Patchy Areas Of Consolidation Research Articles

Pneumonia caused by coagulase - positive methicillin - resistant Staphylococcus aureus

Introduction. Staphylococcus (S.) aureus is one of the most omnipresent and dangerous human pathogens, whose main characteristic is the production of the enzyme coagulase. This characteristic serves to identify and assess the pathogenicity of the bacteria. In addition to skin infections, endocarditis, osteomyelitis, and infectious arthritis, it is a common cause of pneumonia both in children and adults. Case report. We described a case of a 65-year-old woman with a dry cough and malaise with patchy areas of consolidation on the chest X-ray and ?ground-glass? opacity with bronchial wall thickening and unilateral mediastinal lymphadenopathy on chest computed tomography imaging. Methicillin-resistant S. aureus was isolated from the bronchoalveolar aspirate taken during bronchoscopy. The woman was empirically treated with azithromycin, and later, based on the antibiogram findings, azithromycin was replaced with meropenem, after which her health improved. Conclusion. We presented a rare case of pneumonia with unconvincing symptomatology and laboratory and radiological findings. Paying more attention to such cases in the future is crucial, especially to the use of antibiotics to which staphylococci are increasingly developing resistance.

P204 Secondary organizing pneumonia caused by Aspergillus flavus in immunocompromised patients

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMIntroductionFungal pneumonia is a known complication in immunocompromised patients. However fungal infection leading to organizing pneumonia (OP) is a rare entity. Here we present two cases of co-occurrence of OP with Aspergillus lung infectionCase 1: A 33-year-old male with a history of recurrent oral-genital ulcerations and low-grade fever for the last 3 months presented with shortness of breath and high-grade fever for 10 days. On presentation he was hypotensive, tachycardic, and tachypneic, examination revealed bilateral crackles. His initial investigations were hemoglobin (Hb) 8.8, total leucocyte counts (TLC) 13 000, platelet 190 000, liver function test (LFT), and kidney function test (KFT) were normal. High-resolution commuted tomography (HRCT) revealed multifocal areas of interlobular septal thickening with ground glass opacity and patchy areas of consolidation seen in bilateral lung fields (Fig. 1). He was initially managed with broad-spectrum antibiotics and oxygen support by a high flow nasal cannula (HFNC); as the condition deteriorated, he was mechanically ventilated. Fibreoptic bronchoscopy with bronchoalveolar lavage (BAL) was performed. Investigations for tuberculosis, nocardia, pneumocystis carinii, and bacterial infection in BAL was negative. Galactomannan index (GMI) in BAL was 3.15 and grew Aspergillus flavus. Transbronchial biopsy revealed features consistent with organizing pneumonia. He was started on voriconazole and steroids. He was diagnosed with undifferentiated connective tissue disorder. As the patient's condition improved in due course of time, he was extubated and discharged in stable condition on voriconazole and steroids and is currently doing fine.Case 2: A 56-year-old male known case of mantle cell lymphoma on consolidation therapy, presented with 15 days history of shortness of breath and high-grade fever. Chest examination revealed decreased breath sounds bilaterally in the lower lung zones with lower zone crackles. Initial investigations showed Hb 10.9, TLC 3.90, platelet 150000, KFT and LFT were normal. HRCT scan revealed multilobular areas of consolidation showing air bronchogram with ground glass opacities in bilateral lung (Fig. 1). Bronchoalveolar lavage fluid (BALF) revealed the growth of Aspergillus flavus and was GMI 1.97. Investigations for tuberculosis, nocardia, pneumocystis carinii and bacterial infection was negative. Transbronchial biopsy revealed features consistent with organizing pneumonia. He was started on combination therapy with voriconazole and micafungin along with steroids. Initially, he was managed with oxygen support but his oxygenation gradually worsened, he was mechanically ventilated, and received multiple pruning sessions. Patient had refractory organizing pneumonia, did not show any improvement even after 1 month, and left against medical advice.ConclusionBacterial and viral infections are the common causes of secondary OP. Fungal infections implicated in secondary OP are rarely described, of which there are reports of Pneumocystis jiroveci (PJP) and Penicillium infection leading to secondary OP. Aspergillus flavus is a ubiquitous fungal agent and is considered as pathogenic in immunocompromised settings can lead to secondary organizing pneumonia. High index of suspicious for OP is always to be kept in mind while treating Aspergillus flavus pneumonia.

A Case Report on Histomorphological Features in Death Due to H1N1 Influenza

Swine influenza strain can be transmitted from human to human and causes normal symptoms of influenza. Transmission mainly occurs between pigs and pigs and humans. Our present study is of a 72yrs old male who died of H1N1 infection. Postmortem findings showed congested and edematous lungs with patchy areas of consolidation. Histopathological findings in lung revealed edema, pneumonic changes, hyaline membrane formation and focal cytophagocytosis.

Clinicoradiological Correlation of Covid19 Patients in Western Uttar Pradesh, India: A Descriptive Study

Abstract: A pilot study of 150 patients at premier medical institute of western Uttar Pradesh, INDIA. The purpose of this pictorial review article is to describe the most common manifestations and patterns of lung abnormality on CXR in COVID-19 in order to equip the medical community in its efforts to combat this pandemic. The varied spectra of COVID-19 presentation included fever, cough, shortness of breath, sore throat etc. Diabetes mellitus, hypertension, COPD/K-Chest and CAD were found as major comorbid conditions. Symptomatic presentation of COVID-19 was observed to be higher in patients with co morbid disease, especially if multiple. HRCT chest in COVID-19 patients had a major diagnostic and prognostic importance as positive CT findings were more prominent in symptomatic patients and co-morbid patients. Clinical symptoms of patients directly correlated with CT severity index. CT imaging was found to be useful in predicting clinical recovery of patients or progression of disease. Introduction: COVID-19 (coronavirus disease 2019) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), declared as a pandemic on 11th March 2020. The chest imaging findings are nonspecific and most commonly show atypical or organizing pneumonia, often with a bilateral, peripheral and bi-basal predominant distribution. Our study is concerned with the data of COVID positive patients admitted in the institute for the period of March 16- May 17, 2020. Aims and Objectives 1) To correlate clinical and radiological spectra of covid positive patients and their final outcome. 2) To describe the spectrum of lung parenchyma changes in the symptomatic as well as asymptomatic in COVID- 19 patients. Review of literature: This case report series presents a summary of key findings frequently associated with COVID-19, which will assist radiologists and clinicians in preliminary clinical evaluation (PCE). Materials and Methods: The data for the study is sourced from clinically suspected patients from the Covid Ward, LLRM Medical College, Meerut,(U.P.),INDIA which were subjected to chest radiography on 60mAh portable X-Ray machine. The patients are followed up to correlate the findings with clinical outcome. The study has been conducted on a minimum of 150 patients with portable Chest X-Ray machine. Observations & Discussion: The most frequent findings encountered are airspace opacities are viz- Hazy pulmonary opacities, Bilateral lower lobe consolidations, Peripheral air space opacities, Uncommon CXR findings, Diffuse air space disease. Conclusion: Based on our study, few inferences have been deduced; A significant proportion of the clinically symptomatic cases shows characteristic radiological changes on chest X-ray and also how chest radiography can be used as a tool not to substitute but supplement RTPCR in evaluation of COVID positive cases. Keywords: Patchy areas of consolidation, shortness of breath, high resolution CT Scan, RTPCR.

Oxaliplatin-related interstitial pneumonia with high-grade fever and relative bradycardia as the presenting signs: a case report

BackgroundAlthough drug-induced interstitial pneumonia is a well-known adverse side-effect of cancer chemotherapy, the disease is difficult to detect in the early phase. We report a case of oxaliplatin-induced interstitial pneumonia in which eosinophilia and high-grade fever with relative bradycardia were useful presenting signs for the early diagnosis.Case presentationA 76-year-old Japanese woman with postoperative recurrent rectal cancer (peritoneal dissemination and liver metastasis) was admitted to our hospital because of productive cough and consolidation on thoracic computed tomography (CT) images. Two months prior to the consultation, she had started chemotherapy (fluorouracil, oxaliplatin, and bevacizumab). After finishing three courses of chemotherapy, she developed fever and was noted to have relative bradycardia. After another two courses of chemotherapy, she developed productive cough, chest discomfort, and high-grade fever. At this time, thoracic CT revealed patchy areas of consolidation distributed predominantly in the periphery. Despite the administration of tazobacterium/piperacillin, the consolidation seen on CT scans gradually worsened. Fiberoptic bronchoscopy was performed, and bronchoalveolar lavage fluid analysis showed increased lymphocytes, eosinophils, and total cell count but a low CD4/ CD8 ratio. No specific pathogen was identified. With a diagnosis of interstitial pneumonia, prednisolone was started and chemotherapy was temporarily discontinued. Her productive cough gradually decreased, and the infiltrative shadows on the thoracic CT scans improved.ConclusionAlthough cases of oxaliplatin-related pneumonia with complicating relative bradycardia are not uncommon, drug-induced interstitial pneumonia should be taken into account in the differential diagnosis. In this case, an increased circulating eosinophil count and high-grade fever with relative bradycardia were the first signs of drug-induced interstitial pneumonia.

LIPOID PNEUMONIA SEEN IN PATIENT WITH HISTORY OF PURGING

SESSION TITLE: Medical Student/Resident Imaging Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Lipoid pneumonia is seen when mineral oil (commonly used for constipation) is aspirated [1]. Two responses are noted: (1) an inflammatory response with regional edema and intra alveolar hemorrhage; these patients acutely present with cough, fever, and dyspnea, or (2) a “paraffinoma” with aspirated oils encapsulated by fibrous tissues; these patients present asymptomatically with mass seen on imaging [2]. Most patients who develop lipoid pneumonia have risk factors for aspiration. CASE PRESENTATION: Patient is a 61-year-old female with known history of Hepatitis C, anxiety, self-described “obsessive-compulsive disorder”, homebound for eight years, and no recent physician visits, brought in by Emergency Medical Services after patient was standing from chair and heard a loud “snap”. On interview, patient remarked that she consistently “eats healthy” and took “natural” supplements for her “constipation”. On arrival, the patient's vital signs were within normal limits, afebrile, saturating 99 percent on room air. Patient was cachectic appearing with bitemporal wasting and four out of five strength globally. She exhibited pressured speech and tangential thought. Lungs were clear to auscultation bilaterally. Patient was found to have pathologic fracture of left femur on Computed Tomography (CT) imaging and underwent open reduction and internal fixation. Chest X-Ray revealed a right middle lobe or lingular opacity concerning for aspiration or a questionable pneumonia. Further imaging of chest with a noncontrast CT showed fat attenuation and patchy areas of consolidation in the mid to lower lungs bilaterally, compatible with lipoid pneumonia. In-patient psychiatry diagnosed the patient as hypomanic and noted that she exhibited multiple signs of anorexia nervosa including limited oral intake and excessive purging. Patient was otherwise asymptomatic throughout hospital course. DISCUSSION: This presentation is unique in that the patient had been taking mineral oil supplements for purging in addition to emesis; emesis of these oil particles and subsequent aspiration were the cause of her development of lipoid pneumonia. While aspiration of food particles is common, aspiration of organic oils is quite rare. It is important remember that patients with body dysmorphic disorder can use laxatives as a form of purging. All patients that exhibit signs of purging are at great risk for aspiration pneumonitis and pneumonia. CONCLUSIONS: The patient’s presentation and CT findings suggests a “paraffinoma” rather than inflammation with hemorrhage. While typical paraffinomas are skin conditions characterized by granulomatous and fibrotic reactions in subcutaneous fats, interestingly, the same reactions can take place in the lung resulting in above CT findings. Reference #1: Spickard, A., & Hirschmann, J. V. (1994). Exogenous lipoid pneumonia. Archives of internal medicine, 154(6), 686-692. Reference #2: Betancourt, S. L., Martinez-Jimenez, S., Rossi, S. E., Truong, M. T., Carrillo, J., & Erasmus, J. J. (2010). Lipoid pneumonia: spectrum of clinical and radiologic manifestations. American Journal of Roentgenology, 194(1), 103-109. DISCLOSURES: No relevant relationships by George Apergis, source=Web Response No relevant relationships by Karthik Bharadwaj, source=Web Response No relevant relationships by Doris Zavaro, source=Web Response

A Case of Idiopathic Hypereosinophilic Syndrome Presenting With Acute Respiratory Distress Syndrome

Although idiopathic hypereosinophilic syndrome(IHES) commonly involves the lung, it is rarely associated with acute respiratory distress syndrome (ARDS). Here we describe a case of IHES presented in conjunction with ARDS. A 37-year-old male visited the emergency department at Samsung Medical Center, Seoul, Korea, with a chief complaint of dyspnea. Blood tests showed profound peripheral eosinophilia and thrombocytopenia. Patchy areas of consolidation with ground-glass opacity were noticed in both lower lung zones on chest radiography. Rapid progression of dyspnea and hypoxia despite supplement of oxygen necessitated the use of mechanical ventilation. Eosinophilic airway inflammation was subsequently confirmed by bronchoalveolar lavage, leading to a diagnosis of IHES. High-dose corticosteroids were administered, resulting in a dramatic clinical response.

Chronic cough associated with Crohn's disease

A 62-year-old man presented with chronic dry cough. He was known to have Crohn's disease which was in remission. A plain chest radiograph demonstrated bilateral apical infiltrates. A HRCT of the chest showed normal proximal airways. Stenosis of medium size airways was present with post-stenotic dilation. These dilated peripheral bronchi appeared fluid filled. Patchy areas of consolidation were seen as well. These changes were thought to be due to Crohn's disease involving the lungs and responded well to treatment with cortico-steroids. We report this uncommon radiological association with Crohn's disease.

Pulmonary fibrosis associated with psychotropic drug therapy: a case report

IntroductionSertraline and Risperidone are commonly used psychotropic drugs. Sertraline has previously been associated with eosinopilic pneumonia. Neither drug is recognised as a cause of diffuse fibrotic lung disease. Our report represents the first such case.Case PresentationWe describe the case of a 33 year old Asian male with chronic schizophrenia who had been treated for three years with sertraline and risperidone. He presented to hospital in respiratory failure following a six month history of progressive breathlessness. High resolution CT scan demonstrated diffuse pulmonary fibrosis admixed with patchy areas of consolidation. Because the aetiology of this man's diffuse parenchymal lung disease remained unclear a surgical lung biopsy was undertaken. Histological assessment disclosed widespread fibrosis with marked eosinophillic infiltration and associated organising pneumonia - features all highly suggestive of drug induced lung disease. Following withdrawal of both sertraline and risperidone and initiation of corticosteroid therapy the patient's respiratory failure resolved and three years later he remains well albeit limited by breathlessness on heavy exertion.ConclusionDrug induced lung disease can be rapidly progressive and if drug exposure continues may result in respiratory failure and death. Prompt recognition is critical as drug withdrawal may result in marked resolution of disease. This case highlights sertraline and risperidone as drugs that may, in susceptible individuals, cause diffuse pulmonary fibrosis.

Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients.

Our objective was to describe the CT findings of thoracic Wegener's granulomatosis. At presentation, both conventional and thin-section CT scans were available in 30 patients with Wegener's granulomatosis. Serial CT scans (range of intervals: 1-25 months, mean 4.5 months) were available in 20 patients. The initial and follow-up CT scans were analyzed retrospectively by two observers in terms of pattern and extent of parenchymal and airway lesions. Positive CT findings were seen in 29 of 30 (97%) patients at initial presentation. The most common pattern was nodules or masses seen in 27 of 30 (90%) patients. They were multiple in 23 of 27 (85%) patients, bilateral in 18 (67%), subpleural in 24 (89%), and peribronchovascular in 11 (41%) in distribution. Bronchial wall thickening in the segmental or subsegmental bronchi was seen in 22 (73%) patients. Large airways were also abnormal in 9 (30%) patients. Patchy areas of consolidation and ground-glass opacity were seen in 7 (23%) patients, respectively. In 17 of 20 (85%) patients in whom follow-up CT scans were available, the parenchymal or airway lesion showed complete or partial improvement with treatment. The CT findings of Wegener's granulomatosis, although multiple and variable, consist mainly of bilateral subpleural or peribronchovascular nodules or masses and bronchial wall thickening in the segmental or subsegmental bronchi. Parenchymal and airway lesions improve with treatment in most patients.

Update on lymphoid interstitial pneumonitis

Lymphoid interstitial pneumonitis (LIP) involves a clinicopathologic pattern of pulmonary disease characterized by diffuse interstitial reactive lymphoid infiltrates. In adults, it occurs most commonly in autoimmune diseases, such as Sjögren's syndrome (0.9% of these patients) and primary biliary cirrhosis, whereas in children it is usually seen in HIV infection. Dysproteinemias (hyper- and hypogammaglobulinemia) are found in more than 60% of patients. Children can show CD8-lymphocytosis in bronchoalveolar lavage fluid, lung tissue, peripheral blood, and salivary gland, associated with HLA-DR5 haplotype. Radiographically, most patients with LIP have reticulonodular infiltrates, with or without patchy areas of consolidation. CT scans can show both small nodular and ground glass patterns, patterns that are diagnostically nonspecific. Reduced lung volumes and diffusing capacities are consistent and sensitive indicators of disease in LIP. In an experimental model, diffusing capacity was the single most sensitive functional index of disease progression. Microscopically, LIP is part of a spectrum of pulmonary lymphoid proliferations, ranging from follicular bronchitis-bronchiolitis and pulmonary lymphoid hyperplasia (the latter in AIDS patients), proliferations largely limited to airways, to low-grade malignant lymphoma. These patterns may be difficult to differentiate from each other. It appears that LIP sometimes evolves to lymphoma; the frequency of this evolution is probably low but is difficult to assess because low-grade lymphomas may mimic LIP. A relatively high frequency of LIP patients have Epstein-Barr virus DNA in their lungs but not all patients with LIP show this finding, suggesting other possible etiologies.

Bilateral hypoplasia of the soft palate in a foal

Bilateral hypoplasia of the soft palate and aspiration pneumonia occurred in a Standardbred foal. The filly was presented with a history of illthrift, dyspnoea, coughing and bilateral nasal discharge. Abnormal sounds (crackels and wheezes) were auscultated over all lung fields and the cervical trachea. Endoscopy revealed a shortened soft palate with a uvula-like mass protruding from the free border into the nasopharynx. Mucopurulent material was present in the trachea. Samples obtained by tracheal wash were submitted for cytology, culture and sensitivity testing. Results indicated a septic inflammatory process. On lateral radiographs of the thorax there were patchy areas of consolidation and air bronchograms. The foal was euthanased. Necropsy confirmed the presence of a palatal defect and aspiration pneumonia of moderate severity. No other congenital abnormalities were present.

Clinical manifestations of intrathoracic cutaneous T-cell lymphoma.

Intrathoracic involvement with cutaneous T-cell lymphoma (CTCL) was documented in eight patients with mycosis fungoides and two patients with Sĕzary syndrome. The radiographic findings consisted of multiple bilateral parenchymal nodular densities (five patients), patchy areas of consolidation (two patients), diffuse reticulonodular or interstitial infiltration (two patients), and pleural effusion without underlying parenchymal disease (one patient). Dyspnea on exertion and nonproductive cough were the most frequent presenting symptoms, and physical examination of the lungs was usually normal. In one patient a partial Pancoast's syndrome developed from a pulmonary apical mass. Results of blood gas studies and pulmonary function tests indicated an alveolar-capillary block in gas diffusion. Although the antemortem diagnosis was often suggested on cytopathologic preparations or on tissue obtained by transbronchial or percutaneous needle aspiration biopsy, a definitive diagnosis of CTCL usually required an open-lung biopsy. The response of pulmonary infiltrates to various systemic chemotherapeutic agents was variable, and the mean survival after initiation of drug therapy was 9.5 months. The findings suggest that combined modality therapy should be considered for patients with extracutaneous CTCL.