Clinical, High Resolution Computed Tomography and Pulmonary Function in Sulphur Mustard Victims

  • Esmaeil Idani Department of Internal Medicine, Ahwaz Jondishapour University of Medical Sciences, Ahwaz, Iran.
  • Ahmad Ahmadzadeh Mail Department of Internal Medicine, Ahwaz Jondishapour University of Medical Sciences, Ahwaz, Iran.
  • Mahdi Yadollahzadeh Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Habib Heybar Department of Cardiology, Ahwaz Jondishapour University of Medical Sciences, Ahwaz, Iran.
  • Armita Valizadeh Department of Anatomy, Ahwaz Jondishapour University of Medical Sciences, Ahwaz, Iran.
  • Javad Moghimi Department of Internal Medicine, Ahwaz Jondishapour University of Medical Sciences, Ahwaz, Iran.
Chemical victims, Long term, Mustard gas, Respiratory complication


We aimed to evaluate clinical, high resolution computed tomography (HRCT) and pulmonary function test (PFT) findings after 18-23 years of exposure in veterans of sulphur mustard (SM) exposure. We performed a cross-sectional study of 106 patients. Inclusion criteria were 1: documented exposure to SM as confirmed by toxicological analysis of their urine and vesicular fluid after exposure 2: single exposure to SM that cause skin blisters and subsequent transient or permanent sequel. Cigarette smoking and pre-exposure lung diseases were of exclusion criteria. After taking history and thorough respiratory examination, patients underwent high resolution computed tomography and spirometry. Clinical diagnoses were made considering the findings. More than 85% of the patients were complaining of dyspnea and cough. Obstructive pattern (56.6%) was main finding in spirometry followed by restrictive and normal patterns. HRCT revealed air trapping (65.09%) and mosaic parenchymal attenuation patterns (58.49%) as most common results. Established diagnoses mainly were chronic obstructive pulmonary disease (COPD) (54.71%), bronchiolitis obliterans (27.35%) and asthmatic bronchitis (8.49%). There were not any significant association between the clinical findings and results of PFT and HRCT imaging and also between PFT and HRCT findings (P-values were more than 0.05). Considering debilitating and progressive nature of the respiratory complications of SM exposure, attempts are needed for appropriate diagnosis and treatment.


Somani SM, editor. Chemical Warfare Agents. New York: Academic Press; 1992.

Marrs TC, Maynard RL, Sidell FR, editors. Chemical Warfare Agents: Toxicology and Treatment. New York, NY: John Wiley and Sons; 1996.

United Nations Official Reports, New York, S/16433 (1984); S/17911 (1986); and S/18852 (1987).

Balali-Mood M, Hefazi M. Comparison of early and late toxic effects of sulfur mustard in Iranian veterans. Basic Clin Pharmacol Toxicol 2006;99(4):273-82.

Gilman A, Philips FS. The Biological Actions and Therapeutic Applications of the B-Chloroethyl Amines and Sulfides. Science 1946;103(2675):409-36.

Crathorn AR, Roberts JJ. Mechanism of the cytotoxic action of alkylating agents in mammalian cells and evidence for the removal of alkylated groups from deoxyribonucleic acid. Nature 1966;211(5045):150-3.

Bagheri MH, Hosseini SK, Mostafavi SH, Alavi SA. Highresolution CT in chronic pulmonary changes after mustard gas exposure. Acta Radiol 2003;44(3):241-5.

Webb WR, Stein MG, Finkbeiner WE, Im JG, Lynch D, Gamsu G. Normal and diseased isolated lungs: highresolution CT. Radiology 1988;166(1 Pt 1):81-7.

Bakhtavar K, Sedighi N, Moradi Z. Inspiratory and expiratory high-resolution computed tomography (HRCT) in patients with chemical warfare agents exposure. Inhal Toxicol 2008;20(5):507-11.

Emad A, Rezaian GR. The diversity of the effects of sulfur mustard gas inhalation on respiratory system 10 years after a single, heavy exposure: analysis of 197 cases. Chest 1997;112(3):734-8.

Balali-Mood M, Hefazi M, Mahmoudi M, Jalali E, AttaranD, Maleki M, Razavi ME, Zare G, Tabatabaee A, Jaafari MR. Long-term complications of sulphur mustard poisoning in severely intoxicated Iranian veterans. Fundam Clin Pharmacol 2005;19(6):713-21.

Ghanei M, Eshraghi M, Jalali AR, Aslani J. Evaluation of latent hemoptysis in Sulfur Mustard injured patients. Environ Toxicol Pharmacol 2006;22(2):128-30.

Diederich S, Jurriaans E, Flower CD. Interobserver variation in the diagnosis of bronchiectasis on highresolution computed tomography. Eur Radiol 1996;6(6):801-6.

Müller NL, Miller RR. Diseases of the bronchioles: CT and histopathologic findings. Radiology 1995;196(1):3-12.

Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, et al; ATS/ERS Task Force. Standardisation of spirometry. Eur Respir J 2005;26(2):319-38.

The American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, November 1986. Am Rev Respir Dis 1987;136(1):225-44.

Andreoli TE, Carpenter CJ, Plum F. Cecil Medicine. 23rd ed. Philadelphia, PA: WB Saunders; 2008.

Khateri S, Ghanei M, Keshavarz S, Soroush M, Haines D. Incidence of lung, eye, and skin lesions as late complications in 34,000 Iranians with wartime exposure to mustard agent. J Occup Environ Med 2003;45(11):1136-43.

Balali M. Clinical and laboratory findings in Iranian fighters with chemical gas poisoning. Arch Belg 1984;Suppl:254-9.

Afshinniaz F, Ghanei M. Relationship of the chronic respiratory symptoms with spirometric and laboratory parameters. Isfahan University of Medical Sciences, Isfahan, Iran, 1996, Dissertation.

Ghanei M, Mokhtari M, Mohammad MM, Aslani J. Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography. EurJ Radiol 2004;52(2):164-9.

Bijani Kh, Moghadamnia AA. Long-term effects of chemical weapons on respiratory tract in Iraq-Iran war victims living in Babol (North of Iran). Ecotoxicol Environ Saf 2002;53(3):422-4.

Karami A, Ghanei M, Alaeddini F, Soltanpour MJ; Fatemeh pourali, Yassini M, Harandi AA. Vascular endothelial growth factor in bronchoalveolar lavage fluid in sulfur mustard exposed lung patients. Oman Med J 2011;26(2):118-21.

Ghanei M, Ghayumi M, Ahakzani N, Rezvani O, Jafari M, Ani A, Aslani J. Noninvasive diagnosis of bronchiolitis obliterans due to sulfur mustard exposure: could highresolution computed tomography give us a clue? Radiol Med 2010;115(3):413-20.

Hefazi M, Attaran D, Mahmoudi M, Balali-Mood M. Late respiratory complications of mustard gas poisoning in Iranian veterans. Inhal Toxicol 2005;17(11):587-92. 18. 26. Balali-Mood M, Afshari R, Zojaji R, Kahrom H, Kamrani M, Attaran D, Mousavi SR, Zare GA. Delayed toxic effects of sulfur mustard on respiratory tract of Iranian veterans. Hum Exp Toxicol 2011;30(9):1141-9.

How to Cite
Idani E, Ahmadzadeh A, Yadollahzadeh M, Heybar H, Valizadeh A, Moghimi J. Clinical, High Resolution Computed Tomography and Pulmonary Function in Sulphur Mustard Victims. Acta Med Iran. 50(9):603-608.