Chest Ultrasonography Research Articles

Chest ultrasonography compared to chest x-ray in pneumothorax patients before intercostal tube removal

Chest ultrasonography compared to chest x-ray in pneumothorax patients before intercostal tube removal

Chest Sonography in the Diagnosis of Pneumothorax

Few studies have assessed the utility of chest ultrasonography in the diagnosis of pneumothorax in India. Chest ultrasonography was undertaken in 126 haemodynamically stable patients, followed by a chest radiograph within 30 minutes. If pneumothorax was not seen on the chest radiograph, a non-contrast computed tomography of the thorax was performed within 3 hours. The time taken to make or exclude a diagnosis of pneumothorax, by ultrasonography, was assessed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of chest ultrasonography was estimated. For the diagnosis of pneumothorax in any clinical situation, the average time taken on ultrasonography was less than 2 minutes. The sensitivity, specificity, accuracy, PPV and NPV of chest ultrasonography was 89%, 88.5%, 88.9%, 96.7% and 67.6%, respectively. Chest ultrasonography can be used as a primary imaging modality in the diagnosis of pneumothorax in a vast variety of clinical situations.

Chest Sonography in the Diagnosis of Pneumothorax

Few studies have assessed the utility of chest ultrasonography in the diagnosis of pneumothorax in India.Chest ultrasonography was undertaken in 126 haemodynamically stable patients, followed by a chest radiograph within 30 minutes. If pneumothorax was not seen on the chest radiograph, a non-contrast computed tomography of the thorax was performed within 3 hours. The time taken to make or exclude a diagnosis of pneumothorax, by ultrasonography, was assessed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of chest ultrasonography was estimated.For the diagnosis of pneumothorax in any clinical situation, the average time taken on ultrasonography was less than 2 minutes. The sensitivity, specificity, accuracy, PPV and NPV of chest ultrasonography was 89%, 88.5%, 88.9%, 96.7% and 67.6%, respectively.Chest ultrasonography can be used as a primary imaging modality in the diagnosis of pneumothorax in a vast variety of clinical situations.

Evaluation of role of chest sonography in assessment of patients presenting with shock to emergency department

Evaluation of role of chest sonography in assessment of patients presenting with shock to emergency department

ULTRASOUND AS AN AID TO DIAGNOSIS IN DENGUE

Objective: To determine the ultrasound findings in patients with dengue fever and to evaluate their relationship with laboratory parameters. Study Design and Setting: This prospective cross-sectional study was conducted at –removed for blind review---from September 2020 to August 2021. Methodology: Total of 248 patients diagnosed with dengue fever, fulfilling the exclusion and inclusion criteria, were included in the study. Demographic data was recorded on a structured proforma. Serological confirmation along with complete blood counts and liver function tests were obtained. Abdominal and chest ultrasounds were conducted in all patients. The ultrasonographic features of these patients were analyzed with laboratory investigations through SPSS version 23. Student’s t-test and Chi-square tests were used assessingess the association between the ultrasonographic findings and laboratory features. A P-value of <0.05 was considered significant. Results: The most common ultrasonographic feature among dengue patients was acalculous cholecystitis (49.6%) followed by hepatomegaly (47.2%), splenomegaly (46.8%), altered echotexture of the liver (46.4%), ascites (37.5%) and pleural effusion (7.3%). Acalculous cholecystitis and ascites were significantly associated with severe thrombocytopenia and increasing hematocrit. Acalculous cholecystitis, ascites, pleural effusion and altered echotexture of the liver were associated with raised transaminases. A low platelet count showed the strongest relationship with sonographic features of capillary leak syndrome. Conclusion: Ultrasound is a useful investigation to diagnose severe, critical dengue. The development of ultrasonographic features should prompt proactive management of these patients in order to prevent emergence of severe complicated dengue.

Neonatal cardiorespiratory imaging-a multimodality state-of-the-art review.

Advanced cardiorespiratory imaging of the chest with ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) plays an important role in diagnosing respiratory and cardiac conditions in neonates when radiography and echocardiography alone are not sufficient. This pictorial essay highlights the particularities, clinical indications and technical aspects of applying chest US, cardiac CT and cardiorespiratory MRI techniques specifically to neonates, summarising the first session of the European Society of Paediatric Radiology's cardiothoracic task force.

Imaging Findings in A Rare Case of Congenital Intrapericardial Herniation of Liver

Congenital intrapericardial liver herniation via a diaphragmatic defect associated with a peritoneo-pericardial communication is extremely rare and poses a diagnostic dilemma for clinicians. Radiological investigations play an unparalleled role in arriving at an accurate diagnosis. We, therefore, describe the imaging findings on chest roentgenogram, computed tomography, and ultrasonography in a four-day-old infant who presented with difficulty in breathing since birth and was eventually diagnosed as having herniation of the left lobe of the liver into the pericardium. Both ultrasonography and computed tomography can detect the disease by demonstrating anatomical and vascular continuity of the presumed intrapericardial mass with the liver. The correct diagnosis of this unusual condition is essential because surgical management is simple and distinct from other intrapericardial masses. Keywords: Intrapericardial liver herniation, Congenital diaphragmatic hernia, Peritoneo-pericardial defect

Can Chest Ultrasound Replace Chest X-ray in Thoracic Surgery?

Background: There is growing evidence that supports the use of chest ultrasound (CUS) versus conventional chest X-ray (CXR) in order to diagnose postoperative complications. However, data regarding its use after thoracic surgery are scarce and contradictory. The aim of this study was to conduct a systematic review to evaluate the accuracy of CUS after thoracic surgery. Methods: An electronic search in MEDLINE (via PubMed), complemented by manual searches in article references, was conducted to identify eligible studies. Results: Six studies with a total of 789 patients were included in this meta-analysis. Performing CXR decreased in up to 61.6% of cases, with the main reasons for performing CXR being massive subcutaneous emphysema or complex hydrothorax. Agreement between CUS and routine-based therapeutic options was, in some studies, up to 97%. Conclusions: The selectively postoperative use of CUS may reduce the number of routinely performed CXR. However, if CUS findings are inconclusive, further radiological examinations are obligatory.

Bedside Chest Ultrasound in Postoperative Pediatric Cardiac Surgery Patients: Comparison With Bedside Chest Radiography

The primary objective was to study the degree of agreement between the chest ultrasound (CUS) studies and chest x-ray (CXR) studies in postoperative pediatric cardiac surgical patients regarding the diagnosis of thoracic abnormalities, and also to compare the diagnostic performance of CUS in reference to CXR for the detection of thoracic abnormalities. The secondary objective was to compare the necessity for interventions done on the basis of CUS and CXR findings in the postoperative setting. A prospective observational study. At a postoperative pediatric cardiac surgical intensive care unit in a tertiary-care center. One hundred sixty patients between the age of 2 months to 18 years undergoing elective cardiac surgery for various congenital heart diseases. After obtaining permission from the institutional ethics committee, 160 pediatric cardiac surgical patients were studied prospectively in the postoperative period. On the day of surgery (postoperative day [POD] 0), bedside CXR was done in the immediate postoperative period. After bedside CXR, CUS examination was performed and then interpreted by the principal investigator. The CXR was interpreted by the surgical team. Provisional diagnosis was made by the principal investigator and surgical team. Any intervention required was decided based on CXR or CUS findings or both. The procedure was repeated in the morning of POD 1. The degree of agreement between CUS studies and CXR studies in detecting abnormalities was evaluated by Cohen's kappa (k) statistics. The diagnostic performance of CUS was compared with that of CXR using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Overall, kappa analysis (k) showed substantial agreement between the findings of the CUS and CXR studies (k=0.749). The diagnostic performance of CUS, as compared with CXR, was found to have a sensitivity of 96.9%, specificity of 84.75%, PPV of 73.4%, NPV of 98.43%, and diagnostic accuracy of 88.44%. In 94 abnormal findings, the interventions were done based on CUS or CXR findings or both. Overall, there was a substantial agreement (k=0.787) between CUS and CXR regarding the necessity for interventions. The degree of agreement between CUS and CXR studies was substantial for atelectasis, interstitial edema, and diaphragmatic weakness. The degree of agreement between CUS and CXR studies was almost perfect for pneumothorax and fair for pleural effusion. More CUS studies detected intrathoracic pathologies than CXR studies. The CUS also detected abnormalities earlier than CXR and was found to be useful for the early institution of intervention therapy in patients with interstitial edema and atelectasis. It would be reasonable to conclude that CUS may be considered in some instances as an alternative to CXR.

Accuracy of chest ultrasonography in the diagnosis of coronavirus disease 2019 pneumonia

Abstract Background Coronavirus disease 2019 (COVID-19) virus infection is an ongoing, catastrophic, worldwide pandemic with significant morbidity and mortality. Large numbers of people who are getting COVID-19 virus infection are at high risk of developing COVID-19 pneumonia; early diagnosis of COVID-19 pneumonia, patient care, and isolation using simple, less expensive images are required. High-resolution computed tomography chest (HRCT chest) is the reference standard method for the diagnosis of COVID-19 pneumonia; however, it is expensive with increasing the exposure risk; chest ultrasonography (CUS) may be an alternative method. Patients and methods CUS is performed on patients accepting to participate in the study at presentation of COVID-19 suspicious cases. HRCT chest to confirm COVID-19 pneumonia were done within 24 h of CUS examination. Two chest consultants who are experts in CUS at Assiut University Hospital performed CUS. The CUS is done using a convex probe of 3.5 MHz. The CUS was considered positive for pneumonia if the examiners find the presence of abnormal multiple vertical B lines with or without the presence of consolidation dots unilateral or bilateral with good cardiac function; HRCT chest results are recorded. Results In all, 197 patients were included in the study (102 males, mean age 48 ± 16.2 years). Regarding comorbidity: 10% had diabetes mellitus and 9% had hypertension. Ten (5%) patients needed hospitalization with a mean oxygen saturation of 95 ± 5%. One hundred fifty-two patients confirmed COVID-19 pneumonia with HRCT chest, while 45 patients had normal HRCT chest. CUS showed positive pneumonic finding in 128 patients and normal picture in 69 patients. There was good association (r=0.690, P<0.001) between both diagnostic modalities in COVID-19 pneumonia diagnosis. Sensitivity and specificity and accuracy of CUS in the diagnosis of COVID-19 pneumonia were 84.56, 95.83, and 87.31%, respectively, when compared with HRCT chest. One hundred and two patients were successfully followed; all of them showing clinical and ultrasonographic improvement.

Predictive value of chest ultrasound in differentiation between cardiogenic and noncardiogenic pulmonary edema

Background Adult respiratory distress syndrome (ARDS) and acute cardiogenic pulmonary edema (CPE) are common clinical issues. Based on clinical data, it is a big challenge to differentiate between both. Secondary to many limitations of computed tomography, chest ultrasound (CUS) provides pleuropulmonary signs that help in differentiation. Objective The current work aimed to assess the accuracy of CUS in differentiating CPE from ARDS. Patients and methods This is a cross-sectional study conducted on patients admitted to different ICUs with pulmonary edema, comprising 25 patients with CPE and 35 patients with ARDS. CUS, ECG, echocardiography, and chest radiograph were done for all patients. Results The mean age of patients with ARDS was 48.90±11.23 years, whereas the mean age of patients with CPE was 49.10±10.10 years. The majority of both groups were males. Systolic dysfunction and pneumonia were the most frequent etiology in CPE and ARDS, respectively. All patients in both groups had alveolar-interstitial syndrome. Pleural line, absence of lung sliding, and the spared area were presented in all cases with ARDS and absent in those with CPE. Moreover, none of those with CPE had lung pulse, but this finding was presented in 18 (51.4%) patients with ARDS. Conclusion CUS can help in differentiating ARDS from CPE in clinical practice. Based on CUS findings, absent or reduced lung sliding, pleural line abnormalities, and spared areas are diagnostic of ARDS.

Role of chest ultrasonography in the diagnosis of the causes of acute respiratory failure

Abstract Objective To evaluate the role of chest ultrasonography (US) in diagnosing the causes of acute respiratory failure (ARF). Background ARF is a common critical problem and can arise from many diseases. Several modalities such as chest radiograph, US, and computed tomography (CT) scan are being used to diagnose and detect the causes of ARF. Patients and methods The study included 50 patients with ARF admitted to the ICU of Menoufia University Hospital and ICU of Kafr El-Sheikh Chest Hospital. We compared between chest radiograph, chest US, and CT as diagnostic tools to detect the etiology of ARF. Results The sensitivity, specificity, positive predictive value, and negative predictive value and accuracy of lung US in the detection of chest disorders causing ARF were 93.7, 50, 97.8, 45, and 92%, respectively, compared with chest CT as a gold-standard Bedside Lung Ultrasonography in Emergency department protocol was used in the diagnosis of different causes of ARF. Lung US was free in 6% of patients, A profile was found in 12%, A’ profile was found in 2%, A’ profile with anechoic area or hypoechoic area in 6%, B profile was found in 12%, B’ profile in 12%, B’ profile with anechoic area or hypoechoic area in 32%, A/B profile in 6%, no color sign was found in 10%, and hypoechoic simple effusion in 2% of selected patients. Conclusion Chest US is a reliable, quick, bedside, low-cost, noninvasive, and nonionizing imaging tool for early detection of chest-disease causes of ARF.

Chest ultrasound as a differentiating modality between pneumonia and pulmonary edema

Abstract Background Chest ultrasound is still impressing physicians with its capabilities in variable lung disorders. Aim To assess the effectiveness of chest ultrasound as a diagnostic and a differentiating modality in cases of pneumonia and pulmonary edema. It also evaluates chest sonography effectiveness in follow-up of patients with pneumonia and pulmonary edema. Patients and methods Chest ultrasound, chest radiograph, and computed tomography (CT) chest were performed on patients on their arrival, as well as on day 7 and 14 of admission. Patients were divided into group 1, which included 30 patients with clinically consistent signs of pneumonia based on respiratory signs and symptoms in accordance with the American Thoracic Society guidelines 2016, and group 2, which included 15 patients with clinically consistent signs of pulmonary edema. Results The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ultrasound in the follow-up of pneumonia and pulmonary edema were 100% each. The sensitivity, specificity, PPV, NPV, and accuracy of chest radiograph in the follow-up of pneumonia on day 7 were 100, 90, 81.2, 100, and 93.1%, respectively, but for pulmonary edema were 91.7, 66.7, 91.7, 66.7, and 86.7%, respectively. However, the sensitivity, specificity, PPV, NPV, and accuracy of CT chest in the follow-up of pneumonia on day 7 were 88.9, 100, 100, 95.2, and 96.6%, respectively, whereas the sensitivity, specificity, PPV, NPV, and accuracy of CT chest in the follow-up of pulmonary edema on day 7 were 33.3, 100, 85.7, 100, and 86.7%, respectively. Conclusion Chest ultrasound might be a dependable method in the diagnosis and follow-up of pneumonia cases as well as differentiating pulmonary edema, both cardiogenic and noncardiogenic.

Mediastinitis associated with a subcutaneous abscess in the chest of a toddler

A 2-year-old boy presented with 3 days of fever (highest, 39·4°C), and physical examination showed that he had cervical swelling. His white blood cell count was 14·9 × 103/mm3 (reference 4·2–19·5 × 103/mm3), 86·6% neutrophils, and the C-reactive protein concentration was 290·4 mg/L (reference <1·5 mg/L). Neck and chest ultrasonography revealed subcutaneous fluid in the chest. Contrast-enhanced MRI showed an abscess from the chest wall infiltrating the mediastinum (figure), with no osteomyelitis or abscess in the pharynx and larynx.

Diaphragm impairment in patients admitted for severe COVID-19.

Among patients affected by the virus COVID-19, physicians have observed ventilation disorders. It is relevant to assess neurological involvement, including the role of diaphragmatic function. Its possible impairment could be related to the systemic inflammatory response and disease progression that both typify COVID-19 infection. We distinguished two groups (severe group (SG) and mild group (MG)) according to the severity of respiratory symptomatology. We performed neurophysiological and sonography studies to evaluate the diaphragmatic function. Regarding the sonography variables, we identified statistically significant differences in the right mean diaphragmatic thickness along with the expiration, showing 1.56 mm (SEM: 0.11) in the SG vs 1.92 mm (SEM: 0.19) in the MG (p = 0.042). The contractibility of both hemidiaphragms was 15% lower in the severe group, though this difference is not statistically significant. In our examination of the neurophysiological variables, in the amplitude responses, we observed a greater difference between responses from both phrenic nerves as follows: the raw differences in amplitude were 0.40 μV (SEM: 0.14) in the SG vs 0.35 μV (SEM: 0.19) in the MG and the percentage difference was 25.92% (SEM: 7.22) in the SG vs 16.28% (SEM: 4.38%) in the MG. Although diaphragmatic dysfunction is difficult to detect, our combined functional and morphological approach with phrenic electroneurograms and chest ultrasounds could improve diagnostic sensitivity. We suggest that diaphragmatic dysfunction could play a relevant role in respiratory disturbance in hospitalised patients with severe COVID-19.

Sonographic findings of thoracic empyema: outcome perspectives

BackgroundDespite advances in antimicrobial therapy and a range of drainage techniques for the infected pleural area, thoracic empyema continues to be a serious reason behind morbidity and mortality. Although chest ultrasonography has been found to be an efficient diagnostic tool for pleural effusion features, it is rarely utilized to predict the outcomes of pleural illnesses.Aim of the workTo determine the impact of sonographic patterns in predicting the outcomes of thoracic empyema patients.Patients and methodsIn this retrospective study, patients were divided into four groups based on their sonographic patterns: (I) complex non-septated effusions (plankton sign), (II) complex fixed septated effusions, (III) complex mobile septated effusions, and (IV) homogenously echogenic effusions (hematocrit sign). These sonographic patterns were compared to the patients’ co-morbidities, length of stay in the hospital, chest tube drainage, and medicinal or surgical therapy effectiveness.ResultsIn comparison with other sonographic pattern groups, patients in group I (70.6%) and group IV (45.5%) had effective thoracic tube drainage with a very high statistically significant difference (P value < 0.001). For patients in group II (75%) (P value < 0.001), open thoracotomy was a very highly significant effective therapy (P value 0.001).ConclusionThe sonographic pattern of thoracic empyema is a useful tool for guiding treatment decisions in these patients.

Prediction of preoperative intrathoracic adhesions for ipsilateral reoperations: sliding lung sign

IntroductionVideo-assisted thoracic surgery (VATS) for ipsilateral reoperations is controversial, because after the first surgical intervention, pleural adhesions occur frequently in the thoracic cavity and/or chest wall. This study assessed the usefulness of preoperative ultrasonography to reduce the incidence of lung injury at the time of the initial port insertion during secondary ipsilateral VATS.Materials and methodsThis was a retrospective, single-center study. Nine patients who underwent thoracic surgery at Vanvitelli Hospitalfrom September 2019 to February 2022, were scheduled for a second VATS surgeryon ipsilateral lung, because of inconclusive intraoperative histologic examination. All nine patients underwent preoperative ultrasonography to assess the possible presence of pleural adhesions. We evaluated the lung sliding, since the presence of pleural adhesions does not permit to appreciate it.Statistical analysisHard severe adhesions were observed in all nine patients without sliding lung sign (specificity 100%). In this series, the sensitivity, PPV, and NPV of the sliding lung sign were 93%, 100% and 94% respectively.ResultsThe presence of the lung respiratory changes can be evaluated as the “sliding lung sign” by chest ultrasonography; we believe that the sliding lung sign might also predict intrathoracic adhesion.ConclusionsPreoperative detection of pleural adhesions using transthoracic ultrasonography was useful for ipsilateral secondary pulmonary resection patients undergoing VATS. Using preoperative ultrasonography can improve the safety and feasibility of placing the initial port in VATS.

Test Characteristics of Chest Ultrasonography for Rib Fractures Following Blunt Chest Trauma: A Systematic Review and Meta-analysis

Chest ultrasonography has been reported as an accurate imaging modality and potentially superior to chest radiographs in diagnosing traumatic rib fractures. However, few studies have compared ultrasonography to the reference standard of computed tomography (CT), with no systematic reviews published on the topic to date. Our objective was to summarize the evidence comparing the test characteristics of chest ultrasonography to CT in diagnosing rib fractures. This study was performed and reported in adherence to PRISMA guidelines. We searched 5 databases plus gray literature from inception to October 2021. Two independent reviewers completed study selection, data extraction, and a QUADAS-2 risk of bias assessment. Summary measures were obtained from the Hierarchical Summary Receiver Operating Characteristic model. From 1,660 citations, we identified 7 studies for inclusion, of which 6 had available 2×2 data for meta-analysis (n= 663). Of the 6 studies, 3 involved emergency department-performed ultrasonography and 3 radiology-performed ultrasonography. Chest ultrasonography had a pooled sensitivity of 89.3% (95% confidence interval [CI], 81.1 to 94.3) and specificity of 98.4% (95% CI, 90.2 to 99.8) compared with CT imaging for the diagnosis of any rib fracture. The finding of a fracture on ultrasonography, defined as an underlying cortical irregularity, was associated with a+likelihood ratio (LR) of 55.7 (95% CI, 8.5 to 363.4) for CT diagnosed rib fracture, while the absence of ultrasonography fracture held a -LR of 0.11 (95% CI, 0.06 to 0.20). We were unable to detect a difference in test characteristics between emergency department- and radiology-performed ultrasonography (P=.11). The overall risk of bias of included studies was high, with patient selection identified as the highest risk domain. Chest ultrasonography is both sensitive and highly specific in diagnosing rib fractures following blunt trauma.

Diagnostic Inaccuracies Using Extended Focused Assessment With Sonography in Trauma for Traumatic Pneumothorax.

Traumatic pneumothorax (PTX) can be deadly, and rapid diagnosis is vital. Ultrasound (US) is rapidly gaining acceptance as an accurate bedside diagnostic tool. While making the diagnosis is important, not all PTX require tube thoracostomy. Our goal was to evaluate the predictive ability of ultrasound in identifying clinically significant PTX. Over 13months, data was collected on patients undergoing evaluation for trauma. Patients were included if they underwent US, radiograph chest X-ray (CXR), and computed tomography of the chest. Predictive ability of ultrasound was evaluated in identifying clinically significant PTX. Ninety-four patients received evaluation by all 3 modalities. Of these, 32% were diagnosed with PTX. Sixteen patients (17%) had a clinically significant PTX. Chest X-ray and US both had a sensitivity of 75%; however, US had more than twice as many false positives, resulting in a much lower positive predictive value (63% vs 80%). While US can reliably rule out PTX, it may be overly sensitive diagnosing clinically significant PTX. Ultrasound alone should not be used in determining the need for tube thoracostomy as many patients will not require acute intervention.

Operative Use of Thoracic Ultrasound in Respiratory Medicine: A Clinical Study.

For over 15 years, thoracic ultrasound has been applied in the evaluation of numerous lung diseases, demonstrating a variable diagnostic predictive power compared to traditional imaging techniques such as chest radiography and CT. However, in unselected pulmonary patients, there are no rigorous scientific demonstrations of the complementarity of thoracic ultrasound with traditional and standardized imaging techniques that use radiation. In this study 101 unselected pulmonary patients were evaluated blindly with ultrasound chest examinations during their hospital stay. Other instrumental examinations, carried out during hospitalization, were standard chest radiography, computed tomography (CT), and, when needed, radioisotopic investigation and cardiac catheterization. The operator who performed the ultrasound examinations was unaware of the anamnestic and clinical data of the patients. Diffuse fibrosing disease was detected with a sensitivity, specificity and diagnostic accuracy of 100%, 95% and 97%, respectively. In pleural effusions, ultrasound showed a sensitivity, specificity and diagnostic accuracy of 100%. In consolidations, the sensitivity, specificity and diagnostic accuracy were 83%, 98% and 93%, respectively. Low values of sensitivity were recorded for surface nodulations of less than one centimeter. Isolated subpleural ground glass densities were identified as White Lung with a sensitivity of 72% and a specificity of 86%. Only the associations Diffuse ultrasound findings/Definitive fibrosing disease, Ultrasound Consolidation/Definitive consolidation and non-diffuse ultrasound artefactual features/Definitive vascular pathology (pulmonary hypertension, embolism) were statistically significant with adjusted residuals of 7.9, 7 and 4.1, respectively. The obtained results show how chest ultrasound is an effective complementary diagnostic tool for the pulmonologist. When performed, as a complement to the patient’s physical examination, it can restrict the diagnostic hypothesis in the case of pleural effusion, consolidation and diffuse fibrosing disease of the lung.