Irregular Opacities Research Articles

SAT216 Multiple Reasons Of Secondary Hyperthyroidism And Unexpected Results

Abstract Disclosure: I. Dzherieva: None. N. Volkova: None. S. Brovkina: None. I. Reshetnikov: None. L. Gritsenko: None. T. Mamedova: None. U. Ismailov: None. Background: Revealing the cause of secondary hyperparathyroidism might be a difficult problem especially if a patient has a few diseases to lead to this condition. Clinical Case: A 52-year-old-man was referred to our service for revealing the cause of weakness which started after COVID 19. When the patient was treated by rivaroxaban there was an unusual feature such as a hemoptysis, so the medicine was canceled. In medical history only the Achilles tendovaginitis was performed. The patient plays football twice a weak regularly, does not smoke, does not use drags. The physical examination showed nothing special. An arterial blood pleasure was 120/80 mm Hg, Body Mass Index was 25,4 kg/m2. Laboratory workup showed high erythrocyte sedimentation rate (ESR)(33mm/hr), leukocytosis (11000mm3) and a normocytic anemia(Hb 115 g/l),hematuria (16650 RBCsper hpf). Creatinine was 163µmol/L, glomerular filtration rate (GFR) was 43 ml/min/1.73m 2 , total serum calcium corrected for the patient's albumin concentration was 2.47 mM/L (2.15-2.50 mM/L), parathyroid hormone (PTH-intact) was 130 pg/mL (10-65 pg/mL),the level of 25-hydroxyvitamin D was 14.4 ng/mL(30.0-100.0 ng/mL). Chest radiograph findings were as follows: bilateral irregular, nodular, and patchy opacities. After vitamin D deficiency correction level of PTH-intact became normal (65 ng/mL). Serological tests : antinuclear antibody [ANA] and double-stranded DNA [dsDNA], ANCA were performed. Antineutrophil cytoplasmic antibody (ANCA) test result revealed perinuclear ANCA related to myeloperoxidase with the level more than 80 IgG. According to this finding Microscopic polyangiitis was diagnosed. Conclusion: This case has shown that sometimes there are two reasons for development of secondary hyperthyroidism and only successive actions help to choose right way for diagnosis. Presentation: Saturday, June 17, 2023

IgG4-Related Disease, a Systemic or Local Disease: This is the Problem

Background: Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition that forms tumefactive lesions in various organs, presenting with diverse clinical manifestations. Diagnosis of IgG4-RD could be challenging and relies on characteristic histopathological findings and elevated IgG4+ plasma cell counts. Case Presentation: The patient was a 48-year-old woman with diabetes mellitus initially presented with a painless breast mass. Imaging indicated irregular opacities and lymph nodes in the breast. Biopsy results revealed lymphoplasmacytic infiltration with IgG and IgG4 positivity, overall compatible with IG4-related disease. A mass resection was performed, and intraoperative assessment ruled out malignancy. Then, with a 5-month interval of no symptoms, the patient developed a cheek mass, initially misdiagnosed as low-grade spindle cell sarcoma. Subsequently, she underwent partial maxillectomy and further examination and histology confirmed IgG4-RD, meeting all diagnostic criteria. Conclusion: IgG4-RD is a rare, systemic fibroinflammatory condition with potential to mimic neoplastic processes. While IgG4 serum levels can be elevated, they are not a reliable diagnostic criterion. The two main features of IgG-related disease are an elevated number of IgG4-positive plasma cells within the tissue and a characteristic histopathological appearance including a dense lymphoplasmacytic infiltrate, storiform fibrosis, and obliterative phlebitis. Overall, diagnosis is based on the balance of clinical features, histopathology, and serum markers. This case underscores the diagnostic challenges posed by IgG4-RD, often mistaken for malignancies due to its invasive behavior and emphasizes the importance of considering IgG4-RD in differential diagnoses for tumor-like lesions, particularly when affecting multiple organs, to enable timely treatment decisions and prevent unnecessary interventions.

Evaluation of high-resolution computed tomography findings and associated factors in hypersensitivity pneumonitis

Background/Aim: Hypersensitivity pneumonitis (HP) is a lung disease from inhaling diverse environmental and occupational organic substances, such as fungi, bacteria, birds, and occasionally nonorganic materials. An immune response triggers this condition. A high-resolution chest computed tomography (HRCT) scan is typically performed as part of the initial diagnostic assessment. This study assesses HRCT findings in HP patients and examines associated factors between fibrotic and non-fibrotic patient groups. Methods: This retrospective cross-sectional study encompassed all HP patients monitored between 2010 and 2022. The analysis included data from 117 patients. HRCT findings from the patients were categorized based on fibrosis presence, leading to the division of patients into fibrotic and non-fibrotic groups. Comparative analyses were conducted between these groups. Results: Among the 117 subjects analyzed, 59 (50.4%) were male, and 58 (49.6%) were female. The mean age at diagnosis was 52.1 (13.6) years, ranging from 20 to 81. The non-fibrotic HP group comprised 70 (59.8%) patients, while the fibrotic HP group comprised 47 (40.2%). The most prevalent HRCT findings were ground-glass opacity (90.6%), mosaic attenuation (87.2%), and traction bronchiectasis (50.4%). Statistically significant disparities were observed between non-fibrotic and fibrotic HP groups in terms of HRCT findings: ground-glass opacity, irregular linear opacities, reticulation, traction bronchiectasis, honeycombing, and fibrosis (P=0.024, P<0.001). In contrast, the lymphocyte ratio in bronchoalveolar lavage fluid was 28.78 (16.2) in the non-fibrotic HP group and 14.66 (10.3) in the fibrotic HP group. The fibrotic HP group exhibited a statistically significant lower lymphocyte ratio in bronchoalveolar lavage fluid (P<0.001). Conclusion: HRCT findings are pivotal in HP diagnosis and classification. Computed tomography also assists in delineating the HP classification. This study identified ground-glass opacity and mosaic attenuation as the most prevalent HRCT findings in HP patients. Investigating the connection between fibrosis and prognosis is vital for determining patient outcomes, as fibrosis appears to be the principal determinant.

ORAL CRYPTOCOCOSIS IN AN IMMUNOSUPPRESSED PATIENT: A CASE REPORT

A 57-year-old male patient, immunosuppressed after heart transplantation, was hospitalized for suspected disseminated opportunistic infection. The patient complained of pain due to lesions in the mouth, fever, and diarrhea starting 15 days ago. Upon physical examination, crateriform erythematous ulcers covered by a purulent membrane were observed in the anterior region of the hard palate and upper labial mucosa, in addition to erythematous plaques on the upper attached gingiva. Ulcers were also observed in the nose wing and mentual region. Chest tomography revealed irregular reticular opacities in both lungs and ground-glass infiltrate. Biopsies from lung oral lesions were performed, which revealed a granulomatous inflammatory process and small rounded structures. Special Grocott-Gomori staining allowed confirmation of the fungal structure of Cryptococcus, and a final diagnosis of Cryptococcosis was reached. Treatment was conducted with Amphotericin B associated with Fluconazole, and after seven months of follow-up, complete remission of the lesions was observed. Support: CAPES, CNPq. A 57-year-old male patient, immunosuppressed after heart transplantation, was hospitalized for suspected disseminated opportunistic infection. The patient complained of pain due to lesions in the mouth, fever, and diarrhea starting 15 days ago. Upon physical examination, crateriform erythematous ulcers covered by a purulent membrane were observed in the anterior region of the hard palate and upper labial mucosa, in addition to erythematous plaques on the upper attached gingiva. Ulcers were also observed in the nose wing and mentual region. Chest tomography revealed irregular reticular opacities in both lungs and ground-glass infiltrate. Biopsies from lung oral lesions were performed, which revealed a granulomatous inflammatory process and small rounded structures. Special Grocott-Gomori staining allowed confirmation of the fungal structure of Cryptococcus, and a final diagnosis of Cryptococcosis was reached. Treatment was conducted with Amphotericin B associated with Fluconazole, and after seven months of follow-up, complete remission of the lesions was observed. Support: CAPES, CNPq.

Slowly Expanding 18 F-FDG PET-Positive Irregular Opacities in the Lung Due to Diffuse Lymphoid Hyperplasia Preceding Rheumatoid Arthritis.

Pulmonary diffuse lymphoid hyperplasia (DLH), a nonneoplastic lymphoproliferative disorder (LPD), is extremely rare, and no PET/CT findings have been reported for pulmonary DLH. We observed slowly expanding irregular opacities with 18 F-FDG accumulation (SUV max , 3.64) in the right lower lobe of a 51-year-old asymptomatic man. The patient underwent video-assisted thoracoscopic biopsy on suspicion of malignant lesions. Histologically, no neoplastic cells were present, and the lesion was consistent with DLH. Six months later, the patient developed rheumatoid arthritis. DLH should be considered in the differentiation of PET-positive irregular opacities, even in the absence of known immune abnormalities.

Corneal epithelium in keratoconus underexpresses active NRF2 and a subset of oxidative stress-related genes.

Keratoconus (KC) is a multifactorial progressive ectatic disorder characterized by local thinning of the cornea, leading to decreased visual acuity due to irregular astigmatism and opacities. Despite the evolution of advanced imaging methods, the exact etiology of KC remains unknown. Our aim was to investigate the involvement of corneal epithelium in the pathophysiology of the disease. Corneal epithelial samples were collected from 23 controls and from 2 cohorts of patients with KC: 22 undergoing corneal crosslinking (early KC) and 6 patients before penetrating keratoplasty (advanced KC). The expression of genes involved in the epidermal terminal differentiation program and of the oxidative stress pathway was assessed by real time PCR analysis. Presence of some of the differentially expressed transcripts was confirmed at protein level using immunofluorescence on controls and advanced KC additional corneal samples. We found statistically significant under-expression in early KC samples of some genes known to be involved in the mechanical resistance of the epidermis (KRT16, KRT14, SPRR1A, SPRR2A, SPRR3, TGM1 and TGM5) and in oxidative stress pathways (NRF2, HMOX1 and HMOX2), as compared to controls. In advanced KC samples, expression of SPRR2A and HMOX1 was reduced. Decreased expression of keratin (KRT)16 and KRT14 proteins was observed. Moreover, differential localization was noted for involucrin, another protein involved in the epidermis mechanical properties. Finally, we observed an immunofluorescence staining for the active form of NRF2 in control epithelia that was reduced in KC epithelia. These results suggest a defect in the mechanical resistance and the oxidative stress defense possibly mediated via the NRF2 pathway in the corneal keratoconic epithelium.

S2301 Dysphagia: An Unusual Primary Presentation of Non-Small Cell Lung Cancer

Introduction: Respiratory symptoms predominate in patients with lung malignancies. Dysphagia as a presenting symptom is rare with only about 1%-2% of patients presenting with dysphagia as their cardinal symptom. We describe a rare case of a 56-year-old male presenting with only dysphagia in the setting of extrinsic esophageal compression secondary to non-small cell lung cancer. Case Description/Methods: A 56-year-old male with past medical history of hypertension, chronic obstructive pulmonary disease, and chronic tobacco use presented to the emergency department with complaint of persistent emesis for the past 3 months. The patient described the emesis as occurring minutes after eating a meal. He also admitted to loss of appetite, unintentional weight loss, and dysphagia to solids. On admission, the patient was normotensive and tachycardic to a heart rate of 108. CT chest was performed and revealed an 8.0 x 7.5 cm right mediastinal mass with obliteration of the right main pulmonary artery and right main bronchus along with multiple irregular and nodular opacities in the right lung and left lower lobe concerning for metastases. Pulmonology was consulted and performed a bronchoscopy which showed a large obstructing endobronchial lesion of the right mainstem bronchus; biopsies of the lesion were sent. The patient was diagnosed with metastatic non-small cell lung cancer. The patient’s hospital course was complicated by intractable emesis and development of shock. Repeat CT was performed and was remarkable for a moderate volume pneumomediastinum and a small to moderate size right pneumothorax. Gastroenterology was consulted for concerns of esophageal perforation vs. invasion. Esophagogastroduodenoscopy was performed and showed severe extrinsic stenosis 30-32 cm from the incisors. The area of stenosis measured 2 cm in length and was dilated. A 23mm x 120mm EndoMAXX fully covered stent was placed at the 26 cm to 38 cm region of the esophagus. Following stabilization, the patient was able to tolerate mechanical soft diet and thin liquids (Figure). Discussion: Dysphagia associated with lung cancer can occur via 3 mechanisms: mediastinal extrinsic esophageal compression, upper esophageal compression by lymph nodes, and radiation induced esophageal stenosis. Patients may experience decreased quality of life due to poor oral intake, malnutrition, and increased risk for infection. Lung malignancy associated dysphagia can be improved by both surgical and non-surgical interventions such as dilatation or esophageal stenting.Figure 1.: (A) Initial CT Chest findings of a right 8.0 x 7.5 cm mediastinal mass (B) Repeat CT Chest remarkable for a moderate volume pneumomediastinum and a small to moderate size right pneumothorax and (C) EGD imaging of a 23mm x 120mm EndoMAXX fully covered stent placed at the area of severe esophageal stenosis.

Long-Term Follow-Up Study of COVID-19: Evaluation on Thin-Slice CT.

PurposeTo retrospectively analyse the CT imaging during the long-term follow-up of COVID-19 patients after discharge.Patients and MethodsA total of 122 patients entered the study group. All patients underwent CT examinations. The CT images, which included distribution and imaging signs, were evaluated by two chest radiologists. Laboratory examinations included routine blood work, biochemical testing, and SARS-CoV-2 antibody screening. Statistical methods include chi-square, Fisher’s exact test, one-way analysis of variance, rank sum test and logistic regression by SPSS 17.0.ResultsThere were 22 (18.0%) patients in the mild group, 74 (60.7%) patients in the moderate group, and 26 (21.3%) patients in the severe–critical group. The median follow-up interval was 405 days (378.0 days, 462.8 days). Only monocytes, prothrombin activity, and γ-glutamyltransferase showed significant differences among the three groups. We found that the more severe the patient’s condition, the more SARS-CoV-2 IgG antibodies existed. Only 11 patients (11.0%) showed residual lesions on CT. The CT manifestations included irregular linear opacities in nine cases (9.0%), reticular patterns in six cases (6.0%), and GGOs in five cases (5.0%).ConclusionThe proportion of residual lesions on CT in COVID-19 patients was significantly reduced after long-term follow-up. The patients’ age and disease conditions were positively correlated with residual lesions.

A rare presentation of neurosarcoidosis as the superior orbital fissure syndrome

We are reporting a rare case of neurosarcoidosis that presented with superior orbital fissure syndrome. A 51-year-old Indian woman who suffered from 2 weeks duration, insidious onset gradually progressive left sided headache limited to forehead, left periorbital pain, diplopia on looking toward left, and numbness on the left forehead was referred to our hospital. Ophthalmic findings included left oculomotor nerve, trochlear nerve and abducens nerve palsies, absent corneal reflex, and loss of touch, pain and temperature sensation in V1 distribution. Brain and orbit magnetic resonance imaging (MRI) showed contrast enhancing area at the left orbital apex with normal optic nerve. Normal CSF analysis. High ESR, and chest x-ray showing non-homogenous patchy opacities in bilateral lung fields leaded us for neoplastic screening. Chest computed tomography (CT) revealed multiple ill-defined irregular lung parenchymal nodular opacities of varying sizes involving bilateral lungs with enlarged mediastinal and bilateral axillary lymph nodes. Elevated angiotensin converting enzyme level was found. Biopsy of the axillary lymph node showed non-caseating granulomatous lymphadenitis with giant cells containing schaumann bodies and asteroid bodies in the cytoplasm. These findings indicating an inflammatory response induced by sarcoidosis. After the initiation of steroid treatment, the patient experienced complete remission without any recurrence. When examining a case presenting with superior orbital fissure syndrome with contrast enhancing MRI lesion at the orbital apex, the additional chest CT to exclude neoplastic lesions can detect pulmonary sarcoidosis and extraneural lesions. These may avoid delays in the diagnosis and management of neurosarcoidosis.

Multidisciplinary approach for aesthetic rehabilitation in gummy smile and fluorosis: a case report

Background: Teeth, gingiva and lips are the three interrelated primary components in aesthetic dentistry. These combinations warrant a multidisciplinary approach for planning and predictable treatment outcome. Objective: The aim of this article is to describe the multidisciplinary approach for aesthetic rehabilitation involving gingivectomy and minimally invasive tooth preparation with porcelain laminate veneer (PLV) restorations and resin bonded bridge. Case: A 25-year-old female patient attended with existing space between maxillary anterior teeth post orthodontic treatment and missing mandibular anterior teeth. Intraorally, patient had uneven interdental spacing in between 13 to 23, missing 31 and 32, with merging and irregular opacities suggestive of enamel fluorosis appearance. The zenith lines were asymmetrical with short clinical crowns and disharmonious teeth axes. To optimize the aesthetic outcome and overall smile appearance, gingivectomy was performed after confirmation of biologic width. Eight weeks after healing, PLV restorations were delivered from 13 to 23, and zirconia resin bonded bridge were used to restore missing mandibular lateral incisors. Conclusion: The present case illustrates the sequential and predictable approach for management of gummy smile and fluorosis. An alternative treatment modality such as electrocautery may enhanced the smile and obtain positive outcome.

High-resolution computed tomography features of asbestosis versus fibrotic hypersensitivity pneumonitis: an observational study

BackgroundAsbestosis and fibrotic hypersensitivity pneumonitis (FHP) share the pathogenetic mechanisms induced bronchiolocentric fibrotic process secondary to inhalation exposure. Under the occupational and environmental mixed exposures, asbestosis and FHP are needed to make the differential diagnoses on high-resolution computed tomography (HRCT), especially in the countries still using asbestos. The study aimed to analyze the HRCT features of asbestosis versus FHP.MethodsThe patients with asbestosis or with HP were sequentially recruited in this comparative study at Beijing Chaoyang Hospital between January 2006 and December 2016. Patients’ clinical data were obtained from a predesigned charts. The international classification of HRCT for occupational and environmental respiratory diseases was used to categorize chest imaging findings in patients. The calculation of test statistics was used to compare the imaging features of asbestosis and FHP.Results341 patients with asbestosis and 158 patients with HP were sequentially recruited, among which 204 patients with asbestosis and 74 patients with FHP were eligible for data analysis. Patients with asbestosis were older and had a longer latent period until disease manifestation than those with FHP. Asbestosis was characterized by irregular and/or linear opacities, with lower lung preponderance, accompanied by ground-glass opacities and mosaic attenuation. Notably, 98.5% of patients with asbestosis showed benign pleural abnormalities, and 39.7% of these patients had diffuse pleural thickening with parenchymal bands and/or rounded atelectasis. Abnormalities of the mediastinal and diaphragmatic pleura were observed only in cases of asbestosis, and this finding showed high specificity for the diagnosis for asbestosis compared with that for FHP. Subpleural dots or diaphragmatic pleural abnormalities showed moderate sensitivity and high specificity for diagnosis of asbestosis compared with that for FHP. Interobserver reliability was good for evaluation of imaging findings including honeycombing, pleural calcification, lymphadenectasis, and lymph node calcification.ConclusionsHRCT-based imaging findings can distinguish between asbestosis and FHP to a certain extent, particularly with regard to subpleural dots and diaphragmatic pleural abnormalities that characterize the former.

Chest high-resolution CT features analysis in predicting the progression of asbestosis

Objective: To analyze the radiological characteristics of chest high-resolution computed tomography (HRCT) of patients with asbestosis, and to investigate the signs of predicting the disease progression of asbestosis. Methods: A prospective method was used to enroll 68 patients with asbestosis who were regularly followed up from 2013 to 2016. The radiological characteristics of patients with asbestosis were described by the International Classification of HRCT for Occupational and Environmental Respiratory Diseases (ICOERD) , and the differences between patients with and without progression were compared during the observation period. The Cox proportional hazards regression model was used to analyze the chest HRCT radiological signs predicting the progression of asbestosis. Results: The study included 68 patients with asbestosis aged (65.5±7.8) years old, of which 64.7% (44/68) were female, 29.4% (20/68) had a history of smoking. There was no significant difference in age, sex, smoking and asbestos exposure between patients with progressive asbestosis (20.6%, 14/68) and patients without progressive asbestosis (79.4%, 54/68) (P>0.05) . Chest HRCT of patients with asbestosis showed irregular and/or linear opacities, of which 5.9% (4/68) were accompanied by honeycombing. Irregular and/or linear opacities were mainly lower lung preponderant, often accompanied with ground glass opacity and mosaic perfusion. 98.5% (67/68) had pleural abnormalities, of which 39.7% (27/68) had diffuse pleural thickening with parenchymal bands and/or rounded atelectasis. The analysis of multivariable Cox proportional hazard regression showed that the risk of the progression of asbestosis was increased with higher irregular and/or linears opacities cores (HR=1.184, 95%CI: 1.012-1.384, P=0.034) and the appearance of honeycombing (HR=6.488, 95%CI: 1.447-29.097, P=0.015) . Conclusion: The irregular and/or linear opacities scores and honeycombing on chest HRCT are independent influencing factors for predicting the disease progression of asbestosis.

Plasma exchange therapy in refractory inflammatory myopathy with anti-signal recognition particle antibody: a case series.

To explore the efficacy of plasma exchange (PE) therapy in refractory idiopathic inflammatory myopathy (IIM) patients with positive anti-signal recognition particle (SRP) antibody. Nine refractory IIM patients with positive anti-SRP antibody were enrolled, who received PE therapy at Ruijin Hospital from October 2017 to December 2020. The clinical manifestations, laboratory tests, chest CT and lower extremity MRI images before and after PE therapy were compared. The treatment response was evaluated by the 2016 ACR/EULAR myositis response criteria. A total of 88.9% (8/9) of subjects had achieved improvement by 3 weeks after PE therapy, with 55.6% (5/9) minimal improvement and 33.3% (3/9) moderate improvement. There were statistically significant improvements between baseline and after PE therapy at 3 weeks on the core set measures: physician global activity, patient global activity, HAQ, manual muscle testing (MMT), extramuscular disease activity, and muscle enzymes activity including creatine kinase (CK), lactate dehydrogenase (LDH), aspartate transaminase (AST), except for alanine transaminase (ALT). Moreover, the chest CT showed regression of ground glass opacities and irregular linear opacities after PE therapy in four patients with interstitial lung disease. The MRI images of lower extremity in four patients showed reduction of muscle oedema after the therapy. PE therapy is effective for refractory IIM patients with positive anti-SRP antibody. It should be considered as an alternative treatment for those patients who are resistant to the combined therapy of glucocorticoids and immunosuppressive agents.

Vancomycin-Induced Organizing Pneumonia: A Case Report and Literature Review

The long-term administration of vancomycin has increased; however, the pulmonary adverse reactions of long-term vancomycin treatment remain under-studied. A 75-year-old male patient with vertebral osteomyelitis receiving long-term vancomycin therapy developed a fever. High resolution computed tomography showed irregular ground glass opacity and consolidation in the right upper lung. The patient developed organizing pneumonia. This occurred without peripheral eosinophilia or adverse reactions in the skin and liver. The administration of vancomycin was discontinued. He recovered from organizing pneumonia after four weeks of steroid therapy. Solitary organizing pneumonia can develop during treatment with vancomycin. When pulmonary inflammation occurs and other causes of pneumonia are excluded, vancomycin therapy should be discontinued.

Isolated sphenoid sinus opacification is often asymptomatic and is not referred for otolaryngology consultation

Isolated sphenoid sinus opacifications (ISSOs) are clinically important because they can lead to serious complications. However, some patients with ISSOs are asymptomatic, and not all patients are properly referred to the otolaryngology department. Because past studies of ISSOs focused only on patients who received treatment, in this study we selected ISSO cases based on radiology reports, then determined whether these patients had symptoms and were appropriately referred for specialty care. We conducted a retrospective analysis of data collected from patients who underwent computed tomography or magnetic resonance imaging from January 2007 to March 2017 at Osaka General Medical Center. We searched for the terms “sphenoid” or “sphenoidal” using F-REPORT to identify patients who had a sphenoid disease. We checked all selected images and diagnosed ISSOs. Examination of 1115 cases revealed 223 cases of ISSOs, of whom 167 (74.9%) were asymptomatic. We categorized patients with ISSOs into four groups: inflammation, mucocele, fungal diseases, and unclassifiable; the final category was used when edges were irregular or complete opacity was encountered. In the unclassifiable group, the majority of cases required otolaryngology consultation, but 37 of 47 unclassifiable patients did not have an otolaryngology visit. ISSOs are often identified by chance on imaging tests performed by non-otolaryngologists. However, our study revealed that many patients with ISSOs who should be treated by otolaryngologists were not referred to the otolaryngology department. Accordingly, it is important to promote awareness of the disease among other types of clinicians.

High-Resolution CT Features of the COVID-19 Infection During Short-Term Follow-Up

Objective: To estimate the short-term follow-up chest HRCT manifestation in patients with COVID-19 who have left hospitals. Methods: Retrospective analysis was executed on the chest HRCT manifestation of 49 cases with RT-PCR confirmed COVID-19 pneumonia patients diagnosed in Beijing You’An hospital affiliated to capital medical university between 20 January 2020 to April 10, 2020. The study including 21 males and 28 females, and the median age was 59.5 years age ranged from 21 years to 80 years. The evolution characteristics of chest HRCT in short-term follow-up after discharge were analyzed. Results: Forty-nine patients were divided into two groups according to Diagnosis and Treatment Protocol of 2019 New Coronavirus Pneumonia (trial version 7) of National Health Commission of China. Severe group included 23 cases (46.9%) and 26 cases of ordinary (53.1%). The HRCT findings of patients in the 2 groups were analyzed on median follow-up time was 30 day (range, 14 to 46 days) after discharge. The follow-up chest HRCT were normal in 19 of 49 (38.8%) patients, abnormal HRCT findings were detected in 30 of 49 (61.2%) patients. The most frequent abnormality found on follow-up HRCT in COVID-19 patients who recovered from pneumonia was GGO which was seen in 26 of 49 (53.1%) patients, reticular pattern was in 9 of 49 (18.4%), traction bronchiectasis was in 3 of 49 (6.1%), small nodular consolidation was in 6 of 49 (12.2%), other findings including curved line in the subpleural area and irregular linear opacities were in 15 of 49 (30.6%). In the study, 3 of 49 (6.1%) patients were diagnosed with pulmonary fibrosis according to HRCT findings. Three cases were severe patients, aged from 65 to 80 years. Pulmonary fibrosis occurred within 30–50 days of onset. Conclusion: Pulmonary fibrosis may develop in 6.1% of COVID-19 patients, which was lower than that of SARS and MERS, suggesting that the lung damage caused by SARS-COV-2 in the recovered patients was lower than that of SARS and MERS.

Novel compound heterozygous mutations in the CHST6 gene cause macular corneal dystrophy in a Han Chinese family.

BackgroundMacular corneal dystrophy (MCD), a rare autosomal recessive disorder, is caused by pathogenic mutations in the carbohydrate sulfotransferase 6 gene (CHST6) and is characterized by bilateral progressive stromal clouding and vision loss. Corneal transplantation is often necessary. This study aimed to identify disease-causing mutations in a Han-Chinese MCD patient.MethodsA 37-year-old female diagnosed with MCD was recruited. The clinical materials were observed and described, and peripheral blood sample was extracted. Whole exome sequencing (WES) and Sanger sequencing were used to reveal genetic defects. The pathogenicity of identified mutations was assessed using in silico analysis.ResultsThe patient had typical features of MCD, including decreased vision, multiple irregular gray-white corneal opacities, and corneal thinning. A novel nonsense mutation c.544C>T (p.Gln182Ter) and a validated missense mutation c.631C>G (p.Arg211Gly) were identified in the CHST6 gene coding region, both classified as “pathogenic” following the American College of Medical Genetics and Genomics standards and guidelines.ConclusionsThis study reports a Han-Chinese MCD patient with a novel nonsense mutation c.544C>T (p.Gln182Ter) and a recurrent missense mutation c.631C>G (p.Arg211Gly), which expand the spectrum of genetic mutations. The results of this study extend genotype-phenotype correlations between the CHST6 gene mutations and MCD clinical findings, contributing to a more accurate diagnosis and the development of potential gene-targeted MCD therapies.KeywordsCarbohydrate sulfotransferase 6 gene (CHST6); compound heterozygous mutations; Han Chinese family; macular corneal dystrophy (MCD)

Should We Postpone Elective Cardiovascular Procedures and Percutaneous Coronary Interventions During the COVID-19 Pandemic?

Prioritization among patients with coronary artery disease represents a difficult issue during the SARS-CoV-2 pandemic. We present our clinical practices and patients' outcomes after elective, emergent, and urgent cardiovascular surgery and percutaneous coronary interventions (PCI). We also investigated the rate of nosocomial infection of SARS-CoV-2 in health workers (HWs), including surgeons after cardiovascular procedures and percutaneous interventions (PCI). We performed 186 cardiovascular operations and PCI between March 15 and October 15. According to the level of priority (LoP), we performed urgent and emergent coronary artery bypass grafting (CABG) and cardiac valve repair or replacement surgery in 44 patients. In one patient with acute chordae rupture with pulmonary edema, we performed mitral valve replacement. We performed the aortic arch repair in two patients with type-I aortic dissection in urgent situations. Therefore, in 47 patients we performed cardiac operations in urgent or emergent situations. Elective CABG (N = 28) and elective cardiac valve (N = 10) surgeries were performed (total: 38). While rescue PCI was urgently performed in 47 patients with ST-segment elevation myocardial infarction (STEMI), it was performed in elective or emergent situations in 40 patients with myocardial ischemia. Endovascular treatment was performed in four patients with deep venous thrombosis (DVT) and in four patients with chronic arterial occlusion, respectively. Surgical vascular repair and embolectomy were performed in patients with peripheral artery injury (N = 6) and acute arterial embolic events (N = 4), respectively. We performed thoracic computed tomography followed by reverse transcriptase-polymerase chain reaction (RT-PCR) test in patients with irregular diffuse reticular opacities with or without consolidation on chest X-ray. Blood coagulation disorders including d-dimer, thromboplastin time (TT), and partial thromboplastin time (aPTT) were measured prior to procedures. No mortality and morbidity was seen after percutaneous and surgical arterial or venous procedures. The total mortality rate was 4.1% (8 of 186 CAD patients or valve surgery) after urgent and emergent CABG (N = 4), an urgent valve replacement (N = 1), and PCI (N = 3). Low cardiac output syndrome (LOS) and major adverse cardiac cerebrovascular event (MACCE) were the mortality factors after cardiac surgery. The reasons for death after PCI were sudden cardiac arrest related to the dissection of the left main coronary artery during procedure and pneumonia due to COVID-19 (N = 2). Ground-glass opacities in combination with pulmonary consolidations were detected in seven patients. Interlobular septal and pleural thickening with patchy bronchiectasis in the bilateral lower lobe involvement was found after thoracic computed tomography in these patients. We confirmed in-hospital COVID-19 using a PCR test in two patients with STEMI prior to PCI. PT and aPTT increased, but fibrin degradation products did not in those two patients. We confirmed COVID-19 via phone call in six CABG patients and one PCI patient after discharge from the hospital. None of the patients diagnosed with COVID-19 died after being discharged from the hospital. Cardiovascular surgery and PCI can safely be performed with acceptable complications and mortality rates in elective situations, during the COVID-19 pandemic. Preoperative control of OR traffic, careful evaluation of the patient's history, consultation, and precautions taken by healthcare professionals are important, during and after procedures. Also important is wearing a mask and face shield and careful disinfection of equipment and space.

Clinical profiles of SS-ILD compared with SS-NILD in a Chinese population: a retrospective analysis of 735 patients

Background Interstitial lung disease (ILD) is a serious complication in patients with Sjögren’s syndrome (SS). Most studies on primary SS (pSS) with ILD are limited in sample size, and studies on secondary SS (sSS) with ILD are rare. This study aimed to elucidate both primary and secondary SS-associated ILD (SS-ILD) based on a large cohort. Methods The medical records of hospitalized patients diagnosed with SS at the Second Xiangya Hospital of Central South University from January 2010 to May 2020 were retrospectively reviewed. Clinical manifestations, medical history, biological results and imaging data were collected. Results Of the 735 SS patients enrolled in this study, 563 (76.6%) were diagnosed with pSS, 172 (23.4%) were diagnosed with sSS. Additionally, 316 (43.0%) were diagnosed with SS-ILD. No significant difference was found between the pSS and sSS groups concerning the incidence of ILD (p = .718). Factors associated with SS-ILD were older age (p < .001), male sex (p = .032), female sex at menopause (p = .002), Raynaud’s phenomenon (p < .001), low levels of albumin (p = .010) and respiratory symptoms (p < .001). The SS-ILD group showed higher counts of platelets (p < .001). The three most frequent high-resolution CT (HRCT) findings of SS-ILD were irregular linear opacities (42.7%), grid shadows (30.7%) and pleural thickening (28.5%). NSIP (56.3%) was the most frequent HRCT pattern. Compared with pSS patients with ILD (pSS-ILD) patients, sSS patients with ILD (sSS-ILD) patients had a higher incidence of proteinuria (p < .001) and hypercreatinaemia (p = .013), a higher level of erythrocyte sedimentation rate (ESR) (p = .003), low levels of complement 3 (C3) (p = .013), lymphocytes (p = .009) and leukocytes (p = .024), and worse DLCO (%Pred) (p = .035). Conclusions ILD is a common pulmonary involvement in both pSS patients and sSS patients. Older age, male sex, female sex at menopause, Raynaud’s phenomenon, low albumin levels and respiratory symptoms are risk factors associated with SS-ILD. NSIP is important HRCT feature of SS-ILD. sSS-ILD patients showed worse laboratory results and pulmonary function. KEY MESSAGE Older age, male sex, female sex at menopause, Raynaud’s phenomenon, low albumin levels and respiratory symptoms are risk factors associated with SS-ILD. SS-ILD patients show higher counts of platelets and less purpura. sSS-ILD patients have worse laboratory results and pulmonary function.

COVID-19 e suas manifestações nas crianças: uma revisão da literatura

Coronavirus disease is a global public health challenge. Due to its high rate of mutation to adapt to the host, the virus can cause serious human diseases, including in children. The article is a literature review using research on COVID-19 in children, published in the PubMed and Medline database, between November 2019 to March 2021. The clinical signs are similar to other childhood respiratory diseases, and may progress to dyspnea, vomiting, diarrhea, lethargy, cough, and fever. On pediatric chest tomography, we found multiple irregular bilateral opacities in ground glass, which can be sparse and irregular, and/or infiltrate the middle third or periphery of the lung or subpleural. Given the diversity of symptoms and most research on COVID-19 with an adult focus, health services need to improve specific treatment plans to treat pediatric patients infected with the virus.