Lung Apex Research Articles

Relaxin does not prevent development of hypoxia-induced pulmonary edema in rats

Acute hypoxia impairs left ventricular (LV) inotropic function and induces development of pulmonary edema (PE). Enhanced and uneven hypoxic pulmonary vasoconstriction is an important pathogenic factor of hypoxic PE. We hypothesized that the potent vasodilator relaxin might reduce hypoxic pulmonary vasoconstriction and prevent PE formation. Furthermore, as relaxin has shown beneficial effects in acute heart failure, we expected that relaxin might also improve LV inotropic function in hypoxia. Forty-two rats were exposed over 24 h to normoxia or hypoxia (10% N2 in O2). They were infused with either 0.9% NaCl solution (normoxic/hypoxic controls) or relaxin at two doses (15 and 75 μg kg−1 day−1). After 24 h, hemodynamic measurements and bronchoalveolar lavage were performed. Lung tissue was obtained for histological and immunohistochemical analyses. Hypoxic control rats presented significant depression of LV systolic pressure by 19% and of left and right ventricular contractility by about 40%. Relaxin did not prevent the hypoxic decrease in LV inotropic function, but re-increased right ventricular contractility. Moreover, hypoxia induced moderate interstitial PE and inflammation in the lung. Contrasting to our hypothesis, relaxin did not prevent hypoxia-induced pulmonary edema and inflammation. In hypoxic control rats, PE was similarly distributed in the apical and basal lung lobes. In relaxin-treated rats, PE index was 35–40% higher in the apical than in the basal lobe, which is probably due to gravity effects. We suggest that relaxin induced exaggerated vasodilation, and hence pulmonary overperfusion. In conclusion, the results show that relaxin does not prevent but rather may aggravate PE formation.

P28-14 Long-term response to alectinib in a patient with ALK-fusion gene emerged in afatinib-resistant EGFR-mutated lung cancer

When a 71-year-old man developed right putamen hemorrhage, a mass lesion in left lung apex with enlarged mediastinal lymph nodes on CT was detected. A CT-guided biopsy specimen revealed adenocarcinoma with EGFR exon 19 deletion without ALK fusion gene. He was a current smoker (125 pack-year) and performance status was 1. We planned surgery following concurrent thoracic radiation with chemotherapy (cisplatin plus docetaxel) for stage IIIA (cT1bN2M0) non-small cell lung cancer. However, lobectomy could not be performed because pleural dissemination was observed at chest surgery.

Low-cost multiport and uniport video-assisted thoracic surgery bullectomy

Abstract Introduction Egypt, like many other third world countries, faces a problem of rising health care cost, adding that a large number of patients are not covered by medical insurance so they have to fully pay for their health care, pneumothorax due to presence of lung bullae and blebs is a very common presentation in the emergency rooms. Video-assisted thoracic surgery bullectomy is now considered the standard procedure for treatment. We have a relatively low-cost approach for the treatment of apical lung blebs and bullae using a heavy silk suture. Patients and methods Between the year January 2018 and August 2020, we operated on 22 patients with primary spontaneous pneumothorax using the technique of hand ligation of blebs under multiport or uniport video-assisted thoracoscopic surgery. Results This study was carried out on 22 patients, comprising 59.1% male, with a mean age of 44.18 ± 14.09 years. The most frequent complaint was cough in 90.9% of the patients followed by dyspnea in 81.8% and chest pain in 63.6%. The cause of presentation was spontaneous pneumothorax in 31.8%, recurrent pneumothorax in 40.9, and lung bullae in 27.3%. The most frequent previous intervention was intercostal tube insertion (ICT) twice in 54.5% followed by ICT once in 36.4%, and finally, pigtail catheter in 9.1%. The indication of video-assisted thoracic surgery was failure of lung expansion in 59.1% followed by recurrence in 40.9%, and persistent air leak from ICT in 13.6%. Conclusion Our method for treatment of lung blebs and bullae using ligation via multiport or uniport offers better economic results through avoiding the use of expensive disposables, and the clinical outcomes are similar.

Prone Chest Radiographs: Distinguishing Features and Identification of Support Devices.

PurposeProne position is known to improve acute lung injury, and chest radiographs are often necessary to monitor disease and confirm support device placement. However, there is a paucity of literature regarding radiographs obtained in this position. We evaluated prone radiographs for distinguishing features and ability to identify support devices.MethodsPairs of prone and supine radiographs obtained during the COVID-19 pandemic were assessed retrospectively. IRB approval and waiver of informed consent were obtained. Radiographs were assessed for imaging adequacy, distinguishing features, and support device identification (endotracheal tube, enteric tube, or central line). Radiographs were reviewed by ≥ 2 cardiothoracic radiologists.ResultsRadiographs from 81 patients (63yo ± 13, 30% women) were reviewed. Prone and supine radiographs were comparable for imaging the lung bases (81% vs. 90%, p = 0.35) and apices (93% vs. 94%, p = 1); prone radiographs more frequently had significant rotation (36% vs. 19%, p = 0.021). To identify prone technique, scapula tip located beyond the rib border was 89% sensitive (95%CI 80–95%) and 85% specific (76–92%), and a fundal stomach bubble was 44% sensitive (33–56%) and 90% specific (81–96%). For women, displaced breast shadow was 46% sensitive (26–67%) and 92% specific (73–99%). Prone and supine radiographs each identified > 99% of support devices. Prone exams trended toward increased rate of malpositioned device (12% vs. 6%, p = 0.07).ConclusionScapula position reliably distinguishes prone from supine position; fundal stomach bubble or displaced breast shadow is specific for prone position. Prone radiographs reliably identify line and tube position, which is particularly important as prone patients appear at increased risk for malpositioned devices.

A Deadly Spontaneus Hemopneumothorax: A Case Report

Background: Spontaneous hemopneumothorax (SHP) is a subtype of hemopneumothorax in which there is an accumulation of blood and air in the pleural space without trauma or other definitive cause. Spontaneous hemopneumothorax is a rare disease.
 Case presentation: A man, aged 32 years, came with a complaint of sudden shortness of breath due to a right hemopneumothorax patient who was put on a chest tube insertion. It looked like 1500 cc of blood came out accompanied by an air component. Next, the chest tube is connected to the water-sealed drainage. The patient found a decrease in Hb from 15 mg/dl to 12 mg/dl. In the next nine hours, the patient's Hb became 10 mg/dl. As a result of this condition, the patient underwent an emergency thoracotomy to evaluate the source of bleeding, where the patient's source bleeding was found to be an arterial vein malformation (AVM) at the apex of the lung attached to the chest wall. Anatomical and pathological examination showed confirmed arterial vein malformation.
 Conclusion: Spontaneous hemopneumothorax, in this case, is a rare case caused by arterial-vein malformation. The right decision in patient management will determine the outcome and outcome of the treatment given.

Simplified Lung Ultrasound Examination and Telehealth Feasibility in Early SARS-CoV-2 Infection

BackgroundIn COVID-19, inpatient studies have demonstrated that lung ultrasound B-lines relate to disease severity and mortality and can occur in apical regions that can be imaged by patients themselves. However, as illness begins in an ambulatory setting, the aim of this study was to determine the prevalence of apical B-lines in early outpatient infection and then test the accuracy of their detection using telehealth and automated methods.MethodsConsecutive adult patients (N = 201) with positive results for SARS-CoV-2, at least one clinical risk factor, and mild to moderate disease were prospectively enrolled at a monoclonal antibody infusion clinic. Physician imaging of the lung apices for three B-lines (ultrasound lung comet [ULC]) using 3-MHz ultrasound was performed on all patients for prevalence data and served as the standard for a nested subset (n = 50) to test the accuracy of telehealth methods, including patient self-imaging and automated B-line detection. Patient characteristics, vaccination data, and hospitalizations were analyzed for associations with the presence of ULC.ResultsPatients’ mean age was 54 ± 15 years, and all lacked hypoxemia or fever. ULC was present in 55 of 201 patients (27%) at a median of 7 symptomatic days (interquartile range, 5-8 days) and in four of five patients who were later hospitalized (P = .03). Presence of ULC was associated with unvaccinated status (odds ratio [OR], 4.11; 95% CI, 1.85-9.33; P = .001), diabetes (OR, 2.56; 95% CI, 1.08-6.05; P = .03), male sex (OR, 2.14; 95% CI, 1.07-4.37; P = .03), and hypertension or cardiovascular disease (OR, 2.06; 95% CI, 1.02-4.23; P = .04), while adjusting for body mass index > 25 kg/m2. Telehealth and automated B-line detection had 84% and 82% accuracy, respectively.ConclusionsIn high-risk outpatients, B-lines in the upper lungs were common in early SARS-CoV-2 infection, were related to subsequent hospitalization, and could be detected by telehealth and automated methods.

Pancoast Tumor Presenting as Neck Pain in the Chiropractic Office: A Case Report and Literature Review

Patient: Male, 59-year-old Final Diagnosis: Adenocarcinoma of the lung • pancoast tumor Symptoms: Cough • neck and shoulder pain and numbness Medication: — Clinical Procedure: Magnetic resonance imaging (MRI) of the cervical and thoracic spine Specialty: Infectious Diseases • Pulmonology • Radiology • Rehabilitation Objective: Rare disease Background:Pancoast tumors, also called superior sulcus tumors, are a rare type of cancer affecting the lung apex. These tumors can spread to the brachial plexus and spine and present with symptoms that appear to be of musculoskeletal origin.Case Report:A 59-year-old Asian man presented to a chiropractor in Hong Kong with a 1-month history of neck and shoulder pain and numbness that had been treated unsuccessfully with exercise, medications, and acupuncture. He had an active history of tuberculosis, which was currently treated with antibiotics, and a 50-pack-year history of smoking. Cervical magnetic resonance imaging (MRI) was performed urgently, revealing a small cervical disc herniation thought to correspond with radicular symptoms. However, as the patient did not respond to a brief trial of care, a thoracic MRI was urgently ordered, revealing a large superior sulcus tumor invading the upper to mid-thoracic spine. The patient was referred for medical care and received radiotherapy and chemotherapy with a positive outcome. A literature review identified 6 previously published cases in which a patient presented to a chiropractor with an undiagnosed Pancoast tumor. All patients had shoulder, spine, and/or upper extremity pain.Conclusions:Patients with a previously undiagnosed Pancoast tumor can present to chiropractors given that these tumors may invade the brachial plexus and spine, causing shoulder, spine, and/or upper extremity pain. Chiropractors should be aware of the clinical features and risk factors of Pancoast tumors to readily identify them and refer such patients for medical care.

MYCOBACTERIAL INFECTION MIMICKING LUNG METASTASIS

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Tuberculosis (TB) may present as multiple pulmonary nodules mimicking lung metastases. CASE PRESENTATION: A 57-year-old female presented to the hospital with generalized weakness, failure to thrive, and shortness of breath. She had lost 10 pounds in the past 10 months. She had shortness of breath for 3 weeks, associated with cough productive of white–greenish sputum. She denied any fevers, chills, recent travel. On further evaluation- CXR showed a thick-walled cavitary lesion in the right lung apex, irregular wedge-shaped opacification in the left lung apex. CT Angiography chest showed multifocal pneumonia with multiple ground glass nodular foci throughout the lungs. Multifocal pneumonia or malignancy was considered. She was empirically treated with ceftriaxone, azithromycin. Work up for pneumonia was negative. As a part of the malignancy workup, EGD and colonoscopy were unremarkable. CT-guided lung biopsy was done with the suspicion of malignancy. The pathology report showed markedly necrotic lung parenchyma with ill-defined granuloma, many acid-fast bacilli on AFB stain with no evidence of malignancy. Unfortunately, the patient was lost to follow-up and thus could not peruse further workup. DISCUSSION: Bilateral multiple pulmonary nodules are suggestive of metastases, multiple nodules with an upper lobe predominance, Pulmonary Tuberculosis, or Mycobacterium Avium Complex should be considered in the differential diagnosis. CONCLUSIONS: Many asymptomatic cases of TB are detected incidentally on chest radiography, and patients are often negative for acid-fast bacilli staining and culture despite having active TB. It is important to know the imaging findings characteristic of pulmonary TB and its variant forms. DISCLOSURE: Nothing to declare. KEYWORD: Tuberculosis

Surgical lung biopsy for interstitial lung diseases-a single center study of 129 patients.

BackgroundAccording to guidelines for the diagnosis and treatment of interstitial lung diseases (ILDs), a diagnostic surgical lung biopsy should be used to obtain the differential diagnosis of an ILD in patients with ILDs, which are difficult to distinguish clinically. However, the risk of developing postoperative complications such as postoperative pulmonary fistula or acute exacerbation is a concern. The purpose of this study was to evaluate the safety of surgical lung biopsy for the differential diagnosis of ILDs.MethodsFrom October 2007 to July 2019, 129 patients thought to have ILD underwent a surgical lung biopsy at Toho University Omori Medical Center. We conducted a retrospective study on the diagnosis and safety of surgical lung biopsy for patients with ILD.ResultsThe 30- and 60-day mortality was 0%. Postoperative complications occurred in 13 of 129 (10.1%) patients. The complications included pneumothorax in 8 (6.2%) patients after removal of the chest tube, postoperative pneumonia in 2 (1.0%), and acute exacerbation in 1 (0.8%). Postoperative pneumothorax was observed in 4 of 13 patients (30.7%) who underwent a biopsy of the apex of the lung (right S1, left S1+2), which was a significantly higher rate of postoperative pneumothorax than seen for patients undergoing biopsy at other sites (P=0.0086).ConclusionsSurgical lung biopsy for the differential diagnosis of an ILD was performed safely. However, biopsy sites for ILDs need to be carefully selected to avoid postoperative complications.

Right pneumothorax with congenital pericardial defect showed right atrium mimicking bulla in surgery

BackgroundCongenital pericardial defect (CPD) is found incidentally in cases of pneumothorax. CPD is seen in left side rather than right side and it is not generally known among thoracic surgeons how the inside of the pericardial space can be seen from the thoracic cavity in cases of pericardial defect.Case presentationA 52-year-old man with dyspnea was referred to our hospital because of the diagnosis of right pneumothorax. Chest radiography showed a right lung collapse and a pneumopericardium on the left side. Despite insertion of a chest tube, air leakage prolonged, bullectomy at the apex of the right lung was performed under thoracoscopy. During surgery, thoracoscope showed that the right atrium seemed as if it had been a non-pedunculated bulla or cardiac cyst. Heart beating, continuity with the heart, and the absence of respiratory motion could distinguish the right atrium from a bulla, and pericardial defect was confirmed. Preoperatively, the patient had no cardiac symptoms related to the CPD, and therefore, it was determined that a procedure to close the CPD was not necessary. Any complication and recurrence did not occur 6 months after surgery.ConclusionsRight pneumothorax with CPD showed right atrium mimicking bulla in surgery. It is important to consider correction of CPD if there are cardiac symptoms at the onset of pneumothorax, and not to misinterpret the right atrium as a bulla.

P141 CORRELATION BETWEEN TAKO–TSUBO SYNDROME AND OCCULT CANCER

Abstract Introduction Tako–Tsubo Syndrome (“TTS”) is a cardiomyopathy characterized by an acute reversible left ventricular dysfunction, mainly triggered by emotional or physical stress. Several variants have been reported, including reverse TTS, characterized by hypokinesia of basal segments and hyperkinesis of the apical ones. TTS has a clinical presentation similar to acute coronary syndrome but without evidence of obstructive coronary artery disease. A surprising association between TTS and cancer arose out of recent studies. Case Presentation 74–year–old patient got to the emergency room of our hospital for the appearance, apparently in the health, in the absence of physical or emotional stress of oppressive chest pain. On the ECG, there was evidence of ST–segment elevation in inferior leads, for which urgent coronary angiography was performed. It did not show significant stenotic lesions nor evidence of elevated troponin values. The Echocardiogram showed hypokinesia of the basal segments and hyperkinesis of the mid–apical ones, with EF 40%. In the following days, the patient performed MRI–heart with detection of LGE of the intramyocardial type (non–ischemic pattern) in correspondence with the inferior wall in the medioventricular area. During hospitalization on routine chest x–ray, hypodiaphanous image was found in the left apex for which an HR CT scan of the chest was performed which a lesion in the left apical lung area with spiculated margins of a heteroplastic nature, associated with multiple bilateral lesions suggestive of secondaryism. Therefore, the patient was taken over by the Oncology service. Conclusions Such case confirms the association between TTS and occult cancer. In the absence of obvious physical or emotional stress that may explain the onset of TTS, it is important to research for any silent neoplastic pathology. The literature shows that the prevalence of malignant diseases is high in patients with TTS. Recent studies have pinpointed the activation of the sympathetic nervous system promotes cardiac inflammation by upregulating ICAM–1 and the expression of p53. Furthermore, inflammation can lead to the activation of p38 MAP Kinase, thus contributing to myocardial stunning. The specific role of inflammation as a cofactor of adrenaline–induced stunning deserves further investigation in the specific context of malignant tumors, which are frequently associated with an enhanced inflammatory state.

The use of three-dimensional imaging for R0 resection of a left upper lobe adenocarcinoma after coronary artery bypass surgery.

The use of three-dimensional imaging for R0 resection of a left upper lobe adenocarcinoma after coronary artery bypass surgery.

Features of surgical treatment of the apical right lung cancer

The tumor of the upper sulcus of the lung is an atypical form of cancer, which is characterized by invasion into the aperture of the chest and mediastinum, which in turn determines the manifestation of the disease of neurological symptoms.Tactical approaches in the treatment of this disease are well known. To date, complex treatment is used, which includes neoadjuvant chemoradiotherapy followed by surgical treatment. This approach gives the best result in terms of prognosis and survival of patients.Considering the local invasion, planning the surgical stage in the treatment of this group of patients is a difficult task and requires a multidisciplinary approach to determine the optimal surgical tactics.This paper presents our own clinical observation of the successful surgical treatment of a 54‑year‑old patient with a tumor of the upper sulcus of the right lung. In order to adequately visualize the pathological process, safety and convenience of surgical intervention, Hemi‑Clamshell access was used, which combined the advantages of sternotomy and thoracotomy. Taking into account the topical location of the tumor, the greatest technical difficulties during the operation arose when performing mobilization of the upper lobe of the right lung, adequate lymph dissection near large arterial and venous vessels, removal of part of the chest wall of the pleural cavity dome.Also, one of the important issues when planning surgical treatment of this group of patients is to determine the indications for restoring the skeletal function of the chest after rib resection. In our case, despite the resection of the posterior segments of the I–III ribs, all the muscles of the anterior chest wall were preserved, which took over part of the skeletal function of the chest. There was no development of paradoxical breathing in the postoperative period.Surgical interventions of this amount should be performed in specialized thoracic oncology clinics and multidisciplinary medical institutions. At the same time, a multidisciplinary approach of doctors of various specialties, the experience of the operating team in performing such operations and the appropriate anesthesiological and resuscitation service is needed.

Architecture of the bronchial tree in Cuvier's dwarf caiman (Paleosuchus palpebrosus).

We imaged the lungs of five Cuvier's dwarf caiman (Paleosuchus palpebrosus) via computed tomography (CT) and micro-computed tomography (μCT) and compared these data to the lungs of the American alligator (Alligator mississippiensis). These data demonstrate anatomical commonalities between the lungs of P. palpebrosus and A. mississippiensis, and a few notable differences. The structural similarities are (a) a proximally narrow, distally widened, hook-shaped primary bronchus; (b) a cervical ventral bronchus that branches of the primary bronchus and immediately makes a hairpin turn toward the apex of the lung; (c) a sequential series of dorsobronchi arising from the primary bronchus caudal to the cervical ventral bronchus; (d) intraspecifically highly variable medial sequence of secondary airways; (e) sac-like laterobronchi; and (f) grossly dead-ended caudal group bronchi in the caudal and ventral aspects of the lung. The primary differences between the two taxa are in the overall number of large bronchi (fewer in P. palpebrosus), and the number of branches that contribute to the cardiac regions. Imaging data of both a live and deceased specimen under varying states (postprandial, fasting, total lung capacity, open to atmosphere) indicate that the caudal margin and position of the lungs shift craniocaudally relative to the vertebral column. These imaging data suggest that the smooth thoracic ceiling may be correlated to visceral movement during ventilation, but this hypothesis warrants validation. These results provide the scaffolding for future comparisons between crocodilians, for generating preliminary reconstructions of the ancestral crocodilian bronchial tree, and establishing new hypotheses of bronchial homology across Archosauria.

Pancoast tumor presenting with multiple joint pains: a case report

BackgroundPancoast tumors represent a unique subset of lung cancers wherein a primary neoplasm arises in the lung’s apex and invades the surrounding soft tissues. One of the main challenges in the diagnosis and treatment of these apical lung cancers is that they are usually not visualized on initial chest x-ray and, by the time the patient presents with symptoms, the tumor has almost always invaded nearby structures.Case presentationHerein we report a case of a 58-year-old nonsmoking African American male who presented to the neurology clinic with a history of multiple chronic joint pains. The patient complained of shoulder pain that traveled into his right arm and right finger and had worsened over the past 9 months. The patient also reported decreased right proximal strength and swelling of his right hand. Magnetic resonance imaging of the shoulder and cervical region showed mild cervical spondylosis and a questionable right apical mass. A subsequent high-resolution computed tomography scan of the chest revealed a large right apical lung mass, with chest wall invasion and erosion of the adjacent ribs. Biopsy of the mass confirmed poorly differentiated non-small cell lung cancer. Radiation therapy was initiated, and the patient’s pain improved significantly. Given the size of the tumor, chemotherapy was recommended by the oncology team. The patient decided against chemotherapy.ConclusionThis case highlights the importance of early diagnosis by expanding the differential diagnosis in patients presenting with weakness, sensory loss, and shoulder pain beyond radiculopathy or joint-related diseases. A comprehensive history and careful examination may lead to an earlier diagnosis, more appropriate treatment, and better outcome in cases of Pancoast tumor presenting with neuropathic or musculoskeletal pain.

Variations in Pulmonary Fissure: A Source of Collateral Ventilation and Its Clinical Significance.

Introduction: Oblique and horizontal fissures divide the lungs into lobes. Assessing the incompleteness or absence of fissures is important when planning any surgical procedure in this region. This study aimed to investigate the incidence of variations in the fissures and their implication in clinical practice.Methods: The sample consists of 70 formalin-fixed lungs (32 right and 38 left lungs). These lungs were assessed for complete, incomplete, and absent fissures and any variations in the fissures on the sternocostal and mediastinal surfaces.Results: Oblique fissure was incomplete on the sternocostal surface in 18.75% and 21% and on the mediastinal surface in 25% and 21% on the right and left lungs, respectively. Additionally, it was absent in 10.5% of the left lung samples. The horizontal fissure was incomplete in 12.5% on both surfaces and was absent in 25% on the right lung samples, of which 50% had no oblique fissure. No accessory fissure was seen in any of the lungs.Conclusion: Incomplete and absent fissures can be observed in the right as well as the left lung, suggesting the source of collateral ventilation. This study imparts important information to pulmonologists doing bronchoscopic lung volume reduction therapy or bronchopulmonary segment resection and also to radiologists and anatomists.

Platythorax progresses with lung involvement in pleuroparenchymal fibroelastosis.

Patients diagnosed with pleuroparenchymal fibroelastosis (PPFE) exhibit unique clinical features, including upper lobe-dominant lung involvement and platythorax (or flattened thoracic cage). Although platythorax have been shown to be a sign of disease progression, the temporal relationship between the progression of platythorax and the extent of lung involvement has not been closely investigated. We retrospectively investigated patients diagnosed with PPFE, who did not exhibit fibrotic lesions other than PPFE in the lower lobes. We estimated the fibrosis score, which is a visual score indicating the percentage of lung parenchyma occupied by the disease on computed tomography images selected every 2cm from the lung apex to the lung base, and the flat chest index (the ratio of the anteroposterior diameter of the thoracic cage to the transverse diameter of the thoracic cage). Additionally, we investigated serial changes in the flat chest index and fibrosis score. A total of 29 patients were included in this study. The fibrosis score was found to be weakly and inversely correlated with forced vital capacity %predicted at the diagnosis (r=-0.40, p=0.038). Furthermore, the annual changes in the flat chest index and fibrosis score was found to be moderately and inversely correlated (r=-0.663, p=0.0037). These results indicate that there is a causal relationship between the progression of fibroelastosis and that of platythorax in patients with PPFE.

Prognostic value of computed tomographic findings in acute respiratory distress syndrome and the response to prone positioning

BackgroundProne positioning enables the redistribution of lung weight, leading to the improvement of gas exchange and respiratory mechanics. We aimed to evaluate whether the initial findings of acute respiratory distress syndrome (ARDS) on computed tomography (CT) are associated with the subsequent response to prone positioning in terms of oxygenation and 60-day mortality.MethodsWe retrospectively included patients who underwent prone positioning for moderate to severe ARDS from October 2014 to November 2020 at a medical center in Taiwan. A semiquantitative CT rating scale was used to quantify the extent of consolidation and ground-glass opacification (GGO) in the sternal, central and vertebral regions at three levels (apex, hilum and base) of the lungs. A prone responder was identified by a 20% increase in the ratio of arterial oxygen pressure (PaO2) to the fraction of oxygen (FiO2) or a 20 mmHg increase in PaO2.ResultsNinety-six patients were included, of whom 68 (70.8%) were responders. Compared with nonresponders, responders had a significantly greater median dorsal–ventral difference in CT-consolidation scores (10 vs. 7, p = 0.046) but not in CT-GGO scores (− 1 vs. − 1, p = 0.974). Although dorsal–ventral differences in neither CT-consolidation scores nor CT-GGO scores were associated with 60-day mortality, high total CT-GGO scores (≥ 15) were an independent factor associated with 60-day mortality (odds ratio = 4.07, 95% confidence interval, 1.39–11.89, p = 0.010).ConclusionsIn patients with moderate to severe ARDS, a greater difference in the extent of consolidation along the dependent-independent axis on CT scan is associated with subsequent prone positioning oxygenation response, but not clinical outcome regarding survival. High total CT-GGO scores were independently associated with 60-day mortality.

Another rare facet of the ubiquitous mould

Pancoast syndrome is a commonly seen manifestation of lung malignancies, and benign causes are uncommon. We report a case of a patient without any known cause of immunosuppression who presented with Pancoast syndrome and a radiological mass like lesion in the lung apex, that was revealed be due to aspergillosis.

Another rare facet of the ubiquitous mould

Pancoast syndrome is a commonly seen manifestation of lung malignancies, and benign causes are uncommon. We report a case of a patient without any known cause of immunosuppression who presented with Pancoast syndrome and a radiological mass like lesion in the lung apex, that was revealed be due to aspergillosis.