Peripheral Consolidation Research Articles

Chest CT Features of Coronavirus Disease-19 (COVID-19) Pneumonia: Which Findings on Initial CT can Predict an Adverse Short-term Outcome?

Abstract Background COVID-19 is a highly contagious viral disease that caused daunting challenges to the health care system; early diagnosis plays a pivotal role in management and prognosis of the disease. Aim of the Work To study the spectrum of chest CT features in coronavirus disease-19 (COVID- 19) pneumonia and to identify the initial CT findings that may have the potential to predict a poor short-term outcome. Patients and Methods This was a retrospective study that included 60 patients (30 clinically improved and 30 clinically deteriorated patients) with RT-PCR confirmed COVID-19 infection who referred to the Radiodiagnosis Department at Ain Shams University Hospitals for chest HRCT examination. An acceptance from the ethical committee of the Radiology Department and the ethical committee of Faculty of Medicine - Ain Shams University was obtained to use the data stored on PACs system with the patient’s consent waived being a retrospective study. Results Shortness of breath, fatigue and presence of other comorbidities were more common in unstable group, seen in 93%, 86% and 66% respectively. CT severity score was higher in unstable group ranging from 12 to 26 together with anteroposterior distribution, central and peripheral distribution, crazy paving and consolidation with air bronchogram. Conclusion Comparison between clinically stable and unstable COVID-19 patients regarding clinical data at admission and initial CT chest findings revealed that higher percentage of total lung affection, central and peripheral involvement, anteroposterior distribution, crazy paving, consolidation with air bronchogram and vessel enlargement were the harbingers of poor prognosis especially in patients of old age, having other comorbidities and presented with shortness of breath.

Smoking-Related Interstitial Fibrosis and Smoker's Macrophages.

Smoking-related interstitial lung diseases (SRILDs) are a group of heterogeneous diffuse pulmonary parenchymal diseases associated with tobacco exposure. Smoking-related interstitial fibrosis (SRIF) is relatively recent, a pathologically defined form of SRILDs. SRIF is characterized by the accumulation of macrophages in the alveolar spaces, which is associated with interstitial inflammation and fibrosis. The macrophages frequently contain light brown pigment and are called 'smoker's macrophages'. Patients with SRIF who have clinical evidence of interstitial lung disease are most commonly relatively young, heavy smokers with abnormalities on chest computed tomography showing ground-glass opacities, peripheral consolidation, and reticulation. Although SRIF is caused by cigarette smoking, the exact pathophysiological mechanisms by which smoking causes this type of interstitial fibrosis remain unknown. The degree of fibrosis and appearance of macrophage aggregates are important points of distinction when evaluating and diagnosing SRIF. Macrophage heterogeneity, particularly the activation and function of monocyte-derived alveolar macrophages (Mo-AMs) and interstitial macrophages (IMs), has important implications for the pathogenesis of SRIF and developing treatments. Further researches focused on smoker's macrophages are needed to understand of the pathogenesis of SRIF.

LM-DNN: pre-trained DNN with LSTM and cross Fold validation for detecting viral pneumonia from chest CT

ABSTRACT Some of the viruses may cause lung parenchyma and airway involvement. Usually, viral pneumonia causes ground-glass opacities, bilateral peripheral distribution, consolidation, vascular thickening, and reticular opacity. These features are common in COVID-19 rather than Non-Covid-19 viral pneumonia. However, in advanced cases, COVID-19 viral pneumonia may cause organising pneumonia and fibrosis of the lung. Atypical findings of Non-Covid-19 pneumonia have included central peripheral distribution, pleural effusion, lymphadenopathy, nodules, tree-in-bud opacities, and pneumothorax. Therefore, differentiating Non-Covid-19 pneumonia from COVID-19 pneumonia at chest computed tomography (CT) is necessary. In that case, CT scans of the thorax are one of the essential tools for early identification and future prognosis of viral pneumonia. We have proposed a Computer-Aided Diagnostic (CAD) system that can detect features of chest CT using a Deep Neural Network (DNN) with Long Short-Term Memory (LSTM). Transfer learning using pre-trained DNN models (ResNet50, VGG19, InceptionV3, Xception, DenseNet121, and VGG16) is applied to retain both high-level and low-level features effectively. The deep features are passed to the LSTM layer. The LSTM is utilised as a classifier and detects long short-term dependencies. The proposed method employs a hybrid DNN-LSTM network for automatic detection to take advantage of the uniqueness of the two models. The proposed models are trained with common and different features present in the chest CT of COVID-19 and Non-Covid-19 viral pneumonia. The 5-fold cross-validation (CV) method validated and tested the proposed model. The proposed DNN model’s performance is quite improved with LSTM and CV. As a result, the proposed LM-DNN (VGG16+LSTM+CV) model has achieved the classification test accuracy of 91.58% and specificity of 93.86%, which offers superior performance with state-of-the-art. Also, the DenseNet121+LSTM+CV model has reached the classification test accuracy of 90.1% and sensitivity of 92%.

A rare and challenging case of intrapericardial hydatidosis

BackgroundHydatid cysts are most frequently located in the liver and lungs and very rarely can be found in the pericardium. Diagnosis and treatment are quite challenging, as the disease can present itself in many forms depending to the location and the complications that it might cause.Case presentationA 22-year-old man presented to our hospital with ongoing dry cough for more than 1 month prior to admission. Other symptoms included chest pain, fatigue, low grade fever, and night sweats, which have worsened in the past 2 weeks. Physical examination revealed normal respiratory and heart function. Chest X-ray demonstrated mediastinal enlargement and left pleural effusion. Contrast-enhanced computed tomography images showed a walled cystic mass lesion measuring up to 56 × 50 mm in close proximity to the upper left atrium, ascending aorta and pulmonary artery, potentially localized in the pericardium, with a 10 mm endoatrial filling defect, findings were compatible with hydatid cyst, left pleural effusion and peripheral pulmonary upper left lobe consolidation. Cardiac involvement was excluded on magnetic resonance imaging and trans-esophageal ultrasound. The patient underwent fine needle aspiration of the affected lung and thoracocentesis. No malignancy was found, meanwhile the biopsy confirmed the presence of pulmonary infarction. In view of the imaging findings were highly suspicious of a hydatid cyst, we performed a test of antibody titers that was negative. The patient underwent left anterolateral thoracotomy, and after the opening of the pericardium, a cystic mass of 5 cm in diameter was found next to the left atrium and in close proximity with the left pulmonary veins. The content of the cyst was completely removed after the surgical area was isolated with gauze impregnated with hypertonic solution (NaCl 10%). The mass resulted to be an echinococcal cyst with multiple daughter cysts within it that did not penetrate/involve (perforate) the cardiac wall.ConclusionPericardial echinococcosis is a very rare pathology in which a high expertise multidisciplinary approach is required. The compression mass effect caused by the cyst can lead to complications, such as in our case where the pulmonary vein was compressed, leading to pulmonary infarction. The value of radiology studies and transoesophageal ultrasound are very important in the diagnosis. Surgery in these cases is always recommended, but preferred surgical approach is questionable. In cases such as ours, we recommend anterolateral thoracotomy.

External validation, radiological evaluation, and development of deep learning automatic lung segmentation in contrast-enhanced chest CT

ObjectivesThere is a need for CT pulmonary angiography (CTPA) lung segmentation models. Clinical translation requires radiological evaluation of model outputs, understanding of limitations, and identification of failure points. This multicentre study aims to develop an accurate CTPA lung segmentation model, with evaluation of outputs in two diverse patient cohorts with pulmonary hypertension (PH) and interstitial lung disease (ILD).MethodsThis retrospective study develops an nnU-Net-based segmentation model using data from two specialist centres (UK and USA). Model was trained (n = 37), tested (n = 12), and clinically evaluated (n = 176) on a diverse ‘real-world’ cohort of 225 PH patients with volumetric CTPAs. Dice score coefficient (DSC) and normalised surface distance (NSD) were used for testing. Clinical evaluation of outputs was performed by two radiologists who assessed clinical significance of errors. External validation was performed on heterogenous contrast and non-contrast scans from 28 ILD patients.ResultsA total of 225 PH and 28 ILD patients with diverse demographic and clinical characteristics were evaluated. Mean accuracy, DSC, and NSD scores were 0.998 (95% CI 0.9976, 0.9989), 0.990 (0.9840, 0.9962), and 0.983 (0.9686, 0.9972) respectively. There were no segmentation failures. On radiological review, 82% and 71% of internal and external cases respectively had no errors. Eighteen percent and 25% respectively had clinically insignificant errors. Peripheral atelectasis and consolidation were common causes for suboptimal segmentation. One external case (0.5%) with patulous oesophagus had a clinically significant error.ConclusionState-of-the-art CTPA lung segmentation model provides accurate outputs with minimal clinical errors on evaluation across two diverse cohorts with PH and ILD.Clinical relevanceClinical translation of artificial intelligence models requires radiological review and understanding of model limitations. This study develops an externally validated state-of-the-art model with robust radiological review. Intended clinical use is in techniques such as lung volume or parenchymal disease quantification.Key Points• Accurate, externally validated CT pulmonary angiography (CTPA) lung segmentation model tested in two large heterogeneous clinical cohorts (pulmonary hypertension and interstitial lung disease).• No segmentation failures and robust review of model outputs by radiologists found 1 (0.5%) clinically significant segmentation error.• Intended clinical use of this model is a necessary step in techniques such as lung volume, parenchymal disease quantification, or pulmonary vessel analysis.Graphical

Lemierre syndrome: a hidden complication of sore throats

BackgroundLemierre syndrome is a rare but potentially life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein, most commonly caused by Fusobacterium necrophorum.Case presentationA 46-year-old woman with no significant medical history presented with generalized neck swelling and fever. Despite seeking medical attention at multiple outpatient clinics for upper respiratory symptoms lasting 10 days, she only received symptomatic treatment for acute viral pharyngitis. A computed tomography (CT) scan of her neck revealed thrombophlebitis in the left internal jugular vein, and subsequent cultures indicated the presence of Klebsiella pneumoniae. The patient’s oxygen saturation levels suddenly dropped, and the CT scan identified bilateral peripheral consolidation areas in both lungs, consistent with septic emboli. These findings were consistent with a diagnosis of Lemierre syndrome. The patient was treated with 2 weeks of intravenous piperacillin/tazobactam and vancomycin, as well as anticoagulation therapy using heparin, and her symptoms resolved completely.ConclusionThis report presents an unusual occurrence of Lemierre syndrome caused by K. pneumoniae, a less frequently encountered causative pathogen in patients without diabetes mellitus. The case highlights the significance of timely and appropriate antibiotic use to prevent potential complications.

Contrast-Enhanced Ultrasound in Distinguishing between Malignant and Benign Peripheral Pulmonary Consolidations: The Debated Utility of the Contrast Enhancement Arrival Time

Background. Limited studies and observations conducted on a too small number of patients prevent determining the actual clinical utility of pulmonary contrast-enhanced ultrasound (CEUS). The aim of the present study was to examine the efficacy of contrast enhancement (CE) arrival time (AT) and other dynamic CEUS findings for differentiating between malignant and benign peripheral lung lesions. Methods. 317 inpatients and outpatients (215 men, 102 women; mean age: 52 years) with peripheral pulmonary lesions were included in the study and underwent pulmonary CEUS. Patients were examined in a sitting position after receiving an intravenous injection of 4.8 mL of sulfur hexafluoride microbubbles stabilized by a phospholipid shell as ultrasound contrast agent (SonoVue-Bracco; Milan, Italy). Each lesion was observed for at least 5 min in real-time and the following temporal characteristics of enhancement were detected: the arrival time (AT) of microbubbles in the target lesion; the enhancement pattern; the wash-out time (WOT) of microbubbles. Results were then compared in light of the definitive diagnosis of community acquired pneumonia (CAP) or malignancies, which was not known at the time of CEUS examination. All malignant cases were diagnosed by histological results, while pneumonia was diagnosed on the basis of clinical and radiological follow-up, laboratory findings and, in some cases, histology. Results. CE AT has not been shown to differ between benign and malignant peripheral pulmonary lesions. The overall diagnostic accuracy and sensibility of a CE AT cut-off value < 10 s in discriminating benign lesions were low (diagnostic accuracy: 47.6%; sensibility: 5.3%). Poor results were also obtained in the sub-analysis of small (mean diameter < 3 cm) and large (mean diameter > 3 cm) lesions. No differences were recorded in the type of CE pattern showed between benign and malignant peripheral pulmonary lesions. In benign lesions we observed a higher frequency of delayed CE wash-out time (WOT) > 300 s. Anyhow, a CE WOT cut-off value > 300 s showed low diagnostic accuracy (53.6%) and sensibility (16.5%) in discriminating between pneumonias and malignancies. Similar results were also obtained in the sub-analysis by lesion size. Squamous cell carcinomas showed a more delayed CE AT compared to other histopathology subtypes. However, such a difference was statistically significant with undifferentiated lung carcinomas. Conclusions. Due to an overlap of CEUS timings and patterns, dynamic CEUS parameters cannot effectively differentiate between benign and malignant peripheral pulmonary lesions. Chest CT remains the gold standard for lesion characterization and the eventual identification of other pneumonic non-subpleural localizations. Furthermore, in the case of malignancy, a chest CT is always needed for staging purposes.

Chest CT Scan In Patients With Contusion and COVID 19 A Comparative Study With Pure Lung Contusion

Resource allocation for traumatic patients who are positive/negative for COVID-19 challenges the diagnosis. This study aims to compare the chest CT of COVID-19 associated with lung contusion versus those with lung contusion only. CT-scans of 9 RT-PCR positive patients with lung contusion due to MVA (CC group) and 16 patients with lung contusions from pre-COVID-19 (CO group) were revaluated. The distribution and characteristics of presenting CT-scan findings; including presence, shape, distribution of GGO, consolidations, subpleural sparing, crazy-paving and Atoll sign. Presence of effusions and cavities were compared. Time course of the opacities was compared. Bilateral distribution of opacities was noted in 100% of CC and 87.5% of CO group. There was no significant difference between GGO or consolidation shapes (P=0.44 and P=0.66). Both GGO and consolidations were more diffusely distributed in CC, a predominantly peripheral distribution was more commonly seen in the CO group (P=0.03 and P=0.01). Subpleural sparing was noted in 93.8% of CO as compared to 44% of CC group (p=0.04). Time to resolution was significantly longer in CC (15±6days) comparing to CO patients (P=0.02). 'Typical' chest CT findings including bilateral peripheral GGO and consolidations, crazypaving, Atoll signs and also less typical findings e.g. subpleural sparing is seen in lung contusion and COVID-19 pneumonitis. Lesion Time course might be a better radiologic discriminator between the two entities.

Migratory Pneumonia in Prolonged SARS-CoV-2 Infection in Patients Treated With B-cell Depletion Therapies for B-cell Lymphoma.

To report the clinical and radiological characteristics of patients with underlying B-cell lymphoma and coronavirus disease 2019 (COVID-19) showing migratory airspace opacities on serial chest computed tomography (CT) with persistent COVID-19 symptoms. From January 2020 to June 2022, of the 56 patients with underlying hematologic malignancy who had undergone chest CT more than once at our hospital after acquiring COVID-19, seven adult patients (5 female; age range, 37-71 years; median age, 45 years) who showed migratory airspace opacities on chest CT were selected for the analysis of clinical and CT features. All patients had been diagnosed with B-cell lymphoma (three diffuse large B-cell lymphoma and four follicular lymphoma) and had received B-cell depleting chemotherapy, including rituximab, within three months prior to COVID-19 diagnosis. The patients underwent a median of 3 CT scans during the follow-up period (median 124 days). All patients showed multifocal patchy peripheral ground glass opacities (GGOs) with basal predominance in the baseline CTs. In all patients, follow-up CTs demonstrated clearing of previous airspace opacities with the development of new peripheral and peribronchial GGO and consolidation in different locations. Throughout the follow-up period, all patients demonstrated prolonged COVID-19 symptoms accompanied by positive polymerase chain reaction results from nasopharyngeal swabs, with cycle threshold values of less than 25. COVID-19 patients with B-cell lymphoma who had received B-cell depleting therapy and are experiencing prolonged SARS-CoV-2 infection and persistent symptoms may demonstrate migratory airspace opacities on serial CT, which could be interpreted as ongoing COVID-19 pneumonia.

LUNG DAMAGE AS A COMPLICATION OF SYSTEMIC JUVENILE ARTHRITIS

According to modern science, systemic juvenile arthritis (sJA) is an autoinflammatory disease characterized by severe systemic manifestations and life-threatening complications. This article discusses the developmental predictors, clinical and radiological manifestations and pathogenetic features of the disease. Particular attention is paid to genetically engineered biological therapy.&#x0D; Numerous pulmonary complications are now known in sJA children, including interstitial lung disease (ILD), pulmonary alveolar proteinosis (PAP), pulmonary hypertension (PH), and lipoid pneumonia. Fatality rate in sJA patients increases against the macrophage activation syndrome (MAS) development and pulmonary hypertension, which occurs with proliferation of endothelial cells, muscle tissue and fibroblasts in the lungs vessels. A more severe disease progression is typical for children with genetic defects. SAM and PAP relapses are observed more often in such patients. Instrumental diagnostic methods helped to identify, 5 subtypes determining the lung tissue damage in sJA. Computer tomography (CT) revealed the main signs of lung damage in sJA patients: ground-glass opacity, crazy-paving sign, thickening of the bronchial wall, interlobar septum, pleura, peripheral consolidation, and lymphadenopathy. Due to the high level of sJA activity, children were prescribed genetically engineered biological drugs (GEBP). Timely therapeutic correction is necessary to exclude life-threatening adverse reactions. Under dynamic observation, it is possible to diagnose lung damage in children at the early stage and to control the pathology.&#x0D; The purpose of this review is to systematize the existing data on developmental predictors, pathogenetic features of the disease, sJA clinical and radiological manifestations, and genetically engineered biological therapy as a method of sJA treatment.

Utility of the serial portable chest x-ray for the diagnosis and quantification of COVID-19 patients

ObjectiveTo determine the role of the serial portable chest X-ray in the diagnosis and quantification of patients with confirmed COVID-19 admitted to a tertiary care hospital. MethodsA retrospective study was conducted at Dow Institute of Radiology, Dow University of Health Sciences. Confirmed positive cases of COVID-19 from November 2020 to January 2021 were retrospectively studied. Patients' demographics and clinical characteristics, chest X-ray findings, and outcomes were retrieved through electronic medical records. Baseline and final follow-up chest X-rays findings were compared by using chest X-ray severity score. Multivariable logistic regression was used to evaluate the relationship between patients’ characteristics and patient outcomes. ResultsThe study included 329 patients with a mean age of 56.43 ± 13.10 years (range 16–85 years). Peripheral consolidation and ground glass opacities (89.4%) were the most common X-ray findings followed by bilateral lung involvement (79.0%) and perihilar consolidation/ground glass opacities (69.9%). Among the patients who were admitted, 61.4% were discharged, 49.5% had prolonged length of stay ≥10 days, and 37.7% died. After adjustment of all patients' characteristics, the multivariate model showed no significant difference in chest X-ray severity score in relation to the patient's outcome. Patients who were admitted to the intensive care unit, and received oxygen support, bilevel positive airway pressure, and a ventilator were significantly associated with the outcome of being discharged, prolonged hospital stay, and death. ConclusionPeripheral consolidation and ground glass opacities were the most common chest X-ray findings in admitted COVID-19 patients. No significant difference in chest X-ray severity score was noted in the primary outcome of being discharged, prolonged hospital stay, and death. There is no requirement for daily chest X-rays in hospitalized patients until required in the condition of worsening symptoms or significant intervention such as endotracheal intubation.

LYMPHANGITIC CARCINOMATOSIS PRESENTING AS CHRONIC EOSINOPHILIC PNEUMONIA

LYMPHANGITIC CARCINOMATOSIS PRESENTING AS CHRONIC EOSINOPHILIC PNEUMONIA

Coexistence of carbon monoxide intoxication and COVID-19

Introduction&#x0D; This case report aimed to report two patients admitted to the emergency department with a preliminary diagnosis of carbon monoxide intoxication and was diagnosed with COVID-19 during their follow-up.&#x0D; Case 1&#x0D; A 73-year-old female patient presented with weakness and shortness of breath complaints to the emergency department. Carboxyhemoglobin (COhgb) reached 36.2 %. Atypical pneumonic infiltration with peripheral and central patchy consolidations in the zones in hemothorax images from computerized tomography. The patient was tested positive for COVID-19 after a PCR test. The COhgb values of the patient reached 16 % after 3 h. Then, it dropped to 3.0 % after 8 h.&#x0D; Case 2&#x0D; A 77-year-old male patient presented with shortness of breath and nausea complaints to the emergency department. COhgb (carboxyhemoglobin) reached 30%. Emphysematous changes in the lung parenchyma and increased peribronchial densities in the lobes were shown in computed tomography. The patient was tested positive for COVID-19 after a PCR test. The COhgb values of the patient reached 13 after 3 h. It dropped to 2.4 after 8 h. &#x0D; Conclusion&#x0D; Carbon monoxide intoxication is a significant public health problem with a high probability of death. Detailed studies and meta-analyses are needed to affect the prognosis of COVID-19 disease.

Rare, rarer, lung involvement in adult-onset Still's disease: A mini-review

Adult-onset Still's disease (AOSD) is a polygenic systemic autoinflammatory disease which is associated with increased morbidity and mortality. Pulmonary involvement is a rare, but serious complication of AOSD. As in AOSD, IL-1b, IL-18, and IL-6 dominate the molecular pathogenesis, which mediate a type 1 and type 3 inflammatory signature of the adaptive immune system. This is evidenced by the success of IL-1- and IL-6 inhibition in the management of AOSD. However, anaphylactic reactions to treatment with IL-1- or IL-6-inhibitors is currently being discussed as a potential trigger for lung involvement inf AOSD, while genetic risk factors have also been identified. Clinically, pulmonary involvement in AOSD can manifest in many different forms. Parenchymal inflammation with peripheral consolidations is the most frequent form while PAH is less common, but often very difficult to manage. This mini-review provides an overview of the pathophysiology as well as the clinical presentation and the diagnostic features of pulmonary involvement in AOSD.

Small‐cell lung cancer from the peripheral lung is frequently accompanied by emphysema and interstitial lung disease in the background

BackgroundIt has long been thought that small‐cell lung cancer (SCLC) is a central type of tumor that is located in the proximal bronchi and the mediastinum. However, several studies reported that SCLC exhibited several types of spread pattern on computed tomography (CT). The aim of this study is to investigate the relationship between CT images and clinical characteristics in patients with SCLC.MethodsWe retrospectively reviewed the CT images of 92 SCLC patients and classified them into six types of spreading patterns: central, peripheral, lymphangitic spread (LYM), pleural dissemination (PLE), lobar replacement (LOB), and air‐space consolidation (AC). We also evaluated the correlation between primary tumor location and the clinical characteristics of patients.ResultsThe most common type of imaging pattern was peripheral (n = 40, 44%), with the next most common type being central (n = 27, 29%). Atypical types of SCLC, such as LYM (n = 2, 2%), PLE (n = 4, 4%), LOB (n = 8, 9%), and AC (n = 11, 12%), were also recognized in our study. The prevalence of emphysema and interstitial lung disease (ILD) was significantly higher in the peripheral type than in the central type (p = 0.0056 and p = 0.0403, respectively). Meanwhile, no survival difference was seen between the central type and the peripheral type (median months 17.9 vs. 21.9, respectively, p = 0.720).ConclusionsThe peripheral type of tumor was correlated with higher prevalence of emphysema and ILD in SCLC. Our result suggests different mechanisms of development and tumor characteristics according to tumor location.

Alert Germ Infections: Chest X-ray and CT Findings in Hospitalized Patients Affected by Multidrug-Resistant Acinetobacter baumannii Pneumonia.

Acinetobacter baumannii (Ab) is an opportunistic Gram-negative pathogen intrinsically resistant to many antimicrobials. The aim of this retrospective study was to describe the imaging features on chest X-ray (CXR) and computed tomography (CT) scans in hospitalized patients with multidrug-resistant (MDR) Ab pneumonia. CXR and CT findings were graded on a three-point scale: 1 represents normal attenuation, 2 represents ground-glass attenuation, and 3 represents consolidation. For each lung zone, with a total of six lung zones in each patient, the extent of disease was graded using a five-point scale: 0, no involvement; 1, involving 25% of the zone; 2, 25–50%; 3, 50–75%; and 4, involving >75% of the zone. Points from all zones were added for a final total cumulative score ranging from 0 to 72. Among 94 patients who tested positive for MDR Ab and underwent CXR (males 52.9%, females 47.1%; mean age 64.2 years; range 1–90 years), 68 patients underwent both CXR and chest CT examinations. The percentage of patients with a positive CT score was significantly higher than that obtained on CXR (67.65% > 35.94%, p-value = 0.00258). CT score (21.88 ± 15.77) was significantly (p-value = 0.0014) higher than CXR score (15.06 ± 18.29). CXR and CT revealed prevalent bilateral abnormal findings mainly located in the inferior and middle zones of the lungs. They primarily consisted of peripheral ground-glass opacities and consolidations which predominated on CXR and CT, respectively.

Diagnostic Performance of Point Shear Wave Elastography Using Acoustic Radiation Force Impulse Technology in Peripheral Pulmonary Consolidations: A Feasibility Study.

The aim of the study described here was to evaluate the diagnostic performance of lung ultrasound point shear wave elastography using acoustic radiation force impulse (ARFI) in peripheral pulmonary consolidations (PPCs). A total of 87 patients with PPCs diagnosed from April to December 2020 were included retrospectively in the study. The inclusion criteria were (i) a PPC >1 cm; (ii) valid ARFI measurements; and (iii) confirmation of the diagnosis of a PPC by histocytological examination and/or clinical and radiological follow-up. The presence of pleural effusions and mean ARFI velocities (MAVs) of PPCs were evaluated. To examine the MAV for potential cutoff values between benign and malignant PPCs, a receiver operating characteristic analysis was implemented. In total, 48 of 87 PPCs (55.2%) were accompanied by pleural effusions. Benign PPCs had significantly lower MAVs than malignant PPCs (1.82 ± 0.97 m/s vs. 3.05 ± 0.73 m/s, p < 0.001). Selecting 2.21 m/s as a cutoff value yielded a sensitivity and specificity of 89.7% and 75.9%, respectively, in diagnosing malignant PPCs (area under the curve=0.852, 95% confidence interval: 0.773-0.931). In summary, ARFI elastography may be an additional non-invasive tool for differentiating benign from malignant PPCs. Furthermore, the feasibility of using ARFI elastography in PPCs associated with pleural effusions was proved. However, there is some degree of overlap between different disease entities, and diagnosis should always take into account the clinical background.

Successful management report of COVID-19 with unusual symptoms after heart surgery

COVID-19 is a pandemic and general health urgency with global concern which is rapidly spreading with the new sign. A 72-years-old man with diagnosis of myocardial infarction is transferred to the operating room for the coronary artery bypass surgery. The coronavirus-2019 test and the other diagnostic methods related to it were done and the result was negative. He returned to the hospital with hypotension two months after surgery. At first, the surgeon thought that these symptoms were related to the side effects of the cardiac medicines, so stopped taking and decreased the dose of those medicines. However, the hypotension persisted while the patient complained of anorexia, dizziness, and nausea. Considering the fact that the patient’s daughter was a health care worker who suffered from COVID-19, chest High-Resolution CT (HRCT) was conducted showing multi-focal peripheral consolidations in both lungs purposing viral pneumonia. Consequently, the patient was isolated. COVID-19 Polymerase Chain Reaction (PCR) was cheeked, which turned out to be positive and confirmed the diagnosis. Patients received intensive care in the hospital for six days and were discharged in good general condition to pass the rest of the isolation period at home. It is recommended according to the common symptoms of the coronavirus-2019 disease and the side effects of the cardiac patients’ medicines, such as vertigo, nausea, and vomiting, that these symptoms, in the case of these symptoms’ occurrence for the patients of coronary artery bypass surgery, can be resulted from the coronavirus-2019 disease, not from the medicine effects.

Prognostic significance of peripheral consolidations at chest x-ray in severe COVID-19 pneumonia.

To evaluate the possible prognostic significance of the development of peripheral consolidations at chest x-ray in COVID-19 pneumonia, we retrospectively studied 92 patients with severe respiratory failure (PaO2/FiO2 ratio < 200 mmHg) that underwent at least two chest x-ray examinations (baseline and within 10 days of admission). Patients were divided in two groups based on the evolution of chest x-ray toward the appearance of peripheral consolidations or toward a greater extension of the lung abnormalities but without peripheral consolidations. Patients who developed lung abnormalities without peripheral consolidations as well as patients who developed peripheral consolidations showed, at follow-up, a significant worsening of the PaO2/FiO2 ratio but a significantly lower mortality and intubation rate was observed in patients with peripheral consolidations at chest x-ray. The progression of chest x-ray toward peripheral consolidations is an independent prognostic factor associated with lower intubation rate and mortality.

Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillance

ObjectivesTo determine the causes of lobar pneumonia in rural Gambia.Design and settingPopulation-based pneumonia surveillance at seven peripheral health facilities and two regional hospitals in rural Gambia. 7-valent pneumococcal conjugate vaccine...