Chest CT Scan Research Articles

431. RARE CASE OF CONTAINED ESOPHAGEAL PERFORATION IN LONG STANDING ACHALASIA CARDIA AND ITS SUCCESSFUL MANAGEMENT

Abstract Background Esophageal perforation is the most feared complication after any intervention in achalasia cardia, especially after pneumatic dilation. We present a case of contained perforation after manometry in a long-standing case of achalasia cardia and its successful management. Methods A 64-year-old lady, known case of long-standing Rheumatoid arthritis on steroids and methotrexate, presented to us with complains of dysphagia to solids and liquids and 15 kgs weight loss in the past 3 years. On evaluation, she was dehydrated and cachexic. Upper GI endoscopy showed lot of food residue with erosions in body of esophagus and tight LES. Barium swallow showed sigmoid esophagus with typical bird beak appearance. Patient was admitted for hydration and nutritional optimization was done with nasojejunal feeding. She was further subjected to manometry to characterize the achalasia, which couldn’t be completed despite multiple forceful attempts. After 5 days, she was admitted for elective surgery. A CT scan of chest was done to evaluate the anatomy thoroughly before surgery, which showed contained mucosal perforation in lower esophagus on right side with minimal right pleural effusion. We planned for surgery next day. Results Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication was done with thoracoscopic lavage. Intra-operatively, upper GI endoscopy with minimal insufflation was done to confirm adequate cardiomyotomy and to look for the site of perforation. The perforation was not found. Hence, right thoracoscopy was done, which showed reactive pleural effusion without any food contents. Lavage was given and ICD was placed. Feeding jejunostomy was done laparoscopically. Patient was kept NBM for 7 days and JT feeds were started on POD 1 and gradually increased. ICD removed on POD 7. Oral gastrograffin contrast study was done on POD 8, which showed delayed passage at 5 minutes and no extravasation. Oral liquids were started and escalated gradually. Supplemental high protein nutrition was given through JT feeding. Patient was discharged on POD 15. At 1 month follow up, patient had 2 kgs weight gain and tolerated semisoft diet adequately. Conclusion Successful management of contained perforation in long standing achalasia cardia was achieved by targeting the source pathology in an already immunocompromised patient.

217. IMPORTANCE OF PERFORMING BARIUM SWALLOW TEST FOR COLLECT DIAGNOSIS OF ESOPHAGOGASTRIC JUNCTION OUTFLOW OBSTRUCTION INCLUDING ACHALASIA

Abstract Background The clinical manifestation of achalasia is nonspecific (weight loss, vomiting); particularly, making an early diagnosis is often difficult. It often remains unrecognized for a long period or can be initially misdiagnosed as an eating disorder, such as anorexia nervosa, whose main clinical features mimic achalasia. Additionally, several overlooked patients with esophagogastric junction outflow obstruction (EGJOO), including achalasia, are should be identified in the community population. Methods 1. We collected data from 38 patients with achalasia and examined them for diagnostic factors that could lead to a delayed diagnosis. 2. The data of a cumulative total of 489,823 hospital visits at a tertiary medical center were collected. We selected patients with the given suspected diagnoses that could be misdiagnosed, and investigated the kind of imaging tests used in them. Among them, we selected patients with symptoms persisting for >6 months, without a definitive diagnosis, and in whom upper endoscopy, but not barium swallow test, was performed. Subsequently, we performed barium swallow tests in these patients. Results 1. The most important factor that caused a delay in the diagnosis of achalasia was non-performance of a chest CT scan or barium swallow test promptly at first physician contact. 2. We identified 39 people that could have been misdiagnosed, who had undergone upper endoscopy, but not barium swallow testing, with symptoms persisting for >6 months and without a definitive diagnosis. Among them, 16 individuals agreed to undergo the barium swallow test. One of them was confirmed to suffer from EGJOO. Conclusion To avoid a delayed diagnosis of EGJOO, including achalasia, performing a barium swallow test promptly, in addition to routine endoscopy, appears to be extremely important. Furthermore, we successfully identified one patient with EGJOO from among the community population using an extraction algorithm.

Association Between COVID-19 Severity and Olfactory Disturbance

Background: There is little information about prognostic factors in patients with COVID-19. One of the aspects of SARS-CoV-2 involvement is the sudden loss of smell, called anosmia. Objectives: This study assessed the association between COVID-19 severity and olfactory disturbance. Methods: This cohort study was performed at Taleghani Hospital of Iran from March 2021 to March 2022. Patients with a definitive diagnosis of COVID-19, according to a positive PCR test or chest CT scan, entered the study. Data on demographic information, past medical history, severity of COVID-19, olfactory disturbance at the time of hospitalization, and the course of the disease were gathered. Data were analyzed using Stata version 14 software. Results: A total of 390 patients entered the study. According to the multiple logistic regression analysis, patients with severe and critical COVID-19 were less likely to develop olfactory disturbance (OR = 0.5, P-value = 0.035, 95%CI = 0.2-0.9). Also, obesity was a statistically significant negative predictor of developing olfactory disturbance in patients with COVID-19 (OR = 0.4, P-value = 0.043, 95%CI = 0.1 – 0.9). Diabetes mellitus was a statistically significant positive predictor of developing olfactory disturbance (OR = 3.3, P-value = 0.029, 95%CI = 1.1 – 9.9). Conclusions: Patients with severe and critical COVID-19 were less likely to develop anosmia. These patients had lower serum cytokines and presented with milder disease. The severity of olfactory disturbance could be a prognostic factor in COVID-19. It is important to closely monitor patients who exhibit mild olfactory disturbance because they are at risk of more severe COVID-19.

CT Evaluation of the Tracheobronchial Tree in Swine.

Swine are commonly used for research on the respiratory system, but various anatomic features of the tracheobronchial tree of swine are poorly defined. The purpose of our study was to acquire normative measurements of the tracheobronchial tree of swine by using chest CT scans, thus laying a foundation for treating or studying airway disorders in this species. In our study, 33 male swine underwent thoracic CT scans; we measured anatomic features of the tracheobronchial tree, including the diameter, length, and angle of various airway structures. We further analyzed the relationships among selected principal parameters. Our data revealed several similarities and differences in anatomy between swine and humans. This information may be useful in future research.

Transbronchial Cryobiopsy Is Superior to Forceps Biopsy for Diagnosing both Fibrotic and Non-Fibrotic Interstitial Lung Diseases

Background: Interstitial lung disease (ILD) evaluation often requires lung biopsy for definite diagnosis. In recent years, transbronchial cryobiopsy (TBCB) emerged as a procedure with higher diagnostic yield than transbronchial forceps biopsy (TBFB), especially for fibrotic ILDs. Nonetheless, studies comparing these modalities in non-fibrotic ILDs and for specific ILD diagnoses are scarce. Objectives: The aim of this study was to evaluate the diagnostic yield and safety of TBCB and TBFB in patients with fibrotic and non-fibrotic ILDs. Method: An observational retrospective multicenter study including patients with ILD diagnosis by multidisciplinary discussion that underwent TBCB or TBFB between 2017 and 2021. Chest CT scans were reviewed by a chest radiologist. Biopsy specimens were categorized as diagnostic (with specific histological pattern), nondiagnostic, or without lung parenchyma. Nondiagnostic samples were reassessed by a second lung pathologist. TBCB and TBFB diagnostic yields were analyzed by multivariate regression. Procedural complications were evaluated as well. Results: 276 patients were included, 116 (42%) underwent TBCB and 160 (58%) TBFB. Fibrotic ILDs were present in 148 patients (54%). TBCB diagnostic yield was 78% and TBFB 48% (adjusted odds ratio [AOR] 4.2, 95% CI: 2.4–7.6, p < 0.01). The diagnostic yield of TBCB was higher than TBFB among patients with fibrotic ILD (AOR 3.8, p < 0.01), non-fibrotic ILD (AOR 5.8, p < 0.01), and across most ILD diagnoses. TBCB was associated with higher risk for significant bleeding (10% vs. 3%, p < 0.01), but similar risk for pneumothorax. Conclusions: Diagnostic yield of TBCB was superior to that of TBFB for both fibrotic and non-fibrotic ILDs, and across most diagnoses.

Slight Bronchopneumonia in A Centenarian Diagnosed by Chest CT Scan with Maximum Intensity Projection (MIP)

The current case is a 102-year-old female centenarian with slight bronchopneumonia. She did not have any remarkable health or medical problems until 2022. In May 2023, she developed a cough and fever and underwent a lung CT scan, which revealed a consolidation shadow in the left posterior middle lung. This image was created with a 1mm width for each 1mm interval. Additionally, a further image was generated using maximum intensity projection (MIP) with a 3mm width for a slab thickness of 20mm. Based on this data, a diagnosis of slight bronchopneumonia in the left lung was made. She was treated with levofloxacin 500mg/day for 5 days, which led to clinical improvement.

A Systematic Review on Deep Structured Learning for COVID-19 Screening Using Chest CT from 2020 to 2022.

The emergence of the COVID-19 pandemic in Wuhan in 2019 led to the discovery of a novel coronavirus. The World Health Organization (WHO) designated it as a global pandemic on 11 March 2020 due to its rapid and widespread transmission. Its impact has had profound implications, particularly in the realm of public health. Extensive scientific endeavors have been directed towards devising effective treatment strategies and vaccines. Within the healthcare and medical imaging domain, the application of artificial intelligence (AI) has brought significant advantages. This study delves into peer-reviewed research articles spanning the years 2020 to 2022, focusing on AI-driven methodologies for the analysis and screening of COVID-19 through chest CT scan data. We assess the efficacy of deep learning algorithms in facilitating decision making processes. Our exploration encompasses various facets, including data collection, systematic contributions, emerging techniques, and encountered challenges. However, the comparison of outcomes between 2020 and 2022 proves intricate due to shifts in dataset magnitudes over time. The initiatives aimed at developing AI-powered tools for the detection, localization, and segmentation of COVID-19 cases are primarily centered on educational and training contexts. We deliberate on their merits and constraints, particularly in the context of necessitating cross-population train/test models. Our analysis encompassed a review of 231 research publications, bolstered by a meta-analysis employing search keywords (COVID-19 OR Coronavirus) AND chest CT AND (deep learning OR artificial intelligence OR medical imaging) on both the PubMed Central Repository and Web of Science platforms.

Understanding Chest CT Scan Usage Among Adolescent Blunt Trauma Patients at Adult Trauma Centers.

The utility of chest computed tomography (CCT) is not well established in the diagnostic algorithm of adolescent blunt trauma patients. Our study's aim was to review CCT usage in the initial evaluation of adolescent blunt trauma. We retrospectively reviewed adolescent blunt trauma patients treated at our urban level 1 adult trauma center from 2015 to 2019. Our primary outcome was the rate of positive CCT findings. Univariate and multivariate logistic regression analyses were performed. There were 288 patients that met our inclusion criteria and 153 positive CCT and 135 negative CCT. There was no statistically significant difference between both groups in terms of age, gender, and race. Those with a positive CCT were found to have a statistically significant higher ISS than the negative CCT group (20.6 ± 12.3 vs 12.3 ± 7.6; P < .01). Those with a positive CCT were more likely to have a GCS <15 (40% vs 25%), have a positive CXR (38% vs 2%), have chest pain (16% vs 7%), and have an abnormal chest exam (27% vs 7%) than those with a negative CCT (P < .01). On multivariate analysis, positive CXR (P < .05, OR = 13.96) and ISS (P < .05, OR = 3.10) were independently associated with a positive CCT. While CCT may provide valuable information, clinical exam coupled with low-ionizing radiographic imaging (i.e., CXR) may sufficiently identify chest trauma after blunt mechanisms. This shift in management can potentially reduce the risk of radiation without compromising the care of adolescent trauma patients at adult trauma centers.

Donut-like esophageal leiomyoma enucleation in very critical patient

We present here a case of 61 year old man, heavy smoker with hepatic cirrhosis Child-Pugh A alcohol associated. Patient underwent endoscopy and chest CT scan beacause of severe dysphagia and cough. The diagnosis was mid-esopahgeal leiomyoma.

Three to Six-Months Follow-Up Chest CT Findings after COVID-19 Pneumonitis, Incidence of Complications and Correlation to Different Risk Factors

Background Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, has become a global pandemic. As of November 19, 2020, World Health Organization stated that this disease has been found in more than 200 countries. Pathology studies have shown that COVID-19 causes injuries in multiple organs and tissues, with extensive pulmonary involvement similar to that found in other coronavirus infections (ie, severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus infection). Aim of the Work to evaluate pulmonary changes on 3-6 months follow-up chest CT scans and to explore the risk factors for fibrotic-like changes in the lung in patients who recovered from COVID-19 pneumonia. Patients and Methods This was a retrospective and prospective study that included 50 patients who had Symptoms of variable degree of fever, cough, and dyspnea with RT-PCR confirmed COVID- 19 infection at Ain Shams University Hospitals referred to the Radiodiagnosis Department for HRCT chest examination. All patients were evaluated for: (I): Incidence of complications (residual fibrotic like changes in their follow up CT chest scans). (Il): Correlation to different risk factors such as (smoking, diabetes mellitus, hypertension, pre-existing pulmonary disease, pre-existing renal disease and steroid therapy). Results 56% of cases showed residual fibrotic like changes in their follow up chest CT scans while 44% of cases showed total resolution of the disease process. Smoking and old age were significant risk factors while steroid therapy decreased risk of fibrotic like change. Conclusion Twenty eight cases (56%) showed residual fibrotic like changes in their 3-6 months follow-up chest CT scan (CO-RADS III to V). Patients with older age and smokers have higher incidence of residual fibrotic like changes in their follow up chest CT scans, while patients on steroid therapy have less liability to develop fibrotic changes.

Comparison between Lung Ultrasound and Chest Computed Tomography in the Assessment of Severity of Confirmed Coronavirus COVID-19 Pneumonia

Background Coronavirus disease 2019 (COVID-19) was reported for the first time in the Chinese province of Wuhan and then rapidly spread worldwide, to be declared a pandemic on March 11, 2020. It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which has a genome similar to that of the RNA virus group that caused SARS and Middle East respiratory syndrome. Aim of the Work The aim of this study was to determine the correlation between LUS and CT findings in SARS-CoV-2 infection, to assess the performance of lung ultrasound (LUS) to classify lung abnormalities and to evaluate the possibility of using this technique to provide a quantitative assessment of pulmonary involvement in COVID-19 patients. Patients and Methods This was a cross sectional study that included 30 patients who had symptoms of variable degree of fever, cough, and dyspnea with RT-PCR confirmed COVID19 infection by nasopharyngeal swab on admission or during hospitalisation either at ward or intensive care unit (ICU) at Ain Shams University Hospitals and National Hepatology and Tropical Medicine Research Institute from May 2021 to March 2022, for whom CT chest was ordered before admission. An acceptance from the ethical committee of the Radiology Department and the ethical committee of Faculty of Medicine - Ain Shams University and NHTMRI was obtained to use the data stored on PACS with the patient’s consent to perform lung ultrasound. Patients who did not perform PCR test, age &amp;lt;18years, those with known history of interstitial lung disease or with previous lung and thoracic wall surgery, anatomically having thoracic wall abnormalities and patients who did not consent to participate in the study were not included in the study. Results This study showed that in a sample of patients with PCR proven COVID-19, Patients with respiratory symptoms or comorbidities tended to have more changes on LUS and more extensive disease on CT. There was a relationship between the abnormalities detected by the imaging modalities; In addition, LUS score is associated with severity as assessed by chest CT scan and clinical features Conclusion The advantages of ultrasonography compared to CT include portability, no exposure to radiation (pregnant women and patients with extra risk for radiation use), low cost, no need for auxiliary personnel, and repeatability. Thus, it can be used as an alternative to CT chest in severe cases (especially ICU cases).

Diagnosis and management of diaphragmatic pericardial hernia: A case report

Introduction: Diaphragmatic hernias can be congenital or acquired. Congenital diaphragmatic hernia is a relatively common malformation and can be diagnosed in the prenatal period using ultrasound. After birth, computed tomography is the most accurate diagnostic test and helps to assess the anatomical relationships between the viscera. Traumatic diaphragmatic hernia (TDH) is characterized by the passage of part of the abdominal contents into the thoracic cavity through trauma to the thoracoabdominal transition. Pericardial diaphragmatic hernia is a direct communication between the pericardium and the peritoneal cavity, through a defect in the diaphragm. It can be congenital or associated with diaphragmatic rupture after trauma. Case presentation: V.B, 57, complaining of chronic constipation, presented with hiatus hernia on chest X-ray and CT scan. The images showed herniation of fat content and intestinal loops into the chest through the anteromedial wall of the left hemidiaphragm, compressing the medial aspect of the lingula, with no evidence of complications. On April 6, 2023, she underwent diaphragmatic herniorrhaphy via the thoracic route. She returned for post-operative follow-up complaining of nausea, vomiting and asthenia. A new total abdominal tomography scan showed the presence of an anterior diaphragmatic hernia on the left. Subsequently, she underwent a thoracic surgical approach with a proposal to correct the diaphragmatic hernia. However, an inventory of the cavity revealed plication of the lateral diaphragm without herniation points. The decision was therefore made to open the pericardium, showing a diaphragmatic pericardial hernia, with a 0.5 cm ring containing the epipelon, transverse colon and stomach in the pericardium. Adhesions were lysed and the contents returned to the abdominal cavity. The patient evolved satisfactorily in the postoperative period. Discussion: Both diaphragmatic hernia and pericardial diaphragmatic hernia can be serious and require immediate medical intervention. They are rare pathologies that can be confused with other respiratory or cardiac diseases, making it difficult for doctors to diagnose them. Surgery is necessary to repair the hernia and reduce the risk of complications, which increase over time. Final considerations: In this case report, we have highlighted the complexity and importance of early and accurate diagnosis of diaphragmatic hernias, including the rare pericardial diaphragmatic hernia. Diaphragmatic hernia, whether congenital, acquired through trauma or associated with diaphragmatic rupture, can result in painful complications if not recognized and controlled. The clinical situation presented in this case, in which a pericardial diaphragmatic hernia was identified during the postoperative period of a thoracic diaphragmatic hernia, highlights the importance of continuous surveillance after surgical intervention.

Long-Term Follow-Up of Interstitial Lung Abnormality: Implication in Follow-Up Strategy and Risk Thresholds.

Rationale: The optimal follow-up computed tomography (CT) interval for detecting the progression of interstitial lung abnormality (ILA) is unknown. Objectives: To identify optimal follow-up strategies and extent thresholds on CT relevant to outcomes. Methods: This retrospective study included self-referred screening participants aged 50 years or older, including nonsmokers, who had imaging findings relevant to ILA on chest CT scans. Consecutive CT scans were evaluated to determine the dates of the initial CT showing ILA and the CT showing progression. Deep learning-based ILA quantification was performed. Cox regression was used to identify risk factors for the time to ILA progression and progression to usual interstitial pneumonia (UIP). Measurements and Main Results: Of the 305 participants with a median follow-up duration of 11.3 years (interquartile range, 8.4-14.3 yr), 239 (78.4%) had ILA on at least one CT scan. In participants with serial follow-up CT studies, ILA progression was observed in 80.5% (161 of 200), and progression to UIP was observed in 17.3% (31 of 179), with median times to progression of 3.2 years (95% confidence interval [CI], 3.0-3.4 yr) and 11.8 years (95% CI, 10.8-13.0 yr), respectively. The extent of fibrosis on CT was an independent risk factor for ILA progression (hazard ratio, 1.12 [95% CI, 1.02-1.23]) and progression to UIP (hazard ratio, 1.39 [95% CI, 1.07-1.80]). Risk groups based on honeycombing and extent of fibrosis (1% in the whole lung or 5% per lung zone) showed significant differences in 10-year overall survival (P = 0.02). Conclusions: For individuals with initially detected ILA, follow-up CT at 3-year intervals may be appropriate to monitor radiologic progression; however, those at high risk of adverse outcomes on the basis of the quantified extent of fibrotic ILA and the presence of honeycombing may benefit from shortening the interval for follow-up scans.

Clinical and radiological characteristics of pediatric COVID-19 before and after the Omicron outbreak: a multi-center study.

The emergence of the Omicron variant has seen changes in the clinical and radiological presentations of COVID-19 in pediatric patients. We sought to compare these features between patients infected in the early phase of the pandemic and those during the Omicron outbreak. A retrospective study was conducted on 68 pediatric COVID-19 patients, of which 31 were infected with the original SARS-CoV-2 strain (original group) and 37 with the Omicron variant (Omicron group). Clinical symptoms and chest CT scans were examined to assess clinical characteristics, and the extent and severity of lung involvement. Pediatric COVID-19 patients predominantly had normal or mild chest CT findings. The Omicron group demonstrated a significantly reduced CT severity score than the original group. Ground-glass opacities were the prevalent radiological findings in both sets. The Omicron group presented with fewer symptoms, had milder clinical manifestations, and recovered faster than the original group. The clinical and radiological characteristics of pediatric COVID-19 patients have evolved with the advent of the Omicron variant. For children displaying severe symptoms warranting CT examinations, it is crucial to weigh the implications of ionizing radiation and employ customized scanning protocols and protective measures. This research offers insights into the shifting disease spectrum, aiding in the effective diagnosis and treatment of pediatric COVID-19 patients.

Giant cell carcinoma of the lung with hypertrophic pulmonary osteoarthropathy as a paraneoplastic syndrome: a case report

BackgroundHypertrophic pulmonary osteoarthropathy is a rare syndrome characterized by a triad that includes periostitis, digital clubbing, and painful arthropathy of the large joints, especially large joints in the lower limbs with lung cancer. Herein we describe a case of a giant cell carcinoma of the lung with hypertrophic pulmonary osteoarthropathy as a paraneoplastic syndrome. The tumor was successfully resected, and complete remission of the syndrome was achieved after surgery.Case presentationA 48-year-old man with right fingers and bilateral ankle arthralgias was referred to our hospital. These arthropathies were painful and refractory to the oral administration of several non-steroidal anti-inflammatory drugs; thus, oxycodone hydrochloride hydrate was prescribed. Additionally, the fingers and toes had a clubbed appearance and the tubular bones were shown as double lines on radiographs of both arms and legs, indicating periosteal thickening. A 45-mm mass-like shadow was present on the right upper-to-middle lung field on the chest x-ray, which was confirmed to be a mass in the upper lobe of the right lung on the chest CT scan. An abnormal uptake was observed in the area of the mass on the FDG-PET scan; the standardized uptake value maximum was 11.8. The histologic diagnosis of a bronchoscopic biopsy was an undifferentiated carcinoma, and the clinical diagnosis was non-small cell lung cancer. The clinical stage was c-T2bN0M0 with paraneoplastic syndrome as a hypertrophic pulmonary osteoarthropathy. A right upper lobectomy with an S6 partial resection adjacent to the upper lobe of the right lung and an ND2a-2 lymph node dissection was performed. The postoperative course was uneventful. The pathologic diagnosis was a giant cell lung carcinoma, which was classified as p-T3 (52 mm in diameter) N0M0, stageIIB. A gradual decrease in arthritic pain was observed from the first operative day. No anodyne, including oxycodone, was required approximately 2 months after surgery. No tumor or paraneoplastic syndrome recurrence was observed 2 years postoperatively.ConclusionsHypertrophic pulmonary osteoarthritis may occur as a secondary manifestation of lung malignancies. Thus, the paraneoplastic syndrome should be considered in such cases.

Teratomas Mediastinal Recurrent with Massive Pericardial Effusion

Background: Mediastinal teratoma is a medical rare disease that refers to the presence of a regrowing teratoma tumor in the mediastinum. At the pulmonary hospital dr. Ario Wirawan Salatiga, only one case was found, where the patient had previously been operated on at another hospital.Objective: The purpose of this paper was to contribute to the radiology literature by presenting a case of recurrent teratoma.Case Presentation: A 19-year-old male patient complained of persistent shortness of breath. The patient previously underwent teratoma surgery. The patient underwent chest X-rays, CT scans, abdominal and cardiac ultrasounds (USG), and as well as biopsies. The results of the CT scan found a teratoma-type mediastinal tumor accompanied by a large amount of pericardial effusion. A hyperechoic lesion with well-defined borders, round-oval, lobulated, and very large in size. Location in the mediastinum that is urgent and involves the left ventricle, right ventricle, left atrium, and right atrium. There is also an aortic compression lesion accompanied by calcification (+). Examination by ultrasonography (USG) of the heart found many pericardial but not found pressing. Heart valve function in patients did not show any abnormalities.Conclusion: Recurrent teratomas with large-volume pericardial effusions are rare. In this case study, a teratoma is located in the mediastinum. In this case, axial, coronal, and sagittal slices of a contrast thoracic CT scan can be used to establish the diagnosis. The results of heart USG found a pericardial effusion, the heart chambers do not collapse in this case of recurrent teratomas, indicating a mature teratoma type.

Sclerosing pneumocytoma originated in the middle mediastinum: a case report

BackgroundSclerosing pneumocytoma is a benign tumor that occurs mostly in the lungs and very rarely in the middle mediastinum. It may be difficult to diagnose, as its radiological features and histologic heterogeneity mimic malignancy; therefore a histopathologic examination is required to establish a definitive diagnosis.Case presentationThe patient was a 52-year-old woman who was found to have a tumor in the middle mediastinum on a chest CT scan and was referred to our hospital for resection. We performed a resection of the mediastinal tumor, assuming it was thymoma or teratoma, via video-assisted thoracic surgery. Histopathological analysis of the mediastinal tumor revealed it to be a sclerosing pneumocytoma.ConclusionsHerein, we presented a case of a very rare sclerosing pneumocytoma originating from the middle mediastinum where video-assisted thoracic surgery allowed for minimally invasive resection and histopathological diagnosis of the tumor. Such procedures should be considered as the histopathological diagnosis of the tumor may help determine the optimal treatment options.

E53 Anti-OJ synthetase syndrome: a pediatric case report

Abstract Introduction The antisynthetase syndrome (ASS) is a connectivity with variable clinical expression. It is defined by the presence of anti-tRNA synthetase autoantibodies, associated with a clinical phenotype. It is an overlapping myositis associated with the presence of idiopathic inflammatory myopathy autoantibodies. Observation We report the case of an 11-year-old girl with no particular family history. The patient was diagnosed and treated as rheumatic fever 3 years ago and put on extencillin due to arthralgias of large right knee and hip joints with positive antistreptolysin O antibodies and history of repeated angina but without clinical improvement. The polyarthralgias progressed and became bilateral predominantly in the scapular and pelvic girdles associated with intense myalgias of three days before his admission leading to a motor deficit. A biological assessment was requested: creatine phosphokinase (CPK) = 1880UI/l; ASAT = 58UI/l; procalcitonin = 0.15; erythrocytesedimentation rate (ESR) was elevated. The immunological workup showed antibodies specific for myositis; antiRNA synthetase type OJ Positive. Results of immunological tests for other associated autoimmune diseases were (rheumatoid factor, anti-CyclicCitrullinated Peptide antibodies, anti SM and anti-Native DNA) negative. Electromyography showed no abnormalities. A muscle biopsy was not done. Chest CT scan showed no abnormalities. The patient was commenced on corticosteroid therapy at a dose of 1 mg/kg/day for 4–6 weeks then progressive weaning. Conclusion ASS is a complex and heterogeneous autoimmune connective disease. In the presence of extra-pulmonary signs and the positivity of the anti-tRNA synthetase antibody, the diagnosis is confirmed. The management often requires multidisciplinary approach.

Improving the Response rate of RT PCR testing using deep convolutional encoder

The sensitivity of the RT-PCR test is limited, and the method itself is laborious and time-consuming to carry out. When it comes to making a diagnosis of COVID-19, chest CT scans have the potential to be of assistance. If, on the other hand, the infection does not spread to the lungs, then an abnormality check with a CT scan will not be necessary. Complementary assays have the potential to considerably reduce the frequency of false-positive results when they are used in combining with RT-PCR or CT scans. We propose in this study a decision support system that is based on deep learning and has the capability to evaluate the practically commonly required laboratory parameters for the purpose of identifying COVID-19. Here dataset contains the 1428 radiographs (224 COVID-19, 504 Healthy, 700 Pneumonia) are considered for experimentation.

Machine-Learning-Aided Prediction of Brain Metastases Development in Non–Small-Cell Lung Cancers

PurposeNon–small-cell lung cancer (NSCLC) shows a high incidence of brain metastases (BM). Early detection is crucial to improve clinical prospects. We trained and validated classifier models to identify patients with a high risk of developing BM, as they could potentially benefit from surveillance brain MRI. MethodsConsecutive patients with an initial diagnosis of NSCLC from January 2011 to April 2019 and an in-house chest-CT scan (staging) were retrospectively recruited at a German lung cancer center. Brain imaging was performed at initial diagnosis and in case of neurological symptoms (follow-up). Subjects lost to follow-up or still alive without BM at the data cut-off point (12/2020) were excluded. Covariates included clinical and/or 3D-radiomics-features of the primary tumor from staging chest-CT. Four machine learning models for prediction (80/20 training) were compared. Gini Importance and SHAP were used as measures of importance; sensitivity, specificity, area under the precision-recall curve, and Matthew's Correlation Coefficient as evaluation metrics. ResultsThree hundred and ninety-five patients compromised the clinical cohort. Predictive models based on clinical features offered the best performance (tuned to maximize recall: sensitivity∼70%, specificity∼60%). Radiomics features failed to provide sufficient information, likely due to the heterogeneity of imaging data. Adenocarcinoma histology, lymph node invasion, and histological tumor grade were positively correlated with the prediction of BM, age, and squamous cell carcinoma histology were negatively correlated. A subgroup discovery analysis identified 2 candidate patient subpopulations appearing to present a higher risk of BM (female patients + adenocarcinoma histology, adenocarcinoma patients + no other distant metastases). ConclusionAnalysis of the importance of input features suggests that the models are learning the relevant relationships between clinical features/development of BM. A higher number of samples is to be prioritized to improve performance. Employed prospectively at initial diagnosis, such models can help select high-risk subgroups for surveillance brain MRI.