The only difference
between
our cases and those
of
et al is the morphology
of the subpleural
inflammatory
infiltrate,
which was bandlike
in the former
and focal in the latter.
We always found small blood vessels in the region ofthe subpleural
inflammatory
infiltrate,
and sometimes
noted perivascular
inflammatory
infiltrate,
even focal inflammatory
infiltrate,
similar
to that
in the cases of Buchanan
et al. Therefore,
we consider
that any
morphologic
difference in inflammatory inifitrate
reflects
only the
difference
in inflammatory
stage.
The findings of Buchanan
et al
support
our idea that the presence of subpleural mononuclear cell
infiltration
with minimal pleural
inflammation
suggests
the nontuberculous
nature ofthe pleuritis. A prospective study is now under
way to evaluate
more
objectively
the significance of subpleural
inflammatory
infiltrate.
our
paper.
Buchanan
Research
Nobuhiko Nagata,
Diseases ofthe
iristitutefor
Kywshu
University,
Fukuoka,
Reprint
requests:
Chest,
Kyushu
Dr Nagata,
University,
Research
3-1-1
M.D.,
Chest,
Japan
Diseases of the
Higashi-Ku,
FukuOka
Institutefor
Maidashi,
Ficuan
2. Freely
apparent
812, Japan
years
as a
Lung Infiltrates
in
the emphyseniatous
scan.
seen
two cases similar to the one described
by Vandenplas
case report’
in the November
1990 issue of Chest.
Both my patients
had severe
emphysema
and left lower lobe lung
cancer,
no bronchial
obstruction,
and gravity-dependent
left lower
reason
(Figs
had
1 and
standard
one example
to several
who have not seen this phenom-
radiographs.
John
Wtterans
oflipoid
pneumonia,
nor
had
Administration
I any
that this was a consideration.
The common denominator
these cases and the case of Vandenpias
et al is the
severe
emphysema,
which
I believe
is the only requirement
ftw
gravity-dependent
infiltrates.
I have not identified
other cases in 20
V Forrest
Radiology
2).
no history
is
and have shown
institutions
et al in their
lobe infiltrates
These patients
lung
enon. The observation
is much
more apparent on computed
tomographic (CT) scans, and it may be that it occurs occasionally.
However, we rarely obtain CT scans in patients
with
severe
emphysema
and pneumonia,
and the observation is missed
on
lb the Editor:
I have
at different
fluid
tomographic
chest radiologist
colleagues
Gravity-Dependent
flowing
on computed
to think
between
M.D.,
Service,
Medical Center,
LaJolia,
CalIfOrnIa
REFERENCE
1
Vandenpias
0,
Trigaux
JP, Van Beers B, Delaunois
in a patient
with lipoid
Gravity-dependent
infiltrates
Chest 1990; 98:1253-54
L, Sibille
Y.
pneumonia.
u--
lb the Editor:
The cases reported by Dr Forrest demonstrate
that gravitydependent
opacities
can be observed
in a case
of infectious
pneumoniaassociated
with emphysema. This reinkwces
our conclusion that in the presence of alveolar exudate,
emphysema contributes greatly to the mobility ofthe infiltrates.
A striking
feature
in our case was the velocity
of the gravitydependent
changes.
Only a few minutes
elapsed
between
the prone
and
supine
CF
scans.
M.D.,
M.D.,
IMc De15JUflOiS
M.D., EC.C.P,
Bernard %Isn Beers M.D., and
Yves Sibille,
M.D.,
Universitaires
de Mont-Godinrae,
OlIvIer
Vandenplas
Jean-Paul
ClInIqUeS
Trigaux,
Yvoir,
Percutaneous
1.
emphysematous
lkstemanterior
left lower
radiograph
lobe.
shows
a fluid
flacheostomy
7b the Editor:
a:-.
FIGURE
Bejgium
level
in
an
The
by Dr Douglas
editorial
November
1990
issue
J. Mathisen,’
which appeared in the
calls for some comment.
Dr
of Chest,
1178
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Communications
to the EdItor