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Lack of Evidence for an Association Between Neurofibromatosis and Pulmonary Fibrosis^*

^* From the Division of Pulmonary and Critical Care Medicine (Drs. Ryu and Parambil), and the Departments of Medical Genetics (Dr. McGrann) and Radiology (Dr. Aughenbaugh), Mayo Clinic, Rochester, MN.

Correspondence to: Jay H. Ryu, MD, Division of Pulmonary and Critical Care Medicine, Desk East 18, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: ryu.jay{at}mayo.edu

Study objectives: To reassess the association between neurofibromatosis and pulmonary fibrosis.

Design: Retrospective single-center study with analysis of patients’ chest radiographs, CT scans, and medical records.

Setting: Tertiary care, referral medical center.

Patients: One hundred fifty-six adult patients with neurofibromatosis seen over a 6-year period between 1997 and 2002.

Results: A review of chest radiographs revealed abnormal findings in 70 patients (44.9%). The most common radiographic abnormalities were extrapulmonary nodules or masses seen in 22 patients (14.1%), followed by skeletal abnormalities in 16 patients (10.3%). Bilateral interstitial infiltrates were noted in only three patients (1.9%), all of whom had potential causes other than neurofibromatosis for their lung infiltrates, including smoking-related interstitial lung disease, rheumatoid lung disease, recurrent pneumonias, and a history of ARDS. CT scans were available in two of these patients and revealed nonspecific patterns of abnormalities with no honeycombing. Six patients had bullae or cystic airspaces demonstrated on chest radiography or CT scan; all of these findings occurred in the context of smoking-related emphysema. Combined together, bilateral interstitial lung infiltrates or cystic airspaces were demonstrated in five patients (3.2%) by chest radiography, and in eight patients (5.1%) by chest radiography or CT scanning; one patient had both findings on the CT scan.

Conclusions: We found little evidence to support an association between neurofibromatosis and pulmonary fibrosis or any other form of parenchymal lung disease. Interstitial lung disease and bullae described in association with neurofibromatosis in previous reports may have, in part, represented smoking-induced manifestations.

Key Words: genetics • interstitial lung disease • pulmonary fibrosis

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