Lung Parenchymal Abnormalities Research Articles

Physiological Characterization of Preserved Ratio Impaired Spirometry in the CanCOLD Study: Implications for Exertional Dyspnea and Exercise Intolerance.

Rationale: It is increasingly recognized that adults with preserved ratio impaired spirometry (PRISm) are prone to increased morbidity. However, the underlying pathophysiological mechanisms are unknown. Objectives: Evaluate the mechanisms of increased dyspnea and reduced exercise capacity in PRISm. Methods: We completed a cross-sectional analysis of the CanCOLD (Canadian Cohort Obstructive Lung Disease) population-based study. We compared physiological responses in 59 participants meeting PRISm spirometric criteria (post-bronchodilator FEV1 < 80% predicted and FEV1/FVC ⩾ 0.7), 264 control participants, and 170 ever-smokers with chronic obstructive pulmonary disease (COPD), at rest and during cardiopulmonary exercise testing. Measurements and Main Results: Individuals with PRISm had lower total lung, vital, and inspiratory capacities than healthy controls (all P < 0.05) and minimal small airway, pulmonary gas exchange, and radiographic parenchymal lung abnormalities. Compared with healthy controls, individuals with PRISm had higher dyspnea/[Formula: see text]o2 ratio at peak exercise (4.0 ± 2.2 vs. 2.9 ± 1.9 Borg units/L/min; P < 0.001) and lower [Formula: see text]o2peak (74 ± 22% predicted vs. 96 ± 25% predicted; P < 0.001). At standardized submaximal work rates, individuals with PRISm had greater Vt/inspiratory capacity (Vt%IC; P < 0.001), reflecting inspiratory mechanical constraint. In contrast to participants with PRISm, those with COPD had characteristic small airways dysfunction, dynamic hyperinflation, and pulmonary gas exchange abnormalities. Despite these physiological differences among the three groups, the relationship between increasing dyspnea and Vt%IC during cardiopulmonary exercise testing was similar. Resting IC significantly correlated with [Formula: see text]o2peak (r = 0.65; P < 0.001) in the entire sample, even after adjusting for airflow limitation, gas trapping, and diffusing capacity. Conclusions: In individuals with PRISm, lower exercise capacity and higher exertional dyspnea than healthy controls were mainly explained by lower resting lung volumes and earlier onset of dynamic inspiratory mechanical constraints at relatively low work rates. Clinical trial registered with www.clinicaltrials.gov (NCT00920348).

Occult paraquat poisoning causing pneumomediastinum and organizing pneumonia.

Pneumomediastinum is not an uncommon manifestation of lung toxicity in acute paraquat ingestion. The condition is almost invariably seen with other lung parenchymal abnormalities such as consolidations, ground-glass opacities and interlobular septal thickening. The diagnosis may be challenging in cases with no history of toxin exposure, presentation with a subacute illness and/or absence of typical local or systemic features of paraquat toxicity.

Utility of the Enhanced Liver Fibrosis score as a blood biomarker of pulmonary fibrosis secondary to SARS-CoV-2 pneumonia

IntroductionSARS-CoV-2 pneumonia can lead to several sequelae, among them, pulmonary fibrosis. The Enhanced Liver Fibrosis (ELF) score is a panel of serum markers of liver fibrosis. We aimed to describe the utility of the ELF score as a biomarker of pulmonary fibrosis secondary to COVID-19 pneumonia. MethodsChest computed tomography (CT) scan, lung function tests (LFT) and blood analysis were obtained at three months after discharge. Data were analysed according to ELF scores and posteriorly divided into ELF tertiles. ResultsOne hundred twenty-nine patients were recruited; of these, 85.7% presented bilateral pneumonia at diagnosis of SARS-CoV2 infection. At 3 months after discharge, CT scan was available in 123 patients, 73 (59.3%) of whom presented parenchymal lung abnormalities (PLA) and LFT showed impairment in 28 (22.7%) patients. Globally, the most frequent PLA was ground glass opacities (50%), followed by bronchial thickening (26.8%), reticular pattern (19.5%), consolidation (10.5%) and air bronchogram sign (7.3%). Radiological findings were only significant in the higher tertile of ELF, with a reticular pattern as the predominant PLA (p = 0.002). Moreover, patients with both PLA and LFT impairment, presented a trend towards higher levels of ELF compared with patients with only PLA or LFT impairment, or no impairment (9.9 (0.7) vs 9.6 (0.8), 9.1 (1.1) and 9.3 (0.7); p = 0.054). ConclusionPatients with both PLA and LFT alteration at 3 months after SARS-CoV-2 pneumonia had higher ELF scores. The ELF score may be useful to identify patients with risk of fibrotic changes after SARS-CoV-2 pneumonia.

Management of Pulmonary Hypertension Associated with Chronic Lung Disease.

Pulmonary hypertension (PH) is a common complication of chronic lung diseases, particularly in chronic obstructive pulmonary disease (COPD) and interstitial lung diseases (ILD) and especially in advanced disease. It is associated with greater mortality and worse clinical course. Given the high prevalence of some respiratory disorders and because lung parenchymal abnormalities might be present in other PH groups, the appropriate diagnosis of PH associated with respiratory disease represents a clinical challenge. Patients with chronic lung disease presenting symptoms that exceed those expected by the pulmonary disease should be further evaluated by echocardiography. Confirmatory right heart catheterization is indicated in candidates to surgical treatments, suspected severe PH potentially amenable with targeted therapy, and, in general, in those conditions where the result of the hemodynamic assessment will determine treatment options. The treatment of choice for these patients who are hypoxemic is long-term oxygen therapy and pulmonary rehabilitation to improve symptoms. Lung transplant is the only curative therapy and can be considered in appropriate cases. Conventional vasodilators or drugs approved for pulmonary arterial hypertension (PAH) are not recommended in patients with mild-to-moderate PH because they may impair gas exchange and their lack of efficacy shown in randomized controlled trials. Patients with severe PH (as defined by pulmonary vascular resistance >5 Wood units) should be referred to a center with expertise in PH and lung diseases and ideally included in randomized controlled trials. Targeted PAH therapy might be considered in this subset of patients, with careful monitoring of gas exchange. In patients with ILD, inhaled treprostinil has been shown to improve functional ability and to delay clinical worsening.

Pulmonary function and structure abnormalities in children and young adults with osteogenesis imperfecta point to intrinsic and extrinsic lung abnormalities

PurposePulmonary disease is the major cause of morbidity and mortality in osteogenesis imperfecta (OI). We investigated the contribution of intrinsic lung factors to impaired pulmonary function in children and young...

Comparison of single coronal thick-slab minimum intensity projection with flexible bronchoscopy for airway compression in children with lymphobronchial tuberculosis

To generate standardised coronal minimum intensity projection (MinIP) computed tomography (CT) reconstructions, and compare these with flexible bronchoscopy in children with lymphobronchial tuberculosis (LBTB). Standardised coronal MinIP reconstructions were performed from CT images in children with LBTB and the findings of three readers were compared with the reference standard, flexible bronchoscopy (FB), regarding airway narrowing. Intraluminal lesions, the site of the stenosis, and the degree of stenosis were also evaluated. The length of stenosis was evaluated by CT MinIP only. Sixty-five children (38 males; 58.5% and 27 females; 41.5%), with ages ranging from 2.5 to 144 months were evaluated. Coronal CT MinIP demonstrated a sensitivity of 96% and specificity of 89% against FB. The most common site of stenosis was the bronchus intermedius (91%), followed by the left main bronchus (85%), the right upper lobe bronchus RUL (66%), and the trachea (60%). Coronal CT MinIP reconstruction is useful in demonstrating airway stenosis in children with lymphobronchial TB, with high sensitivity and specificity. CT MinIP had additional advantages over FB in that it allowed objective measurement of the diameter of stenosis, measurement of the length of stenosis, and evaluation of post-stenotic segments of the airways and lung parenchymal abnormalities.

Impact of Early Intervention for STAT3 Dominant-Negative Disease

IntroductionSTAT3 dominant negative disease (STAT3 DN) is characterized by elevated IgE, recurrent skin and lung infections, skeletal, connective tissue, and vascular abnormalities. Early genetic diagnosis, especially with familial disease, allows for early intervention, which may impact natural history through minimizing infectious complications. MethodsWe retrospectively reviewed medical records of 18 STAT3 DN pediatric patients born after 2007, when STAT3 genetic testing was available. Clinical features, laboratory results, infections and treatments were compared between those with STAT3 DN family history and probands. ResultsOur cohort included 8 patients with STAT3 DN diagnosed by family history (median age 9 years; range 4–14) and 10 probands (median age 13 years, range 5–14). For those with family history, one was diagnosed in utero, six by 6 months of age, and one at 2 years. Probands were diagnosed at a median age of 2 years (range 1–6 years). STAT3 mutation domains were similar between groups. Those with family history started antiseptic washes at a mean of 2.4 months and prophylactic antibiotics at 0.4 years, whereas probands initiated antiseptics at 4.5 years and prophylactic antibiotics at 3 years. Compared to probands, patients with STAT3 DN diagnosed by family history had significantly (p < 0.05) reduced rates of hospitalizations (mean 0.6 vs 6.2 times), bacterial pneumonias (13% vs 90%), >4 skin abscesses (25% vs 90%), other serious infections (0% vs 40%), recurrent ear infections and/or tympanostomy tube placement (0% vs 60%), and severe eczema (13% vs 60%). Significant differences were not seen in parenchymal lung abnormalities (13% vs 50%, p = 0.09) and non-immunologic features, such as fractures and joint hyperextensibility. Mean peak serum IgE and absolute eosinophil counts (AEC) were comparable (IgE 6,865 vs 13,317 IU/mL; AEC 1,023 vs 1,182 cells/uL in family history vs probands). Those with family history received less advanced therapies than probands, specifically immunoglobulin replacement (13% vs 60%), antifungals (25% vs 60%), and lung surgery (0% vs 40%). One proband received bone marrow transplantation. ConclusionEarly diagnosis and intervention positively impacts disease course and management with markedly reduced rates of infectious complications, which may decrease future morbidity and mortality in this vulnerable patient population.

Lung parenchymal abnormalities and outcomes in hospitalized patients with COVID 19 pneumonia: A positive message from a prospective hospital-based longitudinal study for futureconsiderations

Lung parenchymal abnormalities and outcomes in hospitalized patients with COVID 19 pneumonia: A positive message from a prospective hospital-based longitudinal study for futureconsiderations

Variation of Chest Computed Tomographic Findings in Coronavirus Disease-19 (COVID-19) Positive Patients in a Tertiary Care Hospital, Bangladesh

Background: We aimed to report different patterns of chest computed tomographic (CT) findings in coronavirus disease-19 (COVID-19) infected patients in Bangladesh.&#x0D; Methods: This was a cross-sectional descriptive study of 200 consecutive reverse transcriptase polymerase chain reaction (RT-PCR) positive patients who underwent CT chest. Distribution, type of abnormal lung findings and Prevalence were recorded.&#x0D; Result: Among the total study cohort of 200 patients, 148(74 %) were males and 52 (26 %) were females with mean age of 53.9 ± 16.7 years (range 20–92 years). We observed lung parenchymal abnormalities in 125 (62.0 %) cases whereas 75 (37.5 %) RT-PCR positive cases had a normal chest CT. Common symptom was cough in 108 (54%), Only 18.0% of the patients were dyspneic. Among the patients with abnormal CT findings bilateral involvement was commonest 98/125 (78.4 %), multilobar (54.0 %) lung involvement with a predominant peripheral and posterior distribution was more commonly observed. With regards to the type of opacity, ground glass opacity (GGO) was the predominant abnormality found in 122/125 cases. Pure GGO was observed in 29 (23.2 %), most common pattern was GGO mixed with consolidation was noted in 52(41.6 %). GGO with crazy paving pattern was seen in 33 (26.4 %) and sub pleural linear and curvilinear lines were seen in 23(18.4%). Peri-lesional or intralesional segmental or subsegmental pulmonary vessel enlargement was observed in 36 (70.6 %) cases.&#x0D; Conclusion: In this study population, we found a high proportion of symptomatic laboratory-confirmed SARS-CoV-2 patients had positive chest CT findings. Patients with a positive CT showed typical findings of predominant GGOs in a bilateral and multilobar distribution with peripheral predilection.&#x0D; AKMMC J 2021; 12(1) : 38-44

The prevalence, risk factors, and public health consequences of peripheral lymph node–associated clinical and subclinical pulmonary tuberculosis

ObjectivesRelatively little is known about the prevalence, risk factors, and public health consequences of peripheral lymph node (PLN)–associated pulmonary tuberculosis (PTB). MethodsWe developed a 10-year (2010-2019) population-based cohort of PLNTB patients in Canada. We used systematically collected primary source data and expert reader chest radiograph interpretations in a multivariable logistic regression to determine associations between sputum culture positivity and demographic, clinical, and radiographic features. Public health risks were estimated among contacts of PLNTB patients. ResultsThere were 306 patients with PLNTB, among whom 283 (92.5%) were 15-64 years of age, 159 (52.0%) were female, and 293 (95.8%) were foreign-born. Respiratory symptoms were present in 21.6%, and abnormal chest radiograph in 23.2%. Sputum culture positivity ranged from 12.9% in patients with no symptoms and normal lung parenchyma to 66.7% in patients with both. Respiratory symptoms, abnormal lung parenchyma, and HIV-coinfection (borderline) were independent predictors of sputum culture positivity (odds ratio [OR] 2.24 [95% confidence interval [CI] 1.15-4.39], P = 0.01, OR 4.78 [95% CI 2.41-9.48], P < 0.001, and OR 2.54 [95% CI 0.99-6.52], P = 0.05), respectively. Among contacts of sputum culture-positive PLNTB patients, one secondary case and 16 new infections were identified. ConclusionIsochronous PTB is common in PLNTB patients. Routine screening of PLNTB patients for PTB is strongly recommended.

STUDY OF POST COVID 19 PULMONARY COMPLICATIONS ON CT: A FOLLOW UP STUDY

Introduction: SARS-CoV-2 is a severe acute respiratory syndrome coronavirus with a high pathogenicity to humans. In order to properly diagnose and monitor individuals who have COVID-19 pneumonia, a chest CT scan is essential. In numerous researches, radiographic alterations in the acute course of COVID-19 have been observed. These changes range from mild to severe cases. According to recent studies, 94% of hospitalized patients' discharge CT scans show persisting lung parenchymal abnormalities. With this perspective present study is conducted to evaluate follow up CTndings in Post COVID 19 infection. Aim &amp; Objectives: Aim:To evaluate follow up CTndings in Post COVID 19 infection Objective: 1. To assess clinical prole and CTndings in Post COVID 19 infection patients with brotic changes found on CT 2. To assess clinical prole and CTndings in Post COVID 19 infection patients with no brotic changes 3. To correlate clinical prole and CTndings amongst two groups 4. To assess &amp; correlate CTndings amongst timely performed CTscan at 3 and 6 months after discharge Materials and Methods: 100 COVID-19 patients who had been discharged from the hospital after treatment for COVID-19 were prospectively enrolled at follow up visit. Discharge chest CTscan were reviewed. All 100 patients advised follow-up CTscan of thorax at 3 and 6 months from the Time of discharge. All CT reports were evaluated and patients were categorized into two groups based on presence or absence of traction bronchiectasis, parenchymal bands and/or honeycombing as Group A(Cases with brotic changes) and Group B (Cases without brotic changes). Data are expressed as frequency N (%) or mean ± SD. χ2-test was used to study correlation between variables Observations and Results: Majority had bilateral lung involvement in both groups. Ground glass opacity dominated in CTpattern. Other CTndings were less in proportion in group B (35/71) compared to group A (27/29). Statistically signicant difference found for CT score amongst two groups (P&lt; 0.00001). About 29 (29 %) cases out of total 100 (100 %) showed brotic changes. 22 (22 %) showed Residual GGO/interstitial thickening. 49 (49 %) got complete radiological resolution at the end of 6 months Conclusion: All patients with dyspnoea after SARS-CoV-2 infection should undergo a thorough thin-section CT. Depending on the degree of initial lung involvement and the length of time since infection, certain CT abnormalities are more or less common. According to longitudinal investigations, GGO can be replaced by abnormalities that resemble brosis, and abnormalities may linger in patients who have recognised risk factors.

Risk factors for clinically significant diffuse parenchymal lung abnormalities persisting after severe COVID-19 pneumonia.

The risk factors for clinically significant diffuse parenchymal lung abnormalities (CS-DPLA) persisting after severe coronavirus disease 2019 (COVID-19) pneumonia remain unclear. The present study was conducted to assess whether COVID-19 severity and other parameters are associated with CS-DPLA. The study participants included patients who recovered after acute severe COVID-19 and presented with CS-DPLA at two or six month follow up and control group (without CS-DPLA). Adults volunteers without any acute illness, chronic respiratory illness and without a history of severe COVID-19 were included as healthy controls for the biomarker study. The CS-DPLA was identified as a multidimensional entity involving clinical, radiological and physiological pulmonary abnormalities. The primary exposure was the neutrophil-lymphocyte ratio (NLR). Recorded confounders included age, sex, peak lactate dehydrogenase (LDH), advanced respiratory support (ARS), length of hospital stay (LOS) and others; associations were analyzed using logistic regression. The baseline serum levels of surfactant protein D, cancer antigen 15-3 and transforming growth factor-β (TGF-β) were also compared among cases, controls and healthy volunteers. We identified 91/160 (56.9%) and 42/144 (29.2%) participants with CS-DPLA at two and six months, respectively. Univariate analyses revealed associations of NLR, peak LDH, ARS and LOS with CS-DPLA at two months and of NLR and LOS at six months. The NLR was not independently associated with CS-DPLA at either visit. Only LOS independently predicted CS-DPLA at two months [adjusted odds ratios (aOR) (95% confidence interval [CI]), 1.16 (1.07-1.25); P<0.001] and six months [aOR (95% CI) and 1.07 (1.01-1.12); P=0.01]. Participants with CS-DPLA at six months had higher baseline serum TGF-β levels than healthy volunteers. Longer hospital stay was observed to be the only independent predictor of CS-DPLA six months after severe COVID-19. Serum TGF-β should be evaluated further as a biomarker.

52: PROSPECTIVE REAL-TIME VALIDATION OF A LUNG ULTRASOUND DEEP LEARNING MODEL IN THE INTENSIVE CARE UNIT

Introduction: Lung ultrasound (LUS) shows diagnostic superiority to chest radiography in the ICU setting however its widespread deployment is challenged by limited user base and its dependence on clinical expertise. Artificial intelligence models have been developed to overcome these barriers through LUS automation; however, bedside pragmatic performance has never been demonstrated. In this study, we aimed to evaluate the accuracy of a bedside, real-time deployment of a deep learning model capable of distinguishing between normal (A line pattern) and abnormal (B line pattern) lung parenchyma on lung ultrasound in critically ill patients. Methods: Prospective, observational study evaluating the performance of a previously-trained LUS deep learning (DL) model on 100 admitted patients to an academic intensive care unit (ICU). Enrolled patients received an anterior zone LUS exam (4 views) with frame-by-frame DL model predictions using a portable device. Clip-level model predictions were analyzed and compared to blinded expert review for A vs B line pattern. Four clip-level prediction cutoffs were applied to maximize model sensitivity and specificity at bedside. Results: A total of 100 unique ICU patients (400 clips) were enrolled from two tertiary care sites. The majority of patients were receiving mechanical ventilation (56/100), 12 patients were in the weaning process with ongoing trach-mask trials, 4 patients were on High-Flow Nasal Cannula, 4 were on non-invasive ventilation (BiPAP), and 25 patients were on nasal prongs. The Mindray M9 and Sonosite X-Porte ultrasound machines were used to scan 50 patients each. When compared to gold-standard expert annotation, the real-time inference yielded an accuracy of 95%, sensitivity of 93%, and specificity of 96% for identification of the B line pattern. Varying the prediction cutoffs reveal that diagnostic performance may be readily customized to suit the clinical environment. Conclusions: Promoting the feasibility and direct application of bedside AI in the ICU, we have shown that a binary DL ultrasound model demonstrates excellent bedside accuracy in distinguishing between normal and abnormal lungs when deployed in real-time in the ICU.

Imaging Findings in Chronic Granulomatous Disease (CGD).

To describe prevalence of various imaging findings in chronic granulomatous disease (CGD) patients; and find imaging biomarkers for differentiating chest infections caused by different micro-organisms. A retrospective study was conducted on 15 patients (49 scans) with proven CGD. Scans which had a correlative microbiological diagnosis for organisms were included in the analysis. The scans were reviewed by 3 radiologists on a predefined proforma, under the lung parenchymal, airway, pleural, mediastinal, and extrathoracic abnormalities. Analysis of various imaging parameters on a semiquantitative scale was performed, followed by a correlation of each imaging findings with causative organisms. The mean age of presentation was nearly 7 y, with a male preponderance. Definitive proof of causative organisms was obtained in 22 scans. Bacterial infection was found in 7, fungal in 12, tubercular in 2, and viral in 1 scan. Most prevalent thoracic imaging manifestations included lymphadenopathy (commonest), consolidation, nodules, air trapping, and bronchiectasis. Fungal infections showed necrotic conglomerate lymphadenopathy, cavitating nodules, and multilobar consolidation more frequently than bacterial infections (though not statistically significant). Abscesses and lymphadenopathy were the most common extrathoracic manifestations. In patients with CGD, multifocal or multilobar consolidation, mass-like consolidation, cavitating nodules, and conglomerate necrotic lymphadenopathy should alert the radiologist to a possible fungal cause.

Correlation of lung function with ultra-low-dose CT-detected lung parenchymal abnormalities: a cohort study of 1344 asbestos exposed individuals

IntroductionDeliberate exposure to medical ionising radiation should be as low as reasonably practicable but the reduction of radiation from CT should be balanced against diagnostic image quality. The ability of...

Abstract 166: Lung Parenchymal And Pleural Findings On Computed Tomography After Out-of-Hospital Cardiac Arrest

Introduction: Lung injury and the acute respiratory distress syndrome (ARDS) are common after out-of-hospital cardiac arrest (OHCA), but the imaging characteristics of lung parenchymal and pleural abnormalities in these patients have not been well-characterized. We aimed to describe the incidence of lung parenchymal and pleural findings among patients who had return of spontaneous circulation (ROSC) after OHCA who underwent computed tomography (CT) of the chest. Methods: This was a retrospective cohort study conducted at two academic hospitals from 2014 to 2019. We included adults with OHCA who received a head-to-pelvis or dedicated chest CT scan. The primary outcome was the incidence of lung parenchymal and pleural abnormalities. CT scans were overread by attending radiologists and lung parenchymal and pleural findings were categorized based on predefined criteria. Data are presented as absolute numbers and percentages. Results: We evaluated 243 eligible patients. Median age was 56 years, 32% were women, and 59% were Caucasian. An initial shockable rhythm was found in 29% and in 71 patients (30%) the etiology of arrest was cardiac. A total of 162 patients underwent head-to-pelvis CT and 81 patients had dedicated chest imaging. The median time from OHCA to CT scan was 2.7 (IQR 2.1-3.8) hours. A total of 190 (78%) of patients had abnormal lung parenchymal or pleural findings. The most common findings are depicted in Table 1. Conclusion: Over three-quarters of patients who survive to the hospital post OHCA have lung parenchymal or pleural abnormalities on CT, the most common of which are aspiration, pulmonary edema, and consolidation/pneumonia. Future planned research will characterize the clinical impact of these findings and whether early chest CT could identify patients at risk for ARDS.

Comparison of clinical outcomes of pulmonary sequestration in adults between surgery and non-surgery groups.

Pulmonary sequestration (PS) is a rare congenital lung malformation that can be incidentally diagnosed in adulthood. The natural course of PS in adults is scarcely known. In this retrospective cohort study, medical records and imaging results of adult patients diagnosed with PS between 1994 and 2019 were reviewed. Diagnoses of PS were confirmed by histopathological findings in resected cases, while non-resected cases were diagnosed based on the presence of anomalous systemic arterial supply and abnormal lung parenchyma on enhanced chest computed tomography (CT). Among 104 patients with PS, the median age at diagnosis was 40.5 years, and 69 (66.3%) patients were asymptomatic. Patients in the surgery group were significantly younger (38.6 vs. 45.3 years, respectively, P=0.016), were more likely to be symptomatic initially (51.6% vs. 28.6%, respectively, P=0.015), and had larger PS (90.0 vs. 66.3 mm, respectively, P<0.001) than the non-surgery group. Of the patients in the surgery group, 29.0% (18/62) experienced postoperative complications. In the surgically resected cases, infections were only detected in intralobar PS, not in extralobar PS. Among 25 subjects without initial symptoms in the non-surgery group, 24 (96.0%) remained asymptomatic at the last follow-up. Adults with PS tended to undergo resection if they were young, symptomatic, and had large PS (a median diameter of 90.0 mm). Almost all subjects who were initially asymptomatic and did not undergo surgery remained asymptomatic at the last follow-up. Therefore, considering the indolent course of PS, initially asymptomatic adults with PS could be followed up without surgery.

Reporting and management of incidental lung findings on computed tomography: beyond lung nodules.

Non-nodular incidental lung findings can broadly be categorised as airway- or airspace-related abnormalities and diffuse parenchymal abnormalities. Airway-related abnormalities include bronchial dilatation and thickening, foci of low attenuation, emphysema, and congenital variants. Diffuse parenchymal abnormalities relate to the spectrum of diffuse parenchymal lung diseases cover a spectrum from interstitial lung abnormalities (ILAs) and pulmonary cysts to established diffuse parenchymal lung abnormalities such as the idiopathic interstitial pneumonias and cystic lung diseases. In this review, we discuss the main manifestations of these incidental findings, paying attention to their prevalence and importance, descriptors to use when reporting, the limits of what can be considered "normal", and conclude each section with some pragmatic reporting recommendations. We also highlight technical and patient factors which can lead to spurious abnormalities.

Subsegmental pulmonary embolism and anticoagulant therapy: the impact of clinical context.

Anticoagulation for subsegmental pulmonary embolism (SSPE) is controversial. To assess the impact of clinical context on anticoagulation and outcomes of SSPE. We electronically searched computed tomography pulmonary angiogram reports to identify SSPE. We extracted demographic, risk factor, investigations and outcome data from the electronic medical record. We stratified patients according to anticoagulation and no anticoagulation. From 1 January 2017 to 31 December 2019, we identified 166 patients with SSPE in 5827 pulmonary angiogram reports. Of these, 123 (74%) received anticoagulation. Compared with non-anticoagulated patients, such patients had a different clinical context: higher rates of previous venous thromboembolism (11% vs 0%; P = 0.019), more recent surgery (26% vs 9%; P = 0.015), more elevated serum D-dimer (22% vs 5%; P = 0.004), more lung parenchymal abnormalities (76% vs 61%; P = 0.037) and were almost twice as likely to require inpatient care (76% vs 42%; P < 0.001). Such patients also had twice the all-cause mortality at 1 year (32% vs 16%). SSPE is diagnosed in almost 3% of pulmonary angiograms and is associated with high mortality, regardless of anticoagulation, due to coexistent disease processes rather than SSPE. Anticoagulation appears dominant but markedly affected by the clinical context of risk factors, alternative indications and illness severity. Thus, the controversy is partly artificial because anticoagulation after SSPE is clinically contextual with SSPE as only one of several factors.

Percutaneous Image-Guided Biopsy for a Comprehensive Hybridization Capture-Based Next-Generation Sequencing in Primary Lung Cancer: Safety, Efficacy, and Predictors of Outcome

IntroductionTo evaluate factors associated with successful comprehensive genomic sequencing of image-guided percutaneous needle biopsies in patients with lung cancer using a broad hybrid capture-based next-generation sequencing assay (CHCA). MethodsWe conducted a single-institution retrospective review of image-guided percutaneous transthoracic needle biopsies from January 2018 to December 2019. Samples with confirmed diagnosis of primary lung cancer and for which CHCA had been attempted were identified. Pathologic, clinical data and results of the CHCA were reviewed. Covariates associated with CHCA success were tested for using Fisher’s exact test or Wilcoxon ranked sum test. Logistic regression was used to identify factors independently associated with likelihood of CHCA success. ResultsCHCA was requested for 479 samples and was successful for 433 (91%), with a median coverage depth of 659X. Factors independently associated with lower likelihood of CHCA success included small tumor size (OR = 0.26 [95% confidence interval (CI): 0.11–0.62, p = 0.002]), intraoperative inadequacy on cytologic assessment (OR = 0.18 [95% CI: 0.06–0.63, p = 0.005]), small caliber needles (≥20-gauge) (OR = 0.22 [95% CI: 0.10–0.45, p < 0.001]), and presence of lung parenchymal abnormalities (OR = 0.12 [95% CI: 0.05–0.25, p < 0.001]). Pneumothorax requiring chest tube insertion occurred in 6% of the procedures. No grade IV complications or procedure-related deaths were reported. ConclusionsPercutaneous image-guided transthoracic needle biopsy is safe and has 91% success rate for CHCA in primary lung cancer. Intraoperative inadequacy, small caliber needle, presence of parenchymal abnormalities, and small tumor size (≤1 cm) are independently associated with likelihood of failure.