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Abnormal Flow Volume Loops in Patients With Intrathoracic Hodgkin’s Disease^*

^* From the Pulmonary Service (Drs. White, Vander Els, and Sorhage) and the Lymphoma Service (Dr. Straus) of the Department of Medicine, and the Department of Radiology (Dr. Bach), Memorial Sloan-Kettering Cancer Center and Cornell University Medical College.

Correspondence to: Nicholas J. Vander Els, MD, FCCP, 1275 York Ave, New York, NY 10021; e-mail: vanderen{at}mskcc.org

Study objectives: To study the incidence of upper airway obstruction, as measured on the flow volume loop (FVL), in patients with bulky mediastinal Hodgkin’s disease; to correlate the FVL with CT of the chest; and to follow the changes in the FVL after treatment of the tumor.

Design: Retrospective study of pulmonary function tests (PFTs) and chest CTs performed as part of a clinical trial for Hodgkin’s disease.

Setting: Memorial Sloan-Kettering Cancer Center, a comprehensive cancer care center.

Patients: Twenty-five patients (15 men and 10 women; age range, 20 to 57 years) with bulky mediastinal Hodgkin’s disease enrolled in a clinical trial of chemotherapy followed by external beam radiation therapy.

Measurements and results: Fourteen of 25 patients (56%) had an abnormal FVL prior to therapy; after chemotherapy, only 7 of 25 patients (28%) had an abnormal FVL. The abnormal patterns seen were either those typical of fixed obstruction or variable extrathoracic obstruction. No patient had a pattern typical of variable intrathoracic obstruction. On chest CT scan, 16 patients had grade-I tracheal deformity; 6 had grade-II deformity, and 3 had grade-III deformity. All three patients with grade-III deformity had a fixed obstruction pattern, as did three patients with a grade-I pattern. Patients with a fixed pattern on FVL had significant decreases in inspiratory and expiratory flow rates.

Conclusion: FVL abnormalities suggesting upper airway obstruction occurred in > 50% of patients with bulky mediastinal Hodgkin’s disease. A fixed pattern of obstruction was associated with the lower flow rates and severe tracheal distortion on CT; these patients may warrant special attention prior to general anesthesia or invasive procedures. Asymptomatic patients with abnormal FVLs but normal tracheal profiles need not undergo extensive evaluation. No patients showed the expected pattern typical of intrathoracic obstruction, but rather the major effect was on the inspiratory loop. The authors speculate on the mechanism for this unexpected finding.

Key Words: Hodgkin’s disease • pulmonary function testing • upper airway obstruction

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