Pneumonic Consolidation Research Articles

Word of caution: early life-threatening complication linked to pulmonary flow restrictors.

A 2-month-old female (3.4 kg, 50 cm) with Down syndrome and left-to-right shunting congenital heart defects underwent an unsuccessful transcatheter ductal closure, followed by bilateral implantation of manually modified microvascular plugs (MVP-9Q) from Medtronic (Minneapolis, MN, USA), used as pulmonary flow restrictors. Post-procedure, she developed febrile respiratory distress, leading to admission to the intensive care unit. Despite initial improvement, she was readmitted with respiratory syncytial virus infection, progressing to bilateral pneumonic consolidation. Subsequent complications included pulmonary artery aneurysmal dilatation attributed to pulmonary flow restrictors, which necessitated urgent surgery two months after their implantation. The surgery involved removing the pulmonary flow restrictors and repairing the injuries to the pulmonary artery, followed by management with extracorporeal support and targeted antibiotics. The patient recovered over 12 months.

Diagnosis of Pulmonary Tuberculosis by Xpert MTB/RIF Assay Using Gastric Aspirate in Children with Pneumonic Consolidation

Background: In Bangladesh, there is increased evidence of TB-associated pneumonia in children are currently missed or diagnosed too late resulting in deterioration of condition. The objective of this study was to detect the frequency of pulmonary TB in children presented with pneumonic consolidation by Xpert MTB/RIF assay using gastric aspirate. Materials & Methods: This was a prospective observational study. Admitted children from 6 months to 14 years old from January to December 2020 with clinical features consistent with pneumonia and radiographically confirmed consolidations were enrolled in this study. MT and Xpert MTB/RIF assay using gastric aspirates were done in all cases. Data regarding frequency of TB, clinical features and lab findings of enrolled patients were collected and analyzed. Results: Total 7/60 (11.67%) enrolled patients, were confirmed as Pulmonary Tuberculosis by Gene Xpert using gastric aspirates. The most common clinical signs were fever and cough in all (100%) patients. Others had chest pain 23(38.33%), breathing difficulty 21(35%), vomiting 17(28.33%). Younger children less than 5 years (P=.045), contact with TB patient (P= .001), long duration of fever (P = .001), presence of severe acute malnutrition (P = .001) high ESR (P= .009), positive MT (P=.017) were associated with positive rate of Xpert MTB/RIF assay in children. Conclusions: Xpert MTB/RIF assay can assist in fast diagnosing childhood pulmonary TB especially in patients with fever more than one week, malnutrition and having contact with TB patient. BANGLADESH J CHILD HEALTH 2022; VOL 46 (2) : 65-70

Respiratory syncytial virus vs. Influenza virus infection: mortality and morbidity comparison over 7 epidemic seasons in an elderly population.

Respiratory syncytial virus (RSV) infection is gaining interest due to the recent development of vaccines, but it is still misdiagnosed in the elderly. The primary objective was to compare all-cause mortality at day 30. Secondary objectives were to compare clinical presentation, and rates of consolidative pneumonia, hospitalization, and intensive care unit (ICU) admission. Single-centre retrospective study conducted in a French university hospital during 7 epidemic seasons. All patients aged ≥75 years were included. 558 patients were included: 125 with RSV and 433 with Influenza. Median age was 84.8 years. RSV patients had more respiratory symptoms (wheezing, dyspnea), whereas Influenza patients had more general symptoms (fever, asthenia, myalgia). Consolidative pneumonia (28.8% vs. 17.2%; p = 0.004), hospitalization rates (83.2% vs. 70%; p = 0.003), ICU admissions (7.2% vs. 3.0%; p = 0.034) and length of stay (9 days [2-16] vs. 5 days [0-12]; p = 0.002), were higher in the RSV group. Mortality rates at day 30 were comparable (RSV 9.6%, Influenza 9.7%; p = 0.973). This study included the largest cohort of RSV-infected patients aged over 75, documented in-depth thus far. RSV shares a comparable mortality rate with Influenza but is associated with higher rates of consolidative pneumonia, hospitalization, ICU admissions, and extended hospital stays.

Clinical and Etiological Exploration of Ventilator-Associated Pneumonia in the Intensive Care Unit of a Developing Country.

Background Ventilator-associated pneumonia (VAP) is a critical concern in the intensive care unit(ICU), with significant implications for patient outcomes. This retrospective cross-sectional study aimed to determine the prevalence of VAP in an ICU of a developing country, identify the predominant etiological factors, assess patient outcomes, and underscore the need for tailored interventions in high-risk patient groups. Methods This retrospective cross-sectional study included 589 ICU patients who underwent ventilator-assisted breathing for over 48 hours. Among them, 151 developed VAP. The diagnosis was made on clinical, laboratory, and radiological findings, and tracheal aspirate cultures. Exclusions included pediatric patients, less than 48 hours of ventilation, and pre-existing lung infections. Patient data encompassed gender, age, comorbidities, outcomes, admission reasons, isolated microorganisms, and clinical findings. Results 151 patients out of the 589 developed VAP. The age of the patients ranged between 31 to 69 years and the mean age was 45.43 ± 8.92 years. Clinical diagnoses upon ICU admission varied, including sepsis, trauma, stroke, and metabolic disorders. Chest X-rays commonly revealed atelectasis (19.2%), consolidation (21.9%), pleural effusion (11.9%), and lobar pneumonia (45.7%). Tracheal aspirate cultures predominantly isolated multidrug-resistant gram-negative rods, with methicillin-resistant gram-positive cocci and fungal pneumonia prevalent in neutropenic sepsis cases. Notably, only 54 (35.8%) of patients survived, with significantly poorer outcomes observed in sepsis, neutropenic sepsis, and stroke cases compared to trauma and post-operative admissions. Conclusion Multidrug-resistant organisms and the spread of nosocomial infections are the predominant causes ofVAP in the ICU. This emphasizes the urgent need for multifaceted interventions to prevent and manage VAP effectively. Developing and implementing targeted strategies, considering the unique challenges faced in resource-constrained healthcare settings can aid in decreasing the mortality associated with it.

Clinical Diagnosis of Severe Diseases According to IMCI among Children in a Tertiary Care Hospital- A Cross-Sectional Study

Introduction: IMCI is a systemic approach to children’s health which focuses not only on curative care but also on prevention of disease. The objectives of the strategy are to reduce death and the frequency and severity of illness and disability. The IMCI integrates management of five most important causes of childhood deaths, namely acute respiratory infections, diarrhoeal diseases, measles, malaria and malnutrition. IMCI is based on clinical assessment and classification of illness that is independent of laboratory assistance. Aim of the study: The aim of this study was to find out the clinical diagnosis of very severe diseases according to IMCI from 2 months to 5 years old children. Methods: This was a cross-sectional study and was conducted in the Department of Paediatrics of Rajshahi Medical College Hospital, Rajshahi, Bangladesh during the period from February, 2014 to July, 2014. We included 100 children having any general danger signs with cough or difficult breathing in our study. Result: In our study we found the mean age was 15.7 months. Most of 57% were male and 43% were female. Most 55(81.81%) of the patients have two or more co-existent general danger sign as per IMCI algorithm. The patients having any general danger sign along with cough or difficult breathing IMCI classified them severe pneumonia but physicians diagnosed them as bronchopneumonia 5%, bronchopneumonia with impending heart failure 6%, bronchopneumonia with heart failure 6%, acute bronchiolitis 1%, pleural effusion 1%, pulmonary TB 1%, pneumonic consolidation 1%. The patients having fever with danger sign IMCI classify them as very severe diseases but physicians clinically diagnosed them as febrile convulsion 30%, meningitis 25%, encephalitis 13%, septicaemia 5%, seizure disorder 3%, meningoencephalitis 2%. Conclusion: IMCI approach has been developed for field and primary care facilities to systematically evaluate and treat patients or identify those requiring higher level of health ...

Pneumonic COVIDOMA with Simultaneously Elevated Troponin and D-Dimer in Remarkable Ischemic Heart in a Young Female-Interpretation and Prognostic Value

Rationale: COVID-19 virus is a still worldwide infectious disease with a subsequent severe acute respiratory syndrome (SARS). A cardiovascular impact is a considerable major factor in morbidity and mortality in this pandemic. Coronary artery involvement and cardiac injury may be a serious association. Both cardiac troponins I and T are the diagnostic biomarkers for myocardial injury. D-dimer is an estimator of hypercoagulability. Patient concerns: A 26-year-old, housewife, married, Egyptian female patient was presented to the physician outpatient clinic (POC) with COVID-19 pneumonia and ischemic heart disease. Diagnosis: Pneumonic COVIDOMA with remarkable ischemic injury in a young female patient. Interventions: Chest CT, electrocardiography, and oxygenation. Outcomes: Dramatic response and Good outcomes in the presence of remarkably serious risk factors were the results. Lessons: Female sex with ischemic heart disease, elevated troponin, and elevated D-dimer are constellation risk factors for serious COVID-19. pneumonia. The association of COVID pneumonia with ischemic heart disease is highly interesting in case management. COVIDOMA is a new description for a mass-like pneumonic consolidation in COVID-19 infection

Unexpected Severe Bocavirus Infections among Hospitalized Children during the COVID-19 Pandemic

Abstract Objective Acute respiratory tract infections are one of the leading causes of morbidity and mortality in children. Although human bocavirus (HBoV) infections are not as common as other seasonal respiratory viruses, children who are infected with HBoV are more likely to suffer from a variety of respiratory conditions, including the common cold, acute otitis media, asthma exacerbations, bronchiolitis pneumonia, some of the affected children require pediatric intensive care unit stay. Here, we aimed to evaluate pediatric bocavirus (HBoV) cases presenting with severe respiratory tract symptoms during the coronavirus disease 2019 (COVID-19) pandemic. Methods This retrospective study evaluated the medical records of children diagnosed with respiratory infections, followed up at the Faculty of Medicine, Eskisehir Osmangazi University between September 2021 and March 2022. In this study, patients with HBoV identified using nasopharyngeal polymerase chain reaction (PCR) were considered positive. Cases were analyzed retrospectively for their clinical characteristics. Results This study included 54 children (29 girls and 25 boys) with HBoV in nasopharyngeal PCR samples. The cases ranged in age from 1 month to 72 months (median 25 months). At the time of presentation, cough, fever, and respiratory distress were the most prevalent symptoms. Hyperinflation (48%), pneumonic consolidation (42%), and pneumothorax–pneumomediastinum (7%) were observed on the chest X-ray; 54% of the children required intensive care unit stay. The median length of hospitalization was 6 days. Bacterial coinfection was detected in 7 (17%) children, while HBoV and other viruses were present in 20 (37%) children; 57% of children received supplemental oxygen by mask, 24% high-flow nasal oxygen, 7% continuous positive airway pressure, and 9% invasive mechanical ventilation support. Antibiotics were given to 34 (63%) cases, and systemic steroid treatment was given to 41 (76%) cases. Chest tubes were inserted in three out of the four cases with pneumothorax–pneumomediastinum. All patients were recovered and were discharged from the hospital. Conclusion The COVID-19 pandemic changed the epidemiology of seasonal respiratory viruses and the clinical course of the diseases. Although it usually causes mild symptoms, severe respiratory symptoms can lead to life-threatening illnesses requiring intensive care admission.

The Diagnostic Performance and Utility of Chest XR in Relation to Chest CT in Nontraumatic Respiratory Emergency Patients

ABSTRACT Background and Aim: This study aimed to determine the diagnostic performance and utility of chest radiography in relation to chest computed tomography (CT) in nontraumatic respiratory emergency patients. Patients and Methods: Patients presenting to the emergency department with respiratory complaints due to nontraumatic pathologies and who had consecutive chest XR and chest CT assessments with an interval of fewer than 6 hours were enrolled in the study (n = 561). Results: The two methods were determined to be consistent with moderate agreement in detecting pleural effusion (k = 0.576, P < 0.001), pneumothorax (k = 0.567, P < 0.001), increased cardiothoracic ratio (k =0.472, P < 0.001), and pneumonic consolidation (k = 0.465, P < 0.001). The consistency rate was significantly higher in patients aged <40 years (95.5% in ≤30 years and 90.9% in 31–40 years) as compared to older patients (81.8%, 68.2%, and 72.7% in 41–60 years, 61–80 years, and >80 years, respectively; P < 0.001 for each). The consistency rate was also higher for posteroanterior (PA) chest XR views than for anteroposterior (AP) chest XR views (72.7% vs. 68.2%, P = 0.005) and for high- and moderate-quality chest XR views than for poor-quality views (72.7% and 77.3% vs. 70.5%, P = 0.001). Conclusion: The consistency between the chest XR and CT was more likely in patients aged <40 years and for PA and moderate-to-high quality chest XR views, as compared to older patients and AP and poor-quality views, respectively. We suggest that an upright position PA chest X-ray with high imaging quality may be the first choice, especially in patients aged <40 years admitted to the emergency department with respiratory symptoms.

CLINICAL, HEMATOBIOCHEMICAL AND RADIOGRAPHICAL STUDIES OF CAPRINE PNEUMONIA

Fever, dullness, tachypnea, bilateral nasal discharge, cough, dyspnea, and abnormal lung auscultation were all symptoms of pneumonic goats. To evaluate the hematological, biochemical and pulmonary function changes in 45 pneumonic goats compared with 10 apparently healthy ones, whole blood and serum samples were collected. The results revealed that pneumonic goats had significantly lower (P<0.05) RBCs, Hb, and PCV levels than healthy goats. A decrease in lymphocyte count and an increase in WBCs and neutrophils were found to be significant (P<0.05) in pneumonic goats compared to healthy ones. Blood pH and pO2 were significantly reduced (P<0.05) while pCO2, tCO2, and HCO3 were significantly elevated (P<0.05) in pneumonic goats compared to healthy ones. Biochemically, K, MDA, Hp and SAA showed significant (P<0.05) increase, whereas Cl and TAC showed a significant (P<0.05) decrease in the pneumonic goats compared to control group. The echotexture of the pneumonic consolidation on ultrasound resembles that of the liver. The chest x-ray showed increased opacity with a cotton-wool-like look that may be more grey or white. According to the findings, the diagnostic techniques mentioned above are helpful in diagnosing goat pneumonia. So, this study aimed to evaluate some selected biochemical parameters and different diagnostic methods including ultrasonography and radiography in pneumonic goats.

SYSTEMIC EPSTEIN-BARR VIRUS-RELATED T-CELL LYMPHOPROLIFERATIVE DISORDER: A RARE CAUSE OF DYSPNEA AND PULMONARY INFILTRATES IN AN IMMUNOCOMPETENT ADULT

SYSTEMIC EPSTEIN-BARR VIRUS-RELATED T-CELL LYMPHOPROLIFERATIVE DISORDER: A RARE CAUSE OF DYSPNEA AND PULMONARY INFILTRATES IN AN IMMUNOCOMPETENT ADULT

Role of 18F-FDG PET/CT in patients affected by pulmonary primary lymphoma.

BackgroundPrimary pulmonary lymphoma (PPL) is defined as clonal abnormal hyperplasia of lung parenchyma or bronchial lymphoid tissue originating from bronchial mucosal tissue. However, PPL is rare, which accounts for approximately 3-4% of extraneurotic lymphomas and 0.5-1% of all primary tumors in the lung. Owing to the lack of any typical clinical symptoms and radiological features, it is challenging to accurately diagnose PPL, which affects its clinical management and prognosis. Considering this, herein, we aim to raise awareness of this disease and help physicians understand the role of 18F-FDG PET/CT in the diagnosis of PPL.MethodA retrospective analysis was performed on the clinical and 18F-FDG PET/CT imaging data of 19 patients diagnosed with PPL by biopsy pathology at our hospital from April 2014 to December 2021.ResultsOf the 19 PPL patients, 15 patients showed clinical symptoms with the most common being fever and cough. In addition, there were 4 cases that had no clinical symptoms, and all of them were MALT lymphoma. In fact, 16 patients were misdiagnosed as lobar pneumonia, lung cancer, tuberculosis, and diffuse interstitial inflammation, representing a misdiagnosis rate of 84.2%. Also, 73.7% were MALT lymphomas, representing the most common pathological pattern, along with 3 DLBCL and 2 T-cell lymphomas. With reguard to CT signs, the air-bronchial sign was found to be the most common, followed by the halo sign and the collapsed leaf sign. On the basis of the predominant radiologic features, lesions were categorized as pneumonic consolidation, nodular/mass type, diffuse interstitial type, and mixed type. The average SUVmax of lesions was 7.23 ± 4.75, the ratio of SUVmax (lesion/liver) was 3.46 ± 2.25, and the ratio of SUVmax (lesion/mediastinal blood pool) was found to be 5.25 ± 3.27. Of interest, the different pathological types of PPL showed different values of 18F-FDG uptake. The 18F-FDG uptake of DLCBL was the most prominent with a SUVmax of 15.33 ± 6.30 and was higher than that of MALT lymphoma with a SUVmax of 5.74 ± 2.65. There appeared similarity in 18F-FDG uptake between MALT lymphoma and T-cell lymphoma. For the SUVmax of lesion, we found statistical significance between MALT lymphoma and DLCBL (P value<0.001). In addition, we also found statistical significance (P value < 0.05) in SUVmax of lesions between pneumonic consolidation type and nodal/mass type, I stage, and other stages.ConclusionsOn 18F-FDG PET/CT images, certain features of PPL morphology and metabolism can be identified that may contribute to a better understanding of this disease. In addition, 18F-FDG PET/CT whole-body imaging has the potential to refine the staging of PPL. Most importantly, functional 18F-FDG PET/CT imaging can readily reflect tumor cell activity, thus allowing for the selection of an optimal biopsy site.

SARS-CoV-2 and Chlamydia pneumoniae co-infection: A review of the literature

Bacterial co-pathogens are commonly identified in viral respiratory infections and are important causes of morbid-mortality. The prevalence of Chlamydia (C.) pneumoniae infection in patients infected with SARS-CoV-2 has not been sufficiently studied. The objective of the present review was to describe the prevalence of C. pneumoniae in patients with coronavirus disease 2019 (COVID-19). A search in MEDLINE and Google Scholar databases for English language literature published between January 2020 and August 2021 was performed. Studies evaluating patients with confirmed COVID-19 and reporting the simultaneous detection of C. pneumoniae were included. Eleven articles were included in the systematic review (5 case cross-sectional studies and 6 retrospective studies). A total of 18450 patients were included in the eleven studies. The detection of laboratory-confirmed C. pneumoniae infection varied between 1.78 and 71.4% of the total number of co-infections. The median age of patients ranged from 35 to 71 years old and 65% were male. Most of the studies reported one or more pre-existing comorbidities and the majority of the patients presented with fever, cough and dyspnea. Lymphopenia and eosinopenia were described in COVID-19 co-infected patients. The main chest CT scan showed a ground glass density shadow, consolidation and bilateral pneumonia. Most patients received empirical antibiotics. Bacterial co-infection was not associated with increased ICU admission and mortality. Despite frequent prescription of broad-spectrum empirical antimicrobials in patients with coronavirus 2-associated respiratory infections, there is a paucity of data to support the association with respiratory bacterial co-infection. Prospective evidence generation to support the development of an antimicrobial policy and appropriate stewardship interventions specific for the COVID-19 pandemic are urgently required.

Lung Segmentation in CT Images: A Residual U-Net Approach on a Cross-Cohort Dataset

Lung cancer is one of the most common causes of cancer-related mortality, and since the majority of cases are diagnosed when the tumor is in an advanced stage, the 5-year survival rate is dismally low. Nevertheless, the chances of survival can increase if the tumor is identified early on, which can be achieved through screening with computed tomography (CT). The clinical evaluation of CT images is a very time-consuming task and computed-aided diagnosis systems can help reduce this burden. The segmentation of the lungs is usually the first step taken in image analysis automatic models of the thorax. However, this task is very challenging since the lungs present high variability in shape and size. Moreover, the co-occurrence of other respiratory comorbidities alongside lung cancer is frequent, and each pathology can present its own scope of CT imaging appearances. This work investigated the development of a deep learning model, whose architecture consists of the combination of two structures, a U-Net and a ResNet34. The proposed model was designed on a cross-cohort dataset and it achieved a mean dice similarity coefficient (DSC) higher than 0.93 for the 4 different cohorts tested. The segmentation masks were qualitatively evaluated by two experienced radiologists to identify the main limitations of the developed model, despite the good overall performance obtained. The performance per pathology was assessed, and the results confirmed a small degradation for consolidation and pneumocystis pneumonia cases, with a DSC of 0.9015 ± 0.2140 and 0.8750 ± 0.1290, respectively. This work represents a relevant assessment of the lung segmentation model, taking into consideration the pathological cases that can be found in the clinical routine, since a global assessment could not detail the fragilities of the model.

MECHANICAL VENTILATION FOR INTERSTITIAL LUNG DISEASE BY SYSTEMIC SCLEROSIS WITH CREST SYNDROME. PRESENTATION OF A CLINICAL CASE

INTRODUCTION. Interstitial lung disease (ILD) with acute respiratory failure needs ventilatory support poorly documented. One of the interstitial diseases known is the Systemic sclerosis, its advanced stages develop CREST syndrome. Faverio P, et al. (2016) suggested do not close the door to these patients and open the correct protocol, criticizing the little value that the scientic community concede to invasive mechanical ventilation (IMV). CASE REPORT. 85-year-old male is internalized in critical care unit by pneumonia, the complementary evaluation shows a systemic sclerosis disease with CREST syndrome and it is conrmed by elevation of anti-centromere antibody and positive skin biopsy. Tomography highlights pneumonic consolidation plus interstitial lung involvement and echocardiography reveals pulmonary hypertension. The management is done with IMV, keeping the goal of driving pressure less than 15 as lung protection, recovering respiratory function in 3 weeks. Discussion. The evidence is too insufcient to establish the best decision on IMV to the management of ILD.

Pneumococcal serotypes causing non-invasive pneumonia in adults from a South Indian tertiary care hospital and the impact of the newer conjugate vaccines.

Background Streptococcus pneumoniae is the leading cause of community-acquired pneumonia (CAP) in adults. Ageing, chronic conditions and comorbidities are important risk factors for pneumococcal pneumonia.PurposeThere is lack of data on the pneumococcal serotypes causing non-invasive pneumonia in India. This study aims to determine the prevalent pneumococcal serotypes causing non-invasive pneumonia, the associated comorbidities, and the coverage of both the available pneumococcal vaccines in India and conjugate vaccines that are currently undergoing clinical trials.MethodsA total of 280 subjects (aged >16 years) who had clinical symptoms correlating with radiological findings for non-invasive bacteremic pneumonia and microbiological evidence of S. pneumoniae between 2018 and 2020 were included. The clinical, demographic, radiological and microbiological findings were retrieved from the Hospital Information System (HIS).ResultThe common serotypes in order of prevalence were 19F, 9V, 23F, 6B, 11A, 13, 34, 10A, 19A and 6A. The predominant non-vaccine serotypes were 13, 34, 35B, 31 and 16F. The associated radiological findings were pneumonic consolidation and multi-lobar involvement. Other coinfected bacterial pathogens included H. influenzae, S. aureus, K. pneumoniae and P. aeruginosa.ConclusionThe pneumococcal vaccines: PCV10/GSK, PCV10/SII, PCV13, PCV15, PCV20 and PPSV23 provide an overall serotype coverage of 36, 41, 47, 48, 61 and 69 %, respectively of S. pneumoniae causing non-invasive pneumonia in South India. Increasing catch-up vaccination using PCV10(SII) in pre-school children could have a more significant impact on reducing pneumococcal pneumonia in adults (>50 years) in terms of increased herd immunity at an affordable cost.

CARCINOID TUMOR IDENTIFIED WITHIN A SEQUESTERED LUNG

TOPIC: Lung Cancer TYPE: Fellow Case Reports INTRODUCTION: Pulmonary sequestration is the second most common pulmonary congenital abnormality and is rarely associated with malignancy. We present a case of a young woman with hemoptysis found to have two rare concurrent lung pathologies: a lung carcinoid tumor within a pulmonary sequestration. CASE PRESENTATION: 21 year old female presents following an episode of sudden onset hemoptysis. Patient's medical history was notable for two prior episodes of pneumonia in her teenage years. A CT chest angiogram was obtained and revealed a right upper lobe highly vascular mass-like consolidation. This was followed by bronchial artery angiography which identified a torturous bronchial arterial blood supply to the abnormal area of parenchyma with a large draining vein. Patient underwent a 90 minute right upper lobe robotic resection and the abnormal area was identified with an aberrant arterial blood supply suggestive of a pulmonary sequestration. Pathology consistent with typical carcinoid tumor. Patient was discharged home on post operative day 1 and follow up imaging has not shown recurrence. DISCUSSION: Pulmonary sequestration describes an area of abnormal lung tissue with an anomalous systemic arterial blood supply. It accounts for approximately 6% of all lung congenital abnormalities predominantly affecting males 4:1. Typically patients remain asymptomatic and this finding is incidentally noted on imaging. If superinfected this can be confused with a consolidative pneumonia. Therefore, typical presentation in adults includes history of recurrent infections and hemoptysis. These features are also shared with a primary lung malignancy. Typical carcinoid tumors are indolent neuroendocrine tumors that progress slowly and rarely metastasize. Although primary lung carcinoid tumors are rare, accounting for 1% of lung cancers, it is the most common lung malignancy in children and adolescents. The mainstay of treatment, like pulmonary sequestration, involves resection. Further staging and pathological findings determine additional therapies. This case demonstrates the considerations required in the diagnostic approach of a poorly characterized lesion when a patient presents with a life threatening condition such as hemoptysis. The initial CT imaging showed a vascular lesion, however the degree of aberrant arterial blood supply was only appreciated following bronchial angiography. Endobronchial biopsy carried an increased risk of hemorrhage and may have been inadequate to diagnose the underlying malignancy and sequestration. Therefore, a surgical approach was favored. CONCLUSIONS: This case of an uncommon primary carcinoid lung malignancy identified within a rare congenital abnormality of a pulmonary sequestration highlights the importance of carefully considering these atypical diagnoses and the multidisciplinary approach required for successful diagnosis and treatment. REFERENCE #1: Corbett HJ, Humphrey GM. Pulmonary sequestration. Paediatr Respir Rev. 2004 Mar;5(1):59-68. doi: 10.1016/j.prrv.2003.09.009. PMID: 15222956. REFERENCE #2: Chakraborty RK, Modi P, Sharma S. Pulmonary Sequestration. [Updated 2021 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532314/ REFERENCE #3: Borczuk AC. Pulmonary Neuroendocrine Tumors. Surg Pathol Clin. 2020 Mar;13(1):35-55. doi: 10.1016/j.path.2019.10.002. Epub 2019 Nov 29. PMID: 32005434. DISCLOSURES: No relevant relationships by Robert Cerfolio, source=Admin input No relevant relationships by David Chen, source=Web Response No relevant relationships by Carina Iskandir, source=Web Response No relevant relationships by Benjamin Kwok, source=Web Response No relevant relationships by Elizabeth Morris, source=Web Response No relevant relationships by Roxana Sulica, source=Web Response

Using short-term prophylactic antibiotics for prevention of infectious complications after radial endobronchial ultrasound-guided transbronchial biopsy

BackgroundRadial endobronchial ultrasound-guided transbronchial biopsy (rEBUS-TBB) facilitates the diagnosis of peripheral lung lesions. However, methods to prevent infectious complications afterwards have not been well established. Therefore, we analyzed the efficacy of short-term oral antibiotics for preventing infectious complications. MethodsWe retrospectively analyzed 484 patients. Patients who underwent rEBUS-TBB from March 2018 to March 2019 did not receive prophylactic antibiotics (“no prophylactic” group, n = 233), while patients who underwent rEBUS-TBB from April 2019 to March 2020 did receive prophylactics (oral amoxicillin/clavulanate for 3 days; “prophylactic” group, n = 251). Multivariable logistic regression was used to identify independent factors for infectious complications. ResultsThe median age was 66 years (IQR: 59–74 years), and 58.9% were male. Slightly over half of the patients (54.4%) were previous or current smokers. In 13% (n = 63) of patients, the procedure was performed using a guide sheath. Infectious complications occurred in 12 (5.2%) and 2 (0.8%) cases in the no prophylactic and prophylactic groups, respectively. In multivariable analysis, infectious complications were significantly associated with a cavity or low-density attenuation (LDA) of the lesion, and with obstructive pneumonic consolidation, but not with prophylactic antibiotics. In subgroup analysis, infectious complications occurred less often when prophylactic antibiotics were used in patients with at least one risk factor (22.4% vs. 0%, p = 0.005). ConclusionsThe risk factors for infectious complications were cavities, LDA in the lesion, and obstructive pneumonic consolidation. Use prophylactic antibiotics might reduce incidence of infectious complications in the presence of these risk factors.

Lung Ultrasound Is More Sensitive for Hospitalized Consolidated Pneumonia Diagnosis Compared to CXR in Children.

Background: Pneumonia is the leading cause of death among children; thus, a correct early diagnosis would be ideal. The imagistic diagnosis still uses chest X-ray (CXR), but lung ultrasound (LUS) proves to be reliable for pneumonia diagnosis. The aim of our study was to evaluate the sensitivity and specificity of LUS compared to CXR in consolidated pneumonia. Methods: Children with clinical suspicion of bacterial pneumonia were screened by LUS for pneumonia, followed by CXR. The agreement relation between LUS and CXR regarding the detection of consolidation was evaluated by Cohen’s kappa test. Results: A total of 128 patients with clinical suspicion of pneumonia were evaluated; 74 of them were confirmed by imagery and biological inflammatory markers. The highest frequency of pneumonia was in the 0–3 years age group (37.83%). Statistical estimation of the agreement between LUS and CXR in detection of the consolidation found an almost perfect agreement, with a Cohen’s kappa coefficient of K = 0.89 ± 0.04 SD, p = 0.000. Sensitivity of LUS was superior to CXR in detection of consolidations. Conclusion: Lung ultrasound is a reliable method for the detection of pneumonia consolidation in hospitalized children, with sensitivity and specificity superior to CXR. LUS should be used for rapid and safe evaluation of child pneumonia.

A giant bulla case that developed in the late period after Covid 19: a case report

Covid 19 patients' lung imaging, parenchymal pneumonic opacity areas with ground glass density, mostly located in the subpleural regions, are observed. With the increase in the number of cases, different lung complications have begun to be seen in cases other than pneumonic consolidations. Here, we wanted to emphasize the necessity of follow-up of Covid 19 patients after discharge by presenting our case who developed giant bulla in the late period, but not in the early follow-up after Covid 19.

Cytology of Bronchoalveolar Lavage in Goats: Neutrophil-to-Lymphocyte Ratio as a Biomarker of Pneumonic Consolidation

Cytology of Bronchoalveolar Lavage in Goats: Neutrophil-to-Lymphocyte Ratio as a Biomarker of Pneumonic Consolidation