Changes In Lung Parenchyma Research Articles

Nitrofurantoin Induced Lung Disease

Nitrofurantoin is a synthetic nitrofuran antimicrobial commonly used for the treatment and prevention of recurrent urinary tract infections (UTIs). Although rare nitrofurantoin can cause acute and chronic lung diseases. We report the case of an 81-year-old woman diagnosed with interstitial lung disease (ILD) due to long-term use of Nitrofurantoin for UTI prophylaxis. Despite widespread lung parenchymal changes in the form of fibrosis and ground glass opacities, she responded very well to corticosteroids. This case report highlights the importance of early recognition and favorable response to corticosteroids in nitrofurantoin-induced ILD. Keywords: Nitrofurantoin, Lung Diseases, Interstitial Fibrosis, Corticosteroid.

Correlation between CT-based phenotypes and serum biomarker in interstitial lung diseases

BackgroundThe quantitative analysis of computed tomography (CT) and Krebs von den Lungen-6 (KL-6) serum level has gained importance in the diagnosis, monitoring, and prognostication of interstitial lung disease (ILD). However, the associations between quantitative analysis of CT and serum KL-6 level remain poorly understood.MethodsIn this retrospective observational study conducted at tertiary hospital between June 2020 and March 2022, quantitative analysis of CT was performed using the deep learning-based method including reticulation, ground glass opacity (GGO), honeycombing, and consolidation. We investigated the associations between CT-based phenotypes and serum KL-6 measured within three months of the CT scan. Furthermore, we evaluated the performance of the combined CT-based phenotypes and KL-6 levels in predicting hospitalizations due to respiratory reasons of ILD patients.ResultsA total of 131 ILD patients (104 males) with a median age of 67 years were included in this study. Reticulation, GGO, honeycombing, and consolidation extents showed a positive correlation with KL-6 levels. [Reticulation, correlation coefficient (r) = 0.567, p < 0.001; GGO, r = 0.355, p < 0.001; honeycombing, r = 0.174, p = 0.046; and consolidation, r = 0.446, p < 0.001]. Additionally, the area under the ROC of the combined reticulation and KL-6 for hospitalizations due to respiratory reasons was 0.810 (p < 0.001).ConclusionsQuantitative analysis of CT features and serum KL-6 levels ascertained a positive correlation between the two. In addition, the combination of reticulation and KL-6 shows potential for predicting hospitalizations of ILD patients due to respiratory causes. The combination of reticulation, focusing on phenotypic change in lung parenchyma, and KL-6, as an indicator of lung injury extent, could be helpful for monitoring and predicting the prognosis of various types of ILD.

Unilateral pulmonary vein atresia: Difficulties of radiological diagnosis

Pulmonary vein atresia is a rare congenital abnormality that could manifest in isolation or in association with other congenital abnormalities in the cardiovascular system such as pulmonary vein hypoplasia. Pulmonary vein atresia leads to changes in cardiovascular functioning. This abnormality is often diagnosed in children with recurrent pneumonia and hemoptysis. In adulthood, pulmonary vein atresia is much less common, with clinical symptoms such as dyspnea during physical exercises and hemoptysis. However, some patients are asymptomatic. Owing to the nonspecific imaging findings, lung parenchymal changes are often misdiagnosed as another lung disease, including inflammatory genesis disease. In this article, a case of a young man with asymptomatic unilateral pulmonary vein atresia combined with pulmonary artery hypoplasia and interstitial lung changes in a lung with hypoplasia was presented. These pathologies were first identified in a 21-year-old patient by contrast-enhanced computed tomography.

Artificial intelligence-based quantification of pulmonary HRCT (AIqpHRCT) for the evaluation of interstitial lung disease in patients with inflammatory rheumatic diseases

High-resolution computed tomography (HRCT) is important for diagnosing interstitial lung disease (ILD) in inflammatory rheumatic disease (IRD) patients. However, visual ILD assessment via HRCT often has high inter-reader variability. Artificial intelligence (AI)-based techniques for quantitative image analysis promise more accurate diagnostic and prognostic information. This study evaluated the reliability of artificial intelligence-based quantification of pulmonary HRCT (AIqpHRCT) in IRD-ILD patients and verified IRD-ILD quantification using AIqpHRCT in the clinical setting. Reproducibility of AIqpHRCT was verified for each typical HRCT pattern (ground-glass opacity [GGO], non-specific interstitial pneumonia [NSIP], usual interstitial pneumonia [UIP], granuloma). Additional, 50 HRCT datasets from 50 IRD-ILD patients using AIqpHRCT were analysed and correlated with clinical data and pulmonary lung function parameters. AIqpHRCT presented 100% agreement (coefficient of variation = 0.00%, intraclass correlation coefficient = 1.000) regarding the detection of the different HRCT pattern. Furthermore, AIqpHRCT data showed an increase of ILD from 10.7 ± 28.3% (median = 1.3%) in GGO to 18.9 ± 12.4% (median = 18.0%) in UIP pattern. The extent of fibrosis negatively correlated with FVC (ρ=-0.501), TLC (ρ=-0.622), and DLCO (ρ=-0.693) (p < 0.001). GGO measured by AIqpHRCT also significant negatively correlated with DLCO (ρ=-0.699), TLC (ρ=-0.580) and FVC (ρ=-0.423). For the first time, the study demonstrates that AIpqHRCT provides a highly reliable method for quantifying lung parenchymal changes in HRCT images of IRD-ILD patients. Further, the AIqpHRCT method revealed significant correlations between the extent of ILD and lung function parameters. This highlights the potential of AIpqHRCT in enhancing the accuracy of ILD diagnosis and prognosis in clinical settings, ultimately improving patient management and outcomes.

427. THE ROLE OF CROSS-SECTIONAL IMAGING IN PATIENTS WITH PULMONARY MICRO ASPIRATION

Abstract Background There is increasing evidence of a strong relationship between pulmonary microaspiration of refluxate and pulmonary diseases such as bronchiectasis and lung fibrosis. This group has demonstrated the presence of co-location of pulmonary aspiration on modified reflux scintigraphy with lobar parenchymal lung changes on high resolution computed tomographic imaging of the lung (HRCT-L) in patients with typical and atypical reflux symptoms. There is, however, a cohort of patients who demonstrate evidence of reflux aspiration without evidence of parenchymal changes on HRCT-L. This study aims to demonstrate a group of patients with confirmed reflux micro-aspiration without corresponding changes in lung parenchyma on HRCT. Methods Data were obtained from a prospectively populated database of patients with treatment resistant typical and atypical GORD and suspected reflux pulmonary microaspiration. Modified novel digital technique of reflux pulmonary microaspiration scintigraphy using a previously validated technique was performed to evaluate the possibility of significant GORD or extra-oesophageal symptoms, including typical symptoms such as heartburn and reflux and atypical symptoms such as throat symptoms, cough, globus, mucous, throat clearing, dysphonia and recurrent respiratory infections. Patients who underwent microaspiration studies and had normal HRCT-L for chest symptoms were included. The group was compared to patients with lung changes on HRCT-L corresponding with micro-aspiration studies. Results Inclusion criteria were met by 14 patients (86% female, 14% male). The mean age was 54 years (range: 36 – 81 years). All patients demonstrated reflux microaspiration on scintigraphy in the supine delayed phase and all had intermittent or continuous full column gastro-oesophageal reflux. Lung parenchymal changes on HRCT-L corresponding to site of reflux micro-aspiration on scitigraphy were demonstrated in 66 out of 80 patients listed in the database. Amongst patients with normal HRCT-L typical reflux symptoms were reported in 1 patient, atypical symptoms in 6 patients, both in 5 patients and 2 did not report symptoms. Most common presenting symptom was cough. There was no difference in symptomatology of patients with or without HRCT-L pulmonary parenchymal changes. Patients with pulmonary changes on HRCT were on average 13 years older than patients without CT changes (mean age 67, range 31-91). Conclusion HRCT-L is an important additional investigation in patient with reflux micro-aspiration detected on scintigraphy to identify patients with reflux related lung parenchymal changes. Younger age of patients with normal HRCT-L suggests that parenchymal changes may be developing as a result of prolonged exposure to reflux micro-aspiration over time.

Longitudinal registration of thoracic CT images with radiation-induced lung diseases: A divide-and-conquer approach based on component structure wise registration using coherent point drift

Background and ObjectiveRegistration of pulmonary computed tomography (CT) images with radiation-induced lung diseases (RILD) was essential to investigate the voxel-wise relationship between the formation of RILD and the radiation dose received by different tissues. Although various approaches had been developed for the registration of lung CTs, their performances remained clinically unsatisfactory for registration of lung CT images with RILD. The main difficulties arose from the longitudinal change in lung parenchyma, including RILD and volumetric change of lung cancers, after radiation therapy, leading to inaccurate registration and artifacts caused by erroneous matching of the RILD tissues. MethodsTo overcome the influence of the parenchymal changes, a divide-and-conquer approach rooted in the coherent point drift (CPD) paradigm was proposed. The proposed method was based on two kernel ideas. One was the idea of component structure wise registration. Specifically, the proposed method relaxed the intrinsic assumption of equal isotropic covariances in CPD by decomposing a lung and its surrounding tissues into component structures and independently registering the component structures pairwise by CPD. The other was the idea of defining a vascular subtree centered at a matched branch point as a component structure. This idea could not only provide a sufficient number of matched feature points within a parenchyma, but avoid being corrupted by the false feature points resided in the RILD tissues due to globally and indiscriminately sampling using mathematical operators. The overall deformation model was built by using the Thin Plate Spline based on all matched points. ResultsThis study recruited 30 pairs of lung CT images with RILD, 15 of which were used for internal validation (leave-one-out cross-validation) and the other 15 for external validation. The experimental results showed that the proposed algorithm achieved a mean and a mean of maximum 1 % of average surface distances <2 and 8 mm, respectively, and a mean and a maximum target registration error <2 mm and 5 mm on both internal and external validation datasets. The paired two-sample t-tests corroborated that the proposed algorithm outperformed a recent method, the Stavropoulou's method, on the external validation dataset (p < 0.05). ConclusionsThe proposed algorithm effectively reduced the influence of parenchymal changes, resulting in a reasonably accurate and artifact-free registration.

Role of transforming growth factor beta in assessment of severity of hypersensitivity pneumonitis: a single center study

BackgroundHypersensitivity pneumonitis (HP) is a more frequently diagnosed picture of diffuse parenchymal lung disease. It is an inflammation of the lung tissue, provoked by immune mechanisms, which happens to prone individuals as a reaction to a wide range of antigens. There are different degrees of fibrosis and inflammation. A group of extracellular mediators both proinflammatory and profibrotic claimed to be involved in the pathogenesis of HP. Among these mediators, a significant role is played by transforming growth factor-beta (TGF-β).AimCorrelation between the severity of hypersensitivity pneumonitis and the serum level of TGF beta.Patients and methodsSixty subjects were included in the study who were classified into 30 patients newly diagnosed with hypersensitivity pneumonitis and 30 healthy subjects served as controls. All the participants were subjected to complete history taking, physical examination, spirometry, 6-min walk distance test, HRCT, and serum levels of TGF-β.ResultsThe serum level of TGF beta is elevated in newly diagnosed HP cases (fibrotic and non-fibrotic) in relation to control participants showing statistical significance p value < 0.001, and the serum level of TGF beta in the fibrotic group of HP patients is more than that in non-fibrotic group with statistical significance p value 0.012.ConclusionThe serum level of transforming growth factor can be used in the assessment of the severity of hypersensitivity pneumonitis as regards the intensity of lung parenchymal changes.

Bulk RNA sequencing of human pediatric lung cell populations reveals unique transcriptomic signature associated with postnatal pulmonary development.

Postnatal lung development results in an increasingly functional organ prepared for gas exchange and pathogenic challenges. It is achieved through cellular differentiation and migration. Changes in the tissue architecture during this development process are well-documented and increasing cellular diversity associated with it are reported in recent years. Despite recent progress, transcriptomic and molecular pathways associated with human postnatal lung development are yet to be fully understood. In this study, we investigated gene expression patterns associated with healthy pediatric lung development in four major enriched cell populations (epithelial, endothelial, and nonendothelial mesenchymal cells, along with lung leukocytes) from 1-day-old to 8-yr-old organ donors with no known lung disease. For analysis, we considered the donors in four age groups [less than 30 days old neonates, 30 days to < 1 yr old infants, toddlers (1 to < 2 yr), and children 2 yr and older] and assessed differentially expressed genes (DEG). We found increasing age-associated transcriptional changes in all four major cell types in pediatric lung. Transition from neonate to infant stage showed highest number of DEG compared with the number of DEG found during infant to toddler- or toddler to older children-transitions. Profiles of differential gene expression and further pathway enrichment analyses indicate functional epithelial cell maturation and increased capability of antigen presentation and chemokine-mediated communication. Our study provides a comprehensive reference of gene expression patterns during healthy pediatric lung development that will be useful in identifying and understanding aberrant gene expression patterns associated with early life respiratory diseases.NEW & NOTEWORTHY This study presents postnatal transcriptomic changes in major cell populations in human lung, namely endothelial, epithelial, mesenchymal cells, and leukocytes. Although human postnatal lung development continues through early adulthood, our results demonstrate that greatest transcriptional changes occur in first few months of life during neonate to infant transition. These early transcriptional changes in lung parenchyma are particularly notable for functional maturation and activation of alveolar type II cell genes.

The effectiveness of glucocorticoid treatment in post-COVID-19 pulmonary involvement

RationalePersistent respiratory symptoms following Coronavirus Disease 2019 (COVID-19) are associated with residual radiological changes in lung parenchyma, with a risk of development into lung fibrosis, and with impaired pulmonary function. Previous studies hinted at the possible efficacy of corticosteroids (CS) in facilitating the resolution of post-COVID residual changes in the lungs, but the available data is limited.AimTo evaluate the effects of CS treatment in post-COVID respiratory syndrome patients.Patients and methodsPost-COVID patients were recruited into a prospective single-center observational study and scheduled for an initial (V1) and follow-up visit (V2) at the Department of Respiratory Medicine and Tuberculosis, University Hospital Olomouc, comprising of pulmonary function testing, chest x-ray, and complex clinical examination. The decision to administer CS or maintain watchful waiting (WW) was in line with Czech national guidelines.ResultsThe study involved 2729 COVID-19 survivors (45.7% male; mean age: 54.6). From 2026 patients with complete V1 data, 131 patients were indicated for CS therapy. These patients showed significantly worse radiological and functional impairment at V1. Mean initial dose was 27.6 mg (SD ± 10,64), and the mean duration of CS therapy was 13.3 weeks (SD ± 10,06). Following therapy, significantly better improvement of static lung volumes and transfer factor for carbon monoxide (DLCO), and significantly better rates of good or complete radiological and subjective improvement were observed in the CS group compared to controls with available follow-up data (n = 894).ConclusionBetter improvement of pulmonary function, radiological findings and subjective symptoms were observed in patients CS compared to watchful waiting. Our findings suggest that glucocorticoid therapy could benefit selected patients with persistent dyspnea, significant radiological changes, and decreased DLCO.

Quantitative CT lung volumetry and densitometry in pediatric pectus excavatum.

The purpose of this study was to evaluate the quantitative computed tomography (CT) volumetry and densitometry and in pediatric patients with pectus excavatum (PE). We measured pectus index (PI) and separated inspiratory and expiratory lung volumes and densities. We obtained the total lung volume (TLV) and mean lung density (MLD) during inspiration and expiration, and the ratio of end expiratory to inspiratory volume (E/I volume) and MLD (E/I density) were calculated. The difference between inspiratory and end expiratory volume (I-E volume) and MLD (I-E density) were also calculated. A total of 199 patients, including 164 PE patients and 35 controls, were included in this study. The result shows that the PE group had lower inspiratory TLV (mean, 2670.76±1364.22 ml) than the control group (3219.57±1313.87 ml; p = 0.027). In the PE group, the inspiratory (-787.21±52.27 HU vs. -804.94±63.3 HU) and expiratory MLD (-704.51±55.41 HU vs. -675.83±64.62 HU) were significantly lower than the indices obtained from the control group (p = 0.006). In addition, significantly lower values of TLV and MLD difference and higher value of TLV and MLD ratio were found in the PE group (p <0.0001). PE patients were divided into severe vs. mild groups based on the PI cutoff value of 3.5. The inspiratory MLD and TLV ratio in the severe PE group were lower than those in the mild PE group, respectively (p <0.05). In conclusion, quantitative pulmonary evaluation through CT in pediatric PE patients may provide further information in assessing the functional changes in lung parenchyma as a result of chest wall deformity.

A prospective study on lung parenchymal changes in ingestional poisoning

Abstract Introduction:The ingestion of poison constitutes a critical medical emergency necessitating immediate attention in the emergency department. Respiratory symptoms associated with ingested poisons may manifest through aspiration, cardiopulmonary effects, or direct lung toxicity resulting from alveolar epithelium injury. In the emergency setting, chest imaging, including chest radiographs and CT scans, is commonly employed to assess such symptoms. This study aims to observe and document radiological changes in lung parenchyma among cases of ingestional poisoning admitted to GGH Kakinada. Material and Methods : A prospective observational study was conducted, encompassing cases of ingestional poisoning admitted to GGH Kakinada from January 1st, 2023, to June 1st, 2023. Results: Our findings revealed a predominance of males (71.2%), with the most common age group being 31-40 years (36.6%). Paraquat emerged as the most frequently consumed poison (39.39%). Radiological changes were most prevalent in paraquat poisoning cases (66.67%), and the mortality rate was 39.39%. Conclusion: Paraquat poisoning demonstrates substantial and delayed lung involvement, likely linked to aspiration. All cases resulted in mortality. Early chest X-ray assessment is vital in the emergency department for prompt detection and intervention, anticipating respiratory symptoms in patients with radiological changes.

OGBN P06 Co-location of pulmonary abnormalities on high resolution CT imaging and pulmonary microaspiration reflux scan: Suggests a causative relationship

Abstract Background The relationship between micro-aspiration of refluxate as a form of gastro-oesophageal reflux disease (GORD) and pulmonary diseases including bronchiectasis and lung fibrosis has been circumstantially suggested but not proven. Clarification of the role of GORD and microaspiration in pulmonary disease may enable targeted therapies. This study aims to determine whether there is a relationship between anatomical location of aspiration of radiological tracer on scintigraphic imaging and changes associated with pulmonary disease on high resolution computed tomographic imaging of the lung (HRCT-L). Methods Data were obtained from a prospectively populated database of patients with treatment resistant typical and atypical GORD and suspected reflux pulmonary microaspiration. Patients who underwent microaspiration studies and had concurrent HRCT-L for chest symptoms were included. Modified novel digital technique of reflux pulmonary microaspiration scintigraphy using a previously validated technique was performed to evaluate the possibility of significant GORD or extra-oesophageal symptoms, including typical symptoms such as heartburn and reflux and atypical symptoms such as throat symptoms, cough, globus, mucous, throat clearing, dysphonia and recurrent respiratory infections. HRCT-L was obtained in clinically indicated patients and compared with scintigraphic findings. Results Pulmonary reflux microaspiration scanning was performed in 121 patients (75% female, 25% male). The mean age was 67 years (range: 31 – 91 years). All patients demonstrated reflux microaspiration on scintigraphy in the supine delayed phase and all had intermittent or continuous full column gastro-oesophageal reflux. Lung parenchymal changes were apparent in 66 of 73 patients who underwent HRCT-L. Fibrotic changes were demonstrated in 51% of patients and bronchiectactic changes in 46%. Correlation at anatomical lobar levels with areas of aspiration of isotope on scintigraphic imaging was seen in 97% of fibrosis patients and 85% of bronchiectasis patients. Conclusions Modified reflux pulmonary microaspiration scintigraphy demonstrated the presence of pulmonary aspiration on delayed imaging. This is the first imaging technique with the ability to confirm the presence of lung aspiration of gastric content. Given the large proportion of cases showing lobar co-location of pulmonary abnormality on HRCT-L, this study indicates a strong relationship between aspiration of refluxate and parenchymal lung changes associated with pulmonary diseases such as IPF and bronchiectasis. There may be a significant role for modified technique scintigraphy to accurately diagnose the presence of reflux aspiration, allowing further research into pathogenesis and management of pulmonary disease.

Diagnostic challenge of tuberculosis in systemic lupus erythematosus: a case report and literature review.

Patients with systemic lupus erythematosus (SLE) are at increased risk of tuberculosis (TB) infection due to immune dysfunction and immunosuppressive therapy. We present a case study of a 40-year-old woman with systemic lupus erythematosus (SLE). Initially, she was diagnosed with a lupus flare based on her clinical symptoms and laboratory results. However, upon further investigation, positive polymerase-chain reaction results for M. tuberculosis in the cerebrospinal fluid and lung parenchymal changes on chest computed tomography scan were indicative of TB infection. There was initial uncertainty regarding whether TB had triggered a flare-up of SLE or if TB was merely mimicking the symptoms of a SLE flare-up. However, as increasing the prednisolone dose did not have a positive effect and the patient's condition improved significantly with anti-TB treatment alone, it became clearer that the deterioration observed upon admission was primarily due to TB progression rather than an SLE flare-up. Additionally, we review the current literature on TB and SLE, including risk factors, diagnostic challenges, and treatment considerations, highlighting the importance of considering TB infection in patients with SLE who present with overlapping manifestations. Prompt diagnosis and treatment are essential for improving outcomes in these patients.

High-resolution Computed Tomography Thorax Volumetric Assessment in Coronavirus Disease 2019 Patients and Correlation with Pulmonary Function Tests.

Years after SARS coronavirus disease 2019 (COVID-19) recovery, residual pulmonary abnormalities may still exist. This brings on the question of whether or not COVID-19 could have comparable late consequences. Structural changes in the lungs after recovery can be better visualized using computed tomography (CT) thorax. Computed Tomography Lung Parenchymal changes during hospitalization by COVID-19 and after 4 months of follow-up to correlate with the volumetric high-resolution computed tomography thorax indices, Pulmonary function tests (PFTs) indices, SpO2, and 6 min Walking Test (6MWT). This is a Hospital based cross-sectional study, with a follow-up among 100 Patients from 2020 to 2022. Each patient's different CT parameters and HRCT volumetric indices Normal Lung (NL), Normal Lung Percentage (NL%), Whole Lung (WL) were correlated with the PFT indices (Forced expiratory volume in 1s [FEV1], forced vital capacity [FVC], FEV1/FVC), Oxygen Saturation (SpO2) and 6-Minute Walking Test (6MWT). The mean NL (L) and NL% during COVID were significantly lower than the mean values 4 months post-COVID. Architectural distortion, bronchiolar dilatation, interstitial thickening, and parenchymal bands were reduced considerably after 4 months post-COVID, compared to during COVID. PFTs results, such as PFT indices, were not significantly different after 4 months post-COVID, compared to during COVID. SpO2 (%) and 6 MWT (m) were significantly increased. During COVID and post-COVID, the values of NL (L) and NL (%) had a significant positive correlation with PFT indices, SpO2, and 6MWT (m). Hence, the different CT indices (NL and NL%) can be used as a surrogate for functional recovery of COVID patients since it correlates with the PFT indices (FEV1 and FEV1/FVC), SpO2, and 6MWT post-COVID.

COVID-19-Associated Thrombotic Complication: Is It Pulmonary Embolism or In Situ Thrombosis?

Acute pulmonary embolism is a protentional fatal complication of COVID-19. The aim of this study is to investigate whether pulmonary embolism is due to thrombus migration from the venous circulation to the pulmonary arteries or due to local thrombus formation secondary to local inflammation. This was determined by looking at the distribution of pulmonary embolism in relation to lung parenchymal changes in patients with COVID-19 pneumonia. Retrospectively, we identified pulmonary computed tomography angiography (CTPA) of patients admitted to the Royal Hospital between November 1st, 2020, and October 31, 2021, with a confirmed diagnosis of COVID-19. The CTPAs were examined for the presence of pulmonary embolism and the distribution of the pulmonary embolism in relation with lung parenchymal changes. A total of 215 patients admitted with COVID-19 pneumonia had CTPA. Out of them, 64 patients had pulmonary embolisms (45 men and 19 women; mean age: 58.4 years with a range of 36-98 years). The prevalence of pulmonary embolism (PE) was 29.8% (64/215). Pulmonary embolism was more frequently seen in the lower lobes. 51 patients had PE within the diseased lung parenchyma and 13 patients had PE within normal lung parenchyma. The strong association between pulmonary artery embolism and lung parenchymal changes in patients admitted with COVID-19 pneumonia suggests local thrombus formation.

Development and Disorders of the Airway in Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia (BPD), a disorder characterized by arrested lung development, is a frequent cause of morbidity and mortality in premature infants. Parenchymal lung changes in BPD are relatively well-characterized and highly studied; however, there has been less emphasis placed on the role that airways disease plays in the pathophysiology of BPD. In preterm infants born between 22 and 32 weeks gestation, the conducting airways are fully formed but still immature and therefore susceptible to injury and further disruption of development. The arrest of maturation results in more compliant airways that are more susceptible to deformation and damage. Consequently, neonates with BPD are prone to developing airway pathology, particularly for patients who require intubation and positive-pressure ventilation. Airway pathology, which can be divided into large and small airways disease, results in increased respiratory morbidity in neonates with chronic lung disease of prematurity.

Quantitative analysis of lung function and airway remodeling using ventilation/perfusion single photon emission tomography/computed tomography and HRCT in patients with chronic obstructive pulmonary disease and asthma.

To investigate the role of V/P SPECT/CT and HRCT quantitative parameters in evaluating COPD and asthma disease severity, airway obstructivity-grade, ventilation and perfusion distribution patterns, airway remodeling, and lung parenchymal changes. Fifty-three subjects who underwent V/P SPECT/CT, HRCT, and pulmonary function tests (PFTs) were included. Preserved lung ventilation (PLVF), perfusion function (PLPF), airway obstructivity-grade (OG), proportion of anatomical volume, ventilation and perfusion contribution of each lobe, and V/P distribution patterns were evaluated using V/P SPECT/CT. The quantitative parameters of HRCT included CT bronchial and CT pulmonary function parameters. In addition, the correlation and difference of V/P SPECT/CT-, HRCT-, and PFT-related parameters were compared. There was a statistically significant difference between severe asthma and severe-very severe COPD in CT bronchial parameters, like WA, LA and AA, in the lung segment airways (P < 0.05). CT bronchial parameters, like as WT and WA, were statistically significant (p < 0.05) among asthma patients. The EI of severe-very severe COPD was different from that of the disease severity groups in asthma patients (P < 0.05). The airway obstructivity-grade, PLVF and PLPF differed significantly among the severe-very severe COPD and mild-moderate asthma patients (P < 0.05). And the PLPF was statistically significant among the disease severity groups in asthma and COPD (P < 0.05). OG and PLVF, PLPF, and PFT parameters were significantly correlated, with the FEV1 correlation being the most significant (r = - 0.901, r = 0.915, and r = 0.836, respectively; P < 0.01). There was a strong negative correlation between OG and PLVF (r = - 0.945) and OG and PLPF (r = - 0.853) and a strong positive correlation between PLPF and PLVF (r = 0.872). In addition, OG, PLVF, and PLPF were moderately to strongly correlated with CT lung function parameters (r = - 0.673 to - 0.839; P < 0.01), while lowly to moderately correlated with most CT bronchial parameters (r = - 0.366 to - 0.663, P < 0.01). There were three different V/P distribution patterns, including matched, mismatched, and reverse mismatched patterns. Last, the CT volume overestimated the contribution in the upper lobes and underestimated the lower lobes' contribution to overall function. Quantitative assessment of ventilation and perfusion abnormalities and the degree of pulmonary functional loss by V/P SPECT/CT shows promise as an objective measure to assess the severity of disease and lung function to guide localized treatments. There are differences between HRCT parameters and SPECT/CT parameters among the disease severity groups in asthma and COPD, which may enhance, to some extent, the understanding of complex physiological mechanisms in asthma and COPD.

Postmortem Identification of Vascular Ehlers-Danlos Syndrome in a Lung Transplant Recipient.

Postmortem Identification of Vascular Ehlers-Danlos Syndrome in a Lung Transplant Recipient.

P031 Montelukast antagonising underlying systemic illness

Abstract Background/Aims Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, multisystemic, autoimmune vasculitis involving small to medium-sized blood vessels. It has a well-established affiliation with atopic syndromes, typically adult-onset asthma and sinusitis. More rare associations are linked with drug side effects such as Montelukast. According to the ‘American College of Rheumatology 1990’, the following criteria yield a sensitivity of 84% in identifying a patient with EGPA. The criteria include: asthma, eosinophilia &amp;gt;10% on differential white cell count, mononeuropathy or polyneuropathy, transient pulmonary infiltrates on chest radiography, paranasal sinus abnormality, and blood vessel biopsy demonstrating extravascular eosinophilia, in a patient with symptoms of systemic vasculitis. The multisystemic involvement of EGPA makes both diagnosis and management difficult as presentations can vary. Methods We report the complex case of a 61 year-old gentleman diagnosed with EGPA. His relevant past medical history includes a diagnosis of Asthma in 2002 (managed with inhaled bronchodilators, corticosteroids, and montelukast), recurrent sinusitis, and lower respiratory tract infections. The patient presented with a one month history of abdominal cramping and bloating. This was associated with nausea, constipation, anorexia, and a week of ‘drenching’ night sweats. His full physical examination during this time was unremarkable. Results He had a normal CT Abdomen Pelvis and colonoscopy. His admission chest radiograph demonstrated bilateral parenchymal lung changes. This was followed by a CT Thorax showing bilateral upper and lower lobe bronchiectasis. Mediastinal and hilar adenopathy consistent with a diagnosis of allergic bronchopulmonary aspergillosis with associated reactive adenopathy. His laboratory investigations showed eosinophilia (21.68) and leucocytosis (32.7). In view of these results, an autoantibody screen was sent showing positive ANCA and positive anti-Myeloperoxidase antibodies(MPO titre 55). Two days into his admission he developed pain and paralysis of his right upper limb. He reported marked fatigue followed by a petechial, non-blanching, vasculitic rash on both ankles. Neurological examination reflected a subacute symmetrical sensory and motor polyneuropathy predominantly involving the right side with bilateral foot drop. MRI Brain demonstrated an established infarct in the left external capsule. He was commenced on high dose aspirin. Due to high suspicion for EGPA, methylprednisolone was commenced for 5 days, followed by tapering oral corticosteroid therapy and Rituximab therapy. A skin punch biopsy showed ‘ a vasculopathic type reaction with small vessel vasculitis, associated mixed inflammatory infiltrate which includes some eosinophils’ confirmed his diagnosis. Conclusion A topic of particular relevance to this case is the association between EGPA and montelukast. It has been hypothesised that there may be a relationship between Leukotriene Receptor Antagonist Therapy, specifically Montelukast, with the pathogenesis of EGPA. Some research suggests that treatment with Montelukast permits the decreased need for oral corticosteroids for asthma control. Therefore, suggesting that EGPA could have been masked by corticosteroid therapy. Disclosure Á. Connerton: None.

Interstitial lung disease (ILD) after COVID-19: a new fibro-inflammatory disease?

Introduction. Nowadays post-COVID respiratory symptoms that could be associated with pulmonary fibrosis progression are of concern. Objective. To compare CT and SPECT data of patients with post-COVID pulmonary fibrosis, and to define whether the lung fibrosis progression could be predictable. Material and Methods. Changes in chest CT scan, microcirculation disorders (SPECT) and impaired lung function parameters (DLCO) were analyzed in 74 post-COVID patients with residual consequences of COVID-19. Results. A year or more after the disease, 17 % of patients had isolated ground-glass areas, 24 % of patients had ventilation mosaics and air traps, most patients had compaction of the interlobular interstitial tissue of a short UIP type (67 %); consolidation zones (38 %); zones of pulmonary fibrosis of different lengths (57 %); discoid atelectasis (39 %); bronchiectasis (26 %), pulmonary hypertension (PH) (36 %). Significant decrease of the diffusion capacity and great microcirculation disorders accompanied by more than 50 % perfusion lack were detected. We demonstrated that significant radiological and functional effects of viral pneumonia were likely to be associated with post-viral interstitial lung disease. Conclusions. 1. Complete X-ray examination with lung diffusion capacity determination can contribute to optimal dispensary observation of post-COVID patients. 2. Microcirculation disorder greater than 50 % of the norm is a predictor of the lung parenchyma changes and can contribute to the prediction of long-term effects of the disease. 3. Complete radiation monitoring is required for patients over 60 years of age; post-COVID patients having severe form of the disease; patients having respiratory complaints for more than a year, regardless of the severity of COVID-19.