Interlobular Septal Thickening Research Articles

Uncommon Causes of Interlobular Septal Thickening on CT Images and Their Distinguishing Features.

Interlobular septa thickening (ILST) is a common and easily recognized feature on computed tomography (CT) images in many lung disorders. ILST thickening can be smooth (most common), nodular, or irregular. Smooth ILST can be seen in pulmonary edema, pulmonary alveolar proteinosis, and lymphangitic spread of tumors. Nodular ILST can be seen in the lymphangitic spread of tumors, sarcoidosis, and silicosis. Irregular ILST is a finding suggestive of interstitial fibrosis, which is a common finding in fibrotic lung diseases, including sarcoidosis and usual interstitial pneumonia. Pulmonary edema and lymphangitic spread of tumors are the commonly encountered causes of ILST. It is important to narrow down the differential diagnosis as much as possible by assessing the appearance and distribution of ILST, as well as other pulmonary and extrapulmonary findings. This review will focus on the CT characterization of the secondary pulmonary lobule and ILST. Various uncommon causes of ILST will be discussed, including infections, interstitial pneumonia, depositional/infiltrative conditions, inhalational disorders, malignancies, congenital/inherited conditions, and iatrogenic causes. Awareness of the imaging appearance and various causes of ILST allows for a systematic approach, which is important for a timely diagnosis. This study highlights the importance of a structured approach to CT scan analysis that considers ILST characteristics, associated findings, and differential diagnostic considerations to facilitate accurate diagnoses.

CT Quantification of Interstitial Lung Abnormalities and Changes of Agerelated Pathomorphology.

Interstitial lung abnormalities (ILA) are associated with further disease progression, increased mortality risk, and decline in lung function in the elderly, which deserves enough attention. The objective of this study was to quantify the extent of interstitial lung abnormalities (ILA) in a non-smoking asymptomatic urban cohort in China using low-dose CT (LDCT) and to analyze the age-related pathological changes. We retrospectively analyzed clinical data and chest LDCT images from a cohort of 733 subjects who were categorized into 3 groups: 18-39, 40-59, and ≥60 years old according to age. Furthermore, we selected 40 cases of wax-embedded lung tissue blocks archived after pulmonary bullectomy and the same age groups were categorized. Four representative CT signs of ILA, including interlobular septal thickening (ILST), intralobular interstitial thickening (ILIT), ground-glass opacity (GGO), and reticular shadow (RS), were semi-quantified based on the percentage of the affected area. The scores and distribution of four CT signs of ILA were compared between different sex and age groups. The age-related pathological changes were analyzed. The ILA findings were found predominantly in the lower lobes and the subpleural region. The semi-quantitative scores of four CT signs in all subjects under 40 were 0. However, in subjects over 40 years old, the scores gradually increased with age, although most of them remained low. The size of the alveoli increased, the number of alveoli decreased, the alveolar septum became thinner, and the number of ATII cells increased with age. A statistically significant difference was observed among the different age groups (χ2=50.624, P=0.033; χ2=80.000, P=0.043; χ2=33.833, P=0.000; χ2=13.525, P=0.031). The macrophage population and the percentage of collagen fibers in the alveolar septum increased, while the percentage of elastic fibers decreased with age. There was no significant difference among the different age groups (χ2=19.817, P=0.506; χ2=52.419, P=0. 682; χ2=54.868, P=0.518). When the four CT signs mentioned above are in the upper central area, and the score has a medium or high score, it is crucial to determine the underlying pathological causes. ILA may be the result of chronic lung injury.

Long-term outcomes of survivors with influenza A H1N1 virus-induced severe pneumonia and ARDS: a single-center prospective cohort study.

Systematic evaluation of long-term outcomes in survivors of H1N1 is still lacking. This study aimed to characterize long-term outcomes of severe H1N1-induced pneumonia and acute respiratory distress syndrome (ARDS). This was a single-center, prospective, cohort study. Survivors were followed up for four times after discharge from intensive care unit (ICU) by lung high-resolution computed tomography (HRCT), pulmonary function assessment, 6-minute walk test (6MWT), and SF-36 instrument. A total of 60 survivors of H1N1-induced pneumonia and ARDS were followed up for four times. The carbon monoxide at single breath (DLCO) of predicted values and the 6MWT results didn't continue improving after 3 months. Health-related quality of life didn't change during the 12 months after ICU discharge. Reticulation or interlobular septal thickening on HRCT did not begin to improve significantly until the 12-month follow-up. The DLCO of predicted values showed negative correlation with the severity degree of primary disease and reticulation or interlobular septal thickening, and a positive correlation with physical functioning. The DLCO of predicted values and reticulation or interlobular septal thickening both correlated with the highest tidal volume during mechanical ventilation. Levels of fibrogenic cytokines had a positive correlation with reticulation or interlobular septal thickening. The improvements in pulmonary function and exercise capacity, imaging, and health-related quality of life had different time phase and impact on each other during 12 months of follow-up. Long-term outcomes of pulmonary fibrosis might be related to the lung injury and excessive lung fibroproliferation at the early stage during ICU admission.

HRCT chest: A valuable tool to differentiate other pneumonias from covid-19 pneumonia

To assess how COVID-19 pneumonia differs from other pneumonias in terms of the chest computed tomography features.In this study we included 170 clinically diagnosed cases pneumonia referred to department of radio diagnosis subjected to HRCT thorax which include out patients and in patients out of which 127 patients tested RT-PCR positive for Covid 19 pneumonia for a total duration of 1 year. (March 2020 to March 2021). The parenchymal abnormalities including Ground glass opacities (GGO), ground glass opacities with interlobular septal thickening (crazy paving), GGO with consolidation, consolidation, pulmonary nodules, tree in bud appearances, bronchiolar wall thickening, interlobular septal thickening , halo sign, reverse halo sign, cavitation and pleural effusion and were observed and categorized along with determination of pattern of distribution on chest CT.127 patients who tested positive for COVID 19 and 43 patients with other pneumonia (such as community-acquired pneumonia) were visited, and CT scans were analysed to determine the presence and distribution of the disease pattern.Patients with COVID 19 pneumonia primarily have peripheral-based lesions (90%), whereas patients with other pneumonias primarily have mixed patterns (70%)—a difference that is statistically different (p 0.05).Statistics show that COVID 19 had higher bilateral involvement than other pneumonia (p<0.05). In COVID-19 pneumonia, GGOs, GGOs with interlobular septal thickening (crazy paving), and GGOs with consolidation with peripheral and basal predominance in bilateral lung parenchyma are the most common imaging patterns and findings. These findings will help us distinguish COVID-19 pneumonia from other causes of pneumonia. There is less evidence of tree in bud, pure consolidation, cavitation, and bronchiolar wall thickening.

Short- and Long-Term Chest-CT Findings after Recovery from COVID-19: A Systematic Review and Meta-Analysis.

While ground-glass opacity, consolidation, and fibrosis in the lungs are some of the hallmarks of acute SAR-CoV-2 infection, it remains unclear whether these pulmonary radiological findings would resolve after acute symptoms have subsided. We conducted a systematic review and meta-analysis to evaluate chest computed tomography (CT) abnormalities stratified by COVID-19 disease severity and multiple timepoints post-infection. PubMed/MEDLINE was searched for relevant articles until 23 May 2023. Studies with COVID-19-recovered patients and follow-up chest CT at least 12 months post-infection were included. CT findings were evaluated at short-term (1-6 months) and long-term (12-24 months) follow-ups and by disease severity (severe and non-severe). A generalized linear mixed-effects model with random effects was used to estimate event rates for CT findings. A total of 2517 studies were identified, of which 43 met the inclusion (N = 8858 patients). Fibrotic-like changes had the highest event rate at short-term (0.44 [0.3-0.59]) and long-term (0.38 [0.23-0.56]) follow-ups. A meta-regression showed that over time the event rates decreased for any abnormality (β = -0.137, p = 0.002), ground-glass opacities (β = -0.169, p < 0.001), increased for honeycombing (β = 0.075, p = 0.03), and did not change for fibrotic-like changes, bronchiectasis, reticulation, and interlobular septal thickening (p > 0.05 for all). The severe subgroup had significantly higher rates of any abnormalities (p < 0.001), bronchiectasis (p = 0.02), fibrotic-like changes (p = 0.03), and reticulation (p < 0.001) at long-term follow-ups when compared to the non-severe subgroup. In conclusion, significant CT abnormalities remained up to 2 years post-COVID-19, especially in patients with severe disease. Long-lasting pulmonary abnormalities post-SARS-CoV-2 infection signal a future public health concern, necessitating extended monitoring, rehabilitation, survivor support, vaccination, and ongoing research for targeted therapies.

Subclinical pleuro-pulmonary disease in patients with SLE: functional and radiological methods

Abstract Background Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with highest prevalence of chest involvement; however, early detection of subclinical pleuropulmonary diseases may improve the quality of life and prognosis of patients. This study aimed to identify the subclinical pleuro-pulmonary involvement in SLE patients without respiratory symptoms. Methods A total of 228 patients diagnosed with SLE were recruited and subjected to high-resolution computed tomography (HRCT) chest, ultrasound (US) chest, and spirometry for further evaluation and finding of sub-clinical signs. Results Around 52.63% of patients had pulmonary involvement in HRCT, while in US, it was 73.68%. Ground glass opacity was observed in 31.58% of HRCT cases, and &gt; 1/3 of patients had pleural thickness in US. Spirometry showed that 26.32% of patients had small airway disease. SLE patients with subclinical lung involvement were significantly female and younger and had shorter disease duration, p &lt; 0.05 for all. SLE severity showed a significant negative correlation with lung function, and was positively correlated with pleural thickness and effusion, and pleural nodules in US finding. However, diaphragmatic excursion showed a negative correlation. Moreover, ground glass opacities, honey combing opacities, interlobular septal thickening, pleural thickness, and effusion in HRCT showed positive correlation with disease severity, p &lt; 0.001 for all, yet, the mosaic pattern showed a negative relationship. Conclusion The radiological assessments of SLE patients via HRCT and ultrasound unveiled prevalent findings such as ground glass opacities and pleural abnormalities. The severity of SLE correlated significantly with pulmonary function tests in a negative way, plus the positive correlation with lung opacities and pleural abnormalities.

The Use of Low-Dose Chest Computed Tomography for the Diagnosis and Monitoring of Pulmonary Infections in Patients with Hematologic Malignancies.

The study aimed to assess the image quality and diagnostic performance of low-dose Chest Computed Tomography (LDCCT) in detecting pulmonary infections in patients with hematologic malignancies. A total of 164 neutropenic patients underwent 256 consecutive CT examinations, comparing 149 LDCCT and 107 Standard-Dose Chest CT (SDCCT) between May 2015 and June 2019. LDCCT demonstrated a 47% reduction in radiation dose while maintaining acceptable image noise and quality compared to SDCCT. However, LDCCT exhibited lower sensitivity in detecting consolidation (27.5%) and ground glass opacity (64.4%) compared to SDCCT (45.8% and 82.2%, respectively) with all the respective p-values from unadjusted and adjusted for sex, age, and BMI analyses being lower than 0.006 and the corresponding Odds Ratios of detection ranging from 0.30 to 0.34. Similar trends were observed for nodules ≥3 mm and ground glass halo in nodules but were not affected by sex, age and BMI. No significant differences were found for cavitation in nodules, diffuse interlobular septal thickening, pleural effusion, pericardial effusion, and lymphadenopathy. In conclusion, LDCCT achieved substantial dose reduction with satisfactory image quality but showed limitations in detecting specific radiologic findings associated with pulmonary infections in neutropenic patients compared to SDCCT.

Is it possible to differentiate pulmonary sarcoidosis in tumor patients and pulmonary lymphangitic carcinomatosis caused by extrapulmonary tumors on 18F-FDG PET/CT images?

PurposePulmonary sarcoidosis (PS) and pulmonary lymphangitic carcinomatosis (PLC) can be complications in tumor patients, and both involve the pulmonary interstitium and have similar imaging findings. Our objective was to distinguish PS and PLC on 18F-FDG PET/CT images.Material and methodsThe authors reviewed 18F-FDG PET/CT data of PS and PLC, diagnosed based on histopathology and imaging, in patients with tumors from July 2015 to January 2023. Three independent readers performed a blinded comparative analysis of 18F-FDG PET/CT signs in all patients. A multivariate logistic regression model was used to establish a differential diagnosis model.ResultsA total of 114 patients were included in the study: 56 patients with PS (mean age, 56 ± 11 [SD] years; 10 men) and 58 patients with PLC caused by extrapulmonary tumors (mean age, 51 ± 11 [SD] years; 21 men). For PS, breast cancer and cervical cancer were the most common primary tumors. For PLC, breast cancer and gastric cancer were the most common extrapulmonary tumors. The model constructed using multivariate logistic regression consisted of five factors: area of lymph node involvement, bronchovascular bundle diffuse thickening, interlobular septal thickening, pleural effusion, and subpleural hypermetabolic activity. The area under the model characteristic curve was 0.973 (95% CI 0.925–0.994), with a sensitivity, specificity, and positive and negative likelihood ratios of 87.50%, 98.28%, 50.75 and 0.13 respectively.ConclusionThere are detailed differences in 18F-FDG PET/CT manifestations of PS in tumor patients and PLC caused by extrapulmonary tumors, and the constructed diagnostic model has high clinical application value in differentiating the two.

Retrospective analysis of confirmed cases of pulmonary veno-occlusive disease: a single tertiary referral center study

Abstract Background Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary hypertension that primarily results in intimal fibrosis of the pulmonary venules and veins, the venous lesions are often associated with changes in interlobular septa, lung parenchyma, and pulmonary arterioles and arteries. Purpose We sought to study the clinical characteristics of patients with confirmed PVOD at a single large referral center. Methods We retrospectively reviewed data from a total of 675 patients with pulmonary hypertension (identified by ICD codes or search of text) from 2017 and 2022 from a database obtained from electronic medical records at our institution. Patients with group 2 pulmonary hypertension were excluded. Only 29 cases were confirmed by histology or genetic testing. Results Out of the 29 patients confirmed with PVOD, 28 (96.5%) had a characteristic histology (lung biopsy (55.1%), explanted lung for transplant (27.5%) and autopsy (13.7%)) and 1 (3.4%) had a positive genetic test for EIF2AK4 biallelic mutation. The age at diagnosis was 53±16 years, 14 (48.2%) were men, 2 (6.8%) had systemic scleroderma, 2 (6.8%) had psoriasis, 2 (6.8%) were exposed to cytotoxic agents, 16 (55.1%) were smokers and 2 (6.8%) had a family history of pulmonary hypertension. All patients had computed tomography of the chest but only 12 (41.3%) had all 3 typical features found in PVOD (ground glass opacities, interlobular septal thickening, and lymphadenopathy). The most common feature was interlobular septal thickening in 26 (89.6%), followed by ground glass opacities present in 25 (86.2%) and lymphadenopathy in 12 (41.3%) of the patients. At diagnosis, mean pulmonary artery pressure was 45±15 mmHg and pulmonary vascular resistance was 9±6 WU. The median DLCO was 41 (34-58) %. On echocardiogram, 14 (48.2%) had severely enlarged right ventricle (RV), RV function was ≥moderately reduced in 17 (58.6%), RV systolic pressure was 63±20 mmHg and 6 (20.6%) had pericardial effusion. Out of 21 (72.4%) patients who received pulmonary vasodilators, 4 (13.7%) received single agent. 10 (34.4%) received 2 agents, 6 (20.6%) 3 agents, and 1 (3.4%) received 4 agents. 35.7% of these treated patients reported an improvement or initial worsening of symptoms with subsequent improvement afterwards. 18 (62%) patients with PVOD died, 12 (41.3%) had a lung transplant and 6 (20.6%) were still alive without the transplant until the day data was collected. Mean duration from diagnosis to death and lung transplantation was 446 ± 405 days and 274±479 days respectively. Conclusion PVOD is a rare and lethal cause of pulmonary hypertension. When suspected, a trial of medical therapy should be initiated carefully. The evaluation for lung transplant should be considered early given its high mortality.

The prevalence and significance of the EIF2AK4 variants in the patients with pulmonary arterial hypertension

Abstract Background Eukaryotic translation initiation factor 2 alpha kinase 4 (EIF2AK4) has been reported to be the causative gene of pulmonary veno-occlusive disease (PVOD).[1] Although some patients with pulmonary arterial hypertension (PAH) also carry the EIF2AK4 variants, its importance remains unclear. Purpose The purpose of this study was to evaluate the prevalence and significance of EIF2AK4 variants in patients with PAH. Methods The whole exome sequencing were performed in total 162 patients with idiopathic or heritable PAH. The clinical data including the high-resolution CT scanning, pulmonary function test, laboratory data at diagnosis, and therapeutic response to pulmonary vasodilator were evaluated. Results We identified the heterozygous variants of EIF2AK4 in 6 (3.7%) patients. Among them, 2 patients also had bone morphogenetic protein receptor type 2 (BMPR2) variants which were defined as pathogenic by American College of Medical Genetics and Genomics classification. The other 4 patients did not have known PAH associated gene variants. Although the typical findings of PVOD such as interlobular septal thickening and enlarged mediastinal lymph nodes, were not identified by the CT scanning, the median percent diffusing capacity for carbon monoxide of patients with EIF2AK4 heterozygous variants was reduced to 45.6%. In addition, 4 of 6 patients received prostacyclin injection therapy because oral combination therapy was ineffective, and 2 patients died. Moreover, none of the 6 patients reached mean pulmonary arterial pressure≤30 mmHg despite the combination therapy. We also identified homozygous EIF2AK4 variants in 2 patients with PAH. They did not have the known causative variants of PAH. CT scanning at diagnosis did not detect any characteristic of PVOD in either of the two patients. Although the pulmonary vasodilator was initiated without induction of pulmonary edema, one patient was refractory to the therapy. Conclusions The genetic analysis is crucial for accurate diagnosis even in patients diagnosed with PAH because heterozygous or homozygous variants in EIF2AK4 could be involved in the disease pathology.

High Resolution Computed Tomography chest findings among people affected by corona virus disease in a tertiary hospital of Nepal

Clinical assessment, chest X-ray (CXR) and chest high-resolution computed tomography (HRCT) are used in the management of Corona virus disease-19 (COVID-19). This retrospective cross sectional study included 251 patients admitted to Nepal Medical College Teaching Hospital (NMCTH) with a diagnosis of COVID‑19 infection confirmed by Reverse Transcriptase- Polymerase Chain Reaction (RT‑PCR). These patients underwent chest HRCT within the first two weeks of hospital admission. Images were evaluated for various HRCT findings &amp; semi- quantitative CT Severity Score (CT –SS) was calculated based on the extent of lobar involvement. Out of 251 patients with positive RT PCR test, 127 were male (50.6%) and 124 female (49.4%). Typical bilateral peripheral subpleural ground glass opacities were demonstrated in 98.8% of patients; followed by thoracic lymphadenopathy (80.8%), interlobular septal thickening (80.4%),vascular changes (44.2%), focal consolidation (28.6%), consolidation with ground glass opacity (15%), pleural effusion (13.1%) bronchiectasis (3.8%), fibrotic changes (3.1%) and reversed halo pattern (0.7%). Calculated CT- SS showed moderate score in 130 patients (51.7%) followed by severe score in 67 patients (26.6%) and mild score in 51 patients (20.3%). HRCT can be used as a one stop radiological investigation for the diagnosis and prognosis of corona virus disease and CT -SS might be beneficial for diagnostic workflow in symptomatic cases.

Occult paraquat poisoning causing pneumomediastinum and organizing pneumonia.

Pneumomediastinum is not an uncommon manifestation of lung toxicity in acute paraquat ingestion. The condition is almost invariably seen with other lung parenchymal abnormalities such as consolidations, ground-glass opacities and interlobular septal thickening. The diagnosis may be challenging in cases with no history of toxin exposure, presentation with a subacute illness and/or absence of typical local or systemic features of paraquat toxicity.

Placental transmogrification of the lung: CT findings with pathologic correlation in six patients.

Placental transmogrification of the lung is a very rare benign lung disease with a characteristic finding being alveoli resembling chorionic villi of the placenta. The purpose of this study was to assess the computed tomography (CT) findings of placental transmogrification of the lung in six patients and their relation to the histopathologic findings. Six patients with histopathologically proven placental transmogrification of the lung from 2004 to 2021 were included. Their CT findings were analyzed and their imaging features were compared with pathology specimens. In four of six cases, CT showed variable sized cystic lesions confined to a unilateral lung. One case presented nodule and cystic lesion together. The other case showed solitary pulmonary nodule without cystic lesion. Moreover, nodular interlobular septal thickening and clustered interstitial nodules were observed in all six cases. In four of the six cases, these nodules merged into dense nodular consolidation. Three cases showed dilated pulmonary vasculatures of the involved lung. On CT, placental transmogrification of the lung typically presents as cystic lesion confined to a unilateral lung. Pulmonary nodule with or without associated cystic lesion can also be seen. Nodular interlobular septal thickening and clustered interstitial nodules were observed in all cases. This might be attributable to the proliferation of chorionic villi-like structures in interstitium which are found in histopathologic specimens.

Rapid genome diagnosis of alveolar capillary dysplasia leading to treatment in a child with respiratory and cardiac failure.

Alveolar capillary dysplasia (ACD) is a fatal disorder that typically presents in the neonatal period with refractory hypoxemia and pulmonary hypertension. Lung biopsy is traditionally required to establish the diagnosis. We report a 22-mo-old male who presented with anemia, severe pulmonary hypertension, and right heart failure. He had a complicated hospital course resulting in cardiac arrest and requirement for extracorporeal membrane oxygenation. Computed tomography of the chest showed a heterogenous pattern of interlobular septal thickening and pulmonary edema. The etiology of his condition was unknown, lung biopsy was contraindicated because of his medical fragility, and discussions were held to move to palliative care. Rapid whole-genome sequencing (rWGS) was performed. In 2 d it resulted, revealing a novel FOXF1 gene pathogenic variant that led to the presumptive diagnosis of atypical ACD. Cases of atypical ACD have been reported with survival in patients using medical therapy or lung transplantation. Based on the rWGS diagnosis and more favorable potential of atypical ACD, aggressive medical treatment was pursued. The patient was discharged home after 67 d in the hospital; he is currently doing well more than 30 mo after his initial presentation with only one subsequent hospitalization and no requirement for lung transplantation. Our case reveals the potential for use of rWGS in a critically ill child in which the diagnosis is unknown. rWGS and other advanced genetic tests can guide clinical management and expand our understanding of atypical ACD and other conditions.

ROLE OF CT CHEST IN EVALUATION OF PULMONARY MANIFESTATIONS OF COVID-19 RECOVERED CASES

Objective: Pulmonary manifestations may be seen in a number of coronavirus disease 2019 (COVID-19)-recovered the evidence on post-COVID pulmonary sequelae is still limited. Herein, we aim to assess the role of computed tomography (CT) chest in the evaluation of pulmonary manifestations of COVID-19 recovered cases. Methods: We conducted a hospital-based study in the Department of Radiodiagnosis at Government Medical College and Rajindra Hospital Patiala. It included 182 reverse transcriptase-polymerase chain reaction (RT-PCR)-proven COVID-19 patients after they recovered from the disease with at least one negative RT-PCR test and/or clinical recovery. Clinical data and CT findings in the recovery phase were summarized, and the relationship of different clinical parameters with CT severity scores was analyzed. Results: The mean (±standard deviation [SD]) age of patients was 50.2±14.7 years, and 62.6% of them were males. The mean (±SD) symptomatic-scan interval was 33.05±22.27 days. Pulmonary abnormalities were found in the majority of the cases in the recovery phase, that is, 176 patients accounting for 96.7%, while six patients had normal scans. Bilateral involvement was seen in 169 out of 176 patients. Common CT patterns observed were ground glass opacities (90.34%), reticular pattern (81.82%), interlobular septal thickening (70.45%), linear opacities (90.34% cases), fibrous stripes (78.41% cases), and consolidation (36.93%). The mean (±SD) CT severity score of our study subjects was 16.10±7.95. Patients were also categorized into four groups according to symptomatic scan interval &lt;1 month, 1–2 month, 2–3 month, and &gt;3 months. We found that residual changes were more severe in patients with shorter symptomatic scan interval. Conclusion: COVID-19 patients demonstrate persistent pulmonary abnormalities even after clinical recovery. Hence, follow-up in patients with moderate and severe disease is strongly recommended.

CT Scan Differences of Pulmonary TB According to Presence of Pleural Effusion

Subpleural micronodules and interlobular septal thickening are common computed tomography (CT) findings in tuberculous (TB) pleural effusion. These CT features could help us differentiate between TB pleural effusion and non-tuberculous empyema. Does the frequency of subpleural micronodules and interlobular septal thickening correlate with the presence of pleural effusion in patients with pulmonary TB? CT findings of pulmonary TB, micronodules and their distribution (peribronchovascular, septal, subpleural, centrilobular, and random), large opacity (consolidation/macronodule), cavitation, tree-in-buds, bronchovascular bundle thickening, interlobular septal thickening, lymphadenopathy, and pleural effusion were retrospectively analyzed. Patients were divided into two groups according to the presence of pleural effusion. Clinicoradiological findings of the two groups were then analyzed. We presented Benjamini-Hochberg critical value for multiple testing correction of CT findings with false discovery rate of 0.05. Of a total of 338 consecutive patients diagnosed with pulmonary TB who underwent CT scans, 60 were excluded due to co-existing pulmonary diseases. The frequency of subpleural nodules (47/68, 69% in pulmonary TB with pleural effusion vs. 30/210, 14% in pulmonary TB without effusion, p < 0.001, Benjamini-Hochberg (B-H) critical value = 0.0036) and interlobular septal thickening (55/68, 81% vs. 134/210, 64%, p = 0.009, B-H critical value = 0.0107) was significantly higher in the group of patients with pulmonary TB with pleural effusion than in the group without pleural effusion. In contrast, tree-in-buds (20/68, 29% vs. 101/210, 48%, p = 0.007, B-H critical value = 0.0071) were less frequently seen in patients with pulmonary TB with pleural effusion. Subpleural nodules and septal thickening were more common in pulmonary TB patients with pleural effusion than in those without pleural effusion. TB involvement of the lymphatics in the peripheral interstitium could be associated with the development of pleural effusion.

The HRCT Imaging Findings of the Peripheral Pulmonary Vessels in Patients with Pulmonary Hypertension (PH)

The prominence of the pulmonary vasculature and/or tortuosity (n = 16) and dilatation of the central PA (n = 39) with RV hypertrophy were frequently observed. The interlobular septal thickening (n = 18, 45%), and centrilobular (perivascular) ground glass opacities (n = 6, 15%) were clearly depicted on gapless HRCT. PA aneurysmal dilatation and irregular dilatation with arterio-venous fistula were observed in 2 (5%) and 3 cases (7.5%), respectively. Bronchial artery dilatation was observed in 5 cases.

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

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

Juvenile idiopathic arthritis presenting as diffuse alveolar hemorrhage at onset: A case series.

The etiology of diffuse alveolar hemorrhage (DAH) in childhood is often unknown, and it may be an early manifestation of rheumatic disease. Juvenile idiopathic arthritis (JIA) is one of the most common rheumatic diseases in children, but DAH as an onset manifestation of JIA is rare. This study summarizes the clinical characteristics of patients with JIA presenting as DAH. We retrospectively analyzed the age of onset, clinical manifestations, imaging features, treatments, and prognosis of five cases of JIA presenting as DAH. Themedian age at DAH onset was 6 months (range, 2 months-3 years). Pallor was the most common manifestation of onset (5/5). Other symptoms included cough (2/5), tachypnea (2/5), hemoptysis (1/5), cyanosis (1/5), and fatigue (1/5). Imaging showed ground-glass opacity (GGO) (5/5), subpleural or intrapulmonary honeycombing (4/5), consolidation (3/5), interlobular septal thickening (2/5), and nodules (1/5). Anticitrullinated protein antibodies (ACPA) and rheumatoid factor (RF) were positive in five children (5/5), and antinuclear antibody (ANA) was positive in four children (4/5). ANA in three children and ACPA/RF in one child were positive before the onset of joint symptoms. The median age at the onset of joint symptoms was 3 years and 9 months (2 years and 6 months-8 years). Joint symptoms were mainly characterized by joint swelling, pain, and difficulty walking, and the most commonly affected joints were the knees, ankles, and wrists. After the diagnosis of DAH, the five patients were treated with glucocorticoids. Alveolar hemorrhage was effectively controlled in three cases, but the other two patients still had anemia and poor improvements in chest imaging. After joint symptoms, the patients were treated with glucocorticoids combined with diclofenac, disease-modifying antirheumatic drugs, and biological agents. Alveolar hemorrhage was in remission, and joint symptoms were relieved in the five cases. DAH can be the first clinical manifestation of JIA, and joint involvement occurs 1-5 years later. Children with DAH who are positive for RF, ACPA, and/or ANA and have GGO accompanied by honeycombing on imaging should be concerned about their joint involvement in future.

ROLE OF FOLLOW UP HIGH RESOLUTION COMPUTED TOMOGRAPHY LUNG IN POST COVID 19 INFECTION.

Background: The novel Coronavirus disease 2019 (COVID-19) is an illness caused due to SARS-CoV-2 and are primarily related to the pulmonary system. High resolution computed tomography is used to radiological pattern and manifestation of post covid-19 infection after 1 and 6 months. On High resolution computed tomography small patchy, ground-glass opacity (GGO), and consolidations , interlobular septal thickening, crazy-paving pattern, parenchymal bands , traction bronchiectasis and coarse reticulation were more common in patients. Material &amp; Methods: This was prospective observational study time bound study conducted in a tertiary care center in 160 patients of clinically diagnosed covid 19. HRCT was done at admission, after 1 month and at 6month with radiological nding studied and interpreted in detail. 1) Follow up Results: HRCT lung at one month has shown that most common nding was parenchymal bands in 97 (60.63%) cases followed by interlobular septal thickening in 93 (58.13%), ground glass opacity in 60 (37.5%), tractional bronchiectasis in 54 (33.75%), honeycombing/coarse reticular pattern/brotic changes in 37 (23.13%), consolidation in 25 (15.63%), air bronchogram in 05 (3.13%) &amp; emphysematous changes in 1 (0.6%) case. 2)Follow up HRCT lung at six months has shown that most common nding was interlobular septal thickening in 42 (26.25%) followed by parenchymal bands in 40 (25%) cases, tractional bronchiectasis in 41 (26.63%), honeycombing/coarse reticular pattern/brotic changes in 20 (12.5%), GGO in 15 (9.38%), consolidation in 06 (3.75%) &amp; emphysematous changes in 1 (0.6%) case. Conclusion: 1)HRCT is the modality which diagnoses the severity of disease and post covid 19 disease manifestation. 2)At one month there was persistence of honeycombing/coarse reticular pattern/brotic changes, interlobular septal thickening, parenchymal bands, tractional bronchiectasis &amp; emphysematous changes. 3)At six months there was persistence of tractional bronchiectasis &amp; emphysematous changes indicating persistence &amp; irreversibility of these changes