Pleural Thickening Research Articles

Evaluation of ANCA testing by antigen-specific assays in small vessel vasculitis patients

IntroductionAntineutrophil cytoplasmic antibodies (ANCA) testing is a screening method that may be applied in clinical practice. Testing for vasculitis linked to antineutrophil cytoplasmic antibodies (AAV) usually involves these measurements. ANCAs are not exclusive to vasculitis; immunofluorescence testing can also detect (atypical) ANCA patterns in other inflammatory diseases. As a result, using indirect immunofluorescence (IIF) in addition to an immunoassay was advised. These discoveries led to the establishment of a new worldwide consensus. The 2017 international agreement on ANCA testing states that when immunoassay is used as the primary screening method to detect AAV, IIF should not be necessary.AimAssess the efficacy of the suggested method for ANCA detection based on antigen-specific immunoassay screening. A number of patients with AAV and relevant disease controls, meaning patients for whom ANCA was ordered in relation to small-vessel vasculitis, will be evaluated. These patients may include those with infections, illnesses produced by drugs, connective tissue disease, etc.ResultsRegarding the respiratory features among the two studied groups (ANCA vasculitis group and non-ANCA vasculitis group), it was found that cough with fever (p = 0.024), pulmonary hemorrhage (p = 0.024), interstitial lung disease (ILD) (p = 0.024), pulmonary renal syndrome (0.001), and pleural thickening (p = 0.024) were the most common and the leading clinical manifestation that differentiate between ANCA and non-ANCA vasculitis. Also, in studying different extra pulmonary system features between the two clinical groups for differential diagnosis, it was found that rash (p = 0.001), dry mouth (p = 0.001), bloody diarrhea (p = 0.024), bilateral scleritis (p = 0.024), and vision loss (p = 0.001) were the most clinically leading symptoms Moreover, the laboratory parameters among the two clinically suspected vasculitis groups were in favor of vasculitis if proteinase-3 (pr3) ANCA (p < 0.001) and or the myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO) ANCA (p = 0.001) or the patient had proteinuria and hematuria. Regarding the diagnostic performance of different biomarkers to detect ANCA, it was found that at level > 1.5, the sensitivity of pr3 ANCA is 99.9% and the specificity is 92%, while at level > 3, the sensitivity of MPO ANCA is 90% and the specificity is 55%.ConclusionThe investigation’s findings support the global European consensus reached in 2017 that anti-PR3 and anti-MPO immunoassay should be used for first screening for ANCA-associated vasculitis instead of ANCA testing by IIF. Similar levels of specificity and sensitivity were shown by immunoassays employing direct, capture, and anchor. A positive anti-PR3 test would be very helpful when granulomatosis with polyangiitis (GPA) is suspected, and an anti-MPO might be used to diagnose MPA.

Pleuroparenchymal Fibroelastosis: Update on CT and Histologic Findings.

Pleuroparenchymal fibroelastosis (PPFE) is an interstitial lung disease (ILD) characterized at CT by upper lobe-predominant pleural thickening and subpleural fibrosis and histologically by visceral pleural fibrosis and subpleural fibroelastosis. Although initially classified as a rare idiopathic interstitial pneumonia, many cases are related to known risk factors, particularly hematopoietic stem cell and lung transplant, or observed in association with other ILDs. This review summarizes the diagnostic criteria for PPFE and illustrates the CT and histologic manifestations, aiming to familiarize the radiologist with the range of findings suggestive of the diagnosis. Keywords: Conventional Radiography, CT, Pulmonary, Thorax, Lung, Pleura, Complications, Transplantation, Fibrosis © RSNA, 2025.

Extramedullary Hematopoiesis Presenting as Pleural Thickening in a Patient With Choroidal Melanoma

Extramedullary Hematopoiesis Presenting as Pleural Thickening in a Patient With Choroidal Melanoma

The Conundrum of Computed Tomography Findings in Chronic Pulmonary Aspergillosis: Insights From 103 Cases.

To describe the spectrum of computed tomography (CT) findings in various chronic pulmonary aspergillosis (CPA) subtypes. This retrospective study analyzed the CT scans of consecutively diagnosed CPA cases. Two radiologists independently evaluated the CT findings (both qualitatively and quantitatively) to characterize the lung cavities, intracavitary contents, pericavitary opacities and fibrosis, mediastinal shift, pleural thickening, and underlying structural lung disease. Patients were then classified into CPA subtypes, and between-group differences were assessed using the sample t test, Wilcoxon test, χ2 test, and Fisher exact test. Among 103 patients with CPA (mean age: 47.26 ± 1.98y; 69 men), 77.7%, 15.5%, and 6.8% were categorized as chronic cavitary pulmonary aspergillosis, chronic fibrosing pulmonary aspergillosis (CFPA), and single/simple aspergilloma, respectively. The mean symptom duration was 2.7 ± 3.96 years, with cough being the most common symptom (86.4%). Underlying post-tubercular lung abnormalities were observed in 97.1% of the patients. Cavities were observed in all patients (100%), most commonly in the left upper lobe (68.0%). The difference in cavity number among CPA subtypes was statistically significant (P = 0.003), with 87.5% CFPA and 41.5% chronic cavitary pulmonary aspergillosis cases showing multiple cavities. The overall median cavity wall thickness was 6mm (interquartile range: 2.8), with the highest value in the CFPA. Pericavitary fibrosis was observed in 70.9% of overall cases and in 100% of CFPA cases (P < 0.001). Intracavitary contents were identified in 89.3% of patients. The median pleural thickness was 8mm (interquartile range: 4), which was significantly different among CPA subtypes (P = 0.001). There was excellent interobserver agreement (k = 0.94) between the two readers. Posterior intercostal lymph nodes were identified in 66%, a novel CPA observation. Comprehensive qualitative and quantitative assessment of CT findings improves the characterization of the CPA subtypes. The number and size of lung cavities, mediastinal shift, and pleural thickness, among other quantitative parameters, vary significantly across CPA subtypes, facilitating more accurate differentiation between them.

Clinical value and radiographic features of low dose CT scans compared to X rays in diagnosing mycoplasma pneumonia in children

The aim of this article is to explore the lung characteristics and diagnostic value of X-ray and low-dose computed tomography (LDCT) in children with mycoplasma pneumoniae pneumonia (MPP). A total of 807 suspected children with MPP admitted to outpatient and inpatient departments from August 2023 to November 2023, were selected and divided into X-ray group (n = 389) and LDCT group (n = 418) according to the examination method. The two groups received chest X-ray examination and LDCT examination, respectively. Using pathogen detection results as the gold standard, we compared the imaging visible symptoms, diagnostic rate, sensitivity, specificity, diagnostic accuracy, and missed diagnosis rate of the two examination methods. In the LDCT, the main manifestations were thickened lung markings, patchy and striped shadows, followed by ground glass-like shadows, interstitial infiltration of the lungs, tree-in-fog sign, bronchial wall thickening, pleural thickening, consolidation/atelectasis, air bronchogram sign, and branching linear opacities (tree-in-bud sign). The main manifestations of X-ray were thickening of lung markings, followed by pulmonary patchy shadows, interstitial infiltration, and consolidation/atelectasis. LDCT scans revealed 359 cases of pediatric MPP, with 337 true positives cases, 22 false negatives cases, 23 false positives cases, and 36 true negatives cases. On the other hand, X-ray examinations identified 308 cases of pediatric MPP, with 266 true positive cases, 42 false negative cases, 35 false positive cases, and 46 true negative cases. The diagnostic rate, sensitivity, specificity and diagnostic accuracy of LDCT scans were 80.62%, 93.87%, 61.02% and 89.23%, which were higher compared to X-ray examinations, with the values of 68.38%, 86.36%, 56.79% and 80.21%. The missed diagnosis rate for LDCT was 6.13%, which was lower than the 13.64% rate for X-ray. LDCT demonstrated higher visibility of diagnostic rate, sensitivity, specificity and diagnostic accuracy compared to X-ray examinations, and the missed diagnosis rate of LDCT was lower than that of X-ray. Additionally, the radiographic features of LDCT were more characteristic, with simpler procedure, greater clinical utility.

Effects of different degrees of anthracosis on pleural structure: A preliminary exploratory study.

Effects of different degrees of anthracosis on pleural structure: A preliminary exploratory study.

Diagnostic Examination of Exudative or Transudative Form of Pleural Effusion Based on CT Scan and Ultrasound Findings

Background: Pleural effusion, characterized by the accumulation of excess fluid in the pleural space, necessitates classification into exudative or transudative types to ascertain its etiology. Light's criteria are the standard for this classification, with the serum-pleural fluid albumin gradient serving as an additional tool. Objectives: This study aimed to evaluate the efficacy of ultrasonography and computed tomography (CT) scans in differentiating between exudative and transudative pleural effusions. Methods: A descriptive study was conducted on 72 patients with pleural effusion at Hazrat-e-Rasool Hospital during 2021 - 2022. Simultaneous measurements of pleural fluid and serum albumin levels were performed, and the results of CT scans and ultrasounds were assessed. The albumin gradient and Light's criteria were employed to classify the pleural fluid type. The study also evaluated the predictive value of CT scan and ultrasound findings for the final diagnosis. Data were collected using questionnaires and analyzed with SPSS version 24. Results: The mean age of the 72 patients was 56.1 years, comprising 39 men and 33 women. Eighteen patients had transudative fluid, while 54 patients (75%) had exudative fluid. Pulmonary edema was present in 21 patients (29.2%), lung infections in 29 patients (40.3%), pleural nodules in 11 patients (15.3%), and pleural effusion loculation in 20 patients (27.8%). Pleural thickening exceeding one centimeter was observed in 32 individuals (44.4%). A significant correlation was found between pleural thickening, nodules, fluid loculation, and the type of pleural fluid. Ultrasound demonstrated mild to moderate agreement with CT scans in diagnosing pleural nodules and other lung abnormalities but was less reliable in detecting pleural fluid echogenicity. Conclusions: Imaging features on ultrasound and CT scan, such as pulmonary edema, evidence of pulmonary parenchymal infection, pleural nodules, and pleural thickening, indicate that these criteria are effective in determining the nature of pleural fluid. Therefore, integrating CT scan and ultrasound with existing laboratory criteria could enhance the accuracy of fluid type diagnosis and improve the management of patients with pleural effusion.

The Role of Tuftelin-1 in Mesomesenchymal Transition of Pleural Mesothelial Cells and the Progression of Pleural Fibrosis.

Pleural conditions causing exudative effusions (empyema or complicated parapneumonia), can result in pathological pleural organization leading to pleural fibrosis (PF). Pleural mesothelial cells (PMCs) undergo mesenchymal transition (MesoMT) and acquire a profibrotic phenotype characterized by increased expression of α-smooth muscle actin (α-SMA), collagen 1 (Col-1) and phenotypic changes including elongation, stress fiber formation and contraction. Using RNA sequencing analysis, we identified Tuftelin1 (Tuft1) as a novel potential target. Although Prior studies have shown that Tuft1 expression is associated with aggressive cellular phenotypes, its role in pleural fibrosis (PF) is unknown. Our prior studies show that inhibition of PI3K/Akt, mTORC2, or GSK-3β blocks MesoMT. In this study, we build on previous findings and suggest that Tuft1 plays a key role in promoting MesoMT. In human (PMCs), various mediators that induce MesoMT result in upregulation of Tuft1 expression. Furthermore, we also found that Tuft1 was increased in human pleuritis tissues and in murine models of PF compared to normal lung. In our studies, TGF-β mediated increase in Tuft1 was blocked by the GSK-3β inhibitor 9-ING-41. Knockdown of Tuft1 in vitro, blocked TGFβ mediated MesoMT. Conversely, Tuft1 overexpression induced mTORC2 signaling and promoted MesoMT in the absence of TGF-β. In vivo analyses showed that mesothelial cell-specific Tuft1 knockout mice (Tuft1PMC-/-) were protected from S. pneumoniae-mediated pleural injury. Histological analysis showed that pleural thickening and profibrotic markers were significantly reduced in Tuft1PMC-/- mice compared to WT controls. These studies strongly support therapeutic targeting of Tuft1 as a novel means to mitigate PF.

Prognostication and integration of bedside lung ultrasound and computed tomography imaging findings with clinical features to Predict COVID-19 In-hospital mortality and ICU admission.

Bedside lung ultrasound (LUS) and computed tomography (CT) imaging are valuable modalities in screening and diagnosis of pulmonary diseases. This study aims to investigate the prognostic value of integrating LUS and CT imaging findings with clinical features to predict poor outcomes upon ER admission in COVID-19. Patients visiting the study center with clinical presentation and laboratory findings compatible with COVID-19 between April 2020 to January 2022 were considered for this study. Several imaging findings (ground glass opacity, consolidation, atelectatic bands, mosaic attenuation, ARDS pattern, crazy paving, pleural thickening in CT and A-line, comet-tail artifact, confluent B-Line in BLUS, pleural thickening and Consolidation in both modalities) were evaluated, alongside clinical assessments upon admission, to assess their prognostic value. The top radiological, LUS findings, and clinical signs were integrated in a nomogram for predicting mortality. A total of 1230 patients were included in the analyses. Among the findings, consolidation in BLUS and CT imaging, and absence of A-lines were associated with mortality. In addition to these findings, ground-glass opacities, atelectatic band, mosaic attenuation, crazy paving, and confluent B-line were also associated with ICU hospitalization. Although, the prognostic value of individual markers was poor and comparable (AUC < 0.65), the combined use of top clinical and imaging findings in the associated nomogram led to a high accuracy in predicting mortality (Area under curve: 87.3%). BLUS and CT imaging findings alone provide limited utility in stratifying patients for higher mortality and ICU admission risk and should not be used for risk stratification alone outside the context of each patient and their clinical presentations in suspected COVID-19 patients.

Imaging Techniques in COVID-19 Diagnosis: Evaluating the Role of Chest X-Ray, Chest CT Scan, and Lung Ultrasound in Identifying Key Radiological Features

Abstract: COVID-19 is becoming a pandemic worldwide. The disease can cause mild to severe symptoms. The diagnostic methods currently available include laboratory testing using RT-PCR, as well as imaging techniques such as chest X-rays and CT scans. The most common radiological features in COVID-19 patients are ground glass opacity (GGO), reticular changes, and consolidation. Other features that can be found are thickening of the interlobular septa, bronchiectasis, pleural thickening, and a crazy-paving pattern. The most common distribution is bilateral, peripheral, and with a predominance in the middle or lower parts. Chest X-ray (CXR) examination may show abnormalities in 75% of RT-PCR-confirmed positive cases. Although generally not recommended due to its low sensitivity, CXR is still considered an affordable radiologic imaging technique in diagnosing COVID-19 pneumonia. Chest CT-Scan (CCT) has a higher sensitivity in COVID-19 diagnostics compared to CXR. On CCT examination, there is a CO-RADS classification that can help assess the level of suspicion of COVID-19. Ultrasonography has certain advantages, especially when used in pediatric patients.

Transthoracic Lung Ultrasound in Systemic Sclerosis-Associated Interstitial Lung Disease: Capacity to Differentiate Chest Computed-Tomographic Characteristic Patterns.

Background/Objectives: Even today, interstitial lung disease (ILD) is diagnosed by chest high-resolution computed tomography (lung HR-CT). Large amounts of data are available about the usefulness of transthoracic lung ultrasound (LUS) in ILD. This study aimed to evaluate the transthoracic LUS capacity to discriminate different ILD patterns in systemic sclerosis (SSc) patients, such as usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP) with ground glass opacification/opacity (GGO), and NSIP with GGO and reticulations, as well as the possibility of identifying progressive fibrosing ILD. Methods: We enrolled SSc-patients attending the outpatient Clinic of the Rheumatology Unit of Policlinico of Foggia and the Rheumatology Unit of Policlinico of Bari who satisfied these inclusion criteria: age older than 18 years; the satisfaction of ACR/EULAR 2013 classification criteria for SSc; chest HR-CT scan within three months before or three months after transthoracic LUS evaluation; and availability of recent and complete pulmonary function test. The exclusion criteria were as follows: history or recent reactivation of chronic obstructive pulmonary disease, lung cancer, lung infection, heart failure, pulmonary oedema, pulmonary arterial hypertension, acute respiratory distress syndrome and diffuse alveolar haemorrhage and thoracic surgery. All enrolled SSc-patients underwent transthoracic LUS, performed by an experienced sonographer. The ILD diagnosis and the respective patterns were assessed by chest HR-CT, which still represents the best diagnostic tool. Results: ILD was observed in 99 (63.5%) patients. Of these, 25% had the UIP pattern and 75% the NSIP pattern (46 with GGO, 28 with GGO and reticulations). By receiver operating characteristic (ROC) curve analysis, higher values of accuracy, sensitivity, specificity, and negative clinical utility index (CUI) were found for pleural line irregularity (0.84 (95% CI: 0.75-0.91), 96%, and 73.6%, p = 0.0001; 0.72), and pleural line thickness (0.84 (95% CI: 0.74-0.91), 72%, and 96.4%, p = 0.0001; 0.85) for detecting the UIP pattern. The best performance among transthoracic LUS signs for NSIP with the GGO pattern was observed for B-lines (accuracy: 0.88 (95% CI: 0.80-0.93), sensitivity: 93.4% and specificity: 82.4, p = 0.0001; CUI+: 0.75, CUI-: 0.77). LUS signs with higher accuracy, sensitivity, and specificity for NSIP with GGO and reticulations were pleural line irregularity (0.89 (95% CI: 0.80-0.95), 96.4%, and 82.4%, p = 0.0001) with CUI-: 0.72, and B-lines (0.89 (95% CI: 0.80-0.95), 96.4%, 82.4%, p = 0.0001), with CUI+: 0.80 and CUI-: 0.70. Furthermore, a total number of B-lines > 10 maximises LUS performance with 92.3% sensitivity, and an accuracy of 0.83 (p = 0.0001) for detecting the NSIP pattern, particularly GGO. A sample-restricted analysis (66 SSc patients) evidenced the presence of progressive fibrosing ILD in 77% of these patients. By binary regression analysis, the unique LUS sign associated with progressive fibrosing ILD was the presence of pleural line irregularity (OR: 3.6; 95% CI 1.08-11.9; p = 0.036). Conclusions: Our study demonstrated that transthoracic LUS presented a high capacity to discriminate the different patterns of SSc-ILD. Therefore, the hypothesis that transthoracic LUS is an effective screening method for the evaluation of the presence of SSc-ILD and establishing the correct timing of chest HR-CT, in order to avoid patients receiving excessive exposure to ionising radiation, is supported.

Chest CT characterization of children with necrotizing pneumonia due to Mycoplasma pneumoniae infection

We summarize the chest CT manifestations and prognoses of children with Mycoplasma pneumoniae pneumonia combined with necrotizing pneumonia. We retrospectively analyzed the chest CT manifestations and prognoses of 155 cases of necrotizing pneumonia in children due to Mycoplasma pneumoniae infection and compared the differences in clinical features and laboratory indices between the group with unilateral monolobar necrosis of the lungs (Group A) and the group with unilateral multilobar and bilateral necrosis (Group B). The chest CT findings of the children in both groups revealed that the area of lung necrosis was confined to the unilateral monolobe in 124 children. The necrotic condition of the lungs included only hypodense shadows in 80 children (51.61%) and cystic cavities in the necrotic areas in 75 children (48.39%). Bronchoscopic manifestations: Endobronchitis was present in 135 children, ulcerative necrosis of the bronchi in 47, and occlusive bronchitis in four. A total of 101 children were followed up. A small percentage of patients have residual manifestations such as lobar atelectasis and bronchial wall changes. The number of days of fever and cases of respiratory distress were significantly greater in group B than in group A. Chest CT reveals pulmonary necrosis in children due to Mycoplasma pneumoniae infection: the area of pulmonary necrosis is mostly unilateral and unilobar, the lower lungs are predominant, and areas of reduced enhancement can be seen on enhanced CT. CT manifestations after clinical treatment may be approximately normal or leave a striped shadow, lung atelectasis, or pleural thickening.

Are there features that can predict the unresectability of pleural mesothelioma?

The current clinical staging of pleural mesothelioma (PM) is often discordant with the pathologic staging. This study aimed to identify clinical and radiological features that could help predict unresectability in PM. Twenty-two descriptive radiologic features were retrospectively evaluated on preoperative computed tomography (CT) and/or positron emission tomography/CT (PET/CT) performed in patients with presumably resectable PM who underwent surgery. Measurements of maximum and sum pleural thickness at three levels of the thorax (upper, middle, and lower) were taken and stratified based on the cutpoints provided by the International Association for the Study of Lung Cancer (IASLC). Clinical and radiological features, including clinical-stage, were compared between resectable and unresectable tumors by univariate analysis and logistic regression modeling. Of 133 patients, 69/133 (52%) had resectable and 64/133 (48%) had unresectable PM. Asbestos exposure (p = 0.005), neoadjuvant treatment (p = 0.001), clinical T-stage (p < 0.0001), all pleural thickness measurements (p < 0.05), pleural thickness pattern (p < 0.0001) and degree (p = 0.033), lung invasion (p = 0.004), extrapleural space obliteration (p < 0.0001), extension to subphrenic space (p = 0.0004), and two combination variables representing extensive diaphragmatic contact and/or chest wall involvement (p = 0.002) and mediastinal invasion (p < 0.0001) were significant predictors at univariate analysis. At multivariable analysis, all models achieved a strong diagnostic performance (area under the curve (AUC) > 0.8). The two best-performing models were one that included the upper-level maximum pleural thickness, extrapleural space obliteration, and mediastinal infiltration (AUC = 0.876), and another that integrated clinical variables and radiological assessment through the clinical T-stage (AUC = 0.879). Selected clinical and radiologic features, including pleural thickness measurements, appear to be strong predictors of unresectability in PM. A more accurate prediction of unresectability in the preoperative assessment of patients with pleural mesothelioma may avoid unnecessary surgery and prompt initiation of nonsurgical treatments. About half of pleural mesothelioma patients are reported to receive an incorrect disease stagepreoperatively. Eleven features identified as predictors of unresectability were included in strongly performing predictive models. More accurate preoperative staging will help clinicians and patients choose the most appropriate treatments.

Allergic Bronchopulmonary Aspergillosis in Patients With Prior Pulmonary Tuberculosis: A Study on the Burden, Clinic-Radiological Features, Treatment Outcomes and Comparison With Chronic Pulmonary Aspergillosis and Post-Tubercular Lung Disease Patients.

Post-tuberculosis lung disease (PTLD) is a precursor to Aspergillus-related lung diseases. While Chronic Pulmonary Aspergillosis (CPA) has been extensively studied in the background of tuberculosis, Allergic Bronchopulmonary Aspergillosis (ABPA) has been reported sporadically with limited information on its prevalence, clinical-radiological features, and treatment outcomes. This study, conducted in a high TB burden setting, aimed to address this knowledge gap by systematically evaluating ABPA in PTLD patients. This retrospective cohort study screened PTLD patients presenting with respiratory or constitutional symptoms persisting for more than 3 months. The objective was to report the prevalence, clinical-radiological-laboratory data, and outcomes of ABPA-PTLD compared to a cohort of CPA (CPA-PTLD) and patients with PTLD (PTLD only). Out of a total of 1012 PTLD patients, ABPA was seen in 2.27%, CPA in 20.75% and Aspergillus sensitization in 0.7%. ABPA patients primarily presented with breathlessness (91.3%) and cough (82.6%) while haemoptysis (43.5%), weight loss (13%), and anorexia (21.7%) were also observed, albeit less commonly than in CPA-PTLD. Bronchiectasis (100%) and nodules (87%) were more frequent in ABPA-PTLD patients, whereas consolidation (21.7%), cavities (30.4%), pleural thickening (8.7%), and 'fungal ball' (9.1%) were also seen, although less commonly than in CPA-PTLD. Most patients received azoles (78%) as first-line therapy, with symptomatic improvement (partial/complete) observed in ~78%. ABPA may occur in PTLD patients, with specific clinical (e.g., haemoptysis) and radiological (e.g., cavity and fungal ball) features uncommon in other types of ABPA, but resembling other PTLD conditions. Future studies should focus on identifying differences in the natural course and appropriate treatment paradigms of ABPA-PTLD patients compared to ABPA occurring in asthma and cystic fibrosis patients.

Ultrasonographic evaluation of the thorax in dogs with tick paralysis

Tick paralysis is a rapidly progressing motor paralysis caused by a neurotoxin in the saliva of certain tick species. Delayed diagnosis can lead to increased mortality due to respiratory failure. Thus, the aim of this study is to describe thoracic ultrasonography lesions in dogs with tick paralysis and to identify potential patterns that could aid in diagnosis and prognosis prediction. The animal material consisted of 58 dogs in total, 10 of which were healthy and 48 of which were suspected to be affected by tick paralysis. Clinical, laboratory and thoracic ultrasonographic examinations were performed. Expiratory dyspnea with sinus tachycardia; fine crackles, polyphonic wheezing, and pleural rub on lung auscultation were observed in the tick–paralyzed dogs. The most common abnormal thoracic ultrasonography patterns were, in order of prevalence: B–lines &gt; 3, wet lung, pulmonary nodule, confluent B–lines, loss of A–lines, consolidation, fibrosis, and isolated B–lines. In addition, the pleural thickness of the tick–paralyzed dogs was higher than that of the healthy ones. Among these findings, B–lines &gt; 3 were interpreted as indicative of possible pulmonary parenchymal damage, while the loss of A–lines was attributed to decreased aeration. The presence of pulmonary nodule and fibrosis might be due to bronchopneumonia and aspiration pneumonia due to regurgitation. The wet lung pattern was associated with a predisposition to lung congestion. It was concluded that recognizing thoracic ultrasonography findings may assist in identifying the presence and grading the extent of lung damage, as well as determining the necessity of lung decongestion treatment in tick paralysis cases.

Comments and Illustrations of the European Federation of Societies for Ultrasound in Medicine Guidelines: Benign Pleura Lesions (Benign Pleura Thickening, Lesions and Masses)-What Can Be Seen on Transthoracic Ultrasound?

Pleural thickening can be the result of inflammation or infection but can also have a neoplastic origin. Depending on the clinical context, a pleural lesion or mass is often initially suspected of malignancy. Benign pleural tumors are rare, and their appearance on ultrasound (US) is also described less frequently than pleural metastases or malignancies. There are few descriptions of contrast-enhanced Ultrasound (CEUS) in particular. This review introduces the basics of transthoracic ultrasound (TUS) of the pleura and CEUS of the pleura and lung. CEUS is recommended for pulmonary applications in the EFSUMB guidelines in non-hepatic applications. This article provides an overview of the characteristics of benign pleural thickening, tumor-like lesions, and benign pleural tumors on transthoracic B-mode US with color Doppler imaging (CDI) and CEUS. In detail, characteristics in TUS and CEUS are described for infectious/inflammatory pleural thickening (empyema, tuberculous pleuritis, hemothorax, fibrothorax), pleural thickening in various systemic diseases, in tumor-like conditions (plaques, splenosis, endometriosis, mesothelial cysts, lymphangiomatosis) and benign tumors (lipoma, benign SFT, schwannoma, solitary extramedullary/extraosseous plasmacytoma). The descriptions are illustrated by corresponding US and CEUS images.

Ultrasonography Compared to Computed Tomography in Pediatric Complicated Pneumonia: Beyond Radiation.

Introduction Some children with community-acquired pneumonia (CAP) experience progression to complicated community-acquired pneumonia (CCAP). It is characterized by local pulmonary or systemic complications such as para-pneumonic effusion, empyema, necrotizing pneumonia, and lung abscess. Imaging has an essential contribution to both the diagnosis and treatment of CCAP. While chest radiography and lung ultrasound (LUS) are commonly used for initial evaluation, chest computed tomography (CT), although valuable, raises concerns due to ionizing radiation exposure. Against the backdrop of increasing awareness regarding radiation risks in pediatric patients and the growing availability of bedside LUS, we conducted this study. Objective The aim of this study was to assess the agreement between LUS and contrast-enhanced chest CT in identifying specific findings in patients of complicated pneumonia, such as pleural effusion, pleural thickening, parenchymal consolidation, cavities, atelectasis, and hydropneumothorax. Methods We retrospectively compared CT and LUS images from 50 patients under 18 years of age admitted with clinical and radiological diagnosis of complicated pneumonia between January 2022 and June 2023, who underwent both imaging modalities within a seven-day interval. Images were assessed for pleural effusion, septations, pleural thickening, parenchymal consolidation, cavities, hydropneumothorax, and atelectasis. Results Pleural effusion without septations was found in 25 (50%) patients on chest CT, whereas it was noted in 20 (40%) patients on LUS. Pleural effusion with septations was found in 21 (42%) patients on chest CT, whereas it was noted in 27 (54%) patients on LUS. Pleural thickening was found in 19 (38%) patients on chest CT, whereas it was noted in 9 (18%) patients on LUS. Lung parenchymal consolidation was found in 30 (60%) patients on chest CT, whereas it was noted in 16 (32%) patients on LUS. Atelectasis was found in 25 (50%) patients on chest CT, whereas it was noted in 26 (52%) patients on LUS. Parenchymal cavities were found in six (12%) patients on chest CT, whereas it was noted in two (4%) patients on LUS. Hydropneumothorax was found in six (12%) patients on chest CT, whereas it was noted in one (2%) patients on LUS. Conclusions LUS can be used as an initial investigation in complicated pneumonia, while chest CT is reserved for cases with suspicion of specific complications of pneumonia.

Understanding of Patients with Severe COVID-19 Using Lung Ultrasound.

Lung ultrasound (LUS) has proven valuable in the initial assessment of coronavirus disease 2019 (COVID-19), but its role in detecting pulmonary fibrosis following intensive care remains unclear. This study aims to assess the presence of pulmonary sequelae and fibrosis-like changes using LUS in survivors of severe COVID-19 pneumonia one month after discharge. We prospectively enrolled patients with severe COVID-19 who required mechanical ventilation in the intensive care unit (ICU) and conducted LUS assessments from admission to the outpatient visit after discharge. We tracked changes in key LUS findings and applied our proprietary LUS scoring system. To evaluate LUS accuracy, we correlated measured LUS values with computed tomography scores. We evaluated B-line presence, pleural thickness, and consolidation in 14 eligible patients. The LUS scores exhibited minimal changes, with values of 19.1, 19.2, and 17.5 at admission, discharge, and the outpatient visit, respectively. Notably, the number of B-lines decreased significantly, from 1.92 at admission to 0.56 at the outpatient visit (p&lt;0.05), while pleural thickness increased significantly, from 2.05 at admission to 2.48 at the outpatient visit (p≤0.05). This study demonstrates that LUS can track changes in lung abnormalities in severe COVID-19 patients from ICU admission through to outpatient follow-up. While pleural thickening and B-line patterns showed significant changes, no correlation was found between LUS and high-resolution computed tomography fibrosis scores. These findings suggest that LUS may serve as a supplementary tool for assessing pulmonary recovery in severe COVID-19 cases.

Transthoracic ultrasound as an assessment tool for pleural effusion, pleural adhesion, and pleural thickening in patients undergoing thoracoscopy.

The purpose of this study was to evaluate the use of the transthoracic ultrasonography (US) for pleural adhesions and pleural thickening and to quantify pleural effusion by standardised sonographic techniques and its comparison with thoracoscopic findings. An assessment of the association between pleural thickness and pleural nodularity with histopathological examination findings was also attempted. Thirty-one patients with suspected chest pathologies were initially assessed by transthoracic US followed by videothoracospy. Findings observed were noted and appropriately analysed statistically. Transthoracic US is 100% sensitive and specific for detecting pleural septations in the presence of pleural effusion with 100% accuracy. Gliding sign is a highly sensitive and specific sign to detect the pleural septations in absence of pleural effusion. There was no significant association of thickness of pleural septation with the pleural malignancy. Transthoracic US plays an important role in the quantification of pleural effusion, assessment of the pleura and pleural space for pleural adhesion, pleural thickening, and guiding trocar insertion.

One-Lung Ventilation with Double-Lumen Tube in Decortication of Lung Abscess: A Case Report

A microbial lung infection that causes the pulmonary parenchyma to necrotise is called a lung abscess. Lung decortication can be a straightforward process, but it may also present significant challenges. To allow the underlying lung parenchyma to expand, the thick fibrinous layer must be removed from the pleural surface. Patients with long-standing empyema, pleural thickening, haemothorax, and pleural tumours are candidates for decortication. Such patients require One-Lung Ventilation (OLV), as the lung being operated on must be isolated. Complications, such as the tube becoming malpositioned or the inability to achieve unilateral isolation, are not uncommon when using a Double-Lumen Tube (DLT) due to the intrinsic challenges involved. A DLT can be utilised to accomplish OLV, which is necessary for adequate lung isolation and exposure during surgery. The present article discusses the valuable experience of managing the use of DLT in a 42-year-old male who had a lung abscess and was scheduled for lung decortication due to respiratory distress. Proper preoperative assessment and appropriate anaesthesia planning are essential for handling such cases without complications and achieving better surgical outcomes.