High-resolution Computed Tomography Findings Research Articles

Correlation Between Chest CT Severity Scores and Glycosylated Haemoglobin Levels and its Outcome in Patients With COVID-19: A Retrospective Study in a Tertiary Care Hospital.

BackgroundIn this study, we aimed to compare the imaging findings between coronavirus disease (COVID-19) patients with well-controlled, poorly-controlled, and non-diabetic patients and subsequently find any relation between haemoglobin A1c (HbA1c) levels and high-resolution chest computed tomography (HRCT) chest score.MethodologyA total of 200 individuals with coexisting COVID-19 and type 2 diabetes mellitus were included in this retrospective cohort study. Based on their HbA1c levels, patients were divided into three groups. The imaging data and laboratory values were obtained from the online medical records of the patients. In addition, the chest computed tomography (CT) score was evaluated as the sum of individual scores from five lung lobes: scores of 0, 1, 2, 3, 4, and 5 were assigned to each lobe. Any peripheral opacification pattern was noted. Haemoglobin A1c (HbA1c) levels and HRCT scores were then analysed by multiple linear regression models using R software.ResultsThe prevalence of diabetes in the study population was 71.5%. Of this, 56 patients had well-controlled diabetes (28%) and 87 patients had poorly controlled diabetes (43.5%); 126 (63%) patients were male and the median age was 54.45 years (95% CI: 54.45 ± 15.53). We found that diabetes status, co-presence of ground-glass appearance with mixed consolidation, and consolidation and reverse halo sign in the HRCT findings were significant predictors of the HRCT scores in patients with COVID-19.ConclusionsThe presence of any co-morbidities should be viewed as a high-risk case of COVID-19. Diabetes status is significantly associated with the severity of HRCT findings in lab-confirmed COVID-19 infection. Therefore, it is important to prioritise the patients who have COVID-19 along with diabetes.

Lung involvement in children with newly diagnosed rheumatic diseases: characteristics and associations

BackgroundPulmonary complications of rheumatic diseases may cause functional impairment and increase mortality. However, reports regarding detection of lung involvement in children with treatment-naive, newly diagnosed rheumatic diseases are scarce. Herein, we aimed to describe the characteristics of such patients and explore the association between lung involvement and rheumatic disease.MethodsFrom January 2019 to June 2021, 48 pediatric patients with treatment-naive, newly diagnosed rheumatic diseases at Department of Rheumatology and Immunology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University were included with pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT) findings, and 51 age-matched healthy controls were examined based on PFTs. Univariate and multivariable logistic regression analyses were used to investigate the clinical characters and laboratory parameters associated with lung involvement in these patients.ResultsAsymptomatic patients had a faster respiratory rate and a higher ratio of forced expiratory volume in 1 s/forced vital capacity than the controls (P < 0.05). More patients than controls were observed to have a decreased DLCO below the lower limit of normal (18 of 45 [40.0%] vs. 6 of 36, respectively; P = 0.041). Among the 48 patients, 8 (16.7%) had abnormal HRCT findings and 27 (56.3%) had abnormal PFT results. Thirty-one (64.6%) patients had lung involvement. Logistic regression revealed that increases in the erythrocyte sedimentation rate (ESR) and CD4/CD8 ratio were associated with increased odds ratio of lung involvement (1.037, 95% CI: 1.003–1.072; 9.875, 95% CI: 1.296–75.243, respectively).ConclusionsPediatric patients with treatment-naive, newly diagnosed rheumatic diseases are prone to pulmonary involvement. Increased ESR and CD4/CD8 are associated with elevated odds of lung involvement in patients. We recommend routine pulmonary evaluation in such patients, especially in high-risk patients, even in the absence of respiratory symptoms, once they are diagnosed with rheumatic disease.

Severe Chest Imaging Findings of Coronavirus Disease from March to November 2020 in Palestine

Background: Due to the rising number of Coronavirus disease 2019 (COVID-19) cases, the role of chest radiography and chest CT (computed tomography) scans is essential for rapid diagnosis. The purpose of this study is to provide a thorough analysis of imaging manifestations of patients infected with severe COVID-19. Methods: Through the Picture Archiving and Communications System (PACS) a total of 131 chest radiographs and high-resolution chest CT scans (HRCT) were collected from five Palestinian governmental hospitals from March to November 2020. IBM SPSS Statistical Software Version 23 was used for analysis. Results: 131 patients were included in this study. 67(51.1%) were female while 64(49.9%) were male. The sample population had a mean age of 60 years ranging from 17-90 years. The most frequently occurring severe COVID-19 findings in HRCT (High-Resolution CT) scans were: GGO (ground glass opacity), interlobular septal thickening, air bronchogram, and pulmonary consolidations. The most common chest X-ray (CXR) findings were: GGO, consolidation, and reticular interstitial thickening. Patients 60 and older showed significantly increased incidence of atypical CT findings such as lymphadenopathy and reversed halo sign. A significant relationship between the age of the patients and COVID-19 findings was indicated through a P-value of 0.012. Conclusion: CT and CXR provide a thorough analysis of severe COVID-19 findings. Familiarity with predominant COVID-19 findings assists in early detection and management; therefore, enhancing the capabilities of healthcare systems worldwide.

The Findings of Pulmonary Nocardiosis on Chest High Resolution Computed Tomography: Single centre experience and review of literature.

ObjectivesPulmonary nocardiosis is a rare opportunistic infection that is often encountered in immunocompromised patients, in particular those with the HIV infection and in solid organ transplant recipients. As the number of immunocompromised patients increase, the number of patients with pulmonary nocardiosis is also expected to increase. This study aimed to analyse both the chest high resolution computed tomography (HRCT) findings of patients with confirmed pulmonary nocardiosis and review the imaging features of pulmonary nocardiosis in the literature.MethodsThis retrospective study was conducted at The Royal Hospital, Muscat, Oman, to identify patients with a diagnosis of pulmonary nocardiosis between January 2006 and January 2019. Accordingly, nine patients with pulmonary nocardiosis were identified, but three patients were excluded as no chest HRCT images were available. Patient clinical presentation was recorded and chest HRCT images were retrospectively reviewed.ResultsA total of six patients were enrolled in this study. All were male and with a mean age of 41 ± 11 years. Three patients were immunocompromised, two of whom had undergone a renal transplant. The main HRCT findings were cavitary nodules/masses, non-cavitary nodules/masses, septal thickening, centrilobular nodules, ground glass opacities, consolidation, pleural effusion, pleural thickening, enlarged lymph nodes and necrotic lymph nodes.ConclusionPulmonary nocardiosis shows various findings in a chest CT, the most common of which are pulmonary nodules and masses. Awareness of these findings can help radiologists with a diagnosis in the appropriate clinical settings.

High-Resolution Computed Tomography Findings in Healthy Heavy Smokers and Correlation with Pulmonary Function Tests

Introduction: Chest radiographs and pulmonary function tests (PFTs), may show the adverse effects of smoking on the lungs, but in some cases these methods are inadequate and interpreted as normal. High-resolution computed tomography (HRCT) provides more sensitive and specific imaging features to identify parenchymal-interstitial abnormalities in the early stages of the disease related with smoking. The purpose of this study is to recognize lung HRCT findings of smoking in cigarette smokers and non-smokers and investigate whether there is a relationship with airway obstruction on PFTs. Methods: A total of 155 subjects (110 heavy smokers, 45 non-smokers) who performed both HRCT and PFTs were included in the study. Two radiologists independently evaluated the CT findings for the following characteristics: bronchiectasis, bronchial wall thickening, emphysema, atelectasis, interstitial patterns, and fibrotic changes. Afterwards, the relationship between the HRCT findings and PFTs of the heavy smokers and non-smokers was presented statistically. Results: There were statistically significant differences regarding emphysema and bronchial wall thickening between the heavy smokers and non-smokers (p = 0.001 and p = 0.000, respectively) on HRCT. Emphysema and bronchial wall thickening were more common in patients who had obstructive PFTs. Fibrotic changes, atelectasis, bronchial wall thickening, and emphysema were the most common imaging findings although normal PFTs. Conclusion: It is crucial to recognize the common imaging findings on HRCT of heavy smokers for diagnosis and treatment of smoking related lung disease. HRCT is vital in detecting the early stages of parenchymal-interstitial abnormalities of the lungs due to smoking, despite normal chest radiograms and PFTs.

Radiological findings in nontuberculous mycobacterial pulmonary diseases: A comparison between the Mycobacterium avium complex and the Mycobacterium abscessus complex.

The Mycobacterium abscessus complex (MABC) comprises rapidly growing mycobacteria and has received increasing attention recently, with an increasing number of associated infections reported worldwide. However, the clinical features of MABC pulmonary disease (MABC-PD), especially in terms of the chest computed tomography (CT) findings, are not fully understood. Thus, this retrospective, cross-sectional study aimed to evaluate the clinical background and chest high-resolution CT (HRCT) findings of MABC-PD in comparison with those of Mycobacterium avium complex PD (MAC-PD). Accordingly, 36 patients with MABC-PD and 65 patients with MAC-PD (defined according to the American Thoracic Society criteria), who were newly diagnosed at four major hospitals in Okinawa (Japan) between January 2012 and December 2017, were analyzed. With respect to their clinical background, only cardiovascular diseases were significantly more common in patients with MABC-PD than in those with MAC-PD (38.9% vs. 18.5%, p = 0.0245). HRCT revealed a significantly higher incidence of low attenuation in patients with MABC-PD than in those with MAC-PD (63.9% vs. 10.8%, p<0.0001). On analyzing only never-smokers (20 and 47 patients with MABC-PD and MAC-PD, respectively), this significant difference remained (65.0% vs. 8.5%, p<0.0001), suggesting MABC infection itself caused low attenuation. In terms of the distribution of abnormal shadows, the involvement of the right lower, left upper, and left lower lobes was more common in patients with MABC-PD than in those with MAC-PD. Furthermore, the mean number of involved lung lobes was significantly higher in patients with MABC-PD than in those with MAC-PD (5.6 vs. 4.7, p<0.001). Although further studies are needed, we assume that the aforementioned radiological features of MABC-PD are due to the high virulence of MABC.

High-resolution computed tomography and pure-tone audiometry in patients with otosclerosis in the spongiotic phase.

There is no consensus in the literature regarding the relationship between high-resolution computed tomography findings and hearing thresholds in pure-tone audiometry in otosclerosis. This study evaluated the association between high-resolution computed tomography findings and pure-tone audiometry in otosclerosis in the spongiotic phase. A cross-sectional study was conducted of 57 ears with surgically confirmed stapes fixation and tomographic findings. Air conduction and bone conduction thresholds on audiometry, and air-bone gap, were analysed. There were no correlations between sites affected by otospongiosis and air conduction threshold, bone conduction threshold or air-bone gap in the analysed tomographic images, but the diameter of the otospongiotic focus was greater in the presence of extension of the otospongiotic foci to the cochlear endosteum. There were no relevant associations between high-resolution computed tomography findings and pure-tone audiometric measurements. However, the diameter of the otospongiotic focus was greater in the presence of extension of the otospongiotic foci to the cochlear endosteum.

Measurement of diffusion lung capacity (DLCO) in silicosis patients: Correlation with radiographic abnormalities on high-resolution CT scan chest.

Objective:This study was conducted to evaluate diffusion capacity of lung for carbon monoxide (DLCO) in patients with simple and complicated silicosis and to correlate abnormal findings detected, if any, with the computed tomography abnormalities in these patientsMethods:This study included 56 patients with simple and complicated silicosis and without tuberculosis, in whom we performed DLCO as per standard technique. Various computed tomography findings, that is, presence, size and distribution of nodules associated with relative parenchymal and vascular markings, were recorded in the study subjects and classified into standard grading to be finally compared with DLCO. Visual grading score system was used to describe the extent of emphysematous changes based on the area of abnormally low attenuation, vascular disruption, bullae and so on and data were recordedResults:Results showed that 85.7% patients had small opacities of varying grades and 28.5% showed large opacities, with 16% of them having type ‘C’ large opacities. The mean DLCO (% predicted) of patients with category ‘0’ high-resolution computed tomography (HRCT) abnormality was 92.3 ± 6.8 (within normal limits), and this gradually decreased with increasing HRCT category to 44.2 ± 11.2 in grade ‘4’ of progressive massive fibrosis (PMF) patients in this study (P < 0.01). This reflects a significant inverse correlation between visual HRCT category and the DLCO % predicted (r > −0.89, P < 0.001). The mean DLCO (% predicted) was 51 ± 12.6 in patients with grade ‘1’ emphysema in HRCT, 53 ± 13.5 in grade ‘2’, 43 ± 6.4 in grade ‘3’ and 37.7 ± 6.3 in grade ‘4’; however, there was no correlation between emphysema grading and pulmonary functional index (r = −0.33, P = 0.15)Conclusion:This study observed significant abnormality in DLCO among silicosis patients and its strong correlation with the extent of radiological abnormality. HRCT finding of large opacities could be an important indicator of the severity of silicosis, as reflected by significantly reduced DLCO in such patients.

HRCT chest in patients suffering from COVID-19: Experience from a tertiary care centre in India during second wave of the pandemic

Abstract Aim The objective of the present study is to describe high-resolution CT (HRCT) chest manifestations of coronavirus disease 2019 (COVID-19) patients during second wave of the pandemic in a tertiary care hospital in New Delhi, India. We also aim to compare the findings on the HRCT chest during the second wave of COVID-19 with the data form earlier outbreaks and to look for any features specific to the second wave and thus indirectly to the delta variant of SARS-CoV-2. We also assessed the severity of the pulmonary involvement based on HRCT findings. Methods We analysed HRCT chest findings in 237 patients with COVID-19 admitted at our institute from 1st April 2021 to 31st May 2021. Covid-19 infection was confirmed by reverse transcription polymerase chain reaction (rt-PCR) or rapid antigen test (RAT) in all these patients. Results The mean age in our study group was 51.3 ± 12.1 years (range 19–79 years) comprising of 136 males (57.4%) and 101 females (42.6%). The majority of the patients showed bilateral (95.3%) and peripheral (42.6%) distribution of the disease. Ground glass opacities were the most common finding, seen in 214 (90.3%) patients, followed by interlobular septal thickening in 202 (85.8%) and crazy paving in 194 (81.3%) patients. Majority (36.7%) of these patients had a CT severity score above 20 indicating severe disease. Conclusion A typical pattern of peripheral subpleural often bilateral distribution of ground glass opacities on HRCT chest usually points to the possibility of COVID-19 pneumonia. The higher incidence of abnormalities on HRCT chest in patients with infection mainly from the delta variant of SARS-Cov-2 was mainly because of the more severe disease in the population. More research is needed to further evaluate the role of HRCT chest in the diagnosis of COVID-19 caused by different strains of the virus.

Comparison of pulmonary function test, diffusion capacity, blood gas analysis and CT scan in patients with and without persistent respiratory symptoms following COVID-19

BackgroundLong-lasting symptoms following SARS-CoV2-infection have been described in several studies. However, there is only limited knowledge about the ongoing pathophysiology and the association with pathological findings in medical examinations.MethodsIn this post hoc analysis of a prospective trial, 135 patients following COVID-19 were enrolled and grouped with respect to the presence or absence of respiratory ongoing symptoms following COVID-19. Pulmonary function test (PFT), diffusion capacity measurement (TLCO SB and TLCO/VA), blood gas analysis (BGA), laboratory tests and high-resolution computed tomography (HRCT) of patients with persistent respiratory symptoms were compared to those of asymptomatic patients.ResultsIn this analysis, 71% (96/135) of all patients (mean age 49 years; range 20–91 years) reported long-lasting symptoms after a median (IQR) of 85 days (60–116) following COVID-19 whereby 57.8% (78/135) complained about persistent pulmonary symptoms. Pathological findings in blood test, PFT, TLCO, BGA and/or HRCT were found in 71.8% and 64.1% of patients with and without long-lasting respiratory symptoms respectively. Patients with persistent respiratory symptoms were significantly younger and presented a significant lower FVC (%), TLC (L), and TLCO SB compared to asymptomatic patients (p < 0.05). The multiple logistic regression results in a significant effect of age (p = 0.004) and TLCO SB (p = 0.042).ConclusionFollowing COVID-19, a large proportion of patients experience ongoing symptoms, whereby the respiratory symptoms are the predominant complaints. Compared to asymptomatic patients, patients with ongoing symptoms were younger and presented a significant lower FVC, TLC and TLCO SB. The multiple logistic regression demonstrated only a significant association between the TLCO SB as the only PFT parameter and the perceived symptoms.

E-Cigarette Use, Small Airway Fibrosis, and Constrictive Bronchiolitis

BackgroundVaping, including the use of electronic cigarettes (e-cigarettes), has become increasingly prevalent, yet the associated long-term health risks are largely unknown. Given the prevalence of use, particularly among adolescents early in their lifespan, it is vital to understand the potential chronic pathologic sequelae of vaping.MethodsWe present the cases of four patients with chronic lung disease associated with e-cigarette use characterized by clinical evaluation, with pulmonary function tests (PFTs), chest high-resolution computed tomography (HRCT), endobronchial optical coherence tomography (EB-OCT) imaging, and histopathologic assessment.ResultsEach patient presented with shortness of breath and chest pain in association with a 3- to 8-year history of e-cigarette use, with mild progressive airway obstruction on PFTs and/or chest HRCT findings demonstrating evidence of air trapping and bronchial wall thickening. EB-OCT imaging performed in two patients showed small airway–centered fibrosis with bronchiolar narrowing and lumen irregularities. The predominant histopathologic feature on surgical lung biopsy was small airway–centered fibrosis, including constrictive bronchiolitis and MUC5AC overexpression in all patients. Patients who ceased vaping had a partial, but not complete, reversal of disease over 1 to 4 years.ConclusionsAfter thorough evaluation for other potential etiologies, vaping was considered to be the most likely common causal etiology for all patients due to the temporal association of symptomatic chronic lung disease with e-cigarette use and partial improvement in symptoms after e-cigarette cessation. In this series, we associate the histopathologic pattern of small airway–centered fibrosis, including constrictive bronchiolitis, with vaping, potentially defining a clinical and pathologic entity associated with e-cigarette use. (Funded in part by the National Institutes of Health.)

Role of ground-glass opacity in pure invasive and lepidic component in pure solid lung adenocarcinoma for predicting aggressiveness

ObjectiveLung adenocarcinoma often includes noninvasive components with postoperative lepidic morphology on pathologic specimens that appear on preoperative high-resolution computed tomography (HRCT) images as ground-glass opacity (GGO). We aimed to disclose the role of GGO on the aggressiveness of pathologically confirmed pure invasive tumors in patients with early-stage lung adenocarcinoma. MethodsThe prognosis of 932 patients with clinical stage 0-IA and pathologic node-negative lung adenocarcinoma who underwent lobectomy at 3 institutions between 2010 and 2016 was investigated according to the status of GGO and lepidic components. ResultsThe recurrence-free survival (RFS) of patients with pathologically confirmed pure invasive tumors was worse without (n = 81) than with (n = 43) GGO (69.7%; 95% confidence interval [CI], 57.3%-79.2% vs 90.5%; 95% CI, 76.6%-96.3%, P = .028). The RFS of patients with radiologically confirmed pure solid tumors was worse without (n = 81), than with (n = 173) a lepidic component (69.7%; 95% CI, 57.3%-79.2% vs 85.3%; 95% CI, 77.2%-90.7%, P = .0012). Multivariable Cox regression analysis of overall survival and RFS revealed that pure solid and pure invasive tumors, respectively, determined by HRCT and pathologic assessment together comprised an independent prognostic factor like vascular or pleural invasion for patients with early-stage lung adenocarcinoma. ConclusionsTumors of non–small cell lung cancer with pure solid and pure invasive components were more aggressive than those with some GGO and lepidic components. Complementary HRCT and pathologic findings can predict the malignant aggressiveness of adenocarcinoma.

Etiologic Profile of Older Children With Diffuse Radiological Changes in Eastern China.

Objective:To analyze the etiology of chest diffuse radiological changes (DRC) in children older than 2 years.MethodsA retrospective study was conducted on a primary cohort of children with DRC underwent high resolution computed tomography (HRCT).ResultsDRC mainly included bronchial wall thickening, interlobular septal thickening, pleural thickening, ground glass opacity, mosaic perfusion, reticular & linear opacities, nodular opacity, and tree-in-bud. Of the identified 457 children with DRC, 83 of children older than 2 years with DRC were included in the present study. Ground glass opacity (53, 63.9%) and reticular & linear opacities (44, 53.0%) were frequently identified findings of HRCT, and no tree-in-bud pattern was observed. By contrast, among children with DRC by M. pneumoniae (n = 64), bronchial wall thickening (33, 51.6%), and mosaic perfusion (17, 26.6%) were common patterns of HRCT in addition to ground glass opacity (36, 56.3%). Most of etiologies were connective tissue disease (24, 28.9%), followed by diffuse alveolar hemorrhage syndrome (9, 10.8%), Langerhans cell histiocytosis (7, 8.4%), and recurrent aspiration (6, 7.2%).ConclusionsThis study adds further insights into the role of HRCT in diagnosing childhood interstitial lung diseases, indirectly reflecting disease compositions.

Pulmonary vascular volume is associated with DLCO and fibrotic score in idiopathic pulmonary fibrosis: an observational study

BackgroundIdiopathic pulmonary fibrosis (IPF) is a disease that primarily occurs in elderly individuals. However, it is difficult to diagnose and has a complex disease course. High-resolution computed tomography (HRCT) and lung function testing are crucial for its diagnosis and follow-up. However, the correlation of HRCT findings with lung function test results has not been extensively investigated.MethodsThis study retrospectively analysed the medical records and images of patients with IPF. Patients with evident emphysema and lung cancer were excluded. The diagnosis of all the included cases was confirmed following a discussion among specialists from multiple disciplines. The correlation of HRCT findings, including fibrotic score, HRCT lung volume, pulmonary artery trunk (PA) diameter and pulmonary vascular volume (PVV), with lung function test parameters, such as forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), was analysed.ResultsA total of 32 patients were included. Higher fibrotic and PVV scores were significantly correlated with lower DLCO (r = − 0.59, p = 0.01; r = − 0.43, p = 0.03, respectively) but not with FVC. Higher PVV score significantly correlated with higher fibrotic score (r = 0.59, p < 0.01) and PA diameter (r = 0.47, p = 0.006).ConclusionOur study demonstrated the structural and functional correlation of IPF. The extent of lung fibrosis (fibrotic score) and PVV score were associated with DLCO but not with FVC. The PA diameter, which reflects the pulmonary artery pressure, was found to be associated with the PVV score.

Chronic lung disease in paediatric patients: Does magnetic resonance imaging has a role?

BackgroundPediatric chronic lung disease (CLD) refers to a range of distinct clinical and pathological disorders that affect children. High-resolution CT (HRCT) is critical for detecting and characterizing parenchymal abnormalities as well as determining their nature and distribution. Although magnetic resonance imaging (MRI) shows promising results, however, due to its poor spatial resolution and signal-to-noise ratio, imaging of the lung parenchyma remains a challenge. As a result, in addition to the initial CT, a follow-up MRI is required. The goal of this paper is to highlight the main imaging features of children with CLD and to evaluate the efficacy of MRI lungs in the diagnosis and monitoring of pediatric CLD.ResultsThere was a strong positive correlation between CT and MRI, with a significant P-value. Findings of HRCT and MRI showed a qualitative agreement of 78% complete agreement. MRI helped primary diagnosis in 54% of cases compared to CT in 91% of cases.ConclusionMRI lungs are an equivalent technique to HRCT in assessing pediatric CLD; using the modified Helbich–Bhalla score, a strong correlation is obvious between both in the overall assessment. MRI is beneficial for case surveillance rather than primary diagnosis.

The Relationship between Severity of Lung Involvement Based on High-Resolution Computed Tomography (HRCT) Findings and Lymphopenia in Patients with COVID-19

Background: Lymphopenia may reflect the degree of lung injury in patients with coronavirus disease 2019 (COVID-19). Given that few studies have been conducted in this regard, this study aimed to evaluate the association between severity of lung involvement based on high-resolution computed tomography (HRCT) findings and lymphocyte count in patients with COVID-19. Materials and Methods: This descriptive-analytical study was conducted on 123 patients with COVID-19 from March 2020 to April 2020 in Shahid Sadoughi hospital, Yazd, Iran. Data including age, gender, hospitalization ward, lymphocyte count, and computed tomography (CT) scan findings were extracted from medical records. Results: The mean lung involvement score was 36.8±22.34. The mean lymphocyte count in these patients was 1229.25±536.80 µL. Lymphopenia was observed in 79 patients (64%). No relationship was seen between HRCT findings and lymphopenia in patients with COVID-19 (P=0.31). Although a significant relationship was seen between HRCT findings and lymphopenia in females (P&lt;0.05), there was no relationship between HRCT findings and lymphopenia, regarding age, male gender, and hospitalization wards (P&gt;0.05). Conclusion: There was no significant relationship between HRCT and lymphopenia findings, and parameters such as age and inpatient ward in patients with Covid-19. However, there was an interesting relationship between lymphopenia and lung involvement in women; therefore, more studies are needed to prove this hypothesis.

Spectrum of Typical and Atypical Pulmonary CT Imaging Findings of COVID-19 Infection: A Retrospective Study.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. It was declared a public health emergency by WHO in January 2020. The definitive diagnostic test for COVID-19 is a real time polymerase chain reaction test (RT-PCR) which is highly specific, but sensitivity is variable. COVID-19 typically presents clinically with respiratory and systemic symptoms. The majority of the infected patients are asymptomatic during the course of the disease, which we have not included in our study. Imaging findings on high-resolution computed tomography (HRCT) chest are important to diagnose the disease in early stage, for treatment planning and to predict the patient prognosis. The purpose of our study was to characterize typical and atypical pulmonary and extra-pulmonary HRCT findings in patients with COVID-19 infection and to help in the management of patients. In this retrospective study, we have included 70 patients who had undergone HRCT examination of the chest in the Radiodiagnosis Department, Maharishi Markandeshwar Medical College, Kumarhatti, Solan, Himachal Pradesh, India. The HRCT findings of the chest of these patients in the study will be evaluated and data will be statistically analyzed.

High-resolution CT findings of pulmonary infections in patients with hematologic malignancy: comparison between patients with or without hematopoietic stem cell transplantation

PurposeTo evaluate the high-resolution CT (HRCT) findings of pulmonary infections in patients with hematologic malignancy and compare them between patients with or without hematopoietic stem cell transplantation (HSCT).Materials and methodsA total of 128 patients with hematologic malignancy and pulmonary infection were included in this study. The diagnoses of the patients consisted of bacterial pneumonia (37 non-HSCT cases and 14 HSCT cases), pneumocystis pneumonia (PCP) (29 non-HSCT cases and 11 HSCT cases), and fungal infection other than PCP (20 non-HSCT cases and 17 HSCT cases). Two chest radiologists retrospectively evaluated the HRCT criteria and compared them using chi-squared tests and a multiple logistic regression analysis.ResultsAccording to the multiple logistic regression analysis, nodules were an indicator in HSCT patients with PCP (p = 0.025; odds ratio, 5.8; 95% confidence interval, 1.2–26.6). The centrilobular distribution of nodules was the most frequent (n = 4, 36%) in HSCT patients with PCP. A mosaic pattern was an indicator of PCP in both HSCT and non-HSCT patients. There were no significant differences in other infections.ConclusionThe mosaic pattern could be an indicator of PCP in both HSCT and non-HSCT patients. Nodules with centrilobular distribution might be relatively frequent HRCT findings of PCP in HSCT patients.

Pattern and prevalence of different findings in high resolution computed tomography images in patients with coronavirus disease and kidney injury; a pilot study

Introduction: Since December 2019, an outbreak of pneumonia caused by a new coronavirus has emerged. The standard diagnostic method for COVID-19 infection is the real-time reverse transcriptase-polymerase chain reaction (RT-PCR). High-resolution computed tomography (HRCT) has been proven as a sensitive, feasible and accessible test in Iran. In addition to respiratory system, other organs could also be involved in this disease. The exact mechanism of renal involvement is unknown; however, acute kidney injury (AKI) occurs in almost 5-15% of cases. Different HRCT patterns might be associated with AKI presence and severity of the disease. Objectives: To investigate patterns and prevalence of different HRCT findings in COVID-19 patients with concurrent AKI. Patients and Methods: In this retrospective study, we reviewed all hospitalized patients with COVID-19 infection, from February to April 2020 in Razi hospital, Rasht. Twenty-two cases who had AKI were enrolled. The HRCT findings of the patients were reviewed independently by two radiologists. Percentage and prevalence of HRCT findings were analyzed in SPSS 21 software. Results: All 22 cases had multifocal distribution on HRCT. Around 95.5% had peripheral involvement, 86.4% had central zones opacity while 72.2% of cases had peribronchovascular pattern. Bilateral lung involvement was found in 90.9%, but only 9.1% had unilateral involvement. There was 59.1% of lower lobe predominance for COVID-19 involvement since sub-pleural regions were spared in 18.2% of individuals. All the patients’ HRCTs showed ground glass opacity. Reticular pattern (81.8%), consolidation (77.3%), vascular enlargement in involved zones (68.2%) and airway changes (68.2%) were the next more prevalent findings. Half of the subjects showed crazy paving, 45.5% had pleural effusion and 13.6% had also lymphadenopathy. We found 40.9% of the patients had arcade-like sign. Less frequent findings were nodular opacities (13.6%), halo sign (9.1%) and reverse-halo sign (9.1%), respectively. Conclusion: This study demonstrated that atypical patterns are likely to be more common in COVID-19 patients with kidney injury.

The new useful high-resolution computed tomography finding for diagnosing fibrotic hypersensitivity pneumonitis: \u201chexagonal pattern\u201d: a single-center retrospective study

BackgroundCentrilobular nodules, ground-glass opacity (GGO), mosaic attenuation, air trapping, and three-density pattern were reported as high-resolution computed tomography (HRCT) findings characteristic of fibrotic hypersensitivity pneumonitis (HP). However, it is often difficult to differentiate fibrotic HP from idiopathic pulmonary fibrosis (IPF). In fibrotic HP, the HRCT sometimes shows tortoiseshell-like interlobular septal thickening that extends from the subpleural lesion to the inner layers. This finding is called “hexagonal pattern,” and this study is focused on the possibility that such finding is useful for differentiating fibrotic HP from IPF.MethodsThis study included patients with multidisciplinary discussion (MDD) diagnosis of fibrotic HP or IPF undergoing surgical lung biopsy between January 2015 and December 2017 in Kanagawa Cardiovascular and Respiratory Center. Two radiologists have evaluated the HRCT findings without clinical and pathological information.ResultsA total of 23 patients were diagnosed with fibrotic HP by MDD and 48 with IPF. Extensive GGO, centrilobular nodules, and hexagonal pattern were more frequent findings in fibrotic HP than in IPF. No significant difference was observed between the two groups in the presence or absence of mosaic attenuation, air trapping, or three-density pattern. In the multivariate logistic regression, the presence of extensive GGO and hexagonal pattern was associated with increased odds ratio of fibrotic HP. The sensitivity and specificity of the diagnosis of fibrotic HP in the presence of the hexagonal pattern were 69.6% and 87.5%, respectively.ConclusionHexagonal pattern is a useful finding for differentiating fibrotic HP from IPF.