Bilateral Lung Lesions Research Articles

Chronic COVID 19 Related Disease Requiring Lung Transplantation with Calcified Cavitary Lesions in Explanted Lungs

IntroductionBilateral cavitary lung lesions with calcification in a patient with chronic COVID requiring transplantation are described.Case Report46-year-old woman presented for lung transplant with respiratory failure due to COVID-19 pneumonia following remdesivir, decadron, tocilizumab and baricitinib therapy. Cavitary upper lobe lung lesions were noted on imaging with negative cultures. She was started on VV ECMO as a bridge to bilateral lung transplant. Explanted lungs were consolidated and fibrotic with bilateral upper lobe calcification surrounding cavitary lesions. Varied microscopic pathology included NSIP pattern of inflammation, and foci of airway centered inflammation with giant cells suggesting chronic hypersensitivity reaction. The calcification was reminiscent of dendriform/metastatic calcification, and involved areas of necrotic/mummified parenchyma.SummaryCavitation as a late stage complication of COVID19 has been described in rare cases and is considered atypical. The constellation of findings in our case, including cavitary lesions with associated dendriform like calcifications are unique and maybe attributable to COVID19 itself +/- exacerbation of underlying chronic lung disease +/- intercurrent infection, or COVID19 related cavitation with superimposed secondary changes due to ECMO treatment. Bilateral lung transplantation has a reasonable short-term prognosis for patients with end stage respiratory failure secondary to COVID19; examination of these native lungs may expand our concept of COVID19 related chronic lung injury patterns.

Computed tomography features of COVID-19 in children: A systematic review and meta-analysis.

Background:There are few reports on the chest computed tomography (CT) imaging features of children with coronavirus disease 2019 (COVID-19), and most reports involve small sample sizes.Objectives:To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice.Data sources:We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu.Methods:Reports on chest CT imaging features of children with COVID-19 from January 1, 2020 to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software.Results:Thirty-seven articles (1747 children) were included in this study. The heterogeneity of meta-analysis results ranged from 0% to 90.5%. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8%–70.6%), with a rate of 61.0% (95% CI: 50.8%–71.2%) in China and 67.8% (95% CI: 57.1%–78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7%–48.3%), multiple lung lobe lesions was 65.1% (95% CI: 55.1%–67.9%), and bilateral lung lesions was 61.5% (95% CI: 58.8%–72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported 3 cases of white lung, another reported 2 cases of pneumothorax, and another 1 case of bullae.Conclusions:The lung CT results of children with COVID-19 are usually normal or slightly atypical. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool.

Disorder of Iron Metabolism as a Universal Pathogenetic Factor in Damage to Organs and Systems in Covid-19

Relevance. The pathogenesis of COVID-19 remains one of the most pressing. The literature discusses the role of iron as a factor supporting inflammatory processes, hypercoagulability and microcirculation crisis in severe COVID-19.The aim of study. was to identify changes in iron metabolism in patients with severe COVID-19 and hyperferritinemia.Material and methods. In this study, we used a content analysis of available scientific publications and our own observations of the peculiarities of the clinical picture and laboratory parameters in patients with a severe course of COVID-19 who had hyperferretinemia at the height of the disease. The main group consisted of 30 patients hospitalized in the Department of Anesthesiology, Resuscitation and Intensive Care of N.A. Semashko City clinical Hospital No. 38 with the diagnosis COVID-19, bilateral polysegmental pneumonia, severe course and hyperferritinemia. The diagnosis of a new coronavirus infection was confirmed by visualization of bilateral viral lung lesions with chest CT-scan, positive PCR test for SARS-CoV-2 and the presence of immunoglobulins to SARS-CoV-2. The control group consisted of 20 healthy volunteers. The study evaluated the biochemical parameters of iron metabolism, fibrinolysis and markers of inflammation. Changes associated with impaired iron metabolism were assessed by the level of serum iron, transferrin, daily and induced iron excretion in the urine. Statistical processing was carried out using nonparametric methods.Results. All patients with severe COVID-19 and hyperferritinemia showed signs of impaired iron metabolism, inflammation and fibrinolysis — a decrease in the level of transferrin (p<0.001), serum iron (p><0.005), albumin (p><0.001), lymphocytes (p><0.001) and an increase in leukocytes (p><0.001), neutrophils (p><0.001), CRP (p><0.005), IL-6 (p><0.001), D-dimer (p><0.005), daily urinary iron excretion (p><0.005) and induced urinary iron excretion (p><0.001). Conclusions The study showed that in the pathogenesis of the severe course of COVID-19, there is a violation of iron metabolism and the presence of a free iron fraction. The appearance of free iron can be caused by damage to cells with the “release” of iron from cytochromes, myoglobin, hemoglobin, or violation of the binding of iron to transferrin, which may be the result of a change in the protein structure or violation of the oxidation of iron to the trivalent state. When assessing the degree of viral effect on the body, one should take into account the effect of various regulators of iron metabolism, as well as an assessment of the level of free iron not associated with transferrin. Keywords: new coronavirus infection, COVID-19, SARS-CoV-2, iron metabolism, free iron, ferritin, transferrin, NTBI, nontransferrin bound iron>˂0.001), serum iron (p˂0.005), albumin (p˂0.001), lymphocytes (p˂0.001) and an increase in leukocytes (p˂0.001), neutrophils (p˂0.001), CRP (p˂0.005), IL-6 (p˂0.001), D-dimer (p˂0.005), daily urinary iron excretion (p˂0.005) and induced urinary iron excretion (p˂0.001).Conclusions. The study showed that in the pathogenesis of the severe course of COVID-19, there is a violation of iron metabolism and the presence of a free iron fraction. The appearance of free iron can be caused by damage to cells with the “release” of iron from cytochromes, myoglobin, hemoglobin, or violation of the binding of iron to transferrin, which may be the result of a change in the protein structure or violation of the oxidation of iron to the trivalent state. When assessing the degree of viral effect on the body, one should take into account the effect of various regulators of iron metabolism, as well as an assessment of the level of free iron not associated with transferrin.

Utility of Computed Tomography for the Diagnosis of Invasive Aspergillosis in Hematological Malignancy

Background: Pulmonary computed tomography (CT) scans are commonly used as part of the clinical criteria in diagnostic workup of invasive aspergillosis (IA). Other criteria for diagnosing IA include a combination of host, clinical and mycological factors, such as those recommended in the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. Chest CT criteria include dense, well-circumscribed lesions(s) with or without a halo sign, air-crescent sign, or cavity. We assessed the diagnostic utility of these findings at baseline in a cohort of patients with hematological malignancy and suspected IA who received antifungal treatment.Material/methods: This post hoc analysis assessed data from a prospective, multicenter international trial of voriconazole (with and without anidulafungin) in patients with suspected (possible, probable, or proven using 2008 EORTC/MSG criteria) IA (NCT00531479). Patients who had received at least one dose of study drug and who had at least one CT scan with a description of ‘lung’ at baseline were included in this analysis. Patient records as provided by the investigators were retrospectively reviewed in a blinded manner to identify physician notes describing the presence of observable lesions or abnormalities on CT scan at baseline. The presence of IA was subsequently evaluated to confirm the infection. Patients with proven or probable IA were termed ‘confirmed’ (cIA) and all others as ‘non-confirmed’ (nIA). This assessment was in accordance with 2008 EORTC/MSG criteria, and conducted by an independent review committee.Results: Of 395 patients included, 240 patients (60.8%) were classified as cIA and 155 patients (39.2%) as nIA. Baseline characteristics were comparable between cIA and nIA groups: the mean age was 52.3 years vs 50.5 years, 56.3% vs 60.0% were male, and 71.7% vs 71.0% were white, respectively. The most commonly reported CT scan abnormalities at baseline were pulmonary nodules (46.8% of all patients; Table 1), bilateral lung lesions (37.5%), unilateral lung lesions (28.4%), and consolidation (24.8%). Abnormalities associated with subsequent confirmation of IA were ground-glass attenuation (cIA: 24.2%; nIA: 11.6%; p <0.05) and pulmonary nodules (cIA: 52.5%; nIA: 38.1%; p <0.05). Bilateral lung lesions were more common in cIA (41.3%) than in nIA (31.6%) patients, but this did not reach statistical significance (p=0.0561). No other CT scan abnormality appeared to be associated with confirmation of IA.Conclusions: Generally, chest CT scan abnormalities (including halo signs and air crescent signs) at baseline in patients with hematological malignancy and suspected IA based on the EORTC/MSG criteria were not associated with subsequent confirmation of IA. However, ground-glass attenuation, nodules and, to a lesser degree, bilateral lung lesions were associated with subsequent confirmation of IA. It should be considered that patients with possible IA and abnormal chest CT findings may have had the infection, even if further investigation failed to upgrade the diagnosis to proven/probable; this could result in an underestimation of the discriminative value of chest CT. These findings suggest that chest CT should be interpreted in conjunction with other available clinical data to guide management decisions on individual patients, including whether treatment is reasonable, pending full evaluation. Caution must be taken given this is a post-hoc analysis of a randomized, controlled, prospective trial; further confirmative studies are warranted. [Display omitted] DisclosuresLiu:Pfizer Inc, Beijing: Employment. Pan:Pfizer Inc, Beijing: Employment. Yan:Pfizer Inc, New York: Employment. Aram:Pfizer Inc, New York: Employment. Zhang:Pfizer Inc, Beijing: Employment.

Clinical features and prognostic factors of patients with COVID-19 in Henan Province, China.

Since December 2019, the novel coronavirus SARS-CoV-2 pandemic (COVID-19) outbroke in Wuhan and spread in China. Here we aimed to investigate the clinical and radiological characteristics of COVID-19 cases. We collected and analyzed the clinical data of 172 hospitalized cases of COVID-19 who were diagnosed via qRT-PCR of nasopharyngeal swabs during January 2020 and February 2020. The chest images were reviewed by radiologists and respirologists. The older patients with COVID-19 in Henan Province had more severe disease and worse prognosis. The male sex, smoking history and Wuhan exposure of patients are not related to the severity or prognosis of COVID-19. Family gatherings were showed among 26.7% of patients. A greater proportion of patients in the severe group suffer from combined chronic diseases. CT results showed that most patients had bilateral lung lesions and multiple lung lobes. The lungs of severe patients are more damaged. Both the infection range and inflammatory factor levels are related to the poor prognosis. Antiviral drugs, immunoglobulin and traditional Chinese medicine are mainly used for the treatment of COVID-19 patients. The discharge rate of COVID-19 patients was 93.0%, and the mortality rate was 2.3%. Case type, lymphocyte ratio grade, and respiratory failure at admission are risk factors for poor prognosis, except for the number of infiltrating lung lobes. The results showed that severe disease process, lymphopenia and respiratory failure are risk factors for the COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13577-021-00499-y.

Prostate Cancer Detected by Choroidal Tumor and Complete Response to Hormonal Therapy: Case Report and Literature Review of 24 Patients With Choroidal Metastasis From Prostate Cancer

Metastatic choroidal tumors derived from prostate cancer are rare. In this study, we report a patient who manifested a choroidal tumor as the initial presenting sign of prostate cancer and review 23 patients with choroidal metastasis of prostate cancer in the literature to answer a clinical question how the choroidal metastases would respond to hormonal therapy. A 73-year-old man presented with a choroidal tumor in the right eye. He was in good health and had no previous history except for current hemodialysis in 3 years due to chronic renal failure as a sequel to glomerulonephritis. With the diagnosis of a probable metastatic tumor, positron emission tomography was performed to disclose high-uptake sites in multiple bones, lymph nodes, and the prostate, together with multiple nodular lesions in bilateral lungs on computed tomography (CT) scan. Serum prostate-specific antigen (PSA) was elevated to 541 ng/mL, which supported prostate cancer as the primary site. He had degarelix injection, and the choroidal tumor resolved rapidly and became flat degeneration in a month. Prostate biopsy showed poorly differentiated adenocarcinoma, and he underwent surgical castration. He had no medication until 3 years later when he showed gradual increase of serum PSA up to 6.05 ng/mL and multiple bony metastases on CT scan. Bicalutamide, switched to enzalutamide and then to abiraterone, led to the undetectable level of serum PSA until the last visit with no relapse of the choroidal metastasis, 6.8 years after the initial visit. In the literature review of 24 patients with choroidal metastasis of prostate cancer, including this patient, 8 patients presented a choroidal tumor as the initial sign and the choroidal lesions mostly showed complete response to hormonal therapy. Among 13 patients who were frequently in the course of hormonal therapy, choroidal metastases showed complete or partial response to external beam radiation to the eye in 11 patients and episcleral plaque radiotherapy in 2 patients. In conclusion, metastatic choroidal tumors of prostate cancer would show good response to hormonal therapy when the therapy has not been initiated. Hormone-resistant choroidal metastases in the therapeutic course of prostate cancer could be managed successfully by external beam radiation to the eye.

ФАКТОРЫ РИСКА РАЗВИТИЯ КРИТИЧЕСКИХ СОСТОЯНИЙ, ТРЕБУЮЩИХ ГОСПИТАЛИЗАЦИИ В ОТДЕЛЕНИЕ ИНТЕНСИВНОЙ ТЕРАПИИ И РЕАНИМАЦИИ, У ПАЦИЕНТОВ С ТУБЕРКУЛЕЗОМ

The mortality rate among tuberculosis patients requiring intensive care is high. The development of severe conditions in patients with tuberculosis may be associated with the course of the underlying disease and with concomitant pathology. The aim of this work was to study the risk factors for the development of severe conditions in patients with tuberculosis to prevent death. A retrospective study of risk factors for the development of critical conditions, depending on the nature of the tuberculosis process, co-infection, concomitant diseases and bad habits, was carried out in 154 patients with pulmonary tuberculosis and extrapulmonary tuberculosis hospitalized in the intensive care unit. In a cohort of patients admitted to the intensive care unit and intensive care unit, statistically significant factors influencing the development of critical conditions were: the presence of extrapulmonary localization of the tuberculous process; the presence of bilateral tuberculous lung lesions; the presence of destructive forms of tuberculosis; the presence of tuberculous meningitis/encephalitis; the presence of multidrug-resistant and extensively drug-resistant tuberculosis; application of the traditional "old" treatment regimen; the presence of concomitant HIV infection with a CD4 cell count of less than 200/ul; the presence of concomitant diabetes.

Uniportal subxiphoid video assisted thoracoscopy surgery approach for bilateral lesions

Background: Minimal invasive surgery has become the standard of care for management of lung cancer. Increased use of high resolution CT scans and advent of screening programs has given rise to increased detection of incidental lesions. Conventional thoracoscopy does not provide for simultaneous, single approach surgery for bilateral lung lesions. Advent of subxiphoid technique helps in overcoming this problem. We describe our experience on uniportal subxiphoid thoracoscopy for bilateral lung lesions in a single stage surgery.

Uniportal subxiphoid video assisted thoracoscopy surgery approach for bilateral lesions

Background: Minimal invasive surgery has become the standard of care for management of lung cancer. Increased use of high resolution CT scans and advent of screening programs has given rise to increased detection of incidental lesions. Conventional thoracoscopy does not provide for simultaneous, single approach surgery for bilateral lung lesions. Advent of subxiphoid technique helps in overcoming this problem. We describe our experience on uniportal subxiphoid thoracoscopy for bilateral lung lesions in a single stage surgery.

Comparison of Clinical Characteristics of First and Second Generation Cases of COVID-19

Purpose — To explore the differences in clinical characteristics of the first and second generation cases of COVID-19. Methods — 63 patients with COVID-19 and asymptomatic infections admitted to the Third People's Hospital of Wuhu City and the Fourth People's Hospital of Ma'anshan City from January 24, 2020 to March 3, 2020 were selected as the research objects. The patients were divided into the first and second generation case groups according to the history of epidemiology, and the differences of clinical data between the two groups were compared. Results — There was no significant difference between the two groups of patients in gender, age, and number of smokers (P&gt;0.05). In the first generation group, the number of people with underlying diseases was lower than that in the second generation group (86.80%, 92.00%), and the number of patients of severe or critical type was higher than that in the second generation group (18.40%, 0.00%). The difference was statistically significant (P&lt;0.05). The symptoms of the two groups were compared: fever (84.20%, 64.00%), cough (78.9%, 40.00%), chest tightness (44.70%, 12.00%), nausea (2.60%, 36.00%). The difference was statistically significant (P&lt;0.05). The distribution of lesions in the two groups was compared: bilateral lung lesions (77.80%, 66.70%), unilateral lesions (17.80%, 5.50%), and no lesions (4.40%, 27.80%). The difference was statistically significant (P&lt;0.05). There was no statistically significant difference between the two groups in laboratory tests (P&gt;0.05). Conclusions — Compared with the first generation cases, the second generation cases have different degrees of relief in clinical classification, lower respiratory symptoms and the number of lung lesions; the differentiation of the transmission generation has a certain reference value for the evaluation of the disease condition.

SURGICAL ASPECTS OF DIAGNOSIS AND TREATMENT OF CHEST PATHOLOGY CAUSED BY CORONAVIRUS DISEASE COVID-19, ANALYSIS OF CLINICAL CASE

The COVID-19 pandemic has generated many challenges both for humanity in general, and for the systems of organizing medical care and many areas of specialized treatment, in particular surgical. The very dynamics of the pandemic, the lack of available specific treatment, various approaches to assessing statistical and clinical data in various countries today do not allow generally accepted conclusions to be drawn. Numerous publications on this topic, as a rule, contain information about personal experience of research, diagnosis, treatment and a review of the current literature. We analyzed 68 cases of chest diseases caused by COVID-19 in patients who received consultative, specialized surgical thoracic care in basic medical institutions of Chernivtsi region for the period January-September 2020. Bilateral lung lesions predominated – 70.6 % in older patients 42 years (66.2 %). Surgical interventions were performed in 65 (95.6 %) patients. The most common complication in the acute period was pneumothorax on the background of active viral pneumonia – 40 (58.8 %) patients, 6 (8.8 %) – patients with heart and pericardial lesions, 7 (10.3 %) – hemorrhagic, serous-fibrinous pleurisy. Based on own data in comparison with the histological and pathophysiological researches resulted in the available literature, surgical tactics, separate surgical receptions at patients with virus-induced complications, in particular: drainage of a pleural cavity, pericardium, videothoracoscopic techniques are proved. The algorithm of examinations and treatment tactics in the formation of intrapulmonary pseudocysts after coronavirus disease are presented. We analyzed 5 (7.4 %) cases in which there were complications of major diseases (cancer, nonspecific purulent-septic diseases) caused by COVID-19. Study of the effectiveness of the use of videothoracoscopic electric welding technologies in the destruction of the lung parenchyma caused by viral infections.

Factors significantly associated with COVID-19 severity in symptomatic patients: A retrospective single-center study

IntroductionThe severity of coronavirus disease (COVID-19) in Japanese patients is unreported. We retrospectively examined significant factors associated with disease severity in symptomatic COVID-19 patients (COVID-Pts) admitted to our institution between February 20 and April 30, 2020. MethodsAll patients were diagnosed based on the genetic detection of severe acute respiratory syndrome coronavirus 2. Information on the initial symptoms, laboratory data, and computed tomography (CT) images at hospitalization were collected from the patients’ records. COVID-Pts were categorized as those with critical or severe illness (Pts-CSI) or those with moderate or mild illness (Pt-MMI). All statistical analyses were performed using R software. ResultsData from 61 patients (16 Pt–CSI, 45 Pt-MMI), including 58 Japanese and three East Asians, were analyzed. Pt–CSI were significantly older and had hypertension or diabetes than Pt-MMI (P < 0.001, 0.014 and < 0.001, respectively). Serum albumin levels were significantly lower in Pt–CSI than in Pt-MMI (P < 0.001), whereas the neutrophil-to-lymphocyte ratio and C-reactive protein level were significantly higher in Pt–CSI than in Pt-MMI (P < 0.001 and P < 0.001, respectively). In the CT images of 60 patients, bilateral lung lesions were more frequently observed in Pt–CSI than in Pt-MMI (P = 0.013). Among the 16 Pt–CSI, 15 received antiviral therapy, 12 received tocilizumab, five underwent methylprednisolone treatment, six received mechanical ventilation, and one died. ConclusionsThe illness severity of Japanese COVID-Pts was associated with older age, hypertension and/or diabetes, low serum albumin, high neutrophil-to-lymphocyte ratio, and C-reactive protein.

AN UNUSUAL CASE OF PULMONARY CAVITARY LESIONS IN AN IMMUNOSUPPRESSED PATIENT

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The differential diagnosis of pulmonary cavitary lesions is broad. They can be categorized in to infectious and non-infectious diseases, including neoplasms. Among malignancies, squamous cell carcinoma is a common cause of lung cavitation (1). Herein, we report a rare case of primary pulmonary diffuse large B-cell lymphoma (DLBCL) in a patient with rheumatoid arthritis that presented with multiple cavitary lesions and hypercalcemia. CASE PRESENTATION: 83-year-old male presented with hemoptysis, dyspnea, confusion, and constipation for several weeks. His past medical history was significant for tobacco abuse and interstitial lung disease from rheumatoid arthritis (RA) treated with methotrexate. CT chest showed bilateral cavitary lung lesions, left-pneumothorax and pneumomediastinum, needing chest-tube placement. Pulmonary function test showed a mild restrictive defect with a severe reduction in diffusion capacity. Labs showed hypercalcemia of 13.7 mg/dl, suppressed parathyroid hormone (PTH), elevated PTH-related peptide (PTHrp), and 1-25(OH) 2 Vitamin-D level. Quantiferon gold, sputum acid-fast bacilli and cultures were negative. Blood cultures (1/4 bottles) grew Actinomyces viscosus that was treated with 6-weeks of piperacillin-tazobactam. Bronchoscopy with lavage was unrevealing; however, due to a suspicion for malignancy with elevated PTHrp level, a CT-guided biopsy of left lower lobe lung mass was performed that confirmed a diagnosis of DLBCL, non-germinal center B-cell type. DISCUSSION: Pulmonary lymphoma is very rare and presents with nonspecific pulmonary symptoms (2). The pathogenesis of primary pulmonary DLBCL remains elusive. Patients with autoimmune disorders and recurrent bacterial infections are at a higher risk for developing DLBCL. Chest imaging may show nodular lesions, consolidation or interstitial /mixed alveolar infiltrates (2). DLBCL presenting with multiple cavitary lesions, is rarely reported. In our patient hypercalcemia was mediated by elevation of both PTHrp and 1-25(OH)2 Vitamin-D, which is unusual. Most primary pulmonary lymphomas (PPL) are low-grade mucosa-associated lymphoid tissue (MALT)-type, compared to more aggressive pulmonary diffuse large B-cell lymphoma (DLBCL), which is very uncommon (3). Most likely, our patient's autoimmune disorder (RA) and chronic methotrexate use contributed in the development of his DLBCL. CONCLUSIONS: We report a rare case of primary pulmonary DLBCL that manifested with multiple cavitary lesions and hypercalcemia. DLBCL must be considered in the differential diagnosis of cavitary lung lesions particularly in immunosuppressed patients. Reference #1: Chaudhuri MR. Primary pulmonary cavitating carcinomas. Thorax. 1973;28:354-366 Reference #2: Fujita N, Ando M, Goto A, Sakata M, Ogata M, Usagawa Y, et al. Diffuse large B-Cell lymphoma arising from the lesion of chronic lobar atelectasis. Tohoku J Exp Med. 2020;250(2):129–35. Reference #3: Brown S, Horton J, Rosario D, Dorsey DA, Hetz S, King CS. High-grade primary pulmonary B cell lymphoma presenting as a Necrotic mass. Respir Care. 2011 Jun 1;56(6):871–3. DISCLOSURES: No relevant relationships by Haytham Adada, source=Web Response no disclosure on file for Mahmoud Amarna; No relevant relationships by Pavan Annamaraju, source=Web Response No relevant relationships by Camelia Chirculescu, source=Web Response No relevant relationships by Nino Nemsadze, source=Web Response No relevant relationships by Sana Yakoob, source=Web Response

EP28 A case of ANCA vasculitis presenting with Sjögren’s serology

EP28 A case of ANCA vasculitis presenting with Sjögren’s serology

YOUNG FEMALE WITH CYSTIC LUNG LESIONS: LAM OR CANNABIS-INDUCED?

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Lymphangioleiomyomatosis (LAM) is a rare condition of unknown etiology, which causes cystic lung lesions in young women and often presents with dyspnea and pneumothoraces (1). CASE PRESENTATION: A 39-year-old African American female with a past medical history of asthma, marijuana use, and tobacco use presented to the Emergency Room (ER) with non-specific abdominal pain. She underwent computed tomography (CT) of her chest, abdomen, and pelvis and was incidentally found to have bilateral cystic lung lesions. Her abdominal workup was negative and she was discharged with a referral to pulmonology due to concerns for LAM. On follow-up in pulmonology clinic, her history was significant for dyspnea on exertion for several years, as well as worsening dyspnea during a recent pregnancy. A few months later, the patient presented to the ER with chest pain and was found to have a primary spontaneous pneumothorax (PSP) and a chest tube was placed and removed prior to discharge. A few weeks later the patient developed worsening chest pain and dyspnea and was found to have a recurrent pneumothorax. She underwent repeat chest tube placement and her VEGF-D was negative at that time. She underwent pleurodesis with lobectomy of her lingula, and pathology showed smoking-related mild emphysematous changes, subpleural blebs, reactive mesothelium, and no evidence of LAM. Her cystic lesions, dyspnea, and recurrent pneumothoraces were attributed to her heavy cannabis use. DISCUSSION: Our patient had characteristic findings of LAM including dyspnea, recurrent pneumothoraces, and cystic lung disease. However, her VEGF-D was negative and her lingula biopsy results revealed no evidence of LAM; therefore, she was diagnosed with cannabis cystic lung disease. Young females with cystic lung disease are frequently suspected of having LAM, which is rare. When evaluating females with cystic lung disease, common etiologies such as emphysema and cannabis cystic lung disease should be ruled out. Many case reports have documented the appearance of PSP, dyspnea, and upper to middle lobe bullous emphysema in patients who use cannabis (1,2). These findings are heightened in patients who are users of both cannabis and tobacco, such as our patient (1). The mechanism of bullae formation in cannabis users is unknown, but has been attributed to prolonged breath holding during marijuana smoking, which leads to extended exposure to inhaled toxins and subsequent loss of elastic recoil in lung tissue. The mechanism of pneumothoraces has been attributed to repeated Muller’s and Valsalva maneuvers, in addition to high inspiratory pressures causing barotrauma (3). CONCLUSIONS: Common etiologies such as emphysema and cannabis cystic lung disease should be ruled out when evaluating young females with cystic lung lesions. Reference #1: Martinasek MP, McGrogan JB, Maysonet A. A Systematic Review of the Respiratory Effects of Inhalational Marijuana. Respir Care. 2016 Nov;61(11):1543-1551. Reference #2: Underner M, Urban T, Perriot J, Peiffer G, Harika-Germaneau G, Jaafari N. Spontaneous pneumothorax and lung emphysema in cannabis users. Rev Pneumol Clin. 2018 Dec;74(6):400-415 Reference #3: Mishra R, Patel R, Khaja M. Cannabis-induced bullous lung disease leading to pneumothorax. Medicine (Baltimore). 2017 May; 96(19): e6917. DISCLOSURES: No relevant relationships by Nelly Bellamy, source=Web Response Speaker/Speaker's Bureau relationship with Theravance Please note: $1001 - $5000 Added 06/12/2020 by Edward Charbek, source=Web Response, value=Honoraria No relevant relationships by Joseph Cumming, source=Admin input no disclosure on file for Elizabeth Davaro

Radiographic characteristics and early clinical manifestations of family clustered coronavirus disease 2019 (COVID-19)

ObjectTo study chest computed tomography (CT) findings in family clusters of coronavirus disease 2019 (COVID-19).MethodsTwenty-one patients with confirmed COVID-19 were enrolled at the West District Qingdao Municipal Hospital, the Fifth People's Hospital of Qinghai Province and Jiaozhou Central Hospital. Eleven were family clustered cases and 10 were sporadic cases not associated with family gatherings.ResultsTen patients were male and 11 were female. The time elapsed onset of fever and cough to diagnosis was 3 to 7 days. The body temperatures of patients fluctuated between 36.7 and 38.9°C. One elderly female patient had no fever. On chest CT, 14 patients with family clustered COVID-19 had bilateral lung lesions. By contrast, 7 patients with no history of familial gatherings showed single lung exudative lesions or consolidation. Seven patients with family clustered COVID-19 had bilateral multiple exudative lesions. Four patients with no history of familial gathering had unilateral lesions.ConclusionNot all patients with COVID-19 have direct epidemiological links to an infected case. They may become infected because of poor protection. In patients with family clustered COVID-19, chest CT often showed multiple exudative lesions in both lungs. In some patients, symptoms may be complicated by influenza virus infection.

Bilateral lung nodules resection by image-guided video-assisted thoracoscopic surgery: a case series

BackgroundWe demonstrated the safety and feasibility of image-guided video-assisted thoracoscopic surgery (iVATS) of bilateral lung lesions in a hybrid operating room.MethodsThis study was a retrospective analysis of a case series. A total of 7 patients with 15 small lung nodules underwent bilateral iVATS between July 2018 and May 2019. All procedures were completed within a single anesthesia procedure and performed in a hybrid operating room that had a cone-beam computed tomography (CT) apparatus equipped with a laser navigation system. The lesion characteristics, operation methods, and peri-operative clinical outcomes were summarized.ResultsA total of 7 patients with 15 resected lung nodules were analyzed. The most common pathological result of our bilateral iVATS was metastasis. The median length of hospital stay was 5 days (range from 3 to 10 days). The median right chest tube duration was 2 days (range from 1 to 8 days), and the median left chest tube duration was 3 days (range from 2 to 5 days). Only one patient had a complication during his hospitalization period. There was no surgery-related mortality observed.ConclusionsFor bilateral pulmonary nodules, the iVATS procedure seems to be a feasible and cost-effective approach.

Feasibility of a 5G-Based Robot-Assisted Remote Ultrasound System for Cardiopulmonary Assessment of Patients With Coronavirus Disease 2019

BackgroundTraditional methods for cardiopulmonary assessment of patients with coronavirus disease 2019 (COVID-19) pose risks to both patients and examiners. This necessitates a remote examination of such patients without sacrificing information quality.Research QuestionThe goal of this study was to assess the feasibility of a 5G-based robot-assisted remote ultrasound system in examining patients with COVID-19 and to establish an examination protocol for telerobotic ultrasound scanning.Study Design and MethodsTwenty-three patients with COVID-19 were included and divided into two groups. Twelve were nonsevere cases, and 11 were severe cases. All patients underwent a 5G-based robot-assisted remote ultrasound system examination of the lungs and heart following an established protocol. Distribution characteristics and morphology of the lung and surrounding tissue lesions, left ventricular ejection fraction, ventricular area ratio, pericardial effusion, and examination-related complications were recorded. Bilateral lung lesions were evaluated by using a lung ultrasound score.ResultsThe remote ultrasound system successfully and safely performed cardiopulmonary examinations of all patients. Peripheral lung lesions were clearly evaluated. Severe cases of COVID-19 had significantly more diseased regions (median [interquartile range], 6.0 [2.0-11.0] vs 1.0 [0.0-2.8]) and higher lung ultrasound scores (12.0 [4.0-24.0] vs 2.0 [0.0-4.0]) than nonsevere cases of COVID-19 (both, P < .05). One nonsevere case (8.3%; 95% CI, 1.5-35.4) and three severe cases (27.3%; 95% CI, 9.7-56.6) were complicated by pleural effusions. Four severe cases (36.4%; 95% CI, 15.2-64.6) were complicated by pericardial effusions (vs 0% of nonsevere cases, P < .05). No patients had significant examination-related complications.InterpretationUse of the 5G-based robot-assisted remote ultrasound system is feasible and effectively obtains ultrasound characteristics for cardiopulmonary assessment of patients with COVID-19. By following established protocols and considering medical history, clinical manifestations, and laboratory markers, this system might help to evaluate the severity of COVID-19 remotely.

Plasma therapy cured a COVID-19 patient with long duration of viral shedding for 49 days: The clinical features, laboratory tests, plasma therapy, and implications for public health management.

Plasma therapy cured a COVID-19 patient with long duration of viral shedding for 49 days: The clinical features, laboratory tests, plasma therapy, and implications for public health management.

Preliminary CT findings of coronavirus disease 2019 (COVID-19)

ObjectivesCoronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This paper aims to examine the CT imaging characteristics of COVID-19. MethodsWe evaluated CT images obtained between 10 January 2019 and 16 February 2020 at Taihe Hospital. Scans were conducted 2–6 times per patient and the re-testing interval was 2–7 days. Ninety-five patients with positive SARS-CoV-2 nucleic acid test results were included in this study and we retrospectively analysed their CT imaging characteristics. ResultsNinety-five patients underwent 2–3 SARS-CoV-2 nucleic acid tests and received a definitive diagnosis of COVID-19. Fifty-three were male and 42 were female, and their mean age was 42 ± 12 years (range: 10 months to 81 years). Sixty-nine patients (72.6%) experienced fever, fatigue, and dry cough, while 15 (15.8%) had poor appetite and fatigue, and 11 (11.6%) had a dry cough and no fever. On CT imaging, early stage patients (n = 53, 55.8%) showed peripheral subpleural ground-glass opacities; these were mainly local patches (22/53, 41.5%), while some lesions were accompanied by interlobular septal thickening. Thirty-four (35.8%) patients were classified in the ‘progression stage’ based on CT imaging; these patients typically showed lesions in multiple lung segments and lobes (21/34，61.8%), and an uneven increase in ground-glass opacity density accompanied by consolidation and grid-like or cord-like shadows(30.5%). Two patients (2.1%) showed a severe presentation on CT. These showed diffuse bilateral lung lesions, mixed ground-glass opacities and consolidation with cord-like interstitial thickening and air bronchograms, entire lung involvement with a “white lung” presentation, and mild pleural effusion. Six patients in remission (6.3%), visible lesion absorption, fibrotic lesions. Based on clinical signs, 71 (74.7%), 22 (23.2%), and 2 (2.1%) patients had mild or moderate, severe, and critical disease, respectively. Within the follow-up period, 93 patients recovered and were discharged, including the 53 early stage patients and 34 progression stage patients. The length of hospitalisation was 7–28 days (mean: 10 ± 3.5 days). On discharge, lesions were significantly reduced in area and had in many cases completely disappeared, while slight pulmonary fibrosis was present in some patients. One severe stage patient was still hospitalised at the end of the follow-up period and the other severe stage patient died. The overall mortality rate was 1.05%. ConclusionsUnderstanding the CT imaging characteristics of COVID-19 is important for early lesion detection, determining the nature of lesions, and assessing disease severity.