Turkiye Klinikleri Archives of Lung

.: ORIGINAL RESEARCH
Subcutaneous Fat Tissue Density as a Novel Diagnostic Indicator in Distinguishing Pulmonary Edema from Viral Pneumonias: A Retrospective Cross-Sectional Study
Pulmoner Ödem ile Viral Pnömoniyi Ayırt Etmede Yeni Bir Tanısal Gösterge Olarak Deri Altı Yağ Dokusu Yoğunluğu: Bir Retrospektif Kesitsel Çalışma
Zeynep ATÇEKENa , Yüksel PEKERb,c,d,e, Mahir KAPMAZf , Hüseyin Ekin ERGİNa , Kayhan Çetin ATASOYa
aKoç University Faculty of Medicine, Department of Radiology, İstanbul, Türkiye
bKoç University Faculty of Medicine, Department of Pulmonary Medicine, İstanbul, Türkiye
cGothenburg University, Sahlgrenska Academy, Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Gothenburg, Sweden
dPittsburgh University Faculty of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Pittsburgh, PA, USA
eLund University Faculty of Medicine, Department of Clinical Sciences, Respiratory Medicine and Allergology, Lund, Sweden
fMedipol University Faculty of Medicine, Department of Infectious Diseases, İstanbul, Türkiye
Turkiye Klinikleri Arch Lung. 2025;24(2):25-31
doi: 10.5336/archlung.2025-108298
Article Language: EN
Full Text
ABSTRACT
 Objective: Diffuse pulmonary opacities are seen in both pulmonary edema (PE) and pulmonary infections such as viral pneumonia (VP) and Pneumocystis jirovecii pneumonia (PJP), and distinguishing these from each other might be challenging. We aimed to show whether subcutaneous fat tissue density (SFTD) measurement in computed tomography scans helps to distinguish PE from VP and PJP. Material and Methods: In this retrospective study, SFTD, defined in terms of Hounsfield unit (HU) was evaluated in computed tomography scans of 99 patients with PE, 103 patients with VP and PJP, and 110 healthy individuals. The SFTD was calculated by using a region of interest with a diameter of approximately 1 cm in the subcutaneous adipose tissue, located 3 cm superior-inferior and medial-lateral to the junction of the midclavicular line and the xiphoid tip on the chest wall, blinded to the clinical data. Results: Median SFTD was -82.5 HU [interquartile range (IQR) -88.7; -67.4] in patients with PE, -117.7 HU (IQR - 121.3; -111.8) in patients with VP and PJP, and -120.3 HU (IQR -123.1; -117.0) in the control group (p<0.001). All patients with PE had SFTD at least -95 HU. None of the patients with VP and PJP as well as controls had SFTD less more -101 HU. Conclusion: Our results suggest that a SFTD measurement above -95 HU might be useful in differentiating PE from VP and PJP pneumonia in patients with diffuse lung opacities.

Keywords: Subcutaneous fat tissue density; pulmonary edema; pulmonary infection; chest CT
ÖZET
 Amaç: Diffüz pulmoner opasiteler, hem pulmoner ödem (PÖ) hem de viral pnömoniler (VP) ile Pneumocystis jirovecii pnömonisi (PJP) gibi pulmoner enfeksiyonlarda görülür ve bu durumların birbirinden ayırt edilmesi zor olabilir. Bu çalışmada, toraks bilgisayarlı tomografi görüntülerinde yaygın akciğer opasiteleri olan hastalarda subkütan yağ dokusu dansitesini (SYDD) ölçerek, PÖ'yü, VP ve PJP'lerden ayırt etmeyi amaçladık. Gereç ve Yöntemler: Retrospektif olarak gerçekleştirilen bu çalışmada SYDD, Hounsfield birimi [Hounsfield unit (HU)] cinsinden tanımlandı; PÖ'lü 99 hasta, VP ve PJP'li 103 hasta ile 110 sağlıklı bireyin bilgisayarlı tomografi görüntüleri incelendi. SYDD ölçümleri, klinik bilgiler bilinmeden, midklavikular çizgi ile ksifoid çıkıntının birleşim noktasından 3 cm superior-inferior ve mediyal-lateral olarak göğüs duvarındaki subkütan yağ dokusunda, yaklaşık 1 cm çapında bir ilgi alanı kullanılarak hesaplandı. Bulgular: Medyan SYDD, PÖ hastalarında -82,5 HU [güven aralığı (GA) -88,7; -67,4], VP ve PJP hastalarında -117,7 HU (GA -121,3; -111,8), kontrol grubunda ise -120,3 HU (GA - 123,1; -117,0) olarak bulundu (p<0,001). PÖ hastalarının tamamında, SYDD en az -95 HU idi. Pnömoni hastalarında ve kontrol grubunda ise SYDD hiçbir hastada -101 HU'dan büyük değildi. Sonuç: Sonuçlarımız, yaygın akciğer opasitesi olan hastalarda -95 HU'dan büyük SYDD değerlerinin, PÖ'yü VP ile PJP'den ayırt etmede faydalı bir gösterge olabileceğini düşündürmektedir.

Anahtar Kelimeler: Subkütan yağ dokusu dansitesi; pulmoner ödem; pulmoner enfeksiyon; toraks BT
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