Ground-glass Opacity Lung Research Articles

Clinical characteristics and distinguishing factors of patients with COVID-19 complicated with active pulmonary tuberculosis.

The current study was conducted aimed at exploring the clinical characteristics and distinguishing factors of patients with the novel coronavirus pneumonia (COVID-19) complicated with active pulmonary tuberculosis. A total of 354 patients with COVID-19 in our hospital from November 2022 to February 2023 were included in the present study, of whom 87 patients were also combined with active pulmonary tuberculosis. Significant differences were found in fever, fatigue, nasal congestion, nasal discharge, sore throat, expectoration, and weight loss between the two groups (p < 0.05). There were significant differences in the levels of leukocyte, neutrophil, lymphocyte count, monocyte, hemoglobin, C-reactive protein, and CD4/CD8 between the two groups (p < 0.05). There were significant differences in pulmonary consolidation, multifocal ground-glass opacities in both lungs and infiltrating shadows, "cavity" by CT imaging between the two groups (p < 0.05). The independent variables were set as the indicators with different results of clinical characteristics and CT imaging, including fever, fatigue, nasal congestion, nasal discharge, sore throat, expectoration, weight loss, leukocytes, count neutrophils and lymphocytes, monocytes, hemoglobin, C-reactive protein, CD4/CD8, pulmonary consolidation, multifocal ground-glass opacities in both lungs and infiltration shadows. Our findings have revealed that fever, fatigue, expectoration, leukocytes, neutrophils, monocytes, hemoglobin, C-reactive protein, lymphocytes, CD4/CD8, pulmonary consolidation, multifocal ground-glass opacities in both lungs, and infiltration shadows were the risk factors responsible for the patients with COVID-19 complicated with active pulmonary tuberculosis.

Clinicopathological and genetic analysis of interstitial disease-like pulmonary intravascular large B cell lymphoma

Objective: To investigate the clinicopathological features and genetic mutation status of pulmonary intravascular large B cell lymphoma. Methods: The clinicopathological data of eight patients diagnosed with pulmonary intravascular large B cell lymphoma, from April 2018 to May 2023, were retrospectively analyzed. The genetic profile of six patients was detected via next-generation sequencing (NGS) and followed up. Results: All patients included one male and seven females, with a median age of 64 years (ranging from 45 to 66 years). Respiratory symptoms were the most common (7 cases), B symptoms in two cases, hemophagocytic syndrome in two cases. Multiple diffuse ground-glass opacities in both lungs were observed based on the high-resolution chest CT scan. Six cases of mild to moderate ventilation or diffusion dysfunction were observed based on the pulmonary function tests. Moreover, two cases of hypoxemia and two cases with type Ⅰ respiratory failure were recorded. The serum lactate dehydrogenase level increased (7/8), β2-MG level increased (2/8), neuron-specific enolase level increased (7/8), total number of peripheral blood lymphocytes decreased (7/8), and clinical stages were all stage Ⅳ. The neoplastic lymphoid cells were lodged in the lumina of venules and capillaries of the alveolar septum; the tumor cells were large, with prominent nucleoli and frequent mitotic figures. The malignant cells were detected in the extravascular surrounding lung tissue in all cases. The tumor cells expressed mature B cell-associated antigens CD20 and CD79a, and the vascular endothelial markers CD31 and CD34 showed that the tumor cells were filled in the blood vessels, infiltrated blood vessel walls, and perivascular areas. One case was germinal center-type, seven cases were non-germinal center-type, two cases were double-expressing lymphoma, and all cases were EBER-negative. Furthermore, the top five genes with mutation frequencies detected by NGS were MYD88 (5/6), PIM1 (5/6), CD79B (4/6), TCF3 (4/6), and TP53 (3/6). Of the eight cases, seven patients received R-CHOP-based chemotherapy, six cases had complete remission after chemotherapy, one case died, and one case was lost to follow-up. Conclusions: Pulmonary vascular large B cell lymphoma is rare, which shares similar patterns with interstitial lung disease on imaging. Transbronchial lung biopsy is an effective method to confirm the diagnosis. Immunochemotherapy with BTK inhibitors can provide a survival advantage for patients in the future based on molecular typing.

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.

Quantification of preexisting lung ground glass opacities on CT for predicting checkpoint inhibitor pneumonitis in advanced non-small cell lung cancer patients

BackgroundImmune checkpoint inhibitors (ICIs) can lead to life-threatening pneumonitis, and pre-existing interstitial lung abnormalities (ILAs) are a risk factor for checkpoint inhibitor pneumonitis (CIP). However, the subjective assessment of ILA and the lack of standardized methods restrict its clinical utility as a predictive factor. This study aims to identify non-small cell lung cancer (NSCLC) patients at high risk of CIP using quantitative imaging.MethodsThis cohort study involved 206 cases in the training set and 111 cases in the validation set. It included locally advanced or metastatic NSCLC patients who underwent ICI therapy. A deep learning algorithm labeled the interstitial lesions and computed their volume. Two predictive models were developed to predict the probability of grade ≥ 2 CIP or severe CIP (grade ≥ 3). Cox proportional hazard models were employed to analyze predictors of progression-free survival (PFS).ResultsIn a training cohort of 206 patients, 21.4% experienced CIP. Two models were developed to predict the probability of CIP based on different predictors. Model 1 utilized age, histology, and preexisting ground glass opacity (GGO) percentage of the whole lung to predict grade ≥ 2 CIP, while Model 2 used histology and GGO percentage in the right lower lung to predict grade ≥ 3 CIP. These models were validated, and their accuracy was assessed. In another exploratory analysis, the presence of GGOs involving more than one lobe on pretreatment CT scans was identified as a risk factor for progression-free survival.ConclusionsThe assessment of GGO volume and distribution on pre-treatment CT scans could assist in monitoring and manage the risk of CIP in NSCLC patients receiving ICI therapy.Clinical relevance statementThis study’s quantitative imaging and computational analysis can help identify NSCLC patients at high risk of CIP, allowing for better risk management and potentially improved outcomes in those receivingICI treatment.

Disseminated Nocardia nova in a child with relapsed acute lymphoblastic leukemia: a case report

BackgroundNocardiosis is a rare infection that typically results from inhalation of or inoculation with Nocardia organisms. It may cause invasive disease in immunocompromised patients. This case describes nocardiosis with bacteremia and pulmonary involvement in a child with a hematologic malignancy.Case presentationA boy with testicular relapsed acute lymphoblastic leukemia with marrow involvement presented with sudden onset of fever, body aches, headaches, chills, and moderate respiratory distress during continuation 2 chemotherapy. Radiographic imaging demonstrated consolidation and ground glass opacities in bilateral lower lungs. Central line blood cultures grew Nocardia nova complex, prompting removal of the central line and initiation of triple therapy with imipenem-cilastatin, linezolid, and trimethoprim-sulfamethoxazole with rapid improvement of symptoms. Antibiotic susceptibilities showed a multidrug-susceptible isolate. The patient is anticipated to remain on trimethoprim-sulfamethoxazole for at least 12 months.ConclusionsIn an immunocompromised child, blood cultures, chest imaging, and head imaging can aid in the diagnosis of disseminated nocardiosis. Long-term antibiotic therapy is necessary, guided by the organism and simplified with the results of antimicrobial susceptibility testing.

Artificial intelligence-based analysis of the spatial distribution of abnormal computed tomography patterns in SARS-CoV-2 pneumonia: association with disease severity

BackgroundThe substantial heterogeneity of clinical presentations in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia still requires robust chest computed tomography analysis to identify high-risk patients. While extension of ground-glass opacity and consolidation from peripheral to central lung fields on chest computed tomography (CT) might be associated with severely ill conditions, quantification of the central-peripheral distribution of ground glass opacity and consolidation in assessments of SARS-CoV-2 pneumonia remains unestablished. This study aimed to examine whether the central-peripheral distributions of ground glass opacity and consolidation were associated with severe outcomes in patients with SARS-CoV-2 pneumonia independent of the whole-lung extents of these abnormal shadows.MethodsThis multicenter retrospective cohort included hospitalized patients with SARS-CoV-2 pneumonia between January 2020 and August 2021. An artificial intelligence-based image analysis technology was used to segment abnormal shadows, including ground glass opacity and consolidation. The area ratio of ground glass opacity and consolidation to the whole lung (GGO%, CON%) and the ratio of ground glass opacity and consolidation areas in the central lungs to those in the peripheral lungs (GGO(C/P)) and (CON(C/P)) were automatically calculated. Severe outcome was defined as in-hospital death or requirement for endotracheal intubation.ResultsOf 512 enrolled patients, the severe outcome was observed in 77 patients. GGO% and CON% were higher in patients with severe outcomes than in those without. Multivariable logistic models showed that GGO(C/P), but not CON(C/P), was associated with the severe outcome independent of age, sex, comorbidities, GGO%, and CON%.ConclusionIn addition to GGO% and CON% in the whole lung, the higher the ratio of ground glass opacity in the central regions to that in the peripheral regions was, the more severe the outcomes in patients with SARS-CoV-2 pneumonia were. The proposed method might be useful to reproducibly quantify the extension of ground glass opacity from peripheral to central lungs and to estimate prognosis.

Socioeconomic status and post-covid illness trajectory

Abstract Background The associations between deprivation and illness trajectory after hospitalisation for coronavirus disease-19 (COVID-19) are uncertain. Methods A prospective, multicentre, longitudinal, cohort study involving post-COVID-19 patients enrolled in-hospital or early post-discharge (visit 1) and re-evaluated at 28-60 days post-discharge (visit 2) and in the longer term. Serial research blood tests (biomarkers), digital electrocardiography, and patient-reported outcome measures were obtained at both visits. Novel, multisystem imaging, including chest computed tomography (CT) with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging, was acquired at visit 2. The analysis of primary and secondary outcomes by socioeconomic status was prespecified. The Scottish Index of Multiple Deprivation (SIMD), a small-area measure of social deprivation based on domiciled post code reflecting seven factors including income, employment, education, health, access to services, crime, and housing, and categorized into general population quintiles, was used to measure social deprivation. The EQ-5D-5L, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire-4 (PHQ-4) for Anxiety and Depression, and the Duke Activity Status Index (DASI) were used to assess health status. Follow-up of clinical outcomes was undertaken using electronic health records. Results Two hundred and fifty-two patients (mean±SD age 55.0 ±12.0 years, body mass index (BMI) 31.3 ±6.9 kg/m2,101 (40%) female, and 59 (23%) with diabetes) were enrolled and had follow-up completed at a median 428 (IQR 385, 538) days. Deprivation status was positively associated with BMI (p=0.0444) and diabetes (p=0.0239). One hundred and eighty-six (74%) patients reattended for investigation 28-60 days post-discharge. Lung ground glass opacity and/or consolidation (p=0.0085), obstructive coronary artery disease (p=0.0128) and renal inflammation (p=0.0421) were associated with deprivation. At 28-60 days post-discharge (n=184), health-related quality of life (EQ-5D-5L utility score, p=0.0084), illness perception, (BIPQ, p=0.0004), anxiety and depression (PHQ-4 score, p=0.0038), physical activity (DASI, p=0.002) and estimated peak oxygen consumption (ml/min/kg) (p=0.002) were worse with greater deprivation. At 3 months (n=252), deprivation status was associated with more referrals to secondary care because of ongoing COVID-19 symptoms (p=0.0438). Clinical outcomes did not associate with deprivation. Conclusion In a post-hospital COVID-19 population, socioeconomic deprivation was associated with impaired health status and secondary care episodes. Deprivation influences illness trajectory after COVID-19.

Phytochemical Characterization and Screening of the Anti-Pneumonia (Anti-COVID-19, Anti-Fungal, and Anti-Bacterial) Activities of Cuscuta Campestris Extract

Introduction: Although several vaccines are being approved, no effective antiviral has been developed for Covid-19 infectious. The present investigation was aimed to increase the essential oils of Cuscuta campestris using far-red light treatment and examine the potential of crude extracts of C. campestris against selected pneumonia pathogens and covid-19. Methods: Anti-Covid-19 activity was determined in human lung cell lines and Covid-19 positive patients. Results: Results demonstrated that the aqueous extract had the highest amount of anti-Covid-19, antibiotic and antioxidant activity. The far-red light treatment increased Scoparone, cineole, Benzofuran, 2, 3-dihydro, Cinnamic acid, and Benzo[h]quinoline, 2, 4-dimethyl, which are mainly effective components against Covid-19 inflammation and pneumonia microbes. CT scan and clinical laboratory tests in a clinical case study, a 30-year-old woman who presented with severe 2019-nCoV, demonstrated that inhalation of 30 mg extract nebulized/day for seven days resulted in an improvement in consolidation and ground-glass opacity in lungs on the seventh day of treatment. Conclusion: It is hoped that this study would be led to the introduction of some compounds that could be used to formulate new and more potent anti-Covid-19 antibiotics, or other drugs of natural origin in medicine.

HRCT Chest Findings of Re-expansion Pulmonary Edema: A Case Report

Re-expansion pulmonary edema occurs when the lung re-expands after an extended duration of collapse. It is rare with the reported incidence between 0% and 1%. We present a case of a 51-year male who presented with breathlessness, cough and right-sided chest pain. Chest radiograph showed right-sided pneumothorax. After 2 hours of chest tube insertion, the patient developed tachypnea and severe hypoxemia. HRCT chest revealed consolidation, ground glass opacity and smooth interlobular septal thickening in the right lung as well as a small patch of ground glass opacity in the contralateral lung. The serial radiograph showed resolution of consolidation and ground glass opacities.

Waldenström macroglobulinemia diagnosed by bronchoalveolar lavage.

An 88-year-old woman with no significant medical history was admitted to the emergency room with persistent dyspnea and cough. Chest computed tomography (CT) showed diffuse ground-glass opacities in both the lungs (Fig. 1A). Collagen disease and infection were ruled out, and lymphoproliferative disease was suspected based on high level of WBC 15 200/μL (lymphocyte 63.7%), soluble interleukin 2 receptor 3070 (151–474) IU/mL and LDH 421 (115–245) U/L. Fluorodeoxyglucose (FDG) did not accumulate in the lymph nodes throughout the body, and its accumulation as ground-glass shadows (Fig. 1B) led us to suspect a lung lesion; therefore, we performed a bronchoscopy. The patient experienced severe hypoxemia during bronchoalveolar lavage, and the biopsy was cancelled. Cell block of bronchoalveolar lavage fluid showed CD20-positive atypical lymphocytes and plasma cells, which were κ chain-positive, IgM-positive, IgG-, IgA- and λ chain-negative (Fig. 2). Blood protein fractionation showed M-protein, with increased IgM at 679 (46–260) mg/dL, and decreased IgG at 425 (870–1700) mg/dL and IgA at 8 (110–410) mg/dL. Based on these findings, the patient was diagnosed with Waldenström macroglobulinemia (WM). The patient was treated with steroids, and fever and dyspnea symptoms were relieved. The haematologist performed a bone marrow biopsy (Fig. 3), and confirmed the diagnosis of WM based on the findings of the bone marrow biopsy and flow cytometry of peripheral blood, which showed small B cells with a κ > > λ bias, negative CD5 and CD23, and IgM-κ and Bence Jones protein-κ detected by immunofixation, after which the patient received rituximab. On chest CT 120 days after starting rituximab, the ground-glass opacities in the both lungs disappeared (Fig. 4), and there has been no relapse for more than a year to date.

Pathogenicity, tissue tropism and potential vertical transmission of SARSr-CoV-2 in Malayan pangolins.

Malayan pangolin SARS-CoV-2-related coronavirus (SARSr-CoV-2) is closely related to SARS-CoV-2. However, little is known about its pathogenicity in pangolins. Using CT scans we show that SARSr-CoV-2 positive Malayan pangolins are characterized by bilateral ground-glass opacities in lungs in a similar manner to COVID-19 patients. Histological examination and blood gas tests are indicative of dyspnea. SARSr-CoV-2 infected multiple organs in pangolins, with the lungs the major target, and histological expression data revealed that ACE2 and TMPRSS2 were co-expressed with viral RNA. Transcriptome analysis indicated that virus-positive pangolins were likely to have inadequate interferon responses, with relative greater cytokine and chemokine activity in the lung and spleen. Notably, both viral RNA and viral proteins were detected in three pangolin fetuses, providing initial evidence for vertical virus transmission. In sum, our study outlines the biological framework of SARSr-CoV-2 in pangolins, revealing striking similarities to COVID-19 in humans.

Acute coronary events in SARS-CoV-2 - causal or incidental?

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus can damage respiratory, cardiovascular system by various mechanism which can lead to increased morbidity and mortality. Aims and Objectives: The aim of the study was to assess incidence of acute coronary syndrome (ACS) in moderate to severe cases of infection with SARS-CoV-2. Materials and Methods: This was an observational cross-sectional study including 60 patients of age ≥18 years of either gender presenting to GTB Hospital diagnosed as positive for SARS-CoV-2 by RT-PCR and/or Rapid Antigen Test and belonging to moderate and severe category without any prior history of respiratory, cardiac, gastrointestinal, renal illness, long-term corticosteroid, or immunomodulator use. The cardiac involvement was assessed by history, clinical examinations, and investigations. Results: Cardiovascular involvement was present in 25% patients. Cardiac involvement included ACS including ST elevation myocardial infarction (STEMI) (3.3%), non-STEMI (10%), unstable angina (1.67%), left ventricular hypertrophy (8.3%), bundle branch block (3.3%), atrial fibrillation (1.67%), and bradycardia (1.67%). Raised cardiac enzyme levels positively correlated with ECG abnormalities. Respiratory involvement was seen in 85% of patients. among which 56.7% patients in severe category, 41.67% patients in moderate category, and 1.67% patients in mild category as per CTSI scoring. There was lung parenchymal involvement with ground glass opacities in bilateral lungs (68.3%), lobar consolidation (6.7%), cavitatory lesion (5%), pulmonary edema (5%), pneumothorax (3.3%), emphysematous changes (3.3%), and bilateral pleural effusion (3.3%). Conclusion: ACS occurs frequently in patients with SARS-CoV-2 and it is associated with complications such as congestive heart failure, bundle branch block, atrial fibrillation, bradycardia, and heart block.

Synchronous computed tomography-guided percutaneous biopsy and microwave ablation for highly suspicious malignant lung ground-glass opacities adjacent to mediastinum

Background This retrospective study aimed to assess the safety and efficacy of synchronous biopsy and microwave ablation (MWA) for highly suspected malignant lung ground-glass opacities (GGOs) adjacent to the mediastinum (distance ≤10 mm). Materials and methods Ninety patients with 98 GGOs (diameter range, 6–30 mm), located within 10 mm of the mediastinum, underwent synchronous biopsy and MWA at a single institution from 1 May 2020, to 31 October 2021 and were enrolled in this study. Synchronous biopsy and MWA involving the completion of the biopsy and MWA in a single procedure was performed. Safety, technical success rate, and local progression-free survival (LPFS) were evaluated. The risk factors for local progression were calculated using the Mann–Whitney U test. Results The technical success rate was 97.96% (96/98 patients). The LPFS rates at 3, 6, and 12 months were 95.0%, 90.0%, and 82.0%, respectively. The diagnostic rate of biopsy-proven malignancy was 72.45% (n = 71/98). Invasion of lesions into the mediastinum was a risk factor for local progression (p = 0.0077). The 30-day mortality rate was 0. The major complications were pneumothorax (13.27%), ventricular arrhythmias (3.06%), pleural effusion (1.02%), hemoptysis (1.02%), and infection (1.02%). Minor complications included pneumothorax (30.61%), pleural effusion (24.49%), hemoptysis (18.37%), ventricular arrhythmias (11.22%), structural changes in adjacent organs (3.06%), and infection (3.06%). Conclusions Synchronous biopsy and MWA was effective for treating GGOs adjacent to the mediastinum without severe complications (Society of Interventional Radiology classification E or F). Invasion of lesions into the mediastinum was identified as a risk factor for local progression.

Severe Pneumocystis Pneumonia Associated with Ulcerative Colitis

A 56-year-old woman with a 9-month history of ulcerative colitis (UC) who had been treated with prednisolone (PSL) 40 mg/day and azathioprinefor 2 months was referred to our hospital because of fever and dyspnea. Computed tomography (CT) of the chest revealed diffuse ground-glass opacities in both lungs and consolidation in both lower lobes. PCR of the patient's bronchoalveolar lavage fluid was positive for pneumocystis jirovecii, and she was diagnosed with pneumocystis pneumonia (PCP). The patient developed refractory respiratory failure that required invasive mechanical ventilation. After sulfamethoxazole-trimethoprim administration and methyl prednisolone pulse therapy, her clinical condition improved dramatically. Few reports are available on severe PCP associated with UC. It is important to keep in mind the possibility of complication by PCP in UC patients.

Development and Validation of a Diagnostic Nomogram for Pneumocystis jirovecii Pneumonia in Non-HIV-Infected Pneumonia Patients Undergoing Oral Glucocorticoid Treatment.

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic but potentially fatal infection with increasing prevalence in HIV-free patients. Glucocorticoid therapy is one of the most important risk factors for PJP. The delay in diagnosis contributes to poor outcomes. Hence, the aim of this study was to develop and validate a nomogram for the diagnosis of PJP in patients with non-HIV-infected pneumonia who are undergoing oral glucocorticoid treatment. This study was a retrospective, cross-sectional research. The development group included 434 patients who were admitted with pneumonia from 6 hospitals. Demographics, symptomatic features, laboratory and computed tomography data were analyzed using the least absolute shrinkage and selection operator (LASSO) to select potential diagnostic indicators. Binary logistic regression was used to develop a diagnostic nomogram. Another 119 patients with pneumonia admitted at Sichuan Provincial People's Hospital was used as the validation group. The diagnostic performance of the nomogram was measured by area under the receiver-operating-characteristics curve (AUC), calibration curves, and the net benefit by decision curve. PJP prevalence was 25.3% in the development group. LASSO regression revealed that age, lymphocyte count, fever, dry cough, respiratory failure, ground-glass opacity in lungs, glucocorticoid therapy duration, and immunosuppressive therapy were indicators of PJP. The nomogram showed robust discrimination, with an AUC of 0.82 (95% CI 0.77-0.86) in the development group and an AUC of 0.87 (95% CI 0.80-0.94) in the validation group, both showing acceptable calibration. In the decision curve analysis, our model consistently achieved a greater net benefit across almost all ranges of clinical thresholds. We developed a nomogram with good diagnostic power for PJP diagnosis in pneumonia patients receiving oral glucocorticoids. This nomogram may help promote timely treatment of PJP and thus reduce the mortality rate in these patients.

Ground-glass opacity in a patient with right aortic arch and no left pulmonary artery

BackgroundHere we report a case of patients with mixed ground glass opacity in the left lung combined with congenital right aortic arch, which is only present in 0.01–0.1% of adults.Case presentationA 60-year-old woman was referred to our department with a mixed ground-glass opacity (GGO) in the upper lobe of her left lung. She had congenital right aortic arch, and the left pulmonary artery was absent. Enhanced chest computed tomography, pulmonary perfusion imaging, and three-dimensional reconstruction were performed to confirm the blood supply in the left lung and the exact location of the GGO. Because of the unusual left pulmonary vascular structure, wedge resection was performed to prevent massive hemorrhage. The final pathological examination revealed that the mixed GGO was a well-differentiated pulmonary adenocarcinoma.ConclusionThe surgical options should be evaluated carefully in view of the complications and the prognosis of the patient, when ground glass opacity is combined with congenital cardiovascular anomalies.

EGPA: A DIAGNOSTIC DILEMMA

<h3>Introduction</h3> Eosinophilic granulomatosis with polyangiitis (EGPA) is a diagnostically difficult disorder due to multisystem involvement, and dual categorization with hypereosinophilic syndromes and systemic vasculitides. The early allergic phase may present in isolation for years prior to eosinophilic organ infiltration and vasculitis, highlighting the importance of consistent screening and multidisciplinary treatment in preventing complications. <h3>Case Description</h3> A 40-year-old male with allergic rhinitis, chronic rhinosinusitis with nasal polyps, and severe persistent asthma presented with peripheral eosinophilia (maximum 2950/μL) and uncontrolled asthma. Workup of secondary causes of hypereosinophilia was unrevealing. Sinus CT revealed extensive mucosal thickening with near complete opacification and lung CT showed bilateral lung ground-glass opacities admixed with consolidative opacities. Patient underwent endoscopic sinus surgery and bronchoscopy with biopsies failing to show signs of granulomata/vasculitis or eosinophilic infiltration. Evaluation of pertinent biomarkers and echocardiogram were also unrevealing. Despite this, given the concerning constellation of symptoms and a positive rheumatoid factor, EGPA remained on the differential with possibility of biopsy sampling error and seronegative ANCA vasculitis. Patient was treated with prolonged steroid taper followed by benralizumab for uncontrolled severe eosinophilic asthma with only temporary relief followed by mepolizumab, the first FDA biologic agent approved for EGPA. <h3>Discussion</h3> This patient presents with multiple features concerning for EGPA. Even without a current pathologic diagnosis, EGPA presents in phases and remains high on our differential. It is crucial to continue monitoring for end organ involvement and new systemic symptoms. New biologic agents present a promising therapy resulting in increased remission and reduced glucocorticoid use.

Sars-Cov-2 Persistent Infection May Evolve into Malignancy, Possibly Curbed by Vaccination: A Hypothesis

The three coronavirus variant infections which evolve onto severe respiratory conditions, have occasionally been associated with persistence. The viral RNA might be solely affected, or else, new symptoms might represent the only disease manifestations, often systemic and neurological. At times, it may associate with variable immunity. A persistent COVID-19 may initiate a “long COVID” episode. It has been hypothesized that, pending an expanded follow-up, the persistence of the SARS-CoV-2 might advance into a cancer: TMPRSS2 gene might develop into prostate cancer, while ground glass lung opacities might lead to lung cancer. In contrast, vaccines may impede the development of a malignancy. Among these, the BCG vaccine predominates, together with the MMR vaccine; mumps and measles being possibly responsible for tumor handicap. It is too early to discern a similar role for COVID-19 with anti-SARSCoV-2 vaccines, as they may relate to cancer

Easy Intra-Operative Localization of Pulmonary Nodules during Uniportal Video-Assisted Thoracoscopy: Experience with Hydrogel Plugs at Our Institution.

Background: The diffusion of lung cancer screening programs has increased the detection of both solid and ground-glass opacity (GGO) sub-centimetric lesions, leading to the necessity for histological diagnoses. A percutaneous CT-guided biopsy may be challenging, thus making surgical excision a valid diagnostic alternative. CT-guided hydrogel plug deployment (BioSentry®) was recently proposed to simplify intraoperative nodule localization. Here, we report our initial experience. Methods: We evaluated 62 patients with single, small, peripheral, non-subpleural pulmonary GGO that was suspicious for cancer. All lesions were preoperatively marked, using CT-guidance, with a hydrogel plug (BioSentry®). Then, a uniportal video-assisted thoracoscopy (uniVATS) wedge resection was performed. If cancer was confirmed at the frozen section, a major lung resection was then performed. The study’s end points were the rates of intraoperative localization and of successful resection. Results: The hydrogel plug was correctly placed in 54 of the 62 cases, leading to an effective resection of the target lesion. In the remaining eight cases, the plug was displaced, and so the identification of pleural erosions due to the previous percutaneous procedure guided the resection. The uniVATS resection success rate was 98.3%. Conclusions: CT-guided hydrogel plug placement allowed for the successful detection of lung GGOs and resection with the uniVATS approach. This device allowed us to obtain lung cancer diagnoses and successfully treat 85.4% of cases.

Clinical and radiomic factors for predicting invasiveness in pulmonary ground‑glass opacity.

Patients with preinvasive or invasive pulmonary ground-glass opacity (GGO) often face different clinical treatments and prognoses. The present study aimed to identify the invasiveness of pulmonary GGO by analysing clinical and radiomic features. Patients with pulmonary GGOs who were treated between January 2014 and February 2019 were included. Clinical features were collected, while radiomic features were extracted from computed tomography records using the three-dimensional Slicer software. Predictors of GGO invasiveness were selected by least absolute shrinkage and selection operator logistic regression analysis, and receiver operating characteristic (ROC) curves were drawn for each prediction model. A total of 194 patients with pulmonary GGOs were included in the present study. The maximum diameter of the solid component, waveletHLL_ngtdm_Coarseness (P=0.03), waveletLHH_firstorder_Maximum (P<0.01) and waveletLLH_glrlm_LongRunEmphasis (P<0.01) were significant predictors of invasive lung GGOs. The area under the ROC curve (AUC) for the prediction models of clinical features and radiomic features was 0.755 and 0.719, respectively, whereas the AUC for the combined prediction model was 0.864 (95% CI, 0.802-0.926). Finally, a nomogram was established for individualized prediction of invasiveness. The combination of radiomic and clinical features can enable the differentiation between preinvasive and invasive GGOs. The present results can provide some basis for the best choice of treatment in patients with lung GGOs.