Chest CT Scan Research Articles

Possible dependence of sternum non-metric features on sex, age, and stature from a forensic viewpoint: a study in an Iranian population

Morphological traits of the sternum are rarely evaluated in forensic studies. This study evaluates these features in sex-, age-, and stature-specific groups. A cross-sectional retrospective study was conducted including 400 chest CT scans from 2020 to 2021 which were categorized based on three factors of sex (N = 400; male and female), age (N = 400; group 1: 20–39 years, group 2: 40–59 years, and group 3: >60 years), and stature (N = 190; group 1: 150–159 cm, group 2: 160–169 cm, group 3: 170–179 cm, and group 4: >180 cm). Non-metric parameters of the manubrium, body of sternum, and xiphoid process were investigated. Sex-related distribution of morphologic features of the manubrium in all of the participants demonstrated a significantly higher presence of the arch-shaped prominence (ASP) in males (N = 212, 94.22%) compared with females (N = 135, 77.14%). Morphologic features of the body of the sternum related to sex in all of participants demonstrated a significantly higher flat body shape (BS) in males (N = 142, 63.4%) compared with females (N = 85, 48.3%), and a significantly lower O shape BS in males (N = 5, 2.23%) compared with females (N = 19, 10.8%). Although non-metric morphological traits of the sternum represent a great variety in different studies, some of the features can be considered as possible factors specific to sex (ASP is higher in males than females), age (denticulate costal incisura is higher in <40 than >40 years), and stature (flat BS is higher in >170 than <170 cm).

Preliminary Results of Rib Osteosynthesis at the Teaching Hospital Sylvanus Olympio in Lomé

Introduction: Flaps and rib fractures can be life-threatening due to disruption of hematosis. In certain “many” situations, it is important to quickly restore parietal rigidity by costal osteosynthesis. The objective of our work is to report the surgical results of a first Togolese series of rib osteosynthesis performed in the context of chest trauma.Patients and methods: We proceed by a retrospective study on a series of patients treated for severe blunt chest trauma and who underwent osteosynthesis from 2020 to 2022. Epidemiological and clinical data, in particular the radiological lesion assessment clinic, the therapeutic measures as well as the immediate operative follow-up were collected.Results: six patients with blunt chest trauma. They were four men and two women whose mean age was 44.4 years. Five patients were admitted for polytrauma and one patient for a serious thoracic trauma. All were admitted to intensive care unit on day 0 of the trauma. The radioclinical assessment had noted staged fractures of ribs and/or thoracic flap with an average of six affected ribs. All the patients presented pleural effusions and benefited from pleural drainage on their admission to intensive care, often after a chest X-ray or after carrying out a chest CT scan or a whole-body CT scan. The indication for rib osteosynthesis was retained on the clinical criteria, in particular the existence of a pleural effusion, the instability of the wall and the impact on hematosis, by the drop in peripheral oxygen saturation (Sp02). Despite oxygen therapy above 6 l/min for more than 4 days, and according to the results of the chest CT scan and the evolution of the patient after the implementation of the means of resuscitation. The osteosynthesis material used was “third tube” orthopedic plates molded intraoperatively in three patients, pelvic plates in one patient. The average number of plates used was 4.5 and that of Vis was 18. Two patients underwent osteosynthesis by Judet staple.Conclusion: rib osteosynthesis contributes to a regression of symptoms, in particular chest pain, to reduce the duration of hospitalization, morbidity and mortality, and then improves the functional respiratory prognosis in the short and long term. Despite our reduced technical platform, the results are generally good, reducing the hospital stay in intensive care. This encourages the practice of surgical management of multiple rib fractures associated or not with a rib flap.

Assessing the impact of socioeconomic status on incidental lung nodules at an urban safety net hospital

IntroductionLower socioeconomic status has been identified as an emerging risk factor for health disparities, including lung cancer outcomes. Most research investigating these outcomes includes patients from formal lung cancer screening programs. There is a paucity of studies assessing the relationship between socioeconomic status and incidental lung nodules. This study aimed to investigate the association between socioeconomic status and the size of incidental lung nodules on initial presentation at an urban safety net hospital, which did not have a formal lung cancer screening program or incidental lung nodule program.MethodsA retrospective chart review was conducted on patients with incidental lung nodules on CT chest imaging who were referred from primary care to a pulmonology clinic at a safety net hospital. Patients with incomplete nodule characteristics information were excluded. Data on demographics, comorbidities, smoking history, insurance type, immigration status, and geographical factors were collected. Less commonly studied determinants such as crime index, cost of living, and air quality index were also assessed. Logistic regression analysis was performed to assess relationships between nodule size and socioeconomic determinants.ResultsOut of 3,490 patients with chest CT scans, 268 patients with ILNs were included in the study. 84.7% of patients represented racial or ethnic minorities, and most patients (67.8%) had federal insurance. Patients with non-commercial insurance were more likely to have larger, inherently higher-risk nodules (> 8 mm) compared to those with commercial insurance (OR 2.18, p 0.01). Patients from areas with higher unemployment rates were also less likely (OR 0.75, p 0.04) to have smaller nodules (< 6 mm). Patients representing racial or ethnic minorities were also more likely to have nodules > 8 mm (OR 1.6, p 0.24), and less likely to have nodules < 6 mm (OR 0.6, p 0.32), however, these relationships were not statistically significant.ConclusionThis study found that lower socioeconomic status, indicated by having non-commercial insurance, was associated with larger incidental lung nodule size on initial presentation. While it is established that socioeconomic status is associated with disparities in lung cancer screening, these findings suggest that inequalities may also be present in those with incidental lung nodules. Further research is needed to understand the underlying mechanisms and develop interventions to address these disparities in incidental lung nodule evaluation and improve outcomes.

Correlation between Chest Computed Tomography Severity Scores and Age of Adult Patients with Suspected Covid-19 Pneumonia Admitted in Intensive Care Unit of a Tertiary Care Hospital, Bangladesh

In Bangladesh, the second wave of Covid-19 was devastating. Mostly RT-PCR is used to determine the Covid-19 infection. But when test results are delayed, or when there is a clinical suspicion of Covid-19 despite initial negative RT-PCR testing, CT scan of chest was used to detect Covid-19 and Covid-19 severity. This observational cross-sectional study was carried out at Corona dedicated ICU of Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur during February to June, 2021 to observe the HRCT severity score of the patient and its correlation with different ages. A total of 50 patients with clinically suspected Covid-19 cases who were admitted to the Corona dedicated ICU were included in the study. The chest HRCT images of study participants was gathered, CT severity score was calculated by a particular assignment radiologist. Based on this score; Severe disease was mainly seen in the &gt;60 year age group (50%). A significant moderate positive correlation was observed between age and CT chest severity score. With the increasing age the patients were suffering more and being male may increase the risk and put the patient to get admitted in the ICU, and as an alternative of the RT-PCR, CT scan of chest could be useful. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(2):77-82

Lung Carcinoids: A Comprehensive Review for Clinicians.

Lung carcinoids are neuroendocrine tumors, categorized as typical or atypical carcinoids based on their histological appearance. While most of these tumors are slow-growing neoplasms, they still possess malignant potential. Many patients are diagnosed incidentally on chest X-rays or CT scans. Presenting symptoms include cough, hemoptysis, wheezing, dyspnea, and recurrent pneumonia. Endocrine symptoms, such as carcinoid syndrome or ectopic Cushing's syndrome, are rare. Surgery is the primary treatment and should be considered in all patients with localized disease, even when thoracic lymph node metastases are present. Patients with distant metastases may be treated with somatostatin analogues, chemotherapy, preferably temozolomide-based, mTOR inhibitors, or peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE. Most patients have an excellent prognosis. Poor prognostic factors include atypical histology and lymph node metastases at diagnosis. Long-term follow-up is mandatory since metastases may occur late.

COVID-19 Vaccination Effectively Reduces Pneumonia Severity as Assessed by Routine Chest Computed Tomography

Background: In China, the COVID-19 outbreak infected more than 80% of the population. Few trials have been conducted to assess the effectiveness of the China-manufactured vaccine against COVID-19. Purpose: The purpose of this study was to evaluate the severity of pneumonia in individuals with COVID-19 who were fully vaccinated, partially vaccinated, and unvaccinated, using routine chest computed tomography. Materials and Methods: We analyzed data from patients (aged &gt;18 years) who were hospitalized due to COVID-19 pneumonia between December 2022 and January 2023. Patients who underwent routine chest CT scans were divided into three groups based on their vaccination status. The lobar involvement grading system (0-25) was used to assess the extent of lung injury. The primary outcome was either survival or death. The Pearson chi-square test, Fisher's exact test, and one-way ANOVA were used to compare clinical and imaging features. The receiver operating characteristic (ROC) curve analysis was used to calculate the area under the curve (AUC), sensitivity, and specificity of the CT severity score (CT-SS) in relation to the outcome. Results: Of the 94 patients with COVID-19 pneumonia, 39 patients (41%) were fully vaccinated, 14 (15%) were partially vaccinated, and 41 (44%) were unvaccinated. Among patients with COVID-19 pneumonia, the mean CT severity scores (CT-SS) were 5.9 ± 4.0, 6.5 ± 4.9, and 8.9 ± 4.5 for fully vaccinated individuals, partially vaccinated individuals, and unvaccinated individuals, respectively. The difference was statistically significant (p&lt;0.05). CT-SS of 10.5 or higher was associated with severe pneumonia (100% sensitivity, 81.1% specificity, and an area under the curve of 0.92). Conclusion: COVID-19 vaccination leads to less severe pneumonia based on CT. Fully and partially vaccinated patients with COVID-19 pneumonia have less lung involvement compared to unvaccinated patients. Visual observation by CT imaging provides additional evidence to support the clinical effectiveness of vaccination.

Clinical characteristics of a case of severe pneumonia caused by coinfection of COVID-19 and Chlamydia Psittaci

A 69-year-old female patient was admitted to the Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Xuzhou Medical University due to a "cough and fever for eight days". On admission, a coronavirus disease (COVID-19) nucleic acid test was positive, and a chest CT scan showed progressive patchy shadows and consolidation shadows in both lungs. Arterial blood gas analysis showed type Ⅰ respiratory failure. The primary diagnosis was severe community-acquired pneumonia in an older adult without underlying disease. However, oxygen inhalation, steroid, anti-inflammatory, and antibacterial empirical treatment with piperacillin/tazobactam was ineffective. Metagenomic next-generation sequencing of bronchoscopy alveolar lavage fluid showed Chlamydia psittaci(C. psittaci). Severe pneumonia was confirmed, caused by coinfection with severe acute respiratory syndrome coronavirus 2 and C. psittaci. A combination of doxycycline and moxifloxacin significantly improved the targeted and symptomatic treatment of the underlying cause. After discharge, the patient recovered within four weeks of follow-up. Therefore, clinicians should be alert to the possibility of coinfection of C. psittaci in patients already diagnosed with COVID-19.

A rare combination: a single common pulmonary vein with polysplenia syndrome.

A single common pulmonary vein is a rare anomaly, mostly occurring with asplenia. We wanted to report our case because it co-exists with polysplenia and ciliary dyskinesia.A baby girl about 2 months old with respiratory arrest was admitted to the emergency room of our hospital. She responded to pulmonary resuscitation. We ascertained from her medical history that she had been hospitalised twice because of recurrent lung infections. After the initial check and treatment, we applied imaging modalities to detect underlying problems of recurrent lung infection. Echocardiographic evaluation was suboptimal because of the widespread pulmonary infiltration. Still, we noticed a single common pulmonary vein without obstruction at the junction of the left atrium. Subsequently, a chest CT scan with contrast was performed. It revealed a single common pulmonary vein entering the left atrium with a single orifice, atrial septal defect, two lobes in both lungs, hepatic veins draining directly into the right atrium, and polysplenia. When the flow of a single common pulmonary vein goes directly to the right atrium through the defect, it may cause right heart dilatation as it did in our case. Therefore, patients may need to undergo surgery at an earlier age.

Unusual Intra-Bronchial Foreign Body: About a Case Report

Tracheobronchial foreign bodies Inhalation is a frequent reason for consultation in pediatrics, but rarely seen in adults. We report the case of a 40-year-old woman, without any particular pathological history, presented for a blood- streaked purulent sputum, right subclavicular tingling chest pain and dyspnea on exertion among two days following accidental inhalation of a turkey bone. The clinical examination and the chest X-ray were normal, the chest CT scan showed a calcifield foreign body in the right lower lobar bronchus. Flexible bronchoscopy allowed an extraction of the turkey bone without complications, which was located in the initial part of the intermediate bronchus. The evolution was marked by a complete recovery. Foreign body inhalation is a real emergency and its management must be fast, based on delicate extraction by endoscopy to avoid complications.

Abstract 18155: A Rare Case of Acute Purulent Pericarditis Secondary to Invasive Streptococcal Infection (S. Pyogenes) With Cardiac Tamponade in an Immunocompetent 37-Year Old Female: A Case Report

BACKGROUND: Purulent pericarditis is a rare occurrence in the era of modern antibiotics. It is most often caused by organisms such as Staphylococcus aureus, Streptococcus pneumoniae, viridans streptococci, Haemophilus influenzae, and anaerobic bacteria with Streptococcus pyogenes (S. pyogenes) being a possible, though very uncommon etiology. It is usually associated with an underlying infection or compromised immune system. Purulent bacterial pericarditis is a high mortality entity and represents only 1% of the causes of pericarditis, among these only a few cases have been reported of Streptococcus pyogenes pericarditis. This is an extremely rare case of acute purulent bacterial pericarditis caused by S. pyogenes in an immunocompetent adult patient with no underlying chronic medical conditions. CASE PRESENTATION: A 37-year-old healthy female with no known comorbidities came in for chills, dyspnea, chest pain radiating to the upper back aggravated by deep breathing and relieved with leaning forward. She initially presented with unstable vital signs (hypotension and tachycardia). Electrocardiography demonstrated diffuse ST-segment elevation and PR segment depression, while chest Xray and CT scan showed lobar pneumonia. Blood tests showed leukocytosis with neutrophilic predominance indication infection and workup for autoimmune disease was done which was negative. 2D echo showed large pericardial effusion with tamponade physiology. An urgent pericardiocentesis was done with drainage of 350cc nonclotting purulent serous fluid. Cultures grew Streptococcus pyogenes (S. pyogenes) confirming the diagnosis of acute purulent bacterial pericarditis. Management for pericarditis including daily drainage of pericardial effusion, colchicine, ibuprofen was initiated together with antibiotics for the pneumonia and the patient had resolution of the pericardial effusion as documented by repeat 2DED upon follow up.

Abstract 15614: Pericardial and Abdominal Visceral Adiposity Are Associated With Increased Risk of Hospitalization or Death From SARS-CoV-2 Infection: A Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study

Background Obesity increases risk of death from SARS-CoV-2 infection. Excess ectopic fat may increase this risk through inflammation, hypercoagulability, and immune dysfunction. We hypothesized that greater pericardial (PAT) and visceral adipose tissue (VAT) would associate with higher risk of hospitalization or death from SARS-CoV-2. Methods C4R collected SARS-CoV-2 outcomes from US-based cohort studies. These were linked to chest and abdominal CT scans obtained from Jackson Heart (2007-2010) and CARDIA (2010-2011) studies. We standardized PAT across cohorts and VAT within each cohort to account for differences in VAT measurement protocols. Our outcome was COVID-related hospitalization or death from March 2020 to February 2023 assessed via questionnaires, serosurvey, and record review. Logistic regression models were adjusted for age, sex, race/ethnicity, education, smoking status, and cohort. We adjusted for body mass index (BMI) at COVID assessment in secondary models. Results We included 3002 subjects with mean (SD) age of 62 (6) years, of whom 62% were women, 41% White, 59% Black, 59% never smokers, and 13% current smokers. Sixty-one subjects (2%) had SARS-CoV-2 related hospitalization or death. Every 1-standard deviation (SD) increment in PAT volume was associated with 79% higher odds of hospitalization or death (95%CI 1.38-2.33, Fig A); the estimate was similar after adjusting for BMI (OR 1.71, 95%CI 1.27-2.31). Abdominal VAT was associated with higher odds of hospitalization or death (OR 1.47 per 1 SD, 95%CI 1.20-1.81, Fig B), even after adjustment for BMI (OR 1.35, 95%CI 1.05-1.72). Conclusion Greater pericardial or visceral adiposity measured 10-15 years prior to SARS-CoV-2 emergence, was associated with higher odds of hospitalization or death from SARS-CoV-2 independent of BMI. Lowering PAT and VAT may have collateral benefit for those who develop SARS-CoV-2 infection. Further study of the role of visceral adipose in viral infection is needed.

Abstract 18453: Giant Right Atrial Lipoma Inducing Atrial Flutter and Tachycardia-Mediated Cardiomyopathy: The Value of Multimodality Cardiac Imaging

Case Presentation: A 60-year-old male who presented with progressive dyspnea on exertion and atrial flutter with rapid ventricular response. His TTE showed a large (5.1 x 3.9 cm) right atrial (RA) mass occupying 80% of a severely dilated RA attached to the lateral wall (Fig A) and severe global LV hypokinesis with an ejection fraction of 20 - 25%. A TEE was then performed to further characterize this mass and showed a large (6.3 x 5.5 x 3.7 cm), heterogeneously echoreflectant, bi-lobed, and partially mobile RA mass attached to the lateral wall (Fig B,C) just below the superior vena cava and extending near the tricuspid valve annulus with sparing of the leaflets and only mild tricuspid regurgitation. At last, a chest CT scan showed a large (5.5 x 4.5 x 3.3 cm) mass which was tissue characterized as RA lipoma (Fig D). Therefore, patient underwent an uncomplicated surgical resection of the mass with partial removal of RA free wall (Fig D,E) repaired with a pericardial patch. Pathology confirmed a RA lipoma. Patient’s atrial flutter was then ablated, and patient was discharged home in stable condition. Discussion: This case illustrates an unreported cavitary giant RA lipoma inducing atrial flutter and tachycardia-mediated cardiomyopathy and emphasizes the importance of multimodality cardiac imaging in its diagnosis and management. Cardiac lipomas are rare benign tumors usually of small size and therefore mostly incidentally detected. They can rarely lead to embolization, conduction abnormalities, and flow obstruction requiring surgical resection. In this patient, pre-operative echocardiography and CT imaging were critical in the assessment of the tumor size, tissue characterization, location, motion, relation or extension to other cardiac structures, and obstruction or dysfunction of heart valves. Pre-and-intraoperative echocardiography were also essential in planning and performing the successful surgical resection of the RA lipoma.

Abstract 11787: The Association Between Preoperative Sarcopenia and Outcomes After Cardiac Transplantation

Introduction: Sarcopenia, or reduced muscle mass and function, is underdiagnosed in advanced heart failure and is not routinely assessed. In patients receiving a left ventricular assist device (LVAD), preoperative sarcopenia, defined using CT-derived pectoralis muscle area index (muscle area indexed to height), was an independent predictor of post-operative mortality. The association between preoperative sarcopenia and outcomes after cardiac transplantation is unknown. Aims/Hypotheses: The primary aim was to determine if preoperative sarcopenia, diagnosed using pectoralis muscle area index, is an independent predictor of days alive &amp; out of the hospital at 1-year post-cardiac transplant. We hypothesize that patients with preoperative sarcopenia will have fewer days alive &amp; out of the hospital compared to those without. Methods: Patients who underwent cardiac transplantation from January 2018 to June 2022 with available preoperative chest CT scans (68% of total cohort) were included. Sarcopenia was diagnosed as pectoralis muscle area index in the lowest sex-specific tertile (male &lt; 5.7 cm 2 /m 2 ; female &lt; 4.4 cm 2 /m 2 ). The primary endpoint was days alive &amp; out of the hospital at 1-year post-transplant. Results: 172 patients were included of whom 32.7% met criteria for sarcopenia. Patients with sarcopenia were more likely white with lower body mass index (BMI) (23.5 vs 27.7 kg/m 2 ). Patients with sarcopenia had fewer days alive &amp; out of the hospital compared to those without, with a median difference of 16.5 days (320.5 vs. 337 days, p=0.004). Patients with sarcopenia had a longer index hospitalization (28.5 vs. 22 days) and were more likely to be discharged to a facility other than home (40.4% vs. 12.3%). In a linear regression model, sarcopenia was a significant univariable and the strongest multivariable predictor of days alive &amp; out of the hospital at 1-year when controlling for diabetes status (β = -14.4, 95% CI -28, -1.2, p = 0.032). Conclusions: Preoperative sarcopenia, diagnosed using pectoralis muscle area index, is an independent predictor of poor outcomes after cardiac transplant. This parameter is easily measurable from commonly obtained preoperative CT scans and may be considered in the transplant evaluation as a marker of risk.

Abstract 13805: Associations of Subclavian Artery Calcification With Future Cardiovascular Events and Death: The Multi-Ethnic Study of Atherosclerosis

Introduction: Atherosclerosis affects the upper limbs and may be a marker of diffuse atherosclerosis and increased risk for cardiovascular events. Hypothesis: Subclavian artery calcification (SAC) and thoracic aorta calcification (TAC) obtained by chest CT provide additional information about future CV events and death beyond coronary artery calcification (CAC) and CV risk factors. Methods: Chest CT scans of MESA participants (N = 2519) at exam 5 (2016-18) were interrogated for the presence and extent of SAC, TAC, and CAC. Proportional hazards regression was conducted for associations with incident total CVD events (n = 209), adjusted for age, race/ethnicity, and sex, then SAC, TAC, and CAC adjusted for demographics and each other, and finally adding adjustment for CV risk factors. Results: The mean age of the sample was 68.3±9.2 years; 48% were male, 27% Black, 13% Chinese, 22% Hispanic, 38% White. The prevalence of any calcification was 62% for SAC, while being 60 and 69% for TAC and CAC, respectively. Among those with any calcification, N and median Agatston score were SAC: 1704, 76; TAC: 1655, 152; CAC 1896, 135. CAC predicted future events in all models (Table). After adjustment for demographics, the ln(Agatston score +1) in each calcified vascular bed predicted future CVD. Mean±SD of the predictors were ln(SAC+1): 2.4±2.4, ln(TAC+1) 2.7±2.9 and ln(CAC+1) 3.1±2.6. SAC, but not TAC, was still predictive after mutual adjustment. SAC was marginally predictive (HR: 1.08, p = 0.06) when CV risk factors were also included in the model. Conclusions: Calcification was common in all 3 vascular beds, but there is no evidence that predictions using SAC and TAC are independent of CAC. We speculate that although the tendency to calcify is similar across vascular beds, CAC is most relevant for incident CVD.

Abstract 13076: Geriatric Nutritional Risk Index and Sarcopenia in Patients Undergoing Cardiac Transplantation

Background: The Geriatric Nutrition Risk Index (GNRI) is a simple nutritional assessment tool used in elderly patients. Sarcopenia, defined as reduced muscle mass strength, is widely prevalent in patients with advanced heart failure, and has been associated with worse clinical outcomes including post-transplant infections and mortality but is not routinely assessed. The relationship between GNRI and sarcopenia in advanced heart failure patients undergoing cardiac transplantation has not been well-established. Aims/Hypotheses: The primary outcome was to determine if GNRI was associated with sarcopenia as diagnosed using pectoralis muscle area index. We hypothesize that patients with a higher nutritional risk (GNRI &lt; 92) will have higher rates of sarcopenia. Methods: Patients who underwent cardiac transplantation from January 2018 to June 2022 and who underwent preoperative chest CT scans were included. GNRI was calculated using albumin, height and weight on the day of transplant. Previous literature has defined malnutrition status as a GNRI &lt; 92. The primary outcome was sarcopenia which was diagnosed as pectoralis muscle area index in the lowest sex-specific tertile. Results: 172 patients were included in the primary analysis and were stratified into high (GNRI&lt;92) and low (GNRI&gt;92) nutritional risk. Patients with high nutritional risk had a lower BMI than those with low nutritional risk. Patients with high nutritional risk were more likely to meet criteria for sarcopenia than those with low risk (56.5% vs 28.9%, p=0.02). Additionally, patients with high nutritional risk had a longer hospital length of stay at their index hospitalization than patients with low nutritional risk (29 vs 22 days, p=0.03). There were no significant differences by nutritional risk in outcomes of rehospitalizations, days alive and out of the hospital, or death. Conclusions: Lower GNRI (higher nutritional risk) was associated with a greater prevalence of sarcopenia in patients undergoing cardiac transplantation. This index may represent a simple screening tool utilizing readily available data to ascertain sarcopenia in patients with advanced heart failure.

Abstract 12439: Abdominal Visceral Fat Area and Density Are Associated With Coronary Artery Calcification: A Cross-Sectional Analysis of the Multi-Ethnic Study of Atherosclerosis

Introduction: The associations of body composition components, including muscle and adipose tissue, and markers of subclinical coronary artery disease are unclear. We examined the relationship between abdominal CT-derived measures of the area and density of fat and muscle with coronary artery calcification (CAC), using data from the Multi-Ethnic Study of Atherosclerosis (MESA). Methods: A randomly selected total of 1,974 MESA participants free of coronary heart disease underwent abdominal CT scans at exams 2 or 3, with the resulting images interrogated for abdominal body composition. Using six cross-sectional slices spanning L2-L5, Medical Imaging Processing Analysis and Visualization (MIPAV) software was used to determine abdominal muscle and fat composition by utilizing appropriate Hounsfield units (HU) ranges. CT chest scans obtained during the exam 1 were used to obtain CAC scores, calculated using the Agatston method and spatially weighted calcium score (SWCS). Multivariable linear regression analysis was performed to assess the relationship between both abdominal visceral fat and muscle area and density to prevalent CAC. Results: A total of 1,089 participants had a CAC&gt;0, with an average CAC score of 310. In the fully adjusted model, for every 10 cm 2 increase in visceral fat area, the likelihood of having a CAC &gt;0 increased by 0.60% (p&lt;0.001). In the minimally adjusted model, abdominal muscle area was significantly associated with CAC&gt;0, which became non-significant in the fully adjusted model. For density of visceral fat , every 1 HU increase (less lipid dense fat tissue), the likelihood of having a CAC score&gt;0 decreased by 0.29% (p&lt;0.05). No significant relationship was observed between density of abdominal muscle and CAC&gt;0. Conclusion: Greater area and higher lipid density of abdominal visceral fat was associated with an increased likelihood of having CAC, while there was no significant relationship between abdominal muscle area or density and CAC. Both the quantity and the quality of fat have associations with an important marker of subclinical atherosclerosis, CAC, and their significance with respect to cardiovascular outcomes requires further evaluation.

Influence of liver attenuation on the severity of course COVID-19: a retrospective cohort study

Introduction. A high prevalence of decreased liver density has been shown among patients with COVID-19, but there are no convincing data on the cause of this phenomenon. It is still debatable whether decreased liver attenuation is an independent risk factor for the severe course of COVID-19.Aim. Assessment the prognostic value of liver attenuation on CT scan in patients with COVID-19.Materials and methods. Retrospective cohort study. Data of COVID-19 outpatients were analyzed. Inclusion criteria: two chest CT scans, alanine aminotransferase (ALT), aspartate aminotransferase (AST) blood values, polymerase chain reaction to verify SARS-CoV-2. Four comparison groups were assigned according to the severity of lung lesions. Liver attenuation was analyzed by automatic segmentation, with values less than 40 HU being considered pathologic.Results. Data from 499 patients was included. No correlation between ALT and AST and changes in liver attenuation was found. Groups differed in age and liver attenuation on both CT scans. On follow-up CT, low liver density was seen in males (odds ratio (OR) 2.79 (95% CI 1.42–5.47), p-value = 0.003) and in patients with a baseline reduced liver density (OR 60.59 (95% CI 30.51–120.33), p-value &lt; 0.001). Age over 60 years was associated with the development of lung lesions (OR 1.04 (95% CI 1.02–1.06) for extent of lung injury &lt; 25%, OR 1.08 (95% CI 1.05–1.11) for 25–50%, OR 1.1 (95% CI 1.06–1.15) for 25–50%, p-value &lt; 0.001). Low liver attenuation on the primary CT scan increased the odds of severe lung injury (OR 6.9 (95% CI 2.06–23.07), p-value = 0.002).Conclusion. In COVID-19, patients with low liver attenuation are more likely to develop severe lung damage.

Risk Factors for Omicron Pneumonia in Patients with Hematological Malignancies: A Multicenter Study in China

BACKGROUND Although Omicron's hospitalization rate and mortality rate decreased significantly in the immunocompetent population (Wang B, et al. J Infect 2023; Maslo C, et al. JAMA 2022), it remains a fatal threat to patients with immunocompromised hematological malignancies (HM) (Zhu X, et al. BJH 2023). The overall mortality rate of Omicron infection was 16.5% among hospitalized HM patients according to the “EPICOVIDEHA survey report” (Blennow O, et al. AJH 2022), significantly higher than that observed in the general population. The main cause of Omicron-related death in HMs was respiratory failure caused by Omicron pneumonia and data showed that approximately 10% of HM patients develop Omicron pneumonia after infection (Zhu X, et al. BJH 2023). However, little is known about the risk factors for Omicron pneumonia in HM patients after Omicron infection. METHODS The data in this study comes from a registered multi-center, prospective, observational study during the latest Omicron wave in Chongqing, China (November 2022 to January 2023), of which the initial purpose was to investigate the neutralizing antibody levels in HM patients after Omicron infection. Detailed information can be found on international clinical trials registry platform (ICTRP) of world health organization (WHO) (https://trialsearch.who.int/) (No.ChiCTR2300071830) or the Chinese clinical trial registry website (http://www.chictr.org.cn). Patients were enrolled at the time of diagnosis of SARS-CoV-2 infection. Immune function stats, which was assessed by the counts of immune cells including neutrophils, total lymphocytes, CD4 (+) T cells, B cells, NK cells, were measured at the time of enrollment. All patients were followed up once a week for a total of 6 weeks after enrollment. During the period, chest CT scans were performed to determine Omicron pneumonia on patients with any of the following characteristics: 1) Sustained high fever &amp;gt; 3 days; 2) Respiratory rate ≥ 30 beats/minute; 3) Oxygen saturation at rest &amp;lt; 93%; 4) PaO 2/FiO 2 ≤ 300mmHg. The sequencing results were download from the Global Initiative on Sharing Avian Influenza Data (GISAID) database (https://db.cngb.org/gisaid) to identify the potential SARS-CoV-2 strains present in our patients. Risk factors were analysed by logistic univariate / multivariate regression methods. RESULTS Omicron subvariant BA.5.2.48 was speculated to be the dominant SARS-CoV-2 strain in our patients. A total of 475 HM patients enrolled in this study. Omicron pneumonia was observed in 15.8% (75/475) of patients. In the Omicron pneumonia group, patients had a median age of 58 years [IQR 48-69] and males accounting for 61.3%, 56 (74.7%) patients with a baseline disease of lymphoma, 41 (54.7%) with disease status of active disease, 33 (44.0%) patients had no COVID-19 vaccination history, and 65 (86.7%) patients had received targeted chemotherapy; B/ CD4 (+) T/ NK-cell reduction rate were 49 (65.3%), 66 (88.0%) and 47 (62.7%), respectively. Risk factors associated with Omicron pneumonia included active disease status of HM at infection (OR=3.42, 95% CI: 1.59-7.37, P=0.002), (1-2) dose of COVID-19 vaccination (OR=2.55, 95% CI: 1.28-5.10, P=0.008), no COVID-19 vaccination history (OR=4.81, 95% CI: 2.45-9.43, P&amp;lt;0.001), chemotherapy prior to infection &amp;lt;6 months (OR=2.58, 95% CI: 1.12-5.96, P=0.027), chemotherapy prior to infection ≥ 6 months (OR=2.93, 95% CI: 1.31-6.53, P=0.009) and NK-cell reduction (&amp;lt; 150/μL) (OR=2.19, 95% CI: 1.27-3.79, P=0.005). CONCLUSIONS Our study investigated risk factors for Omicron pneumonia in HM patients after Omicron (BA.5.2.48) infection. Highlights that HM patients with these risk factors, may be susceptible to lung involvement after Omicron infection and need to be taken seriously in clinical practice.

Protocol for a mixed-method study to assess chronic cough in patients with renal cell carcinoma: the prevalence, impact on quality of life, trigger and potential clinical application of chronic cough as an early screening tool in patients with kidney cancer

IntroductionCough as a symptom of renal cell carcinoma (RCC) was first described by Creevy in 1935, and despite one (unpublished) study suggesting it may affect 31% of these patients, as...

Misdiagnosed periappendiceal and intestinal tuberculosis during the COVID-19 pandemic

Introduction and importance: The coronavirus disease 2019 (COVID-19) was first reported in Wuhan, Hubei Province, China. It mainly involves the respiratory system, causing fever, cough, chest tightness, and other symptoms. However, when combined with other common or rare diseases, such as appendicitis and intestinal tuberculosis (TB), it can cause other systemic lesions, thus making the original disease lose its specific clinical manifestations. This case highlights the importance of early identification and clinical precision medicine diagnosis and treatment. Case presentation: A young woman presented with intermittent pain and discomfort in the right lower quadrant. Ultrasonography suggested appendicitis with a peripheral abscess. The nucleic acid test of COVID-19 was positive, and the chest computed tomography scan showed pulmonary involvement. She was sent for surgery. Postoperative body temperature increased regularly, and the TB T-cell test was positive. Clinical discussion: Multiple infections caused by common bacteria, pandemic virus, and specific mycobacterium TB cause a series of nonspecific clinical manifestations, which brings challenges to clinical diagnosis and treatment. Therefore, when facing a complex infection case, the authors should consider the possibility of multiple infections and give targeted treatment for the pathogens. Conclusions: During the epidemic of COVID-19, the incidence of intestinal TB is relatively low, which is easy to be overlooked and misdiagnosed, especially in the case of appendicitis. Therefore, clinicians must be highly vigilant in the diagnosis process to avoid missed diagnosis or misdiagnosis, so as to provide the best diagnosis and treatment plan.