Abnormal Chest Chest Computed Tomography Research Articles

The Study of Lung Ultrasound, Chest CT and Chest X-ray in Children with COVID-19 Hospitalized in Mofid Children's Hospital During a Six-Month Period

Background: Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The primary diagnostic tool for pediatric COVID-19 patients is polymerase chain reaction (PCR). Chest imaging findings in pediatric COVID-19 cases are often normal or mild. The correlation of lung ultrasound (LUS) with chest computed tomography (CT) and chest X-ray (CXR) in pediatric COVID-19 patients has not been extensively studied. Objectives: This study aimed to assess the correlation of LUS with chest CT and CXR in detecting COVID-19 pneumonia in children. Methods: This single-center cross-sectional study included patients under 18 years of age diagnosed with COVID-19 by PCR or by abnormal chest CT findings suggestive of COVID-19, admitted to Mofid Pediatric Hospital between December 2021 and August 2022. All patients underwent LUS. Approximately half of the patients also had a chest CT, and CXR was performed on 35 patients. Lung ultrasound and CT scores were calculated, and the correlation between these scores was evaluated. The correlation between LUS and CXR was also analyzed. Results: Sixty patients were included, of whom 21 were female, with a mean age of 4.9 ± 4.0 years. A significant correlation was observed between LUS and CT scores (correlation coefficient = 0.467, P = 0.011). Lesion distribution was similar between LUS and CT. However, no significant correlation was found between LUS scores and CXR findings (P = 0.392). Sixteen out of 19 patients with normal CXRs had LUS scores ≤ 4. Notably, three patients with normal CXRs had LUS scores of 8, 14, and 14. Conclusions: Lung ultrasound was more sensitive than CXR and demonstrated a significant correlation with CT. Lung ultrasound may serve as a safe alternative to CT for detecting COVID-19 pneumonia in pediatric patients.

Screening Chest CT Prior to Allogenic Hematopoietic Stem Cell Transplantation

Pulmonary complications constitute a major cause of morbidity and mortality in the post-allogenic hematopoietic stem cell transplant (alloHSCT) period. While Chest X-ray (CXR) is customarily used for screening, we have utilized chest computed tomography (CT). To characterize the prevalence of abnormalities and explore their impact on alloHSCT eligibility and outcomes post-transplant, we conducted a retrospective analysis utilizing real-world data collected at our center for adult patients who were evaluated for alloHSCT from January 2013 through December 2020 and identified 511 eligible patients. The most common primary disease was acute myeloid leukemia in 49% of patients, followed by myelodysplastic syndrome in 23%, lymphoma in 11%, and acute lymphocytic leukemia in 10%. Abnormal screening chest CT was found in 199 patients (39%). The most frequent detected abnormality was pulmonary nodule in 78 patients (35%), followed by consolidation in 42 (19%), ground-glass opacification in 33 (15%), bronchitis and bronchiolitis in 25 (11%), pleural effusions in 14 (6%), and new primary cancer in 7 (2%). CXR detected abnormalities in only about half of the patients (48%) with an abnormal chest CT. Among 199 patients with abnormal chest CT, 98 patients (49%) underwent further assessment and/or intervention before transplant. The most common work up was pulmonary consultation in 32%, infectious diseases consultation in 24%. Lung biopsy was obtained in 20% and antimicrobial therapy was initiated after confirming an infection diagnosis in 20% of patients. Patients with abnormal chest CT demonstrated worse overall survival (P= 0.032), non-relapse mortality (P=0.015), and pulmonary related death (P < 0.001) compared to those who had normal chest CT. Our study suggests that pre-transplant screening chest CT is beneficial in uncovering invasive infections and underlying malignancies and allows appropriate interventions before alloHSCT to prevent potentially serious post-transplant complications without causing a delay in alloHSCT. Nevertheless, abnormal CT findings prior to transplant may be associated with overall worse prognosis.

Post-discharge clinical, laboratory and radiographic features of coronavirus disease 2019 (COVID-19) patients at university hospitals in Japan.

Coronavirus disease 2019 (COVID-19) has affected nearly half million people in Japan. However, information on the prolonged symptoms as well as laboratory and radiographic findings after hospital discharge remains limited. We retrospectively collected the symptoms, laboratory test results, and chest imaging results of COVID-19 patients at the time of the hospital admission and the ambulatory visits after discharge at two university hospitals between July and December 2020. A total of 126 COVID-19 patients, including of 88 with mild to moderate disease and 38 with severe to critical disease, were included. The time between symptom onset and the first outpatient visit was 46 days (Interquartile range, 39 to 55). At the ambulatory visits, 36.5% of patients had at least one symptom. The most frequent symptom was shortness of breath (12.8%), followed by cough (11.1%), and fatigue (8.8%). Of 120 patients with post-discharge laboratory test results, 27 patients (22.5%) had abnormal alanine aminotransferase levels, and 35 patients (29.1%) had lymphocytopenia, including 24 and 27 mild and moderate patients. Of 122 patients with post-discharge chest computed tomography (CT) scans, 105 (83.3%) had abnormal findings. This abnormality was found in both mild to moderate and severe patients. Shortness of breath, abnormal liver function test results and chest CT images often persisted for at least one month after discharge, even when symptoms were mild or moderate during hospitalization.

1369. Ten Year Trends of Typhus Fever in North Texas: Epidemiologic Characteristics and Clinical Manifestations

Abstract Background Murine Typhus remains endemic in southern California and in southern Texas where it is transmitted by fleas, with opossums serving as the amplifying host. In Texas, the disease is increasingly recognized in municipalities outside its historic rural range and is spreading in a northward distribution. Since its expansion, we have observed increased cases in the Dallas-Fort Worth (DFW) area and aim to describe murine typhus in North Texas from 2011-2021. Methods Leveraging the electronic health record, we retrospectively identified 482 individuals tested for murine typhus by Rickettsia typhi (R. typhi) serology in 2 Dallas hospitals. We subsequently collected epidemiologic characteristics, clinical features, and outcomes of 58 patients with positive R. typhi serologies ( &amp;gt;1:64). Results Of the 58 patients with positive R. typhi serology, 39 (67%) were male, 45 (78%) were White, and 23 (40%) were Hispanic. Seventy-nine percent had symptom onset between May and November, and 36/58 (62%) were diagnosed in 2020 and 2021. Twenty-six (45%) had exposure to dogs, 18 (31%) to cats, and 13 (22%) to opossums. Twelve (21%) patients were immunocompromised. Fifty-two (90%) had fever, 35 (60%) headache, 26 (45%) nausea and vomiting, 26 (45%) rash, 25 (43%) myalgia, 20 (34%) cough, and 17 (29%) abdominal pain. In 2020 and 2021, 35/36 (97%) patients were additionally tested for COVID-19, and 29/35 (83%) patients had more than one negative SARS-CoV-2 test prior to R. typhi serologies being sent. Twenty-one out of fifty (42%) had an abnormal chest x-ray (CXR) and 28/30 (93%) had an abnormal chest computed tomography (CT). Nine (16%) had hypoxia, 9 (16%) required an intensive care unit, and 3 (5%) required mechanical ventilation. No patients died within 30 days of diagnosis. Conclusion Our study highlights the expansion of murine typhus in North Texas (Figure 1) and demonstrates the heightened need for clinicians to be aware of this disease in the appropriate epidemiologic and clinical settings. We also describe increasing rates of respiratory findings, demonstrated through over half of patients having at least one respiratory symptom, and 93% having an abnormal chest CT (findings traditionally associated with severe disease). Figure 1:Heatmap Distribution of Murine Typhus Cases in the Dallas-Fort Worth Metroplex (2011-2021) Disclosures Christoph U. Lehmann, MD, FAAP, FACMI, FIAHSI, Celanese: Stocks/Bonds|Markel: Stocks/Bonds|Springer: Honoraria Helen L. King, MD, Gilead Sciences: Grant/Research Support.

Long-term outcomes of COVID-19 convalescents: An 18.5-month longitudinal study in Wuhan

ObjectivesThis study aimed to describe the full scope of long-term outcomes and the ongoing pathophysiological alterations among COVID-19 survivors. MethodsWe established a longitudinal cohort of 208 COVID-19 convalescents and followed them at 3.3 (interquartile range [IQR]: 1.3, 4.4, visit 1), 9.2 (IQR: 9.0, 9.6, visit 2), and 18.5 (IQR: 18.2, 19.1, visit 3) months after infection, respectively. Serial changes in multiple physical and psychological outcomes were comprehensively characterized. We, in addition, explored the potential risk factors of SARS-CoV-2 antibody response and sequelae symptoms. ResultsWe observed continuous improvement of sequelae symptoms, lung function, chest computed tomography (CT), 6-minute walk test, and the Borg dyspnea scale, whereas sequelae symptoms (at least one) and abnormal chest CT patterns still existed in 45.2% and about 30% of participants at 18.5 months, respectively. Anxiety and depression disorders were alleviated for the convalescents, although depression status was sustained for a longer duration. ConclusionsMost COVID-19 convalescents had an overall improved physical and psychological health status, whereas sequelae symptoms, residual lesions on lung function, exercise impairment, and mental health disorders were still observed in a small proportion of participants at 18.5 months after infection. Implementing appropriate preventive and management strategies for the ever-growing COVID-19 population is warranted.

Serum levels of laminin and von Willebrand factor in COVID-19 survivors 6 months after discharge

ObjectivesThe aim of this study was to evaluate the clinical characteristics, pulmonary diffusion function, chest computed tomography (CT), and serum lung cell damage indicators of coronavirus disease 2019 (COVID-19) survivors 6 months after discharge. MethodsData of COVID-19 survivors discharged from hospital between January 21, 2020 and January 11, 2021 and healthy controls were collected. Serum levels of surfactant protein D (SP-D), the receptor for advanced glycation end products (RAGE), laminin, and von Willebrand factor (vWF) were measured in the healthy controls and COVID-19 survivors 6 months after discharge. The relationships between serum lung cell damage indicator levels and various parameters were explored. ResultsFifty-two COVID-19 survivors (31 with non-severe disease and 21 with severe disease) and 30 controls were included. Serum levels of laminin in COVID-19 survivors 6 months after discharge were significantly higher than those in the controls. The increase was more significant in elderly and female patients. Serum levels of RAGE and vWF were not statistically different from those of the controls. However, 6 months after discharge, COVID-19 survivors with abnormal chest CT and those in the severe group had higher vWF levels. ConclusionsCOVID-19 patients had abnormal lung injury indicators 6 months after discharge. The recovery time after infection is currently unknown, and long-term observation is required.

Fungal biomarker monitoring and CT scans for early detection of invasive fungal disease in neutropenic hematological patients

By using data from the CEDMIC trial (n=413), we conducted a post-hoc analysis of the diagnostic value of biomarker monitoring and chest computed tomography (CT) scans for the early detection of invasive fungal disease (IFD) in neutropenic hematological patients. IFDs were defined in accordance with the EORTC/MSG definition with some modifications. Biomarkers such as Aspergillus galactomannan (GM) and (1→3)-β-D-glucan (βDG) were measured weekly. The positive predictive value (PPV) of GM and βDG in cases of high-risk treatment were 0.70 and 0.69, while those in low-risk treatment were 0.08 and 0, respectively. All of the positive biomarkers that were measured before the development of fever in low-risk treatment were false positives. The proportion of patients who had abnormal chest CT findings was 19% in persistent fever at 4-6 days, 57% at 7 days or later and 36% in recurrent fever. Sixty-nine percent of the patients who had abnormal findings at 7 days or later did not have abnormalities at 4-6 days. Afebrile screening of biomarkers in low-risk treatment is not useful. Chest CT should be reevaluated in persistent fever lasting for 7 days or longer even in patients who did not have abnormalities within 6 days.

Chest computed tomography findings among adult Indigenous Australians in the Northern Territory of Australia.

There is sparse evidence in the literature in relation to the chest computed tomography (CT) findings among adult Indigenous Australians with chronic respiratory conditions. In this retrospective study, patients who underwent chest CT between 2012 and 2020 among those referred to undergo lung function tests (spirometry) were assessed for the prevalence of abnormal chest CT radiological findings. Of the 402 patients (59% female) included in this study, 331 (82%) had an abnormality identified on chest CT. Most abnormalities occurred alongside one (25%) or multiple (46%) other CT abnormalities. Airway disease ((AD) (including, emphysema, airway wall thickening and small airway disease) (35%), atelectasis: segmental or lobar collapse (27%), inflammatory opacities (24%) and bronchiectasis (23%) were the most common findings. AD and bronchiectasis were also the most common concurrent abnormalities in 40-50%. Other CT abnormalities noted in isolation or in combination with other CT findings were lung nodules (19%), lymph node enlargement (17%), consolidation or mass (17%), followed by lung cysts, ground-glass opacity, lung parenchymal architectural distortion, cavitating lung lesions and chronic pleural effusion were observed in ≤10%. Predictive models for odds of abnormality and outcomes showed age, smoking and underweight were associated with AD, and male sex and very remote residence were associated with bronchiectasis. This study has illustrated that Indigenous Australian adults have a high prevalence of multiple chest CT abnormalities that may impose unprecedented diagnostic and therapeutic challenges in this population. Further studies are warranted to determine the long-term implications and prognostic significance of the CT findings as demonstrated in this study.

Clinical characteristics of COVID-19 in family clusters: a systematic review.

BackgroundCoronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the world and reports of children during early epidemic period showed features of family clusters. The aim of this study is to assess clinical profiles of COVID-19 in family clusters with children.MethodsWe performed a systematic literature review of English database (PubMed, Web of Science) and Chinese database (“www.cnki.net”, “www.cqvip.com” and “www.Wanfangdata.com.cn”) to identify papers on family clusters of COVID-19 with children and their family members.ResultsEighteen studies involving 34 children and 98 adults from 28 families were included. Fever, cough and ground-grass opacity change of chest computed tomography (CT) were the dominant features, whereas proportion of asymptomatic infections for children was higher than adults with statistical significance (32.4% and 13.3%, respectively, P < 0.05). Median time of longer incubation period (10 days) and shorter duration of pharyngeal swab nucleic acid test positive period (11 days) were seen in children than adults (7 and 17 days, respectively) with statistical significance (P < 0.05). There were statistically significant differences in lymphopenia, increased C-reactive protein and abnormal chest CT between children and adult patients (P < 0.05). Twenty-seven families reported adults as first case of COVID-19 in family clusters.ConclusionsThe same virus strain can cause milder disease in children compared with their caregivers. Children of COVID-19 were infected by adults in family during the early epidemic period. Asymptomatic patients can transmit the virus.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12519-021-00434-z.

Clinical, laboratory, and chest CT features of severe versus non-severe pediatric patients with COVID-19 infection among different age groups

BackgroundThis study was performed with the intention of comparing the clinical, laboratory, and chest computed tomography (CT) findings between severe and non-severe patients as well as between different age groups composed of pediatric patients with confirmed COVID-19.MethodThis study was carried out on a total of 53 confirmed COVID-19 pediatric patients who were hospitalized in Namazi and Ali Asghar Hospitals, Shiraz, Iran. The patients were divided into two severe (n = 27) and non-severe (n = 28) groups as well as into other three groups in terms of their age: aged less than two years, aged 3–12 years and 13–17 years. It should be noted that CT scans, laboratory, and clinical features were taken from all patients at the admission time. Abnormal chest CT in COVID-19 pneumonia was found to show one of the following findings: ground-glass opacities (GGO), bilateral involvement, peripheral and diffuse distribution.ResultFever (79.2%) and dry cough (75.5%) were the most common clinical symptoms. Severe COVID-19 patients showed lymphocytosis, while the non-severe ones did not (P = 0.03). C-reactive protein (CRP) was shown to be significantly lower in patients aged less than two years than those aged 3–12 and 13–17 years (P = 0.01). It was shown also that O2 saturation experienced a significant increase as did patients’ age (P = 0.01). Severe patients had significantly higher CT abnormalities than non-severe patients (48.0% compared to 17.9%, respectively) (P = 0.02).ConclusionLymphocytosis and abnormal CT findings are among the factors most associated with COVID-19 severity. It was, moreover, showed that the severity of COVID-19, O2 saturation, and respiratory distress were improved as the age of confirmed COVID-19 pediatric patients increased.

Epidemiological and clinical characteristics of 1663 hospitalized patients infected with COVID-19 in Wuhan, China: a single-center experience

BackgroundThe COVID-19 outbreak in late December 2019 has quickly emerged into pandemic in 2020. We aimed to describe the epidemiology and clinical characteristics of hospitalized COVID-19 patients, and to investigate the potential risk factors for COVID-19 severity. Method1663 hospitalized patients with laboratory-confirmed diagnosed COVID-19 from Tongji Hospital between January 14, 2020, and February 28, 2020 were included in the present study. Demographic information, exposure history, medical history, comorbidities, signs and symptoms, chest computed tomography (CT) scanning, severity of COVID-19 and laboratory findings on admission were collected from electronic medical records. Multivariable logistic regression was used to explore the association between potential risk factors with COVID-19 severity. ResultsIn the present study, the majority (79%) of 1663 COVID-19 patients were aged over 50 years old. A total of 2.8% were medical staff, and an exposure history of Huanan seafood market was document in 0.7%, and 7.4% were family infection. Fever (85.8%), cough (36.0%), fatigue (23.6%) and chest tightness (11.9%) were the most common symptoms in COVID-19 patients. As of February 28, 2020, of the 1663 patients included in this study, 26.0% were discharged, 10.2% were died, and 63.8% remained hospitalized. More than 1/3 of the patients had at least one comorbidity. Most (99.8%) patients had abnormal results Chest CT, and the most common manifestations of chest CT were local patchy shadowing (70.7%) and ground-glass opacity (44.8%). On admission, lymphocytopenia was present in 51.1% of the patients, mononucleosis in 26.6%, and erythrocytopenia in 61.3%. Most of the patients had increased levels of C-reactive protein (80.4%) and D-dimer (64.4%). Compared with non-severe patients, severe patients had more obvious abnormal laboratory results related to inflammation, coagulation disorders, liver and kidney damage (all P < 0.05). Older age (OR = 2.37, 95% CI: 1.47–3.83), leukocytosis (OR = 2.37, 95% CI: 1.47–3.83), and increased creatine kinase (OR = 2.37, 95% CI: 1.47–3.83) on admission were significantly associated with COVID-19 severity. ConclusionTimely medical treatment and clear diagnosis after the onset might be beneficial to control the condition of COVID-19. Severe patients were more likely to be to be elder, and tended to have higher proportion of comorbidities and more prominent laboratory abnormalities. Older age, leukocytosis, and increased creatine kinase might help clinicians to identify severe patients with COVID-19.

COVID-19 in Post-Operative Patients: Imaging Findings.

Background: Coronavirus 2019 (COVID-19) in the post-operative period is challenging. Its clinical manifestations may have similarities to other septic, thoracic, or gastrointestinal post-surgical complications. Additionally, the post-operative period may be a time of increased risk for severe manifestations of COVID-19. We sought to evaluate the frequency of COVID-19 in a cohort of patients who had recently had operations who were undergoing imaging for acute symptoms and the role of chest computed tomography (CT) in this setting. Patients and Methods: We included all patients who had chest CT for acute symptoms in the 15 days after a surgical procedure between March 1 and 31, 2020. Results: Of 46 patients with acute post-operative symptoms requiring chest imaging, eight (17%) were ultimately diagnosed with COVID-19. Among them, five (62%) required mechanical ventilation and two (25%) died. All had abnormal chest CT with typical findings of COVID-19 in 87%. Computed tomography provided an alternate diagnosis in 53% of patients who did not have COVID-19. The average time between a COVID-19-positive chest CT and the polymerase chain reaction (PCR) confirmation was 1.2 days (range, 0-4 days). Conclusion: COVID-19 is a serious post-operative condition associated with significant morbidity and mortality. Chest CT provides prompt diagnosis of COVID-19. In centers with a high prevalence of COVID-19, chest acquisition should be included in CT scans done for acute post-operative symptoms.

Clinical predictors of abnormal chest CT scan findings following blunt chest trauma: A cross-sectional study

PurposeSome surgeons believe that chest computed tomography (CT) scan should be used more prudently in management of blunt chest trauma patients. This study aimed to evaluate the clinical predictors of abnormal chest CT scan findings in trauma patients. MethodsThis cross-sectional study was conducted on blunt chest trauma patients aged ≥18 years who were referred to the emergency departments of two educational hospitals and underwent chest CT scan. These patients were enrolled in the study using a non-probability sampling method. The exclusion criteria included: class III or IV hemodynamic shock, need for immediate surgical or neurosurgical interventions, penetrating trauma, lack of required information, and pregnancy. Demographic factors, accident details, trauma mechanism, vital signs, and level of consciousness in predicting abnormal chest CT scan findings were evaluated. Analysis was performed using IBM SPSS statistics 21. ResultsA total of 977 patients (male 51.5%, female 48.5%) with the mean age of (41.71 ± 14.24) years, range 18–88 years were studied; 34.2% of them with high energy trauma mechanism. With 334 (34.2%) patients had abnormal findings on chest X-ray (CXR) and 332 (34.0%) cases had an abnormal findings on chest CT scan (agreement rate was 99.4%). There was a significant correlation between male gender (p < 0.0001), GCS<15 (p < 0.0001), high energy trauma mechanism (p < 0.0001), unstable hemodynamics (p < 0.01), and clinical signs and symptoms (p < 0.0001) with chest CT findings. Chest wall deformity (odds = 8; p < 0.0001), generalized tenderness (odds = 6.6, p < 0.0001), and decreased cardiac sound (odds = 3.8, p < 0.0001) were the important and independent clinical predictors of abnormal chest CT scan findings. ConclusionBased on the findings, chest wall deformity, generalized tenderness, decreased cardiac sound, distracting pain, chest wall tenderness, high energy trauma mechanism, male gender, respiratory rate > 20 breathes/min, decreased pulmonary sound, and chest wall crepitation were independent clinical predictors of abnormal chest CT scan findings following blunt trauma.

Early-Life Pseudomonas aeruginosa Infection in Cystic Fibrosis and Lung Disease Progression.

Lung disease in cystic fibrosis (CF) starts early, with studies identifying abnormalities on chest computed tomography (CT) scan even in infancy. In this retrospective study, abnormal chest CT was the main outcome; body mass index (BMI) z score and forced expiratory volume percent predicted (FEV1%) predicted at age 6 to 7 years were secondary outcomes. Pseudomonas aeruginosa infection prior to 12 months of age was the main explanatory variable. There was no association between early P aeruginosa infection and abnormal CT after adjustment for CFTR (cystic fibrosis transmembrane conductance regulator) functional mutation class, gender, and other pathogens (odds ratio = 0.30; 95% confidence interval = 0.07-1.35; P = .11). No significant associations were demonstrated for BMI z score and FEV1% predicted. Children with class I-III CFTR mutations had increased risk of abnormal CT findings (odds ratio = 11.67; 95% confidence interval = 1.11-115.06; P = .035) and lower FEV1% predicted (P = .04). In the current era, early-life P aeruginosa infection in CF might not influence the severity of lung disease in school age as much as previously. Larger studies are needed to confirm this finding.

Abstract P6-11-05: Chest imaging in patients with breast cancer treated with curative intent

Abstract Background: With progressive advances in contemporary medicine, care of cancer patients has become increasingly complex and costly. Nationwide demands to regulate health care expenditure have escalated, urging healthcare providers (HCP) to reassess their investigative strategies in patient care for optimal resource utilization. An abnormal chest x ray (CXR), done routinely as preoperative work up for breast cancer patients, commonly prompts further imaging if found to be abnormal. Data regarding whether this additional imaging is useful is scant. Method: This IRB approved retrospective analysis identified all patients diagnosed with breast cancer from 2004 through 2014. Data collected included age at diagnosis, ethnicity, smoking history, insurance status, respiratory symptoms, tumor histology and stage, hormonal receptor status, HER-2 receptor status and radiographic imaging. Results: Data from 2400 patients were analyzed. 194 patients were excluded: 117 stage IV disease and 77 incomplete data. 2206 had clinical stages I, II and III. 14% stage 0; 27% stage I; 35% stage II; 23% stage III. Demographics: 99.5% female and 0.5% males. Mean age 54.4 (range 18-92); 4% White, 23% African descent, 1% Asian, 72% Hispanic, 39% uninsured. Smoking history: 79% never smoked, 10% former smokers, 11% current smokers. 2017 (91%) had a preoperative CXR; 83% were normal and 17% abnormal. Abnormalities: nodules(41%), granulomas(18%), atelectasis(11%), infiltrates(4%), masses(4%), other findings(21%). 70% of patients with abnormal CXR had a chest computed tomography (CT) scan; abnormal/normal 88%/12%. Chest imaging in patients with breast cancer treated with curative intent Clinical Stage 0123Total number of patients (n = 2206)14%27%35%23%CXR (Abnormal / Total, n = 2017)11%17%17%20%Chest CT (Abnormal / Total, n = 241)92%92%86%86%Finding on abnormal chest CT (n = 211) Nodule55%70%67%62%Granuloma27%15%15%8%Metastasis0%9%15%15%Other18%15%10%14%Patients with follow-up chest CT (n = 111)55%43%47%63%Mean number of follow-up chest CTs per patient21.811.851.96Table 1 Abnormalities: pulmonary nodules (65%), granulomas (13%) and metastases (9%), other findings (13%). Pulmonary nodules measured &amp;lt;4 mm (40%), 4-6 mm (35%), 6-8 mm (13%) and &amp;gt;8mm (13%). Of the 214 patients with abnormal chest CT, 52% had follow-up CT done, with mean follow-up of 1.89 per patient. There were more abnormal CXR in smokers than never smokers (23 vs 16%, p=0.001) but not chest CT scans (91 vs 86%, p = 0.35). There was no difference in rate of abnormal CXR based on age, race, ethnicity or insurance status. Evaluation of abnormal CXR's with chest CT scans found metastasis: stage 0(0%), stage 1(0%), stage 2(9%), stage 3(15%), p = 0.014. Conclusions: Later clinical stage predicts for finding metastasis on chest CT scans, done for evaluation of abnormal CXR. The use of chest CT scans for patients with non-specific pulmonary findings on CXR is not useful for women with clinical stage 0 and stage 1 disease. Citation Format: Dawar R, Palacio S, Monge J, Torres A, Salzberg M, Malpica Castillo LE, Saravia D, Amarapurkar P, Hurley J. Chest imaging in patients with breast cancer treated with curative intent. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-11-05.

Symptomless Pulmonary Cryptococcosis in a Psoriatic Arthritis Patient during Infliximab Therapy.

Dear Editor: Pulmonary cryptococcosis is a common opportunistic infection in immunosuppressed patients1. To our knowledge, this is the first reported case of pulmonary cryptococcosis in a psoriasis patient undergoing treatment with biologics. A 55-year-old man presented with an itching eruption on his head for 2 years. His skin condition got progressively worse and he reported polyarticular pain. At the initial visit, he had a systemic psoriatic eruption (Psoriasis Area and Severity Index [PASI] 14.8) and swollen joints of the shoulders, left wrist, left digitus minimus, and left knee (Disease Activity Score 28 including C-reactive protein [DAS 28-CRP]). Although he had been treated with topical steroids and vitamin D3 ointment, the treatment was not effective. Infliximab therapy (5 mg/kg) was started for both the psoriatic skin lesions and arthritis in December 2012. The screening examination for infliximab therapy revealed normal laboratory data and chest computed tomography (CT), as well as a serum Krebs von den Lungen (KL)-6 level of 266 U/ml (normal is less than 401 U/ml). A raised serum level of KL-6 is known to exist in interstitial pneumonia2. He was then treated with 5 mg/kg of intravenous infliximab that was administered at weeks 2 and 6, and then every 8 weeks thereafter. At 7 months after initiation of the infliximab therapy, although the patient denied cough or sputum or fever, and his β-D glucan, cryptococcal antigen and QuantiFERON-TB Test (Cellestis Ltd., Carnegie, Victoria, Australia) were all within the normal range, his serum KL-6 level was elevated at 585 U/ml. The patient's chest CT showed ground glass opacities bilaterally in the lower lobes and multiple small nodules in the right middle lobe (Fig. 1A). The cytology of the bronchoalveolar lavage fluid revealed encapsulated yeast, indicating the presence of cryptococcus (Fig. 1B). Thus, the patient was diagnosed with pulmonary cryptococcosis. The infliximab therapy was discontinued and oral fluconazole (200 mg/day) treatment was initiated. After 3 months, the abnormal chest CT shadow and the serum KL-6 level improved. Fig. 1 (A) Chest computed tomography showed multiple small nodules at the right middle lobe (circle). (B) Cytology of bronchoalveolar lavage fluid showed encapsulated yeasts (arrows), which is consistent with cryptococcosis species (Papanicolaou stain, ×400). ... Infliximab is a tumor necrosis factor-α (TNF-α) inhibitor for the treatment of psoriasis and other inflammatory diseases. The main, severe adverse events related to anti TNF-α therapy are infectious diseases. Cryptococcosis species infections have been reported at a rate of 5.08 per 100,000 in infliximab-treated patients3. Although there are several case reports of pulmonary cryptococcosis in patients treated with infliximab, one of them is a case of pulmonary cryptococcosis in a Crohn's disease patient who was receiving infliximab monotherapy without other immunosuppressive drugs4. There are no reports of pulmonary cryptococcal infection in psoriasis patients treated with biologics. It is generally accepted that cryptococcosis usually occurs as an opportunistic infection in a compromised host. We speculated that the immunosuppression caused by infliximab treatment must have resulted in pulmonary cryptococcosis in the previously reported in vivo cases5. Dermatologists recognize that continual careful monitoring of unexpected side effects is necessary in psoriasis patients treated with biological drugs. Pulmonary cryptococcosis must now be recognized as a potential severe complication of treatment with biologics in psoriasis patients.

Yield of diagnostic procedures for invasive fungal infections in neutropenic febrile patients with chest computed tomography abnormalities

Haematological patients with neutropenic fever are frequently evaluated with chest computed tomography (CT) to rule out invasive fungal infections (IFI). We retrospectively analysed data from 100 consecutive patients with neutropenic fever and abnormal chest CT from 1998 to 2005 to evaluate their chest CT findings and the yield of diagnostic approaches employed. For their initial CTs, 79% had nodular opacities, with 24.1% associated with the halo sign. Other common CT abnormalities included pleural effusions (48%), ground glass opacities (37%) and consolidation (31%). The CT findings led to a change in antifungal therapy in 54% of the patients. Fifty-six patients received diagnostic procedures, including 46 bronchoscopies, 25 lung biopsies and seven sinus biopsies, with a diagnostic yield for IFI of 12.8%, 35.0% and 83.3%, respectively. In conclusion, chest CT plays an important role in the evaluation of haematological patients with febrile neutropenia and often leads to a change in antimicrobial therapy. Pulmonary nodules are the most common radiological abnormality. Sinus or lung biopsies have a high-diagnostic yield for IFI as compared to bronchoscopy. Patients with IFI may not have sinus/chest symptoms, and thus, clinicians should have a low threshold for performing sinus/chest imaging, and if indicated and safe, a biopsy of the abnormal areas.

Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature

To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients. After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent observers included studies on the accuracy of parameters derived from history, physical examination, or diagnostic imaging that might predict injuries at (multidetector row) CT in adults and that allowed construction of 2x2 contingency tables. For each article, methodological quality was scored and relevant predictors for injuries at CT were extracted. For each predictor, sensitivity, specificity, positive and negative likelihood ratio and diagnostic odds ratio (DOR) including 95% confidence intervals were calculated. Of 147 articles initially identified, the observers included 10 original studies in consensus. Abnormalities at physical examination (abnormal respiratory effort, need for assisted ventilation, reduced airentry, coma, chest wall tenderness) and pelvic fractures were significant predictors (DOR: 2.1-6.7). The presence of any injuries at conventional radiography of the chest (eight articles) was a more powerful significant predictor (DOR: 2.2-37). Abnormal chest ultrasonography (four articles) was the most accurate predictor for chest injury at CT (DOR: 491-infinite). The current literature indicates that in blunt trauma patients with abnormal physical examination, abnormal conventional radiography, or abnormal ultrasonography of the chest, CT was likely to reveal relevant chest injuries. However, there was no strong evidence to suggest that CT could be omitted in patients without these criteria, or whether these findings are beneficial for patients.

Role of Chest Computed Tomography in Head and Neck Cancer

To evaluate the role of chest computed tomography (CT) in patients with head and neck squamous cell carcinoma (HNSCC) and to determine the optimal timing and predictive factors for positive findings. Retrospective analysis. Tertiary referral center. Two hundred seventy screening chest CT scans performed in 192 patients with HNSCC during a 42-month period were reviewed. The scans were categorized as new cases, follow-up cases, or recurrent cases. The results were classified as abnormal or normal. Scans of patients having a radiologic diagnosis of a malignant neoplasm of the lung or an indeterminate lesion were considered abnormal. Factors correlating with an abnormal chest CT scan or development of malignant neoplasm of the lung were analyzed, including the timing of imaging and the patients' clinicopathologic data. Seventy-nine scans (29.3%) were considered abnormal. The rate of an abnormal scan was significantly higher in the follow-up case group (44.2%) than in the new case group (14.2%) (P < .001). Ten of 15 indeterminate scans (66.7%) with small (<1 cm) solitary pulmonary nodules showed disease progression on subsequent follow-up scans, changing the patients' diagnoses to a malignant neoplasm of the lung. The predictive factors for development of a malignant neoplasm of the lung were initial N2 or N3 disease, stage IV disease, recurrent disease, and distant metastasis to another site. Chest CT is recommended for high-risk patients, especially during the follow-up period. Intensified evaluation and management are mandatory for indeterminate small solitary pulmonary nodules because of the high rate of malignant neoplasms.