Chest Scans Research Articles

ROLE OF IMAGING TECHNOLOGY AND CURRENT STATUS OF CORONAVIRUS DISEASE 2019 (COVID-19): A CRITICAL REVIEW

Lately, there was an outbreak of Coronavirus disease (COVID-19) in Wuhan, a city of province Hubei, China. The infectious and transferrable virus originated in bats, seafood and animals. COVID-19 belongs to Coronviradae family. Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) also belong to this family and their outbreak occurred in China and Saudi Arabia back in 2003 and 2012. The number of deaths due to COVID-19 is much greater than that of SARS and MERS. The clinical symptoms of infected individuals from virus are almost the same but diagnostically they are different from one another. Reverse transcription polymerase chain reaction (RT-PCR) laboratory technique is a standard test for evaluation and confirmation of COVID-19 disease. In early stages, imaging modalities can be used for screening purposes. X-Ray is used to identify the gross changes within the chest region while Computed Tomography Scanning (CT Scan) chest is used for detailed modification which occurs due to coronavirus. CT scan evaluates the different characteristics in the individuals infected from COVID-19 such as presence of bilateral ground glass opacities, presence of diffuse consolidation, presence of nodules with halo sign, enlarge thoracic lymph nodes, presence of thicken inter-lobar septa, presence of bronchiectasis and pleural effusion. Each lung lobe was assigned different score on the basis of lobe area involvement. A lobe having no involvement is of score 0, minimal involvement lobe score is 1, mild involvement lobe score is 2, moderate involvement lobe score is 3, and severe involvement lobe score is 4. The lobes are assessed for different degree of involvement and then are divided as none (0%), minimal (1% to 25%), mild (26% to 50%), moderate (51% to 75%) and severe 76% to above level. These all techniques are very effective and responsible for the exact location of the area involved and also show the extension of pathology that can only be possible on CT scan. CT scan not only evaluates the disease but it also provides the assessment of the disease severity. Keywords: Computed Tomography scan; Coronavirus; Real time polymerase chain reaction; SARS; SARS-CoV-2; MERS

Machine Learning Algorithms to Differentiate Among Pulmonary Complications After Hematopoietic Cell Transplant

Pulmonary complications, including infections, are highly prevalent in patients after hematopoietic cell transplantation with chronic graft-vs-host disease. These comorbid diseases can make the diagnosis of early lung graft-vs-host disease (bronchiolitis obliterans syndrome) challenging. A quantitative method to differentiate among these pulmonary diseases can address diagnostic challenges and facilitate earlier and more targeted therapy. We conducted a single-center study of 66 patients with CT chest scans analyzed with a quantitative imaging tool known as parametric response mapping. Parametric response mapping results were correlated with pulmonary function tests and clinical characteristics. Five parametric response mapping metrics were applied to K-means clustering and support vector machine models to distinguish among posttransplantation lung complications solely from quantitative output. Compared with parametric response mapping, spirometry showed a moderate correlation with radiographic air trapping, and total lung capacity and residual volume showed a strong correlation with radiographic lung volumes. K-means clustering analysis distinguished four unique clusters. Clusters 2 and 3 represented obstructive physiology (encompassing 81%of patients with bronchiolitis obliterans syndrome) in increasing severity (percentage air trapping 15.6%and 43.0%, respectively). Cluster 1 was dominated by normal lung, and cluster 4 was characterized by patients with parenchymal opacities. A support vector machine algorithm differentiated bronchiolitis obliterans syndrome with a specificity of 88%, sensitivity of 83%, accuracy of 86%, and an area under the receiver operating characteristic curve of 0.85. Our machine learning models offer a quantitative approach for the identification of bronchiolitis obliterans syndrome vsother lung diseases, including late pulmonary complications after hematopoietic cell transplantation.

RETRACTED ARTICLE: Deep learning system to screen coronavirus disease 2019 pneumonia

Radiographic patterns on CT chest scans have shown higher sensitivity and specificity compared to RT-PCR detection of COVID-19 which, according to the WHO has a relatively low positive detection rate in the early stages. We technically review a study that compared multiple convolutional neural network (CNN) models to classify CT samples with COVID-19, Influenza viral pneumonia, or no-infection. We compare this mentioned study with one that is developed on existing 2D and 3D deep-learning models, combining them with the latest clinical understanding, and achieved an AUC of 0.996 (95%CI: 0.989–1.00) for Coronavirus vs Non-coronavirus cases per thoracic CT studies. They calculated a sensitivity of 98.2% and a specificity of 92.2%.

A comprehensive review on epidemiology, aetiopathogenesis, diagnosis and treatment of the novel coronavirus syndrome – COVID-19

Since the outbreak of the novel Coronavirus in December 2019 in Wuhan China, this novel Coronavirus disease(COVID-19) has spread worldwide taking not only epidemic proportions but with its rapid spread world health organization(WHO) was forced to declare it as a pandemic. The Severe Acute respiratory syndrome (SARS)-Coronavirus (CoV2) virus is responsible for clusters of severe respiratory illness that simulates acute respiratory syndrome that was what was initially. It is thought although that it is equivalent to the high altitude pulmonary oedema (HAPE), showing glass ground opacities in lungs. More experience is getting acquired with changes in treatment approaches from PEEP to avoid intubation and just ensure oxygen levels maintained. Human to human transmission through droplets, contaminated hands as well as surfaces, has been revealed with an incubation period varying from 2-14 days. Early diagnosis using reverse transcription polymerase chain reaction (RT-PCR) or computed tomography (CT) scan chest, quarantine, as well as supportive treatment are necessary for getting a cure. In this review we have tried to analyze the epidemiology, diagnosis, isolation, and treatment, including antiviral drugs like remdesivir, favipiravir, chloroquine and hydroxychloroquine, corticosteroids, antibiotics, and ivermectin. With 3 successful cases of convalescent plasma achieved in USA, trials going on in India along with vaccines are also detailed in this article.

Associations of abdominal muscle area and density with coronary artery calcium volume and density: The multi-ethnic study of atherosclerosis

BackgroundDue to the opposing cardiovascular risk profiles of CAC volume and density, we tested the hypothesis that increased abdominal muscle area (AMA) and density (AMD) were significantly associated with lower coronary arterial calcium (CAC) volume and higher CAC density. MethodsUsing data from 787 participants from the Multi-Ethnic Study of Atherosclerosis, Ancillary Body Composition Study, we analyzed abdominal and chest computed tomography (CT) scans. Abdominal scans were scored for muscle area, muscle density (attenuation) and visceral and subcutaneous fat. Chest scans were scored for CAC volume and Agatston values, which were used to derive CAC density scores. ResultsThe mean (SD) age and BMI of the participants was 67.8 (9.0) years and 27.9 (4.8) kg/m2, respectively. Forty-one percent were female, 46% were Caucasian, 60% had hypertension, 17% had diabetes, and 46% had dyslipidemia. AMA was positively associated with CAC volume (p < .001) and inversely associated with CAC density (p < .001). Conversely, AMD was inversely associated with CAC volume and positively associated with CAC density in minimally adjusted models (p < .001), but not significant in confounder adjusted models. ConclusionAMA and AMD had differing associations with CAC volume and density, with AMA significantly associated with a higher risk CAC profile (high volume, low density) and AMD not significantly associated with CAC volume or density. Future research needs to account for the unique components of both muscle composition and CAC.

Evaluation of chronic cough in children aged 2 year to 12 years

Background: Chronic cough is a common complaint in children which causes distress and affects the quality of life of parents and children. While cough may be seen as a common condition of childhood without serious consequences, ignoring a cough that may be the sole presenting symptom of an underlying illness can lead to delayed diagnosis and progression to a chronic respiratory morbidity. Aims and objectives of the study was to evaluate the specific diagnosis and prognosis of chronic cough in children aged 2 to 12 years.Methods: A prospective study was done in 100 children with chronic cough (history of cough &gt;4 weeks) at Narayana Hospital, Nellore. Routine investigations like complete blood count with differential count, Mantoux test, sputum examination, and X ray chest and other investigations like bronchoscopy, HIV, CT scan chest and paranasal sinuses, barium swallow, endoscopy and biopsy whenever needed. Pearson Chi square test carried out to quantify significance difference, p value &lt;0.05, considered significant.Results: The mean duration of chronic cough was 56.27 days (1-5 months). Most of the children belonged to &lt;6 years age with higher boys’ prevalence. Breathlessness and fever noticed in 79% cases; it was found mostly in pneumonia cases as compared to other diagnosis (p=0.001). Sputum production noticed in 4, which found to be bronchiectasis. 1 case noticed with regurgitation, which is gastro oesphageal reflux disease. History of triggers for the symptoms of cough, wheeze and breathlessness is found to have a significant correlation with asthma (p=0.000). Asthma in 14% of cases, of which 12 were mild persistent and 2 were moderate persistent. Tuberculosis was diagnosed in 14% cases, Pneumonia in 12% cases, and Bronchiectasis in 12 cases. Undernourished children noticed in 56%, maximum number in tuberculosis group. Asthma was associated with pneumonia, mucous plug obstruction and collapse lung. Recurrent pneumonia was associated with airway anomaly, gastro esophageal reflux disease.Conclusions: It should be remembered that a prolonged cough can be indicative of a more serious underlying condition, and always warrants thorough investigation.

A Review of Coronavirus Disease-2019 (COVID-19).

There is a new public health crises threatening the world with the emergence and spread of 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus originated in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, Hubei province, China in December 2019. There have been around 96,000 reported cases of coronavirus disease 2019 (COVID-2019) and 3300 reported deaths to date (05/03/2020). The disease is transmitted by inhalation or contact with infected droplets and the incubation period ranges from 2 to 14 d. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, malaise among others. The disease is mild in most people; in some (usually the elderly and those with comorbidities), it may progress to pneumonia, acute respiratory distress syndrome (ARDS) and multi organ dysfunction. Many people are asymptomatic. The case fatality rate is estimated to range from 2 to 3%. Diagnosis is by demonstration of the virus in respiratory secretions by special molecular tests. Common laboratory findings include normal/ low white cell counts with elevated C-reactive protein (CRP). The computerized tomographic chest scan is usually abnormal even in those with no symptoms or mild disease. Treatment is essentially supportive; role of antiviral agents is yet to be established. Prevention entails home isolation of suspected cases and those with mild illnesses and strict infection control measures at hospitals that include contact and droplet precautions. The virus spreads faster than its two ancestors the SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), but has lower fatality. The global impact of this new epidemic is yet uncertain.

Impact of pulmonary interstitial lesions on efficacy and prognosis of EGFR-TKI-treated advanced non-small cell lung cancers.

BackgroundThis study aimed to assess the impact of pre-existing pulmonary interstitial lesions (PIL) on the efficacy and prognosis of patients with epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC) treated with EGFR tyrosine kinase inhibitor (TKI).MethodsPatients with advanced NSCLC harboring EGFR exon 19 deletion (E19 del) or exon 21 (E21) L858R were enrolled in this study. All patients underwent high resolution computed tomography (HRCT) chest scans prior to EGFR-TKI treatment. Pre-existing PIL was graded according to HRCT imaging (PIL 0, 1, 2, and 3). Cox proportional-hazards regression models were used to identify the prognostic factors for progression-free survival (PFS).ResultsA total of 134 eligible patients were enrolled. The overall objective response rate (ORR) and median PFS were 73.1% and 10.0 months (95% CI: 7.51–12.49), respectively. There were 62 (46.3%), 25 (18.7%), 28 (20.9%), and 19 (14.1%) cases of PIL grade 0, 1, 2, and 3, respectively, with median PFS and ORR of 12.9 months and 80.6%, 11.0 months and 72.0%, 10.0 months and 71.4%, and 7.0 months and 52.6%, respectively. Multivariate analysis showed that squamous cell carcinoma (vs. adenocarcinoma, HR =4.33), E21 L858R (vs. E19 del, HR =1.57), and PIL grade 3 (vs. grade 0–2, HR =1.60–2.48) were poor prognostic factors for PFS (P<0.05 for all).ConclusionsPre-existing PIL grade is an independent prognostic factor for predicting resistance to EGFR-TKIs in patients with EGFR-mutant advanced NSCLC. Higher PIL grade suggests higher risk of early progression.

Role of soft tissue metastases on tumor progression in castrate-resistant metastatic prostate cancer.

214 Background: While visceral metastases in castrate resistant prostate cancer (mCRPC) are a negative prognostic factor, patients may still derive treatment benefits. Given varying anatomic sites of tumor may display differing treatment responses we investigated the role of soft tissue metastases in progressive disease (PD) by anatomic site. Methods: A retrospective review of anonymized patients enrolled in phase 3 clinical trials was performed. Patients were excluded if lacked Tc bone scan or CT chest, abdomen and pelvis (CT CAP) on trial. Subjects were included if they had soft tissue disease per RECIST 1.1. Bone disease was defined by automated BSLA criteria. All CT CAPs per clinical trial protocol were assessed by RECIST 1.1. Soft tissue PD was noted as target|nontarget lesion growth and/or presence of new lesions by anatomic site. Bone PD was defined by &gt;20% increase in BSLA score. Results: Of 322 total patients, 138 met criteria of soft tissue disease at baseline. Baseline anatomic sites of metastases per RECIST included: visceral (74, 53.6%), lymph node only (52, 37.7%) and soft tissue bone (12, 7.1%). PD occurred in 46 patients with baseline soft tissue disease; with PD first detected by BSLA (23, 16.7 %), RECIST (19, 13.8 %) or with PD occurring simultaneously by BSLA and RECIST (4, 2.9%). Of the 138 patients with baseline soft tissue disease, PD occurred by RECIST in 25 patients. This occurred due to worsening visceral (11, 68.8%), lymph node (4, 25.0%) or soft tissue bone (1, 6.3%) disease. PD by new lesions only occurred in 9 patients (36.0%), as a result of 77.8% visceral and 22.2% lymph node. Conclusions: In mCRPC with soft tissue disease at baseline, progression by BSLA bone score still accounts for a large portion of PD. Further analyses must be performed to better differentiate disease phenotypes amongst mCRPC with combined visceral/osseous disease.

Abstract OT2-04-05: Pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease: Translational Breast Cancer Research Consortium (TBCRC) 44 trial

Abstract Background: Chest wall recurrence can occur as a complication of breast cancer. This type of breast cancer is difficult to treat with short-lived responses to therapy, and associated with the development of distant metastases. Better therapies are needed in this setting. Immune checkpoint inhibition is being explored in breast cancer, with an immunotherapy agent currently approved for triple-negative breast cancer (TNBC). We hypothesize that pembrolizumab, an anti-programmed cell death 1 (PD-1) antibody, may be effective in treating chest wall recurrence of breast cancer given the inflammatory nature of this disease and high expression of PD-1 seen in tumors with lymphovascular invasion that may predispose patients to chest wall recurrence. Platinum chemotherapy may augment anti-tumor immunity, with the combination of pembrolizumab and carboplatin shown to be effective in advanced lung cancer. This study is evaluating the efficacy of pembrolizumab and carboplatin for breast cancer patients with chest wall disease. Methods: In this phase II study, 84 patients are being randomized 2:1 to treatment with pembrolizumab in combination with carboplatin (Arm A) versus carboplatin alone (Arm B) with an option to cross over to pembrolizumab alone (Arm Bx) on progression. Pembrolizumab is dosed at 200 mg IV every 3 weeks, and carboplatin is dosed at AUC 5 IV every 3 weeks. Patients may have TNBC, hormone receptor positive (HR)+/HER2- breast cancer that has progressed on 2 prior lines of hormone therapy, or refractory HER2+ breast cancer (may continue herceptin). Patients may have distant metastases, but must have surgically unresectable disease. Prior chest wall radiation is allowed. The primary endpoint is to determine the disease control rate (chest wall and distant sites) at 18 weeks of treatment. Patients undergo chest wall assessments with photography of skin lesions with every cycle of treatment, and imaging (CT chest, abdomen, and pelvis, and bone scan) every 2 cycles to evaluate for progression. The study is powered to determine a 20% difference in disease control rates between arms A and B (hazard ratio of 0.52, α= 0.10, β= 0.20). Secondary endpoints include response stratified by tumor programmed death ligand 1 (PD-L1) expression, progression free survival, response by irRECIST, and toxicity. The study incorporates many translational studies using chest wall biopsy tissue collected at baseline and after 2 cycles of treatment, as well as correlative blood tests, including assessing changes in tumor and blood PD-L1 expression, circulating cell-free DNA, circulating tumor cells, soluble PD-L1 expression, and changes in the expression of MYC, an oncogene that may upregulate the expression of PD-1. Patients are currently being enrolled at 7 sites in the TBCRC. As of July 2019, 30 patients are enrolled. This study is supported by Merck and the TBCRC. (NCT03095352). Citation Format: Neelima Vidula, Rita Nanda, Kathy Miller, Vandana Abramson, Paula Pohlmann, Adam Brufsky, Ben Park, Minetta Liu, Andrei Goga, Hope S. Rugo. Pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease: Translational Breast Cancer Research Consortium (TBCRC) 44 trial [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT2-04-05.

Clinical features and high resolutionCT imaging findings of preliminary diagnosis novel coronavirus pneumonia

Objective To summarize the clinical characteristics of 141 patients with novel coronavirus pneumonia (NCP) and the imaging characteristics of High Resolution CT(HRCT) in the chest. Methods From January 20, 2020 to 28, 141 NCP patients, 77 males and 64 females, with a median age of 49 (9,87), were retrospectively analyzed. The clinical features, laboratory examination indexes and HRCT findings of 141 NCP patients were analyzed. Results In 141 NCP patients, 38 (26.95%) had a decrease in leukocyte count and 71 (50.35%) had a decrease in lymphocyte ratio. Among 141 NCP patients, 139 (98.58%) had fever (over 37.5 ° C), 106 (75.18%) coughed, 11 (7.80%) had headache, 41 (29.08%) coughed up sputum, 93 (65.96%) had chest distress, and 4 (2.84%) had diarrhea. HRCT of 141 NCP patients were abnormal, 52 (36.88%) showed ground glass shadow (GGO) and patchy shadow, mainly subpleural distribution; 23 (16.31%) showed GGO with focal consolidation; 27 (19.15%) had small patchy blur; 20 (14.18%) had large patchy consolidation; 48 (34.04%) had bronchovascular bundle thickening and vascular perforator sign; 5 (3.55%) had Air bronchus sign; small nodule shadow in 7 cases (4.96%); fibrosis, grid shadow or strip shadow in 5 cases (3.55%); bilateral pleural effusion in 7 cases (4.96%); mediastinal or bilateral hilar lymphadenopathy in 4 cases (2.84%). Conclusions The clinical features and HRCT images of NCP are various. Under the specific epidemiological background of NCP, HRCT scan of chest should be carried out in time to make early warning of disease. Key words: Novel coronavirus pneumonia; Tomography, X-ray computed

Pulmonary arteriovenous malformation and follow-up imaging.

Image in medicine An 85-year-old Caucasian female with past medical history of hypertension, hyperlipidemia, polymyalgia rheumatica, coronary artery disease, Osler-Weber-Rendu syndrome (diagnosed 18 years ago), intermittent epistaxis and pulmonary arteriovenous malformation (AVM) was referred to the clinic for abnormal chest imaging. She underwent multiple bilateral AVM embolization 17 years ago. She had minimal shortness of breath without epistaxis, hemoptysis, hematemesis or hematochezia. One month ago, her chest X-ray revealed multiple embolization coils bilaterally (A). Computed tomography (CT) chest scan without contrast showed multiple embolization coils, multiple tortuous vascular malformations in both lungs with enlargement of left lower lobe AVM (B). Magnetic resonance imaging (MRI) brain 17 years ago did not show brain vascular malformation. The diagnosis of progressive Osler-Weber-Rendu or hereditary hemorrhagic telangiectasia (HHT) was made. She was referred to HHT center and underwent coiling. After that, she has been clinically stable and a repeat CT chest on the follow-up visit showed smaller left lower lobe AVM (B), so conservative management was planned. Figure 1 A) chest X-ray showing multiple embolization coils bilaterally; B) CT chest without contrast showing large AVM at left lower lobe (arrow); C) a repeat CT chest without contrast one year later showing smaller AVM at left lower lobe after coiling (arrow)

Case Report for Two Hemodialysed Patients Diagnosed for COVID-19 at the Donka National Hemodialysis Center

In December 2019, coronavirus disease (COVID-19) due to infection with the novel SARS-CoV-2 virus began to break out. Hemodialysis patients are at high risk because of the co-morbidities. We report the clinical and biological characteristics of two patients who developed COVID-19 infection in our dialysis center in Donka National Hospital. None of the patients had contact with an infected person. The age was 38 and 54 years. The symptoms common to both patients were: fatigue, diarrhea, fever. Lymphopenia was present in both patients. None of them had a chest X-ray or chest scan because they were positive for the test before admission.

This is how breast cancer should not be managed!

Image in medicine We are presenting a case of a 54-year-old lady who was referred to us following a recent catastrophic incomplete excision done by a general surgeon for a locally advanced right breast 62mm invasive ductal carcinoma, grade III, estrogen and progesterone positive, Her2 negative disease, with no axillary procedure initially carried out. We treated her with completion mastectomy and axillary lymph node clearance followed by adjuvant chemotherapy and radiotherapy as well as hormonal treatment. Locally advanced breast cancer is a complex entity which needs expert management; appropriate imaging at presentation, including digital mammogram as well as breast ultra sound scan, followed by breast and axillary biopsies to delineate cancer characteristics is standard practice. Staging computed tomography (CT) chest, abdomen and pelvis scan is reserved for locally advanced disease or nodal involvement. Multi-disciplinary team input discussing options of neo-adjuvant (endocrine/chemotherapy) treatment to downstage the tumour before surgical treatment ensures a better outcome. Also, breast to tumour volume ratio assessment as well as the use of oncoplastic breast resection techniques can avoid such a drastic outcome. Silk sutures are not used any more to close breast incisions; also if a drain is needed, a small-bore closed system suction drain should be placed rather than a corrugated rubber drain. Figure 1 postoperative picture following right breast wide local excision

Lack of early systematic investigations among young victims of sudden cardiac arrest

Since a large proportion of patients resuscitated from out-of-hospital sudden cardiac arrest (SCA) die in the intensive care unit (ICU), early systematic investigation towards identifying etiology may be crucial to ensure appropriate future prevention among relatives, especially when the index case is young. We hypothesized that etiologic investigations were not initiated in a timely manner in a significant proportion of young SCA patients prior to death. In this prospective ongoing multicenter, population-based registry (6.7 million inhabitants), data from all SCA over a 5-year period were analyzed with a specific focus on young patients (< 45 year-old) alive at hospital admission and who eventually died in ICU. Investigations and diagnoses arrived at were analyzed from the medical records by two cardiologists for each case. Of the 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 3,028 were admitted alive to ICU. Among them, 2,190 (72.3%) died in ICU, including 367 (16.8%) young cases (< 45 y.o.). Among the young patients, while 163 cases (44.4%) had a specific diagnosis established, 204 (55.6%) remained unexplained. Coronary angiograms (18.3%), CT scan (brain and chest) (24.5%), and transthoracic echocardiography (29.1%) were all underutilized. Main SCA causes were acute coronary syndrome (44.5%), followed by structural non-ischemic heart disease (25.5%), pulmonary embolism (13.6%), chronic CAD (10%), non-structural heart disease (1.8%) and miscellaneous (4.6%). The proportion of autopsy (10.9%), as well as blood sample collection for further genetic testing (1.4%) was low. Information on family screening was rarely provided in the ICU. More than half of young SCA cases who died in ICU remained unexplained. Efforts to promote early systematic investigation through better collaboration between intensivist and cardiologist may improve future targeted preventive strategies for family members.

Radiology Features of Chest Imaging and Its Correlation to Clinical Severity in Patients with COVID-19

<i>Background:</i> COVID-19 caused by SARS CoV-2 involves respiratory system leading to respiratory failure and Acute Respiratory Distress Syndrome (ARDS) in critical patients. Several chest imaging features have been reported in patients with COVID-19 ranging from focal to diffuse lung opacities. There is no data from Saudi Arabia on the chest imaging findings in these patients. <i>Material and Methods:</i> CT chest data of 29 patients who were admitted with confirmed diagnosis of COVID-19 by real-time reverse transcriptase polymerase chain reaction (RT-PCR) was reviewed. Radiology abnormality was categorized based upon pattern and distribution. Clinical and laboratory data of patients were collected by reviewing the electronic medical record. Patients were divided into mild and severe group based on clinical assessment and laboratory criteria. Radiology changes were compared with disease severity. <i>Results:</i> Median (Q1, Q3) age was 58 (41,70) years and median (Q1, Q3) time from symptom onset to CT scan was 6.5 (3.0, 9.75) days. Bilateral ground glass opacities were the most common CT scan feature in patients with COVID-19 (76%). Opacities were dominant in the lower zone (72%) and frequently distributed peripherally (48%). Severe disease was most likely to have bilateral opacities compared with mild (p = 0.001) and it was correlated with rise of inflammatory markers, Ferritin (p=0.014) and C-reactive protein (p=0.0003). <i>Conclusion:</i> Most patients with COVID-19 who have abnormal CT scan of chest show ground glass opacities. Bilateral opacities are more common in severe disease and is correlated with elevated inflammatory markers.

Aftermath of pulmonary tuberculosis: computed tomography assessment

PurposePulmonary tuberculosis (PTB) has clinically significant sequelae, even after recommended treatment completion. It is important to recognise these sequelae for accurate assessment of severity and treatment planning, if indicated.Material and methodsWe retrospectively analysed contrast-enhanced computed tomography (CT) scans of chest of 100 patients with previous history of treated pulmonary tuberculosis, excluding those with active pulmonary disease. CT findings were analysed based on parenchymal, airway, pleural, mediastinal, and vascular sequelae of PTB.ResultsParenchymal sequelae included fibrosis with architectural distortion and volume loss (90%), cavities (21%) (with aspergillomas noted in 19% of these cases), and tuberculomas (54%). Airway involvement was noted as bronchiectasis (77%) and bronchial stenosis (4%) but none with broncholithiasis. Mediastinal sequelae included lymph node calcification (74%), fibrosing mediastinitis (1%), and pericardial tuberculosis (2%). Pleural sequelae included pleural thickening (22%), with 40.9% of these patients showing calcifications, and one patient with chronic chylous pleural effusion. Vascular sequelae included Rasmussen aneurysms (4%), enlarged bronchial arteries (3%), and systemic bronchial collaterals in 1% of our patients.ConclusionsPTB has multiple appalling sequelae, which require due attention and appropriate treatment in symptomatic cases. Radiological evaluation forms an integral part in patient assessment and decision making.

Comparative study of lung ultrasonography and chest radiography in suspected cases of pneumonia in critically ill patients

Objective: To evaluate the diagnostic performance of lung ultrasonography (LUS) in comparison to chest radiography in suspected cases of pneumonic consolidation in critically ill patients. Setting and Design: From October 2012 to May 2014, bedside lung ultrasonography was performed on 55 patients presenting to the emergency room with respiratory symptoms suggestive of pneumonia. Materials and Methods: Patients fitting the above criteria were evaluated with a chest radiograph and lung ultrasonography on the same day. A CT scan of chest was performed in cases with clinical suspicion of complications or wherever it was clinically indicated. Clinical course of the patient in hospital, lab parameters and CT scan of the chest (wherever available) was taken as a confirmation of pneumonia. Estimation of the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and overall diagnostic accuracy of chest sonography and chest radiography was done. Results: Out of 55 patients, a final diagnosis of pneumonic consolidation was made by the treating senior physician in 40 patients. Pneumonia was correctly diagnosed by LUS in 39 of 40 cases (97.5%) and by X-ray in 28 of 40 cases (70%). On the other hand, pneumonia was correctly ruled out by LUS in 14 of 15 patients (93.3%) and by X-ray in 13 of 15 patients (86%). Conclusion: Sensitivity, specificity and diagnostic accuracy of lung ultrasound is better than chest radiography in diagnosing pneumonic consolidation in critically ill patients.

Primitive Neuroectodermal Tumor of Cervix: Report of a Rare Case and Review of Literature

Background – Primitive neurocetodermal tumor / Ewing’s sarcoma (PNET/ES) of uterine cervix is extremely rare tumor and only 27 cases have so far been reported in the literature. We hereby present one case report diagnosed by histopathology and IHC and review of literature. Objective –A young girl aged 20 years was admitted. Her routine investigations and CT and MRI scan of chest, abdomen and pelvis were performed. Biopsy was taken from vaginal mass and histopathologist reported as round cell tumor. The slides were reviewed by another pathologist and found to be rhabdomyosarcoma. Thus immunohistopathology was done and a diagnosis of PNET/ES was established. Methods – The patient presented with complains of vaginal bleeding, generalized body ache, poor nutritional intake, found extensive loco regional disease with metastases to liver, lung and multiple bones, stage FIGO IV, performance score ECOG -4. Owing to her low general condition, we could not plan any anti-cancer treatment like chemotherapy or radiation therapy. She was discharged on symptomatic treatment. Results – Her biopsy and immunohistopathology turn out to be PNET/ES of uterine cervix. Conclusion - The rarity of this entity poses a challenge to pathologists and oncologists. The PNET/ES of uterine cervix can be potentially curable if presented at an early stage and found operable. IHC plays an important role in establishing this rare diagnosis.

Airway wall thickness and airflow limitations in asthma assessed in quantitative computed tomography.

Background:Asthma is a frequent chronic disease of the airways. In spite of the fact that symptoms of asthma are well known, the pathogenesis has not yet been fully understood. Quantitative computed tomography (qCT) of the lung allows for the measurment of a set of parameters. The aim of this study was to evaluate the usefulness of quantitative computed tomography in the assessment of airway wall thickness in asthma.Methods:The prospective study was performed on a group of 83 patients with well-defined, long-term asthma between 2016 and 2018. The control group was composed of 30 healthy volunteers. All examined subjects were non-smokers. All computed tomography (CT) studies were performed using a 128 multi-slice CT scanner with no contrast, following a chest scanning protocol in the supine position, at full inspiration and breath-holds.Results:Quantitative bronchial tree measurements were obtained from the third up to the ninth generation of the posterior basal bronchi (B10) of the right lung in a blinded fashion. The value of the wall thickness in patients with asthma was significantly higher in all measured generations of the bronchial tree (third to ninth generation). The lumen area and the inner diameter significantly correlated with the lung function tests and were substantially smaller in the examined group from the seventh to the ninth generation of the bronchi (p < 0.05).Conclusions:We conclude that airway remodelling occurs in most patients with long-term asthma and is associated mainly with the medium and small airways. Imaging techniques, especially qCT can be useful in the diagnosis and management of asthma. The reviews of this paper are available via the supplemental material section.