IMAGES IN THORAX

Delayed-onset bronchiolitis obliterans with organising pneumonia associated with massive acetic acid steam inhalation

B-F Sheu¹, C-C Lee², Y-R Young¹, L-F Li³, S-S Chang^1,4

¹ Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung College of Medicine, Taoyuan, Taiwan
² Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou, Taiwan
³ Department of Chest Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
⁴ Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan

Correspondence to:
Dr C-C Lee, Department of Emergency Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan; chnchnglee@yahoo.com

The first 150 words of the full text of this article appear below.

A 34-year-old worker had massive exposure to acetic acid steam from an explosion in a chemical factory. At the emergency department respiratory distress, hoarseness and swelling of the oropharyngeal mucosa were noted. The chest radiograph showed bilateral infiltration (fig 1). After being diagnosed with inhalation injury and chemical pneumonitis, he was prophylactically intubated and given parenteral steroid with prophylactic antibiotics. Diagnostic fibreoptic bronchoscopy revealed diffuse trachobronchial mucosal redness and friability (fig S1A,B available online only). Scattered throughout the airway were multiple corrosive ulcerations. A follow-up thin-section CT scan at day 15 showed ground-glass attenuation in the bilateral upper lung (fig 2). Lower sections of the chest CT scan did not show signs of severe airway obstruction. At day 21 he began to feel chest tightness and dyspnoea and had massive repeated haemo-ptysis. Repeated bronchoscopy showed diffuse mucosal pallor, scattered ulcerations, fibrous exudates and granulation tissue in . . . [Full text of this article]

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