Chest Imaging Research Articles

Serum ferritin as a guide for CT chest indication in patients suspected to COVID-19

Background: The coronavirus disease 2019 (COVID‐19) has rapidly developed into a pandemic. Increased levels of ferritin due to cytokine storm and secondary hemophagocytic lymphohistiocytosis were found in severe COVID‐19 patients. Therefore, the aim of this study was to evaluate the role of ferritin level as indicator for positive chest CT. scan. Patients and methods: 185 Patients involved through February to June. In this study, the blood sample was collected in patients suffering from fever, sore throat with or without dry cough. Then S.ferritin was estimated and after that we did chest-scan. Result: 164 patients were positive findings for chest- Cscan finding at the level from 10-410 ng/ml of ferritin. Conclusion: Serum ferritin is a valuable marker that can aid in triaging and determining the need for CT chest imaging in suspected COVID-19 cases. However, its use should be integrated with a broader clinical assessment to ensure appropriate and effective management

Artificial Intelligence-Empowered Radiology—Current Status and Critical Review

Humanity stands at a pivotal moment of technological revolution, with artificial intelligence (AI) reshaping fields traditionally reliant on human cognitive abilities. This transition, driven by advancements in artificial neural networks, has transformed data processing and evaluation, creating opportunities for addressing complex and time-consuming tasks with AI solutions. Convolutional networks (CNNs) and the adoption of GPU technology have already revolutionized image recognition by enhancing computational efficiency and accuracy. In radiology, AI applications are particularly valuable for tasks involving pattern detection and classification; for example, AI tools have enhanced diagnostic accuracy and efficiency in detecting abnormalities across imaging modalities through automated feature extraction. Our analysis reveals that neuroimaging and chest imaging, as well as CT and MRI modalities, are the primary focus areas for AI products, reflecting their high clinical demand and complexity. AI tools are also used to target high-prevalence diseases, such as lung cancer, stroke, and breast cancer, underscoring AI’s alignment with impactful diagnostic needs. The regulatory landscape is a critical factor in AI product development, with the majority of products certified under the Medical Device Directive (MDD) and Medical Device Regulation (MDR) in Class IIa or Class I categories, indicating compliance with moderate-risk standards. A rapid increase in AI product development from 2017 to 2020, peaking in 2020 and followed by recent stabilization and saturation, was identified. In this work, the authors review the advancements in AI-based imaging applications, underscoring AI’s transformative potential for enhanced diagnostic support and focusing on the critical role of CNNs, regulatory challenges, and potential threats to human labor in the field of diagnostic imaging.

A multivariable prediction model for invasive pulmonary aspergillosis in immunocompromised patients with acute respiratory failure (IPA-GRRR-OH score).

Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection in immunocompromised patients. The diagnosis is often made late, with mortality reaching 90% when mechanical ventilation is needed. We sought to develop and validate a risk prediction model for the diagnosis of IPA. We used two independent datasets of immunocompromised patients with acute respiratory failure admitted to 12 intensive care units (ICUs). The derivation dataset include 3262 patients. Factors associated with probable or proven IPA were identified, and a risk prediction model was developed. This model was then validated in a prospective dataset (776 patients). IPA prevalence was 4.5% (146/3262) and 3.3% (26/776), in the derivation and the validation cohorts, respectively. The final model included eight variables constitutive of the IPA-GRRR-OH score: type of immunosuppression, high-dose or long-term corticosteroids, neutropenia, the presence of structural lung disease, time from symptoms onset to ICU admission > 7 days, hemoptysis, focal alveolar pattern on the chest imaging, and viral co-infection. The median score [IQR] was 2 [1-3] in the derivation and 1 [0-3] in the validation cohort. The best cutoff score for IPA diagnosis was 4 (sensitivity 23.1%; specificity 90.5%; negative predictive value 91.4%). Discrimination and calibration were good in both the derivation (AUC 0.72 [0.68-0.76]) and the validation cohort (AUC 0.85 [0.76-0.93]). The IPA-GRRR-OH is a clinical score, easily available at ICU admission, which reliably predicts IPA in immunocompromised patients with acute respiratory failure. Studies to demonstrate benefits from the bedside implementation of this score are warranted.

Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: ASCO Guideline Update.

To provide updated guidance regarding neoadjuvant chemotherapy (NACT) and primary cytoreductive surgery (PCS) among patients with stage III-IV epithelial ovarian, fallopian tube, or primary peritoneal cancer (epithelial ovarian cancer [EOC]). A multidisciplinary Expert Panel convened and updated the systematic review. Sixty-one studies form the evidence base. Patients with suspected stage III-IV EOC should be evaluated by a gynecologic oncologist, with cancer antigen 125, computed tomography of the abdomen and pelvis, and chest imaging included. All patients with EOC should be offered germline genetic and somatic testing at diagnosis. For patients with newly diagnosed advanced EOC who are fit for surgery and have a high likelihood of achieving complete cytoreduction, PCS is recommended. For patients fit for PCS but deemed unlikely to have complete cytoreduction, NACT is recommended. Patients with newly diagnosed advanced EOC and a high perioperative risk profile should receive NACT. Before NACT, patients should have histologic confirmation of invasive ovarian cancer. For NACT, a platinum-taxane doublet is recommended. Interval cytoreductive surgery (ICS) should be performed after ≤four cycles of NACT for patients with a response to chemotherapy or stable disease. For patients with stage III disease, good performance status, and adequate renal function treated with NACT, hyperthermic intraperitoneal chemotherapy may be offered during ICS. After ICS, chemotherapy should continue to complete a six-cycle treatment plan with the optional addition of bevacizumab. Patients with EOC should be offered US Food and Drug Administration-approved maintenance treatments. Patients with progressive disease on NACT should have diagnosis reconfirmed via tissue biopsy. Patients without previous comprehensive genetic or molecular profiling should be offered testing. Treatment options include alternative chemotherapy regimens, clinical trials, and/or initiation of end-of-life care.Additional information is available at www.asco.org/gynecologic-cancer-guidelines.This guideline has been endorsed by the Society of Gynecologic Oncology.

Longitudinal Recovery Trajectories and Ventilatory Modalities in Covid-19 ARDS Survivors

IntroductionThe impact of the different ventilatory support modalities and the timing of intubation on longitudinal lung recovery trajectories in patients with severe COVID-19 is unknown.MethodsA multicenter, prospective observational study conducted in 52 Spanish intensive care units (ICUs) involving critically ill COVID-19 patients admitted between February 25th, 2020, to February 28th, 2021. 1854 COVID-19 patients were followed after hospital discharge at 3, 6 and 12 months with lung diffusing capacity (DLCO) and a chest imaging. Patients were classified regarding the ventilatory support received during the ICU stay: noninvasive mechanical ventilation (NIMV), high-flow nasal cannula (HFNC) and invasive mechanical ventilation (IMV) divided into early IMV (intubation <24 h) and late IMV (intubation >24 h). The primary objective is to evaluate the impact of the different respiratory support modalities during the ICU stay and time of intubation on DLCOmeasurements and their recovery trajectories over a one-year follow-up. Secondary outcomes include other pulmonary function parameters and chest imaging findings.ResultsA total of 360 (19.4%) and 290 (15.6%) patients received HFNC and NIMV, respectively. 1204 (64.9%) patients underwent IMV; 966 received early IMV and 238 late IMV. The latter exhibited a significantly worse percentage of predicted DLCOduring the one-year follow-up with adjusted differences (95%CI; p-value) of 6.9 (3.9 to 10; p<0.001), 4.2 (1.1 to 7.2; p=0.007) and 4.9 (1.7 to 8.2; p=0.003) at 3, 6 and 12 months compared with early IMV. NIMV patients exhibited greater lung damage at follow-up than those under HFNC with an adjusted difference of DLCOvalues of 5.2 (1.7 to 8.7; p=0.003) at 6 months and greater presence of radiological abnormalities during the follow-up. Matched and sensitivity analysis showed results consistent with those reported.ConclusionsDelay in intubation implies the worst outcomes; however, patients with NIMV exhibited a slower lung recovery in terms of DLCOmeasurements and more radiological abnormalities compared with HFNC patients. These results should be used to optimize follow-up protocols for COVID-19 ARDS survivors. These findings may serve as a valuable consideration for optimizing follow-up protocols for survivors of COVID-19 ARDS.

Inpatient service utilization amongst infants diagnosed with Respiratory Syncytial Virus infection (RSV) in the United States.

Respiratory syncytial virus (RSV) is the leading cause of hospitalization among US infants. Characterizing service utilization during infant RSV hospitalizations may provide important information for prioritizing resources and interventions. The objective of this study was to describe the procedures and services received by infants hospitalized during their first RSV episode in their first RSV season, in addition to what proportion of infants died during this hospitalization. In this retrospective observational study, we analyzed three different administrative claims datasets to examine healthcare service utilization during RSV hospitalizations among infants. The study population included infants born between July 2016 and February 2020 who experienced an RSV episode during their first RSV season and had an associated inpatient hospitalization. We stratified infants into three comorbidity groups: healthy term, palivizumab-eligible, and other comorbidities. Outcomes included extracorporeal membrane oxygenation, supplemental oxygen use (in-hospital and post-discharge), mechanical ventilation (invasive and non-invasive), chest imaging, infant mortality, length of inpatient stay, intensive care unit (ICU) admission, and number of days in the ICU. Chest imaging was the most frequently administered procedure during RSV-associated hospitalizations, with approximately 34-38% of infants receiving it. Around one-quarter of infants were admitted to the ICU during their first RSV hospitalization. Median lengths of stay in the hospital were 3-4 days, extending to 4-6 days in the presence of ICU admission. Palivizumab-eligible infants had higher utilization of healthcare services and spent more time in the hospital or ICU compared to healthy infants or those with other comorbidities. This study provides insights into the utilization of healthcare services during RSV hospitalizations among infants. Understanding service utilization patterns can aid in improved management and resource allocation for infants in the United States, ultimately contributing to better outcomes and reduced healthcare costs overall. However, likely under-ascertainment of ventilation and oxygen-related services in insurance claims remains an impediment to studying these outcomes.

Leveraging Artificial Intelligence as a Safety Net for Incidentally Identified Lung Nodules at a Tertiary Center.

Artificial intelligence (AI)-powered platforms may be used to ensure that clinically significant lung nodules receive appropriate management. We studied the impact of a commercially available AI natural language processing tool on detection of clinically significant indeterminate pulmonary nodules (IPNs) based on radiology reports and provision of guideline-consistent care. All computed tomography (CT) scans performed at a single tertiary care center in the outpatient or emergency room setting between 20-Feb-2024 and 20-March-2024 were processed by the AI natural language processing algorithm. CT radiology reports mentioning a lung nodule or focal indeterminate lesion were flagged. All flagged reports were reviewed by a lung nodule expert two weeks after nodule identification. IPNs were classified as "appropriately followed" if follow-up imaging, referral to a nodule clinic, or other guideline-consistent care was ordered. IPNs were classified as "not appropriately followed" if no acknowledgement of the reported nodule was documented in the electronic health record within two weeks of being flagged. The AI software processed 76,507 unique radiology reports, identified 2,585 CT scans with chest imaging, and found 389 IPNs. Review determined that 272 (70%) nodules were appropriately followed while 117 (30%) were not appropriately followed. Of the 117 nodules without documented follow-up, 67 (57%) were > 8mm and 24 (20.5%) were > 15mm. IPNs that would not have received follow-up in the absence of the AI software generated 43 additional clinical appointments and 3 procedures. At a large tertiary care center, 30% of clinically significant incidental pulmonary nodules that would have otherwise been missed were brought to the attention of lung nodule clinicians by an AI software, allowing for initiation of appropriate follow-up.

Clinical characteristics and risk factors of severe pneumonia caused by human bocavirus in children

BackgroundThe aim of this study was to investigate the clinical characteristics of severe pneumonia caused by human bocavirus (HBoV) infection to explore the associated risk factors.MethodsWe conducted a retrospective review of data from children hospitalized with HBoV pneumonia. Based on the severity of pneumonia, patients were categorized into severe pneumonia and non-severe pneumonia groups. Clinical manifestations, laboratory examination results, chest imaging and pathogens were analyzed. Logistic regression was employed to identify the risk factors for severe HBoV pneumonia.ResultsA total of 334 patients were admitted, with 44 (13.17%) patients diagnosed with severe pneumonia and 290 (86.83%) with non-severe pneumonia. There were no significant differences in age distribution, presence of fever, lung moist rales, pleural effusion and reduced breath sounds between the two groups (all P > 0.05). 57.19% of the HBoV-positive children co-infected with other pathogens and HRV was the most common co-infected pathogens with HBoV. No significant differences were observed in the rate of co-infection between the two groups (χ2 = 0.50, p = 0.48). The univariate analysis revealed significant differences between the severe pneumonia group and the non-severe group in terms of gender distribution, presence of underlying chronic diseases, wheezing, premature delivery, lung wheezing rales, pneumothorax, bronchoscopy procedures, length of hospital stay, duration of symptoms prior to admission, neutrophil count, CRP levels, CKMB levels, IgA levels, CD3+(%), CD3+CD4+(%), CD3+CD8+%, and CD3−CD19+% (all P < 0.05). Multivariate logistic regression analysis identified female gender, wheezing and neutrophil count were independent risk factors and the ratio of CD3+CD4+ cells was protective factor for severe HBoV pneumonia. The cut-off values of neutrophil count and the ratio of CD3+CD4+ cells were 6.81 × 109/L and 32.48 respectively.ConclusionOur study indicated that female gender, wheezing and neutrophil count greater than 6.81 × 109/L were independent risk factors and the ratio of CD3+CD4+ cells greater than 32.48 was protective factor for severe HBoV pneumonia.

Retrospective analysis of clinical characteristics and treatment differences between severe and non-severe neonatal types of pneumonia with RSV infection.

Understanding the differences between children with severe and non-severe types of neonatal pneumonia is crucial for clinical treatment and disease management. In this study, we retrospectively analyzed the clinical data of infants with neonatal pneumonia diagnosed as respiratory syncytial virus infection at Wuhan Children's Hospital between December 1, 2022 and November 30, 2023. Further, the recruited subjects were categorized into severe and non-severe groups based on the severity score. The collected data included general information, symptoms and signs, chest imaging results, and examination indices of the children. Finally, the data between the groups were statistically analyzed using the R software. The data showed no significant differences between the critical and noncritical groups on several dimensions. The critical group presented a longer hospital stay, a higher percentage of cesarean deliveries, as well as a significantly higher incidence of shortness of breath and cyanosis than the noncritical group. Concerning the laboratory indices, the critical group exhibited lower hemoglobin levels and a faster heart rate than the noncritical group. In terms of life-saving measures, respiratory support and drugs were more frequently required in the critical group than in the noncritical group. The utilization of some specific antibiotics was higher in the critically ill group than in the noncritically ill group. In summary, the study clarified the differences between critically and noncritically ill children with neonatal pneumonia, which could lead to the development of individualized treatment plans and improved quality of life and prognosis of children.

Perceptions of radiographers on reporting chest images at Public Hospitals in Malawi

IntroductionMalawi health facilities' major challenge is inequalities in access to reporting services due to a shortage of radiologists to report on radiographic images. Radiographers in the developed world acquire formal training in image reporting, however, there is no postgraduate training programme in Malawi. Thus, there is a need to explore radiographers' perceptions of reporting chest images in Malawi's hospitals. The study aims to explore radiographers’ perceptions of being tasked with the responsibility of reporting on chest images at public hospitals in Malawi. MethodThe study was conducted through a quantitative cross-sectional design. Data was collected using a self-developed questionnaire. Data collected was analyzed with the assistance of a statistician using the Statistical Package for Social Scientists (SPSS) version 29. The measurement scales and questions included quantitative 10-point Likert. Statistical analysis used the Mann -Whitney U test. ResultsSeventy-one (71) radiographers representing 81 % of the total population from five public hospitals participated in the study. The results from this study found that most radiographers (97.2 %) agreed that radiographers needed to report on chest images in the department. Findings demonstrated that the majority of radiographers (80.3 %) supported ongoing professional development, and of the radiographers (78.9 %) also agreed that reporting on chest images required post-graduate training. Overall confidence in reporting chest images was 81.6 % with no difference by years worked as a qualified radiographer (p=0.196) with the less than 10 years were as confident to report chest images as 10 years or more . Confidence in detecting abnormality on chest images (78.8 %) demonstrated no variation by years worked as qualified radiographer (p=0. 196) or level in department (junior of senior radiographer (p =0.323). Perceived impact of radiographer's involvement in chest image reporting to improved cost effective service delivery, work efficiently, and potential impact on patient care and safety. ConclusionBased on the findings of this study, there were positive perceptions among the majority of radiographers about the reporting of chest images in Malawi. It was recommended that policymakers change Malawi's health care policy, especially the radiological sector to allow radiographers to report on chest images.

Rare cause of chronic cough in a young healthcare worker - A case of exogenous lipoid pneumonia!

ABSTRACT Exogenous lipoid pneumonia (ELP) is a rarely reported entity caused by aspirating or inhaling fat or oil-containing substances. Clinically, patients present with subacute to chronic-onset non-specific symptoms such as cough, fever, breathlessness, and general malaise. In addition, lobar or multifocal interstitial and parenchymal infiltrates on chest imaging can mimic any other infectious etiology. Diagnosis of lipoid pneumonia is often missed or delayed in many cases and requires a high index of clinical suspicion. We report a case of a 36-year-old nursing officer who presented with a cough and right-sided pneumonia on chest imaging. She was being treated empirically with antitubercular therapy without any clinical response to the treatment. ELP was diagnosed after carefully evaluating the radiological findings, reviewing the clinical history, and finding supportive evidence of lipid-laden alveolar macrophages in her broncho-alveolar lavage fluid. It is vital to uphold a heightened clinical suspicion for non-infectious etiologies in non-resolving pneumonia and investigate the patient thoroughly before resorting to empirical treatments.

Assessment of scattered and leakage radiation from ultra-portable X-ray systems in chest imaging: An independent study.

Ultraportable (UP) X-ray devices are ideal to use in community-based settings, particularly for chest X-ray (CXR) screening of tuberculosis (TB). Unfortunately, there is insufficient guidance on the radiation safety of these devices. This study aims to determine the radiation dose by UP X-ray devices to both the public and radiographers compared to international dose limits. Radiation dose measurements were performed with four UP X-ray devices that met international criteria, utilizing a clinically representative CXR set-up made with a thorax phantom. Scatter and leakage radiation dose were measured at various positions surrounding the phantom and X-ray tube, respectively. These measurements were used to calculate yearly radiation doses for different scenarios based on the median of all UP X-ray devices. From the yearly scatter doses, the minimum distances from the phantom needed to stay below the international public dose limit (1 mSv/year) were calculated. This distance was longest in the direction back towards the X-ray tube and shortest to the left/right sides of the phantom, e.g., 4.5 m and 2.5 m resp. when performing 50 exams/day, at 90 kV, 2.5 mAs and source skin distance (SSD) 1 m. Additional calculations including leakage radiation were conducted at a typical radiographer position (i.e., behind the X-ray tube), with a correction factor for wearing a lead apron. At 2 m behind the X-ray tube, a radiographer wearing a lead apron could perform 106 exams/day at 2.5 mAs and 29 exams/day at 10 mAs (90 kV, SSD 1 m), while keeping his/her radiation dose below the public dose limit (1 mSv/year) and well below the radiographer dose limit (20 mSv/year). In most CXR screening scenarios, the radiation dose of UP X-ray devices can be kept below 1 mSv/year by employing basic radiation safety rules on time, distance and shielding and using appropriate CXR exposure parameters.

Concomitant Interstitial Pneumonia and Disseminated BCG Infection after Intravesical BCG Therapy: A Case Report.

An 83-year-old man presented with persistent fever after intravesical BCG therapy for bladder cancer. Chest computed tomography (CT) and bronchoscopy revealed diffuse ground-glass opacities with multiple micronodules and lymphocyte-predominant bronchoalveolar lavage fluid with a high CD4/CD8 ratio, respectively. Therefore, corticotherapy for interstitial pneumonia was initiated. Anti-fast staining of the respiratory specimens was negative; however, anti-tuberculosis treatment was added based on CT findings suggesting disseminated BCG infection. Fifty days post-admission, Mycobacterium bovis BCG was identified in the initial sputum cultures. Concomitant interstitial pneumonia and BCG infection should be considered in patients with abnormal chest imaging following intravesical BCG therapy.

A case report of pulmonary paragonimiasis diagnosed via the deterioration of pulmonary cavities during high-dose corticosteroid therapy for chronic eosinophilic pneumonia

A 32-year-old Chinese woman with a cough and bloody sputum was diagnosed with chronic eosinophilic pneumonia. After starting corticosteroid therapy, chest radiography showed improvement in the bilateral infiltrative shadow. However, chest image findings showed worsening of the bilateral infiltrative shadow and pulmonary cavities during the 20 mg/day of oral prednisolone therapy. Transbronchial lung biopsy and bronchoalveolar lavage were repeated, and the patient was diagnosed with pulmonary paragonimiasis. After starting praziquantel treatment, chest radiography findings and clinical symptoms improved. Careful follow-up during corticosteroid therapy is important to judge whether transient improvement and true deterioration of radiological findings.

New Frontiers in Asthma Chest Imaging.

Modern pulmonary imaging can reveal underlying pathological and pathophysiological changes in the lungs of people with asthma, with important clinical implications. A multitude of imaging modalities are now used to examine underlying structure/function relationships including computed tomography, magnetic resonance imaging, optical coherence tomography, and endobronchial ultrasound. Imaging-based biomarkers from these techniques, including airway dimensions, blood vessel volumes, mucus scores, ventilation defect extent and air trapping extent, often have increased sensitivity compared to traditional lung function measurements, and are increasingly used as endpoints in clinical trials. Imaging has been crucial to recent improvements in our understanding of relationships between T2-inflammation, eosinophilia, and mucus extent. With the advent of effective anti-T2 biologic therapies, computed tomography and magnetic resonance imaging techniques can identify not just which patients benefit from therapy, but why they benefit. Clinical trials have begun to assess the utility of imaging to prospectively plan airway therapy targets in bronchial thermoplasty and have potential to direct future bronchoscopic therapies. Together, imaging techniques provide a diverse set of tools to investigate how spatially-distributed airway, blood, and parenchymal abnormalities shape disease heterogeneity in patients with asthma.

Prevalence and clinical features of interstitial lung disease in patients with psoriasis

BackgroundDespite the autoimmune nature of psoriasis, the potential association between psoriasis and interstitial lung disease (ILD) remains underexplored. This study aimed to investigate the frequency and clinical features of ILD in patients with psoriasis and propose a new conceptual framework of “ILD associated with psoriasis”.MethodsA retrospective analysis of 117 patients with psoriasis was conducted, excluding those without chest imaging prior to methotrexate or biologic use and those with other comorbidities leading to ILD.ResultsILD was identified in 12 (10%) patients with psoriasis; 6/50 with psoriasis vulgaris and 6/65 with psoriatic arthritis. Three of 12 patients had no history of smoking. Serum Krebs von den Lungen-6 (KL-6) levels were elevated in patients with ILD compared to those in patients without ILD. The indeterminate for usual interstitial pneumonia (UIP) pattern was the most prevalent CT finding. A lung biopsy specimen from a representative case revealed equivalent indeterminate for UIP. Over a median 8.9-year observation period, ILD progressed in only 5 patients, with no cases of respiratory failure or death due to ILD progression, suggesting generally favourable prognoses.ConclusionsILD associated with psoriasis would be present, and its frequency is 10% of patients with psoriasis. We propose that chest radiography and a serum KL-6 test at the initial diagnosis of psoriasis would be useful in screening for the detection of ILD. We also recommend that a physician diagnosing ILD should carefully examine the skin findings, considering if psoriasis could be associated with ILD.Trial registrationNot applicable.

Effects of acute-phase COVID-19-related indicators on pulmonary fibrosis and follow-up evaluation

BackgroundPost-COVID-19 pulmonary fibrosis is a significant long-term respiratory morbidity affecting patients’ respiratory health. This exploratory study aims to investigate the incidence, clinical characteristics, and acute-phase risk factors for pulmonary fibrosis in COVID-19 patients. Additionally, it evaluates pulmonary function and chest CT outcomes to provide clinical evidence for the early identification of high-risk patients and the prevention of post-COVID-19 pulmonary fibrosis.MethodsWe retrospectively analyzed 595 patients hospitalized for COVID-19 from January 2022 to July 2023. Patients were divided into fibrosis and nonfibrosis groups on the basis of imaging changes. Baseline data, including demographics, disease severity, laboratory indicators, and chest imaging characteristics, were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for pulmonary fibrosis. Pulmonary function and chest CT follow-ups were conducted for the fibrosis group. The data were processed via SPSS 26.0, with P < 0.05 considered statistically significant.ResultsThe incidence of pulmonary fibrosis was 4.37%, with 2.08% in moderate cases and 8.22% in severe cases. Significant differences were found between the fibrosis and nonfibrosis groups in sex; disease severity; NLR; ALB and LDH levels; and percentages of lung reticular lesions, consolidations, and GGOs (P < 0.05). Multivariate analysis revealed LDH (OR = 1.004, 95% CI 1.000–1.007, P = 0.035), ALB (OR = 0.871, 95% CI 0.778–0.974, P = 0.015), lung reticular lesion volume (OR = 1.116, 95% CI 1.040–1.199, P = 0.002), and lung consolidation volume (OR = 1.131, 95% CI 1.012–1.264, P = 0.030) as independent risk factors. The follow-up results revealed significant improvements in pulmonary function, specifically in the FVC%, FEV1%, and DLCO%, but not in the FEV1/FVC. Quantitative chest CT analysis revealed significant differences in lung reticular lesions, consolidation, and GGO volumes but no significant difference in honeycomb volume.ConclusionsThe incidence of pulmonary fibrosis post-COVID-19 increases with disease severity. LDH, ALB, lung reticular lesions, and consolidation volume are independent risk factors for patients with fibrosis.

Characteristics of achalasia and detection of pulmonary complications: A comparison of findings in younger and elderly patients

Background: Achalasia is a rare esophageal motility disorder of unknown etiology, which leads to changes in the pressure and relaxation of the lower esophageal sphincter (LES), affecting peristalsis and contraction of the esophageal body. Dysphagia can impact individuals of any age, it is frequent in the elderly. Non-specific gastrointestinal symptoms are delayed and can give false diagnoses. The aim of this study is to compare clinical presentation and pulmonary complications in younger (Group I) and elderly patients (Group II). Methods: 108 patients with achalasia were separated into two groups—young and elderly patients. Demographic, clinical, radiological and manometric data, smoking status, and symptom score were compared between these groups. Results: There was no significant difference in gender, duration of symptoms, body mass index (BMI), or diameter of esophagus between the two patient groups. There was a statistically significant difference between frequencies of comorbidity between groups (p = 0.009). Even though there were no differences in chest tomography scan (CT) findings and diameter, there were statistical differences in diffusion capacity (p = 0.041). Respiratory symptoms occurred in 38 (48.7%) patients in Group I and in 20 (66.7%) in Group II (p = 0.011). Cough was dominant in the younger group, but fatigue and chest pain were statistically significant and frequent in elderly group patients with achalasia. There was no significant difference in Eskardt symptom score (ESS), but there was the difference in the frequency of individual symptoms. Vomitus and regurgitation were statistically higher frequent in Group I, but dysphagia and weight loss in Group II. Subtype 1 was dominant in the younger group, and subtype 2 in a group with older patients. Conclusion: The younger achalasia population group was found to be associated with decreased diffusion capacity, type 1 achalasia, cough, and gastrointestinal symptoms such as vomitus and regurgitation. Geriatric status was found to be associated with frequent comorbidities, subtype 2, frequent respiratory symptoms, dysphagia, and weight loss. Our findings demonstrated an association between esophageal motility abnormalities and characteristics of geriatric population.

Clinical Characteristics and Outcomes of COVID-19 in Pediatric Cancer Patients: A Retrospective Cohort Study

Background: The impact of COVID-19 on pediatric cancer patients remains a critical area of investigation. Objectives: This study aimed to compare the clinical characteristics and outcomes of COVID-19 in children with and without malignancies. Methods: A retrospective cohort study was conducted at Mofid Children's Hospital in Tehran, Iran, from July 2020 to December 2022. The study included 210 children with confirmed SARS-CoV-2 infection: 105 with malignancies (case group) and 105 without malignancies (control group). Clinical presentations, laboratory parameters, imaging findings, and outcomes were analyzed. Results: Children with malignancies exhibited lower rates of fever (P = 0.044), respiratory distress (P = 0.035), and nausea/vomiting (P = 0.002). Significant differences in laboratory findings were observed between the case and control groups, including WBC count (P = 0.007), hemoglobin levels (P &lt; 0.001), platelet count (P = 0.002), and ESR (P = 0.001). Ground-glass opacity on chest imaging was significantly associated with malignancy (P = 0.003). Although not statistically significant, the malignancy group showed a trend toward higher mortality (OR = 2.686, P = 0.105). Thrombotic events were rare in both groups. Conclusions: Pediatric cancer patients with COVID-19 exhibited more severe symptoms and distinct laboratory and imaging findings compared to non-cancer patients. While mortality rates were similar, the trend toward higher risk in the malignancy group highlights the need for specialized management strategies for this vulnerable population.

Chest X-Ray Features in 130 Patients with Bronchiectasis.

Background/Objectives: The prevalence of bronchiectasis is increasing globally, and early detection using chest imaging has been encouraged to improve its prognosis. However, the sensitivity of a chest X-ray as a screening tool remains unclear. This study examined the chest X-ray features predictive of bronchiectasis. Methods: We retrospectively reviewed the chest X-rays of patients with bronchiectasis diagnosed using high-resolution computed tomography who visited our institute from January 2013 to March 2020. Patients with cardiac pacemakers, lung cancer, and interstitial pneumonia, which might bias the detection of bronchiectasis, were excluded. Two respiratory physicians independently determined the presence or absence of potential features reflecting bronchiectasis, including a vague cardiac silhouette on chest X-rays. Results: The study enrolled 130 patients, including 72 women (55.4%), with a mean age of 72 years. The features observed on chest X-rays included granular shadows (88.5%, n = 115), vague cardiac silhouettes (48.5%, n = 64), nodular shadows (45.4%, n = 59), a tram-track appearance (35.4%, n = 46), pleural thickening (26.9%, n = 35), vague diaphragm silhouettes (25.4%, n = 33), and a ring sign (24.6%, n = 32). The kappa values for these features were 0.271, 0.344, 0.646, 0.256, 0.312, 0.514, and 0.376, respectively. Conclusions: Although traditional chest X-ray features believed to reflect bronchiectasis, such as the tram-track appearance or ring sign, were not frequently seen, vague cardiac silhouettes and granular shadows had high positivity rates, indicating their potential utility for bronchiectasis screening. However, the interobserver concordance rates were unsatisfactory.