Computed Tomography Of Thorax Research Articles

The clinical significance and burden of thyroid nodules discovered incidentally.

The majority of thyroid nodules are benign; however current guidelines suggest that thyroid incidentalomas should be appropriately evaluated to rule out malignancy. This study aims to determine the incidence of thyroid incidentalomas and the likelihood that they harbour sinister pathology in the largest Irish cohort studied to-date. A retrospective observational chart review was conducted using data from July 2018 to December 2018 using the Radiology Database in use at Cork University Hospital. The text of 1000 imaging reports (500 carotid Doppler and 500 computed tomography thorax) was manually screened for phrases such as "thyroid mass" or "thyroid nodule". On 1000 scans, 14 (1.4%) thyroid incidentalomas were discovered. The occurrence of incidentalomas by imaging was 2/500 (0.4%) for ultrasound and 12/500 (2.4%) for computed tomography. Three of these nodules (21.4%) were further evaluated with a subsequent ultrasound and due to a size of more than 1cm underwent fine needle aspiration. Using the Thy classification, all three were given a Thy 2 (non-neoplastic) grading. This study found that there was no clinical benefit to reporting the presence of thyroid incidentalomas incidentally noted on radiology investigations. Although the overall percentage of thyroid incidentalomas is low, this number may be enough to cause unnecessary strain on the healthcare system and burden patients with invasive investigations in addition to causing unnecessary anxiety.

Role of Unenhanced Computed Tomography of the Chest in the Prediction of Anaemia: A Cross-sectional Study

Introduction: Anaemia is a common clinical condition. The detection of incidental findings on unenhanced Computed Tomography (CT) that predict the presence of anaemia may play a pivotal role in early diagnosis, treatment and prognosis. Aim: To assess the role of unenhanced CT thorax in predicting anaemia by determining the sensitivity and specificity of the Interventricular Septum Sign (IVS) and Aortic Rim Sign (ARS) in the prediction of anaemia. Materials and Methods: This was a cross-sectional study conducted on 300 patients who underwent High-resolution Computed Tomography (HRCT) of the thorax using a 128-slice CT scanner in the Department of Radiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India, Nizams Institute of Medical Sciences, Hyderabad, from July 2022 to September 2022. An estimation of haemoglobin levels was performed from a peripheral blood sample within 24 hours of the scan and the diagnosis of anaemia was made based on World Health Organisation (WHO) guidelines of haemoglobin values according to age and gender. On imaging, the following parameters were analysed: the variables considered for each patient included age and gender, the presence or absence of ARS, the presence or absence of an IVS and the Hounsfield Units (HU) values of seven selected Regions of Interest (ROI) on each examination. Three ROIs were placed in the Left Ventricular (LV) cavity, three on the IVS and a single ROI was placed in the aorta at the same level. Mean, percentage, frequency and standard deviation were calculated. The Chi-square test was applied for statistical analysis and a p-value of <0.05 was considered significant. Results: Out of the total sample size of 300, 188 were males and 112 were females with the mean age of 47.16±19.77 years. The mean haemoglobin percentage in the study was 11.62±2.25 gm%. Approximately 195 (65%) out of 300 patients were found to be anaemic based on blood reports. Among them, the majority were diagnosed with moderate anaemia 109 (36.3%), followed by mild anaemia 76 (25.3%) and severe anaemia 10 (3.3%), respectively. The sensitivity of the dense IVS was 100% for severe anaemia, 75.6% for moderate anaemia and 55.3% for mild anaemia. In comparison, the aortic rim sign showed a sensitivity of 100% for severe anaemia, 86.5% for moderate anaemia and 67.69% for mild anaemia, with a specificity of 88.57%. Conclusion: The presence of an IVS on an unenhanced CT predicts the likelihood of underlying anaemia and suggests the need for further evaluation and timely management.

Automatic patient centering in computed tomography: a systematic review and meta-analysis.

To comprehensively examine the influence of auto-patient centering technologies on positioning accuracy, radiation dose, image quality, and time efficiency of computed tomography (CT) scans. A systematic search of peer-reviewed English publications was performed between January 2000 and November 2023 in PubMed, Embase, CINAHL, Scopus, and Web of Science. Two postgraduate students and an academic lecturer independently reviewed the articles to verify adherence to the inclusion criteria. The QUADAS-2 tool was employed to evaluate study quality. We derived summary estimates on positioning accuracy, radiation dose reduction, image quality, and time efficiency using proportion and meta-analysis methodologies. Nine studies were identified comparing automatic and manual CT positioning. Automatic positioning improved accuracy by reducing vertical offsets to 7 mm and 4 mm for thorax and abdominal CTs, compared to 19 mm and 18 mm with manual methods. Most studies showed significant reductions in radiation dose, ranging from 5.71 to 31%. Image quality results were mixed, automatic methods generally produced images with less noise, but differences were minimal. Time efficiency was better, with automatic positioning reducing preparation time from 0.48 min versus 0.67 min for manual positioning. This review confirms that automatic patient-centering technologies enhance positioning accuracy and decrease preparation times in CT scans. While reductions in radiation doses and some improvements in image quality were observed, the evidence remains mixed. Findings support integrating these technologies into clinical practice to optimize patient care. Question Does automatic patient centering in CT enhance positioning accuracy, reduce radiation exposure, and improve image quality? Findings Findings indicate that automatic centering can optimize image quality, reduce examination times and contribute to overall improvements in imaging efficiency. Clinical relevance Automatic patient centering in CT improves positioning accuracy, minimizes radiation exposure, enhances image quality, and accelerates imaging workflows, contributing to safer, more efficient imaging procedures that benefit patient care.

Post COVID rhino-cerebral mucormycosis at a tertiary hospital in Central India: a retrospective cohort study

BackgroundUsually non-pathogenic in immunocompetent individuals, mucormycosis is an aggressive, angio-invasive fungus. It is a rare, opportunistic infection belonging to the zygomycete family. The second wave of COVID-19 saw the emergence of a more dangerous and a potentially deadly invasive fungal sinusitis evolving in rhino-cerebral mucormycosis thus compounding and complicating the pandemic. Alarming and exponential rise in the number of cases of rhino-cerebral mucormycosis in India versus the rest of the world when the treatment protocols essentially remained the same needs to be probed scientifically along with its prompt management. Here an attempt has been made to explore this in the study of 50 cases of rhino-cerebral mucormycosis. This study aims to explore the cause and extension of the disease along with its treatment and outcome in 50 cases of post COVID rhino-cerebral mucormycosis.ResultsThis is a retrospective cohort study conducted on 50 patients with post COVID-19 invasive mucormycosis of the paranasal sinuses with extension to surrounding structure visiting Otorhinolaryngology department at Acharya Vinoba Bhave Rural Hospital, Wardha. Among 50 patients, 86% males in 4th to 7th decade with mean age of 51.08 years. Large majority had mild–moderate severity on high-resolution computed tomography thorax with 84% having uncontrolled diabetes and 18% newly diagnosed diabetic cases. Seventy-two percent had history of steroid intake for COVID-19 management. Maxillary sinus was most commonly involved sinus in 94% cases while 32% had commonest extra nasal spread hard palate. Seventy-eight percent of the post operated mucormycosis cases are alive with no recurrence, 8% are alive and had recurrence of the disease while 14% resulted in death.ConclusionEffective management and control of the infection can be achieved with the use of strong antibiotics, oral or systemic antifungal drugs, extensive surgical excision of diseased tissue, and addressing underlying risk factors can effectively manage and control the infection. This approach results in positive outcomes and reduced morbidity compared to the time prior to the COVID-19 pandemic including cases with extensive disease.

Role of CT-based body composition parameters in the course of COVID-19.

A significant correlation is observed between the course of coronavirus disease 2019 (COVID-19) and body composition parameters including visceral fat quantification, muscle mass, and hepatic attenuation. The aim of the study was to investigate the correlation between the extent of lung involvement and various computed tomography (CT) parameters, as well as laboratory findings in COVID-19 patients. A retrospective analysis was conducted on 72 adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who underwent two consecutive thorax CT scans at least 2 weeks apart. The patients were divided into two groups, as progressive and nonprogressive, based on the presence of two consecutive CT scans. Skeletal muscle area (SMA), subcutaneous fat area (SFA), visceral fat area (VFA), total fat area (TFA), liver-to-spleen (L/S) density ratio, and laboratory findings were compared between the groups. The correlation between the extent of lung involvement and CT parameters, as well as the laboratory findings were assessed. A total of 72 patients were included in the study, with 34 (47.2%) females and 38 (52.8%) males. Hemoglobin levels were significantly lower in the progressive group compared to the nonprogressive group. C-reactive protein (CRP) values were higher in the progressive group at follow-up. The nonprogressive group exhibited decreases in the SFA, VFA, and TFA, while liver density increased. The progressive group showed a decrease in the twelfth thoracic vertebra (T12) paravertebral muscle area and muscle index. In the comparison of the laboratory and radiological data in the course of COVID-19, white blood cell (WBC) and neutrophil counts increased, SMA T12, and the skeletal muscle index (SMI) decreased in the lung progressive group. Hemoglobin and CRP levels at admission may indicate disease progression. Future studies are warranted to increase the reliability with larger series.

Computed tomography–guided percutaneous transthoracic core needle biopsy for the diagnosis of mediastinal masses

Mediastinal masses encompass a wide spectrum of diseases; therefore, histopathological diagnosis is crucial for adequate surgical or medical treatments. Herein, we report six cases of mediastinal tumors that were definitively diagnosed by computed tomography (CT)-guided core needle biopsy. Case 1: A 35-year-old woman was found to have an anterior mediastinal mass on both a chest X-ray and a CT thorax. A CT-guided core needle biopsy of the mediastinal mass revealed type A thymoma. The patient underwent surgery and remained well 1 year of post-surgery. Case 2: A 47-year-old man was found to have a solid and cystic mass with areas of calcifications on a CT scan. A CT-guided core needle biopsy of the mediastinal mass revealed an immature teratoma. The patient is now under chemotherapy. Case 3: An 18-year-old boy was found to have a tumor in the anterior mediastinum on both a chest x-ray and CT scan. A CT-guided core needle biopsy of the mediastinal mass revealed a yolk sac tumor. The patient received only two cycles of chemotherapy and died. Case 4: A 26-year-old man was found to have a left anterior mediastinal mass with internal necrosis and calcification on a CT scan. A CT-guided core needle biopsy of the mediastinal mass revealed a malignant germ cell tumor. The patient is now under chemotherapy. Case 5: A 17-year-old boy was found to have an anterior mediastinal mass on both a chest X-ray and a CT scan. A CT-guided core needle biopsy of the mediastinal mass showed non-Hodgkin lymphoma. The patient received chemotherapy and remained well 6 months after the treatment. Case 6: An 8-year-old child was found to have an anterior mediastinal mass on a chest C-ray and a CT scan. A CT-guided core needle biopsy of the mediastinal mass revealed neuroblastoma. After six courses of chemotherapy the patient passed away. Percutaneous CT-guided core needle biopsy of mediastinal mass lesions is a safe, accurate, and cost-effective procedure.

Clinical and radiological characteristics of mediastinal melioidosis: A four-year retrospective cohort from Sabah, Malaysia

BackgroundMelioidosis is a potentially fatal tropical infection. Little is known about mediastinal involvement in melioidosis. This study aimed to (a) describe the prevalence and demographics of various morphologies of mediastinal melioidosis, (b) propose a classification for radiological morphologies of mediastinal melioidosis. MethodsA retrospective cohort study was performed. Case records of consecutive patients with culture-positive melioidosis who underwent computed tomography (CT) thorax from January 1, 2018–February 28, 2022, were reviewed. Results486 culture-positive melioidosis patients were identified, of which 70 underwent CT thorax. 41 patients demonstrating mediastinal involvement were included in the final analysis, of which four were mediastinal collections, while the rest were classified into those with necrotic or matted appearances, and subcentimeter and larger than 1 cm. Culture-positivity was proven from blood in 83 % of patients (n = 34), with the remaining from chest wall pus, neck abscess pus, sputum, liver abscess, seminal vesicle, pleural, pericardial and peritoneal fluid. The most commonly associated pulmonary manifestations were consolidation and pleural effusion. Half had diabetes; a quarter had chronic kidney disease, while one had syphilis. Exposure to soil was present in six patients: quarry (n = 1), construction (n = 2), farmer (n = 1), living environment (n = 2). Seven patients succumbed before the end of 6-week intensive phase antibiotic treatment. ConclusionMediastinal melioidosis is a spectrum with multiple overlapping features consisting of necrosis, matted lymph nodes, multiseptated and non-septated collections. Further studies will elucidate the prognostic implications of mediastinal melioidosis.

When Undergoing Thoracic CT (Computerized Tomography) Angiographies for Congenital Heart Diseases, Is It Possible to Identify Coronary Artery Anomalies?

The aim of this study was to evaluate the coronary arteries in patients undergoing thoracic CT angiography for congenital heart disease, to determine the frequency of detection of coronary artery anomalies in congenital heart diseases, and to determine which type of anomaly is more common in which disease. In our investigation, a 128-detector multidetector computed tomography machine was used to perform thorax CT angiography. The acquisition parameters were set to 80-100 kVp based on the patient's age and mAs that the device automatically determined based on the patient's weight. During the examination, an intravenous (IV) nonionic contrast material dose of 1-1.5 mL/kg was employed. An automated injector was used to inject contrast material at a rate of 1.5-2 mL/s. In the axial plane, 2.5 mm sections were extracted, and they were rebuilt with 0.625 mm section thickness. Between October 2022 and May 2024, 132 patients who were diagnosed with congenital heart disease by echocardiography and underwent Thorax CT angiography in our department were retrospectively evaluated. Of the evaluated patients, 32 were excluded with exclusion criteria such as patients being younger than 3 months, older than 18 years, insufficient contrast enhancement in imaging and contrast-enhanced imaging, thin vascular structure, and motion and contrast artifacts; the remaining 100 patients were included in this study. The age range of these patients was 3 months to 18 years (mean age 4.4 years). In congenital heart diseases, attention to the coronary arteries on thoracic CT angiography examination in the presence of possible coronary anomalies may provide useful information.

The Enigma of Collapsed Lung in a Young Female

Abstract The most common cause for primary spontaneous pneumothorax (PTX) is congenital blebs or bullae. All patients with primary spontaneous PTX require high-resolution computed tomography thorax to find the underlying structural lung disease if any, as the cause for PTX. A thorough family history and physical examination are also essential to find the underlying predisposing causes if any. We report a case of primary spontaneous PTX in a young female with localized multiple bullae without any obvious predisposing factors which is unusual.

Imaging the Impact: Computed Tomography Thorax in COVID-19 - A Comprehensive Review and Clinical Analysis

This comprehensive review and clinical analysis explore the pivotal role of thorax computed tomography (CT) in the context of COVID-19. As the world grapples with the ongoing pandemic, the need for effective diagnostic tools and management strategies remains paramount. This review meticulously examines the impact of thorax CT imaging on the understanding, diagnosis, and clinical management of COVID-19. The review encompasses an extensive analysis of the existing literature, shedding light on the nuances of thorax CT findings in COVID-19 patients. It explores the characteristic imaging features, such as ground-glass opacities, consolidations, and other pulmonary abnormalities, providing insights into the pathophysiology of the disease. Furthermore, the clinical analysis component synthesizes data from diverse studies to elucidate the diagnostic accuracy and sensitivity of thorax CT, particularly in cases where molecular testing may present challenges. The review also delves into the role of thorax CT in early detection, risk stratification, and longitudinal monitoring of patients with COVID-19, offering valuable perspectives for healthcare professionals. Importantly, considerations of radiation exposure and ethical use of thorax CT are addressed, emphasizing the judicious integration of imaging into clinical practice. The article concludes with practical recommendations for optimizing the utility of thorax CT in the broader context of COVID-19 diagnosis and patient care.

Do all traumatic hemothorax require a tube thoracostomy: A retrospective review

Abstract Background: Blunt thoracic trauma accounts for a majority of trauma-related admissions. The Eastern Association for the Surgery of Trauma guidelines recommend placement of a tube thoracostomy for all patients with a hemothorax. Our study was conducted to look at those managed without an intercostal drain (ICD) and the factors that could predict a failure in conservative management. Materials and Methods: A retrospective study was conducted from January 2020 to June 2022 at a level-one trauma center in South India to account for patients who required a tube thoracostomy after planned expectant management for hemothorax. All adult patients above 16 years, with traumatic hemothorax were included. Those who had ICD inserted in the emergency department before computed tomography (CT) and those who did not have a CT Thorax were excluded. A retrospective review of patient records was conducted and analyzed using Stata (ver. 16). Results: Eighty-eight patients were included in the study, of whom 11 patients required a tube thoracostomy after an initial trial of conservative/expectant management (i.e., not inserting an ICD). The most common reason for failure was an increase in the size of the hemothorax. Among all the predictors we looked at, only a systolic blood pressure of <90 mm Hg on presentation was statistically significant for predicting failure of expectant management. Conclusion: Our study suggests not all patients with a traumatic hemothorax require a tube thoracostomy and can be managed expectantly provided close monitoring is possible. An increase in the size of the hemothorax was the main indication for a tube thoracostomy.

Predictors of 2-year mortality in geriatric patients hospitalized with COVID-19 in Türkiye: a retrospective cohort study.

Aim: To reveal factors affecting 2-year mortality in geriatric patients hospitalized with COVID-19.Methods: Demographic characteristics, clinical and laboratory data, thorax computed tomography (CT) images, second-year survival status, and causes of death were analyzed.Results: The 2-year post-discharge mortality rate of 605 patients was 21.9%. Mean age of patients in the deceased group was 76.8±8.1years, which was shorter than the life expectancy at birth in Türkiye. Older age (≥85), delirium, some co-morbidities, and atypical thorax CT involvement were associated with a significant increase in 2-year mortality (p<0.05).Conclusion: This is the first study to evaluate factors associated with 2-year mortality in older COVID-19 patients. Identifying risk factors for long-term mortality in geriatric COVID-19 patients is important.

Chronic Airway Obstruction in the Post-COVID-19 Era: Is There a Cause or Effect?

ABSTRACT Introduction: Chronic airway obstruction (CAO) is the terminology used to address chronic obstructive airway diseases, namely bronchial asthma (BA), chronic obstructive pulmonary disease (COPD), bronchiectasis, and posttuberculosis (TB) COPD. We studied the profile of the CAO at the respiratory medicine department post the COVID-19 lockdown to understand any cause or effect of past COVID-19. Materials and Methods: This prospective observational study enrolled 164 cases of CAO. Clinical and radiological details of the two groups of CAO with and without a past history of COVID-19 were noted. Results: Of 164, 101 (61.59%) were men and 63 (38.41%) were women. Thirty-nine had a history of COVID-19. Of the 164 cases, 39 (23.7%) had BA, 51 (31.09%) had COPD, 61 (37.19%) had post-TB COPD, and 13 (7.92%) had bronchiectasis. In patients with a history of COVID-19, 9 (23.1%) had BA, 9 (23.1%) had COPD, 15 (38.5%) had post-TB COPD, and 6 (15.3%) had bronchiectasis. Eight had normal lung functions, 4 had mild obstructions, 75 had moderate obstruction, and 74 had severe obstructions. The clinical and spirometry differences in those with and without a history of COVID-19 were statistically insignificant. On high-resolution computed tomography thorax, 46 (28.1%) had emphysema, 16 (9.7%) had air trapping, 65 (39.7%) had fibrobronchiectasis, and 37 (22.5%) were normal. In patients with a history of COVID-19, 6 (15.3%) had emphysema, 2 (5.2%) had air trapping, 23 (58.9%) had fibrobronchiectasis, and 8 (20.5%) were normal. The difference in radiological findings was statistically significant and more in the group with a history of COVID-19 (P = 0.029). Conclusion: COVID-19 did not affect the distribution, clinical characteristics of CAO, however, impacted radiological findings significantly.

Adaptive local boundary conditions to improve deformable image registration

Objective. In medical imaging, it is often crucial to accurately assess and correct movement during image-guided therapy. Deformable image registration (DIR) consists in estimating the required spatial transformation to align a moving image with a fixed one. However, it is acknowledged that for DIR methods, boundary conditions applied to the solution are critical in preventing mis-registration. This poses an issue particularly when areas of interest are located near the image border. Despite the extensive research on registration techniques, relatively few have addressed the issue of boundary conditions in the context of medical DIR. Our aim is a step towards customizing boundary conditions to suit the diverse registration tasks at hand. Approach. We analyze the behavior of two typical global boundary conditions: homogeneous Dirichlet and homogeneous Neumann. We propose a generic, locally adaptive, Robin-type condition enabling to balance between Dirichlet and Neumann boundary conditions, depending on incoming/outgoing flow fields on the image boundaries. The proposed framework is entirely automatized through the determination of a reduced set of hyperparameters optimized via energy minimization. Main results. The proposed approach was tested on a mono-modal computed tomography (CT) thorax registration task and an abdominal CT-to-MRI registration task. For the first task, we observed a relative improvement in terms of target registration error of up to 12% (mean 4%), compared to homogeneous Dirichlet and homogeneous Neumann. For the second task, the automatic framework provides results close to the best achievable. Significance. This study underscores the importance of tailoring the registration problem at the image boundaries. In this research, we introduce a novel method to adapt the boundary conditions on a voxel-by-voxel basis, yielding optimized results in two distinct tasks: mono-modal CT thorax registration and abdominal CT-to-MRI registration. The proposed framework enables optimized boundary conditions in image registration without prior assumptions regarding the images or the motion.

Real-World Clinical Profile and Safety of Nintedanib in Systemic Sclerosis-Associated Interstitial Lung Disease: A Subgroup Analysis of Interstitial Lung Disease Data From an Interstitial Lung Disease (ILD) Specialty Clinic in India.

Systemic sclerosis (SSc) is a multisystem autoimmune disorder characterized by dysregulated innate and adaptive immunity. Interstitial lung disease (ILD) is a common and serious complication of SSc, often leading to significant morbidity and mortality. Consistent demographic characteristics that aid in the early diagnosis of ILD in SSc are lacking. This study aims to identify clinical and demographic parameters associated with ILD in SSc patients and assess the safety and tolerability of nintedanibwith other immunosuppressants. This study is a subgroup analysis of data from the ILD clinic at All India Institute of Medical Sciences Raipur, collected between January 2022 and January 2024. We assessed the clinical and demographic profiles, high-resolution computed tomography thorax patterns, autoantibody profiles, lung function, and treatments used in the patients. We enrolled 57 patients with SSc-associated ILD. The mean age of the participants was 39.0 ± 11.1 years, with 53 (92.9%) being women. The mean body mass index was 20.4 ± 4.32 kg/m². Dyspnea was the most common symptom, followed by skin tightening and cough. Antinuclear antibody tests were positive in 92.9% of patients, and anti-Scl-70 antibodies were positive in 57.9%. Rheumatoid arthritis-SSc overlap was observed in 15.8% of patients. The mean predicted forced vital capacity was 46.5 ± 19.9%, the mean predicted total lung capacity was 64.5 ± 20.4%, and the mean predicted diffusing capacity for carbon monoxide was 46.2 ± 15.7%. The mean six-minute walk distance was 360.3 ± 81.2 meters, and the mean King's Brief Interstitial Lung Disease score was 63.9 ± 10.7. Common radiological abnormalities included ground-glass opacities in 57.8%, traction bronchiectasis in 43.8%, and honeycombing in 28.07%. The predominant ILD pattern was nonspecific interstitial pneumonia. Patients received a combination of prednisolone (5 mg/day) with mycophenolate mofetil (63.2%), hydroxychloroquine (17.5%), cyclophosphamide (12.3%), and methotrexate (7.02%). Nintedanib, the only antifibrotic used, was administered to 17 (29.8%) patients. ILD is relatively common in SSc, particularly in patients with diffuse cutaneous SSc and those with anti-topoisomerase antibodies. Female patients comprised the predominant population in this study. Patients tolerated mycophenolate mofetil and cyclophosphamide well. Nintedanib was the only antifibrotic used, and all patients tolerated the combination of antifibrotics and immunosuppressants well. Early diagnosis is crucial to slow disease progression and preserve lung function. Our results highlight the need for vigilant screening in high-risk groups and suggest that MMF, cyclophosphamide, and nintedanib can be safely incorporated into treatment regimens, offering a potential strategy to improve patient outcomes.

Unenhanced computed tomography as a diagnostic tool in suspected pulmonary hypertension: a retrospective cross-sectional pilot study.

Computed tomography pulmonary angiography (CTPA) has been proposed to be diagnostic for pulmonary hypertension (PH) in multiple studies. However, the utility of the unenhanced CT measurements diagnosing PH has not been fully assessed. This study aimed to assess the diagnostic utility and reproducibility of cardiac and great vessel parameters on unenhanced computed tomography (CT) in suspected pulmonary hypertension (PH). In total, 42 patients with suspected PH who underwent unenhanced CT thorax and right heart catheterization (RHC) were included in the study. Three observers (a consultant radiologist, a specialist registrar in radiology, and a medical student) measured the parameters by using unenhanced CT. Diagnostic accuracy of the parameters was assessed by area under the receiver operating characteristic curve (AUC). Inter-observer variability between the consultant radiologist (primary observer) and the two secondary observers was determined by intra-class correlation analysis (ICC). Overall, 35 patients were diagnosed with PH by RHC while 7 patients were not. Main pulmonary arterial (MPA) diameter was the strongest (AUC 0.79 to 0.87) and the most reproducible great vessel parameter. ICC comparing the MPA diameter measurement of the consultant radiologist to the specialist registrar's and the medical student's were 0.96 and 0.92, respectively. Right atrial area was the cardiac measurement with highest accuracy and reproducibility (AUC 0.76 to 0.79; ICC 0.980, 0.950) followed by tricuspid annulus diameter (AUC 0.76 to 0.79; ICC 0.790, 0.800). MPA diameter and right atrial areas showed high reproducibility. Diagnostic accuracies of these were within the range of acceptable to excellent, and might have clinical value. Tricuspid annular diameter was less reliable and less diagnostic and was therefore not a recommended diagnostic measurement.

Computed tomography imaging-based radiologic evaluation of pulmonary artery thrombosis in a series of patients with Behcet's disease.

Pulmonary artery involvement is a severe complication of Behcet's disease (BD). Although venous thrombosis is common in BD, pulmonary embolism is considered to be rare because the inflammatory nature makes the thrombi strongly adherent to the venous walls. This study aimed to define the radiological characteristics of pulmonary artery thrombosis (PAT) on computed tomography (CT) imaging in BD patients. We retrospectively evaluated 165 BD patients with vascular involvement. Among the patients with venous involvement (n = 146), we identified 65 patients who had undergone thorax CT imaging previously. Fourteen patients who were diagnosed with PAT were included in the study. Expert radiologists re-evaluated the patients' initial and control thorax CT scans, classified the PAT as acute or chronic based on their radiological features. The patients' median age was 35 (min-max: 15-60) years at the time of the initial CT scan, and nine were male. Twelve (85.7%) patients were symptomatic at the time of CT evaluation. Upon re-evaluating the thorax CTs, acute PAT was diagnosed in six (42.8%); chronic PAT was detected in eight (57.1%) patients. Two patients with chronic PAT also had acute PAT. Pulmonary artery aneurysms were present in three (21.4%) patients, and intracardiac thrombus was found in three (21.4%) patients. A significant number of BD patients with venous involvement had radiological findings consistent with acute PAT potentially due to pulmonary emboli in this study. The clinical importance of these lesions has to be defined with future studies.

A study on clinicoradiological profile of patients with hydropneumothorax in a tertiary care hospital in Eastern India

Background: Hydropneumothorax is an abnormal presence of air and fluid in the pleural space. It is a common presentation in the Indian scenario. However, there is a scarcity of studies from Eastern India. Aims and Objectives: The study aimed to evaluate the clinical and radiological presentation, etiological factors, treatment modalities, and outcome of patients of hydropneumothorax. Materials and Methods: Descriptive, observational, cross-sectional study conducted in a tertiary care hospital for 1 year. Adult patients of both genders presenting with a diagnosis of hydropneumothorax were studied. Detailed history and clinical examination were recorded. Chest X-ray, blood, pleural fluid, sputum investigations, and computed tomography (CT) thorax were done. An intercostal drainage (ICD) tube was inserted and the duration of ICD stay was noted. Results: Thirty-six patients were studied. The mean age of presentation is 40.8±14.8 (Mean±SD) years with male predominance. Breathlessness and cough were the most common symptoms (86.1%). Right-sided hydropneumothorax was more common (52.7%). All patients had exudative pleural fluid. Cavity (38.9%) was the most commonly associated radiological finding in CT thorax. Tuberculosis (TB) was the most common etiology (61.1%), followed by acute bacterial infection (36.1%), and malignancy (2.7%). All patients have undergone ICD insertion. About 61.11% of patients had an ICD stay of less or equal to 15 days. Conclusion: Pleural fluid analysis is essential in establishing the etiological diagnosis of hydropneumothorax. TB is the common etiology. ICD insertion along with appropriate chemotherapy are essential components of management.

Immunoglobulin G4-related thoracic disease: clinical and radiological findings of a Turkish cohort.

Thoracic involvement of Immunoglobulin G4-related disease (IgG4-RD) is relatively rare and may be disregarded at the time of initial diagnosis due to its asymptomatic nature. This study aimed to ascertain the prevalence and patterns of thoracic involvement in a retrospective cohort of Turkish patients with IgG4-RD. A total of 90 patients (47 males and 43 females, with a mean age of 57.7±15.5 years) diagnosed with IgG4-RD were reviewed retrospectively. All computed tomography (CT) scans were re-evaluated by two thoracic radiologists and IgG4-related thoracic disease was assessed on four compartments: The mediastinum, pulmonary parenchyma, airways, and pleura. IgG4-related thoracic disease was categorized as: definite, highly probable, probable or possible. There were 64 patients who had undergone at least one thorax CT examination, and 18 (28%) were diagnosed with IgG4-related thoracic disease. The rate of IgG4-related thoracic disease increased by 20% and reached a ratio of 48.4% (n=31) after a thorough reevaluation of registry data specifically to thoracic findings. The mediastinum was the most frequently involved compartment, affecting 16 (51.6%) patients, followed by pulmonary parenchyma in 14 (45.2%) patients, and airways and pleura in 10 (32.3%) patients each. Other organ involvements were more prevalent and IgG4 levels were higher in patients with thoracic involvement. Eosinophils were significantly elevated in patients with thoracic involvement (p=0.023). IgG4-related thoracic disease is heterogeneous and likely to be more prevalent than currently recognized. The mediastinum is the most frequently involved compartment. It is important to assess IgG4-related thoracic disease at the time of initial diagnosis. Elevated levels of serum IgG4 and eosinophils, as well as a greater number of organ involvements may serve as indicators of thoracic involvement.

Diagnostic Value of Lung Ultrasonography in COVID-19 Patients Presenting to the Emergency Department

Aim: It was aimed to investigate whether ultrasonographic evaluation of the lungs has a diagnostic value for COVID-19 pneumonia in patients who presented to the emergency department (ED) with symptoms suggestive of COVID-19. Materials and Methods: A prospective, cross-sectional, observational study was conducted in the Emergency Medicine Department of XXX Hospital over 2 months. A total number of 204 adult patients who presented with symptoms suggestive of COVID-19 were included in the study. The findings and results obtained from the Lung Ultrasonography (LUS) and Thorax Computed Tomography (CT) were collected. Results: 112 patients had Thorax CT findings consistent with COVID-19 pneumonia. 104 (92.86%) of them were “LUS positive”. The sensitivity of LUS in the diagnosis of COVID-19 was 93.33% and specificity was 80%, Positive Predictive Value was 82.96%, and Negative Predictive Value was 92%. Patchy B-lines was the most sensitive LUS finding. ROC analysis was performed for two different COVID-19 LUS scores: In the patient group, an “LUS score” above 13 had a 80% sensitivity and 52.63% specificity in terms of 14-day mortality. Also a “Total LUS Score” above 13 had a sensitivity of 79.46% and specificity of 57.89% for 14-day mortality. Conclusion: LUS can assist the emergency physician in triage and clinical decision-making in COVID-19. We have defined a novel COVID-19 “Total LUS Score”. This score had a better specificity, and similar sensitivity compared to “LUS Score” which was defined in the literature before, and both were found to be associated with poor clinical outcomes. Patchy B-lines (89.3%) and Pleural Thickening (63.4%) are the most common COVID-19 related findings in LUS. It is recommended to look for these two findings in patients with suspected COVID-19.