Chest X-ray Findings In Patients Research Articles

Chest X-Ray Findings in Patients With COVID-19 Pneumonia.

Currently, there are limited research and reports on how a chest radiograph plays a role in the treatment of COVID-19 patients, but some of the findings up to now have demonstrated that they are useful in specific situations, such as when symptoms are severe, other testing is limited, and an acute outbreak occurs (Blain et al., 2021). As referenced by Rubin et al. (2020) a consensus statement made by the Fleischner Society recommended that imagining should not be ordered in patients with mild symptoms, but it can be used in diagnosing COVID-19 if deemed necessary. Chest radiography is a relatively inexpensive, quick imaging method with minimal radiation exposure for finding typical COVID-19 lesions such as ground glass opacities or consolidation findings as the viral infection progresses. Chest radiography can also be helpful in inpatient settings when there are possible superimposed complications such as pleural effusions or pneumothorax (Chalian, 2020).

Evaluation of Admission Chest X-Ray Findings in Patients With Respiratory Infection During the COVID-19 Pandemic.

Aims: To evaluate the prevalence of X-ray findings in hospitalized patients requiring hospitalization with suspected Coronavirus disease 2019 (COVID-19) infection and potential differences in the laboratory values and clinical outcomes related to the presence of abnormal chest X-ray (CXR) findings.Methods: A total of 117 patients suspected of COVID-19 pneumonia and hospitalized with symptoms of lower respiratory tract disease were included in this study. Patients were divided into subgroups according to COVID-19 diagnosis and statistical comparisons were made according to CXR findings.Results: In our cohort, CXR abnormalities were more common in patients with confirmed COVID-19 diagnosis and were associated with increased mortality. Patients with abnormal chest X-rays had a significantly lower PaO2/FiO2 ratio both in the COVID-19 and non-COVID-19 groups.Conclusion: CXR is a routine examination in all patients with symptoms of lower respiratory tract disease and its findings relate to in-hospital mortality and PaO2/FiO2 ratio. Thus, it can be a significant measure of disease severity, especially in resource restrained settings and emergency situations such as the COVID-19 pandemic.

Initial findings in chest X-rays as predictors of worsening lung infection in patients with COVID-19: correlation in 265 patients

Background and aimsWe aimed to analyze the relationship between the initial chest X-ray findings in patients with severe acute respiratory syndrome due to infection with SARS-CoV-2 and eventual clinical worsening and to compare three systems of quantifying these findings. Material and methodsThis retrospective study reviewed the clinical and radiological evolution of 265 adult patients with COVID-19 attended at our center between March 2020 and April 2020. We recorded data related to patients’ comorbidities, hospital stay, and clinical worsening (admission to the ICU, intubation, and death). We used three scoring systems taking into consideration 6 or 8 lung fields (designated 6A, 6B, and 8) to quantify lung involvement in each patient’s initial pathological chest X-ray and to classify its severity as mild, moderate, or severe, and we compared these three systems. We also recorded the presence of alveolar opacities and linear opacities (fundamentally linear atelectasis) in the first chest X-ray with pathologic findings. ResultsIn the χ2 analysis, moderate or severe involvement in the three classification systems correlated with hospital admission (P = .009 in 6A, P = .001 in 6B, and P = .001 in 8) and with death (P = .02 in 6A, P = .01 in 6B, and P = .006 in 8). In the regression analysis, the most significant associations were 6B with alveolar involvement (OR 2.3; 95%CI 1.1.–4.7; P = .025;) and 8 with alveolar involvement (OR 2.07; 95% CI 1.01.–4.25; P = .046). No differences were observed in the ability of the three systems to predict clinical worsening by classifications of involvement in chest X-rays as moderate or severe. ConclusionModerate/severe extension in the three chest X-ray scoring systems evaluating the extent of involvement over 6 or 8 lung fields and the finding of alveolar opacities in the first pathologic X-ray correlated with mortality and the rate of hospitalization in the patients studied. No significant difference was found in the predictive ability of the three classification systems proposed.

Hallazgos iniciales en la radiografía de tórax como predictores de empeoramiento en la infección pulmonar por SARS-CoV-2. Correlación en 265 pacientes

Background and aimsWe aimed to analyze the relationship between the initial chest X-ray findings in patients with severe acute respiratory syndrome due to infection with SARS-CoV-2 and eventual clinical worsening and to compare three systems of quantifying these findings. Material and methodsThis retrospective study reviewed the clinical and radiological evolution of 265 adult patients with COVID-19 attended at our center between March 2020 and April 2020. We recorded data related to patients’ comorbidities, hospital stay, and clinical worsening (admission to the ICU, intubation, and death). We used three scoring systems taking into consideration 6 or 8 lung fields (designated 6A, 6B, and 8) to quantify lung involvement in each patient's initial abnormal chest X-ray and to classify its severity as mild, moderate, or severe, and we compared these three systems. We also recorded the presence of alveolar opacities and linear opacities (fundamentally linear atelectasis) in the first chest X-ray with pathologic findings. ResultsIn the χ2 analysis, moderate or severe involvement in the three classification systems correlated with hospital admission (p=0.009 in 6A, p=0.001 in 6B, and p=0.001 in 8) and with death (p=0.02 in 6A, p=0.01 in 6B, and p=0.006 in 8). In the regression analysis, the most significant associations were 6B with alveolar involvement (OR 2.3; 95%CI 1.1.–4.7; p=0.025;) and 8 with alveolar involvement (OR 2.07; 95% CI 1.01.–4.25; p=0.046). No differences were observed in the ability of the three systems to predict clinical worsening by classifications of involvement in chest X-rays as moderate or severe. ConclusionModerate/severe extension in the three chest X-ray scoring systems evaluating the extent of involvement over 6 or 8 lung fields and the finding of alveolar opacities in the first abnormal X-ray correlated with mortality and the rate of hospitalization in the patients studied. No significant difference was found in the predictive ability of the three classification systems proposed.

To assess clinical profile of oral glucose tolerance in pulmonary tuberculosis patient

Introduction: Tuberculosis (T.B), which is one of the oldest disease known to affect human and is likely to have existed in pre hominids, is a major cause of death worldwide. This disease is caused by bacteria of the mycobacterium tuberculosis complex and usually affects the lungs, although other organs are involved in upto one- third of cases. Diabetes Mellitus (D.M.) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.Subject and Methods: In this study 75 newly diagnosed cases of pulmonary tuberculosis patients were evaluated. A cross section of both male and female diagnosed case of pulmonary tuberculosis attending the outdoor and indoor of various department were taken into study. A detailed history, clinical examination and relevant investigations were performed. Collected data were analysed by using appropriate software.Result: This study of 75 cases showed overall incidence of impaired glucose tolerance as 17.33% in patients with pulmonary tuberculosis. Among 82.67% patients GTT was normal (Fasting 126mg/dl and 2hours >200 mg/dl) was diagnosed.Conclusion: This study showed no statistically significant association of sex, age and chest X-ray findings in patients with pulmonary tuberculosis and diabetes mellitus.

Chest radiographic findings of pulmonary tuberculosis in human immunodeficiency virus-seropositive patients in a teaching hospital in Kano Northwest, Nigeria

Background: Tuberculosis (TB) is one of the most common infections to occur in the course of human immunodeficiency virus (HIV) infection and remains a global emergency despite substantial investment in health services. Aim: This study aims to determine the spectrum of chest X-ray findings in patients with HIV/TB coinfection. Materials and Methods: A retrospective cross-sectional study of the clinical and radiographic features of pulmonary TB (PTB) in 244 confirmed HIV-seropositive patients aged 9 months to 80 years. Descriptive statistics was employed in analyzing mean percentages and frequencies. Level of statistical significance between clinical findings, radiographic findings, age group, and gender was determined using z-test. Statistical significance was set atP ≤ 0.05. Results: The study constituted of 104 (42.62%) males and 140 (57.38%) females with mean age of 31.62 ± 16.93 years. The major clinical features among HIV-related PTB patients in this study are cough in 56.6% patients, chest pain in 11.44% patients, weight loss in 10.26% patients,P Conclusions: Normal chest X-rays constitute the major findings; primary and postprimary patterns of PTB account for the least findings with the age group 26–38 years as the most occurring (91, 37.30%). Females were more frequently involved in TB coinfection. The preponderance of normal radiographs does not exclude the presence of TB coinfection.

‘Presenting CXR phenotype of H1N1’ flu compared with contemporaneous non-H1N1, community acquired pneumonia, during pandemic and post-pandemic outbreaks’

AimsTo review, phenotype and assess potential prognostic value of initial chest X-ray findings in patients with H1N1 influenza during seasonal outbreaks of 2009 and 2010, in comparison with non-H1N1, community acquired pneumonia (CAP). MethodsWe retrospectively identified 72 patients admitted to hospital with pneumonia during the seasons of 2009 and 2010. H1N1 cases were confirmed by virology PCR. Presenting chest X-rays were jointly read by 2 radiologists, who were ‘blinded’ to further patient details and divided into 6 zones. Total number of opacified zones, the pattern and distribution of changes and length of hospital stay were recorded. ResultsPatients with H1N1 demonstrated more opacified zones (mean of 2.9 compared with 2.0; p=0.006), which were bilateral in two-thirds compared with a quarter of those with non-H1N1 CAP (p=0.001). H1N1 radiographs were more likely to be ‘patchy’ versus ‘confluent’ changes of non-H1N1 CAP (p=0.03) and more often demonstrated peripheral distribution (p=0.01). H1N1 patients tended to stay in hospital longer (not significant; p=0.08). A positive correlation existed between number of affected zones and length of inpatient stay, which was statistically significant for the cohorts combined (p=0.02). The findings were the same for the two evaluated seasons. ConclusionH1N1 patients demonstrated more extensive disease, which was more likely bilateral, ‘patchy’, and peripheral in distribution. With increasing global cases of H1N1, knowledge of the typical findings of the H1N1 presenting chest X-ray may assist with early triage of patients, particularly where rapid viral testing is not available.

The relationship between pulmonary hemodynamics and chest X-ray findings in patients with sequelae of pulmonary tuberculosis

For better understanding of pathophysiological aspects of tuberculosis sequelae, we investigated the relationship between pulmonary hemodynamics and chest X-ray findings. One hundred and seven patients with sequelae of pulmonary tuberculosis were examined by the right cardiac catheterization, and pulmonary hemodynamic values were measured and calculated. Chest X-ray findings were defined and classified into the following five items. The items were emphysematous change; fibrosis, bronchiectasis and/or cavity (hereafter abbreviated as "fibrosis"); pulmonary resection and/or atelectasis; pleural thickening; and thoracoplasty. The extent of each finding was defined. We tried to describe chest X-ray findings by applying and categorizing these classifications and the extent to each case. First, we tried to estimate the grade of pulmonary hypertension by categorized X-ray findings. Further, we analyzed what kinds of findings were most influential on the increase of pulmonary artery mean pressure (PPA) and pulmonary arteriolar resistance (PAR). Secondly, we investigated whether PPA, cardiac index (CI) and PAR changed before and after oxygen administration. Thirdly, we analyzed what kind of X-ray findings most affected pulmonary hemodynamics under 100% oxygen administration for 10 minutes. The results were as follows: (1) Out of 107 cases, it was possible to predict PPA by categorized chest X-ray findings in 75 cases by Hayashi's first method of quantification, one of multivariative analyses. "Pleural thickening" was the most influential finding on the increase of PPA. "Fibrosis" was the most influential on the increase of PAR. (2) The values of PPA, CI and PAR decreased more after 100% oxygen administration than under room air breathing. Therefore, PAR was used as the index to estimate pulmonary hemodynamics under the condition of oxygen administration. (3) It was possible to measure PAR under oxygen administration (PARO2) in 72 cases. "Emphysematous change" was the most influential X-ray finding on the increase of PARO2. From these results, it was thought that pulmonary circulatory disorder in patients with tuberculosis sequelae was caused by the combination of various chest X-ray findings with the different extent. It was possible to predict pulmonary hypertension to a certain degree from categorized chest X-ray findings. It was suggested that "emphysematous change" less related to hypoxic pulmonary vasoconstriction than "fibrosis" and "pleural thickening" from the results of comparison among the partial correlation coefficients, which were associated with the increase of PAR under room air breathing and oxygen administration.(ABSTRACT TRUNCATED AT 400 WORDS)

Chest radiographic findings in swine origin influenza A (H1N1) viral infection experienced in a tertiary care university hospital in Saudi Arabia

The aim of this study is to review the chest X-ray findings in patients with swine origin influenza A (H1N1) virus infection. Materials and methodsRetrospective review of the archive of the infection control department with swine flu whom afterwards had a chest X-ray. Search yielded 201 patients of whom only 179 patients had a chest radiographs. Our study group of patients consisted of 100 males and 79 females. Ranging in age from 2 to 89years old with the mean age of 44±4.44. PCR was positive for all patients. However, the rapid antigen test was positive in only 17 of 179 patients. ResultsA normal chest radiograph was seen in 112 patients representing 62.5% of the studied population.Patients who had peribronchovascular increased thickening and increased markings/hyperinflation were 35 representing 19.5% of the studied population.Patients with unilateral ground glass opacity and/or consolidation were 12 representing 0.67% of the study population.Patients with bilateral ground glass opacity and/or consolidation were 20 representing 0.11%. ConclusionThe most common abnormal findings in the chest radiographs in patients with S-OIV infection are increased peribronchovascular markings and hyperinflation, followed by unilateral, or bilateral ground glass opacity and/or consolidation.

Descriptive patterns of severe chronic pulmonary hypertension by chest radiography

To find chest roentgenographic (CXR) features to help differentiate two representative diseases with severe chronic pulmonary hypertension (PH). Thirty-six consecutive patients with chronic thromboembolic PH (CTEPH), 38 with primary PH (PPH), and 37 with left heart disease and PH. CXRs were reviewed about 6 features (left 2nd arc protrusion, right descending pulmonary artery diameter (rPAD), cardiothoracic ratio (CTR), right 2nd arc width, avascular area and pleural abnormality). Hemodynamic data and the degree of tricuspid regurgitation (TR) on echocardiography were compared with CXR findings. The diagnostic pattern of CTEPH was the presence of one of two findings, an avascular area or marked rPAD (>20mm) together with pleuritic change. The diagnostic pattern of PPH was one of the two features; without pleuritic abnormality, marked left 2nd arc protrusion (>10mm) or moderate left 2nd arc protrusion (5-10mm) with marked rPAD (<20mm). The sensitivity for the diagnosis of CTEPH among the three diseases was 78% and specificity was 92%. The sensitivity for the diagnosis of PPH was 45% and specificity was 88%. CTR and right 2nd arc width were related to the degree of TR in CTEPH and PPH. Characteristic roentgenographic findings can help differentiate two frequent diseases associated with chronic pulmonary hypertension and reflect the severity of disease.

Amiodarone Pulmonary Toxicity: Assessment by Bronchoalveolar Lavage

Bronchoalveolar lavage was used to demonstrate morphologic changes in alveolar macrophages characteristic of amiodarone effect in lung tissue obtained by biopsy. This procedure may be useful in the assessment of abnormal chest x-ray findings in patients suspected to have amiodarone toxicity.

Routine antenatal chest x-ray findings in patients drawn from a currently surveyed population

1.1. Analysis is made of the findings on routine chest photofluorography in 3,576 pregnancies. The cases examined were equivalent in number to nearly half of all resident gravidas in a county of 100,000 population, simultaneously undergoing survey and study of tuberculosis.2.2. Four per cent of all patients showed sufficient signs of abnormality to warrant investigation.3.3. Thirty cases of clinically important nontuberculous pathologic conditions were diagnosed, principally cardiovascular disease, a proportion of one in 119 of the total cases.4.4. There were 37 women with 43 pregnancies in whom pulmonary tuberculosis was diagnosed ante partum; one for every 83 cases examined.5.5. The single microfilm screening of all prenatal referrals resulted in the discovery of tuberculosis, not suspected by the obstetrician, in 14 women or one in 255. The remaining cases diagnosed were either known previously, or referred as suspicious.6.6. There were found 10 cases of pulmonary tuberculosis, diagnosed from one to twenty months post partum, never previously suspected. Five of these patients had been reported as normal on the screening examination. Thus, among 42 individuals with tuberculosis in pregnancy, or shortly to develop the disease, our routine screening mechanism failed to yield a warning in one out of eight.7.7. Comparison of the prenatally diagnosed group with those whose cases were discovered post partum shows a marked difference in fatality, with a more disastrous course of the disease in both mothers and infants among the latter group.8.8. Our findings support the view that x-ray examination of the chest in all pregnancies is a highly useful procedure in terms of newly discovered tuberculous lesions otherwise unknown to the obstetrician.9.9. Additional value of the method is attested by the frequency with which nontuberculous thoracic pathology of clinical importance is disclosed. Cases of this nature deserve more investigation than was possible in this study.10.10. Despite the small numbers involved, our findings indicate that a single chest x-ray, in early to mid-pregnancy, is an insufficient sample upon which to assume that clinically important disease is unlikely to develop later in pregnancy or subsequent to delivery. The need for a supplementary examination of all patients, about the time of the initial postpartum visit, is suggested.