Computed Tomography Imaging findings in Chemical Warfare Victims with pulmonary Complications

Data on imaging findings in pulmonary complications of chemical agents is scarce. The current study aimed to evaluate radiological findings of late onset pulmonary complications in chemical warfare victims (CWV) and to guide pulmonologists in diagnosis of these subjects. Ninety- three male CWV were enrolled in this prospective study, 20-25 years (mean=23) after exposure. Demographic and clinical data were recorded. High resolution computed Tomography (HRCT) of the lung was performed during inspiration and expiration and was double reported blindly by two radiologists. Final diagnosis was made according to HRCT findings. The HRCT findings, final diagnosis, and distribution of the abnormalities were compared between subjects whom had been exposed to more complex chemical agents used during the second half of the war and simpler agents during the first half. The most frequent HRCT findings were air trapping (56.7%) and mosaic attenuation (35.1%). The distribution of abnormalities was mostly local (79.4%) and bilateral (73%) especially in lower regions (61.3%). The diagnosed respiratory diseases included bronchiolitis obliterans (43%), chronic obstructive pulmonary disease (COPD) (27.9%), asthma (23.6%), bronchiectasis (13.9%) and interstitial lung disease (ILD) (9.6%). Frequency of subjects involved in the second half of the period of war was more than the first period (P-value < 0.05) but the HRCT findings were similar. Bronchiolitis obliterans with picture of focal bilateral air trapping was the most common finding in CWV but asthma appeared to have become a new problem in these subjects.