right lung. Note barium in left lower lobe due to an esophagobronchial fistula.
with other autoimmune disorders, there are few readily dif- ferentiating features. Its relapsing nature can clinically point to the diagnosis, and this paper demonstrates the temporal profile of the radiological features in order to pinpoint any characteristic pattern. However, clinical experience has shown variability in the course and extent of organ involve- ment in different patients. 3 Prognosis is linked to laryngeal, tracheal, and cardio- vascular involvements. 7 Chondritis of the respiratory tract is one of the most serious complications of RP, occurring especially in women, and accounts for up to 50% of deaths due to RP. 3,7,8 Pneumonia, which is the most common cause of death, is directly related to airway chondritis. 9 The respi- ratory tract is involved in up to 50%of documented cases, 1,3,10 and so it is crucial to look for respiratory signs in order to offer timely and appropriate treatment. The case in point was followed up radiologically from diagnosis to the patient’s terminal stage, using various mo- dalities, and thus, the evolution of RP as seen in the patient is informative. This paper also contributes to currently sparse data in a non-Caucasian patient of a disease known to occur predominantly in Caucasians. 1 CONCLUSION This case presents with radiological features that ac- curately correlate with clinically demonstrable features of RP. The temporal evolution of the disease is emminently demonstrated by radiological imaging and gives us an “in- side view” of a well-described, albeit uncommon, clinical condition. This profile would enable physicians, and radi- Figure 5: An esophagram showing an esophagobronchial fistula with contrast draining into the stented left main bronchus. Note a calcified lymph node in the left hilum.
58 J La State Med Soc VOL 166 March/April 2014
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