Chest HRCT Findings Research Articles

High resolution chest computed tomography findings in patients with clinically suspected COVID-19 pneumonia in Uganda: a cross-sectional study.

The alarming spread of the COVID-19 pandemic has led to a shortage of RT-PCR kits in Uganda necessitating the use of high-resolution chest Computed Tomography to guide patient management and treatment. To describe the chest HRCT findings in patients with clinically suspected COVID-19 pneumonia and to compare its diagnostic accuracy to RT-PCR. . In this cross-sectional study, chest HRCT findings of 384 patients and available RT-PCR laboratory results were reviewed and recorded in the data collection form. The commonest chest HRCT findings were bilateral ground glass opacities (78.2%). Out of the 31.7% patients that took the PCR test only 26.9% tested positive. 16 out of 17 patients who tested negative, were classified under CORADS 5.The sensitivity of chest HRCT was 90.4%, 95% CI (82.6-95.5), positive predictive value of 84.2%, 95% CI (75.6-90.7), and accuracy of 77.5%, 95% CI (71.5-87.1). HRCT was found superior to RT-PCR in diagnosing COVID-19. A patient with positive HRCT findings should be treated as COVID 19 when RT-PCR is inaccessible or results are negative. A patient with negative HRCT requires complimentary RT-PCR and possibly follow up CT scans if symptoms persist before treating for COVID 19.

Association between sputum culture results and pulmonary changes in children with cystic fibrosis.

Despite the significant improvement in the prognosis of cystic fibrosis (CF), it is still regarded as the most common life-shortening genetic disease in Caucasian populations. This disease is the most important cause of chronic lung disease and exocrine pancreatic insufficiency in infancy and childhood. The aim of our study was to assess the potential association between bacterial colonization detected by sputum cultures and pulmonary structural and functional changes in Iranian children with CF. In this cross-sectional study, 76 CF children ≥6 years old registered in the CF Foundation of Children's Medical Center Hospital, Tehran, Iran, who underwent high resolution CT scan (HRCT), pulmonary function test, and sputum cultures within a month of each other during the study period were included. For each patient, demographic characteristics (age and sex), results of sputum cultures, forced expiratory volume in 1st second (FEV1), and chest HRCT findings based on the Bhalla scoring system were recorded in a check list. Sixty seven percent of the patients had positive sputum cultures, with the most commonly isolated microorganism being Pseudomonas aeruginosa (mucoid strain). Based on categorization of Bhalla scores, none of the patients had severe pulmonary involvement. FEV1 was mainly >70%. There was a statistically significant correlation between colonization with mucoid P. aeruginosa and lower Bhalla scores in children aged 14-16 years (P=0.001). Colonization with mucoid P. aeruginosa was also significantly associated with patient's age (P=0.020) and FEV-1 (P=0.001). Severity of lung involvement in CF children is clearly dependent to mucoid P. aeruginosa colonization in airways and this notorious bacterium is the most prevalent one in Iranian CF children. Prompt identification and eradication by proper nebulized and systemic antibiotics can have valueless effects on patients' quality of life and prevent lifelong destructive complications such as bronchiectasis. Timely lung CT scan wisely advised by expert CF treatment team can meticulously detect injuries and it seems to act more efficacious than -still helpful-clinical scores and pulmonary function tests.

Structured report improves radiology residents' performance in reporting chest high-resolution computed tomography: a study in patients with connective tissue disease.

PURPOSE To evaluate the performance of radiology residents (RRs) when using a dedicated structured report (SR) template for chest HRCT in patients with suspected connective tissue disease-interstitial lung disease (CTD-ILD), compared to the traditional narrative report (NR). METHODS We retrospectively evaluated 50 HRCT exams in patients with suspected CTD-ILD. A chest-devoted radiologist reported all the HRCT exams as the reference standard, pointing out pulmonary fibrosis findings (i.e., honeycombing, traction bronchiectasis, reticulation, and volume loss), presence and pattern of ILD, and possible other diagnoses. We divided four RRs into two groups according to their expertise level. In each group, RRs reported all HRCT examinations alternatively with NR or SR, noting each report's reporting time. The Cohen's Kappa, Wilcoxon, and McNemar tests were used for statistical analysis. RESULTS Regarding the pulmonary fibrosis findings, we found higher agreement between RRs and the reference standard reader when using SR than NR, regardless of their expertise level, except for volume loss.RRs' accuracy for "other diagnosis" was higher when using SR than NR, moving from 0.48 to 0.66 in the novel group (p = 0.035) and from 0.44 to 0.80 in the expertise group (p < 0.001). No differences in accuracy were found between ILD presence and ILD pattern. The reporting time was significantly lower (p = 0.001) when using SR than NR. CONCLUSION SR is of value in increasing the reporting of critical chest HRCT findings in the complex CTD-ILD scenario and should be used early and systematically during the residency.

Clinical and HRCT features of amyopathic dermatomyositis associated with interstitial lung disease: A retrospective study of 128 patients with connective tissue disease-related interstitial lung disease

BackgroundThis study retrospectively analyzed the laboratory data and chest images of patients with amyopathic dermatomyositis associated with interstitial lung disease (ADM-ILD) and patients with other connective tissue disease-related ILDs (CTD-ILDs) to find a characteristic index for the early recognition of ADM-ILD and help clinicians consider the possibility of ADM-ILD as soon as possible. MethodsIn our cohort study, the records of 128 Chinese patients with CTD-ILD, including 33 ADM-ILD patients, 37 rheumatoid arthritis (RA)-ILD patients, 33 primary Sjogren's syndrome (pSS)-ILD patients, 14 systemic sclerosis (SSc)-ILD patients and 11 systemic lupus erythematosus (SLE)-ILD patients. The patients’ clinical features, laboratory parameters, and chest HRCT findings were analyzed. ResultsADM-ILD patients generally had significantly higher LDH (333.52±160.21 U/L), AST (66.21±83.66 U/L), and CK-MB (18.23±8.28 U/L) levels than other CTD-ILD patients. A total of 90.91% (30/33) of ADM-ILD patients had elevated LDH. Patients with ADM-ILD were more prone to organizing pneumonia radiologic patterns on chest HRCT scans than patients with other CTD-ILDs (χ2=37.39, p < 0.001) and were found in 18 of 33 ADM-ILD patients. Anti-MDA5 (45.45%) was the most commonly detected autoantibody in ADM-ILD patients, followed by anti-PL-7 (21.21%), anti-Jo-1 (12.12%), and anti-PL-12 (9.09%), and levels of ALT (96.93±119.79 vs. 17.50±6.218 U/L), AST (113.00±106.13 vs. 23.56±6.91 U/L), LDH (415.00±198.51 vs. 261.94±67.75 U/L) and CK-MB (22.57±5.91 vs. 14.61±8.36 U/L) were significantly higher in anti-MDA5-positive patients, but these patients had significantly lower WBC counts (4.82±2.61 vs. 7.14±3.00 × 109/L), lymphocyte counts (0.72±0.20 vs. 1.23±0.53 × 109/L), and ALB levels (31.90±4.76 vs. 35.49±4.71 g/L). ConclusionsADM-ILD patients have higher serum LDH, AST and CK-MB levels, especially serum LDH levels, and are more prone to organizing pneumonia radiologic patterns on chest HRCT scans than other CTD-ILD patients. A high level of serum LDH with ILD may be a useful characteristic index for recognizing ADM-ILD.

Patient with false negative RT-PCR for COVID-19 referred to cancer hospital for lung cancer screening: A case report

Background: Even though RT-PCR tests are generally considered the gold standard for diagnosing SARS-CoV-2, they are not without flaws, and the likelihood of detecting an infection varies depending on when the test is performed. There is chance of false negative due to different pitfalls. So there is essential of correlation of radiological characteristics, abnormalities in biochemical tests and symptoms of suspected patient during COVID-19 epidemic.&#x0D; Case presentation: Herein, we report a 42-year-old male patient with high-grade fever, dry cough, headache and dizziness. He went for the RT-PCR test two times and reported negative. On the chest X-Ray, there was opacity on both lungs and referred to cancer-hospital for lung-cancer screening. The patient underwent chest-HRCT and laboratory tests for further evaluation and was identified as typical COVID-19 findings. Then the patient was isolated and treatment of given according to COVID-19 treatment guidelines &#x0D; Conclusion: It is concluded that a clinically symptomatic patient with typical chest HRCT and abnormal lab findings for COVID-19 should be considered as a COVID-19 patient and isolated even with two negative RT-PCR tests.

P5‐57: Comparison of chest HRCT findings between COVID‐19 pneumonia and anti‐MDA5 antibody‐positive interstitial pneumonia by computer‐based quantitative CT image analysis

P5‐57: Comparison of chest HRCT findings between COVID‐19 pneumonia and anti‐MDA5 antibody‐positive interstitial pneumonia by computer‐based quantitative CT image analysis

Learning from pathophysiological aspects of COVID-19 clinical, laboratory, and high-resolution CT features: a retrospective analysis of 128 cases by disease severity.

BackgroundThe classic chest CT imaging features of COVID-19 pneumonia have low specificity due to their similarity with a number of other conditions. So, the goal of the present study is to learn from the pathophysiology of COVID-19 clinical features, laboratory results, and high-resolution CT manifestations in different stages of disease severity to provide significant reference values for diagnosis, prevention, and treatment.MethodsThis was a multicentered study that included 128 patients. Demographic, clinical, and laboratory data, in addition to chest HRCT findings, were evaluated. According to chest HRCT features, radiologic scoring were grade 1 and 2 for mild grades of the disease, 3 and 4 for moderate grades of the disease, and 5 and 6 for severe grades of the disease.ResultsPatient clinical symptoms ranged between fever, dry cough, muscle ache (myalgia)/fatigue, dyspnea, hyposomia, sore throat, and diarrhea. Lymphocytes and WBCs were significantly lower in patients with severe COVID-19. A significant negative correlation was found with WBCs (r = − 0.245, P = 0.005), lymphocytes% (r = − 0.586, P < 0.001), RBCs (r = − 0.2488, P = 0.005), Hb (gm/dl) (r = − 0.342, P < 0.001), and HCT (r = − 0.377, P < 0.001). Transferrin and CRP were significantly higher in moderate and severe COVID-19 than mild degree and showed a significant positive correlation with CT score (r = 0.356, P < 0.001) and (r = 0.429, P < 0.001), respectively. The most common CT features were peripheral pulmonary GGO and air space consolidation.ConclusionClinical features, laboratory assessment, and HRCT imaging had their characteristic signs and performances. Correlating them can make it possible for physicians and radiologists to quickly obtain the final diagnosis and staging of the COVID-19 pneumonia.

Effectiveness of corticosteroids on chest high-resolution computed tomography features of COVID-19 pneumonia.

Objective:The aim of our study was to assess the effect of a short-term treatment with low-moderate corticosteroid (CS) doses by both a quantitative and qualitative assessment of chest HRCT of COVID-19 pneumonia.Methods:CORTICOVID is a single-center, cross-sectional, retrospective study involving severe/critical COVID-19 patients with mild/moderate ARDS. Lung total severity score was obtained according to Chung and colleagues. Moreover, the relative percentages of lung total severity score by ground glass opacities, consolidations, crazy paving, and linear bands were computed. Chest HRCT scores, P/F ratio, and laboratory parameters were evaluated before (pre-CS) and 7–10 days after (post-CS) methylprednisolone of 0.5–0.8 mg/kg/day.Findings:A total of 34 severe/critical COVID-19 patients were included in the study, of which 17 received Standard of Care (SoC) and 17 CS therapy in add-on. CS treatment disclosed a significant decrease in HRCT total severity score [median = 6 (IQR: 5–7.5) versus 10 (IQR: 9–13) in SoC, p < 0.001], as well in single consolidations [median = 0.33 (IQR: 0–0.92) versus 6.73 (IQR: 2.49–8.03) in SoC, p < 0.001] and crazy paving scores [mean = 0.19 (SD = 0.53) versus 1.79 (SD = 2.71) in SoC, p = 0.010], along with a significant increase in linear bands [mean = 2.56 (SD = 1.65) versus 0.97 (SD = 1.30) in SoC, p = 0.006]. GGO score instead did not significantly differ at the end of treatment between the two groups. Most post-CS GGO, however, derived from previous consolidations and crazy paving [median = 1.5 (0.35–3.81) versus 2 (1.25–3.8) pre-CS; p = 0.579], while pre-CS GGO significantly decreased after methylprednisolone therapy [median = 0.66 (0.05–1.33) versus 1.5 (0.35–3.81) pre-CS; p = 0.004]. CS therapy further determined a significant improvement in P/F levels [median P/F = 310 (IQR: 235.5–370) versus 136 (IQR: 98.5–211.75) in SoC; p < 0.001], and a significant increase in white blood cells, lymphocytes, and neutrophils absolute values.Conclusion:The improvement of all chest HRCT findings further supports the role of CS adjunctive therapy in severe/critical COVID-19 pneumonia.

Prognostic factors for primary Sjögren's syndrome-associated interstitial lung diseases.

Interstitial lung disease (ILD) is a condition characterized by a higher mortality rate in primary Sjögren's syndrome (pSS). However, factors influencing the outcome of patients with pSS-associated ILD remain unclear. The aim of the present study was to evaluate predictive factors associated with a worse prognosis in pSS-ILD. This retrospective study included 99 consecutive patients with pSS-ILD. Clinical characteristics, laboratory findings, and pulmonary function tests at the time of diagnosis were analyzed. Chest HRCT images were reviewed by two experienced chest radiologists. Prognostic factors were assessed by univariate and multivariate analyses, using Cox proportional hazards regression model. Median age was 68 years (73% women). In the total patient population, the 5- and 10-year survival rates were 89.8% and 79.0%, respectively. Univariate analysis revealed a significant association between prognosis and age, serum Krebs von den Lungen-6 (KL-6) levels, and %FVC. None of the chest HRCT findings were related to patient outcomes. Based on multivariate analyses adjusted by age and gender, lower levels of %FVC and higher levels of KL-6 were significantly associated with poor outcomes. Using optimal cutoff levels, according to receiver operating characteristic curve analyses, KL-6 > 800 U/mL were significantly associated with worse prognosis (HR: 2.91, 95% CI: 1.04-8.10). Patients with elevated serum KL-6 levels (>800 U/mL) showed a higher mortality rate than those without elevated serum KL-6 levels (p = 0.02). Lower %FVC and higher serum KL-6 levels are predictive factors for poor outcome in patients with pSS-ILD.

Extra-Parenchymal Chest HRCT Findings in Patients with Systemic Sclerosis at the Time of Initial Diagnosis

Extra-Parenchymal Chest HRCT Findings in Patients with Systemic Sclerosis at the Time of Initial Diagnosis

Study of Interstitial Lung Disease With Reference to Radiological Profile

Background: Interstitial lung disease Diagnosis requires extensive investigation into the patient's symptoms, life style, work history, exposures, and medications forming the clinical context. Subjects and Methods: The cross sectional perspective and high spatial resolution makes HRCT superior to other imaging modalities like chest X-Ray, lung tomography and conventional CT Scanning multiplanar imaging with aim to determine the radiological profile in a clinically suspected cases of Interstitial Lung Disease the present study conducted over 50 patients during the period of 12 months from October 2012 to October 2013 in kamineni hospital, Hyderabad. Results: Out of 50 clinically suspected patients of interstitial lung disease, a specific pattern was observed in 44patients on HRCT and 33 patients on chest radiograph. Patterns found on chest radiograph were correlated with patterns found on HRCT. Out of 44 interstitial lung diseases on HRCT, 28 patients revealed correlation between chest radiograph and HRCT pattern. Out of 50, thirty one patients had correlation between Chest radiograph and HRCT findings. Conclusion: HRCT is superior to chest radiograph in detection of all basic patterns associated with ILD and scores more in their distribution and lung parenchymal involvement.

Extra-parenchymal chest HRCT findings of patients with systemic sclerosis at the time of initial diagnosis

Extra-parenchymal chest HRCT findings of patients with systemic sclerosis at the time of initial diagnosis

H1N1 viral pneumonia: Spectrum of chest HRCT findings

Influenza viruses are common and important pathogens affecting human. Seasonal epidemics and unpredictable pandemics associated with influenza A (“swine” influenza or H1N1) virus had been declared by the World Health Organization (WHO), last one on June 11, 2009.Clinically, wide range of illness was described ranging from asymptomatic infection to acute respiratory distress syndrome (ARDS) complicated by multi-organ failure. Vulnerable groups showed high risk for morbidity and mortality.Radiologically, also wide range of chest HRCT findings were described including sub-centimeter air-space nodules, patchy ground-glass opacities and air-space consolidations. Diffuse alveolar damage (DAD) and ARDS were considered to be the end result.Aim of study was to evaluate different patterns and imaging findings associated with H1N1 lung infection using MSCT of the chest. Aim of the workThe aim of study was to evaluate different patterns and imaging findings associated with H1N1 lung infection using MSCT of the chest. MethodsThis study was conducted on 50 patients from September 2013 till February 2016. All patients were examined by multi-detector computed tomography (MDCT). ResultsHRCT findings associated with H1N1 chest infection can overlap and range from mild cases with patchy ground glass opacities (with or without crazy paving pattern) up to air space consolidations, alveolar hemorrhage, diffuse alveolar damage (DAD) and ARDS. Manifestation of bronchiolitis obliterans was also detected including mucous plugging, mosaic attenuation with mixed air trapping and ground glass opacities (head cheese pattern) and bronchiectasis. ConclusionMDCT picture of H1N1 chest infection is highly variable with a spectrum of HRCT findings ranging from focal patchy ground glass attenuation to diffuse alveolar damage (DAD) or adult respiratory distress syndrome (ARDS). Still, constellation of clinical data and HRCT findings especially in endemic areas can raise the suspicion of H1N1.

Multifocal Pulmonary Neuroendocrine Tumours: Genesis, Diagnostics and Treatment

Multifocal neuroendocrine lung tumour is a rare diagnosis. Multiple lung foci of different sizes are usually apparent on chest CT scans. It is assumed that multifocal neuroendocrine lung tumours originally develop from diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). This results in cell aggregations formed by proliferation of neuroendocrine cells that are already physiologically present in the bronchial system. If these cell proliferations break through the bronchial basement membrane, they are considered to constitute tumourlets if they measure ≤ 5 mm and carcinoid tumours if they are larger than 5 mm. The speed of proliferation of the cell hyperplasias appears to vary. Many of the patients are completely asymptomatic, the multifocal neuroendocrine lung tumours being diagnosed by chance. However, other patients complain of breathlessness, reduced physical capacity and cough. There may also be reduction of lung function. In these cases, chest HRCT often reveals peribronchial fibrosis or bronchiectasis in addition to the lung foci. Bronchoscopy is usually not helpful. Surgical lung biopsy is considered to be the diagnostic gold standard. Histological examination typically shows a mixture of cell hyperplasias, tumourlets and carcinoid tumours. There is no consensus on the treatment of multifocal neuroendocrine tumours. Taking the clinical situation and the chest HRCT findings as our starting point, we developed a stepwise approach that is guided by the success of the individual therapeutic procedures. The most favourable prognosis is found in affected people without clinical symptoms whose lung foci all measure less than 5 mm. In these cases the 5-year survival rate is over 90%.

Organizing pneumonia: chest HRCT findings.

OBJECTIVE: To determine the frequency of HRCT findings and their distribution in the lung parenchyma of patients with organizing pneumonia. METHODS: This was a retrospective review of the HRCT scans of 36 adult patients (26 females and 10 males) with biopsy-proven organizing pneumonia. The patients were between 19 and 82 years of age (mean age, 56.2 years). The HRCT images were evaluated by two independent observers, discordant interpretations being resolved by consensus. RESULTS: The most common HRCT finding was that of ground-glass opacities, which were seen in 88.9% of the cases. The second most common finding was consolidation (in 83.3% of cases), followed by peribronchovascular opacities (in 52.8%), reticulation (in 38.9%), bronchiectasis (in 33.3%), interstitial nodules (in 27.8%), interlobular septal thickening (in 27.8%), perilobular pattern (in 22.2%), the reversed halo sign (in 16.7%), airspace nodules (in 11.1%), and the halo sign (in 8.3%). The lesions were predominantly bilateral, the middle and lower lung fields being the areas most commonly affected. CONCLUSIONS: Ground-glass opacities and consolidation were the most common findings, with a predominantly random distribution, although they were more common in the middle and lower thirds of the lungs.

Community-acquired pneumonia: a correlative study between chest radiographic and HRCT findings.

To elucidate what kinds of lesions tend to be overlooked or misinterpreted and why they were overlooked or misinterpreted on chest radiographs in the diagnosis of community-acquired pneumonia (CAP) by comparing radiographic findings with HRCT findings. In 129 patients with CAP (107 bacterial and 22 atypical) and 105 healthy subjects, the chest radiographic findings were correlated with the HRCT findings. The diagnostic accuracy of each chest radiographic finding was evaluated by comparing it with the HRCT finding. The false negative rate of radiographic interpretation tended to be higher for nodules and thickening of the bronchial wall, especially in patients with atypical pneumonia. The most frequent reason for false negative interpretations of nodules and bronchial wall thickening was the overlapping of these findings with airspace consolidation or ground-glass opacity (GGO). Thin lesions were the most frequent reasons for the false negative interpretation of airspace consolidation and GGO. The chest radiographic interpretations of GGO and airspace consolidation were influenced by the thickness of lesions, and those of nodules and thickening of bronchial walls were influenced by coexisting GGO and airspace consolidation and may contribute to a misinterpretation of these lesions and an incorrect diagnosis of CAP.

Studies in primary and iPSC-derived human Gaucher macrophages demonstrate impaired macrophage function and defective autophagy

computerized tomography (HRCT) mainly in type I GD adults. So, this study will determine the clinical spectrum of severity of lung involvement in Egyptian children mainly type 3 GD, the radiological changes,assess clinical significance of these findings and their response to ERT. The study included 34 GD children diagnosed by enzyme assay and genotype and are on ERT, imiglucerase 30-60 IU/kg/2 weeks. 31 GD type 3 children (29L444P/L444P, 2 D409H/D409H) and 3 GD type I (1 R359Q/R359Q and 2 with unknown genotype) were followed over 7 years. Their pulmonary status was clinically and radiologically assessed by chest x-ray and HRCT and its response to ERT determined. Clinical variables and radiological findings were statistically correlated. Patients’ median age is 8.6 years and mean duration of ERT is 6.5 years. Twenty (59%) type 3 L4444P/L444P GD children, 13 males and 7 females had chest symptoms with 14 having recurrent chest infections, dyspnea and wheezing, 4 requiring intensive care admission and 1 died of severe pulmonary involvement. Children showed statistically significant higher prevalence of chest symptoms at younger age (p= 0.04). The chest xray and HRCT findings included coarse interstitial pulmonary thickening of variable severity in 26/34(76.5%) and in 90% of the symptomatic group. Other changes included bronchiectasis, gound glass veiling, hyperinflation, mediastinal lymphadenopathy, military infiltration, consolidation, atelectasis and air trapping. In 12/14 asymptomatic GD children findings varied from interstitial thickening to ground glass veiling and bronchiectactic changes. 3 children were splenectomised without worsening of their chest condition. In 13 symptomatic children there was dramatic clinical response to ERT but radiological findings were stationary. All L444P/L444P children showed moderate to severe neurological involvement, 4 had epilepsy, 8 mesenteric lymphadenopathy, 3 severe bone involvement, 2 severe skeletal deformities, aortic and mitral calcifications in D409H/D409H patients. Nearly all children with recurrent infections and significant chest findings have at least one other severe system involvement. Our study showed heterogeneity in clinical presentation and response of lung involvement to ERT in type 3 GD children. 76.5% had variable degrees of interstitial lung disease and nearly all children without clinical lung involvement had abnormal radiological findings. Chest symptoms showed improvement in 65%. Lung involvement can be among the determinants of severity of type 3 GD in children.

Diagnostic criteria and follow-up in neuroendocrine cell hyperplasia of infancy: a case series

OBJECTIVE: Neuroendocrine cell hyperplasia of infancy (NEHI) is a form of childhood interstitial lung disease characterized by tachypnea, retractions, crackles, and hypoxia. The aim of this study was to report and discuss the clinical, imaging, and histopathological findings in a series of NEHI cases at a tertiary pediatric hospital, with an emphasis on diagnostic criteria and clinical outcomes. METHODS: Between 2003 and 2011, 12 full-term infants were diagnosed with NEHI, based on clinical and tomographic findings. Those infants were followed for 1-91 months. Four infants were biopsied, and the histopathological specimens were stained with bombesin antibody. RESULTS: In this case series, symptoms appeared at birth in 6 infants and by 3 months of age in the remaining 6. In all of the cases, NEHI was associated with acute respiratory infection. The most common initial chest HRCT findings were ground-glass opacities that were in the middle lobe/lingula in 12 patients and in other medullary areas in 10. Air trapping was the second most common finding, being observed in 7 patients. Follow-up HRCT scans (performed in 10 patients) revealed normal results in 1 patient and improvement in 9. The biopsy findings were nonspecific, and the staining was positive for bombesin in all samples. Confirmation of NEHI was primarily based on clinical and tomographic findings. Symptoms improved during the follow-up period (mean, 41 months). A clinical cure was achieved in 4 patients. CONCLUSIONS: In this sample of patients, the diagnosis of NEHI was made on the basis of the clinical and tomographic findings, independent of the lung biopsy results. Most of the patients showed clinical improvement and persistent tomographic changes during the follow-up period, regardless of the initial severity of the disease or type of treatment.

Clinical and Radiological Features of Acute-Onset Diffuse Interstitial Lung Diseases in Patients with Rheumatoid Arthritis Receiving Treatment with Biological Agents: Importance of &lt;i&gt;Pneumocystis&lt;/i&gt; Pneumonia in Japan Revealed by a Multicenter Study

Acute-onset diffuse interstitial lung disease (AoDILD) in patients with rheumatoid arthritis (RA) has been a serious concern, especially for those under treatment with biological agents which may affect the presentation and outcome of AoDILD, including Pneumocystis pneumonia (PCP). Therefore, we conducted a retrospective, multi-center study of AoDILD in RA patients receiving biological agents. Patients who developed AoDILD while receiving biological agents (infliximab, etanercept, adalimumab and tocilizumab) were enrolled in the study. Definite PCP was defined as patients who showed either P. jirovecii organisms in their respiratory samples by microscopic examination, or positive tests for both P. jirovicii DNA-PCR with respiratory samples and an elevated serum 1,3-β-D-glucan level above the cut-off value. Probable PCP was defined as either a positive test for P. jirovicii PCR or an elevated serum β-D-glucan level. Chest HRCT findings were evaluated and scored by two board-certified radiologists. The final diagnoses for 26 patients examined were definite PCP for 13 patients, probable PCP for 11, and methotrexate-associated pneumonitis in 2 patients. Definite and probable PCP cases were clinically indistinguishable. Generalized, diffuse ground-glass opacity (GGO) is the characteristic HRCT finding in patients with definite or probable PCP, which was different from our previous findings in RA patients, mostly without biologics, showing GGO distributed in a panlobular or multilobular manner. The clinical outcome was favorable by treatment with trimethoprim-sulfamethoxazole and glucocorticoids. The possibility of PCP should be intensively investigated in RA patients developing AoDILD while receiving biological agents.

Chronic Complications of Inhalation Injury: Chest HRCT Findings and a Correlation with the Pulmonary Function Test in Reactive Airway Dysfunction Syndrome

Purpose: To evaluate the HRCT findings and to correlate the findings with the results of a pulmonary function test (PFT) in patients with reactive airway dysfunction syndrome (RADS). Materials and Methods: On March 2003, a fire at a boarding house of primary school soccer players caused a multiple casualty disaster. After 8 months, nine boys that presented with chronic cough and dyspnea were treated, and were subjected to follow-up evaluations. Eight patients underwent a chest radiograph, HRCT, and a PFT. Two patients with severe symptoms received extended follow-up after 1 year. Two radiologists retrospectively reviewed the chest radiographs and the follow-up HRCT scans. We correlated the HRCT findings with the results of the PFT. Results: Six patients with an inhalation injury were diagnosed with RADS. On the chest radiographs, eight patients showed no abnormal findings. On an HRCT scan, four patients showed abnormal findings. The abnormal findings were mosaic air trapping (n = 4), bronchial wall thickening (n = 1), and parenchymal consolidation (n = 1). In all four patients that showed abnormal findings in the HRCT scan, abnormal results of the PFT were also seen. The two patients that received extended follow-up showed an improvement of the clinical symptoms, as seen by the PFT, and had a decreased extent and degree of mosaic air trapping, as seen on HRCT. Conclusion: An HRCT scan is an essential modality for the diagnosis and follow-up of patients with RADS. Both a full expiratory and inspiratory HRCT scan must be performed for an accurate diagnosis.