Computed Tomography Of Thorax Research Articles

Prevalence of adrenal incidentaloma in patients performed thorax computed tomography for suspected COVID-19 infection

Aims: The primary purpose of this study is to make a retrospective evaluation of adrenal incidentaloma (AI) prevalence in patients performed thorax computed tomography (TCT), along with determining whether the diagnosed AIs were assessed functionally for adrenal gland hyperfunction and to detect the rate of hyperfunctional AI.
 Methods: The patients who applied to with the suspected COVID-19 and performed TCT between January 2020 and December 2021, were included in the present study. However, the patients who were followed-up due to a known adrenal mass and a malignant tumor were excluded.
 Results: TCT imaging, including adrenal glands, was performed on 2580 patients. The mean age for these patients was 54±16.8. However, when the patients were separated into groups in terms of adrenal pathology (AP), the mean age for the patients with and without AP was 61.4±11 and 53.8±16.9, respectively (p

Risk factor analysis for major mediastinal vessel invasion in thymic epithelial tumors based on multi-slice CT Imaging.

To explore the characteristics and risk factors for major mediastinal vessel invasion in different risk grades of thymic epithelial tumors (TETs) based on computed tomography (CT) imaging, and to develop prediction models of major mediastinal artery and vein invasion. One hundred and twenty-two TET patients confirmed by histopathological analysis who underwent thorax CT were enrolled in this study. Clinical and CT data were retrospectively reviewed for these patients. According to the abutment degree between the tumor and major mediastinal vessels, the arterial invasion was divided into grade I, II, and III (< 25%, 25 - 49%, and ≥ 50%, respectively); the venous invasion was divided into grade I and II (< 50% and ≥ 50%). The degree of vessel invasion was compared among different defined subtypes or stages of TETs using the chi-square tests. The risk factors associated with TET vascular invasion were identified using multivariate logistic regression analysis. Based on logistic regression analysis, male patients (β = 1.549; odds ratio, 4.824) and the pericardium or pleural invasion (β = 2.209; odds ratio, 9.110) were independent predictors of 25% artery invasion, and the midline location (β = 2.504; odds ratio, 12.234) and mediastinal lymphadenopathy (β = 2.490; odds ratio, 12.06) were independent predictors of 50% artery invasion. As for 50% venous invasion, the risk factors include midline location (β = 2.303; odds ratio, 10.0), maximum tumor diameter larger than 5.9 cm (β = 4.038; odds ratio, 56.736), and pericardial or pleural effusion (β = 1.460; odds ratio, 4.306). The multivariate logistic model obtained relatively high predicting efficacy, and the area under the curve (AUC), sensitivity, and specificity were 0.944, 84.6%, and 91.7% for predicting 50% artery invasion, and 0.913, 81.8%, and 86.0% for 50% venous invasion in TET patients, respectively. Several CT features can be used as independent predictors of ≥50% artery or venous invasion. A multivariate logistic regression model based on CT features is helpful in predicting the vascular invasion grades in patients with TET.

Radiological “Triangle sign” in chest imaging in left lower lobe tuberculosis: A real puzzle

Abstract Pulmonary tuberculosis is the most common etiology for lobar or multilobar atelectasis of the lung followed by foreign body and lung malignancy in the list. The left lower lobe atelectasis is underdiagnosed due to presentation as retrocardiac opacity, which is commonly missed by treating physicians. In this case report, a 46-year-old female presented with constitutional symptoms and retrocardiac triangular opacity in the chest cardiograph. High-resolution computed tomography thorax documented collapse with consolidation and necrosis in the posterior basal segment with loss of lung volume. Bronchoscopy documented purulent secretions coming out from the left lower lobe posterior basal segment without endobronchial abnormality. Bronchoscopy-guided bronchoalveolar lavage showed acid-fast bacilli, and nucleic acid amplification tests documented Mycobacterium tuberculosis genome without rifampicin resistance. She is treated with antituberculosis treatment for 6 months and observed good clinical, bacteriological, and radiological outcomes as “cure.” We recommend basic regular training of family physicians for common radiological signs for early diagnosis and timely treatment with a successful outcome.

Comparing Sensitivity and Specificity of Ultrasonography With Chest Radiography in Detecting Pneumothorax and Hemothorax in Chest Trauma Patients: A Cross-Sectional Diagnostic Study.

Background Thoracic trauma accounts for 20-25% of all traumas and is the third most frequent cause of death, after abdominal injury and head trauma. In the Emergency Department (ED), shifting an unstable patient to the X-ray room for detecting pneumothorax and hemothorax is always risky and bedside X-ray causes radiation exposure not only to the particular patient but also to the surrounding patients in a congested and busy ED. This can be avoided by using bedside ultrasonography (USG) as the initial imaging modality in chest trauma patients. Objective To compare the sensitivity and specificity of ultrasonography and chest radiography in detecting pneumothorax and hemothorax in chest trauma patients. Methods This cross-sectional diagnostic study was conducted for a period of one year at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, a tertiary care centre.All consecutive patients (n=255) with a suspected history of chest trauma were included in the study. The patients were evaluated bedside using USG by point of care ultrasonography trained emergency medicine physician and subsequently underwent chest radiography for documentation of pneumothorax and hemothorax. Sensitivity and specificity were calculated for ultrasonography and chest X-ray (CXR) compared with the composite gold standard (chest radiography and computed tomography thorax). Results Of the 255 patients, 89% were males. The mean age of the patients was 43.46 (standard deviation 16.3). Road traffic accident (RTA) was the most common mode of injury (81%). The median (interquartile range) time interval between injury and arrival at the hospital was four hours (2.5-7). About 16.1% of the patients had subcutaneous emphysema. About 88.2% of the patients were hemodynamically stable and 78% of the patients had associated other system injuries. The sensitivity and specificity of USG in detecting pneumothorax were 85.7% and 95.3% respectively and that of CXR were 71.4% and 100% respectively. Our study found that the sensitivity and specificity of USG in detecting hemothorax were 79% and 97.9% respectively and that of CXR were 62.9% and 100% respectively. Even in the subset of patients in whom a computed tomography scan was done, the sensitivity of USG was higher than that of CXR in detecting pneumothorax and hemothorax. The specificity of USG in detecting pneumothorax was the same as that of CXR and the specificity of USG in detecting hemothorax was higher than that of CXR in that subset of patients. Conclusion The sensitivities of USG in detecting pneumothorax and hemothorax were higher than that of CXR. The specificities of USG in detecting pneumothorax and hemothorax were comparable to that of CXR. Hence bedside USG performed by emergency physician during resuscitation helps in rapid diagnosis and early management of chest trauma patients.

Preoperative spontaneous regression of type B2 thymoma in a patient with myasthenia gravis

Thymoma is the most common tumor of the anterior mediastinum. Spontaneous regression of thymoma is extremely rare. A 34-year-old female patient without any known disease, admitted by a myasthenic crisis, had a mass of 76 x 53 x 88 mm on thorax computed tomography (CT). The patient received intravenous immunoglobulin (IVIg) treatment for 5 days, pyridostigmine 60 mg/8 hours and prednisone 30 mg/day for the treatment of myasthenic crisis. Thorax CT on the 18th day showed that the mediastinal mass regressed to 63 x 30 x 63 mm. Histopathological analysis after extended thymectomy revealed the diagnosis of type B2 thymoma.

High-resolution Computed Tomography Thorax Volumetric Assessment in Coronavirus Disease 2019 Patients and Correlation with Pulmonary Function Tests.

Years after SARS coronavirus disease 2019 (COVID-19) recovery, residual pulmonary abnormalities may still exist. This brings on the question of whether or not COVID-19 could have comparable late consequences. Structural changes in the lungs after recovery can be better visualized using computed tomography (CT) thorax. Computed Tomography Lung Parenchymal changes during hospitalization by COVID-19 and after 4 months of follow-up to correlate with the volumetric high-resolution computed tomography thorax indices, Pulmonary function tests (PFTs) indices, SpO2, and 6 min Walking Test (6MWT). This is a Hospital based cross-sectional study, with a follow-up among 100 Patients from 2020 to 2022. Each patient's different CT parameters and HRCT volumetric indices Normal Lung (NL), Normal Lung Percentage (NL%), Whole Lung (WL) were correlated with the PFT indices (Forced expiratory volume in 1s [FEV1], forced vital capacity [FVC], FEV1/FVC), Oxygen Saturation (SpO2) and 6-Minute Walking Test (6MWT). The mean NL (L) and NL% during COVID were significantly lower than the mean values 4 months post-COVID. Architectural distortion, bronchiolar dilatation, interstitial thickening, and parenchymal bands were reduced considerably after 4 months post-COVID, compared to during COVID. PFTs results, such as PFT indices, were not significantly different after 4 months post-COVID, compared to during COVID. SpO2 (%) and 6 MWT (m) were significantly increased. During COVID and post-COVID, the values of NL (L) and NL (%) had a significant positive correlation with PFT indices, SpO2, and 6MWT (m). Hence, the different CT indices (NL and NL%) can be used as a surrogate for functional recovery of COVID patients since it correlates with the PFT indices (FEV1 and FEV1/FVC), SpO2, and 6MWT post-COVID.

Significance of Differential Diagnosis for Febrile and Fatigued Patients in an Endemic Area During The COVID-19 Pandemic: Consideration of COVID-19, Brucellosis, and Crimean-Congo Hemorrhagic Fever

Introduction: Brucellosis and Crimean-Congo Hemorrhagic Fever (CCHF) are diseases that can present with similar clinical and laboratory findings to those of COVID-19, leading to misdiagnosis or confusion by visiting multiple departments. This can delay diagnosis and increase the risk of nosocomial transmission in the case of CCHF. Although misdiagnosis of Brucellosis and CCHF, and even a case of coinfection have been reported in the literature, no case report mentioning CCHF and Brucellosis coinfection hospitalized with the pre-diagnosis of COVID-19 was found. Case Report: A 35-year-old female patient presented to the emergency service with complaints of fever and fatigue. The patient was evaluated in the emergency triage and was taken to the area where COVID-19 pre-diagnosed patients were being examined. A thorax computed tomography (CT) without intravenous contrast usage was reported as normal, and the patient was discharged after being informed about COVID-19 transmission routes. The patient re-applied to the emergency service with complaints of fever, fatigue, headache, and myalgia four days later. The laboratory findings showed a white-cell count of 1600/mm³, haemoglobin of 12.8 g/liter, platelet of 146000/mm³, urea of 21.5 mg/dl, creatinine of 0.81 mg/dl, alanine aminotransferase (ALT) of 134 U/liter, aspartate aminotransferase (AST) of 303 U/liter, lactate dehydrogenase (LDH) of 714 U/liter, creatine kinase (CK) of 1796 U/liter, C-reactive protein (CRP) of 3 mg/liter, D-dimer of 2000 µg/liter, and a thorax CT showed minimal ground-glass opacity. The patient was hospitalized with a preliminary diagnosis of COVID-19 by the chest diseases clinic. Conclusion: A patient with Brucellosis and CCHF coinfection was hospitalized with a preliminary diagnosis of COVID-19. This case highlights the importance of considering other diseases with similar clinical and laboratory findings in endemic regions of Brucellosis and CCHF to avoid misdiagnosis and delay in treatment. Early diagnosis and appropriate management are crucial for improving patient outcomes and preventing nosocomial transmission.

Role of interleukin-6 in coronavirus disease 2019 pneumonia: sensitive marker of inflammation, a predictor of ventilatory support and early marker of post-coronavirus disease lung fibrosis. A single center experience

Abstract Background Robust data on interleukin-6 (IL-6) is available in bacterial infection, and now it can be utilized in the currently ongoing coronavirus disease 2019 (COVID-19) pneumonia pandemic to guide treatment strategy as a marker of inflammation. Patients and methods Prospective, observational, and 12 weeks follow-up study, included 1000 COVID-19 cases confirmed with reverse transcription PCR. All cases were assessed with lung involvement documented and categorized on high-resolution computed tomography thorax, oxygen saturation, IL-6 at the entry point, and follow-up. Age, sex, comorbidity, and bilevel positive airway pressure/noninvasive ventilation (BIPAP/NIV) use and outcome as with or without lung fibrosis as per computed tomography severity. Statistical analysis is done by χ 2 test. Results In the study of 1000 COVID-19 pneumonia cases, age (&lt;50 and &gt;50 years) and sex has a significant associations with IL-6. High-resolution computed tomography severity score at entry point has significant correlation with IL-6 level (P&lt;0.00001). IL-6 level has a significant association with duration of illness (P&lt;0.00001) comorbidities has a significant association with IL-6 level (P&lt;0.00001). IL-6 level has a significant association with oxygen saturation (P&lt;0.00001). BIPAP/NIV requirement has a significant association with IL-6 level (P&lt;0.00001). Timing of BIPAP/NIV requirement during the course of hospitalization has significant association with IL-6 level (P&lt;0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point abnormal IL-6 has a significant association in post-COVID lung fibrosis (P&lt;0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point normal IL-6 has a significant association in post-COVID lung fibrosis (P&lt;0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point abnormal IL-6 has a significant association in predicting cytokine storm irrespective normal or abnormal of IL-6 at entry point (P&lt;0.0001). Conclusion IL-6 has documented a very crucial role in COVID-19 pneumonia in predicting the severity of illness, progression of illness, and ‘cytokine storm.’ Sequential IL-6 titers will help assess response to treatment during hospitalization and analyze post-COVID lung fibrosis.

Orbital tuberculosis presenting as proptosis: A case report

A 53-year-old male complained of gradual, painless dimness of vision with swelling of the right eye (R/E) for 15 days. Best-corrected visual acuity in R/E: Hand movement, left eye: 6/9, abaxial proptosis, restricted extraocular movements in all directions, conjunctival injection, and high intraocular pressure R/E were noted. Fundus showed pale optic disc R/E and macular exudates in both eyes. The patient was diabetic and on oral hypoglycemic agents with raised erythrocyte sedimentation rate and C-reactive protein; random blood sugar: 152 mg/dL. Magnetic resonance imaging (MRI) showed right-sided orbital abscess involving extraconal compartment extending into the right orbital apex with compression of the right optic nerve. Mantoux test was positive and computed tomography thorax was normal. Histopathology of biopsy from middle turbinate showed granulomatous inflammatory cellular lesion. The patient was started on anti-tubercular therapy. He got relieved of symptoms. Repeat MRI showed reduction in disease process.

Pulmonary involvement in antineutrophil cytoplasmic antibody-associated vasculitides: A single center experience from Turkey.

Pulmonary involvement is an important cause of mortality and morbidity in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). In this study, we aimed to evaluate the type and frequency of pulmonary involvement and investigate the potential relationship between thorax computed tomography (CT) signs and other systemic clinical findings in AAV. A total of 63 patients over the age of 18 and diagnosed with AAV were included in this study. Thoracic CT imaging findings and clinical features of the patients at the time of diagnosis were retrospectively evaluated. The frequency and distribution of detected pathological findings on imaging according to disease types, in addition to the relationship of these findings with other systemic findings and disease severity, were analyzed. Of 63 patients, 50 (79.4%) had pulmonary symptoms at the time of presentation. Most frequently observed pulmonary finding of thorax CT was nodular opacity. Consolidation, cavitary nodules, bronchiectasis, emphysema and fibrotic sequelae change were more common in the patients with diagnosis of granulomatosis with polyangiitis. Honeycomb, atelectasis, interstitial pneumonia, pulmonary venous congestion and pleural effusion were more common in the patients with diagnosis of microscopic polyangiitis. Ground-glass appearance, central airway disease, peribronchovascular nodules, pericardial effusion and lymphatic adenomegaly (>10 mm) were more common in the patients with diagnosis of eosinophilic granulomatosis with polyangiitis. Interstitial lung disease, pulmonary hemorrhage and severe lung involvement were found significantly increased in patients with myeloperoxidase antibody (MPO)-ANCA positivity (P < 0.05). Lung involvement was detected in almost all of the patients with AAV. Both interstitial lung disease and severe lung involvement were more frequently found in patients with MPO-ANCA positivity compared to other patients. Pulmonary examination by an imaging technique in all patients with AAV may be useful to determine the vasculitis subtype and to determine the extent of the disease. Pulmonary involvement is quite common in AAV. Every patient with suspected AAV should be examined with imaging for lung involvement, even in the absence of respiratory symptoms. Severe pulmonary involvement is associated with the presence of severe disease and MPO-ANCA positivity.

Study of pulmonary hypertension in post-COVID-19 patients by transthoracic echocardiography

BackgroundA devastating medical disorder, the coronavirus pandemic infection (COVID-19), produced by the coronavirus 2 (SARSCoV-2), is primarily characterized by severe pneumonia. Pulmonary hypertension (PH), which may cause right ventricular (RV) involvement and dysfunction, can occur as a result of lung parenchymal injury and disturbed pulmonary circulation. Transthoracic echocardiography (TTE) is a very reliable noninvasive approach to determining the severity of PH. Similar to that, thorax computer tomography (TCT) can effectively detect the severity of lung damage during the acute phase of a COVID-19 infection.AimsThe goal of this research is to examine PH and altered right ventricular function by TTE in post-COVID-19 cases.Patients and methodsThis retrospective case–control study was conducted at Tanta Chest University Hospital, Tanta, Egypt. The study started from October 2021 to September 2022 on 50 post-COVID-19 cases with one or more clinical manifestations of PH. These cases underwent TTE (group I showed normal PAP “control group,” groups II & III with PH further subdivided according to PaO2).ResultsRisk factors of age, BMI, diabetes mellitus, and smoking were substantially raised in group III, but sex and hypertension were insignificant. Symptoms of chest pain, dyspnea, and palpitation were worse in group III. Levels of LDH, d-dimer, ESR, and serum bilirubin were substantially increased in group III in comparison to the other groups. Post-COVID-19-associated lung fibrosis and embolism were higher in group III. Mean values of estimated systolic pulmonary artery pressure (esPAP) and right atrial and right ventricular diameters were substantially increased in groups III and II in comparison to group I. Mean values of RV-GLS and TAPSE were lower in groups III and II in comparison to group I. FEV1, FVC, PEFR, and FEF25–75% percentage of the predicted were significantly low in groups II and III. FEV1/FVC ratio was substantially lower in group II in comparison to groups I and III.ConclusionsThe incidence of pulmonary hypertension in post-COVID-19 patients with suspected manifestations of PH is 70%. Increased age, BMI, DM, smoking, decreased PaO2, increased CORADS score, and abnormal spirometry are risk factors for PH in post-COVID-19 patients. Patients with post-COVID-19 PH stay more either in ICU or ward.

A Closer Look—Who Are We Screening for Lung Cancer?

ObjectiveTo evaluate the characteristics of individuals receiving lung cancer screening (LCS) and identify those with potentially limited benefit owing to coexisting chronic illnesses and/or comorbidities. Patients and MethodsIn this retrospective study in the United States, patients were selected from a large clinical database who received LCS from January 1, 2019, through December 31, 2019, with at least 1 year of continuous enrollment. We assessed for potentially limited benefit in LCS defined strictly as not meeting the traditional risk factor inclusion criteria (age <55 years or >80 years, previous computed tomography scan within 11 months before an LCS examination, or a history of nonskin cancer) or liberally as having the potential exclusion criteria related to comorbid life-limiting conditions, such as cardiac and/or respiratory disease. ResultsA total of 51,551 patients were analyzed. Overall, 8391 (16.3%) individuals experienced a potentially limited benefit from LCS. Among those who did not meet the strict traditional inclusion criteria, 317 (3.8%) were because of age, 2350 (28%) reported a history of nonskin malignancy, and 2211 (26.3%) underwent a previous computed tomography thorax within 11 months before an LCS examination. Of those with potentially limited benefit owing to comorbidity, 3680 (43.9%) were because of severe respiratory comorbidity (937 [25.5%] with any hospitalization for coronary obstructive pulmonary disease, interstitial lung disease, or respiratory failure; 131 [3.6%] with hospitalization for respiratory failure requiring mechanical ventilation; or 3197 [86.9%] with chronic obstructive disease/interstitial lung disease requiring outpatient oxygen) and 721 (8.59%) with cardiac comorbidity. ConclusionUp to 1 of 6 low-dose computed tomography examinations may have limited benefit from LCS.

Miliary Pulmonary Tuberculosis After Intravesical BCG Instillation in a Patient with High-Grade Bladder Cancer

Intravesical administration of Bacillus Calmette-Guerin (BCG) vaccine is used in the treatment of superficial bladder cancer. In clinical practice, intravesical BCG immunotherapy after transurethral tumor resection is a highly effective treatment option in preventing tumor recurrence and progression in medium and high risk superficial bladder tumors. Since patients are given live tuberculosis (TB) bacillus, serious side effects such as pneumonia, sepsis and even death can be seen. Lung involvement occurs in less than 1% of patients and most commonly presents as interstitial pneumonia or miliary TB. Miliary TB is difficult to diagnose and is usually based on high clinical suspicion, as Mycobacterium bovis is not isolated in most cases. Treatment is not completely standardized. However, in severe cases, a combination of antituberculosis drugs and corticosteroids is recommended. In this report, a case of miliary tuberculosis, a very rare complication after instillation of BCG into the bladder in a patient with a diagnosis of superficial bladder cancer, was presented. A 73-year-old male patient diagnosed with bladder tumor underwent transurethral resection of bladder tumor, and then weekly intravesical injection of BCG-MEDAC for six weeks had no adverse effects. Three weeks of intravesical BCG supplementation was planned for the patient who had no signs of recurrence when checked three months later by cystoscopy. Two hours after the first dose, the patient, who applied to the emergency department with the complaint of chills and shivering, was hospitalized for further follow-up and treatment. Afterwards, repeat cultures were taken from the patient whose fever continued on the seventh day of treatment with broad-spectrum antibiotics (meropenem and teicoplanin). In addition, when abdominal and thorax computed tomography (CT) were performed, multiple miliary nodular lesions were detected in both lungs and were evaluated in favor of miliary TB. With these findings, the patient was started on miliary TB therapy [isoniazid (INH), rifampicin (RIF), ethambutol (EMB) and streptomycin (STM)] targeting Mycobacterium bovis, since it was an infection that developed after BCG injection. In the third week of the treatment, the patient's fever was under control, and he was discharged on the 25th day of his hospitalization because of significant improvement in infection markers [C-reactive protein(CRP)-procalcitonin]. At the end of two months, there was clear regression of pulmonary abnormalities on control thorax CT. In conclusion, miliary TB developing after intravesical BCG instillation is a very rare condition, the cause of which is not fully understood, the etiology of fever can be easily missed, and the diagnosis is difficult. In addition, this case is presented to draw attention to a critical disease that requires long treatment and follow-up and requires attention.

Biochemically recurrent prostate cancer: rationalisation of the approach to imaging

To assess the utility of magnetic resonance imaging (MRI) in addition to the additive benefit of the conventional imaging techniques, computed tomography (CT) and nuclear medicine (NM) bone scintigraphy, for investigation of biochemical recurrence (BCR) post-prostatectomy where access to prostate specific membrane antigen (PSMA) positron-emission tomography (PET)-CT is challenging. Relevant imaging over a 5-year period was reviewed. Ethical approval was granted by the internal review board. All patients with suspected BCR, defined as a PSA ≥0.2 ng/ml on two separate occasions, underwent a retrospective imaging review. This was performed on PACS archive search database in a single centre using search terms "PSA" and "prostatectomy" in the three imaging methods; MRI, CT, and NM bone scintigraphy. All PSMA PET CT performed were recorded. One hundred and eighty-five patients were identified. Patients with an MRI pelvis that demonstrated distant metastases (i.e., pelvic bone metastases or lymph node involvement more cranial to the bifurcation of the common iliac arteries) were more likely to have a positive CT and/or NM bone scintigraphy. The Pearson correlation coefficient between the findings of M1 disease at MRI pelvis and the presence of distant metastases at CT thorax, abdomen, pelvis and NM bone scintigraphy was calculated at 0.81 (p<0.01) and 0.91 (p<0.01) respectively. An imaging strategy based on risk stratification and technique-specific selection criteria leads to more appropriate use of resources, and in turn, increases the yield of conventional imaging methods. MRI prostate findings can be used to predict the additive value of CT/NM bone scintigraphy allowing a more streamlined approach to their use.

Multivariate Analysis of Effective Dose and Size-Specific Dose Estimates for Thorax and Abdominal Computed Tomography.

The study aimed to compute the effective dose (E) and size-specific dose estimate (SSDE) of routine adult patients undergoing thorax and abdominal computed tomography (CT) imaging and to present their multivariate analysis. All adult thorax and abdominal CT examinations conducted from March 2022 to June 2022 were prospectively included in this study. The Water Equivalent Diameter (Dw) and SSDE of all the examinations were computed from CT dose index volume (CTDIvol) and Dose length product (DLP) displayed on the dose report in the CT console. The multivariate statistical analysis was performed to investigate the correlation of SSDE and E on CTDIvol, Dw area of the region of interest (ROI) (AreaROI), body mass index (BMI), conversion factor (fsize) and hounsfield (HUmean) number in the ROI at 95% level of significance (P < 0.05). The linear regression analysis was performed to investigate the dependence of SSDE and E on other parameters for both abdominal and thorax patients. A total number of 135 (Abdomen = 61 and Thorax = 74) measurements were performed. The mean value of effective dose for abdomen and thorax patients was found to be 7.17 ± 3.94 and 4.89 ± 2.16 mSv, respectively. The SSDE was observed to be 13.24 ± 3.61 and 13.04 ± 3.61 mGy for thorax and abdomen respectively. The multivariate analysis suggests that SSDE for abdominal CT is found significantly dependent on CTDIvol, Dw and fsize with P < 0.05 and E is found to be significantly dependent on DLP, AreaROI, Dw and fsize at 95% level of confidence for abdominal CT imaging. SSDE for thorax CT was found significantly dependent on BMI, CTDIvol, HUmean, Dw and fsize at 95% level of confidence. Furthermore, E was observed dependent on DLP at P < 0.05. The linear regression analysis also shows that E is strongly correlated with DLP (r = 1.0) for both thorax and abdominal CT, further the SSDE was observed strongly correlated with CTDIvol with r = 0.79 and r = 0.86 for abdomen and thorax CT respectively. A strong correlation was observed between BMI and for Dw abdominal CT imaging (r = 0.68). The mean value of SSDE for thorax is slightly greater than abdomen. The average value of effective dose for abdomen and thorax measurements was found to be 7.17 ± 3.94 and 4.89 ± 2.16 mSv and , correspondingly. SSDE for both abdomen and thorax CT is significantly dependent on CTDIvol, Dw and fsize at 95% level of confidence. The strong correlation was also observed E on DLP and SSDE on CTDIvol for both Abdomen and Thorax CT. The strong dependence of Dw on BMI (r = 0.68) is due to the excessive fat concentration around the stomach and abdomen.

COMPARING DIAGNOSTIC ACCURACY OF LUNG ULTRASOUND AGAINST CHEST XRAY FOR DETECTION OF PNEUMOTHORAX USING HRCT AS GOLD STANDARD.

Thoracic trauma is one of the most common locations of injury with an overall mortality rate of up to 10% making its recognition a priority in chest trauma assessment . Imaging plays a key role in guiding interventions and management in patients with chest trauma. Conventional imaging in the form of chest radiographs, ultrasounds, and computed tomography (CT) are usually performed in the emergency settings with CT scan as the gold standard for this diagnosis. But high radiation dose in CT scan has made chest X-ray a popular initial diagnostic tool in these cases. Apart from various disadvantages of chest X ray, many studies suggest its poor sensitivity and specicity in identifying intrathoracic injuries culminating in lower diagnostic yield. Recently, chest ultrasonography has emerged as a portable, inexpensive, safe, and fast alternative for radiography in detection of traumatic intrathoracic injuries. So, the present study was undertaken to compare the diagnostic accuracy of this newly surfaced chest ultrasonography and the conventional chest radiography in identifying traumatic intrathoracic injuries. Objective: To evaluate and compare the accuracy, sensitivity and specicity of chest ultrasound and chest x ray as a diagnostic tool in detection of pneumothorax, in trauma patients using CT thorax as gold standard. Study design: Descriptive study. Place and duration of study :Department of General Surgery, Lala Lajpat Rai Hospital, GSVM Medical College, Kanpur, UP, India, between December 2020 to October 2022. Methodology : In the present descriptive study, patients with traumatic intrathoracic injuries, who were referred to the emergency department between December 2020 to October 2022, were assessed. The patients underwent bedside chest ultrasound (USG), x ray and computed tomography (CT) scan examinations based on ATLS recommendations. Results : Eighty ve patients with mean age 41.13 ± 17.2 ( range 7-87 ) were taken (68.24 % males ).CT scan showed pneumothorax, in 94.12 %, cases Whereas chest ultrasonography in comparison to radiography detected pneumothorax in 69.41 % respectively. Comparison of sensitivity, specicity, positive predictive value and negative predictive value after taking CT thorax as gold standard gave accuracy of 76.27 % to USG thorax and 50.85 % to chest x ray (p =0.0005 )for detecting pneumothorax , Conclusions : The results of the present study showed that ultrasonography is preferable to radiography in the initial evaluation of patients with traumatic injuries to the thoracic cavity.

Rapid estimation of patient-specific organ doses using a deep learning network.

Patient-specific organ-dose estimation in diagnostic CT examinations can provide useful insights on individualized secondary cancer risks, protocol optimization and patient management. Current dose estimation techniques mainly rely on time-consuming Monte Carlo methods or/and generalized anthropomorphic phantoms. We proposed a proof-of-concept rapid workflow based on deep learning networks to estimate organ doses for individuals following thorax Computed Tomography (CT) examinations METHODS: CT scan data from 95 individuals undergoing thorax CT examinations were used. Monte Carlo simulations were performed and three-dimensional (3D) dose distributions for each patient were obtained. A fully connected sequential deep learning network model was constructed and trained for each organ considered in this study. Water-equivalent diameter (WED), scan length and tube current were the independent variables. Organ doses for heart, lungs, esophagus, and bones were calculated from the Monte Carlo 3D distribution and used to train the deep learning networks. Organ dose predictions from each network were evaluated using an independent data set of 19 patients. The trained networks provided organ dose predictions within a second. There was very good agreement between the deep learning network predictions and reference organ dose values calculated from Monte Carlo simulations. The average difference was -1.5% for heart, -1.6% for esophagus, -1.0% for lungs, and -0.4% for bones in the 95 patients dataset, and -5.1%, 4.3%, 0.9%, and 1.4% respectively in the 19 patients test dataset. The proposed workflow demonstrated that patient specific organ-doses can be estimated in nearly real-time using deep learning networks. The workflow can be readily implemented and requires a small set of representative data for training. This article is protected by copyright. All rights reserved.

Chylothorax due to thrombosis of the jugular and subclavian veins in a patient with gastric cancer: a case report

BackgroundChylothorax is a rare condition due to leakage of chyle in the thoracic cavity. When large amounts of chyle leak into the thoracic cavity, it can lead to severe respiratory, immune, and metabolic complications. Chylothorax has many potential underlying etiologies, and the most common causes are traumatic chylothorax and lymphoma. Venous thrombosis of the upper extremities is a rare cause of a chylothorax.Case presentationA 62-year-old Dutch man with a medical history of gastric cancer, treated with neoadjuvant chemotherapy and surgery 13 months prior, presented with dyspnea and a swollen left arm. Computed tomography thorax showed bilateral pleural effusion that was more prominent on the left side. The computed tomography scan further revealed thrombosis of the left jugular and subclavian veins and osseal masses suggesting cancer metastasis. Thoracentesis was performed to confirm the suspicion of gastric cancer metastasis. The obtained fluid was milky with a high level of triglycerides, but contained no malignant cells; hence, the diagnosis of the pleural effusion was chylothorax. Treatment with anticoagulation and a medium-chain-triglycerides diet was started. Furthermore, bone metastasis was confirmed with a bone biopsy.ConclusionOur case report demonstrates chylothorax as a rare cause of dyspnea in a patient with pleural effusion and a history of cancer. Therefore, this diagnosis should be considered in all patients with a history of cancer with new-onset pleural effusion and thrombosis of the upper extremities or clavicular/mediastinal lymphadenopathy.

Novel Corona Virus 2019 Disease: Assessment on High-Resolution Computed Tomography Thorax.

Objectives This particular study was undertaken to assess the role of high-resolution computed tomography (HRCT) thorax in diagnosing patients with novel Corona virus-2019 disease and screening suspected COVID-19 cases. It also involves an assessment of the severity of bilateral lung involvement in proven and suspected cases of COVID-19 infection. Materials and methods Two hundred and fourteen symptomatic cases referred to the department of radio-diagnosis were evaluated in this study. HRCT thorax was performed on SIEMENS Somatom Emotion 16-slice spiral CT. Initially, a tomogram was taken, followed by sections in the lung window at B90s, kVp 130, with a pitch of 1.15. The images are then reconstructed into 1.0-mm-thin slices. Radiologists then interpreted the scans for features of COVID-19 disease. Various imaging features and the severity of the disease were analysed in all patients. Results We observed that the male population was more affected by the disease (72% of the total cases). The most consistent and common HRCT finding is that of ground-glass opacity (GGO), which was present in 172 cases, corresponding to 78.4% of the cases. Crazy pavement appearance was seen in 41.2 % of the cases. Other findings included consolidation, discrete nodules surrounded by ground-glass opacification, subpleural linear opacities, and tubular bronchiectasis. Conclusion HRCT thorax plays an ideal role in diagnosing COVID-19 disease with high sensitivity and also provides prompt results as compared to RT-PCR. It also helps in grading the severity of the disease based on various patterns and the extent of lung parenchyma involved. Therefore, because of the immediate results and the ability to grade the disease, HRCT became invaluable in directing the treatment of COVID-19 disease.

Massive pleural effusion post-emergency cesarean in undiagnosed congenital diaphragmatic hernia

Introduction: Bochdalek’s hernia is a congenital diaphragmatic hernia (CDH) resulting from inadequate closure of the membrane over the left side of the hemidiaphragm. Patients will start to develop symptoms upon displacement of abdominal contents into the thoracic cavity. This case report highlights the radiological modality findings that can be used in diagnosing a late-presentation CDH in adults. Case Report: A 35-year-old postpartum woman developed shortness of breath, left-sided chest pain, episodes of vomiting and epigastric tenderness within 24 hours post-emergency cesarean section. An initial diagnosis of left tension hydrothorax was made based on the clinical and radiological findings. Left diagnostic and therapeutic thoracocentesis using landmark technique was performed and brownish fluid was obtained upon aspiration. Post-procedural chest X-ray (CXR) reported cystic-like features over the left hemithorax. Therefore, computed tomography (CT) thorax was proceeded and confirmed the left diaphragmatic hernia with a mediastinal shift to the right. However, the patient’s condition worsened and required emergency open thoracotomy with left diaphragmatic hernia repair. Intraoperative findings showed left Bochdalek’s hernia complicated by multiple visceral organ perforations secondary to previous thoracocentesis. The patient was discharged well after a few weeks of hospital stays. Conclusion: The diagnosis of late-presentation Bochdalek’s diaphragmatic hernia remained challenging and can be easily missed. Therefore, a comprehensive evaluation is required prior to performing an invasive diagnostic procedure. Chest X-ray and ultrasound are useful diagnostic aid in the absence of CT thorax and magnetic resonance imaging (MRI) modalities.