Chest Radiographic Appearances Research Articles

Temporal evolution of chest radiographic appearances in COVID-19 with clinicoradiological associations: a multicentre United Kingdom resident-led study

To describe the (a) frequency of improving, static, and worsening chest radiograph (CXR) appearances; (b) differences in demographic, initial rudimentary haematological and CXR variables and these patterns; and (c) frequency of different trajectories of serial CXR evolution, in COVID-19 patients presenting consecutively. This multicentre retrospective study included all COVID-19 patients admitted from 1-30 April 2020, meeting the inclusion criteria across 24 (blinded) hospitals. Follow-up CXRs on admission, the subsequent (where available), and at 4-8 weeks were scored for the presence of parenchymal opacities across six zones. Three cohorts were defined: improved, static, and/or worsened. The chi-squared and Kruskal-Wallis tests were used to compare demographic, laboratory, and CXR variables. Trajectories of CXR evolution were assessed when all three CXRs were available (226 patients). Of 452 included patients (median age 66 years, interquartile range 54.3-79, 262 men), 211 (46.7%) improved, 140 (31%) were static, and 101 (22.3%) worsened. Improving patients were more likely younger, with a classic COVID-19 radiograph and higher initial CXR zonal severity scores (both p<0.001), while worsening patients had lower initial lymphocyte counts (p=0.008). The most frequent trajectory was worsened then improved (n=63, 27.9%) followed by static then improved (n=46, 20.4%) and static (n=42, 18.6%). Most patients with COVID-19 during the first wave of the pandemic demonstrated radiographic improvement; these patients were more likely younger with classic COVID-19 appearances and initially more extensive abnormality. Conversely, radiographic deterioration was associated with lower lymphocyte counts. The three most common trajectories were worsening then improvement, static then improvement, and static throughout.

Chest Radiograph appearance of SARS-Cov-2 Infection: A Prospective Observational Study of Ambulatory Patients from a Field Hospital in a Middle-Income Country

Background: The ongoing COVID-19 pandemic has had a profound impact on both individuals and society, resulting in widespread illness and death, as well as a global economic downturn. In order to examine chest X-rays (CXRs) of ambulatory patients diagnosed with COVID-19 in a field isolation center, our aim is to determine the proportion of patients with normal versus abnormal chest radiographs. Moreover, in cases where abnormal findings are present on the CXR, our goal is to document the distribution and patterns of these abnormalities.&#x0D; Method: This prospective observational study was conducted on a cohort of 510 consecutive COVID-19 patients who tested positive for the virus and presented at the field isolation center between March 15th and May 15th, 2020. The study encompassed patients of all ages and both genders, with the exclusion criteria being patients requiring intensive care and those with unreadable CXRs due to technical limitations. The review of CXRs was performed by two certified radiologists, ensuring reliable and accurate assessments. Age, gender, and X-ray findings were noted.&#x0D; Results: Among the total of 510 patients included in the study, 463 (90.8%) were male, while 47 (9.2%) were female. The age range of the study population spanned from 12 to 64 years, with the majority falling within the 23-33 year age group. During the review of CXRs, 433 (84.90%) were classified as normal, while 77 (15.10%) were deemed abnormal. The most frequently observed abnormal pattern was ground glass opacification, accounting for 54.5% of the cases, followed by the reticular pattern at 45.5%.&#x0D; Conclusion: CXRs obtained from confirmed COVID-19 patients were normal in 85% of the patients. The most common abnormality seen in our study population was involvement of the lower lobes with patchy peripheral ground glass opacities or reticular shadowing, which was focal or multifocal in location.

Chest Radiograph and CT Findings in Patients Hospitalized with Breakthrough COVID-19.

PurposeTo characterize chest radiograph and CT imaging appearance in patients with breakthrough COVID-19 (defined as an illness occurring in patients that previously received a COVID-19 vaccination) in a hospital setting.Materials and MethodsIn this retrospective study, all patients admitted to the hospital between August 26 and September 8, 2021 with a positive SARS-CoV-2 reverse transcription polymerase chain reaction-confirmed infection who were fully vaccinated against COVID-19 were evaluated. Clinical, laboratory data, and outcomes were collected and assessed. All patients had chest imaging performed (either radiography, CT, or a combination of both). Chest radiographs and CTs were assessed and scored on admission and on follow up to determine the extent and type of pulmonary involvement. Descriptive statistics were used.ResultsCharts of 60 hospitalized patients that tested positive for SARS-CoV-2 were reviewed for a prior history of COVID-19 vaccination. Eight (13.3%) such patients were identified and included for analysis (mean age, 54 years; range 34–81 years; four women). Patients received either two doses of Pfizer-BioNTech (n = 6), two doses of Moderna (n = 1), or one dose of Johnson and Johnson (n = 1). Five (63%) patients were immunosuppressed at the time of presentation, and six (75%) reported respiratory symptoms. Most of the patients had normal radiographs (4 of 7; 57%). The most common chest CT findings were ground glass opacities (three of five), with mild to moderate severity scores (average, 51; range 8–88). Two patients required intensive care unit admission. However, no patients died and all were either discharged or were on room air without residual respiratory symptoms by the end of the study period.ConclusionIn hospitalized patients with COVID-19 breakthrough illness, normal to mild or moderately positive imaging findings were observed.©RSNA, 2021

False-negative RT-PCR for COVID-19 and a diagnostic risk score: a retrospective cohort study among patients admitted to hospital

ObjectiveTo describe the characteristics and outcomes of patients with a clinical diagnosis of COVID-19 and false-negative SARS-CoV-2 reverse transcription-PCR (RT-PCR), and develop and internally validate a diagnostic risk score to...

Hemothorax or not: Use of extrapleural fat sign

Extrapleural hematoma is a collection located between the chest wall and the parietal pleura and is usually associated with rib fractures. Computed tomography is an excellent modality to diagnose extrapleural hematoma and rib fractures as well as differentiate it from a pleural collection. Extrapleural hematoma needs to be differentiated from a hemothorax for appropriate management. We hereby report a case of a large extrapleural hematoma and associated pleural effusion following trauma being managed as a hemothorax based only on chest radiograph appearance.

Spectrum of pleuropulmonary paragonimiasis: An analysis of 685 cases diagnosed over 22 years

Paragonimiasis is a global foodborne zoonosis. Overlapping clinical and imaging features with other lung pathologies hamper correct diagnosis and require differential diagnosis. During 1982-2003, 49,012 samples were referred for immunodiagnosis of helminthiases. We detected paragonimiasis cases by enzyme-linked immunosorbent assay (ELISA). We assessed clinical, radiographical and laboratory characteristics, and diagnostic dilemmas associated with delayed diagnosis. We analyzed 685 pleuropulmonary paragonimiasis cases. ELISA-positive was 665. Eggs were detected in 50. Symptom duration correlated well with the appearance of chest radiographs; 359 pleural, 33 pleuroparenchymal, and 264 parenchymal lesions (P < 0.001). Twenty-nine had normal chest images. Eosinophilia, seen in 304, was common in pleural and pleuroparenchymal patients (P < 0.05). Chest pain and dyspnea were characteristic for pleurisy patients. Sputum (odds ratios [OR]: 6.79; 95% CI: 4.41-10.47), blood-tinged sputum (OR: 5.62; 95% CI: 3.75-8.42), and foul-odor (OR: 2.70; 95% CI: 1.42-5.16) were significant in parenchymal patients. Delayed diagnosis (119) for ≥ 25 weeks was attributed mainly to misdiagnosis as tuberculosis, malignancy, or chronic obstructive pulmonary disease (COPD) (OR: 111.75; 95% CI: 43.25-288.74). Variable symptoms and radiographs of pleuropulmonary paragonimiasis depended on the stage of infection. Suspicion of tuberculosis, malignancy, or COPD was major cause of delayed diagnosis.

Radiographic manifestations of COVID-19 pneumonia: Initial experience from an epicenter in North-West, Nigeria

Background: COVID-19, a zoonotic disease caused by severe acute respiratory syndrome coronavirus-2, is responsible for the pandemic of 2020. Despite the availability and usefulness of chest radiographs (CXR) in diagnosis and monitoring of suspected as well as infected patients with COVID-19, there is paucity of studies about imaging findings in COVID-19 from Sub-Saharan Africa including Nigeria. Aim: This study aims to describe the findings and correlates of chest radiographic appearances in COVID-19 pneumonia at Kano, Nigeria. Materials and Methods: This was a retrospective study conducted at radiology units of four radiology diagnostic facilities that were very active during the peak period of the pandemic in Kano metropolis. All patients with confirmed COVID-19 infection and also underwent chest radiographic examinations at these facilities were included. The findings considered in the evaluation were the presence or absence and the type of pulmonary or pleural lesions/abnormality, and their distribution; including their association with demographics and clinical presentations. Statistical analysis was performed using SPSS version 23.0. Results: Of 125 patients, 98 (78.4%) were male. The mean age was 57.3 ± 12 years. One hundred and one (80.8%) of them had abnormal chest radiographic findings. These patients showed significant higher occurrences of anosmia than those with normal CXRs (P < 0.05). The occurrence of ground-glass opacity in both lower zones was significantly seen in 43 (62.3%) patients between 40 and 60 years and in 40 (85%) of those older than 60. Anosmia and age were respectively the only symptoms that independently predict if the COVID-19 patient may likely present with the abnormal CXRs or not (0.175 [0.057–0.542] P = 0.002; 3.7 [1.423–9.622] P = 0.007). Conclusions: Majority of our patients presents with abnormalities on CXRs. Older age, anosmia were the major predictors of chest radiographic abnormalities, which were mainly bilateral asymmetric lower zones ground glass opacities.

PARADOXICAL RESPONSE DURING TREATMENT OF PULMONARY TUBERCULOSIS

Paradoxical response (PR) is defined as a clinical or radiological worsening in patients receiving adequate anti-tuberculosis treatment, with the exclusion of documented relapse or of other disease presentations. Although most patients with PR show spontaneous improvement, some cases presenting with diffuse alveolar damage have also been reported. Retrospective clinical and laboratory data were collected on 89 patients of pulmonary tuberculosis who were treated at our hospital between April 2013 and January 2019. PR occurred in 21 patients (24%), and the median onset time after anti-tuberculosis treatment was 22 days. The time to onset of PR was shorter in diffuse pulmonary infiltrates group than in local pulmonary infiltrates group or in pleural effusion group. Low serum albumin, elevated lactate dehydrogenase (LDH), high Creactive protein (CRP) and chest radiographic appearance exceeding one-lung area were associated with PR incidence. There was no difference in sputum smear grading and pulmonary cavitation. Six out of the ten patients died, developing PR with diffuse pulmonary infiltrates. Low albumin and chest radiographic appearance exceeding one-lung area were risk factors for developing PR. Diffuse pulmonary infiltrates in early phase of anti-tuberculosis treatment was related with Inhospital mortality.

Keeping up appearances: the radiographic evolution of cardiovascular implantable electronic devices

In recent years, there has been a significant evolution in the field of cardiovascular implantable electronic devices (CIEDs). Pacemakers can now be leadless, implantable cardioverter defibrillators can be entirely subcutaneous and implantable loop recorders have become miniaturized. Driven by technological advances and an ageing population implant numbers have also steadily increased. These highly prevalent systems are all radio-opaque and are frequently observed on chest radiographs, yet the devices are neither well recognized nor understood. We present a pictorial review of CIEDs; describing the chest radiograph appearances of both newer generation systems and their traditional predecessors. Furthermore, we discuss the clinical role of chest radiography in both CIED implantation and follow up, with the aim of improving understanding in this important and expanding field. Finally, we present a collection of interesting and challenging radiographs, where multiple CIED systems have been implanted.

H1N1 influenza: Characterization of initial chest radiographic findings and prognostic value of serial chest radiographs

ObjectiveThe aim of this study was to recognize and characterize the initial chest radiographic findings of H1N1 infection and to evaluate whether serial chest radiographs were useful in assessing the severity of infection and predicting the clinical outcome. Materials and methods27 patients hospitalized for H1N1 infection, from January 2015 to May 2016 were retrospectively evaluated, including 17 (62.9%) female patients and 10 (37.1%) male patients, with age ranging between 2 days and 65 years. Radiographs obtained at the time of admission were reviewed and studied for characteristic imaging patterns, laterality (unilateral or bilateral) and zonal distribution of the opacities. Serial chest radiographs taken were reviewed to look for progression or resolution of the imaging findings and compared with the final outcome. ResultsOf the female patients, 4 (23%) were pregnant and 1 (6%) was in the immediate post-partum period. Of the 27 patients, 25 (92.6%) had abnormal and 2 (7.4%) had normal radiological findings on initial chest radiographic appearance. One patient was lost to follow-up, 16 (62%) of the remaining 26 succumbed to the disease while the remaining 10 (38%) improved. Three of the pregnant patients and the postpartum patient had adverse outcomes. Involvement of greater than 4 lung zones and bilateral involvement indicated a poor prognosis. Abnormal chest radiographic findings included consolidation, peribronchial cuffing, nodular opacities and reticulo-nodular opacities, with the most common being consolidation with or without peribronchial cuffing. Patients with more than 4 zones of involvement invariably had an adverse clinical outcome. ConclusionInitial chest radiographic findings help in diagnosing the type of pneumonia, and consolidation associated with peribronchial cuffing is a common finding in viral pneumonia like H1N1. Prognosis based on evaluation and monitoring of serial chest radiographs is a valuable tool in predicting the final clinical outcome of the patient. Extensive involvement of both lungs, in the form of multi-zonal and bilateral lung opacities is frequently associated with adverse prognosis.

Novel Method to Improve Radiologist Agreement in Interpretation of Serial Chest Radiographs in the ICU.

Objectives:To determine whether a novel method and device, called a variable attenuation plate (VAP), which equalizes chest radiographic appearance and allows for synchronization of manual image windowing with comparison studies, would improve consistency in interpretation.Materials and Methods:Research ethics board approved the prospective cohort pilot study, which included 50 patients in the intensive care unit (ICU) undergoing two serial chest radiographs with a VAP placed on each one of them. The VAP allowed for equalization of density and contrast between the patients’ serial chest radiographs. Three radiologists interpreted all the studies with and without the use of VAP. Kappa and percent agreement was used to calculate agreement between radiologists’ interpretations with and without the plate.Results:Radiologist agreement was substantially higher with the VAP method, as compared to that with the non-VAP method. Kappa values between Radiologists A and B, A and C, and B and C were 46%, 55%, and 51%, respectively, which improved to 73%, 81%, and 66%, respectively, with the use of VAP. Discrepant report impressions (i.e., one radiologist's impression of unchanged versus one or both of the other radiologists stating improved or worsened in their impression) ranged from 24 to 28.6% without the use of VAP and from 10 to 16% with the use of VAP (χ2 = 7.454, P < 0.01). Opposing views (i.e., one radiologist's impression of improved and one of the others stating disease progression or vice versa) were reported in 7 (12%) cases in the non-VAP group and 4 (7%) cases in the VAP group (χ2 = 0.85, P = 0.54).Conclusion:Numerous factors play a role in image acquisition and image quality, which can contribute to poor consistency and reliability of portable chest radiographic interpretations. Radiologists’ agreement of image interpretation can be improved by use of a novel method consisting of a VAP and associated software and has the potential to improve patient care.

Determination of the effect of highly active antiretroviral therapy on radiographic features of pulmonary tuberculosis in HIV infected patients

Background: The chest radiographic appearances of HIV-seropositive patients presenting with pulmonary tuberculosis (PTB) are diverse, creating difficulty in diagnosis and treatment. Determination of the effect of highly active antiretroviral therapy (HAART) on radiographic features of pulmonary tuberculosis among HIV infected patients was investigated in order to find out the pattern in our environment and to provide an empirical approach for early diagnosis and treatment of patients. Aim: The aim of this study is to determine the effect of HAART on radiographic features of pulmonary tuberculosis in HIV-infected patients. Materials and Methods: A cross sectional study of 60 consecutively confirmed HIV- seropositive patients who had been diagnosed of the infection for at least six months before the commencement of this study, aged between 19 and 50 years (Mean ± SD: 32.9 ± 7.15) comprising 22 males and 38 females with newly diagnosed sputum smear positive PTB was conducted at the infectious disease clinic of the University of Maiduguri Teaching Hospital, between March 2010 and February 2011. The subjects were HIV/PTB patients on HAART for at least 6 months before presenting with PTB (32) and HIV/PTB but Antiretroviral (ARV)-naive who were already confirmed HIV positive for at least 6 months before presenting with PTB (28). Posterior-anterior (PA) and lateral chest radiographs were obtained with film screen at 50-70 kVp in majority of the patients. CD4 + lymphocyte counts were obtained for all the patients. The chest radiographic images were evaluated for the presence of either typical or atypical patterns of PTB. Apical opacities with or without cavitations was considered typical while atypical patterns included miliary, lower or mid-zone consolidation, reticulonodular opacities, pleural effusion, hilar adenopathy and normal radiograph. Results: Majority (78.6%) of HIV/PTB patients on HAART with CD4 counts of ≥ 200 cells/μl had typical pattern of PTB whereas atypical pattern of PTB was significantly seen in HIV/PTB ARV naive patients with majority of this group of patients (62.5%) had CD4 count of <200 cells/μl (P = 0.001). Conclusion: Majority (78.6%) of HIV/PTB patients on HAART had typical pattern of PTB whereas atypical pattern of PTB was significantly seen in HIV/PTB ARV naive patients (62.5%) (P = 0.001). We concluded that radiographic patterns of PTB in HIV varied over a spectrum and are related to HIV disease stage and HAART treatment.

A rapid change in a patient's chest radiograph appearances

A 72-year-old man with a history of rheumatoid arthritis (on multiple immunosuppressants: leflunomide, etanercept and hydroxychloroquine) was admitted with headache and fever. He had no other symptoms or relevant medical...

Relationship between the radiographic pattern of pulmonary tuberculosis and CD4 cell count in patients with human immune deficiency virus infection

Background: The chest radiographic appearances of human immunodeficiency virus (HIV)-seropositive patients presenting with pulmonary tuberculosis (PTB) are diverse, creating difficulty in diagnosis and treatment. This study determined the relationship between the degree of immunosuppression and the various radiological patterns of PTB in HIV-infected patients with TB. Materials and Methods: Sixty consecutive patients with PTB, and positive for HIV antibodies as detected using enzyme-linked immunosorbent assay and confirmed by immunoComb 11 (IMMUNOCOMBFIRM), who presented at the infectious diseases clinic of University of Maiduguri Teaching Hospital, Maiduguri and fulfilled the inclusion criteria were included in to a prospective cross-sectional study after obtaining an informed written consent. CD4+ lymphocytes counts were obtained for all the patients. Posterior anterior and lateral chest radiographs were obtained. The chest radiographic images were evaluated for the presence of either typical or atypical patterns of PTB. Results: The mean CD4 counts of those with typical and atypical PTB pattern were 339.8 ± 139.52 and 138 ± 41.78 cells/μl, respectively (P = 0.001). Majority of the patients with typical pattern had a CD4 count of ≥200 cells/μl and they belonged to the HIV/PTB on highly active antiretroviral therapy (HAART) group (56.3%) as against 21.4% of HIV/PTB antiretroviral (ARV)-naive patients. More of HIV/PTB patient who were ARV-naive and had CD4 count Conclusion: We concluded that radiographic patterns of PTB in HIV varied over a spectrum and are related to HIV disease stage and that atypical radiographic pattern was a good predictor of low CD4 counts.

Peripartum cardiomyopathy with biventricular thrombus which led to massive cerebral embolism

A 37-year-old female who delivered her second child via a cesarean section 4 months previously presented to our hospital with gradual worsening of dyspnea on effort. Chest radiographic appearance showed cardiomegaly (cardiothoracic ratio 61%) and slight bilateral pulmonary congestion. Echocardiogram revealed diffuse hypokinesis of both left and right ventricles (left ventricular ejection fraction 29%) and large biventricular thrombus [left ventricular apex (28mm×21mm, 22mm×14mm) and right ventricular apex (16mm×11mm)]. She was diagnosed as having peripartum cardiomyopathy (PPCM) and anticoagulation therapy was started. Surgical thrombectomy was not selected because of risk of complications. Massive cerebral infarction occurred 10 days after diagnosis. She was discharged with aphasia and right incomplete hemiplegia 65 days after admission.Biventricular thrombus is a rare complication of PPCM. If high risk of massive embolism is considered, surgical thrombectomy may be warranted even in cases with low cardiac function.<Learning objective: Biventricular thrombus is a rare complication of peripartum cardiomyopathy (PPCM). We report a case of biventricular thrombus secondary to PPCM. The decision to perform prophylactic surgical approach to ventricular thrombus is difficult in cases with low cardiac function.>

Pulmonary Parenchymal Consolidation on Thoracic CT

Consolidation is defined pathologically as an exudate, or other disease product, that replaces alveolar air and renders the pulmonary parenchyma airless. The chest radiographic appearance of consolidation is usually relatively nonspecific and may be the result of a wide variety of disorders, including infection, neoplasm, hemorrhage, and rare infiltrative diseases. Similarly, the appearance of consolidation on thoracic computed tomography (CT) is rarely specific enough to suggest a single diagnosis. Occasionally, however, the attenuation characteristics of consolidation on thoracic CT may provide a specific etiology for pulmonary parenchymal infiltration; such is the case when low attenuation material, representing fat, is seen in patients with lipoid pneumonia on thoracic CT. Often the diagnosis of lipoid pneumonia is difficult to establish clinically, and abnormalities detected on thoracic CT may first suggest this condition. Once thoracic CT indicates the presence of lipoid pneumonia, directed history often discloses the offending agent. Bronchoscopy with bronchioloalveolar lavage may disclose lipid-laden macrophages within the lung parenchyma in selected patients. Therapy may then be directed at discontinuation of the offending lipid and treatment of any coexistent bacterial superinfection. Patients with acute lipoid pneumonia often improve clinically and radiographically with appropriate therapy, whereas patients with chronic lipoid pneumonia may show relatively little improvement despite appropriate treatment.

Chest radiographic appearances in swine flu

Chest radiographic appearances in swine flu

Chest radiographic appearances in adult inpatients admitted with swine flu infection: Local experience in Melbourne

The influenza A virus (H1N1) pandemic began in Mexico in March 2009. As of July 2009, there were 5298 reported cases in Australia including 10 deaths. The aim of this review is to demonstrate the local chest radiographic findings in adult inpatients with proven H1N1, to assess the radiological disease progression and resolution, and to evaluate whether the severity of chest X-rays findings had a bearing on the length of admission and need for intensive care admission. Eleven H1N1 patients (5 males and 6 females, mean age of 36), presenting with cough (64%), fever (55%) and shortness of breath (55%), were admitted to our hospital between 13 August and 1 November 2010. Details of radiographic features, risk factors, clinical course including length of stay, doubling time of consolidation and time for 50% resolution of consolidation were recorded and analysed. Seventy-three per cent of our patients presented with bilateral mid and/or lower zone alveolar consolidation. One patient with underlying cystic fibrosis had only bilateral upper zone consolidation. No pleural effusion, lymphadenopathy or cardiomegaly was noted on any of the plain chest radiographs. The mean doubling time of consolidation was 1.5 days. The mean time for 50% resolution of consolidation after antiviral treatment was 10.5 days. The average length of stay in hospital was 22 days. Ninety-one per cent of our patients required intensive-care unit admission with 50% of those requiring intubation. Rapid progression of bilateral mid and lower zone air-space opacities in relatively young unwell patients, with lack of pleural effusion, pericardial effusion or lymphadenopathy on plain radiographs, should raise the clinical suspicion of H1N1 infection. Patients requiring hospital admission usually show slow clinical and radiological improvement, and require prolonged hospital stays.

Pneumonia in the immunocompetent patient

Pneumonia is an acute inflammation of the lower respiratory tract. Lower respiratory tract infection is a major cause of mortality worldwide. Pneumonia is most common at the extremes of life. Predisposing factors in children include an under-developed immune system together with other factors, such as malnutrition and over-crowding. In adults, tobacco smoking is the single most important preventable risk factor. The commonest infecting organisms in children are respiratory viruses and Streptoccocus pneumoniae. In adults, pneumonia can be broadly classified, on the basis of chest radiographic appearance, into lobar pneumonia, bronchopneumonia and pneumonia producing an interstitial pattern. Lobar pneumonia is most commonly associated with community acquired pneumonia, bronchopneumonia with hospital acquired infection and an interstitial pattern with the so called atypical pneumonias, which can be caused by viruses or organisms such as Mycoplasma pneumoniae. Most cases of pneumonia can be managed with chest radiographs as the only form of imaging, but CT can detect pneumonia not visible on the chest radiograph and may be of value, particularly in the hospital setting. Complications of pneumonia include pleural effusion, empyema and lung abscess. The chest radiograph may initially indicate an effusion but ultrasound is more sensitive, allows characterisation in some cases and can guide catheter placement for drainage. CT can also be used to characterise and estimate the extent of pleural disease. Most lung abscesses respond to medical therapy, with surgery and image guided catheter drainage serving as options for those cases who do not respond.

Concurrent allergic bronchopulmonary aspergillosis and aspergilloma: is it a more severe form of the disease?

The mould Aspergillus , a genus of spore forming fungi, affects the respiratory system in more ways than one. The clinical spectrum of Aspergillus involvement of the lungs ranges from various hypersensitivity manifestations to invasive disease which can be fatal. The inhaled spores hardly affect healthy persons but in asthmatic subjects these spores are trapped in the viscid secretions found in the airways. Repeated inhalation of Aspergillus antigens triggers allergic reactions in atopic individuals, which may manifest as Aspergillus -induced asthma, allergic bronchopulmonary aspergillosis (ABPA) and allergic Aspergillus sinusitis (AAS) [1]. Saprobic colonisation of airways, cavities and necrotic tissue leads to the development of aspergillomas. Although ABPA is predominantly a disease of asthmatics, only a few asthmatics actually suffer from it. Contemporary reports suggest that ABPA occurs in up to 11% of patients with asthma [2–6]. The variable prevalence rates of ABPA in asthma may be attributable to the lack of a single diagnostic criterion and standardised tests [7]. A set of eight major and three minor criteria for the diagnosis of ABPA has evolved over time but minimal essential criteria have been identified: 1) asthma; 2) immediate cutaneous reactivity to A. fumigatus ; 3) total serum immunoglobulin (Ig)E >1,000 ng·mL−1; 4) elevated specific IgE- Af /IgG- Af ; and 5) central bronchiectasis in the absence of distal bronchiectasis [8]. This ‘picturesque’ disease causes a wide spectrum of chest radiographic appearances, which could be either transient or permanent [9]. The most characteristic transient changes are “fleeting …