Interstitial Opacities Research Articles

The Association of the MeMed BV Test With Radiographic Pneumonia in Children.

The MeMed BV Test produces a score that increases with increasing likelihood of bacterial infection. We evaluated its association with radiographic pneumonia in children. We performed a secondary analysis of a multicenter prospective study of febrile children 90 days to 18 years presenting to an emergency department. We evaluated the association of the MeMed BV test with radiographic pneumonia in adjusted logistic regression models. Of 182 children, 74 (41%) had radiographic pneumonia. Among children with a high likelihood of having viral illness per the BV test, 26% had radiographic pneumonia; this increased to 64% among those with a BV test which indicated a high likelihood of bacterial infection. The sensitivity and specificity for radiographic pneumonia when using a BV test classification of moderate or high likelihood of bacterial infection were 60.8% and 62.0%, respectively. A BV test indicating the highest likelihood of bacterial infection had 23.61 higher adjusted odds (95% confidence interval 6.30-88.6) of radiographic pneumonia. The most common radiographic finding among children classified as having a high likelihood of viral infection by the BV test was interstitial opacities. The most common finding among children classified as having a high likelihood of bacterial infection were infiltrates. Except for antibiotic use, clinical outcomes occurred in similar proportions by BV category. Children with moderate to high likelihoods of bacterial infection on the BV test had higher odds of radiographic pneumonia. Apart from antibiotic use, the test was not significantly associated with clinical outcomes in this study.

Metal Pneumonitis from “Non-toxic” Decorative Cake Dust Aspiration: A Case Report

Introduction: Metallic luster dusts are decorative agents for cakes and other confections. While some powders are labeled “non-edible,” they are also marketed as “non-toxic.” We present a case of a child who developed acute metal pneumonitis after accidental aspiration of metallic luster dust. Case Report: A four-year-old presented to the emergency department (ED) in respiratorydistress after attempting to ingest gold decorative metallic luster dust. In the ED she was placed on supplemental oxygen. Her initial chest radiograph (CXR) was unremarkable. Her condition worsened despite high-flow nasal cannula oxygen, and she was intubated. A repeat CXR revealed patchy perihilar and peribronchial opacities. While receiving aggressive ventilatory support, her CXR worsened over the next 48 hours as bilateral interstitial and alveolar opacities progressed, likely representing acute metal pneumonitis with acute respiratory distress syndrome (ARDS). She remained intubated until hospital day (HD) 5, requiring supplemental oxygen until HD 9. She was discharged home on HD 10. A CXR obtained four months later demonstrated increased interstitial markings throughout both lungs with overinflation and subsegmental atelectasis. The patient had persistent dyspnea upon exertion, with pulmonology documenting that her symptoms were likely sequelae from inhalation of the cake luster dust. Conclusion: Non-edible metallic cake dusts are toxic. “Non-edible” labeling does not convey the health risks associated with handling by children, as evidenced by this case of metal pneumonitis with associated ARDS and chronic pulmonary disease. Accordingly, this descriptor should be abandoned for these products, and physicians should be aware of this potential complication.

Persistent Residual Lung Abnormalities (PRLAs) as Post COVID Lung Sequel in Recovered Severe Pneumonia Case with Lung Function Abnormality at Two Year Follow Up

Coronavirus related (SARS-CoV-2) global pandemic has caused significant mortality and morbidity globally in the last three years. Although, pandemic has waned since last year, we are not in great peace of relief due to lingering effects of COVID-19 persisted even after two years of illness. Radiological phenotypes are radiological patterns or observable characteristics of COVID-19 pneumonia. Radiological outcomes are initially interpreted as post covid lung fibrosis in short term follow-up of recovered COVID-19 cases in post covid care settings and during long term evaluation these abnormalities are defined as post covid sequalae’s. In present case report, 38-year male, presented in outdoor unit for shortness of breath on exertion with history of severe COVID-19 Pneumonia resulted into acute respiratory distress syndrome with hospitalization in intensive care unit one year back and required high flow nasal cannula (HFNC) with Non-invasive ventilatory support (NIV) for two weeks. He was offered oxygen supplementation at home with antibiotics for three months and no requirement of oxygen and some respiratory symptoms even after one year. His HRCT thorax documented at one year of discharge from hospital revealed typical interstitial opacities labelled as Persistent Residual lung abnormalities (RLAs) which 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.

Imaging patterns of Lophomonas blattarum infection in the respiratory tract: a registry-based analysis

BackgroundLophomonas blattarum is an emerging protozoan that mostly infects the lower respiratory tract and causes pulmonary lophomoniasis. Radiologic findings in patients with pulmonary lophomoniasis have yet to be studied. Thus, we conducted a registry-based clinical investigation to evaluate the radiologic findings of lophomoniasis.MethodsIn this cross-sectional study, 34 Lophomonas positive patients were enrolled. Demographic data, relevant characteristics, and radiologic findings of the patients were recorded and analyzed.ResultsThirty-four (male = 18, female = 16) patients with an average age of 52.21 ± 20.48 years old were examined. Radiological findings such as Alveolar consolidation (26.5%), Ground glass opacity (5.9%), Centrilobular nodules (23.5%), Tree -in- bud (38.2%), Cavitation (23.5%), Pleural effusion (23.5%), Interstitial opacity (8.8%), Lymphadenopathy (23.5%), Bronchocele (5.9%), Bronchiectasis (29.4%), Nodules (8.8%) and Mass (11.8%) were obtained, that the frequency of all radiological findings was less than 50%.ConclusionIn this study, the most common radiological findings in patients with lophomoniasis were tree-in-bud nodules, alveolar consolidation, bronchiectasis, and centrilobular nodules which were mostly seen in the right lung and its middle and lower lobes. Given that the radiologic findings of this disease are unknown, it can be considered in differential diagnosis.

Lung Imaging and Artificial Intelligence in ARDS.

Artificial intelligence (AI) can make intelligent decisions in a manner akin to that of the human mind. AI has the potential to improve clinical workflow, diagnosis, and prognosis, especially in radiology. Acute respiratory distress syndrome (ARDS) is a very diverse illness that is characterized by interstitial opacities, mostly in the dependent areas, decreased lung aeration with alveolar collapse, and inflammatory lung edema resulting in elevated lung weight. As a result, lung imaging is a crucial tool for evaluating the mechanical and morphological traits of ARDS patients. Compared to traditional chest radiography, sensitivity and specificity of lung computed tomography (CT) and ultrasound are higher. The state of the art in the application of AI is summarized in this narrative review which focuses on CT and ultrasound techniques in patients with ARDS. A total of eighteen items were retrieved. The primary goals of using AI for lung imaging were to evaluate the risk of developing ARDS, the measurement of alveolar recruitment, potential alternative diagnoses, and outcome. While the physician must still be present to guarantee a high standard of examination, AI could help the clinical team provide the best care possible.

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

ABSTRACT Coronavirus coronavirus-related (severe acute respiratory syndrome-corona virus-2) global pandemic has caused significant mortality and morbidity globally in the last 3 years. Although the pandemic has weaned off since last year, we are not in great peace of relief due to lingering effects of COVID-19 persisted even after 2 years of illness. These long COVID-19 manifestations are documented selected cases of COVID-19 pneumonia in pulmonary and extrapulmonary systems with variable impact on quality of life. In the present case report, a 57-year-old male, presented in the outdoor unit for shortness of breath on exertion, on oxygen supplementation at home during ambulation with a history of severe COVID-19 pneumonia resulted in acute respiratory distress syndrome with hospitalization in the intensive care unit 12 months back and required high flow nasal cannula with noninvasive ventilatory support for 3 weeks. His clinical and radiological severity were very well correlated with highly raised inflammatory markers such as C-reactive protein, interleukin-6, ferritin, lactate dehydrogenase, and D-Dimer. He was offered oxygen supplementation at home with antifibrotics for 3 months and observed significant improvement in clinical and radiological outcomes with persistent requirement of oxygen during ambulation and persistent respiratory symptoms even after 1 year of discharge from hospital. Rheumatological workup documented antinuclear antibody (ANA) and rheumatoid factor positive with inconclusive ANA profile reports. His high-resolution computerized tomography thorax documented at 1 year of discharge from the hospital revealed typical interstitial opacities labeled as progressive residual lung abnormalities (PRLAs) which are predominantly reticular and linear opacities in peripheral parts of lungs with honeycombing within typical pleural-based areas with parenchymal bands and altered lung architecture and decreased lung volume in both lungs. Honeycombing is a typical feature of progressive type of RLAs. We recommend these radiological outcome phenotypes as progressive radiological abnormalities (RLAs) at 1 year should be considered pulmonary fibrosis of unclassified type from a pulmonologist perspective due to pattern and presentation after COVID-19 which is not enrolled into interstitial lung disease classification as of now and progressive pulmonary fibrosis as per radiologists’ perspective due to progressive nature of the disease.

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.

A 58-year-old man with progressive dyspnea suffering from Munier-Kuhn syndrome

A 58-year-old man who was a former smoker and had a 20-pack-year smoking history presented to the hospital with worsening shortness of breath. Pulmonary function tests revealed mixed obstructive-restrictive physiology. Forced vital capacity (FVC) was predicted at 68%, forced expiratory volume in 1 second (FEV1) at 60% was predicted, FEV1/FVC at 67% was predicted, and Carbon monoxide (DLCO) diffusion capacity is expected to be 70%. Chest images show increased interstitial density around the hilum. There is massive tracheobronchiomegaly with a tortuous appearance in the airways. There is also a small degree of parenchymal scarring and fibrosis-like reticular perihilar interstitial opacity. CT images show traction bronchiectasis is a finding in the setting of fibrotic lung disease. When lung tissue becomes inelastic due to the formation of dense fibrosis, the airways appear blocked and dilated. Although this patient has dilated airways, the bronchiectasis is greater than the small amount of parenchymal fibrosis seen. Therefore, this process is not caused by parenchymal fibrosis, but rather by inherent pathology of the airway wall. The most frequently reported symptoms of Mounier-Kuhn syndrome are severe cough, difficulty breathing, and recurrent respiratory infections. Patients may complain of chest pain and hemoptysis, but systemic symptoms are rare and require immediate investigation for other diseases. Pulmonary function tests often reveal obstructive pulmonary disease, but in advanced stages there may be limited parenchymal changes, resulting in a mixed appearance, as in a patient's case. Because airway changes are considered irreversible, treatment is aimed at managing symptoms and reducing long-term complications. Recommended lifestyle modifications include quitting smoking and avoiding irritants/particulates. Concurrent COPD or asthma is addressed to limit further morbidity. The infection is treated aggressively, usually requiring broad-spectrum antibiotics to treat atypical infections. The use of expectorants and chest physiotherapy is considered helpful in preventing recurrent infections. Tracheal stenting may be considered if there are specific airways prone to collapse, but the spread of airway involvement limits its potential utility.

Predictors of in-hospital mortality in COVID 19 patients with type 2 diabetes mellitus in South India: A cross sectional study

Introduction: Evidence suggests that patients with diabetes who developed the COVID-19 infection are known to have glycaemic instability, impaired immunity and associated comorbidities such as heart diseases and obesity leading to increased risk of mortality. Hence the current study was planned to assess the factors affecting mortality in diabetic COVID-19 patients admitted in tertiary care hospitals in South India. Methods: This was a retrospective study involving diabetic COVID-19 patients hospitalized in South India, data was collected from hospital records using pre-tested semi-structured validated questionnaire from January 2021 to February 2022. Results: Out of 397 study patients, 66% (263) them were males. Mean age of the patients was 61± 11.6, male 60.6±11.8, and female was 61.5±11.3. Most common presenting symptoms were fever 62% (235), cough 47% (172), breathlessness 42% (149), followed by weakness 29% (114). 46% (184) patients had uncontrolled diabetes. Co-morbidity like hypertension etc., were seen in 63% (250) of the patients. Saturation below 93% was seen in 20% (75) patients. 26% (69) were on ventilators, 48(42%) were admitted in intensive care unit. Laboratory profile showed high C-reactive protein in (86%) 264, elevated D-dimer in 86% (240), low lymphocyte in 46% (182), elevated ferritin in 63% (177), high neutrophil in 30% (118) and low Hb in 24% (85). Radiological finding shows interstitial opacity in 58 % (148) and CT-ground glass opacity in 21% (86). Complications like acute kidney injury were seen in 29% (115) and acute respiratory distress in 10% (39). The case fatality rate was 14% (56). Elevated neutrophil, elevated aspartate aminotransferase, low oxygen saturation was found to be significantly associated with mortality in COVID-19 diabetic patients. Conclusion: In diabetic COVID 19 patients elevated aspartate alanine transaminase, neutrocytosis and oxygen saturation below 93% are independent risk factors for mortality.

‘Stepladder Lung Cavities’ with ‘Starry Sky Pattern’ in HRCT Thorax with Constitutional Symptoms: A Strong Predictor of Active Pulmonary Tuberculosis

Pulmonary Tuberculosis is most common diseases in India with significant mortality and morbidity. Tuberculosis can cause diverse thoracic presentations ranging from nodules, consolidations & cavitation, mediastinal adenopathy, pleural effusion to diffuse endobronchial disease presenting like bronchial asthma. In this case report, 29- year male, presented with constitutional symptoms for 4 months duration with partial response to medical treatment received according to their knowledge and experience towards bronchial asthma, enteric fever and jaundice. Radiological investigations documented only prominent hilum left side of thorax which was underestimated due to presence of wheeze. Recurrent, progressive and partially responding constitutional symptoms was the reason for referral to our center. We have also noted prominent hilum with inhomogeneous infiltrates left lung field and localized wheeze and crepitations on left side of thoracic cavity in mammary and interscapular region. We have further evaluated with HRCT thorax and observed thick-walled cavities in left upper lobe posterior segment. ‘Stepladder Lung Cavities’ in HRCT is defined as multiple cavities adjacent with each other partially communicating to noncommunicating of variable size and shape unilaterally or bilaterally in stepladder fashion. ‘Starry sky pattern’ in HRCT Thorax is defined as randomly placed nodular opacities presenting as discrete or conglomerated, interstitial and acinonodular opacities unilateral or bilateral adjacent to pulmonary cavities usually reported as satellite nodules. Satellite nodules are defined as nodular opacities adjacent to pulmonary primary caviatary lung disease and indicator lymphatic local spread and active pulmonary tuberculosis. We have done sputum examination and documented acid-fast bacilli in sputum smear and MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test. Treatment initiated with anti-tuberculosis (ATT) and recorded near complete radiological resolution, bacteriological cure after six months with good compliance. High index of suspicion is must while managing these cases with constitutional symptoms with typical ‘Stepladder Lung Cavities’ with ‘starry sky pattern’ in HRCT Thorax to have successful treatment outcome.

Correlation between the severity of lung involvement and nasal mucociliary clearance time and acute phase biomarkers in patients with COVID-19

Objectives: The aim of this research was to evaluate the correlation between the increased nasal mucociliary clearance time (NMCT) and chest computed tomography severity scores (CT-SS) and acute phase biomarkers in patients diagnosed with coronavirus disease 2019 (COVID-19) pneumonia. Patients and Methods: A total of 116 hospitalized patients were included in the prospective study between November 2021 and June 2022. For the measurement of the NMCT, all patients underwent the saccharin test. The patients were separated into two groups: Group 1, which included 53 patients (28 females, 25 males; mean age: 50.1±13.2 years; range, 19 to 75 years) with an NMCT of 7-13 min, and Group 2, comprising of 63 patients (32 females, 31 males; mean age: 52.3±12.1 years; range, 30 to 82 years) with an NMCT of 14-21 min. The CT-SS was adapted from a previous method including ground-glass opacity, interstitial opacity, and air entrapment and was used to express the severity and rate of involvement of COVID-19 pneumonia. Results: The mean CT-SS was 3.8±1.6 in Group 1 and significantly higher in Group 2 with 6.2±2.0 (p<0.001). In addition, a strong positive correlation was determined between the NMCT and CT-SS (r=0.711). The mean lung lobe involvement was 3.6±1.5 in Group 1 and 4.8±0.5 in Group 2, and the difference was statistically significant (p<0.001). The mean ferritin levels showed a statistically significant difference at 244.6±146.9 mg/L in Group 1 and 436.5±449.1 mg/L in Group 2 (p=0.038). Conclusion: The saccharin clearance test is not routinely used in clinical practice but with the lights of our study’s results increased NMCT results correlates with pneumonia severity scores in CT and it may be useful in the prediction of prognosis of pneumonia in COVID-19 patients.

Índices de oxigenación en relación con el grado de compromiso infeccioso pulmonar en tomografía computarizada

The reserch was based on describing oxygenation indices in relation to the compromise of lung parenchyma evaluated by diagnostic images of the thorax in patients with a diagnosis of lower respiratory tract infection. Retrospective cohort study in subjects who underwent oxygenation indices measurements and at least one chest CT scan with evidence of opacities, consolidation, pleural effusion, or no abnormal findings. A descriptive analysis was performed summarizing the qualitative variables in frequencies and percentages, and the quantitative variables in mean and standard deviation if their distribution was normal, median, and interquartile range if their distribution was not normal. A total of 3,150 patients were admitted to the final analysis, of whom 71.37% (2,248/3,150) had abnormal tomographic findings. The average age of the patients with opacity was 62.64 (SD: 18.15) compared to 60.69 (SD: 17.97) of the patients without opacity (p=0.014). SpO2/FiO2 was 8.72 average points lower (353.14 vs. 361.82; p=0.026) and PaO2/FiO2 was 12.61 average points lower (231.90 vs. 244.53; p=0.001) in patients with interstitial opacities versus patients without abnormal findings. SpO2/FiO2, SaO2, PaO2, and PaO2/FiO2 showed greater deterioration in patients with bilateral consolidation compared to patients without opacities (p<0.001, p<0.001, p<0.001, and p<0.001, respectively). Interstitial and/or alveolar opacities, consolidation, and pleural effusion present greater deterioration in oxygenation indices compared to patients without pulmonary involvement described in chest tomography.

ODP100 Hypoparathyroidism in the Setting of COVID-19: Increasingly Common Phenomenon

Abstract Background Acquired hypoparathyroidism (HPT) in adults is most commonly caused by post-surgical or autoimmune damage to the parathyroid glands. Genetic defects causing abnormal gland development, impaired parathyroid hormone (PTH) production or action are rare and typically diagnosed in childhood. Recent literature suggests surprisingly high prevalence of hypocalcemia in patients with SARS-CoV-2 infection and this finding is associated with poor outcomes. [1] We present a case of new onset HPT in a patient admitted with respiratory failure due to COVID-19. Case presentation A 63-year-old woman with history of obesity, GERD, asthma, presented to the ED with fever, cough, dyspnea, and diarrhea. She was found to have low O2 saturation, CXR revealed multifocal interstitial and airspace opacities. Her PCR SARS-CoV-2 test was positive and she was admitted to ICU. She was incidentally found to have severe hypocalcemia Ca 5.2 mg/dL (8.5 - 10.3 mg/dL), ionized Ca 2.46 mg/dL (4.50 - 5.10 mg/dL), albumin 3.7 g/dL (3.5 - 5. 0 g/dL). She denied any history of neck surgery, radiation or trauma and personal or family history of autoimmune or calcium disorders. Her calcium levels were normal over the past 4 years. She denied symptoms of hypocalcemia prior to presentation and reported leg cramps and finger numbness in the ED. Further work-up revealed PTH 13 pg/mL (15 - 65 pg/mL), 25-OH vitamin D 16 ng/mL (30 - 80 ng/mL), Mg 1.2 mg/dL (1.4 - 2.5 mg/dL), phosphorus 4.9 mg/dL (2.3 - 4.5 mg/dL), bicarbonate 26 mmol/L (22 - 32 mmol/L). Patient was started on Ca (IV and PO), Mg, and vitamin D replacement. PTH reassessment on days 6, 14, and 19 showed persistently low/inappropriately normal PTH (22, 14, and 8 pg/mL respectively) despite normalization of magnesium levels. Patient was discharged on Ca, Mg, and vitamin D supplementation with follow-up in Endocrinology clinic for further evaluation of her hypoparathyroidism progression. Conclusion SARS-CoV-2 infection causes a hypersensitive immune reaction and widespread inflammation. Emerging evidence suggests that this cytokine-mediated reaction and hypoxia associated with COVID-19 can affect the parathyroid glands, resulting in impaired PTH secretion. Furthermore, direct parathyroid tissue invasion and destruction by means of entry via angiotensin-converting enzyme 2 receptors has also been proposed [2]. Hypocalcemia in our patient could be multifactorial, however we believe that COVID-19 induced HPT was the leading mechanism. We hope that further research explores this hypothesis and elucidates the underlying pathophysiology.

Radiographic Features of COVID-19 in Children-A Systematic Review.

The SARS-CoV-19 (COVID-19) pandemic has become a global problem but has affected the paediatric population less so than in adults. The clinical picture in paediatrics can be different to adults but nonetheless both groups have been subject to frequent imaging. The overall aim of this study was to comprehensively summarise the findings of the available literature describing the chest radiograph (CXR) findings of paediatric patients with confirmed COVID-19. The COVID-19 landscape is rapidly changing, new information is being constantly brought to light, it is therefore important to appraise clinicians and the wider scientific community on the radiographic features of COVID-19 in children. Four databases, which included, PubMed; Medline; CINAHL; ScienceDirect were searched from the 30 November 2020 to the 5 March 2021. The review was conducted using the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA" guidelines. Studies were included for (1) publications with full text available, (2) patients with confirmed COVID-19 diagnoses, (3) CXR imaging features of COVID-19 were reported, (4) the age of patients was 0-18 years, (5) studies were limited to human subjects and (6) a language restriction of English was placed on the search. Quality assessment of included articles used the National of Health Quality Assessment Tool for Case Series Studies. Eight studies met our criteria for inclusion in the review. All eight studies documented the number of CXRs obtained, along with the number of abnormal CXRs. Seven out of the eight studies noted greater than 50% of the CXRs taken were abnormal. Opacification was the number one feature that was recorded in all eight studies, followed by pleural effusion which was seen in six studies. Consolidation and peri-bronchial thickening features were both evident in four studies. Opacification was sub-divided into common types of opacities i.e., consolidation, ground glass opacities, interstitial, alveolar and hazy. Consolidation was reported in half of the studies followed by ground glass opacities and interstitial opacities which was seen in three out of the eight studies. This systematic review provides insight into the common COVID-19 features that are seen on CXRs in paediatric patients. Opacification was the most common feature reported, with consolidation, ground glass and interstitial opacities the top three opacifications seen. Peri-bronchial thickening is reported. in the paediatric population but this differs from the adult population and was not reported as a common radiographic finding typically seen in adults. This systematic review highlights the CXR appearances of paediatric patients with confirmed SARS-CoV-19, to gain insight into the disease pathophysiology and provide a comprehensive summary of the features for clinicians aiding optimal management.

AN UNCOMMON PRESENTATION OF ANTISYNTHETASE SYNDROME-RELATED INTERSTITIAL LUNG DISEASE IN A YOUNG INDIAN MALE

AN UNCOMMON PRESENTATION OF ANTISYNTHETASE SYNDROME-RELATED INTERSTITIAL LUNG DISEASE IN A YOUNG INDIAN MALE

PRIMARY SJÖGREN SYNDROME AND PULMONARY INVOLVEMENT: UTILITY OF SALIVARY GLAND BIOPSY IN DIAGNOSIS

PRIMARY SJÖGREN SYNDROME AND PULMONARY INVOLVEMENT: UTILITY OF SALIVARY GLAND BIOPSY IN DIAGNOSIS

DYSKERATOSIS CONGENITA: A RARE CAUSE OF USUAL INTERSTITIAL PNEUMONIA

DYSKERATOSIS CONGENITA: A RARE CAUSE OF USUAL INTERSTITIAL PNEUMONIA

Diagnostic value of lung ultrasonography compared with chest radiography among children with pneumonia in Rivers State University Teaching Hospital, Port Harcourt

Abstract Background: Pneumonia is an acute inflammatory condition affecting the lung alveoli. The current gold standard for diagnosis pneumonia in children is chest radiography (CXR). Lung ultrasound scan (LUS) may be used as a safer diagnostic alternative since it does not use ionizing radiation. Aim: The study is to evaluate the diagnostic value of LUS compared with CXR among children with pneumonia. Materials and Methods: It was a prospective cross-sectional study among 100 patients aged between 0 and 5 years, diagnosed with pneumonia. The spectrums of LUS findings were compared with chest radiographic findings of the same patients to ascertain the diagnostic value LUS. The LUS was performed using a 3.5–5.0 MHz convex probe and a high-frequency (7.5–10.0 MHz) linear transducer fitted to a Logic PRO 6.0, general electric ultrasound machine. Results: The mean age of the participants was 17.6 (±12.4) months with males and females accounting for 60% and 40%, respectively. CXR and LUS detected pneumonia in 78% and 93% of patients respectively (P = 0.002). In LUS, the most common findings were subpleural consolidation (73.0%), and pleural-line distortions (66%), while the commonest CXR findings were interstitial opacities (69%), and homogeneous consolidations (37%). The sensitivity and specificity of LUS in this study are 96.2% and 18.2%, respectively, with positive and negative predictive values of 80.6% and 57.1%, respectively. Conclusion: LUS had a higher positive detection rate than CXR. Its high sensitivity, lack of ionizing radiation, and portability make it a useful first-line imaging modality in the diagnosis and manage pneumonia.

A RARE PRESENTATION OF TB-RELATED SEPTIC SHOCK

TYPE: Case Report TOPIC: Lung Pathology INTRODUCTION: Without treatment, tuberculosis (TB) may lead to septic shock in immunocompetent individuals. Through the interaction of lipoarabinomannan (LAM) on the mycobacterium cell wall with antigen presenting cells, TB may be able to survive in host cells for long periods of time; causing widespread lung damage and systemic disease. We report a unique case of a 24-year-old woman with an untreated mycobacterial infection who developed bronchiectasis and TB-related septic shock. CASE PRESENTATION: A 24-year-old Guyanese woman with no past medical history presented to the hospital with shortness of breath, weight loss, and hemoptysis. She was hemodynamically unstable and severely cachectic with coarse lung sounds. Imaging demonstrated diffuse interstitial opacities and large cystic changes. Fluids were given, her sputum was positive for acid fast bacilli, and she was started on R.I.P.E. treatment for tuberculosis. The patient became severely hypoxic requiring intubation. She ultimately developed refractory hypotension despite 4 different vasopressors. She became pulseless and ACLS protocol was initated, though, she remained in asystole throughout the arrest. DISCUSSION: Lipoarabinomannan, a glycolipid on the mycobacterium cell wall with virulent properties, directly activates SHP-1 through phosphorylation. SHP-1, a signaling molecule which regulates many different cellular processes, may deactivate proinflammatory cytokines and inhibit INF-y release. This inability to activate macrophages promotes intracellular survival of TB in host cells. This mechanism may account for diffuse bronchiectasis and a systemic inflammatory response, as in our patient. CONCLUSIONS: This case highlights the possibility of tuberculosis-related septic shock in the critical care setting and draws attention to mechanisms of pathogenesis if left untreated. DISCLOSURE: Nothing to declare. KEYWORD: septic shock

CT features of community-acquired pneumonia at the emergency department

BackgroundChest computed tomography (CT) was reported to improve the diagnosis of community-acquired pneumonia (CAP) as compared to chest X-ray (CXR). The aim of this study is to describe the CT-patterns of CAP in a large population visiting the emergency department and to see if some of them are more frequently missed on CXR. Materials and MethodsThis is an ancillary analysis of the prospective multicenter ESCAPED study including 319 patients. We selected the 163 definite or probable CAP based on adjudication committee classification; 147 available chest CT scans were reinterpreted by 3 chest radiologists to identify CAP patterns. These CT-patterns were correlated to epidemiological, biological and microbiological data, and compared between false negative and true positive CXR CAP. ResultsSix patterns were identified: lobar pneumonia (51/147, 35%), including 35 with plurifocal involvement; lobular pneumonia (43/147, 29%); unilobar infra-segmental consolidation (24/147, 16%); bronchiolitis (16/147, 11%), including 4 unilobar bronchiolitis; atelectasis and bronchial abnormalities (8/147, 5.5%); interstitial pneumonia (5/147, 3.5%). Bacteria were isolated in 41% of patients with lobar pneumonia-pattern (mostly Streptococcus pneumoniae and Mycoplasma pneumonia) versus 19% in other patients (p = 0.01). Respiratory viruses were equally distributed within all patterns. CXR was falsely negative in 46/147 (31%) patients. Lobar pneumonia was significantly less missed on CXR than other patterns (p = 0.003), especially lobular pneumonia and unilobar infra-segmental consolidation, missed in 35% and 58% of cases, respectively. ConclusionLobar and lobular pneumonias are the most frequent CT-patterns. Lobar pneumonia is appropriately detected on CXR and mainly due to Streptococcus pneumoniae or Mycoplasma pneumoniae. Chest CT is very useful to identify CAP in other CT-patterns. Prior the COVID pandemic, CAP was rarely responsible for interstitial opacities on CT.