High-resolution Computed Tomography Of Thorax Research Articles

Tamarind Seeds in Tracheobronchial Tree: Challenges during Rigid Bronchoscopy.

Tamarind seed aspiration is not frequent in children and is usually observed in kids from rural backgrounds, with easy access to tamarind fruits and their by-products. We report a retrospective review of five patients managed in the pediatric surgery department for tamarind seed aspiration into the tracheobronchial tree. The data were analyzed based on age, clinical presentation, bronchoscopic observations, and the challenges faced during the rigid bronchoscopic retrieval and postoperative course. There were four boys and one girl with a median age of 10 years. High-resolution computed tomography thorax was done in all patients. The foreign body was identified in the right main bronchus in one and the left main bronchus in four patients. All five patients underwent rigid bronchoscopy and retrieval of the seed. Two patients had an early presentation (within a week) - they needed temporary tracheotomy as the swollen seed could not be negotiated through the narrow glottis. Two patients had a late presentation (around 15 days) - they required removal in piecemeal using crushing forceps and multiple insertions of bronchoscope prolonging surgical time. One patient presented at 22 days posttamarind aspiration. It was soft enough for easy disintegration with crocodile forceps and expeditiously removed in three to four pieces. All patients recovered uneventfully. Removal of tamarind seed foreign body from the tracheobronchial tree is challenging. Anticipating the difficulties and being prepared well, helps to reduce the intraoperative difficulty, and allow successful removal with favorable patient outcomes.

Clinical and radiological correlation of pulmonary manifestations in rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis with various extra-articular manifestations, pulmonary being the most involved. Aims and Objectives: This study aims to identify the radiological patterns in the lungs among patients with RA. Materials and Methods: A total of 39 patients with RA were chosen randomly. They were examined and imaged by chest X-ray and high-resolution computed tomography (HRCT) thorax, and findings were analyzed. Results: The mean age of patients was 53.9 and had a female preponderance of 74.4%. Among the 39 patients studied, 30 had no respiratory symptoms. The most common HRCT thorax findings were bronchiectasis and ground-glass opacities. Conclusion: Radiological pulmonary manifestations of RA identified in HRCT imaging are wide and occur in the majority of clinically asymptomatic patients.

Epididymo-orchitis with epididymal abscess in a patient with disseminated tuberculosis

Abstract Tuberculosis remains a global health concern, and while primarily affecting the lungs, extrapulmonary manifestations like genitourinary tubercular epididymitis are rare and diagnostically challenging. Accurate differentiation is crucial for appropriate treatment. This case study presents a 34-year-old male with left scrotal swelling, backache, and fever, highlighting the importance of considering tuberculosis in genitourinary conditions. High-resolution sonography revealed an edematous left testis with increased vascularity and hypoechoic nodules. Further imaging, including high-resolution computed tomography thorax and contrast-enhanced magnetic resonance imaging Dorso-lumbar spine, confirmed disseminated tuberculosis. Despite negative urine culture, aspiration cytology from the epididymal collection indicated tubercular etiology. Urogenital tuberculosis, especially isolated epididymal involvement without renal effects, presents diagnostic challenges, often occurring in immunocompromised patients. The case underscores the role of clinical, biochemical, and radiological evidence in establishing a correct diagnosis. High-resolution ultrasonography plays a crucial role in diagnosing scrotal pathologies, and when accompanied by an epididymal collection, further diagnostic steps involving biochemical parameters and aspiration followed by cytoanalysis and culture are essential. The diagnosis of tuberculous epididymitis can be confirmed through acid-fast bacilli (AFB) identification, positive AFB culture, or granulomas seen in a biopsy specimen in the right clinical context. Radiological imaging aids in detecting local and disseminated disease forms, including complications like hydrocele, testicular calcifications, scrotal abscesses, sinus tracks, and fistulous communications.

Prevalence and risk factors for chronic pulmonary aspergillosis in chronic obstructive pulmonary disease patients with acute exacerbations.

Chronic obstructive pulmonary disease (COPD) patients often experience acute exacerbations requiring hospitalization. Recently, attention has focused on Aspergillus sensitization in the airways of these COPD patients. This study aimed to assess the prevalence of chronic pulmonary aspergillosis (CPA) in COPD patients with acute exacerbations and identify associated risk factors. A cross-sectional descriptive study was conducted at the Jawaharlal Institute of Postgraduate Medical Education and Research from January 2021 to June 2022. Sixty-one COPD patients presenting with acute exacerbations were included. Demographic details, blood investigations, and sputum examinations were performed for all patients. A high-resolution computed tomography thorax was conducted for eligible patients. The prevalence of CPA among patients with an acute exacerbation of COPD was found to be 9.8%, with chronic cavitary pulmonary aspergillosis being the most common presentation (50%). Among post-tubercular COPD patients, the prevalence of CPA was significantly higher at 22.7%. Hemoptysis (p<0.001) and a previous history of tuberculosis (p=0.008) were associated with Aspergillus sensitization. This study highlights the substantial prevalence of CPA in COPD patients with acute exacerbations, particularly in those with a history of tuberculosis. Early recognition and targeted management of CPA in COPD patients may improve outcomes and reduce hospitalization rates. Further large-scale multi-center studies are needed to validate these findings and comprehensively address the impact of CPA on all COPD patients.

Persistent residual lung abnormalities as final outcome in recovered severe COVID-19 pneumonia with lung function abnormalities in spirometry: Pulmonologist and radiologist perspective

Coronavirus-related (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) global pandemic has caused significant mortality and morbidity globally in the last 3 years. In the present case report, a 51-year-old man presented in the outdoor unit for shortness of breath on exertion with a history of severe coronavirus disease-2019 (COVID-19) pneumonia resulted in acute respiratory distress syndrome with hospitalisation in the intensive care unit 1 year back and required high-flow nasal cannula (HFNC) with noninvasive ventilatory support (NIV) for 2 weeks. He was offered oxygen supplementation at home with antibiotics for 3 months and there was no requirement of oxygen and some respiratory symptoms even after 1 year. His high-resolution computed tomography thorax documented at 1 year of discharge from the hospital revealed typical interstitial opacities labelled as persistent residual lung abnormalities (RLAs) that are predominantly reticular and linear opacities in peripheral parts of lungs without honeycombing within typical pleural-based areas with parenchymal bands and minimally altered lung architecture and preserved lung volume.

Bronchiectasis with Trans Mediastinal Herniation of Left Upper Lobe in 3-Year-Old Child: A Case Report

BACKGROUND: Bronchiectasis is a disorder characterized by destruction of smooth muscle and elastic tissue due to inflammation which leads to permanent dilation of bronchi and bronchioles. It may develop in association with Cystic Fibrosis, a single severe episode or recurrent episodes of pneumonia and exposure to tuberculosis. The principal conditions associated with bronchiectasis are obstruction and infection. Infections primarily originate from issues with airway clearance, which cause bronchi and bronchioles to enlarge irreversibly. Vertical airways are notably affected, while distal bronchi and bronchioles are more severely affected. The degree of disease activity and chronicity may affect the histological findings. Childhood bronchiectasis can proceed to severe consequences including persistent bacterial bronchitis, in developing nations like India due to a lack of effective diagnosis and treatment as a result of poor health care infrastructure in the rural areas as well as limited awareness on the part of general public and health care professionals. THE CASE: A 3.5-year-old Indian boy presented with productive cough and cold for 8 days associated with low grade fever. Patient was admitted through Out Patient Department (OPD) due to respiratory distress and facial swelling. Clinical exam revealed presence of crepitation, wheeze and pectus carinatum. Patient has history of multiple hospital admissions due to pneumonia and respiratory distress. There is history of exposure to tuberculosis. His mother had been diagnosed with tuberculosis when the child was 3 months old. She received anti-tubercular drugs and is now cured. HRCT thorax reveals collapse of basal segment of right lung, trans-mediastinal space shift of left upper lobe and bi-lateral bronchiectatic changes which include unusually thickened enlarged airways exhibiting the characteristic tram-track appearance. Echocardiogram findings show thickened pericardium, mild pericardial collection and trace tricuspid valve regurgitation. The case is unique since it is quite rare for a young child to have such a severe form of bronchiectasis. CONCLUSION: Diagnosis can be done with the help of radiological and clinical examination. However, High Resolution Computed Tomography (HRCT) scan is the investigation of choice. Early management is a key factor in minimizing more serious complication like severe hemoptysis and cor pulmonale. Current treatment modalities include antibiotics, bronchodilators, anti-inflammatory drugs and chest physical therapy. Severe cases may require injectable antibiotics. Bronchiectasis was thought to be an orphan disease that seldom progressed to severe consequences, especially after the introduction of newer antimicrobials. There exist guidelines that advocate treatments for bronchiectasis, and reports of therapy have been shown to be linked with clinical success. However, such guidelines do not exist in India at present. This case is noteworthy as it portrays bronchiectasis in an Indian child that has proceeded to the severe complication of transmediastinal herniation, demonstrating that it is relatively common albeit under-diagnosed in developing countries. Though is an irreversible disease in adults, in children if detected early there is almost complete restoration of pulmonary function and adequate exercise tolerance. Early diagnosis with suitable pharmacological and non-pharmacological management is critical for a positive outcome and prevention of sequelae like persistent bacterial bronchitis.

High-resolution Computed Tomography Thorax Volumetric Assessment in Coronavirus Disease 2019 Patients and Correlation with Pulmonary Function Tests

Introduction: Years after SARS coronavirus disease 2019 (COVID-19) recovery, residual pulmonary abnormalities may still exist. This brings on the question of whether or not COVID-19 could have comparable late consequences. Structural changes in the lungs after recovery can be better visualized using computed tomography (CT) thorax. Computed Tomography Lung Parenchymal changes during hospitalization by COVID-19 and after 4 months of follow-up to correlate with the volumetric high-resolution computed tomography thorax indices, Pulmonary function tests (PFTs) indices, SpO2, and 6 min Walking Test (6MWT). Materials and Methods: This is a Hospital based cross-sectional study, with a follow-up among 100 Patients from 2020 to 2022. Each patient’s different CT parameters and HRCT volumetric indices Normal Lung (NL), Normal Lung Percentage (NL%), Whole Lung (WL) were correlated with the PFT indices (Forced expiratory volume in 1s [FEV1], forced vital capacity [FVC], FEV1/FVC), Oxygen Saturation (SpO2) and 6-Minute Walking Test (6MWT). Results: The mean NL (L) and NL% during COVID were significantly lower than the mean values 4 months post-COVID. Architectural distortion, bronchiolar dilatation, interstitial thickening, and parenchymal bands were reduced considerably after 4 months post-COVID, compared to during COVID. PFTs results, such as PFT indices, were not significantly different after 4 months post-COVID, compared to during COVID. SpO2 (%) and 6 MWT (m) were significantly increased. During COVID and post-COVID, the values of NL (L) and NL (%) had a significant positive correlation with PFT indices, SpO2, and 6MWT (m). Conclusion: Hence, the different CT indices (NL and NL%) can be used as a surrogate for functional recovery of COVID patients since it correlates with the PFT indices (FEV1 and FEV1/FVC), SpO2, and 6MWT post-COVID.

Novel Corona Virus 2019 Disease: Assessment on High-Resolution Computed Tomography Thorax.

Objectives This particular study was undertaken to assess the role of high-resolution computed tomography (HRCT) thorax in diagnosing patients with novel Corona virus-2019 disease and screening suspected COVID-19 cases. It also involves an assessment of the severity of bilateral lung involvement in proven and suspected cases of COVID-19 infection. Materials and methods Two hundred and fourteen symptomatic cases referred to the department of radio-diagnosis were evaluated in this study. HRCT thorax was performed on SIEMENS Somatom Emotion 16-slice spiral CT. Initially, a tomogram was taken, followed by sections in the lung window at B90s, kVp 130, with a pitch of 1.15. The images are then reconstructed into 1.0-mm-thin slices. Radiologists then interpreted the scans for features of COVID-19 disease. Various imaging features and the severity of the disease were analysed in all patients. Results We observed that the male population was more affected by the disease (72% of the total cases). The most consistent and common HRCT finding is that of ground-glass opacity (GGO), which was present in 172 cases, corresponding to 78.4% of the cases. Crazy pavement appearance was seen in 41.2 % of the cases. Other findings included consolidation, discrete nodules surrounded by ground-glass opacification, subpleural linear opacities, and tubular bronchiectasis. Conclusion HRCT thorax plays an ideal role in diagnosing COVID-19 disease with high sensitivity and also provides prompt results as compared to RT-PCR. It also helps in grading the severity of the disease based on various patterns and the extent of lung parenchyma involved. Therefore, because of the immediate results and the ability to grade the disease, HRCT became invaluable in directing the treatment of COVID-19 disease.

CO RADS grade of HRCT Thorax and RT PCR testing for the diagnosis of coronavirus disease 2019 (COVID 19): A descriptive hospital based study of asymptomatic planned surgery cases.

The coronavirus disease 2019 (COVID-19) reporting and data system (CO-RADS) grade of high-resolution computed tomography (HRCT)-thorax scan investigation is an innovative tool for the diagnosis of COVID-19 patients. By this tool, majority of moderate-to-severe COVID-19 patients are screened to detect lung pathologies. Hardly any study has explored its use vis-a-vis reverse transcriptase-polymerase chain reaction (RT-PCR) in asymptomatic patients. (1) The objective of the study is to assess the frequency COVID-19 patients among asymptomatic subjects who were admitted in the hospital for planned surgery, (2) estimate the sensitivity and specificity of CO-RADS grade of HRCT-thorax investigation for the diagnosis of COVID-19 patients where RT-PCR test was considered as "Gold Standard" test. A descriptive retrospective study was conducted by studying the records in the case files of 150 patients who were admitted in the Department of General Surgery, Man Mohini Health Clinic, Murshidabad, West Bengal for minor surgical procedures between September 1 and December 31, 2020. Data were collected from hospital records. The CO-RADS grade of HRCT-thorax investigation and RT-PCR test were performed for the diagnosis of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) virus. The MS-excel application was applied for data analysis. The mean age of the participants was 42.58 ± 14.29 years. A total of 17 (11%) and 39 (26%) of the patients were diagnosed with COVID-19 by HRCT-thorax and RT-PCR test, respectively. The sensitivity and specificity of CO-RADS grade of HRCT-thorax investigation for diagnosis of COVID-19 patients were 43.58% and 100%, respectively. The positive and negative predictive values of CO-RADS grade of HRCT-thorax investigation were 100% and 83.45%, respectively. The frequency of asymptomatic patients with COVID-19 that was missed by HRCT thorax was high, compared to the gold standard RT-PCR, reflecting its low sensitivity and low negative predictive value in the diagnosis of SARS-CoV-2 virus infection. Hence, it is difficult to conclude in favor of HRCT thorax as first-line screening modality in all individuals.

Post-COVID-19 sequelae in lungs: retrospective computed tomography analysis in selected tertiary care hospitals of Mangalore.

The radiological features of COVID-19 during the active disease process are well established, but the radio-logical features in the convalescent and post-recovery period of the disease are still unclear. The objectives of this study are to document and assess the proportion of the residual changes in lung post COVID-19 infection and to look for evidence and the proportion of fibrosis post COVID-19 infection on high-resolution computed tomography (HRCT). HRCT thorax of COVID-positive cases done during the disease process and in the recovery/post recovery phase were included in the study. Sample Size: 75. Categorical data are represented in the form of frequencies and proportions. The c2 test was used as a test of significance for qualitative data. Continuous data are represented as mean and standard deviation. A p-value (probability that the result is true) of < 0.05 was considered as statistically significant after assuming all the rules of statistical tests. Initial computed tomography (CT) findings mainly included ground glass opacity (GGO) (93.3%), inter-lobular septal thickening (66.7%), consolidation (52.0%), and fibrotic bands (8.0%). Ninety-two per cent of the CT scans demonstrated some pulmonary change in the follow-up CT. This was mostly in the form of GGO (58%). Approximately 17% of cases showed fibrotic changes in the follow-up CT. Post-COVID lung sequelae can be present in a significant number of patients. This are mostly seen in patients with severe initial disease and in older patients. Statistically significant post-COVID sequelae changes include GGO, fibrotic bands, and bronchiectasis.

Role of High-Resolution CT Thorax in Diagnosing Interstitial Lung Disease and Its Association With Smoking and Connective Tissue Disorder.

Introduction Interstitial lung diseases (ILDs)primarily affect the interstitium, an alveolar wall tissue between the capillary endothelium and the alveolar epithelium. The term 'interstitial,'however, is misleading since alveolar spaces, peripheral airways, and vessels can be involved in most of these disorders.They often require a multidisciplinary diagnosis i.e., an integration of clinical, radiological, and pathological findings. A chest radiograph is relatively insensitive because of nonspecific patterns. Generally, these disorders can progress to irreversible pulmonary fibrosis and are an important cause of morbidity and mortality. It is critical to make a prompt and accurate diagnosis of the underlying causes so that patients can be managed appropriately. ILD is subdivided into idiopathic interstitial pneumonia, of which idiopathic pulmonary fibrosis (IPF) is one subset, and diffuse parenchymal lung diseases, which may be secondary to a variety of occupational or environmental exposures or others. Theycan complicate multiple rheumatic or connective tissue diseases (CTDs). Apart from ILD, other forms of lung damage involving the pleura, vasculature, airways, and lymphatic tissuecan complicate CTDs. Aims Aims include studying the role of high-resolution computed tomography (HRCT) in diagnosing various ILDs based on morphologic patterns,evaluating the correlation between ILD and various connective tissue disordersand the prevalence of complications in such patients, andevaluating the association of smoking with various ILDs. Methods This is a retrospective study in which HRCT thorax was performed on a 128-slice PhilipsCT scanner machine on 50 patients from December 2020 to February 2022 in SVPHospital, Ahmedabad. No age orgender bias was followed. Result Out of 50 patients studied, 19 (38%) patients had the usual interstitial pneumonia (UIP) pattern and 12 (24%) had the nonspecific interstitial pneumonia (NSIP) pattern. These two were the most common among all ILD patterns. Other patterns found were hypersensitivity pneumonitis(5; 10%), respiratory bronchiolitis-related ILD (3;6%), and organizing pneumonia (2; 4%). Innine patients, the morphologic pattern was either subtle (3; 6%) or mixed (6; 12%), and the final diagnosis remained inconclusive; patients were advised clinical correlation and biopsy. Eleven (22%) patients had a history of smoking. Amongsmokers, the most common pattern was UIP while all patients with respiratory bronchiolitis (RB) ILD had a history of smoking. Fourteen (28%) patients showed a positive association with CTD. Amongthem, rheumatoid arthritis (RA) was the most commonCTD and the most common pattern among RApatients was UIP. Ten (20%) of patients developed pulmonary arterial hypertension, of which two patients who had connective tissue disorder developed pulmonary arterial hypertension at a young age(24 years). The rest of the patients who developed pulmonary arterial hypertension were above 45 years of age. Among these, two were smokers. Conclusion HRCT plays an important role in the diagnosis of ILD on the basis of various morphological patterns. CTD plays a significant role in the development of ILD. UIP is the most common ILD amongpatients with a smoking history and RA. NSIP Is the most common in patients with CTD other than RA. Pulmonary arterial hypertension (PAH) develops early in patients with CTD. There is a significant risk of the development of PAH in patients with chronicILD.

Comparative Study of High-Resolution Computed Tomography Thorax in Unvaccinated and Vaccinated COVID-19 Patients

Comparative study of High-Resolution Computer Tomography (HRCT) Thorax of 153 COVID-19 patients (includes unvaccinated as well as vaccinated patients) have been reported to check the severity level of the COVID-19 pulmonary infection. Investigation included only those patients those who had tested positive for the virus on RT-PCR. All patients underwent HRCT Thorax using radiation optimizing protocol. The present study indicates that COVID-19 pulmonary infection is still seen in the vaccinated patients. However, the severity in the vaccinated patients is less than the unvaccinated patients.

Computed Tomography Severity Scoring on High-Resolution Computed Tomography Thorax and Inflammatory Markers With COVID-19 Related Mortality in a Designated COVID Hospital.

IntroductionRadiological Society of the Netherlands introduced the coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) and the corresponding CT severity score (CTSS) to diagnose COVID-19 severity. However, data regarding the same is very limited.ObjectivesThe objective of this study was to correlate the computed tomography severity scoring (CTSS) on high-resolution computed tomography (HRCT) thorax and inflammatory markers with COVID-19 related mortality.MethodsA retrospective observational study was conducted in a tertiary center between June 2020 to May 2021 among 2343 adult patients at the department of radio-diagnosis with suspected and confirmed COVID-19 cases who received an HRCT thorax. Data was collected retrospectively from the records regarding age, sex, and information regarding inflammatory markers such as C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), D-dimer, and neutrophil-to-lymphocyte ratio. Information on HRCT thorax of patients was reviewed for radiological suspicion of COVID-19 related lung changes using CO-RADS scoring and severity of lung involvement using CT-severity scoring. Data was analyzed using SPSS version 22 (IBM Inc., Armonk, New York).ResultsThe mean age was 51.69 ± 16.02 years, and most of the study participants were male (1592, 67.95%). The majority (999, 42.64%) had diabetes as a comorbidity. The reverse transcription polymerase chain reaction (RT-PCR) test was positive in 1571 (67.05%) participants. The majority (1571, 67.05%) had a CO-RADS score of six, and only 150 (6.40%) had CO-RADS score of four. The CT severity score was normal in 147 (6.27%), mild in 724 (30.90%), moderate in 903 (38.54%), and severe in 569 (24.29%) participants. The CRP levels were moderate in 1200 (51.22%) and severe in 428 (18.27%) participants. The mean ferritin, D-dimer and interleukin-6 (IL-6) levels were 321.83 ± 266.42 ng/ml, 1.51 ± 0.85mg/l, and 323.05 ± 95.52pg/ml, respectively. The mean length of hospital stay was 10.25 ± 6.52 days. Most of them (1926 out of 2343, 82.20%) survived, and nearly 417 out of 2343 (17.80%) died. Out of 2343, 569 participants had severe CT severity scores, out of which 205 (36.03%) died, and 364 (63.97%) participants survived.ConclusionA positive correlation was found between CT severity scoring on HRCT thorax and inflammatory markers with COVID-19 related mortality and can be used in early diagnosis and timely management of COVID-19 positive patients.

Surprise evidence of a bronchial rent in a case of pulmonary Koch’s posted for lung decortication using the one-lung ventilation protocol

Tracheobronchial injury is a potentially life-threatening clinical scenario. In the case of surprise evidence of bronchial wall tear while doing lung surgery, tracheal tube extubation and post-operative management pose a challenge to the anaesthesiologist. We present a case of a 16-year-old girl, a known case of pulmonary Koch’s taking anti-Koch’s treatment, admitted with hydropneumothorax, who was posted for left lung decortication. She presented with complaints of left-sided chest pain and cough since 3 months and a weight loss of 13 kg in 3 months. An inter-costal drain was inserted on the left side.Her high-resolution computed tomography thorax showed multiple cavitatory lesions with ground glass opacities in right lung parenchyma,Hydropneumothorax from the upper lobe to lower lobe of the left lung; consolidation, calcification in the left lower lobe; mediastinal shift toward the right.In the Operation theatre, the patient was pre-oxygenated, induced with Inj Propofol + Inj Fentanyl + Inj Suxamethonium according to the patient’s weight, and intubated with a 28 Fr’ left-sided double lumen tube (DLT). Left-sided decortication was performed uneventfully. On conclusion of surgery, while checking for leaks, it was noted that the exhaled tidal volume was unacceptably low and a rent on the left main bronchus of around 2 x 2 cm with scarred borders was detected, which was repaired with tissue patch suturing by the surgeons. After closure, the DLT was removed and re-intubation was performed with endotracheal tube no. 6. The patient was shifted to the intensive care unit, electively ventilated, and gradually weaned off in 2 days. Then, the patient was discharged in a week.To conclude, meticulous planning, vigilant monitoring of vital parameters, and close communication between the surgeons and the anaesthesiologists are essential to timely manage a life-threatening complication.

Pneumomediastinum: Radiological profile and associations of uncommon complication of COVID-19.

Introduction:Spontaneous pneumomediastinum is an uncommon complication of Corona Virus Disease (COVID)-19 presenting mostly in moderate to severe cases.Materials and Methods:This is a retrospective observational imaging and hospital data-based study done on 15 confirmed patients of COVID-19 who underwent high resolution computed tomography (HRCT) thorax at the Department of Radio-Diagnosis of a tertiary medical center in the Himalayan foothills. The clinico-radiological profile of the study group was assessed and it was aimed at finding the association of pneumomediastinum with the severity of lung changes.Results:A strong association of pneumomediastinum was observed with severe lung changes on HRCT thorax (n = 13, 87%, P < 0.00001). Dyspnea was the most common presenting factor. The mortality rate is high in mechanically intubated patients of pneumomediastinum with COVID-19 (75%).Conclusion:Pneumomediastinum is a complication of a severe COVID-19 disease spectrum. Along with severe lung parenchymal disease, systemic inflammation, systemic steroid therapy, comorbid state, and mechanical intubation, it is a part of the pool of poor prognostic factors. HRCT is essential for making a quick and comprehensive diagnosis, thereby, guiding the clinician for further management.

“Chronic refractory cough with dyspnea” as presenting feature of metastatic renal cell carcinoma: “Beaded Interlobular Septum” on HRTC Thorax Needs Cautious Workup to Rule out Underlying Malignant Pathology

Cough is the most common respiratory symptoms with infective and noninfective etiological factors involving upper and lower airways. Chronic refractory cough (CRC) has limited etiology and associated symptoms play a crucial role in differentiating it from underlying benign to malignant pathology. Computed tomography (CT) thorax has a vital role in evaluating “CRC with dyspnea” and findings like interlobular septal thickening with nodules will be good answer to etiology. “Beaded interlobular septum with nodules, and enhancing cannonball like nodule” clinching causative factor may be malignant process outside the thoracic cavity. In this case report, a 52-year male presented with CRC and documented lymphangitis with nodule on high-resolution computed tomography thorax and CT abdomen documented right renal mass, ultrasound-guided right renal biopsy documented renal papillary carcinoma. Renal metastasis which predominantly involves both lymphatic and hematogenous route, and propensity of these metastases are hyper-vascular type and presenting with lymphatic interlobular septal dissemination with lymphatic edema resulting in refractory chronic cough with dyspnea which is refractory to steroids and bronchodilators.

Utility of Maximum Intensity Projections in Volumetric High Resolution Computed Tomography Lung in the Evaluation of Diffuse Lung Diseases- A Retrospective Analysis

Introduction: Though volumetric High Resolution Computed Tomography (HRCT) has increased the sensitivity of diagnosing diffuse lung diseases, there are some drawbacks related with lesion detection. Post processing techniques like Maximum Intensity Projection (MIP) can help in increasing the sensitivity of HRCT further. Aim: To study various possible utilities of MIP in HRCT lung. Materials and Methods: A retrospective cross-sectional study was done in a tertiary care hospital, including all Computed Tomography (CT) scans performed in July 2020 to August 2020, with multiple lung findings and diffuse involvement of lungs. Two radiologists reviewed the base mean axial images of 1 mm and MIP images in sliding scale from 2 to 10 mm in lung window. They recorded the findings in every scan based on widely accepted basic pattern of interpretation of HRCT thorax. The slice/slab thickness that best depicted each finding was noted. Inter reader agreement was calculated for each finding. Results: Fifty nine CT cases, which included scans of 34 males and 25 female patients with a mean age of 37.4±12.5 years were reviewed. There was near perfect to substantial agreement between the two radiologists on various findings (kappa &gt; 0.75). MIP images of 6-10 mm slab thickness were best suited to detect smaller nodules, assess vessel size in areas of mosaic attenuation and detect dense lesions in images with poor breath hold. The MIP images of 2-5 mm thickness were useful in detecting the location in relation to secondary pulmonary lobule, reticular densities and crazy-paving densities. Conclusion: The MIP being an easy to use and readily available post processing technique, when used with volumetric HRCT dataset of thorax enhanced the value of HRCT in detecting various lesions.

Role of HRCT in Assessing Requirement of Oxygen for COVID-19 Patients: A Retrospective Study from Amalapuram, Andhra Pradesh, India

Introduction: Coronavirus Disease 2019 (COVID-19) infection has affected many countries in the world with its high rate of infectivity and created havoc with its mortality rate. A High Resolution Computed Tomography (HRCT) thorax scan is useful in detection and to assess the involvement of lung which is helpful to plan the management. Aim: To assess the oxygen requirement in COVID-19 patients based on the lung involvement using HRCT scan. Materials and Methods: A retrospective study was conducted from 1st May to 30th June 2021 in the Department of Radiodiagnosis, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India. HRCT thorax scans of 600 patients with COVID-19 infection were included. The patients were categorised based on their lung involvement into three groups (mild, moderate, severe) and then they were followed-up for the oxygen support that each patient received during their stay in hospital. Results: Among the 184 mild COVID-19 infection cases none required Bilevel Positive Airway Pressure (BiPAP)/ intubation. Sixty four out of 340 moderate COVID-19 infection cases required BiPAP and intubation and 28 out 76 severe COVID-19 infection cases required BiPAP and intubation. None in mild cases, 60 (17.6%) in moderate cases, and 32 (42.1%) in severe cases had mortality. The rate of oxygen support and risk of intubation increased as the score increases (p&lt;0.001). The Computed Tomography Severity Index (CTSI) also showed significant difference with the age and co-morbidities of the patients (p&lt;0.01). Conclusion: The HRCT is helpful in assessing the requirement of oxygen support in COVID-19 patients and to plan the management. There is increased non invasive and invasive ventilatory support along with increased morbidity and mortality as the score increases.

Clinical, laboratory and high-resolution computed tomography (HRCT) thorax profile of reverse transcription polymerase chain reaction (RT-PCR) negative COVID-19 suspects with moderate to severe disease.

Diagnostic dilemma arises when patients with clinical suspicion of COVID-19 disease having moderate-to-severe respiratory symptoms yield negative result for COVID-19 in reverse transcription polymerase chain reaction (RT-PCR). This study evaluated the clinical, laboratory and HRCT thorax findings among RT-PCR-negative COVID-19 suspects with moderate-to-severe disease. A hospital-based retrospective observational study was conducted between July 2021 to December 2021, among 60 moderate and severe symptomatic COVID-19 suspects admitted in the severe acute respiratory illness (SARI) ward and intensive care unit (ICU), who were negative for COVID-19 in RT-PCR. Data were abstracted from the medical records section of the hospital using a predesigned data abstraction form and presented by descriptive statistics. Mean age of study participants was 55.5 years (SD 14.1 years), and majority were males (n = 43, 71.7%). Common presenting symptoms were fever (n = 60, 100%), dyspnea (n = 57, 95%), and cough (n = 54, 90%). The common laboratory findings were rise of C-reactive protein (n = 60, 100%), NLR (n = 49, 81.7%), d-dimer (n = 47, 78.3%), ferritin (n = 46, 76.7%), and LDH (n = 40, 66.7%). HRCT scan of thorax revealed ground glass opacities with or without consolidations located bilaterally with diffuse or peripheral distribution, interlobar septal thickening (n = 43, 74.1%), vascular thickening (n = 35, ≥58.3%), and sub-pleural lines (n = 32, 53.3%). Median CT-SS value was 15 (IQR 11-19), and majority (n = 56, 93.3%) belonged to CO-RADS ≥4. Diagnosis of COVID-19 can be presumed in RT-PCR-negative suspected COVID-19 patients with moderate-to-severe disease, with marked rise of inflammatory markers and HRCT revealing typical findings of COVID-19 pneumonia.

Severe COVID-19 Case with HRCT Score of 25/25: A Survival Story

With the rapid spread of severe acute respiratory syndrome SARS-CoV2, the incidence of the disease is increasing each day with a higher infectivity rate and unpredictable morbidity and mortality. The second wave in India has higher morbidity and mortality compared to the previous wave of SARS-Cov2. With the increasing trend of screening hypoxic patients with high resolution computed tomography (HRCT) of thorax, treatment modalities, and investigational approaches have changed drastically. Here we report a case of a 31-year-old female who presented to a tertiary care centre in the rural area with a history of fever five days back and a history of breathlessness of 3 days duration and dry cough of 3 days duration. She was hypoxic on admission and later on diagnosed with SARS-Cov2 infection. HRCT thorax revealed a CT severity score of 25/25. She was treated according to standard treatment protocols. The patient was discharged after 46 days with normal oxygen saturation on room air. The aim of this case study is to emphasize the wholesome approach in the management of COVID-19.