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. 1997;24(2):125–129. doi: 10.1007/BF02439543

Detection of acute inhalation injury in fire victims by means of technetium-99m DTPA radioaerosol inhalation lung scintigraphy

Wan-Yu Lin 1,✉, Chia-Hung Kao 1, Shyh-Jen Wang 1
PMCID: PMC7101543  PMID: 9021108

Abstract

Mortality and morbidity in fire victims are largely a function of injury due to heat and smoke. While the degree and area of burn together constitute a reliable numerical measure of cutaneous injury due to heat, as yet no satisfactory measure of inhalation injury has been developed. In this study, we employed technetium-99m diethylene triamine penta-acetic acid (DTPA) radioaerosol lung scintigraphy (inhalation scan) to evaluate acute inhalation injury in fire victims. Ten normal controls and 17 survivors from a fire accident were enrolled in the study. All patients suffered from respiratory symptoms (dyspnoea and/or cough with sputum).99mTc-DTPA aerosol inhalation lung scintigraphy was performed in all subjects, using a commercial lung aerosol delivery unit. The degree of lung damage was presented as the clearance rate (k; %/min) calculated from the time-activity curve over the right lungs. In addition, the distribution pattern of the radioactivity in the lungs was evaluated and classified into two groups: homogeneous distribution and inhomogeneous distribution. A plain chest radiograph (CxR) and pulmonary function test (PFT) were performed in the same group of patients. The results showed that 6/17 (35.3%) opatients had inhomogeneous distribution of radioactivity in their inhalation scans, and 11/17 (64,7%) had homogeneous scans. Five of the six patients with inhomogeneous scans were admitted for further management, and all patients with homogeneous scans were discharged from the emergency department and needed no further intensive care. The clearance rates of the right lung were 0.73%±0.13%/min from normal controls and 1.54%±0.58%/min for fire victims. The difference was significant, with aP value of less than 0.01. Using a cut-off value of 0.9%/min (all normal subjects were below 0.9%/min) 14 (82.4%) patients had abnormal clearance rates of99mTc-DTPA from the lung. In contrast, only three (17.6%) patients had abnormal CxR and three (17.6%) had abnormal PFTs. We conclude that (1) conventional CxR and PFT are not good modalities for evaluating inhalation injury in fire victims because of their low sensitivity, and (2)99mTc-DTPA radioaerosol inhalation scintigraphy can provide an objective evaluation of inhalation injury during a fire accident and may be useful in therapeutic decision-making and disease monitoring.

Key words: Inhalation injury, Fire victim, Radioaerosol, Technetium-99m diethylene triamine penta-acetic acid, Lung scintigraphy

References

  • 1.Clark CJ, Reid WH, Gilmour WH, Campbell D. Mortality probability in victims of fire trauma: revised equation to include inhalation injury. Br Med J. 1986;292:1303–1305. doi: 10.1136/bmj.292.6531.1303. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Cahalane M, Demling RH. Early respiratory abnormalities from smoke inhalation. JAMA. 1984;251:771–773. doi: 10.1001/jama.251.6.771. [DOI] [PubMed] [Google Scholar]
  • 3.Stephenson SF, Esrig BC, Polk HC, Jr, et al. The pathophysiology of smoke inhalation injury. Ann Surg. 1975;182:652–660. doi: 10.1097/00000658-197511000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Herndon DN, Langer F, Thompson P, et al. Pulmonary injury in burned patients. Surg Clin North Am. 1987;67:31–46. doi: 10.1016/s0039-6109(16)44131-9. [DOI] [PubMed] [Google Scholar]
  • 5.Shirani KZ, Pruitt BA, Mason AD. The influence of inhalation injury and pneumonia on burn mortality. Am Surg. 1987;205:82–87. doi: 10.1097/00000658-198701000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Stone H, Rhome DW, Corbett JD, Given KS, Martin JD., Jr Respiratory burns: a correlation of clinical and laboratory results. Ann Surg. 1967;165:157–159. doi: 10.1097/00000658-196702000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Eaton RJ, Senior RM, Pierce JA. Aspects of respiratory care pertinent to the radiologists. Radiol Clin North Am. 1973;2:93–107. [PubMed] [Google Scholar]
  • 8.Jones JG, Berry M, Hulands GH. The time course and degree of change in alveolar-capillary membrane permeability induced by aspiration of hydrochloric acid and hypotonic saline. Am Rev Respir Dis. 1978;118:1007–1013. doi: 10.1164/arrd.1978.118.6.1007. [DOI] [PubMed] [Google Scholar]
  • 9.Newhouse MI, Jordana M, Dolovich M. Evaluation of lung epithelial permeability. Eur J Nucl Med. 1987;13:S58–S62. doi: 10.1007/BF00253293. [DOI] [PubMed] [Google Scholar]
  • 10.Meignan M, Rosso J, Leveau J, Katz A, Cinotti L, Madelaine G, Galle P. Exercise increases the lung clearance of inhaled technetium-99m-DTPA. J Nucl Med. 1986;27:274–280. [PubMed] [Google Scholar]
  • 11.Meignan M, Rosso J, Robert R. Lung epithelial permeability to aerosolized solutes: relation to position. J Appl Physiol. 1987;62:902–911. doi: 10.1152/jappl.1987.62.3.902. [DOI] [PubMed] [Google Scholar]
  • 12.Jones JG, Minty BD, Lawler P, Hulands G, Crawley JC, Veall N. Increased alveolar epithelial permeability in cigarette smokers. Lancet. 1980;I:66–68. doi: 10.1016/S0140-6736(80)90493-6. [DOI] [PubMed] [Google Scholar]
  • 13.Mason GR, Ulzer JM, Effros RM, Reid E. Rapid reversible alteration of pulmonary epithelium permeability induced by smoking. Chest. 1983;83:6–11. doi: 10.1378/chest.83.1.6. [DOI] [PubMed] [Google Scholar]
  • 14.Lin WY, Kao CH, Wang SJ, Yeh SH. Lung toxicity of chemotherapeutic agents detected by Tc-99m DTPA radioaerosol inhalation lung scintigraphy. Neoplasma. 1995;42:113–115. [PubMed] [Google Scholar]
  • 15.Rosso J, Guillon JM, Parrot A, Denis M, Akoun G, Mayaud C, Scherrer M, Meignan M. Techneitium-99m-DTPA aerosol and gallium-67 scanning in pulmonary complications of human immunodeficiency virus infection. J Nucl Med. 1992;33:81–87. [PubMed] [Google Scholar]
  • 16.Fanti S, Monetti N, DeFabritiis A, Aloisi D, Cavalli A, Corbelli C, Marengo M, Dondi M. Detection of subclinical pulmonary involvement in systemic sclerosis by means of 99mTc-DTPA clearance. Eur J Nucl Med. 1993;20:827–827. [Google Scholar]
  • 17.Clark CJ, Kinsella J, Reid WH, Cambell D. The role of fibreoptic bronchoscopy in early diagnosis of smoke inhalation injury. Thorax. 1988;43:828–828. doi: 10.1136/thx.43.10.745. [DOI] [Google Scholar]
  • 18.Clark CJ, Pollock AJ, Reid WH, Campbell D, Gemmell C. Role of pulmonary alveolar macrophage activation in acute lung injury after burns and smoke inhalation. Lancet. 1988;II:872–874. doi: 10.1016/S0140-6736(88)92471-3. [DOI] [PubMed] [Google Scholar]
  • 19.Fein A, Leff A, Hopewell PC. Pathophysiology and management of the complications resulting from fire and the inhaled products of combustion. Crit Care Med. 1980;8:94–98. doi: 10.1097/00003246-198002000-00008. [DOI] [PubMed] [Google Scholar]
  • 20.Peitzman AB, Shires GT, III, Corbett WA, Curreri PW, Shires GT. Measurement of lung water in inhalation injury. Surgery. 1981;90:305–312. [PubMed] [Google Scholar]
  • 21.Trunkey D. Inhalation injury. Surg Clin North Am. 1978;135:250–263. doi: 10.1016/s0039-6109(16)41681-6. [DOI] [PubMed] [Google Scholar]
  • 22.Teixidor MS, Rubin E, Novick GS, Alonso DR. Smoke inhalation: radiological manifestations. Radiology. 1983;149:383–387. doi: 10.1148/radiology.149.2.6622680. [DOI] [PubMed] [Google Scholar]
  • 23.Lee MJ, O'Connell DJ. The plain chest radiograph after acute smoke inhalation. Clin Radiol. 1988;39:33–37. doi: 10.1016/S0009-9260(88)80334-9. [DOI] [PubMed] [Google Scholar]

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