Presence Of Pleural Thickening Research Articles

Contribución de PET/CT a la diferenciación de derrame pleural benigno y maligno en pacientes con cáncer de ovario

ObjectiveThe present study investigates the ability of non-invasive contribution of positron emission tomography (PET)/computed tomography (CT) to distinguish between benign pleural effusions (BPE) and malignant pleural effusions (MPE) in patients diagnosed with ovarian carcinoma (OC). Material and methodIncluded in the study were 32 OC patients with a PE diagnosis. The cases with BPE and MPE were compared in terms of the PE maximum standardized uptake value (SUVmax), PE SUVmax/mean standardized uptake (SUVmean) value of the mediastinal blood pool (TBRp), the presence of pleural thickening, the presence of supradiaphragmatic lymph node, unilateral or bilateral PE, pleural effusion diameter, patient age and CA125 value. ResultsThe mean age of the 32 patients was 57±2.8 years. TBRp>1.1, pleural thickening and supradiaphragmatic lymph node were observed significantly more frequently in the MPE than the BPE cases. While no pleural nodules were detected in patients with BPE, they were present in 7 of the patients with MPE. The rates of distinction between the MPE and BPE cases were as follows: the sensitivity of the TBRp value was 95.2% and specificity was 72.7%; the sensitivity of pleural thickness was 80.9% and specificity was 81.8%; the sensitivity of supradiaphragmatic lymph node was 38% and specificity was 90.9%; and the sensitivity of the pleural nodule was 33.3% and specificity was 100%. There were no significant differences between two groups in any other factors. ConclusionPleural thickening and TBRp values ascertained through PET/CT may aid the distinction between MPE-BPE, especially in patients with advanced stage OC with a poor general condition, or those who cannot undergo surgery.

The contribution of PET/CT to the differentiation of benign and malignant pleural effusion in patients with ovarian carcinoma

ObjectiveThe present study investigates the ability of non-invasive contribution of positron emission tomography (PET)/computed tomography (CT) to distinguish between benign pleural effusions (BPE) and malignant pleural effusions (MPE) in patients diagnosed with ovarian carcinoma (OC). Material and methodsIncluded in the study were 32 OC patients with a PE diagnosis. The cases with BPE and MPE were compared in terms of the PE maximum standardized uptake value (SUVmax), PE SUVmax/mean standardized uptake (SUVmean) value of the mediastinal blood pool (TBRp), the presence of pleural thickening, the presence of supradiaphragmatic lymph node, unilateral or bilateral PE, pleural effusion diameter, patient age and CA125 value. ResultsThe mean age of the 32 patients was 57±2.8 years. TBRp>1.1, pleural thickening and supradiaphragmatic lymph node were observed significantly more frequently in the MPE than the BPE cases. While no pleural nodules were detected in patients with BPE, they were present in 7 of the patients with MPE. The rates of distinction between the MPE and BPE cases were as follows: the sensitivity of the TBRp value was 95.2% and specificity was 72.7%; the sensitivity of pleural thickness was 80.9% and specificity was 81.8%; the sensitivity of supradiaphragmatic lymph node was 38% and specificity was 90.9%; and the sensitivity of the pleural nodule was 33.3% and specificity was 100%. There were no significant differences between two groups in any other factors. ConclusionsPleural thickening and TBRp values ascertained through PET/CT may aid the distinction between MPE-BPE, especially in patients with advanced stage OC with a poor general condition, or those who cannot undergo surgery.

Computed tomography in secondary spontaneous pneumothorax: Reading the fine print.

Objectives:To identify specific characteristics, distribution and associated findings of lesions causing secondary spontaneous pneumothorax (SSP)Methods:Computed tomography (CT) chest of 37 patients (between October 2011 and January 2020) was evaluated by two radiologists. They were classified into ‘Infectious’ and ‘Non-infectious’ groups, based on cause of pneumothorax. A scoring system (score 0–10) was proposed based on parameters which were statistically significantResults:Out of 37 patients with pneumothorax, 18 could be attributed to infectious aetiology and remaining 19 were due to noninfectious causes. The most common infectious cause of spontaneous pneumothorax was tuberculosis and noninfectious cause was chronic obstructive airway disease (COAD). Statistically significant difference was found for lesion wall thickness and presence of solid component between these two groups. No significant difference was found between both groups when comparing age, gender, lesion size and lesion distribution. The presence of pleural thickening, consolidation and mediastinal lymphadenopathy were statistically significant. Pleural effusion was never present in the noninfectious group. The area under receiver operating characteristic for differentiating patients in the two groups was 0.931 (standard error, 0.038; 95% CI, 0.856–1.000), and optimal threshold score for identifying patients with infectious causes was 4.5, with 77.8% sensitivity and 89.5% specificityConclusion:Pneumothorax is almost equally common due to infectious and noninfectious causes. The most common infectious cause of spontaneous pneumothorax was tuberculosis and noninfectious cause was COAD. Based on certain CT findings, we have proposed a scoring system to differentiate between these two groups.

Prevalence and risk factors of multidrug-resistant tuberculosis in Cubal, Angola: a prospective cohort study.

Although the Republic of Angola is one of the 14 countries figuring in the three high tuberculosis (TB) burden country lists, the true multidrug-resistant TB (MDR-TB) situation is unknown. Patients aged 16 years with a diagnosis of pulmonary TB were prospectively enrolled from June 2014 to July 2015. Sputum samples were collected for culture and drug susceptibility testing in all patients, and for Xpert® MTB/RIF testing in all previously treated patients and in new patients whose sputum remained smear-positive after 2 months of treatment. A total of 422 patients were included; Mycobacterium tuberculosis was isolated in 308 sputum samples. The prevalence of MDR-TB was 8.0% (18/225) in new patients and 71.1% (59/83) in previously treated patients. Male sex (OR 2.95, 95%CI 1.35-6.44, P = 0.007), previous anti-tuberculosis treatment (OR 20.86, 95%CI 9.53-45.67, P < 0.001), presence of pleural thickening (OR 7.68, 95%CI 1.57-37.43, P = 0.012) and duration of illness >4 months (OR 3.34, 95%CI 1.45-7.69, P = 0.005) were independent risk factors for MDR-TB. The prevalence of MDR-TB in Cubal, Angola, was higher than estimated by the World Health Organization for Angola and one of the highest worldwide. Facilities to diagnose and treat MDR-TB are urgently needed in Angola.

Cause of massive hemoptysis in critical patients and the effect of bronchial artery embolization

To investigate the cause of massive hemoptysis in critical patients, and to evaluate the effect of bronchial artery embolization (BAE) on critical patients with massive hemoptysis. A retrospective controlled analysis was conducted. The clinical data of 35 patients with life-threatening massive hemoptysis admitted to intensive care unit (ICU) of the First Hospital Affiliated to Guangzhou Medical University from January 2009 to December 2017 were analyzed. The patients were divided into BAE and non-BAE group according to whether receiving BAE or not. BAE patients were subdivided into subgroups: hemoptysis after ventilation and hemoptysis before ventilation subgroups, as well as survival and non-survival subgroups. The etiology of all massive hemoptysis was analyzed. The gender, age, acute physiology and chronic health evaluation II (APACHE II) score, amount of hemoptysis, whether presence of pleural thickening in chest CT, the length of ICU stay, total length of hospital stay, the duration of mechanical ventilation (MV), clinical effective and prognostic indicators of patients were recorded. The correlation between variables was analyzed by Spearman correlation analysis. All 35 patients were enrolled in the finally analysis. The main cause of critical patients with massive hemoptysis was fungal infection [37.1% (13/35)], followed by pneumonia and abnormal coagulation [17.1% (6/35)], bronchiectasis [11.4% (4/35)], tumor [8.6% (3/35)], etc. In all 35 patients, 27 were treated with BAE and 8 were treated without BAE. There was no difference in gender, age, the length of ICU stay, total length of hospital stay, the duration of MV, amount of hemoptysis, APACHE II score, whether use antiplatelet agents or anticoagulants, or whether presence of pleural thickening in chest CT between the two groups. The rate of hemoptysis remission in BAE group was significantly higher than that of non-BAE group [92.6% (25/27) vs. 25.0% (2/8), P < 0.01], but there was no statistically significant difference in hospital survival as compared with that of non-BAE group [48.1% (13/27) vs. 25.0% (2/8), P > 0.05]. Subgroup analysis showed that 64.3% (9/14) of patients with hemoptysis after ventilation was caused by pulmonary fungal infection, which was significantly higher than those with hemoptysis before ventilation [15.4% (2/13), P = 0.018]. Compared with hemoptysis after ventilation group, the length of ICU stay and the duration of MV in hemoptysis before ventilation group were significantly shortened [the length of ICU stay (days): 12.0 (14.0) vs. 30.0 (81.8), the duration of MV (days): 10.0 (16.0) vs. 25.0 (68.3)], the patients using antiplatelet drugs or anticoagulant drugs was decreased significantly (case: 1 vs. 9, all P < 0.05). However, there was no statistically significant difference in gender, age, total length of hospital stay, amount of hemoptysis, APACHE II score, whether presence of pleural thickening in chest CT, the rate of hemoptysis remission, the incidence of secondary BAE or hospital survival rate between the two groups. Compared with the survival subgroup (n = 13), more patients in the non-survival subgroup (n = 14) were treated with antiplatelet or anticoagulants (P < 0.05); and Spearman correlation analysis showed that the survival of the patients with BAE was negatively correlated with the use of antiplatelet or anticoagulants (r = -0.432, P = 0.024). There was no significant difference in the gender, age, the length of ICU day, total length of hospitalization, duration of MV, estimated hemoptysis, APACHE II score, or the proportion of pleural thickening between the two groups. The study indicated that the etiology of massive hemoptysis in critical patients was complicated. Fungal infection was the main cause in patients with hemoptysis after ventilation. BAE was effective in the control of massive hemoptysis in ICU, but it was not ideal for patients with abnormal coagulation function or abnormal platelet count or platelet dysfunction from antiplatelet or anticoagulant drugs, the overall survival rate was still low.

Predictive Variables for Failure in Administration of Intrapleural Tissue Plasminogen Activator/Deoxyribonuclease in Patients With Complicated Parapneumonic Effusions/Empyema

Combined intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) has been shown to reduce the need for surgical intervention for complicated pleural effusion/empyema (CPE/empyema). For patients in whom tPA/DNase is likely to fail, however, receipt of this therapy may simply delay the inevitable. The goal of this study was to identify risk factors for failure of combined intrapleural therapy. We performed a retrospective chart review of patients who received intrapleural tPA/DNase for the treatment of CPE/empyema. Clinical variables included demographic data, radiographic parameters at time of diagnosis, and results from pleural fluid analysis. We used gradient boosted trees-an ensemble machine learning technique, with hyperparameter tuning to mitigate overfitting-to rank the importance of 19 candidate clinical variables with respect to their ability to predict failure of tPA/DNase therapy. We identified 84 patients who received intrapleural tPA/DNase for the treatment of complicated pleural effusions/empyema over a 5-year period. Resolution of CPE/empyema with intrapleural tPA/DNase was achieved in two-thirds of the patients (n= 57). Of the 19 candidate predictors of tPA/DNase failure, the presence of pleural thickening was found to be the most important (48%relative importance), followed by the presence of an abscess or necrotizing pneumonia (24%), the pleural protein level (6%), and the presence of loculated effusion (4%). Our analysis found that the presence of pleural thickening and the presence of an abscess/necrotizing pneumonia helps to triage patients in whom combined intrapleural therapy is likely to fail. The results warrant further study and validation in a prospective multicenter study.

Efficacy Of ultrasonography and computed tomography in differentiating transudate from exudate in patients with pleural effusion

Purpose: To evaluate USG and CT imaging findings in differentiating transudative and exudative pleural effusion. Materials and methods: A prospective observational study was performed over a period of eighteen months between January 2016 and June 2017. Eighty patients with pleural effusion were included and were evaluated with USG and CT along with diagnostic thoracocentesis. USG appearances and CT attenuation values along with additional findings like presence of pleural thickening, pleural nodules and loculation were evaluated. Results: 24 (30%) were transudates and 56 (70%) were exudates. Transudative were always anechoic. Exudates were complex septated (62.5%), echogenic (25%) or complex non-septated (8.9%) on USG with very few being anechoic (3.5%). Loculations were better appreciated on ultrasound while pleural thickening and nodules were better seen on CT. Mean attenuation values were significantly higher in exudates (14.65 ± 6.07; mean ± SD, range: 4.5 to 34) than transudates (4.66 ± 2.29; mean ± SD, range: 1.3 to 8.2) with a P value <0.01. Effusions can be considered as transudative if the CT attenuation value is <8, with a sensitivity of 91.6% and specificity of 82.7% with a significant P value <0.01. Pleural thickening, nodules and loculations were seen commonly in exudates than transudates with a high specificity (91.6 %, 95.8% and 100% respectively). Conclusion: USG is a helpful non-invasive and bedside tool in determining the nature of pleural effusion. CT attenuation values play a useful role in differentiating the nature of pleural effusion. Transudative effusions can be considered when HU values are <8.

Lung cancer screening and prevention in a still endemic region for granulomatous disease: Brazil

The aim of this article is to give a perspective on how to perform lung cancer screening in places with high incidence of granulomatous diseases (GDs). Regarding improvements in diagnosis and treatments, TB remains one of the major health problems to be faced in Brazil and worldwide. The aspect of the primary complex is the same as that of the indeterminate pulmonary nodule, which may increase the rate of “positive” findings during a screening program. The multidisciplinary team is able to differentiate such nodules from those with greater suspicion, especially when analyzing the whole set of computed tomography (CT) findings associated with the “positive” pulmonary nodule. Considering the lung cancer importance in the depicted epidemiological profile, primary and secondary prevention are fundamental to change the actual scenario. For secondary prevention, periodic lung cancer screening may be useful. In Brazil, there are major concerns that in heavy smokers many benign nodules might be found secondary to GD, leading to unnecessary diagnostic testing and surgical intervention. It is important to emphasize that low-dose CT (LDCT) examinations performed in people from regions with high prevalence of GD may be interpreted by radiologists with experience seeing its most common findings, such as scars at the apex of the lungs, presence of pleural thickening and occurrence of multiple micro nodules. In the experience of our group, with the accomplishment of LDCT screening in about 800 asymptomatic individuals, active tuberculosis (TB) was diagnosed in only three cases, where the radiological suspicion aroused in the absence of significant symptoms. In this scenario, it seems to be feasible to engage asymptomatic high-risk persons for cancer screening in large-scale programs within areas with high prevalence of GDs. Benefits of case-finding in both circumstances of benign transmission able disease or lethal cancer type outweigh most of the harms encountered.

Predictive CT Features of Visceral Pleural Invasion by T1-Sized Peripheral Pulmonary Adenocarcinomas Manifesting as Subsolid Nodules.

The objective of our study was to determine whether visceral pleural invasion (VPI) of T1-sized peripheral pulmonary adenocarcinomas manifesting as subsolid nodules (SSNs) abutting the pleural surface or associated with pleural tags can be predicted. Our study population consisted of 188 T1-sized peripheral pulmonary adenocarcinomas that appeared as SSNs (24 pure ground-glass nodules [GGNs] and 164 part-solid nodules) and underwent surgical resection between January 2007 and December 2013. Logistic regression analysis was performed to identify significant factors in predicting VPI. VPI occurred in 36 of 188 adenocarcinomas (19.1%). There were no cases of VPI in patients with pure GGNs. In part-solid nodules, there were significant differences regarding the presence of pleural contact, presence of pleural thickening, presence of solid portion abutting the pleura, nodule size, solid portion size, solid proportion, interface length, and length of the solid portion contacting the pleura (p < 0.05). Multivariate analysis revealed pleural contact (p < 0.001), pleural thickening (p = 0.003), solid proportion greater than 50% (p = 0.002), and nodule size greater than 20 mm (p = 0.015) as significant independent predictive features for VPI with adjusted odds ratios of 8.300, 3.966, 4.636, and 2.993, respectively. In part-solid nodules, the CT features of pleural contact, pleural thickening, solid proportion greater than 50%, and nodule size greater than 20 mm were shown to be significant indicators of VPI by T1-sized peripheral adenocarcinomas.

Pleural thickening in a population environmentally exposed to amphibole asbestos as children

Introduction. Residents of Libby, MT, a small community in the northern Rocky Mountains, were exposed to a mined material that was naturally contaminated with amphibole asbestos (LA). The purpose of this study was to evaluate lung findings among adults who were exposed to this material during childhood. Methods. Eligible participants lived in Libby for a minimum of six months but left the area prior to ages 23 for males and 21 for females. Cumulative exposure to LA via several environmental pathways was characterized from exposure history questionnaire, and people were excluded if they had worked for the local mining company. Participants underwent chest computed tomography (CT) and pulmonary function tests. A pleural score (PS) was calculated among those with pleural thickening (PT). Logistic and multivariate linear regression was used to evaluate associations between LA exposure, PT and pulmonary function measures. Results. A total of 198 subjects (59% female) were recruited with a mean (sd) age of 50.2 (11.4). PT was demonstrated in 96 (48%). The OR (and 95% CI) for presence of PT adjusted for age, gender and body mass index was 1.73 (1.14-2.64) per interquartile increase in the cumulative metric for environmental exposure. Among those with PT, unit increase in PS was inversely associated with change in percent predicted for forced vital capacity (adjusted parameter coefficient (95% CI) = -0.92 (-1.5, -0.36)), total lung capacity (-0.74 (-1.3, -0.19)) and diffusing capacity of the lung (-1.6 (-2.4, -0.72)). Conclusions. Participants in this study experienced low, non-occupational exposure to LA only during childhood, yet almost half had PT. We demonstrated that the extent of PT was associated with lower pulmonary function measures. Prospective follow-up will be necessary to examine related risk of restrictive asbestos-related pleuropulmonary disease among this environmentally exposed population.

Changes in chest CT findings of pulmonary tuberculosis after linezolid treatment.

The purpose of the present study was to evaluate the changes in successive chest CT examinations in patients with pulmonary tuberculosis who achieved culture conversion with linezolid treatment. We reviewed the follow-up CT scans of 14 patients with pulmonary tuberculosis who had sputum-culture conversion after linezolid treatment. This study evaluated cavity, centrilobular nodules, consolidation, bronchial wall thickening, calcified nodule or consolidation, bronchiectasis, irregular lines, and lung destruction. The presence of pleural thickening, pleural effusion and lymphadenopathy was recorded. Follow-up CT scans showed a partial decrease in the extent of centrilobular nodules in all cases. Consolidation was partially cleared in 8 patients and newly developed consolidation was observed in 2 patients. All of the cavities showed a decrease in size and thickness. But the cavities persisted after linezolid treatment in 8 of 9 patients. Bronchial wall thickening was completely or partially cleared in 6 patients and 5 patients, respectively. Newly developed irregular lines, lung destruction and pleural thickening were observed in 1, 1, and 3 patients, respectively. Successive chest CT examinations in patients with linezolid treatment may help in the early assessment of linezolid treatment efficacy because of its rapid availability. Early assessment of linezolid treatment efficacy will help to set up a treatment plan, such as duration of treatment or linezolid dosage. However, they may not be useful for deciding pulmonary tuberculosis activity following linezolid treatment.

Intrapleural fibrinolytic therapy (IPFT) in loculated pleural effusions—analysis of predictors for failure of therapy and bleeding: a cohort study

ObjectivesTo assess risk factors associated with failure and bleeding in intrapleural fibrinolytic therapy (IPFT) for pleural effusions.DesignRetrospective case series.SettingTwo tertiary-care centres in North America.ParticipantsWe identified 237 cases that received IPFT...

Differential CT features of infectious pneumonia versus bronchioloalveolar carcinoma (BAC) mimicking pneumonia

The purpose of this study was to evaluate retrospectively the differential CT features of bronchioloalveolar carcinoma (BAC) mimicking pneumonia and infectious pneumonia at the lung periphery. CT images were reviewed in 47 patients with focal areas of parenchymal opacification at the lung periphery. We evaluated the presence of ground-glass attenuation, marginal conspicuity of the lesion, CT angiogram sign, air-bronchogram sign, a bubble-like low-attenuation area within the lesion, presence of pleural thickening and retraction associated with the lesion, presence of pleural effusion and extra-pleural fatty hypertrophy, presence of bronchial wall thickening proximal to the lesion, and air-trapping in the normal lung near the lesion. BAC (n=18) depicted the presence of a bubble-like low-attenuation area within the lesion, whereas infectious pneumonia (n=29) represented the pleural thickening associated with the lesion and bronchial wall thickening proximal to the lesion (P<0.05). The other CT findings showed no significant differences (P>0.05). The focal areas of the parenchymal opacification on the CT images may suggest infectious pneumonia rather than BAC when they show bronchial wall thickening proximal to the lesion and pleural thickening associated with the lesion, whereas BAC is characterized as the presence of a bubble-like low attenuation area within the tumor.

Systemic-to-pulmonary venous shunt in superior vena cava obstruction: depiction on computed tomography venography.

To describe computed tomography (CT) venographic appearances of systemic-to-pulmonary venous shunts with CT venography and three-dimensional reconstruction images from patients with superior vena cava obstruction. From January 1994 to April 2002, CT venography was performed in 45 patients with superior vena cava obstruction using a single-detector helical CT scanner (n=38) and four-detector row CT scanner (n=7). Analysis of CT scan data included the cause and degree of venous obstruction, the presence of pleural thickening and enhancement, and the attenuation of pulmonary veins. The causative factor for systemic-to-pulmonary venous shunt was evaluated using the Fisher exact test. Systemic-to-pulmonary venous shunts were observed in four patients (9%) who had high-attenuated pulmonary veins and pleural enhancement on CT venography. Pleural thickening (P=0.01) and a history of pulmonary tuberculosis (P=0.034) are statistically significant risk factors. CT venography showed strong pleural enhancement and high-attenuated pulmonary veins indicating systemic-to-pulmonary venous shunts. Radiologists should study the earlier enhancement of pulmonary veins in patients with superior vena cava obstruction.

Pleural thickening as a manifestation of aspergillus superinfection.

Pleural thickening is a very frequent manifestation of Aspergillus superinfection in patients with cavitary or cystic pulmonary disease. It was seen in all 33 cases in this series.The presence of pleural thickening in pulmonary disease not usually associated with it, or an increase in the amount in diseases in which pleural thickening is commonly seen, both suggest Aspergillus superinfection. When such pleural thickening is seen, diligent search should be made for this fungus.