Inflammatory bowel disease (thoracic manifestations)
Thoracic manifestations of both ulcerative colitis and Crohn's disease can be variable and can't be used to differentiate between these entities.
They can develop at any time with respect to the clinical onset of the underlying disease. Actually, they can also predate the colonic disease or develop after colectomy.
The spectrum includes:
- affecting large airways
- affecting small airways
- as lesions mimicking granulomatosis with polyangiitis 1
- as a pulmonary vasculitis
- as necrobiotic nodules
- pulmonary eosinophilia
- pulmonary bullae
- apical fibrosis
- as interstitial lung disease
It is important to differentiate these from adverse drug reactions to medications given for the underlying disease (IBD).
Diagnosis is important, as pulmonary abnormalities in ulcerative colitis and Crohn's disease can present years after the onset of the bowel disease and can - as stated above - affect any part of the lungs. Early recognition is of utmost importance as symptoms can be strikingly steroid-responsive 7,8.
Complexity is not decreased by the fact that several entities may coexist or be linked to IBD, e.g. sarcoidosis and IBD 3 to mention just one.
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- 2. Camus P, Colby T. European Respiratory Monograph. 2011; (52): . doi:10.1183/1025448x.10004110
- 3. Betancourt SL, Palacio D, Jimenez CA et-al. Thoracic manifestations of inflammatory bowel disease. AJR Am J Roentgenol. 2011;197 (3): W452-6. doi:10.2214/AJR.10.5353 - Pubmed citation
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- 5. Camus P, Colby T. European Respiratory Monograph. 2005;34: . doi:10.1183/1025448x.00034011
- 6. Mahadeva R, Walsh G, Flower CD et-al. Clinical and radiological characteristics of lung disease in inflammatory bowel disease. Eur. Respir. J. 2000;15 (1): 41-8. Pubmed citation
- 7. Yamamoto AK, Babar JL. Case 184: ulcerative tracheobronchitis. Radiology. 2012;264 (2): 609-13. doi:10.1148/radiol.12110413 - Pubmed citation
- 8. Sostegni R, Daperno M, Pera A. Pulmonary manifestations of inflammatory bowel disease. Dig Liver Dis. 2007;39 (3): 239-41. doi:10.1016/j.dld.2006.11.007 - Pubmed citation