Pulmonary Interstitial Syndrome Research Articles

E16 Extra-articular manifestations and hip involvement in juvenile idiopathic arthritis: what is the link?

Abstract Introduction Juvenile idiopathic arthritis (JIA) is a complex pediatric rheumatism. The systemic and structural involvement of the disease is both functional and life threatening. Hip involvement can reach 50% of cases, especially in severe and destructive cases. Objectives The objective of this work is to study the relationship between systemic and hip involvement in JIA. Methods This was a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years (1994–2022). Socio-demographic, clinical, biological, and radiographic data were collected. Results There were 29 patients (17 females and 12 males), the mean age was 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years. At least one extra-articular manifestation was noted in 20 patients. An ocular dry syndrome was present in 6 cases, with a delay of onset of 132.14 ± 134.18 [0–312] months. Skin involvement was present in 4 cases with a mean onset delay of 24.25 ± 47.83 [0–96] months. Three patients had a pulmonary interstitial syndrome, the onset delay of this pulmonary involvement was 228.00 ± 74.94 [0–312] months. Valvular involvement was present in 3 cases and pericarditis in only one case, the onset delay of cardiac involvement was 211.33 ± 129.40 [70–324] months. Renal involvement was noted in 2 cases: one case of proteinuria and one case of renal failure, the time of onset of renal involvement was 12.50 ± 16.26 [1–24] months. Furthermore, hematological damage such as anaemia was noted in 20 of the patients included. No patients had macrophage activation syndrome in our study population. Hip involvement was noted in 14 patients. It was bilateral in 9 cases. Twenty-three hips were affected in total. Hip involvement was diagnosed 14.5 ± 9.37 [1–28] years after disease onset. Our statistical study identified a single correlation between hip involvement and cardiac involvement during JIA (r = 0.413; P = 0.026). In contrast, no other correlation was identified between hip involvement and the rest of the extra-articular involvement in JIA. Conclusion Extra-articular and hip involvements are common in JIA. Both have a prognostic impact and must be systematically screened throughout the follow-up. In our study, hip involvement was correlated with cardiac involvement.

Point-of-Care Lung Ultrasound Pattern in Healthy Parturients: Prevalence of Pulmonary Interstitial Syndrome Following Vaginal Delivery, Elective and Unplanned Intrapartum Cesarean Delivery

(Anesth Analg. 2021;133:739–746. doi: 10.1213/ANE.0000000000005464) The risk of pulmonary edema for parturient women increases near term, and factors during and post labor lead to even greater risk of pulmonary edema in the early postpartum period. Lung ultrasound (LUS) is a tool that helps to diagnose pulmonary edema earlier. Data on the effect of labor and early postpartum fluid shifts and hormonal changes on the occurrence of pulmonary interstitial syndrome is unknown. This exploratory study seeks to estimate the prevalence of pulmonary interstitial syndrome following vaginal delivery (VD), elective cesarean delivery (eCD), and unplanned intrapartum cesarean delivery (uCD). Secondary aims of the study include finding associations between positive lung regions found on lung ultrasound and several variables (eg, mode of delivery, duration) and estimating the prevalence of positive lung regions.

Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis.

Background and Aims:Appropriate volume assessment and fluid management can prevent maternal deaths in the severely pre-eclamptic (SPE) parturients. We planned a systematic review and meta-analysis (MA) to evaluate the role and ability of point-of-care ultrasound (POCUS) in the assessment of volume status and early detection of lung oedema in an SPE parturient.Methods:An e-literature search was done from several databases. Data were extracted under five domains including POCUS-derived parameters like echo comet score (ECS), lung ultrasound (LUS) scores, B-patterns, optic nerve sheath diameter (ONSD), E/e' ratio, presence of pleural effusion, pulmonary interstitial syndrome and pulmonary congestion. The risk of bias was assessed. Extracted data were analysed using MetaXL and Revman 5.3. Heterogeneity in the studies was evaluated using the Cochrane Q test and I2 statistics. Funnel plots were used for the assessment of publication bias.Results:Seven prospective studies including 574 parturients (including 396 pre-eclamptics) were selected. POCUS included lung, optic nerve, cardiac and thoracic US. In two studies, the ECS and LUS scores pre-delivery were higher in pre-eclamptics. Two studies found a mean ONSD of 5–5.84 mm before delivery. MA revealed a significantly lower mean ECS score at post-delivery than pre-delivery, and the summary prevalence of B-pattern and pleural effusion among SPE parturients was found to be 0.28 (0.03–0.84) and 0.1 (0–0.2), respectively. A good correlation was observed between B-line patterns and diastolic dysfunction (increased E/e' ratio), LUS score and thoracic fluid content, ONSD and ECS in individual studies.Conclusion:POCUS parameters can be useful as early markers of fluid status and serve as useful tools in the precise clinical management of pre-eclampsia.

Renal involvement in sarcoidosis

Sarcoidosis is a systemic granulomatosis that affects the lungs and mediastinum. Renal involvement is rare in this disease. It's most commonly granulomatous interstitial nephritis. The most common form of presentation is naked renal failure. This is a retrospective study that collected 12 cases of sarcoidosis complicated by acute renal failure. The study consisted of identifying the epidemiological, clinical, biological and histologic data that confirmed the diagnosis from January 1994 to January 2016. A search for extra-renal placement of sarcoidosis concerned all cases. Then, a study of the therapeutic and evolutionary profile was carried out in all cases. Twelve patients (8 males and 4 females) with a mean age of 43 years. The intradermal tuberculin reaction sit negative in 6 cases. Biological analysis showed acute renal failure with a median creatinine of 54.32 mg/L, biological inflammatory syndrome in all cases, normal blood calcium in 9 cases, hypercalcaemia in 6 cases, hypercalciuria in 4 cases, hypergammaglobulinemia of polyclonal appearance in 3 cases and elevated proteinuria in 2 cases. Renal ultrasound was normal in all patients. The renal biopsy performed in all cases showed tubulointerstitial nephropathy. The extra-renal signs found were pulmonary interstitial syndrome in 4 cases, dry syndrome in 4 cases, mediastinal lymphadenopathy in 4 cases, one patient presented a unilateral uveitis. Two patients underwent extra-renal treatment. All patients were on corticosteroids with a clear improvement in creatinine and normalisation of renal function in all patients. The average follow-up time was 18 months. Renal involvement during sarcoidosis is rare (10%) but may progress to renal failure (3% of cases). The renal biopsy is of great interest to maintain the diagnosis of sarcoidosis, especially in the absence of other extra-renal signs. Renal involvement during sarcoidosis is rarely revealing and may delay diagnosis, leading to chronic and even end-stage renal disease.

Evaluation by Point of Care Ultrasound in Patients with Sepsis

At present, point of care ultrasound (POCUs) is widely used in emergency and critical care disciplines, to realize the rapid diagnosis and evaluation of critical diseases such as dyspnea and shock. The rapid diagnosis and evaluation of critical diseases such as dyspnea and shock can provide a good reference for the development of anesthesiology and a rapid diagnostic tool for the perioperative critical diseases of respiratory or circulation disorders. Point of care ultrasound has the characteristics of real-time, dynamic, non-radiation and repeatability, so it has a good advantage in perioperative application. provide visual evidence for treatment, and promote perioperative treatment closer to the direction of evidence-based medicine. Point of care ultrasound has many simple and effective protocols for the diagnosis of critical diseases. The corresponding procedures can be selected according to different symptoms, and different procedures can also be combined to achieve the comprehensiveness and accuracy of the assessment, avoid missing important information, especially for emergency patients. Perioperative pulmonary edema leads to hypoxemia, etiology can be quickly identified and dynamically evaluated by point of care ultrasound, B-lines detected by lung sonography are signs of pulmonary interstitial syndrome. Point of care gastric ultrasound can effectively and reliably evaluate the nature and volume of gastric contents, and its clinical application can be extended to the evaluation of gastric contents in patients with delayed gastric emptied emergency, thus reducing the risk of perioperative reflux aspiration, point of care ultrasound provides visual evidence for perioperative decision making, ensure patient safety and improve outcomes.

Application of pulmonary ultrasound in the diagnosis of COVID-19 pneumonia in neonates

Objective: To investigate the application of pulmonary ultrasound in the diagnosis of neonatal COVID-19. Methods: In this retrospective study, the clinical data of 5 infants, who were admitted to the Department of Neonatology in Wuhan Children's Hospital from 31(st) January to 25(th) February 2020, were collected. Bedsides pulmondary ultrasound was conducted on admission, during the hospitalization, and before discharge, the result were compared with the chest X-ray or CT done at the same time. Results: Among the 5 cases who aged 1-18 days, 3 were male. The main clinical manifestations were respiratory and gastrointestinal symptoms. The pulmonary ultrasonography on admission showed abnormal pleural line and pulmonary edema of different severity in all 5 cases, presented as increase and fusion of B-line, and pulmonary interstitial syndrome; among them, one case also had a small-range consolidation. The chest CT on admission showed no obvious parenchymal infiltration in 2 cases, small strip or patchy high-density shadow in 2 cases, and ground glass change in one case. The re-examination of ultrosound during the hospitalization and at discharge showed improvement in all cases and were consistent with the chest X-ray taken at the same time. Conclusions: The main changes on the pulmonary ultrasonography in neonates with COVID-19 pneumonia are increase and fusion of B-line, abnormal pleural line, and alveolar interstitial syndrome, and may coexist with small range of pulmonary consolidation. The sensitivity of pulmonary ultrasound is higher than that of chest X-ray and CT in the diagnosis of pulmonary edema, and could be used in monitoring and evaluation of the disease.

Imatinib-induced interstitial pneumonitis – a literature review and case report

Imatinib is generally well tolerated, with mild common side effects such as nausea and vomiting, diarrhea, muscle cramps, fatigue, skin rash and edema; however, pulmonary complications are uncommon. A 73-year-old woman undergoing one month treatment with Imatinib for chronic myeloid neoplasm associated with eosinophilia was admitted for sudden alteration of her performance status, dyspnea at rest and productive cough. On clinical examination, the patient was hypoxic (oxygen saturation on room air was 87%), and auscultation of her lungs revealed diffuse bilateral fine crackles. Computed tomography showed bilateral pulmonary interstitial syndrome. Imatinib was discontinued and the patient received systemic corticosteroid therapy and oxygen therapy. After one month, the symptoms and radiological findings were resolved. When Imatinib therapy was resumed, respiratory symptoms reappeared, which is why treatment with Imatinib was interrupted. Imatinib-induced pneumonitis should take into consideration when patients develop respiratory symptoms or abnormal pulmonary radiological features.

Point-of-Care Ultrasound Abnormalities in Late-Onset Severe Preeclampsia: Prevalence and Association With Serum Albumin and Brain Natriuretic Peptide

(Anesth Analg. 2019;128(6):1208–1216) Care providers frequently use point-of-care ultrasound (POCUS) on pregnant women diagnosed with preeclampsia to prevent serious afflictions such as cerebral complications or cardiorespiratory failure. Present-day ultrasound research has found a number of indicators for pulmonary interstitial syndrome (PIS) and a higher optic nerve sheath diameter (ONSD), the latter of which could indicate elevated intracranial pressure. As of now, irregular laboratory markers of oncotic pressure and cardiac dysfunction have inconclusive clinical applications; many experts posit that reduced serum albumin level is a contributor to excessive brain fluid and brain swelling. These investigators examined patients with preeclampsia to determine how PIS, ONSD, brain natriuretic peptide (BNP), and serum albumin level contribute to cardiac dysfunction. They also aimed to study the comparison of information acquired from a POCUS examination to information recorded with traditional clinical methods.

Point-of-Care Ultrasound Abnormalities in Late-Onset Severe Preeclampsia: Prevalence and Association With Serum Albumin and Brain Natriuretic Peptide.

Pilot studies applying point-of-care ultrasound (POCUS) in preeclampsia indicate the presence of pulmonary interstitial edema, cerebral edema, and cardiac dysfunction. Laboratory markers of oncotic pressure (albumin) and cardiac dysfunction (brain natriuretic peptide [BNP]) may be abnormal, but the clinical application remains unclear. We investigated the prevalence of pulmonary interstitial syndrome (PIS), cardiac dysfunction, and increased optic nerve sheath diameter (ONSD) in late-onset preeclampsia with severe features. The primary aim was to examine the association between PIS or ONSD and maternal serum albumin level. The secondary aims were to explore the association between cardiac dysfunction and PIS, ONSD, BNP, and serum albumin level and between POCUS-derived parameters and a suspicious or pathological cardiotocograph. Ninety-five women were enrolled in this prospective observational cohort study. A POCUS examination of lungs, heart, and ONSD was performed. PIS was defined as a bilateral B-line pattern on lung ultrasound and diastolic dysfunction according to an algorithm of the American Society of Echocardiography. ONSD >5.8 mm was interpreted as compatible with raised intracranial pressure (>20 mm Hg). Serum BNP and albumin levels were also measured. PIS, diastolic dysfunction, systolic dysfunction, and raised left ventricular end-diastolic pressure (LVEDP) were present in 23 (24%), 31 (33%), 9 (10%), and 20 (25%) women, respectively. ONSD was increased in 27 (28%) women. Concerning the primary outcome, there was no association between albumin level and PIS (P = .4) or ONSD (P = .63). With respect to secondary outcomes, there was no association between albumin level and systolic dysfunction (P = .21) or raised LVEDP (P = .44). PIS was associated with diastolic dysfunction (P = .02) and raised LVEDP (P = .009; negative predictive value, 85%). BNP level was associated with systolic (P < .001) and diastolic dysfunction (P = .003) and LVEDP (P = .007). No association was found between POCUS abnormalities and a suspicious/pathological cardiotocograph (P = .07). PIS, diastolic dysfunction, and increased ONSD were common in preeclampsia with severe features. Cardiac ultrasound abnormalities may be more useful than albumin levels in predicting PIS. The absence of PIS may exclude raised LVEDP. The further clinical relevance of PIS and raised ONSD remains to be established. BNP level was associated with cardiac ultrasound abnormalities. Although this study was not designed to directly influence clinical management, the findings suggest that POCUS may serve as a useful adjunct to clinical examination for the obstetric anesthesiologist managing these complex patients.

Value of bedside lung ultrasound in the diagnosis of infectious pneumonia in premature infant

Objective To investigate the clinical value of lung ultrasound ( LUS) in the diagnosis of infectious pneumonia in premature infant. Methods 20 premature infants with infective pneumonia were selected and examined by high-frequency ultrasound. The results were compared with chest X-ray data. Pulmonary ultrasound was monitored on the 3rd to 5th, 8th to 10th days of treatment and before discharge. The total number and maximum depth of pulmonary consolidation were calculated and the changes of the above parameters with the progression of pulmonary diseases were compared. Results The LUS imaging of 20 cases showed: A-line disappearance and pulmonary interstitial syndrome (100%), lung consolidation (95%), abnormal pleural lines (55%), interstitial syndrome (100%) and pleural effusion (15%). The X-ray of 20 cases showed: increased lung texture(100%), patchy blurred glass shadow (40%), lung consolidation(40%). The maximum depth of lung consolidation and the total number of lung consolidation involving rib clearance are decreased after therapy. Conclusions LUS is of great value in diagnosis and monitor the progresses of infectious pneumonia in premature infant, and can be used as the preferred diagnostic method in imaging. Key words: Ultrasonography; Infant, premature; Pneumonia

Integrated Use of Lung Ultrasound and Chest X-Ray in the Detection of Interstitial Lung Disease

Background: Current data have shown that lung ultrasound (LUS) may be useful in the detection of interstitial lung disease (ILD) by the evaluation of B-lines, the sonographic marker of pulmonary interstitial syndrome. Nevertheless, no prospective study has compared LUS to chest X-ray (CXR) for ILD assessment, and there is no general agreement on the specific echographic diagnostic criteria for defining ILD. Objectives: The aims of this study were (1) to compare the accuracy of LUS and CXR in the detection of ILD using high-resolution CT (HRCT) as the gold standard and (2) to compare the accuracy of different echographic diagnostic criteria for ILD diagnosis. Methods: LUS was performed on 104 patients undergoing HRCT for suspected ILD. In 49 patients, a CXR scan performed within 3 months of HRCT was analyzed. ILD was defined as the presence of ≥5 B-lines in ≥3 chest areas. A total B-line score (TBLS) was also calculated, as in previous studies. The observers evaluating LUS and CXR were blinded to the HRCT results and clinical data. Results: On HRCT, ILD was assessed in 50 patients. CXR was specific (91%; 95% CI 80-100) but not sensitive (48%; 95% CI 28-67). Conversely, LUS showed high sensitivity (92%; 95% CI 84-99) and low specificity (79%; 95% CI 69-90). Using a TBLS, sensitivity did not change, while specificity decreased. Conclusions: LUS could be a sensitive tool for ILD detection. CXR and LUS have different but complementary features, and their combined use could reduce the need for HRCT. The use of different diagnostic criteria for defining ILD does not affect sensitivity but influences specificity.

Lung Ultrasonography to Diagnose Transient Tachypnea of the Newborn.

This study explored the sensitivity and specificity of ultrasound for diagnosing transient tachypnea of the newborn (TTN). Ultrasound was performed by one export. Patients were placed in a supine, lateral recumbent, or prone position. The probe was placed perpendicular or parallel to the ribs, and each region of the lung was scanned. The scan results were compared with conventional chest radiographic results. A total of 1,358 infants were included in this study. We identified 412 cases without pulmonary diseases, 228 TTN cases, 358 respiratory distress syndrome (RDS) cases, 85 meconium aspiration syndrome (MAS) cases, 215 infectious pneumonia cases, and 60 other cases. The primary ultrasonic characteristic of TTN was pulmonary edema. "White lung" or a "compact B-line" were only observed in severe cases, whereas TTN primarily presented as pulmonary interstitial syndrome or "double lung point." Furthermore, double lung point could appear during the recovery period of severe TTN or RDS, MAS, and pneumonia. Lung consolidation with air bronchograms was not observed in TTN patients. The results showed that white lung or a compact B-line exhibited a sensitivity of 33.8%and a specificity of 91.3%in diagnosing TTN, whereas double lung point exhibited a sensitivity of 45.6%and a specificity of 94.8%in diagnosing severe TTN. Pulmonary edema, alveolar-interstitial syndrome, double lung point, white lung, and compact B-line are the primary ultrasound characteristics of TTN. Ultrasonic diagnosis of TTN based on these findings is accurate and reliable. TTN can be ruled out in the presence of lung consolidation with air bronchograms.

Evaluation of a novel simulation method of teaching B-lines: hand ultrasound with a wet foam dressing material.

ObjectiveThe aim of this study was to evaluate the effectiveness of teaching A- and B-lines, and lung sliding with a novel simulation methods using hand ultrasound.MethodsAll subjects enrolled were medical school students who were novices in lung ultrasound. All subjects attended a 20-minute lecture about lung ultrasound using simulated video clips of A-lines, B-lines, and lung sliding; and then a 20-minute post-test was administered. The post-test included questions on the presence or absence of A-lines, B-lines, and lung sliding using a random mixture of 20 real video clips and 20 simulated video clips created by using hand ultrasound with or without foam dressing materials. A Wilcoxon signed rank test was used to compare the scores of A-lines, B-lines, and lung sliding between the real images (RG) and simulated models (SG).ResultsThere was a statistically significant difference in the median score of the correct answers for A-lines (RG, 18; SG, 17; P=0.037). Correct answers for B-line were significantly different between RG and SG group (RG, 18; SG, 17; P=0.008). There was a statistically significant difference in the median score of the correct answers for lung sliding (RG, 16; SG, 18; P<0.001).ConclusionWe found this novel B-line teaching model by using a hand ultrasound with a wet foam dressing material is effective for beginners who are less experienced with lung ultrasound and pulmonary interstitial syndrome.

Epidemiological, Clinical and Follow-Up Data in a Series of Thirteen Renal Insufficiencies Complicating Sarcoidosis

The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It’s a retrospective study implicating 13 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and the interest of considering sarcoidosis diagnosis in case of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 13 women with an average age of 41 years. Biological investigations showed an abnormal normocalcemia in 8 cases, a hypercalcemia in 5 cases, a hypercalciuria in 11 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 540 umol/L. The renal echography was normal in all patients. The kidney biopsy performed in all patients showed tubulo-interstitial nephritis. The extra-renal signs were: pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymphadenopathy in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 3 cases and a polyarthritis in 6 cases. Six patients benefited from hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis should be made rapidly in order to avoid end stage renal failure.

Interstitial Pneumonitis during Imatinib Therapy in a Patient with Gastrointestinal Stromal Tumor: A Case Report

Introduction: Imatinib is approved for the treatment of chronic myeloid leukemia and for gastro intestinal stromal tumors. It is generally well tolerated with mild common toxicities such as diarrhea, fatigue, skin rash and edema, however pulmonary complications are uncommon. Case presentation: In May 2013, a Moroccan 81-year-old man without medical history underwent an emergency wedge resection of the stomach for severe hematemesis with hemodynamic instability. The pathology report showed a gastric gastro intestinal stromal tumor. In July 2013, Imatinib 400 mg per day was started, the patient showed good tolerance to the drug, although mild diarrhea was present. After 16 months, the patient showed a sudden alteration of his performance status, dyspnea, productive cough and fever. Chest X-rays and computed tomography revealed a left pulmonary interstitial syndrome with bilateral pleural effusions. As these findings were highly suggestive of Imatinib-induced interstitial pneumonitis, Imatinib was discontinued. In the meantime, the patient was given oral prednisone: 60mg daily for 10 days. Under the corticosteroid therapy, his symptoms and radiological findings were resolved. The patient comes in regularly for symptomatic control without any signs of tumor’s relapse. Conclusion: Physicians should consider the possibility of Imatinib-induced pulmonary toxicities when patients develop respiratory symptoms or abnormal radiologic features during Imatinib treatment. The usual treatment is to discontinue the drug, and administer corticosteroids.

Systemic sarcoidosis complicated of acute renal failure: about 12 cases.

The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It's a retrospective study implicating 12 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and then to indicate the interest to consider the diagnosis of sarcoidosis in cases of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 12 women with an average age of 40 years. Biological investigations showed an abnormal normocalcemia in 7 cases, a hypercalcemia in 5 cases, a hypercalciuria in 10 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 520 umol/L. For all patients, the renal echography was normaln however, the kidney biopsy showed tubulo-interstitial nephritis. The extra-renal signs highlighting pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymph nodes in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 2 cases and a polyarthritis in 5 cases. Five patients benefited of hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis must be done quickly to prevent renal failure.

Value of lung ultrasound on diagnosing transient tachypnea of newborn

Objective To evaluate the diagnostic value of lung ultrasonography for transient tachypnea of newborn (TTN). Methods From January to December 2014, a total of 1 358 children were hospitalized in the Neonatal Intensive Care Center and underwent lung ultrasonography at the Bayi Children's Hospital, Beijing Military General Hospital.According to the patients' medical histories, clinical presentations, arterial blood gas analysis, chest X-ray examinations, and lung ultrasound examinations, there were 412 cases of patients without pulmonary lesions, 228 cases of TTN, 358 cases of respiratory distress syndrome (RDS), 85 cases of meconium aspiration syndrome (MAS), 215 cases of infectious pneumonia, and 60 other cases at the time of hospital admission.In a resting state, the patients were placed in a supine, lateral recumbent or prone position.By using the anterior and posterior axillary lines as boundaries, the lung was divided into 3 regions: anterior, lateral, and posterior.The probe was perpendicular or parallel to the ribs, and each region of both sides of the lung was scanned.The scan results were compared to the conventional chest X-ray results. Results The main ultrasonic characteristics of TTN was pulmonary edema.In severe cases, the ultrasound showed a white lung or compact B-line.Compact B-line had 100.0% sensitivity and 95.3% specificity for diagnosing severe TTN.Mild TTN presented as pulmonary interstitial syndrome or double lung point.Double lung point might appear during the recovery period of mild TTN or other diseases, such as RDS, MAS, and pneumonia, among others.Lung consolidation and air bronchogram were not observed in patients with TTN.Pleural effusion might occur in a variety of lung diseases, and pleural line abnormality, A-line disappearance, and B-line or pulmonary interstitial syndrome were common ultrasonic manifestations of a variety of lung diseases. Conclusions Ultrasonic diagnosis of TTN, mainly based on pulmonary edema without lung consolidation and air bronchogram, is accuracy and reliable; however, double lung point is not a specific sign of TTN, whereas the identification of a white lung and compact B-line is a sensitive and specific sign of severe TTN. Key words: Transient tachypnea; Lung ultrasound; Infant, newborn

THU0315 Long-term outcome of juvenile idiopathic arthritis (JIA): A french multicenter study based on 353 patients

BackgroundStudies about JIA outcome in adulthood are still limited.ObjectivesTo describe medical outcome in adulthood of a cohort of JIA patients followed in 3 French paediatric rheumatology centers since the disease...

Realization of a poro-elastic ultrasound replica of pulmonary tissue.

In this work we describe the fabrication of a biocompatible hydrophilic scaffold composed of cross-linked gelatin that mimics the porous three-dimensional structure of pulmonary tissue as well as its water content and mechanical properties. The lung replica also reproduces the characteristic sonographic signs of pulmonary interstitial syndrome, the B-lines or ultrasound lung comets.

Histoplasmose disséminée : forme ulcéreuse atypique chez un malade infecté par le VIH

Histoplasma capsulatum var capsulatum is a dimorphic fungi predominating on the American continent. It is responsible for disseminated histoplasmosis associated with AIDS. The presentation in the form of cutaneous ulceration is uncommon and misleading. A 25 year-old man presented with 3 ulcerations, of 2 to 4 cm in diameter, localized on the lower lip and knees. The patient exhibited fever, alteration in his general status of health and a pulmonary interstitial syndrome. He was seropositive for the human immunodeficiency syndrome (HIV). His lymphocyte CD4+ level was of 1/mm3. Diagnosis of histoplasmosis was established by direct examination and culture of the cutaneous ulcerations and bronchoalveolar washing fluid. The clinical aspect of cutaneous localizations of disseminated histoplasmosis is usually multiple, disseminated, papular or nodular-type lesions. Ulcerations represent less than 20% of the cases described. In our patient, the aspect of the lesions at first evoked cutaneous leishmaniosis. Direct mycological examination followed by culture confirmed the final diagnosis.