J Korean Med Sci.  2009 Aug;24(4):636-640. 10.3346/jkms.2009.24.4.636.

The Area of Ground Glass Opacities of the Lungs as a Predictive Factor in Acute Paraquat Intoxication

• Kim YT
• Jou SS
• Lee HS
• Gil HW
• Yang JO
• Lee EY
• Hong SY

• KMID: 1779196
• DOI: http://doi.org/10.3346/jkms.2009.24.4.636

Abstract

Even though plasma paraquat (PQ) levels have known to be an informative predictor, many patients succumb at low PQ levels in acute PQ intoxication. This study was designed to see whether the high resolution computerized tomography (HRCT) of the lungs would be a predictive measure in acute PQ intoxication. HRCT of the lungs was obtained from 119 patients with acute PQ intoxication on 7 days after PQ ingestion. The areas with ground glass opacities (GGOs) were evaluated at five levels with the area measurement tool of the picture archiving and communication systems. Among 119 patients, 102 survived and 17 died. The plasma PQ levels were significantly higher in the non-survivors than in the survivors (2.6+/-4.0 microgram/mL vs. 0.2+/-0.4 microgram/mL, P=0.02). The area with GGOs was 2.0+/-6.4% in the survivors and 73.0+/- 29.9% in the non-survivors (P<0.001). No patients survived when the area with GGOs was more than 40% but all of the patients survived when the area affected by GGOs was less than 20%. In conclusion, the area of GGOs is a useful predictor of survival in acute PQ intoxication, especially in patients with low plasma PQ levels.

Keyword

Paraquat; Lung; High Resolution Computerized Tomography; Predictive Measure; Ground Glass Opacities

MeSH Terms

Acute Disease
Adult
Diagnosis, Differential
Female
Herbicides/blood/*poisoning
Humans
Lung Injury/*chemically induced/mortality/*radiography
Male
Middle Aged
Paraquat/blood/*poisoning
Predictive Value of Tests
Retrospective Studies
Survivors
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 The areas of GGO were measured at five locations (the top of aortic arch, AP window, LUL bronchus, right inferior pulmonary vein and the top of left diaphragm respectively) using the measurements of the free-pen tool of PACS. To calculate the percents of lung injury, the sum of the areas of GGO (A) at the five levels were divided by the sum of the area of the total lungs (B) at the respective levels.

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  Fig. 2 Plasma PQ levels related to area of GGOs (%) and time interval after PQ ingestion. Note that no patient died when the area of lung GGOs was less than 20% of the total lung volume (A). While deaths occurred at low levels of PQ, almost near the bottom line (B).

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