Pulmonary Changes In Patients Research Articles

Lung ultrasound to evaluate pulmonary changes in patients with cardiogenic shock undergoing extracorporeal membrane oxygenation: a retrospective study

PurposeThe aim of the study was to evaluate the value of lung ultrasound (LUS) in patients with cardiogenic shock treated by venoarterial extracorporeal membrane oxygenation (VA-ECMO).MethodsA retrospective study was conducted in Xuzhou Central Hospital from September 2015 to April 2022. Patients with cardiogenic shock who received VA-ECMO treatment were enrolled in this study. The LUS score was obtained at the different time points of ECMO.ResultsTwenty-two patients were divided into a survival group (n = 16) and a nonsurvival group (n = 6). The intensive care unit (ICU) mortality was 27.3% (6/22). The LUS scores in the nonsurvival group were significantly higher than those in the survival group after 72 h (P < 0.05). There was a significant negative correlation between LUS scores and PaO2/FiO2 and LUS scores and pulmonary dynamic compliance(Cdyn) after 72 h of ECMO treatment (P < 0.001). ROC curve analysis showed that the area under the ROC curve (AUC) of T72-LUS was 0.964 (95% CI 0.887 ~ 1.000, P < 0.01).ConclusionLUS is a promising tool for evaluating pulmonary changes in patients with cardiogenic shock undergoing VA-ECMO.Trial registrationThe study had been registered in the Chinese Clinical Trial Registry(NO.ChiCTR2200062130 and 24/07/2022).

Possible Role of Chest Ultrasonography for the Evaluation of Peripheral Fibrotic Pulmonary Changes in Patients Affected by Idiopathic Pulmonary Fibrosis—Pilot Case Series

Lung ultrasonography (LUS) provides an estimation of peripheral airspace (PAS) geometry of the lung. Altered PAS produces sonographic interstitial syndrome (SIS). Idiopathic pulmonary fibrosis (IPF) involves peripheral lung with altered PAS. The aim of the study is to correlate echographic patterns with peripheral fibrotic changes on high-resolution Chest CT scan (HRCT). Patients underwent LUS and HRCT on the same date. Four LUS patterns were described: (1) near normal; (2) SIS with predominance of reverberant artifacts; (3) SIS with vertical predominance; (4) white lung. Four HRCT grades of peripheral fibrotic infiltrates were reported: grade 1 mild; grade 2 moderate; grade 3 severe; grade 4 massive or honeycomb. LUS pattern 1 was indicative of mild to moderate fibrotic alterations in 100% of cases. LUS pattern 2 matched with HRCT grade 2 in 24 out of 30 cases (77%). Huge discordance in four cases because of large honeycomb cysts. LUS pattern 3 was indicative of severe to massive alterations in 100% of cases. LUS pattern 4 showed a heterogeneous distribution of HRCT grades, severe changes, and ground glass opacities (GGO). This preliminary work demonstrates some level of agreement between LUS patterns and HRCT grades. Limitations and methodological issues have been shown to support subsequent studies of agreement.

Computed tomographic pulmonary changes in patients with chronic rhinosinusitis.

To investigate whether patients with a diagnosis of chronic rhinosinusitis (CRS) show characteristic pulmonary changes on chest CT compared with a control group without sinusopathy. This retrospective, observational study included patients with and without a diagnosis of CRS who underwent CT examination of the lungs between 2012 and 2014. Two radiologists, who were blinded for the presence of CRS, reviewed the scans for the presence of any abnormalities consensually. The χ(2) test was used for correlative analysis, with a significance level of 0.05. A total of 123 CT series (51.2% from male patients, mean age 41 ± 16 years) were reviewed, including those from 59 (48%) patients with a diagnosis of CRS. Patients with CRS were more likely than the control group to exhibit atelectasis, bronchiolectasis, centrilobular nodules and ground-glass opacities (all p < 0.05), with a significant predilection for middle lobe and lingular involvement observed (p < 0.001). Other abnormalities, such as bronchial wall thickening and air trapping, did not differ between groups. Atelectatic changes, ground-glass opacities, bronchiolectasis and centrilobular nodules are the most frequent abnormalities associated with CRS, with peculiar middle lobe and lingular involvement observed on chest CT examinations. CRS is a frequent disorder that displays typical pulmonary changes at CT. The recognition of such findings can prevent patients with this condition from undergoing unnecessary investigations that might be based on the presence of the aforementioned radiological features.

HRCT in cystic fibrosis in patients with CFTR I1234V mutation: Assessment of scoring systems with low dose technique using multidetector system and correlation with pulmonary function tests.

Background and Aims:Pulmonary changes in patients with cystic fibrosis (CF) with CFTR I1234V mutation have not been extensively documented. Impact of geographic influence on phenotypical expression is largely unknown. This descriptive clinical study presents the high-resolution computed tomography (HRCT) pulmonary findings and computed tomography (CT) scoring with respect to pulmonary function tests (PFT) in a small subset of CF group.Materials and Methods:We examined 29 patients between 2 and 31 years of age with CFTR I1234V mutation. HRCT and PFT were performed within 2 weeks of each other. Imaging abnormalities on HRCT were documented and analyzed by utilizing the scoring system described by Bhalla et al., Brody et al., Helbich et al.,and Santamaria et al. Efficacy of the scoring system with respect to PFT was compared.Statistical Analysis:Inter-observer reliability of the scoring systems was tested using intraclass correlation (ICC) between the two observers. Spearman correlation coefficients were calculated between the scoring systems and between the scoring systems and PFT results.Results:In our study, right upper and middle lobes were the most frequently involved sites of involvement. Bronchiectasis and peribronchial thickening were the most frequent imaging findings. Scores with all four scoring systems were reproducible, with good ICC coefficient of 0.69. There was good agreement between senior radiologists in all scoring systems.Conclusion:We noted pulmonary imaging abnormalities in a large majority (96%) of our CF patients. There was no significant difference in the CT scores observed from various systems. The CT evaluation system by Broody is detailed and time consuming, and is ideal for research and academic setup. On the other hand, the systems by Bhalla and Santamaria are easy to use, quick, and equally informative. We found the scoring system by Santamaria preferable over that of Bhalla by virtue of additional points of evaluation and ease of use, and therefore better suited for busy clinical practice.

Cardiopulmonary changes in Rheumatoid arthritis

Rheumatoid arthritis should be viewed as a multisystem disease affecting multiple organs. Vigilance for lung and cardiac involvement is necessary among rheumatologists and patients. Despite the absence of effective treatment for advanced respiratory and cardiovascular disease, it is possible that therapeutic intervention at an early stage may be beneficial. Keeping in view the above mentioned facts, we have undertaken this study to see the various cardiac and pulmonary changes associated with rheumatoid arthritis and, their age and sex wise distribution in study population. Objective; To study prevalence and severity of cardiovascular and pulmonary changes in patients of rheumatoid arthritis in accordance to age and sex. Method; All patients fulfilling 1987, revised criteria for diagnosis of rheumatoid arthritis, proposed by American College of Rheumatology were selected without any bias for age, sex, duration, severity of disease. Result; Female to male ratio was 2.6: 1 with hypertension as most common co-morbid disease. Anti-cyclic citrullinated peptide was more specific than rheumatoid factor. 40.5% cases had abnormal pulmonary function test results in the form of restrictive and/or obstructive abnormality. 35.7% had abnormal echocardiography with valvular lesions, pericardial effusion and left ventricular dysfunction in decreasing order. Mitral valve was involved in 87.5% of total valvular involvement. Conclusion; Cardiopulmonary involvement were restrictive pattern of lung involvement along with mitral valve lesions, pericardial effusion and left ventricular dysfunction. Anti-cyclic citrullinated peptide was more specific than rheumatoid factor

Oscilometría de impulso en adultos: una prueba de función pulmonar complementaria

La oscilometría de impulso es una prueba no invasiva que se ha retomado recientemente para determinar la impedancia del sistema respiratorio, principalmente en aquellos pacientes que tengan compromiso de la vía aérea pequeña y cuando no se pueda realizar un esfuerzo adecuado o maniobras convencionales. Puede servir como un método complementario o alternativo a la espirometría en la evaluación del estado del sistema respiratorio. Fue desarrollada desde 1956 pero solo hasta 2007 se incluyó en las guías ATS/ERS para la evaluación de la función pulmonar en preescolares. Consiste en la medición del impedimento natural al flujo de aire, lo cual incluye pérdidas friccionales y cargas elásticas e inerciales. Mide las resistencias centrales (R20) y las resistencias totales (R5), así como el delta de resistencia (ΔR=R5-R20), la reactancia capacitiva distal (X5), la frecuencia de resonancia (Fres) y el área de reactancia (AX). Tiene unos criterios de aceptabilidad que deben cumplirse y se sugiere que la interpretación se realice de manera sistemática. Los valores comparativos para su interpretación se han tomado de diferentes ecuaciones de acuerdo con edad, sexo, raza, altura y peso.Se ha utilizado para evaluar de forma temprana la impedancia del sistema respiratorio en asma y enfermedad pulmonar obstructiva crónica, enfermedades pulmonares intersticiales, cambios pulmonares mecánicos en pacientes con insuficiencia cardíaca congestiva, obstrucción de la vía aérea superior, disfunción de cuerdas vocales, como alternativa para la realización de test de broncoprovocación, como herramienta de evaluación complementaria en el manejo de pacientes con enfermedad pulmonar obstructiva crónica, respuesta a broncodilatadores, cambios en la resistencia de la vía aérea en pacientes con síndrome de apnea/hipopnea obstructiva del sueño, resistencias respiratorias en pacientes con lesión en la médula espinal, entre otras aplicaciones.Sin embargo, se requieren más estudios de calidad apropiada para determinar la utilidad de esta prueba diagnóstica en la práctica clínica.

Study the mechanical pulmonary changes in patients with congestive heart failure (CHF) by impulse oscillometry

BackgroundHeart failure is one of the most leading cause of death worldwide, but the mechanical characteristics of the pulmonary system in these patients have not been studied enough. The aim of this study was to measure mechanical pulmonary changes in patients with congestive heart failure (CHF) by using impulse oscillometry (IOS), which can obtain data by simpler means and independently from respiratory muscle strength. Materials and methodsWe assessed 24 CHF patients and 24 controls by spirometry and IOS using the Jaeger IOS system. IOS measures central and peripheral airway resistances (R20, R5) and central and peripheral reactances (X20, X5) using sound waves with different frequencies, which superimposed on the patients respiratory tidal volume and then records reflects. P value < 0.05 was taken to be significant. ResultsThe mean age of patients and controls was 61 ± 10 and 57 ± 7 years, respectively. The mean ejection fraction (EF) was 37 ± 17% for patients and 55 ± 7% for controls. Patients had a lower X5 (−0.20 ± 0.13 vs −0.13 ± 0.07; P < 0.05), forced expiratory volume in 1 second (FEV1; 2.26 ± 0.68 vs 3.09 ± 0.82: P < 0.01 L/min), and forced vital capacity (FVC; 2.55 ± 0.86 vs 3.32 ± 0.87; P < 0.05) compared to the controls. They also had elevated R5: 0.37 ± 0.21 vs 0.27 ± 0.09; P < 0.06). X5 was correlated with spirometric abnormalities (P < 0.05) and was lower in patients than in controls. ConclusionX5 was lower and R5 was higher in patients than in controls. CHF patients can be assessed by IOS more comfortable than by spirometry. IOS can reliably measure peripheral airway resistance in this group of patients.

Interstitial pulmonary changes in patients with hepatitis C-related chronic liver disease

Background and study aims Several extrahepatic manifestations (EHMs) have been reported in the natural history of hepatitis C virus (HCV) infection. Some studies had demonstrated a higher frequency of HCV in patients with idiopathic interstitial pulmonary fibrosis (IPF). The aim of this study is to investigate interstitial pulmonary changes via high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) in patients with HCV infection. Patients and methods Forty patients with HCV infection without diagnosis of any pulmonary diseases (group I) and 10 healthy persons (group II) were enrolled in the study. PFT and HRCT were performed in all cases. Results Findings of interstitial pulmonary involvement were detected in the HRCT of 19 out of 40 patients (47.5%). A decrease lower than 80% of the predicted value was detected in forced vital capacity (FVC) with restrictive pattern together with post-exercise hypoxia, in 21 (52.5%) patients. There was a significant difference between both groups in the findings of HRCT ( x 2 = 7.66, df = 1, p = 0.004) and PFTs ( x 2 = 9.05, df = 3, p = 0.002). According to the Child–Pugh classification, in group I, 15 patients were of class A, 16 were of class B and nine of class C, with no significant difference between classes as regards HRCT findings and PFT values. Six patients were positive for serum cryoglobulins. In these patients, all the parameters were not related to age. Conclusion Pulmonary interstitial changes are prevalent in HCV-infected patients, irrespective of the severity of their liver condition. It may also occur without respiratory symptoms.

Pulmonary Complications After Acute Kidney Injury

The development of respiratory failure in patients with AKI is a particularly devastating consequence that greatly increases patient mortality. When respiratory failure and AKI occur together, the mortality is greater than 80%. A clear understanding of the mechanisms leading to respiratory failure is of great clinical relevance to patients with AKI in order to prevent and treat this life-threatening complication. Pulmonary edema leading to respiratory failure has been a recognized complication of kidney failure since 1901. Remarkably, the pathogenesis of this complication remains elusive, despite over 100 years of clinical and experimental debate in the literature. A review of this literature suggests that there are 4 causes of pulmonary edema leading to respiratory failure in patients with AKI: (1) volume overload (cardiogenic edema), (2) left ventricular dysfunction (cardiogenic edema), (3) increased lung capillary permeability (noncardiogenic edema), and (4) acute lung injury (noncardiogenic edema with inflammation). In this review, these mechanisms are presented in historical context including the original descriptions of pathology and pathophysiology, recent epidemiologic data, and experimental studies in animals. Although volume overload is a well-accepted mechanism of pulmonary edema in patients with AKI, the purpose of this review was to highlight the evidence showing that noncardiogenic edema and acute lung injury also occur. By recognizing that the pulmonary complications of AKI are not simply from volume overload, specific treatment strategies may be discovered and used to improve outcomes in patients with the ominous and life threatening combination of AKI and respiratory failure.

Sequential Radiologic and Functional Pulmonary Changes in Patients with Paraquat Intoxication

The sequential changes of paraquat-induced pulmonary damage were studied using high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) in long-term follow-up. Among the cohort of 27 patients who had ingested paraquat, the HRCT findings showed a normal (n = 14) and an abnormal group (n = 13). Increased paraquat ingestion in the abnormal group was associated with more rapid and severe pulmonary changes. Ground-glass opacity on HRCT peaked on day 7 after ingestion. Between 2 weeks and 1 month, consolidation increased and pulmonary fibrosis progressed, and slow improvements were observed for up to six months. Compared with the PFT results obtained at 1 and 6.5 months, FVC, FEV1, and diffusing capacity all improved slightly. Lung changes after paraquat intoxication are functionally and radiologically reversible following treatment.

Inspiratory and expiratory HRCT findings in Behçet's disease and correlation with pulmonary function tests

Purpose: The purpose of our study was to describe the pulmonary parenchymal changes of Behçet's disease using high-resolution computed tomography and to correlate them with pulmonary function tests. Materials and methods: Thirty-four patients with Behçet's disease (18 men, 16 women), 3 of whom were symptomatic, were included as the study group. Four of 34 patients were smokers. Twenty asymptomatic volunteers (12 men, 8 women), 4 of whom were smokers, constituted the control group. The pulmonary function tests and high-resolution computed tomography were performed for both groups. Results: Inspiratory high-resolution computed tomography findings were abnormal in nine patients (26.5%) of the study group. In eight patients, there were multiple abnormalities, whereas one patient had only one abnormality. Pleural thickening and irregularities, major fissure thickening, emphysematous changes, bronchiectasis, parenchymal bands, and irregular densities, and parenchymal nodules were the encountered abnormalities. Inspiratory high-resolution computed tomography scans were normal in the control group. On expiratory scans, there was statistically significant difference between study group and control group when air trapping, especially grades 3 and 4, was compared ( P < 0.01). Pulmonary function tests of both the study and the control groups were in normal ranges, and there was no statistically significant difference between the two groups according to pulmonary function tests ( P > 0.05). Discussion and conclusion: High-resolution computed tomography is sensitive in the demonstration of pulmonary changes in patients with Behçet's disease. End-expiratory high-resolution computed tomography examination is very useful and necessary to show the presence of air trapping, thus the presence of small airway disease, even if the patient is asymptomatic or has normal pulmonary function tests.

Frequency of broncho-bronchiolar disease in rheumatoid arthritis: an examination by high-resolution computed tomography

To assess the frequency of pulmonary changes in patients with rheumatoid arthritis (RA), we evaluated a subject group (all outpatients with RA visiting the hospital during a period of three consecutive days) by plain chest radiographs (CRs) and high-resolution computed tomography (HRCT). The study population consisted of 186 patients (32 men, 154 women; mean age 59.8 years), including 6 smokers or exsmokers. Chest radiography was performed on all patients. Seventy (Group A) patients demonstrated abnormal findings and 116 (Group B) did not. HRCT scans were performed on 69 of Group A and 54 of Group B. HRCT demonstrated centrilobular micronodules (n = 29; 23.6%), septal lines (n = 24; 19.5%), subpleural curvilinear shadows (n = 24; 19.5%), bronchiectasis (n = 21; 17.1%), dependent opacity (n = 14; 11.4%), nodules (n = 12; 9.8%), and honeycombing (n = 11; 8.9%). Ten (34%) of the patients with centrilobular micronodules also had bronchiectasis. The most frequent disorder was broncho-bronchiolar disease. Contrary to the CRs finding of no abnormality, HRCT detected pulmonary pathological findings in 40 of 54 patients (74.1%). Pulmonary diseases may be frequently latent, and HRCT is useful in evaluating them in patients with RA.

膠原病の肺病変に関する臨床的研究

膠原病の肺病変に関する臨床的研究

膠原病の肺病変に関する臨床的研究

膠原病の肺病変に関する臨床的研究

Cardiovascular and pulmonary changes in patients with myocardial infarction treated in an intensive care and research unit

These observations show that acute myocardial infarction not only damages the left ventricle with subsequent failure of cardiac output but also may have profound effects on such organs as the lungs, kidneys, brain, endocrines and acid-base metabolism as well as reflex effects on the circulation by way of the autonomic nervous system. At present, many of these mechanisms are not completely understood, and further research is necessary to give a clearer appreciation of why the patient is ill.

The Modifying Influences of Silicosis and Silicosis with Infection upon the Healthy Chest

FOR years, the spectacular roentgen findings of pneumoconiosis were regarded with passive interest. More recently, because of the occupational importance of the disease and its controversial medico-legal aspects, it has received considerable recognition. At the present time, it is generally conceded that the roentgen examination when properly done is the most precise method for determining pulmonary changes in patients suspected of having pneumoconiosis. The absence of pathognomonic signs and symptoms in pneumoconiosis has placed a heavy responsibility upon physicians interpreting roentgenograms in questionable cases. It behooves these men, therefore, to become thoroughly familiar with (1) the anatomy of the chest and its physiologic changes; (2) the normal roentgenographic and fluoroscopic appearances and their permissible variations; (3) the histology of the lungs and pulmonary lymphatics; (4) the pathology of pneumoconiosis and the diseases with which it may be confused; (5) the roentgenographic appearances of pneumoconiosis and the conditions simulating it; (6) the physical background involved in the production of pneumoconiosis, and (7) the proper technic for obtaining the most diagnostic chest films. Pneumoconiosis is a general term for the condition induced by the long-continued inhalation of dust. A discussion of the entire subject is beyond the province of this report. Our remarks will be confined to silicosis, a condition of the lungs caused by the inhalation of free silica. For years, physicians have classified silicosis according to the degree of lung involvement. These classifications have overtly connoted continued activity and progressive changes as the result of the silicotic invasion. Recent experiences with workers in pure silica have led us to endorse a more simple classification. This classification divides silicosis into two large groups: (a) simple silicosis, and (b) silicosis with infection, which is more simple and probably of more practical value. The various “stages” of silicosis used in other classifications may be explained on the basis of coexisting respiratory infections and the modifying influences of respiration and other contaminating dust. According to Miller (1–4), the lymphatics of the lung may be divided into two main systems. One of them, the deep lymphatics, courses through the lung as a series of vessels which follow the bronchovascular tree toward the hilum. The other, or superficial set, runs through the pleura and empties into the tracheobronchial nodes. These two systems communicate in the periphery of the lung through a series of short lymphatic vessels containing valves which allow lymph to escape from the deep-set into the superficial lymphatics. In addition, there exist small tufts of lymphoid tissue which may be found in the walls of the primary lobule.