Spiral Chest CT Scan Research Articles

Aggressive Behavior in a Critically Ill COVID-19 Patient: Possible Role of Medication Discrepancies

Coronavirus disease 2019 (COVID-19) has different clinical manifestations that besides its iatrogenic intervention could affect brain cognitive function. Medication omission has serious effects on a patient’s clinical course changing the disease’s mortality and morbidity; herein possible role of the iatrogenic intervention that increased the risk of psychological disturbance including medication omission was reported.
 A 40-years-old man with a history of gout treated with allopurinol was admitted due to productive cough and hemoptysis. His physical exam and lung spiral chest CT scan revealed moderate to severe lung infiltrations in favor of COVID-19 which was confirmed with COVID-19 RT-PCR. Due to his clinical course tocilizumab, methylprednisolone pulse, and other conservative therapies were started while allopurinol was omitted. During his hospitalization anxiety and irritability appeared and progressed gradually making him refuse to get oxygen supplementation. Through immediate intervention and controlling his behavioral symptoms with psychotherapy, selective serotonin reuptake inhibitors, benzodiazepines, and initiation of allopurinol, the patient’s psychological disturbance were relieved. In the end, he died due to acute respiratory distress syndrome.
 COVID-19 and its iatrogenic interventions could trigger a psychiatric disturbance in patients with a variety of pathways. Corticosteroid therapy, non-hypnotic antihistamines, quarantine stress conditions, hypoxia, and medication omission are underlying factors for it. Reporting this medication omission would help physicians become familiar with this pharmacological phenomenon, its prevention, and the way to respond to it. On the other hand, researchers can study the etiology of this phenomenon to understand the mood-stabilizing role of allopurinol in additional studies.

Wharton's jelly-mesenchymal stem cells treatment for severe COVID 19 patients: 1-year follow-up

Recently, attention has been focused on mesenchymal stem cells (MSC) because of their unique ability to suppress inflammation induced by cytokine storms caused by COVID-19. Several patients have been successfully treated in this manner. After one year of treatment with Wharton's jelly-derived MSC injections, this study evaluated the safety and efficacy of injecting MSCs intravenously in patients with COVID-19. This study treated four patients with severe COVID-19 with Wharton's jelly-derived mesenchymal stem cells. In this study, patients were followed up for routine tests, tumor markers, and whole-body imaging (spiral neck CT scan (with contrast), spiral chest CT scan (with & without contrast), and spiral abdominopelvic CT scan (with IV & Oral contrast)) one year after cell therapy. The results indicated that lymphocyte; lymph count significantly increased, and neutrophil, ESR, ferritin, and CRP significantly decreased. LDH showed a non-significant decrease (P-value<0.05). One year after the WJ-MSC injection, the tumor markers were normal, and no tumors were observed in patients after one year. Also, the CT scan result was normal. In patients, no serious complications were observed after a one-year follow-up. After monitoring the patient via laboratory tests, tumor markers, and whole-body imaging, we concluded that the Wharton jelly-derived mesenchymal stem cells did not cause severe complications, including tumor formation, in severe COVID19 patients within a year. More clinical trials with higher sample sizes need to be performed on cell therapy with Wharton jelly-derived mesenchymal stem cells in the future.

Diabetes insipidus as the first manifestation of granulomatosis with polyangiitis: A case report

Background: Granulomatosis with Polyangiitis (GPA) is a necrotizing granulomatosis vasculitis that may influence most organs, but posterior pituitary involvement as the first manifestation is unusual. However, there are some case reports in this regard. Case presentation: A 49-year-old menopausal woman presented with polyuria, polydipsia and weight loss over time headache, purulent nasal discharge, malaise, ear pain developed. After right myringotomy due to secretory otitis media and nasal cavity biopsy, the symptoms exacerbated. Diabetes insipidus was documented by Deprivation test. Thus, 20 microgram nasal spray DDAVP was prescribed. Pituitary MRI +/- Gad demonstrated pituitary involvement. Pituitary axis hormone evaluation was consistent with menopausal state. Chest spiral CT scan showed speculated border soft tissue mass lesion. GPA confirmed with ACR criteria and C-ANCA positive. Therefore, corticosteroid and rituximab were started. Symptoms of DI responded well to the treatment and the spray dosage was decreased. Conclusion: DI can be the first manifestation of GPA; although it is rare, it is worth to be diagnosed early and serious treatment of vasculitis should be started to prevent irreversible damage to the hypophysis cell and unnecessary procedure. Keywords: GPA; granalomatosis vasculitis; diabetes insipidus.

The administration of interferon-beta1b and favipiravir in patients with COVID-19 pneumonia

Purpose: To assess the efficacy of interferon-beta1b (INF-beta1b) in combination with favipiravir in early treatment of patients with COVD-19 pneumonia. Methods: This prospective non-controlled study was performed on admitted patients with moderate to severe COVID-19 disease to Amir-Alam hospital. The diagnosis of COVID-19 pneumonia was based on positive RT-PCR test from nasopharyngeal samples and typical spiral chest CT scan findings. At the time of this study, there was the shortage of efficient anti-COVID drugs especially “Remdesivir” due to sanction of Iran. All the patients received subcutaneous IFN-beta1b plus favipiravir. The patients with severe infection received intravenous dexamethasone. Those who underwent invasive or noninvasive mechanical ventilation, at the admission onset, were excluded from the study. Results: One hundred and eighty-two patients with moderate to severe COVID-19 pneumonia were included in this study. Among182 patients, 90 cases had moderate and 92 had severe pneumonia. Twenty-one cases with severe pneumonia and 14 cases with moderate pneumonia were transferred to ICU to receive invasive or non-invasive mechanical ventilation. The mean duration of hospital ward admission and ICU stay was 10.69±7.54 and 5.45±2.72 days, respectively. One hundred and seventy-four patients (80.7 %) recovered completely and discharged without need to ICU admission. The response rate was the same in patients with moderate and severe pneumonia. Nine cases (4.9 %) were passed away. Diabetic patients had higher mortality rates. Conclusion: This study showed the efficacy of IFN-beta1b plus favipiravir in early treatment of patients with moderate to severe COVID-19 pneumonia who did not need to mechanical ventilation.

Analysis of epigenomic signatures in cell-free DNA (cfDNA) from cancer patients and high-risk controls: A blinded test cohort of THUNDER-II study.

e22518 Background: Early detection of cancer has the potential to provide a clinical benefit to patients, especially for those with hard-to-treat diseases like ovarian and pancreatic cancer. The THUNDER (the unintrusive detection of early-stage cancers) program was designed to develop and validate a multicancer detection blood test (ELSA-seq) through a series of prospective, observational case-control studies. The second sub-study of THUNDER program (THUNDER-II) includes a discovery, training/validation, and single-blind test (SBT) phase. This new analysis, comprising data from the SBT set of THUNDER-II, evaluated performance of ELSA-seq in an independent group of participants, including individuals at high risk of certain cancer types for the first time. Methods: In the SBT group reported here, all participants were recruited from sites that were not represented in training or validation. The cancer group focused on six deadly cancer types (lung, colorectal, liver, pancreatic, esophageal, and ovarian cancer), and the non-cancer controls were stratified to ‘healthy’ and ‘high-risk’ subgroups based on examination results of low-dose spiral chest CT scan (LDCT), abdominal ultrasound, and Hepatitis B serologic test (HBsAg). 10ml of blood from each participant was collected and methylation-sequencing libraries were prepared by ELSA-seq as described previously. The detection results were automatically reported by a locked computational pipeline to mimic a real-world test scenario (Burning Rock Biotech, China). All samples were delinked from the donors’ cancer status and experiments were performed by blinded personnel. Results: In general, the cancer and non-cancer groups were comparable with respect to age, sex, and tobacco/alcohol-consumption history. The assessment is still in progress, and we have studied 360 eligible participants including 202 cancer cases and 158 non-cancer controls (76 ‘healthy’; 82 ‘high-risk’). Overall, ELSA-seq achieved a specificity of 98.1% (95%CI: 94.1-99.5%) and a sensitivity of 74.8% (95%CI: 68.1-80.5%), consistent with the performance in training and validation1. Among six pre-specified cancer types, sensitivity was 53.0% (95%CI: 40.4-76.3%) in stage I, 73.3% (95%CI: 57.8-84.9%) in stage II, 90.4% (95%CI: 78.2-96.4%) in stage III, and 92.3% (95%CI: 78.0-98.0%) in stage IV. In terms of identifying the diseased organ(s), 80.8% (95%CI: 73.4-86.6%) of the predications matched the true TOO status. Conclusions: ELSA-seq demonstrated consistent results in sites that did not contribute to training, supporting that performance was not subject to sample-/site-dependent bias. It also showed a very low false positive rate in asymptomatic individuals with or without certain cancer-prone conditions, suggesting a potential applicability to broad populations.

Diagnostic value of chest spiral CT scan and Doppler echocardiography compared to right heart catheterization to predict pulmonary arterial hypertension in patients with scleroderma.

Background:Because of invasive nature of catheterization, using other noninvasive tools is more preferred to assess pulmonary arterial hypertension (PAH). The present study assessed the value of chest spiral CT scan and Doppler echocardiography compared to right heart catheterization (RHC) to predict PAH in patients with scleroderma.Methods:This cross-sectional study was performed on 15 patients with limited scleroderma. All subjects underwent Doppler echocardiography (to assess PAP) and chest spiral CT scan without injection (to assess pulmonary trunk length or PUL), followed by RHC to assess PAH.Results:Comparing PUL in spiral CT scan with PAP in RHC yielded a sensitivity of 75.0% and a specificity of 100% for predicting PAH. Similarly, comparing PAP value in echocardiography with PAP in RHC achieved a sensitivity of 100% and a specificity of 63.6% to discriminate PAH from normal PAP condition. Analysis of the area under the ROC curve showed high power of CT scan to predict PAH (AUC = 1.000). The best cutoff point for PUL to predict PAH was 29.95 yielding a sensitivity of 100% and a specificity of 100%. Also, ROC curve analysis showed high value of echocardiography to discriminate PAH from normal PAP status (AUC = 0.841) that considering a cutoff value of 22.88 for PAP assessed by echocardiography reached to a sensitivity of 72.7% and a specificity of 100%.Conclusion:Both chest spiral CT scan and Doppler echocardiography are very useful to diagnose PAH and its severity in patients with scleroderma. (www.actabiomedica.it)

A diagnostic challenge presented in a 37-year-old man with severe weight loss and

[1] A 37-year-old man, Iranian resident in Zanjan, presented to the gastroenterology clinic of Taleghani Hospital; a teaching referral hospital in Tehran, Iran, with chief complaint of a significant weight loss about 20 kg in recent 4 months. He denied any concomitant systemic signs and symptoms except for a generalized malaise. He did not mention any change in bowel habit and eating pattern but a slight decrease in appetite without nausea and vomiting. He denied smoking and use of any illicit drug or alcohol. His past medical history was negative. He was admitted for further work regarding his unexplained weight loss. On admission, he was well with stable vital signs. His blood pressure was 110/70 mmHg, body temperature: 36.5 o C, heart rate: 84 bites per minute, and respiratory rate: 13 per minute all within normal limits. His physical exam was only notable for a mild epigastric and right upper quadrant (RUQ) tenderness. His laboratory tests were normal except for a normochromic normocytic anemia with a hemoglobin concentration of 12 mg/dl. Serum iron level was 37 mcg/dl with a total iron binding capacity (TIBC) level of 275 mcg/dl and a ferritin level of 10 mcg/l revealing an iron deficient erythropoiesis. Further laboratory tests evaluating tumor markers, thyroid function tests, liver function tests, serum bilirubin level, urine analysis and stool examination were all normal. We decided to proceed with an upper gastrointestinal endoscopy and colonoscopy in the next step of the management of the patient with significant weight loss. Total colonoscopy was unremarkable and esophagogastroduodenoscopy demonstrated a sessile polyp in antrum pathologically consistent with hyperplastic polyp. His spiral chest CT scan was normal but an abdominopelvic CT scan revealed dilation of intrahepatic ducts disseminated all over the liver prominently in the periphery of the right hepatic lobe. Periductal parenchyma was enhanced in some parts indicative of infective or neoplastic processes. Scattered celiac and mesentric lymph nodes with maximum diameter of 6 mm were also detected (figure 1). To have a better visualization of extrahepatic ducts besides intrahepatic ducts, an endoscopic ultrasound (EUS) was performed. As reflected in figure-2, findings of EUS were unremarkable except for 3 hypoechoic and round hilar lymph nodes with the largest diameter of 21mm, most probably indicative of reactive lymph nodes. This patient’s signs and symptoms continued to remain stable, so he was discharged and was advised to follow other diagnostic modalities in the outpatient clinic. Some months later, he referred to the gastroenterology clinic with similar complaints of inability to weight gain and anorexia. Given the previous history of intrahepatic duct dilation, an MRCP was demanded which revealed heterogeneity of the liver parenchyma due to multiple masses or microabscesses in the liver. Laboratory results were negative for infectious, helminthic and parasitic disorders for this kind of liver involvement, and imaging reports were unable to rule out a neoplastic process and give a definite diagnosis. This made us proceed with a liver biopsy. What is your diagnosis? What is the next step? Received: 24 September 2020 Accepted: 8 December 2020 Reprint or Correspondence: Saeed Abdi, MD. Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: saeedabdi75@yahoo.com ORCID ID: 0000-0002-2375-3748

Amiodarone‐Induced Neuropathy with chronic inflammatory demyelinating polyneuropathy‐like presentation

AbstractLong‐term administration of amiodarone may have various neurological complications and systemic involvement. Herein, we report a 46‐year‐old male patient who was admitted as a result of paresthesia and progressive four‐limb weakness started six months before. Spiral chest CT scan showed bilateral hyper‐dense consolidations predominately seen in peripheral and lower lobes. We checked the serum level of amiodarone that was 3.1 mg/L (therapeutic range: 1.5 and 2.5 µg/mL). According to the characteristic pulmonary findings in lung CT scan, demyelinating polyneuropathy, and lack of response to treatment, with the suspicion of amiodarone toxicity, CT‐guided percutaneous core needle biopsy was performed. The pathological assessment revealed chronic interstitial inflammation and fibrosis, and exudation of macrophages with finely cytoplasmic vacuolization associated with hyperplasia of type II pneumocytes in alveoli with necrosis. These findings are consistent with amiodarone‐induced pulmonary toxicity. Chronic use of amiodarone may present as a CIDP‐like presentation, which may be overlooked if clinical suspicion is not high upon presentation.

Langerhans cell histiocytosis (LCH) presenting as pneumothorax and neck lymphadenopathy

Langerhans Cell Histiocytosis (LCH) is a rare clonal disease characterized by dendritic cells infiltration in various main organs. We report a 6-month-old infant with severe respiratory distress, cervical lymphadenopathy, and reddish skin rashes on face. Diagnostic work up revealed spontaneous pneumothorax on Chest X-ray (CXR). Multiple thin-walled lung cysts and emphysema was discovered on spiral chest CT scan. Lung tissue and cervical lymph node biopsy revealed dendritic cells infiltration. Broncho alveolar lavage (BAL), cervical lymph node and lung tissue biopsy was performed and histopathology was assessed. It was suggestive of LCH with positive immunohistochemistry markers including CD1a, CD68 and S100.

Visceral Leishmaniasis with Massive Pulmonary Involvement: A Case Report

: Visceral leishmaniasis (VL) is an endemic disease in East and South Africa and the Mediterranean area. Fever, splenomegaly, and weakness are the most common symptoms of VL, but pulmonary involvement is very rare. The present study reports a patient with VL and pulmonary complication. An 18-year-old immunocompetent patient was referred to a local hospital with submandibular lymphadenopathy, nonproductive cough, and occasional fever. In spiral chest CT scan, bilateral massive bronchopulmonary consolidation with a diffused nodular pattern was seen. After a few days, because of absent response to antibiotic therapy and prednisolone, fine needle aspiration from pulmonary nodules was done that showed multiplex Leishman bodies. The patient showed a good response to amphotericin B and glucantime.

Prevalence of Venous Thromboembolic Events After Elective Major Thoracolumbar Degenerative Spine Surgery

A case-control study. The purposes of this study were to establish the prevalence of venous thromboembolic disease in patients undergoing elective major thoracolumbar degenerative spine surgery and identify risk factors. Venous thromboembolic events (VTE) are a serious complication of orthopedic surgery, but the prevalence of VTE after elective thoracolumbar degenerative spine surgery is not well known. This was a case-control study of 5766 consecutive elective thoracolumbar degenerative spine surgeries. Symptomatic pulmonary emboli (PE) were diagnosed by spiral chest CT scans, nuclear scintigraphic ventilation-perfusion, and angiography. Deep vein thromboses (DVT) were diagnosed by venous duplex scans. The prevalence of VTE was analyzed according to patient demographic variables and type of surgery performed. The prevalence of developing a VTE was 1.5% (89/5766), with a prevalence of symptomatic PE of 0.88% (51/5766) and DVT of 0.66% (38/5766). There were 47% males and 53% females with a mean age of 60.3 years. In patients undergoing 5-segment fusions the prevalence of PE was 3.1% (P=0.022). Patients who had ≥4 segments fused had a prevalence of PE of 1.7% (P=0.014). The odds of having a PE in those above 65 years at the time of surgery were 2.196 times as large as for those below 65 years. Noncontributory factors included sex, instrumentation, and revision surgery. This case-control study of 5766 patients who underwent elective thoracolumbar degenerative spine surgery revealed a prevalence of VTE of 1.5%, with a prevalence of PE of 0.88% and DVT of 0.66%. Patients with increasingly extensive surgery had a higher risk of PE, specifically those undergoing fusion of ≥5 segments.

The Sequential Interventional Treatment of a Case of Right-Sided Lung Cancer with Atelectasis

Lung cancer combined with severe airway stenosis is a medical emergency, and unlike mild-to-moderate stenosis, is difficult to treat with percutaneous or bronchoscopic biopsy and stenting. We report the successful treatment of a case of lung cancer with severe airway stenosis that was treated sequentially with initial airway angiography, forceps biopsy using interventional radiology, stent placement, regional perfusion chemotherapy through a bronchial artery and radiotherapy. A 66 year-old male patient presented with a 1-month history of a productive cough, with dyspnea in the preceding 6 days. A chest spiral CT scan showed obstruction of the right hilum and complete right lung atelectasis with plugging of the right main bronchus. The patient was initially managed with oxygen before undergoing airway angiography and biopsy. A Y-shaped stent was placed through the affected bronchus, which alleviated the atelectasis. The patient further responded to locally-delivered chemotherapy and regional radiotherapy. After two years of follow-up, the patient was still alive, and no longer breathing difficultied, chest CT review showed that the tumor was no significant progress. Sequential therapy with a range of interventions can lead to an improved quality of life and a prolonged survival duration in a patient with an acute presentation of severe airway stenosis.

Lung volume assessments in normal and surfactant depleted lungs: agreement between bedside techniques and CT imaging.

BackgroundBedside assessment of lung volume in clinical practice is crucial to adapt ventilation strategy. We compared bedside measures of lung volume by helium multiple-breath washout technique (EELVMBW,He) and effective lung volume based on capnodynamics (ELV) to those assessed from spiral chest CT scans (EELVCT) under different PEEP levels in control and surfactant-depleted lungs.MethodsLung volume was assessed in anaesthetized mechanically ventilated rabbits successively by measuring i) ELV by analyzing CO2 elimination traces during the application of periods of 5 consecutive alterations in inspiratory/expiratory ratio (1:2 to 1.5:1), ii) measuring EELVMBW,He by using helium as a tracer gas, and iii) EELVCT from CT scan images by computing the normalized lung density. All measurements were performed at PEEP of 0, 3 and 9 cmH2O in random order under control condition and following surfactant depletion by whole lung lavage.ResultsVariables obtained with all techniques followed sensitively the lung volume changes with PEEP. Excellent correlation and close agreement was observed between EELVMBW,He and EELVCT (r = 0.93, p < 0.0001). ELV overestimated EELVMBW,He and EELVCT in normal lungs, whereas this difference was not evidenced following surfactant depletion. These findings resulted in somewhat diminished but still significant correlations between ELV and EELVCT (r = 0.58, p < 0.001) or EELVMBW,He (0.76, p < 0.001) and moderate agreements.ConclusionsLung volume assessed with bedside techniques allow the monitoring of the changes in the lung aeration with PEEP both in normal lungs and in a model of acute lung injury. Under stable pulmonary haemodynamic condition, ELV allows continuous lung volume monitoring, whereas EELVMBW,He offers a more accurate estimation, but intermittently.

The comparison of the lengths and diameters of main bronchi measured from two-dimensional and three-dimensional images in the same patients.

BackgroundRecently, multi-planar reconstruction of the three-dimensional (3D) spiral chest CT scan has demonstrated superiority in the evaluation of the tracheobronchial tree. The goal of this study was to measure the lengths of the right and left main bronchi and their anteroposterior (AP) and transverse (TR) diameters using the 3D and two-dimensional (2D) images in the same adult respectively, and to evaluate the degree of correlation between them.MethodsWe measured the lengths of the right and left main bronchi from the carina to the first of their branches and the AP and TR diameters at the mid-portion of the right main bronchus and 2 cm below the carina in the left main bronchus. We determined the size of the left-sided double-lumen tube (DLT) based on the measured AP diameter of the left main bronchus from the 3D and 2D images, respectively.ResultsThere was moderate correlation between the lengths of both main bronchi obtained from the 3D images and the 2D images, and between the AP diameter of the left main bronchus obtained from the 3D images and the 2D images. Same sized DLTs were estimated in 69% of the men and 34% of the women.ConclusionsThe lengths of the right and left main bronchi and their AP and TR diameters obtained from 3D images were not strongly correlated with those from 2D images. Therefore, a further study is needed to verify the superiority of 3D images in selecting the appropriate size of left-sided DLT.

Pitfalls of fluorodeoxyglucose positron-emission tomography-CT in tuberculosis mimicking malignancy in 60 patients

Objective To analyze the pitfalls of 18 F fluorodeoxyglucose (FDG) positron emission tomography/computer tomography (PET-CT) scan in the diagnosis of 60 patients of tuberculosis mimicking malignancy. Methods The study included 60 patients with PET-CT diagnosis of probable malignancy.Fifty patients were proved to be tuberculosis by pathological examinations and 10 were diagnosed by clinical follow-up.The images of whole body were acquired at 60 min after administration of 222—555 MBq 18 F-FDG.The PET-CT imaging characteristics and clinical data,including lesion size,distribution,standardized uptake value (SUV) were retrospectively analyzed.After the whole body scan of PET-CT,each patient had a chest spiral CT scan for detailed observation of lung lesions.Contrast enhanced CT (CECT) was performed in 8 patients. Results (1) Thirty patients were misdiagnosed as lung cancer,14 patients as malignant lymphoma,6 patients as malignant mesothelioma,3 as intestine carcinoma,2 as bone malignancy,1 patient as hepatocarcinoma,spleen malignancy,ovarian cancer,laryngocarcinoma and nasopharyngeal carcinoma respectively. (2) 90.9% (20/22) of patients showed normal level of serum CEA and 100% (13/13) of patients showed normal level of CA199.Increasing serum CA125 was found in all patients (6/6) with active TB patients accompanied with ascites,pleural fluid and (or) pericardial effusion. (3) 93.3% (28/30) active tuberculosis showed accumulated 18 F-FDG which was incorrectly interpreted as malignancy.The most common sites of TB lymphadenopathy were bilateral cervical tissues,which was accounted for 85.7% (12/14).CECT revealed characteristics of peripheral enhancement and central necrosis in tubercular lymphadenopathy,which was 87.5% (7/8). Conclusions The diverse manifestations of TB on imaging and high uptake of 18 F-FDG on PET imaging result in misdiagnosis of malignancy.It is important for radiologists and nuclear medicine physicians to identify the common imaging features and patterns of TB to make a correct diagnosis.Integration of reconstruction HR CT,PET-CT and lab examinations may improve the diagnostic accuracy. Key words: Tuberculosis,pulmonary; Lung neoplasms; Lymphoma; Positron-emission tomography; Tomography,X-ray computer

Biomarkers Can Promote Risk Stratification in CT Scanning for Lung Cancer Detection

Biomarkers Can Promote Risk Stratification in CT Scanning for Lung Cancer Detection Despite recent advances in surgical options, radiation and chemotherapy for the treatment of lung cancer, cure rates have not changed in 30 years, and lung cancer continues to kill more people than the next four leading causes of cancer death combined. This occurs in part because lung cancer most often does not present itself until the advanced stages when it is essentially incurable. However, if lung cancer is detected early, surgery can cure a majority of patients. If more patients are identified earlier in their disease course, lung death rates could drop significantly. To this end, low-dose spiral chest CT scans are effective in detecting lung cancer in its early stages, with a 20% reduction in mortality in heavy smokers who were screened.

Soft tissue sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Soft tissue sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Exploration d’une hypertension pulmonaire

Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure (PAPm) superior than 25mmHg at rest or superior than 30mmHg with exercise. The classification of PH differentiates between "secondary" PH which results from a well-known disease, such as PH due to thromboembolic disease (obstructive PH), left cardiac failure (passive PH), or chronic respiratory diseases (hypoxic PH), and pulmonary arterial hypertension (PAH). PAH is a rare disease characterized by a progressive increase of pulmonary vascular resistance leading to right ventricular failure. PAH is classified as idiopathic, familial, or associated with various conditions (connective tissue diseases, congenital heart diseases with systemic-to-pulmonary shunts, portal hypertension, infection with the human immunodeficiency virus, or appetite-suppressant drugs). Transthoracic Doppler echocardiography is the investigation of choice for non invasive detection of PAH but right-heart catheterization is necessary to confirm the diagnosis of PAH and determine its mechanism. Pulmonary function tests and chest CT scan may detect an underlying chronic pulmonary disease (hypoxic PH). Lung perfusion scan and contrast-enhanced chest spiral CT scan can lead to the diagnosis of thromboembolic PH, which is to be confirmed by pulmonary angiography. Assessment of the severity of PH is based on clinical parameters (NYHA, right heart failure), functional tests (six-minute walk test), echocardiography and hemodynamics. Characterization of PH is essential in the management of PH because it determines the appropriate treatment: an etiological treatment in passive, obstructive or hypoxemic PH, or vasodilatator and antiproliferative therapies in PAH.

Computed Tomography Scanning Techniques for the Evaluation of Cystic Fibrosis Lung Disease

Multidetector computed tomography (MDCT) scanners allow diagnosis and monitoring of cystic fibrosis (CF) lung disease at substantially lower radiation doses than with prior scanners. Complete spiral chest CT scans are accomplished in less than 10 seconds and scanner advances now allow the acquisition of comprehensive volumetric datasets for three-dimensional reconstruction of the lungs and airways. There are two types of CT scanning protocols currently used to assess CF lung disease: (1) high-resolution CT (HRCT) imaging, in which thin 0.5-1.5-mm slices are obtained every 0.5, 1, or 2 cm from apex to base for inspiratory scans, and limited, spaced HRCT slices obtained for expiratory scans; and (2) complete spiral CT imaging covering the entire lung for inspiratory and expiratory scanning. These scanning protocols allow scoring of CF lung disease and provide CT datasets to quantify airway and air-trapping measurements. CF CT scoring systems typically assess bronchiectasis, bronchial wall thickening, mucus plugging, and atelectasis/consolidation from inspiratory scans, whereas air trapping is scored from expiratory imaging. Recently, CT algorithms have been developed for both HRCT and complete spiral CT imaging to quantify several airway indices, to determine the volume and density of the lung, and to assess regional and global air trapping. CT scans are currently acquired by either controlled-volume scanning techniques (controlled-ventilation infant CT scanning or spirometer-controlled CT scanning in children and adults) or by voluntary breath holds at full inflation and deflation.

A dumbbell thrombus entrapped in patent foramen ovale

A 75-year-old lady came to emergency room due to dizziness and presyncopal attacks during exertion since two days prior to admission. Transesophageal echocardiography revealed a thrombus like mass in right atrium traversing patent foramen ovale and extending to left atrium. Spiral chest CT scan showed bilateral pulmonary thromboemboli. Operative and pathological findings confirmed the diagnosis.