Lung nodules and IgG4 related disease: a single-center based experience

Yan Xie,Tony Marion,Yi Liu,Anji Xiong

doi:10.1186/s12890-020-01250-3

Abstract

BackgroundThis study was undertaken in an attempt to characterize the frequency and clinical features of lung nodules in IgG4 related disease (IgG4-RD) patients as an insight for help with the diagnosis of lung nodules.MethodsA retrospective study was carried out in West China Hospital, Sichuan University from January 2012 to December 2018, 89 patients with definite IgG4-RD were enrolled.ResultsFifty of 89 patients with definite IgG4-RD had radiologically confirmed lung nodules, 6 of whom were diagnosed with definite IgG4 related lung disease. Lung nodules detected in more than 40 patients were small and solid, always with regular margins. Multiple (41/50) and bilateral (34/50) distributions was also a major characteristic of these lung nodules. Lobulation and speculation were simultaneously detected in 3 patients, including 2 patients combined with pleural indentation. Calcification of nodules was detected in only one patient. Thirty-seven patients also had additional radiological abnormalities of lungs, including ground-glass opacity (21/50), thickening of pleura (9/50), thickening of interlobular septa (4/50), thickening of bronchial wall (3/50), pleural effusion (4/50), mass (3/50), interstitial changes (5/50), and mediastinal or hilar lymphadenopathy (32/50). Most patients (44/50) were treated with glucocorticoids alone or combined with immunosuppressive agents. Sixteen patients received a re-examination by chest computed tomography (CT) scan after treatment, 10 of whom showed a decrease in the size and/or the number of nodules.ConclusionsThe incidence of lung nodules in IgG4-RD patients can be high. For an IgG4-RD patient with lung nodules, the possibility that the lung nodules related to IgG4-RLD is high. It is hard to differentiate IgG4 related lung nodules from other lung diseases, in particular, lung cancer. Radiological characteristics and positive responses to glucocorticoids and immunosuppressive agents can help with the differential diagnosis. For these patients, regular follow-up is also important.

Highlights

This study was undertaken in an attempt to characterize the frequency and clinical features of lung nodules in IgG4 related disease (IgG4-RD) patients as an insight for help with the diagnosis of lung nodules
Our goal is to provide clinical information and insight for the diagnosis of IgG4-RD in patients who present with asymptomatic, non-neoplastic small lung nodules
From January 2012 to December 2018, a total of 89 patients were diagnosed with definitive IgG4-RD in West China Hospital, Sichuan University, 50 (56%) of whom had computed tomography (CT)-confirmed lung nodules were included in this retrospective study

Summary

Introduction

This study was undertaken in an attempt to characterize the frequency and clinical features of lung nodules in IgG4 related disease (IgG4-RD) patients as an insight for help with the diagnosis of lung nodules. Clinical presentation of nodules in the lungs of patients can be a challenge for diagnosis, especially when the nodules are small and asymptomatic. (IgG4-RD), must be considered for such presentation of asymptomatic small nodules, in the lungs, liver, or lymph nodes [1]. The most common manifestations of the disease include swelling of salivary and lacrimal glands, lymphadenopathy, and type 1 autoimmune pancreatitis (AIP). Other organs, such as lung, bronchi, kidney, retroperitoneum, thyroid, heart, mesenterium, meninges, and skin, can be involved. The IgG4-RLD presentation can be heterogeneous, and its radiologic manifestations are often extensive, even when clinically asymptomatic [7]

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