Diagnosis Of Pulmonary Pathologies Research Articles

Epidemiological Factors Associated with Gross Diagnosis of Pulmonary Pathology in Feedyard Mortalities.

Respiratory disease continues to be the major cause of mortality in feedyard cattle, with bronchopneumonia (BP) and acute interstitial pneumonia (AIP) as the two most common syndromes. Recent studies described a combination of these pathological lesions with the presence of AIP in the caudodorsal lungs and BP in the cranioventral lungs of necropsied cattle. This pulmonary pathology has been described as bronchopneumonia with an interstitial pneumonia (BIP). The epidemiological characteristics of BIP in U.S. feedyard cattle are yet to be described. This study's objectives were to describe the agreement between feedyard clinical and necropsy gross diagnosis and to characterize epidemiological factors associated with four gross pulmonary diagnoses (AIP, BIP, BP, and Normal pulmonary tissue) observed during feedyard cattle necropsies. Systemic necropsies were performed at six feedyards in U.S. high plains region, and gross pulmonary diagnoses were established. Historical data were added to the dataset, including sex, days on feed at death (DOFDEATH), arrival weight, treatment count, and feedyard diagnosis. Generalized linear models were used to evaluate epidemiological factors associated with the probability of each pulmonary pathology. Comparing feedyard clinical diagnosis with gross pathological diagnosis revealed relatively low agreement and the frequency of agreement varied by diagnosis. The likelihood of AIP at necropsy was higher for heifers than steers and in the 100-150 DOFDEATH category compared with the 0-50 DOFDEATH (p = 0.05). The likelihood of BIP increased after the first treatment, whereas the DOFDEATH 0-50 category had a lower likelihood compared with the 150-200 category (p = 0.05). These findings highlight the importance of necropsy for final diagnosis and can aid the development of future diagnosis and therapeutic protocols for pulmonary diseases.

Usefulness of thoracic ultrasound for diagnosis and follow-up of pneumonia.

Classically the diagnosis of both bacterial and viral pneumonias was made with chest radiology, later the use of chest CT was implemented, however in recent years lung ultrasound has become very important in the diagnosis of pulmonary pathology and increased in pandemic by SARS-CoV-2, due to the practicality of being done at the patient’s bedside, the ability to be reproducible, and the decrease in radiation exposure to patients

Challenges in the morphological diagnostics of infectious lung diseases among HIV-infected patients: a case-series study

HIV-infection is a long-term infectious disease, characterized by deterioration of the immune system and it is often complicated by the development of opportunistic diseases, mainly of infectious origin. HIV-associated infections become generalized in the late stages of the disease and often may combine, that makes challenges in the diagnosis of these diseases. Differential morphological diagnosis of HIV-associated lung infections is quite complex. Most frequently, there is the need to differentiate between tuberculosis, bacterial or septic pneumonia, cytomegalovirus lung lesions, and deep mycoses. The aim. To demonstrate the expediency and necessity to apply special complex morphological methods in HIV-infected patients with secondary lung lesions using the series of clinical cases as an example. Materials and methods. The case series consisted of 7 cases with discordance between the clinical-radiologic, laboratory data and histological conclusions. Of these, there were 5 cases of life-time and 2 autopsy diagnoses. All the clinical and laboratory data of these cases were retrospectively analyzed, and a number of additional special histological examinations were performed. The Ziehl–Neelsen and fluorescent methods, Gomori–Grocot and alcian blue-PAS staining as well as immunohistochemical examinations were used for the detection of mycobacterial antigens with different antibodies to M. tuberculosis. Results. The case series of initial morphological misdiagnosis or indeterminate histological diagnosis was revealed among hospitalized HIV-infected patients. Clinical data did not provide an accurate diagnosis of pulmonary pathology. According to the traditional histological examination, a tuberculous process was diagnosed in 3 cases, a chronic granulomatous process – in 2 cases, but without specifying the etiology. In two cases of autopsy, pneumocystis pneumonia was suspected in combination with other infections. Additional morphological examination with using 2–6 special methods made it possible to determine the correct diagnosis. In 2 cases of provisional diagnosis of tuberculosis, invasive cryptococcosis and “pneumonia in a drug user” were revealed. Cryptococcosis and pneumocystis pneumonia were detected in 2 cases with an unspecified process. In the autopsy cases, the diagnosis of pneumocystis pneumonia was ruled out, while viral-bacterial pneumonia and tuberculosis associated with cytomegalovirus infection were detected. Conclusions. The presented factual material demonstrates the principal importance of using a comprehensive morphological examination in cases of lung inflammatory processes in HIV-infected patients. Clinical patient data, namely HIV-status at the time of diagnostic procedures as well as radiological and microbiological findings serve as a substantial aid in the diagnosis.

Chest MRI of a pregnant woman with COVID-19 pneumonia

This paper presents a clinical case of a 39-year-old pregnant woman with respiratory signs of the novel coronavirus Covid-19 infection. Chest MRI showed bilateral lesions in basal segments. The PCR test was positive. A lung condition was assessed without loss of significant diagnostic information. Besides that, the absence of exposure to ionizing radiation allowed to avoid a high loading dose on the patient and the fetus. This case reveals potential opportunities of MRI in the diagnosis of pulmonary pathology without exposure to ionizing radiation, especially in patient risk groups (children, pregnant women, etc.).

Computerized acoustical techniques for respiratory flow-sound analysis: a systematic review

Computerized respiratory sound analysis has recently captured the attention of researchers, and its implementation can assist physicians in the diagnosis of pulmonary pathologies. The relationship between respiratory sounds and breathing flow reveals the pathophysiology of the respiratory system and can be used as a basis for acoustical airflow estimation. Respiratory sound signals are also acoustically analysed for the detection of breath phases. Although this research area is being actively studied, the available literature has not been reviewed. This manuscript highlights the previous studies that focused on the use of computer-based acoustical techniques for the analysis of respiratory sounds and airflow. Articles related to computerized respiratory flow-sound analysis were identified through a search of the Scopus academic database, and 66 articles were ultimately selected for this systematic review. A brief overview of the subject details, auscultation sites, respiratory manoeuvres, sound parameters of interest and techniques used is provided. The findings revealed the following: (1) deterministic relationships can be established between airflow and respiratory sounds, (2) an established strong flow-sound correlation can be used for airflow estimation, (3) breath phase detection and identification without flow measuring devices remains in the infancy research stage and (4) further research needed to examine the potential of computerized respiratory sound analysis in revealing the pathophysiology of airways for future clinical implementation. This review concludes by discussing the possibilities and recommendations for further advancements in computerized acoustical flow-sound analysis.

Correlation between sputum and bronchoscopy-guided cytology (bronchoalveolar lavage fluid, transbronchial needle aspiration, and bronchial brush) with bronchial biopsy in the diagnosis of pulmonary pathology

Background: Pulmonary pathologies constitute a major ailment in terms of morbidity and mortality. Recent technological advancements provide cytological analysis that accentuates accurate diagnosis, early intervention, management, and ease of clinical follow-up with improved outcomes. This study aimed to correlate the sensitivity and describe advantages and disadvantages of the various cytological means of the diagnosis of lung pathologies along with the sequential approach. Materials and Methods: This was a prospective study performed during the period of January 2013 to January 2015. Samples of sputum and bronchoscopy-mediated bronchoalveolar lavage (BAL) fluid, air-dried and alcohol-fixed smears of bronchial brushing (BB), transbronchial needle aspiration (TBNA), and formalin-fixed bronchial biopsy tissues were received, processed, and analyzed from all clinically and radiologically suspected cases of pulmonary pathologies. Results: Two hundred cases of lung lesions were included with all the four cytological sampling interventions and tissue biopsy in the present study with an age range of 21–90 years and male:female ratio of 2.45:1. There were 111 neoplastic and 89 nonneoplastic cases. The diagnostic sensitivity was maximum with BB cytology for nonneoplastic as well as neoplastic lesions. The overall diagnostic utility observed in 200 cases reveals sputum cytology as least sensitive and BB cytology as most sensitive investigation. Conclusion: Sputum cytology is used in patients who are unfit for bronchoscopy and inpatients for their routine evaluation of underlying infection. BAL enhances yield from intraluminal lesions, and TBNA enhances yield in submucosal and mediastinal lesions. The proposed protocol for cytomorphological diagnosis should be as sputum > BAL > TBNA > BB in order of ease.

Ultrasonido para el diagnóstico diferencial de la patología pulmonar en el paciente crítico

Durante los últimos años, la ecografía se ha convertido en una herramienta diagnóstica de primera línea para el enfoque y el manejo del paciente críticamente enfermo y es considerada hoy día uno de los pilares en la evaluación integral de todos los pacientes. Se ha demostrado que el ultrasonido mejora el rendimiento diagnóstico de la patología pulmonar y de la falla respiratoria aguda. Su utilidad radica en la capacidad de realizar el estudio a la cabecera del paciente, sin irradiación, de manera inmediata por el mismo médico tratante, sumado a la capacidad diagnóstica para identificar condiciones tales como el edema pulmonar cardiogénico y no cardiogénico, describir los patrones de ocupación alveolar y consolidación pulmonar, caracterizar y cuantificar el derrame pleural y diagnosticar la presencia de neumotórax. Adicionalmente, de la mano de una ecografía cardíaca enfocada, aumenta el rendimiento diagnóstico tempranamente en el tromboembolismo pulmonar con compromiso de ventrículo derecho (VD) o la falla cardíaca descompensada. En esta revisión se ilustran los hallazgos ultrasonográficos más importantes en el diagnóstico diferencial de la patología pulmonar y se revisa la evidencia disponible sobre su rendimiento diagnóstico. Es indiscutible la utilidad de esta herramienta para el abordaje del paciente crítico en las unidades de cuidados intensivos (UCI) o en los servicios de emergencias. Su prontitud, el buen rendimiento diagnóstico y la oportunidad de inicio temprano de terapias específicas obligan a los clínicos que manejan pacientes críticos a incorporar el ultrasonido en la práctica diaria.

Integrated Cardiac and Lung Ultrasound (ICLUS) in the Cardiac Intensive Care Unit

This review highlights the use of basic lung ultrasound and introduces the concept of integrated cardiac and lung ultrasound (ICLUS) in the care of patients in the cardiac intensive care unit (ICU). Cardiac ultrasound is a fundamental imaging modality that is the gold standard for the diagnosis of cardiac pathology at the bedside. However, the demographics of the modern cardiac ICU are evolving to encompass patients with complex multi-organ system dysfunction in addition to acute cardiovascular disease. Therefore, a more comprehensive diagnostic approach is needed to allow the cardiologist to unravel the potential interplay of multiple pathologic processes. Literature on lung ultrasound has expanded dramatically in recent years as it has proven to be a feasible and accurate exam that provides rapid diagnosis of pulmonary pathology including pneumothorax, pleural effusion, pneumonia, and pulmonary edema. Furthermore, combined cardiac and lung sonography exposes the interaction of circulatory and pulmonary physiology that is central to the diagnosis and management of acute cardiovascular disease. ICLUS provides valuable information for the diagnosis and management of conditions such as respiratory failure, shock, and heart failure. Numerous studies in recent years have illustrated the utility of lung ultrasound in various clinical settings. Integration of lung and cardiac ultrasound provides the cardiologist with a more holistic examination of the medically complex patients that are admitted to the modern cardiac ICU.

Endobronchial placer mining for neoplastic cells.

In recent years, with the advent of mass survey chest x-rays, the emphasis placed upon diagnosis of pulmonary pathology,* and the increasing incidence of neoplasm, the subject of lung cancer has received widespread attention. Fortunately, the primary effort has been directed toward early diagnosis and therapy because of the severity of this lesion. With the emphasis on case finding, the problem of demonstrating abnormal tissue for diagnosis prior to surgery has fallen upon the endoscopist. Unfortunately, in many early lung lesions, direct examination with the bronchoscope shows little or no evidence of neoplastic activity. In such cases biopsy becomes haphazard and of doubtful value. It is in these cases that directed, excoriating aspirations of small tissue fragments and cell clumps have proved to be of great value. The diagnosis of lung neoplasms by bronchoscopic examination has showed disparity in positive results, varying from 30% to as high as 80%.† Because