Chest CT Findings Research Articles

A decision tree analysis to evaluate the optimal approach to screen allergic bronchopulmonary aspergillosis in asthmatic patients

ABSTRACT Background Various methods are available to screen for allergic bronchopulmonary aspergillosis (ABPA) in asthma, but their comparative performance remains uncertain. Objectives To identify the optimal screening algorithm for ABPA in asthmatic patients and evaluate the crude cost of various diagnostic approaches. Methods We performed a post hoc analysis of prospectively collected data from consecutive adult asthmatic patients evaluated for ABPA. The diagnosis was based on the revised International Society for Human and Animal Mycology ABPA Working Group criteria. Initial evaluations included measurements of serum Aspergillus fumigatus-IgE (≥0.35 kUA/L), serum total IgE (≥500 IU/mL), serum A. fumigatus-IgG (≥27 mgA/L), blood eosinophil count (BEC ≥500 cells/μL), and chest CT findings. A decision tree was manually constructed using recursive partitioning to identify the most effective diagnostic pathway. Results Among 543 adult asthmatics, 106 were diagnosed with ABPA. Serum A. fumigatus-IgE was positive in 221 (40.7%) patients, while serum total IgE was elevated (≥500 IU/mL) in 300 (55.3%) patients. The serum total IgE-based approach required 196 additional tests during screening, compared to 115 in the A. fumigatus-IgE method. The BEC-based strategy missed 28 cases of ABPA. Although the CT-directed protocol had the fewest false positives, it required 437 additional screening radiographic procedures and missed eight ABPA cases. The A. fumigatus-IgE pathway emerged as the most cost-effective, whereas imaging-based strategies were the most expensive. Conclusions Serum A. fumigatus-IgE is the optimal screening test for ABPA in asthma. It minimizes unnecessary testing while maintaining high diagnostic accuracy, making it a preferable approach in clinical practice.

Centrilobular nodules are predictive chest CT findings related to adult T-cell leukemia/lymphoma development in human T-lymphotropic virus type I carriers

AIMTo evaluate predictive chest CT findings associated with the development of adult T-cell leukemia/lymphoma (ATLL) in human T-lymphotropic virus type I (HTLV-1) carriers. MATERIALS AND METHODSThis retrospective study examined 171 adult T-cell leukemia/lymphoma and 158 HTLV-1 carriers who were treated from November 2004 to April 2021. The radiological features of 888 chest CT scans in total were retrospectively assessed by two chest radiologists who were unaware of the underlying diagnoses, and compared between the groups. RESULTSIn patients with aggressive type ATLL (acute type and lymphoma type), lymph node enlargement was the most frequently observed abnormality (65.2%), followed by ground-glass opacity (33.3%) and pleural effusion (30.4%). In patients with indolent type (chronic type and smoldering type), lymph node enlargement and bronchiectasis were the most frequently observed abnormalities (5.6% and 5.6%, respectively). In each type, centrilobular nodules were observed in none and in one patient, respectively. In the 158 HTLV-1 carriers, centrilobular nodules (n=62; 39.2%) were the most frequently observed abnormality. Centrilobular nodules were significantly frequently observed in HTLV-1 carriers compared with ATLL patients. No HTLV-1 carrier with centrilobular nodules on CT developed ATLL during the duration of care. A comparative analysis between CT scans performed before ATLL development in ATLL patients and those of HTLV-1 carriers showed that no centrilobular nodules were observed on the pre-ATLL CT scans, and a statistically significant difference in centrilobular nodules was found between these two groups. CONCLUSIONThe presence of centrilobular nodules may be an indicative CT finding in HTLV-1 carriers who are less likely to develop ATLL.

Role of Impulse Oscillometry (IOS) Together with Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) and High-Resolution Computed Tomography for the Chest in Early Diagnosis of Interstitial Lung Disease in Patients with Connective Tissue Diseases

Abstract Background Connective Tissue Diseases (CTDs) are systemic autoimmune conditions characterized by frequent lung involvement. Interstitial lung disease (ILD) is a severe pulmonary complication in CTD and associated with significant increased morbidity and mortality, so early detection of ILD is essential. Aim of the Work To find the best modality for early diagnosis of interstitial lung disease in patients with connective tissue disorders by using DLCO, impulse oscillometry and HRCT chest. Patients and Methods This observational, analytical and cross sectional study was conducted upon 60 patients whom were diagnosed as connective tissue disease during the period from march 2022 to march 2023 who were admitted to chest and rheumatology department or outpatient clinics visitors, to Ain Shams University Hospitals. Results regarding our results, there was high statistical significance between DLCO and IOS (Best x5). Sensitivity and specificity of Diffusion lung of CO2; DLCO score in prediction of outcome in CT Chest Findings showing significance in DLCO score; p = 0.024 with CI ranged between 53.9-81.4% and sensitivity 67.6%. Sensitivity and specificity of the impulse oscillation method; R5, R20,and Best-X5 score in prediction of outcome in CT Chest Findings. Showing no significance in all with sensitivity 50.2%, 46.1%, 43.4% and 57.5% respectively Conclusion ILD should always be considered in patients with CTD. Diagnosis of CTD-ILD is challenging so Early diagnosis of ILD using DLCO, HRCT chest or by using IOS is important as it could affect therapy plans.

Chest CT Findings at Six Months Following COVID-19 ARDS - Correlation With the mMRC Dyspnea Scale and Pulmonary Function Tests.

Background: Many survivors of severe COVID-19 pneumonia experience lingering respiratory issues. There is limited research on follow-up chest imaging findings in patients with COVID-19 ARDS, particularly in relation to their mMRC dyspnea scores and pulmonary function tests (PFTs). This study addresses this gap by investigating the clinical characteristics, mMRC dyspnea scores, PFTs, and chest CT findings of COVID-19 ARDS patients at the 6months post-recovery. By analyzing these variables together, we aim to gain a better understanding of the long-term health consequences of COVID-19 ARDS. Methods: This prospective observational study included 56 subjects with COVID-19 ARDS with dyspnea at the six-month follow-up visits. These patients were evaluated by chest CT, mMRC dyspnea scale, and PFT. The CT severity score was calculated individually for each of the four major imaging findings - ground glass opacities (GGOs), parenchymal/atelectatic bands, reticulations/septal thickening, and consolidation - using a modified CT severity scoring system. Statistics were carried out to find any association between individual CT chest findings and the mMRC dyspnea scale and forced vital capacity (FVC). p values < 0.05 were considered statistically significant. Results: Our study population had a mean age of 55.86 ± 9.60 years, with 44 (78.6%) being men. Grades 1, 2, 3, and 4 on the mMRC dyspnea scale were seen in 57.1%, 30.4%, 10.7%, and 1.8% of patients respectively. Common CT findings observed were GGOs (94.6%), reticulations/septal thickening (96.4%), parenchymal/atelectatic bands (92.8%), and consolidation (14.3%). The mean modified CT severity scores for GGOs, reticulations/septal thickening, parenchymal/atelectatic bands, and consolidation were 10.32 ± 5.51 (range: 0-21), 7.66 ± 4.33 (range: 0-19), 4.77 ± 3.03 (range: 0-14) and 0.29 ± 0.91 (range 0-5) respectively. Reticulations/septal thickening (p = 0.0129) and parenchymal/atelectatic bands (p = 0.0453) were associated with an increased mMRC dyspnea scale. Parenchymal/atelectatic bands were also associated with abnormal FVC (<80%) (p = 0.0233). Conclusion: Six-month follow-up chest CTs of COVID-19 ARDS survivors with persistent respiratory problems showed a statistically significant relationship between increased mMRC dyspnea score and imaging patterns of reticulations/septal thickening and parenchymal/atelectatic bands; while parenchymal/atelectatic bands also showed a statistically significant correlation with reduced FVC.

Role of confocal laser endomicroscopy compared to high definition i- scan video bronchoscopy in patients with suspected lung cancer

Abstract Background Lung cancer is the leading cause of cancer-related mortality worldwide. Overall 5-year survival is poor at 15% with little improvement over the last twenty years (1.59 million deaths). Besides effective prevention strategies against the commonest risk factor; tobacco smoking, lung cancer mortality can be reduced if cases are detected and treated early. It is important to detect bronchial carcinoma in situ (CIS) since over 40% of these can develop into invasive cancer. Screening tests using sputum cytology and chest radiograph have been used with limited success Objective to study the diagnostic performance of confocal laser endomicroscopy in comparison to high definition i-scan videobronchoscopy in patients with suspected lung cancer. Patients and Methods The study was performed at Pulmonary diseases hospital in Kobry Elkobba military complex for 2 years since January 2018 to December 2019. The study included 25 patients all had chest CT findings suspicious of lung cancer. Results i-scan findings showed 68% accuracy and 73.3% specificity, and findings of confocal laser endomicroscopy were 92% accuracy and 90% specificity. Conclusion This was the preliminary study establishing patient characteristics in Egypt in the form of a comparison between tow methods of diagnosis of lung cancer. The study showed the higher sensitivity of confocal laser endomicroscopy in the diagnosis of lung cancer approved by the results of the pathological specimens optioned under the visual of confocal laser endomicroscopy in comparison to I-scan method.

Chest CT Features of Coronavirus Disease-19 (COVID-19) Pneumonia: Which Findings on Initial CT can Predict an Adverse Short-term Outcome?

Abstract Background COVID-19 is a highly contagious viral disease that caused daunting challenges to the health care system; early diagnosis plays a pivotal role in management and prognosis of the disease. Aim of the Work To study the spectrum of chest CT features in coronavirus disease-19 (COVID- 19) pneumonia and to identify the initial CT findings that may have the potential to predict a poor short-term outcome. Patients and Methods This was a retrospective study that included 60 patients (30 clinically improved and 30 clinically deteriorated patients) with RT-PCR confirmed COVID-19 infection who referred to the Radiodiagnosis Department at Ain Shams University Hospitals for chest HRCT examination. An acceptance from the ethical committee of the Radiology Department and the ethical committee of Faculty of Medicine - Ain Shams University was obtained to use the data stored on PACs system with the patient’s consent waived being a retrospective study. Results Shortness of breath, fatigue and presence of other comorbidities were more common in unstable group, seen in 93%, 86% and 66% respectively. CT severity score was higher in unstable group ranging from 12 to 26 together with anteroposterior distribution, central and peripheral distribution, crazy paving and consolidation with air bronchogram. Conclusion Comparison between clinically stable and unstable COVID-19 patients regarding clinical data at admission and initial CT chest findings revealed that higher percentage of total lung affection, central and peripheral involvement, anteroposterior distribution, crazy paving, consolidation with air bronchogram and vessel enlargement were the harbingers of poor prognosis especially in patients of old age, having other comorbidities and presented with shortness of breath.

Correlation between Severity of Lung Disease in COVID-19 Infection and Acute CNS Abnormalities

Abstract Background Sever acute respiratory syndrome corona virus 2 (SARS-COV 2) began in Wuhan,China,in December 2019 and has rapidely spread around the world to become pandemic,as COVID-19 can produce pathologic changes in chest imaging,COVID-19 related brain imaging findings are also well known. Aim of the Work The aim of this current study is to correlate retrospectively between the severity of lung affection in patients with COVID-19 infections and development of acute CNS abnormalities. Patients and Methods This study is Retrospective study, the study was conducted at Ain Shams University Hospitals over a course of six months from march 2022 to September 2022 and the main source of data for this study was the archived CT and MRI imaging of the patients referred to the department of Radiology. Our inclusion criteria were patients that diagnosed with sever acute respiratory syndrome corona virus 2 infection with acute neurologic manifestation and available chest CT and brain imaging. The 5 lobes of the lungs were individually scored on a scale 0-5 (0 correspond to no involvement and 5 &amp;gt; 75% involvement),A CT lung severity score was determined as the sum of lung involvement,ranging from 0 (no involvement) to 25 (maximum involvement). Results A total 55 patients met the inclusion criteria,In attempt to describe and evaluate the brain and lung imaging correlation in patients with COVID-19, Compared to 20 patients without acute abnormal findings on neuroimaging,there were 35 patients with acute abnormal findings on neuroimaging and those patients were found to have significantly higher mean CT lung severity score (p &amp;lt; 0.0001) and they are more likely to present with ischemic stroke (14, 40%), A threshold of CT lung severity score &amp;gt; 18 was found to be 97% sensitive and 90% specific for acute abnormal findings on neuroimaging, the neuroimaging hallmark of these patients were acute ischemic infarcts (40%),invasive fungal sinusitis (22.9.%), Isolated cavernous sinus thrombosis,PRES,and vasculitis (each one 8.6%),cerebral venous sinus thrombosis other than cavernous sinus (5.7%),cerebritis and abnormal white matter signal (each one 2.8%).The predominant CT chest findings were peripheral ground -glass opacities with or with out consolidation. Conclusion The CT lung severity score may be predictive of acute abnormalities on neuroimaging in patients with COVID-19 with neurologic manifestation. This can be used as predictive tool in patients management to improve clinical outcome.

Genomic characteristics of tumour necrosis in lung squamous cell carcinoma.

e20030 Background: Tumor necrosis and cavity on enhanced chest CT are common hallmarks of lung squamous cell carcinoma (LUSC). However, the genetic characteristics of necrosis on CT scan remain unclear. This study aims to elucidate the genetic landscape of LUSC with tumor necrosis. Methods: We implemented transcriptome and whole-exome sequencing to analyze early postoperative LUSC specimens. They were classified into necrosis and non-necrosis group based on preoperative enhanced chest CT. Subsequently, the genomic landscape between the two groups were compared. To substantiate our findings, we further employed immunohistochemistry and analysis of a clinical cohort as comprehensive methods of validation. Results: In study cohort (65 samples), the necrosis group (n = 37) showed a higher number and length of copy number variations (CNVs) and elevated Genomic Instability Index (GII) compared to the non-necrosis group (n = 28). Transcriptome sequencing revealed increased hypoxic hallmarks and activation of 11 fundamental metabolic pathways in the necrosis group. Endothelial cells were observably fewer, but matrix remodeling score was higher in the necrosis group. Here, the decreased activity of several immune-related pathways, such as antigen processing and presentation, natural killer cell-mediated cytotoxicity, etc, were notably suppressed in the necrosis group. Immunohistochemistry indicated that the expressions of hypoxy-related genes (HIF-1, NDRG1), proliferation-related genes (ki-67) and angiogenesis related genes (CD31) in necrosis group were significantly higher than those in non-necrosis group. In the clinical validation cohort, we enrolled 538 advanced LUSC patients from 25 medical centers receiving systemic treatment, categorized into chemotherapy (n = 270) and ICIs (n = 268) groups. A notable difference in progression-free survival (PFS) was observed in the ICIs group, with patients without tumor necrosis or cavity exhibiting significantly longer PFS (8.7 vs. 6.5 months; HR 0.67; 95% CI 0.42–0.63; p &lt; 0.001). Multivariate Cox analysis identified necrosis or cavity as an independent predictor of reduced PFS (HR 0.68; 95% CI, 0.51-0.9; p = 0.007). Conclusions: LUSC with necrosis is distinguished by increased genomic instability, hypoxia, enhanced tumor proliferation, matrix remodeling, and an immunosuppressive tumor microenvironment. Baseline chest CT findings of tumor necrosis or cavities may serve as negative predictors for the efficacy of ICIs treatment in LUSC.

Lymphatic plastic bronchitis and primary chylothorax: A study based on computed tomography lymphangiography.

This study presents an evaluation of the computed tomography lymphangiography (CTL) features of lymphatic plastic bronchitis (PB) and primary chylothorax to improve the diagnostic accuracy for these two diseases. To improve the diagnosis of lymphatic PB or primary chylothorax, a retrospective analysis of the clinical features and CTL characteristics of 71 patients diagnosed with lymphatic PB or primary chylothorax was performed. The clinical and CTL data of 71 patients (20 with lymphatic PB, 41 with primary chylothorax, and 10 with lymphatic PB with primary chylothorax) were collected retrospectively. CTL was performed in all patients. The clinical manifestations, CTL findings, and conventional chest CT findings of the three groups of patients were compared. The chi-square test or Fisher's exact test was used to compare the differences among the three groups. A difference was considered to be statistically significant when P < 0.05. (1) The percentages of abnormal contrast medium deposits on CTL in the three groups were as follows: Thoracic duct outlet in 14 (70.0%), 33 (80.5%) and 8 (80.0%) patients; peritracheal region in 18 (90.0%), 15 (36.6%) and 8 (80.0%) patients; pleura in 6 (30.0%), 33 (80.5%) and 9 (90.0%) patients; pericardium in 6 (30.0%), 6 (14.6%) and 4 (40.0%) patients; and hilum in 16 (80.0%), 11 (26.8%) and 7 (70.0%) patients; and (2) the abnormalities on conventional chest CT in the three groups were as follows: Ground-glass opacity in 19 (95.0%), 18 (43.9%) and 8 (80.0%) patients; atelectasis in 4 (20.0%), 26 (63.4%) and 7 (70.0%) patients; interlobular septal thickening in 12 (60.0%), 11 (26.8%) and 3 (30.0%) patients; bronchovascular bundle thickening in 14 (70.0%), 6 (14.6%) and 4 (40.0%) patients; localized mediastinal changes in 14 (70.0%), 14 (34.1%), and 7 (70.0%) patients; diffuse mediastinal changes in 6 (30.0%), 5 (12.2%), and 3 (30.0%) patients; cystic lesions in the axilla in 2 (10.0%), 6 (14.6%), and 2 (20.0%) patients; and cystic lesions in the chest wall in 0 (0%), 2 (4.9%), and 2 (4.9%) patients. CTL is well suited to clarify the characteristics of lymphatic PB and primary chylothorax. This method is an excellent tool for diagnosing these two diseases.

PULMONARY VENO–OCCLUSIVE DISEASE ASSOCIATED WITH METHAMPHETAMINE ABUSE: A FIRST CASE DESCRIPTION

Abstract Background Recreational methamphetamine is widely used worldwide (about 35 million people), mainly as 3,4–Methylenedioxymethamphetamine (MDMA). A definite association has been established between methamphetamine and pulmonary arterial hypertension (PAH). This drug–associated form of PAH shares histological, clinical and hemodynamic characteristics, prognosis and treatment strategies with idiopathic PAH. However, the association between MDMA and a rarer and devasting form of PAH with concomitant venous involvement (pulmonary veno–occlusive disease, PVOD), has never been reported. Notably, initiation of PAH–specific treatment in PVOD may lead to catastrophic consequences. Case Description A 32–year–old man was fast–track referred to our PH Centre in December 2023, due to high echocardiographic probability of pulmonary hypertension (PH). After interrogation, he admitted the regular use of MDMA. No other risk factor for PAH was found. Right heart catheterization showed a pre–capillary PH (mean pulmonary artery pressure 35 mmHg; wedge pressure 12 mmHg; pulmonary vascular resistance 5.9 WU) with low cardiac output (2.2 L/min/m2) and no acute response to vasoreactivity testing. Exercise capacity was severely reduced (oxygen consumption 19.6 mL/Kg/min, 50% of predicted) due to absent stroke volume reserve, accompanied by augmented exercise hyperventilation (VE/VCO2 slope 60) and exercise–induced desaturation (SaO2 94 à 77%), this latter not explained by a right–to–left shunt. Diffusion capacity of the lung was severely reduced (DLCO 28%). Chest CT and perfusion scan excluded both thromboembolic etiology and parenchymal lung disease. A diagnosis of PVOD was made, based on the presence of pre–capillary PH, oxygen desaturation, extreme exercise hyperventilation and very low DLCO, even in the absence of pathognomonic CT features. Counselling for stopping MDMA abuse was offered. Cautious monotherapy with macitentan was started and was well tolerated. A genetic testing for EIF2AK4 is ongoing. Contact with transplant center has been performed. A follow–up RHC has been planned before careful therapy up–titration. Conclusions This is the first case reported of the potential association between methamphetamines and PVOD. Due to the large worldwide use of MDMA, this link should be considered because of its prognostic and therapeutic implications. The diagnosis of PVOD is a clinical one, needing a high index of suspicion especially in the absence of chest CT findings.

Chronic Chest Computed Tomography Findings Following COVID-19 Pneumonia

Respiratory symptoms are a frequent manifestation of patients with post-acute sequela of SARS-CoV-2 (PASC), also known as long-COVID. Many cohorts of predominantly hospitalized patients have shown that a significant subset may have persistent chest CT findings for more than 12 months after the acute infection. Proper understanding of the evolving long-term imaging findings and terminology is crucial for accurate imaging interpretation and patient care. The goal of this article is to review the chronic chest CT findings of patients with PASC and common pitfalls.

Role of confocal laser endomicroscopy compared with high definition i-scan video bronchoscopy in patients with suspected lung cancer

Abstract Background Lung cancer is the one of the most important leading cause of mortality related to cancer worldwide. The 5-year survival is not optimistic with a percentage of 15% with mild improvement along the past 20 years (1.59 million deaths). The best effective and sensitive strategies of prevention is avoiding the common risk factor; tobacco smoking. The mortality of lung cancer can be reduced by early detection and treatment of the cases. Bronchial carcinoma in situ is one of the important stages to detect since over 40% of these can develop into invasive cancer. Sputum cytology and chest imaging have been used as a screening tests with limited success. Objective To study the diagnostic performance of confocal laser endomicroscopy in comparison to high definition i-scan videobronchoscopy in patients with suspected lung cancer. Patients and methods The study was performed at pulmonary diseases hospital in Kobry Elkobba military complex for 2 years since January 2018 to December 2019. The study included 25 patients all had chest CT findings suspicious of lung cancer. Results i-scan findings showed 68% accuracy and 73.3% specificity, and findings of confocal laser endomicroscopy were 92% accuracy and 90% specificity. Conclusion This was a study including patient characteristics in Egypt as a comparison between two methods of diagnosis of lung cancer. The study showed the higher sensitivity of confocal laser endomicroscopy in the diagnosis of lung cancer approved by the results of the pathological specimens optioned under the visual of confocal laser endomicroscopy in comparison with i-scan method.

Short- and Long-Term Chest-CT Findings after Recovery from COVID-19: A Systematic Review and Meta-Analysis.

While ground-glass opacity, consolidation, and fibrosis in the lungs are some of the hallmarks of acute SAR-CoV-2 infection, it remains unclear whether these pulmonary radiological findings would resolve after acute symptoms have subsided. We conducted a systematic review and meta-analysis to evaluate chest computed tomography (CT) abnormalities stratified by COVID-19 disease severity and multiple timepoints post-infection. PubMed/MEDLINE was searched for relevant articles until 23 May 2023. Studies with COVID-19-recovered patients and follow-up chest CT at least 12 months post-infection were included. CT findings were evaluated at short-term (1-6 months) and long-term (12-24 months) follow-ups and by disease severity (severe and non-severe). A generalized linear mixed-effects model with random effects was used to estimate event rates for CT findings. A total of 2517 studies were identified, of which 43 met the inclusion (N = 8858 patients). Fibrotic-like changes had the highest event rate at short-term (0.44 [0.3-0.59]) and long-term (0.38 [0.23-0.56]) follow-ups. A meta-regression showed that over time the event rates decreased for any abnormality (β = -0.137, p = 0.002), ground-glass opacities (β = -0.169, p < 0.001), increased for honeycombing (β = 0.075, p = 0.03), and did not change for fibrotic-like changes, bronchiectasis, reticulation, and interlobular septal thickening (p > 0.05 for all). The severe subgroup had significantly higher rates of any abnormalities (p < 0.001), bronchiectasis (p = 0.02), fibrotic-like changes (p = 0.03), and reticulation (p < 0.001) at long-term follow-ups when compared to the non-severe subgroup. In conclusion, significant CT abnormalities remained up to 2 years post-COVID-19, especially in patients with severe disease. Long-lasting pulmonary abnormalities post-SARS-CoV-2 infection signal a future public health concern, necessitating extended monitoring, rehabilitation, survivor support, vaccination, and ongoing research for targeted therapies.

Evaluation of the efficacy of pretreatment chest CT markers in predicting response to neoadjuvant chemoradiotherapy in locally advanced non-small cell lung cancer (NSCLC)

Aim: To investigate baseline enhanced chest CT findings that may predict progression or response to neoadjuvant chemoradiotherapy.&#x0D; Materials and methods: Multiple parameters to be obtained from baseline enhanced chest CT scans of 140 patients with NSCLC who had baseline enhanced chest CT scans before neoadjuvant chemoradiotherapy were noted. In addition to CT features of tumour tissues, age, gender, tumour cell types, lymph node TNM stages, distant metastases on baseline enhanced chest CT, bronchial and vascular invasion were also evaluated. Chest CT findings and changes in tumour tissue at 3 and 6 months during neoadjuvant treatment were noted. Patients were operated after the end of neoadjuvant treatment. It was investigated which parameters could predict response to neoadjuvant treatment and which findings could predict progression.&#x0D; Results: Progression and mortality rates were found to be low in patients with remission (p

Clinical analysis of 4 children with cryptogenic organizing pneumonia

Objective: To analyze the clinical features of children with cryptogenic organizing pneumonia (COP) confirmed by pathology. Methods: The clinical manifestations, imaging, pathology, treatment and outcome data of 4 children with COP confirmed by thoracoscopic lung biopsy were retrospectively analyzed, who were hospitalized at Respiratory Department of Shenzhen Children's Hospital from January 2004 to December 2022. Results: All of the 4 patients were male, the age ranged from 1 year 3 months to 14 years. The time from onset to diagnosis was 3 months to 3 years. The follow-up duration was 6 months to 6 years. All the 4 cases had cough, 2 cases had tachypnea and wheezing, 1 case had expectoration, 1 case had chest pain, 1 case had decreased activity tolerance and weight loss. Rales in 2 cases and hypoxemia in 1 case. Pulmonary high resolution CT showed diffuse distribution, involvement of both lungs in 3 cases, and single lung combined migration in 1 case.Three cases showed ground-glass opacity, consolidation, patchy or fibrous strips, and 1 case presented air bronchogram and "reversed halo sign". All the 4 cases were performed thoracoscopic lung biopsy, and the pathological findings showed cellulose exudate or small nodules filled with granulation tissue or fibroblasts in the alveolar cavity and small airways, and 1 case was Masson corpuscle positive. Three patients achieved remission after glucocorticoid therapy. Spontaneous remission without treatment was seen in 1 patient.Two cases were followed up for 17 months and 6 years, respectively, who had excellent outcome. Conclusions: The manifestations of COP in children include cough, expectoration and chest pain. Infants and young children may have tachypnea and wheezing. The most common chest CT findings are diffuse distribution of ground-glass opacity, patchy and consolidation in both lungs. Diagnosis should depend on pathological examination. The effect of glucocorticoid therapy is good.

Immune Dysregulation in SARS-CoV-2 patients coinfected with Mycobacterium tuberculosis (Mtb) or HIV in China

BackgroundSARS-CoV-2 infections usually cause immune dysregulation in the human body. Studies of immunological changes resulting from coinfections with Mycobacterium tuberculosis (Mtb) or HIV are limited.MethodsWe conducted a retrospective study focusing on patients with COVID-19. A total of 550 patients infected with SARS-CoV-2 were enrolled in our study and categorized into four groups based on the presence of coinfections; 166 Delta-infected patients, among whom 103 patients had no coinfections, 52 who were coinfected with Mtb, 11 who were coinfected with HIV, and 384 Omicron-infected patients. By collecting data on epidemiologic information, laboratory findings, treatments, and clinical outcomes, we analyzed and compared clinical and immunological characteristics.ResultsCompared with those in the Delta group, the median white blood cell, CD4 + T-cell and B-cell counts were lower in the Mtb group and the HIV group. Except for those in the Omicron group, more than half of the patients in the three groups had abnormal chest CT findings. Among the three groups, there were no significant differences in any of the cytokines. Compared with those in the Delta group, the disease duration and LOS were longer in the Mtb group and the HIV group. For unvaccinated Delta-infected patients, in the Mtb and HIV groups, the number of B cells and CD4 + T cells was lower than that in the Delta group, with no significant difference in the LOS or disease duration. In the Mtb group, three (6%) patients presented with a disease duration greater than four months and had decreased lymphocyte and IL17A counts, possibly due to double infections in the lungs caused by SARS-CoV-2 and M. tuberculosis.ConclusionsWe found that SARS-CoV-2 patients coinfected with Mtb or HIV exhibited a longer disease duration and longer LOS, with a decrease in B cells and CD4 + T cells, suggesting that these cells are related to immune function. Changes in cytokine levels suggest that coinfection with Mtb or HIV does not result in dysregulation of the immune response. Importantly, we discovered a chronic course of coinfection involving more than four months of Mtb and SARS-CoV-2 infection.

Chest CT findings in severe acute respiratory distress syndrome requiring V-V ECMO: J-CARVE registry

BackgroundChest computed tomography findings are helpful for understanding the pathophysiology of severe acute respiratory distress syndrome (ARDS). However, there is no large, multicenter, chest computed tomography registry for patients requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO). The aim of this study was to describe chest computed tomography findings at V-V ECMO initiation and to evaluate the association between the findings and outcomes in severe ARDS.MethodsThis multicenter, retrospective cohort study enrolled patients with severe ARDS on V-V ECMO, who were admitted to the intensive care units of 24 hospitals in Japan between January 1, 2012, and December 31, 2022.ResultsThe primary outcome was 90-day in-hospital mortality. The secondary outcomes were the successful liberation from V-V ECMO and the values of static lung compliance. Among the 697 registry patients, of the 582 patients who underwent chest computed tomography at V-V ECMO initiation, 394 survived and 188 died. Multivariate Cox regression showed that traction bronchiectasis and subcutaneous emphysema increased the risk of 90-day in-hospital mortality (hazard ratio [95% confidence interval] 1.77 [1.19–2.63], p = 0.005 and 1.97 [1.02–3.79], p = 0.044, respectively). The presence of traction bronchiectasis was also associated with decreased successful liberation from V-V ECMO (odds ratio: 0.27 [0.14–0.52], p < 0.001). Lower static lung compliance was associated with some chest computed tomography findings related to changes outside of pulmonary opacity, but not with the findings related to pulmonary opacity.ConclusionsTraction bronchiectasis and subcutaneous emphysema increased the risk of 90-day in-hospital mortality in patients with severe ARDS who required V-V ECMO.

Latent tuberculosis infection in psoriasis patients

Aims: Psoriasis is a chronic, inflammatory, and life-long skin disease. Patients may need to change the treatment regimen by time due to the course of the disease. According to the guidelines, patients should be screened for latent tuberculosis infection (LTBI) before starting treatment with biological agents. We aimed to evaluate the associations between positive interferon-gamma release assay (IGRA) tests, the chest CT findings and inflammatory blood markers of the psoriasis patients who have undergone screening for LTBI before starting systemic treatment with biological agents or conventional options. Methods: The electronic medical records, Chest CT reports and blood tests of 123 consecutive patients with a diagnosis of psoriasis who were candidates for systemic treatment (methotrexate, cyclosporin and biological agents) and screened for LTBI were examined. Results: The mean age of the patients was 49.24 and 64 (52%) of them were males. 37(30%) had a family history of tuberculosis 103(83%) of them had BCG vaccination scars. 59% had radiological features on their Chest CT scans. 28% of the patients had positive Quantiferon test results. When compared to the Quantiferon negative group, there was no difference between the two groups according to demographic characteristics, comorbidities, family history of tuberculosis, BCG vaccination status, smoking habits, occupation, and qualification details (p&amp;gt;0.05). The values of WBC, neutrophils, lymphocyte, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, systemic inflammation index and erythrocyte sedimentation rates were found statistically higher in the patients with positive Quantiferon test (p&amp;lt;0.05). Conclusion: The patients with psoriasis requiring systemic treatment and having positive IGRA test results have increased levels of inflammation. Psoriasis and LTBI might have a synergistic action in the inflammatory response which necessitates further studies to find out the associations between these two entities.

Relationship between electrocardiogram and findings of serum protein, transaminase and chest CT in male AIDS patients

Relationship between electrocardiogram and findings of serum protein, transaminase and chest CT in male AIDS patients

Postmortem temporal chest CT and its pathological correlation in piglets.

Post-mortem computed tomography (PMCT) is a useful tool to investigate the cause of death. To appropriately use PMCT for cause-of-death analysis, it is necessary to know natural courses after death such as hypostasis in the lungs. We aimed to investigate the natural time-course change of postmortem chest CT findings and its pathological correlation in piglets. Serial chest PMCT scans of four piglets were performed each hour for 24 h and the chronological changes of the lung were evaluated. Immediately after the final CT scan, the autopsy was conducted and bilateral lungs were taken for pathological examination. Two additional piglets were sacrificed and pathological specimens were prepared immediately after death for reference. On pulmonary PMCT, ground glass attenuation (GGA) appeared after the first several hours and increased gradually. Histologically, GGA corresponded to pulmonary edema. The time-related increase in CT attenuation was more prominent in the dorsal lung. Consolidation, endotracheal air defects, and pleural effusion were not observed on PMCT. GGA appeared after the first several hours and increased gradually, and it corresponded to pulmonary edema. GGA in the lung as one of the natural postmortem processes needs to be distinguished from pathogenic findings depending on the time elapsed since death. J. Med. Invest. 71 : 232-236, August, 2024.