Pulmonary Involvement In Patients Research Articles

Characterization and Outcomes of SARS-CoV-2 Infection in Patients with Sarcoidosis.

To analyze the clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with sarcoidosis from a large multicenter cohort from Southern Europe and to identify the risk factors associated with a more complicated infection. We searched for patients with sarcoidosis presenting with SARS-CoV-2 infection (defined according to the European Centre for Disease Prevention and Control guidelines) among those included in the SarcoGEAS Registry, a nationwide, multicenter registry of patients fulfilling the American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and Other Granulomatous Disorders 1999 classification criteria for sarcoidosis. A 2:1 age-sex-matched subset of patients with sarcoidosis without SARS-CoV-2 infection was selected as control population. Forty-five patients with SARS-CoV-2 infection were identified (28 women, mean age 55 years). Thirty-six patients presented a symptomatic SARS-CoV-2 infection and 14 were hospitalized (12 required supplemental oxygen, 2 intensive care unit admission and 1 mechanical ventilation). Four patients died due to progressive respiratory failure. Patients who required hospital admission had an older mean age (64.9 vs. 51.0 years, p = 0.006), a higher frequency of baseline comorbidities including cardiovascular disease (64% vs. 23%, p = 0.016), diabetes mellitus (43% vs. 13%, p = 0.049) and chronic liver/kidney diseases (36% vs. 0%, p = 0.002) and presented more frequently fever (79% vs. 35%, p = 0.011) and dyspnea (50% vs. 3%, p = 0.001) in comparison with patients managed at home. Age- and sex-adjusted multivariate analysis identified the age at diagnosis of SARS-Cov-2 infection as the only independent variable associated with hospitalization (adjusted odds ratio 1.18, 95% conficence interval 1.04–1.35). A baseline moderate/severe pulmonary impairment in function tests was associated with a higher rate of hospitalization but the difference was not statistically significant (50% vs. 23%, p = 0.219). A close monitoring of SARS-CoV-2 infection in elderly patients with sarcoidosis, especially in those with baseline cardiopulmonary diseases and chronic liver or renal failure, is recommended. The low frequency of severe pulmonary involvement in patients with sarcoidosis from Southern Europe may explain the weak prognostic role of baseline lung impairment in our study, in contrast to studies from other geographical areas.

Value of Bedside Lung Ultrasound in Severe and Critical COVID-19 Pneumonia.

Lung ultrasound (LUS) is an effective imaging modality that can differentiate pathological lung from non-diseased lung. We aimed to explore the value of bedside LUS in patients with severe and critical coronavirus disease 2019 (COVID-19)-associated lung injury. Sixty-three severe and 33 critical hospitalized subjects with COVID-19 were enrolled in this study. Bedside LUS was performed in all subjects; chest computed tomography was performed on the same day as bedside LUS in 23 cases. The LUS protocol consisted of 12 scanning zones. LUS score based on B-lines and lung consolidation was evaluated. The most common abnormality of LUS was the various forms of B-lines, detected in 93 (96.9%) subjects; as the second most frequent abnormality, 80 (83.3%) subjects exhibited lung consolidation, mainly located in the posterior lung region. Twenty-four (25.0%) subjects had pleural line abnormalities, and 16 (16.7%) had pleural effusion; 78 (81.3%) subjects had ≥ 2 abnormal LUS patterns, and 93 (96.9%) had bilateral lung involvement. The proportion of bilateral or unilateral lung consolidation and pleural effusion in the critical COVID-19 group were higher than that in the severe group (P < .05). The lung consolidation of critical subjects showed a marked increase in most lung areas, including bilateral lateral lung, posterior lung, and left anterior-inferior lung area. The median (interquartile range) LUS scores of critical cases were higher than those of severe cases: left: 14 (12-17) vs 7 (5-12); right: 14 (10-16) vs 8 (3-12); bilateral: 28 (23-31) vs 15 (8-22) (P < .001 for all). There was a good correlation between the LUS score and the chest computed tomography score (r = 0.887, P < .001). The most common abnormal LUS pattern in subjects with severe and critical COVID-19 pneumonia was B-lines, followed by lung consolidation. Bedside LUS can provide important information for pulmonary involvement in patients with COVID-19.

ТЯЖЕЛЫЕ ПОРАЖЕНИЯ ЛЕГКИХ И ПРОГНОЗИРОВАНИЕ РИСКА ИХ РАЗВИТИЯ У ПАЦИЕНТОВ СО СПОНДИЛОАРТРИТАМИ И РЕВМАТОИДНЫМ АРТРИТОМ

The severity of pulmonary involvement in patients with spondylarthritеs and rheumatoid arthritis is determined by the nature of lung affection and functional disorders. Objective. To single out severe affection of the lungs among the varieties of pulmonary involvement in patients with spondylarthritеs and rheumatoid arthritis and to devise a model predicting the risk of development of severe lung affection in patients with spondylarthritеs and rheumatoid arthritis. Materials and methods. The study involved 172 patients with spondylarthritеs and rheumatoid arthritis. The patients were interviewed. The presence of antibodies to atypical lung infections in blood was determined. The multispiral computer tomography of thorax was performed. The diffusion lung capacity was tested. In order to process the data Statistica 10 software package was used. With aim to predict the risk of development of severe lung affection logistic regression was carried out, also a logistic model was built. Results. Varieties of lung involvement leading to a decrease in the diffusion lung capacity were qualified as severe lung involvement. In view of the revealed risk factors a logistic model was built which predicted the risk of development of severe lung affection in patients with spondylarthritеs and rheumatoid arthritis. The predictive value of the model was 80,7%. According to ROC-analysis the cut-off point was 0,47. AUC=0,81±0,05; р&lt;0,001. Model sensitivity was 83,9%, its specificity was 70,0%. Its working capacity was confirmed on an independent sample of patients. In accordance with the check results the predictive value of the model was 78,1%. Conclusion. Severe lung affection in patients with spondylarthritеs and rheumatoid arthritis leads to a decrease in the lung gas exchange. The logistic regression model makes it possible to predict the risk of development of severe lung involvement in this group of patients.

Gastrointestinal symptoms as an indicator of progression of pulmonary involvement in patients with COVID-19

Background: While the patients with coronavirus disease 2019 typically present with respiratory illness, some patients also report gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain. In this case study, four different cases with the progression of pulmonary computed tomography (CT) findings following the onset of gastrointestinal symptoms are presented. Case presentation: Case 1, A 37-year-old male patient presented with fever, cough, fatigue, muscle and joint pain. On the fifth day of treatment, gastrointestinal symptoms including anorexia, nausea and vomiting were observed. A follow-up chest CT revealed progression in pulmonary involvement. Case 2, A 46-year-old male patient presented with fever, shortness of breath, muscle and joint pain. On the fourth day of treatment, gastrointestinal symptoms including anorexia, nausea and vomiting were observed. A follow-up chest CT revealed progression of pulmonary findings in both lungs. Case 3, A 50-year-old male presented with no symptoms other than dry cough. On the fourth day of treatment, gastrointestinal symptoms including anorexia, nausea and vomiting were observed. A follow-up chest CT revealed bilateral peripherally ground-glass and consolidation areas. Case 4, A 34-year-old female patient presented with fever, cough, fatigue, muscle and joint pain. On the third day of the treatment, gastrointestinal symptoms including anorexia, nausea, vomiting and diarrhea were observed. A follow-up chest CT revealed bilateral progression of pulmonary findings. Conclusion: Many studies reported that patients with gastrointestinal symptoms have a more serious clinical course than patients without these symptoms. No study has yet been presented to the literature in which this clinical situation is supported by radiological findings.

Pulmonary Involvement in Patients with Systemic Sclerosis

Background: Systemic sclerosis is a multisystem autoimmune disease of unknown etiology. The pulmonary system is involved in Systemic sclerosis and causes a significant increase in morbidity and mortality. This study aimed to assess the extent of pulmonary system involvement in patient with systemic sclerosis. Methods: This study was a case control study, done on thirty patients with systemic sclerosis and twenty age and sex matched as a control group . All patients included in the study were subjected to the following: Full history, evaluation of skin involvement using modified Rodnan skin thickness score. Investigations including: Pulmonary function test, radiological examination (plain chest X-ray and high-resolution computed tomograghy. Results: predominance of females among patients. 53.33% had limited scleroderma. Modified Rodnen Score ranged from 12 to 35 with mean of 21.03 ± 7.04. Regarding skin changes of systemic sclerosis patients, skin thickness (60%), hyper or hypopigmentation (100%), ischemic ulcers (30%) and subcutaneous calcinosis (20%). A higher frequency of ILD was observed among SSc patients included in this study. The most common patterns in the HRCT in the current study were ground-glass appearance, followed by, honeycombing. Pulmonary hypertension occurred in 30% patients There were highly statistically significant differences (p < 0.001) between cases and the control group regarding PFTs and the severity of restrictive pattern. Conclusion: Pulmonary manifestations are very common in SSc in the form of ILD and PH. PFTs are cornerstone in the evaluation of dyspnea and for detection of pulmonary involvement in SSc patients.

Pathophysiology and Pathology of Acute Kidney Injury in Patients With COVID-19.

Acute kidney injury (AKI) is common among hospitalized patients with Coronavirus Infectious Disease 2019 (COVID-19), with the occurrence of AKI ranging from 0.5% to 80%. The variability in the occurrence of AKI has been attributed to the difference in geographic locations, race/ethnicity, and severity of illness. AKI among hospitalized patients is associated with increased length of stay and in-hospital deaths. Even patients with AKI who survive to hospital discharge are at risk of developing chronic kidney disease or end-stage kidney disease. An improved knowledge of the pathophysiology of AKI in COVID-19 is crucial to mitigate and manage AKI and to improve the survival of patients who developed AKI during COVID-19. The goal of this article is to provide our current understanding of the etiology and the pathophysiology of AKI in the setting of COVID-19.

Temporal changes of COVID-19 pneumonia by mass evaluation using CT: a retrospective multi-center study.

BackgroundCoronavirus disease 2019 (COVID-19) has widely spread worldwide and caused a pandemic. Chest CT has been found to play an important role in the diagnosis and management of COVID-19. However, quantitatively assessing temporal changes of COVID-19 pneumonia over time using CT has still not been fully elucidated. The purpose of this study was to perform a longitudinal study to quantitatively assess temporal changes of COVID-19 pneumonia.MethodsThis retrospective and multi-center study included patients with laboratory-confirmed COVID-19 infection from 16 hospitals between January 19 and March 27, 2020. Mass was used as an approach to quantitatively measure dynamic changes of pulmonary involvement in patients with COVID-19. Artificial intelligence (AI) was employed as image segmentation and analysis tool for calculating the mass of pulmonary involvement.ResultsA total of 581 confirmed patients with 1,309 chest CT examinations were included in this study. The median age was 46 years (IQR, 35–55; range, 4–87 years), and 311 (53.5%) patients were male. The mass of pulmonary involvement peaked on day 10 after the onset of initial symptoms. Furthermore, the mass of pulmonary involvement of older patients (>45 years) was significantly severer (P<0.001) and peaked later (day 11 vs. day 8) than that of younger patients (≤45 years). In addition, there were no significant differences in the peak time (day 10 vs. day 10) and median mass (P=0.679) of pulmonary involvement between male and female.ConclusionsPulmonary involvement peaked on day 10 after the onset of initial symptoms in patients with COVID-19. Further, pulmonary involvement of older patients was severer and peaked later than that of younger patients. These findings suggest that AI-based quantitative mass evaluation of COVID-19 pneumonia hold great potential for monitoring the disease progression.

Mixed Airway and Pulmonary Parenchymal Disease in Patients With Primary Sjögren Syndrome: A 6-year Follow-up.

To assess pulmonary function and chronic obstructive pulmonary disease (COPD) development over time in patients with primary Sjögren syndrome (pSS), as well as the association between pulmonary function, radiographic findings, respiratory symptoms, and clinical features of pSS, taking cigarette consumption into account. Forty patients with pSS (mean age 66 yrs; range 42-81 yrs; 39 women), previously participating in a cross-sectional study on pulmonary involvement in pSS, were reassessed by pulmonary function tests after a mean follow-up time of 6 years. At follow-up, patients were also assessed by high-resolution computed tomography of the chest, as well as for pSS disease activity, respiratory symptoms, and cigarette consumption. Patients with pSS showed significantly decreased percentages of predicted total lung capacity (TLC), residual volume (RV), RV/TLC ratio, and diffusing capacity of the lungs for carbon monoxide, as well as an increase in predicted forced expiratory volume in 1 second/vital capacity (FEV1/VC) ratio from baseline to follow-up. The proportion of COPD in patients with pSS did not change significantly from baseline to follow-up (38% vs 40%, respectively). Radiographic signs of bronchial involvement and interstitial lung disease were each found in 38% of the patients. Both airway and pulmonary parenchymal disease were commonly found in patients with pSS, with a coexistence of both an obstructive and restrictive pulmonary function pattern, where the latter tended to deteriorate over time. COPD was a common finding. Airway and pulmonary involvement may be underdiagnosed in pSS, which is why special attention to clinical assessment of pulmonary involvement in patients with pSS is mandated.

Correlation With Disease Activity Score 28 (Das28) With Pulmonary Function Test In Rheumatoid Arthritis Patients

Rheumatoid Arthritis (RA) is a chronic inflammatory disease of unknown etiology involving both small and large joints with many extra-articular manifestations. There may be a variety of pulmonary complications associated with RA based on its disease activity and levels of RF and anti-CCP titers. Pulmonary involvement may be seen at different levels of the respiratory system, with infection being the most common cause of mortality. Our study shows the association and degree of pulmonary involvement in patients with RA based on the pulmonary function test and its correlation with the DAS 28 score. The aim of our study was to assess the prevalence of pulmonary involvement in patients with Rheumatoid Arthritis. The study population was 100 patients with RA diagnosed based on the 2010 ACR/EULAR criteria following all the exclusion. The patients were subjected to a PFT on diagnosis and repeated at 6 and 18 months following treatment. In our study, there is a higher prevalence of pulmonary involvement seen in doing PFT, even in asymptomatic patients with RA when compared to other studies. Pulmonary complications occurring in patients with Rheumatoid Arthritis may be identified on doing a PFT or HRCT thorax. Pulmonary involvement carries significant mortality and morbidity. Disease duration and disease activity score 28 were found to have a significant association with pulmonary complications. Although our study brings out the incidence of higher risk of pulmonary involvement in patients with RA, more studies meta-analysis are required.

Pulmonary involvement in patients with measles

Pulmonary involvement in patients with measles

Assessment of Occult Pulmonary Involvement in Ulcerative Colitis

Introduction: Nearly 50% of patients with inflammatory bowel disease (IBD) experience at least one extraintestinal manifestation. Bronchopulmonary involvement is rare in IBD. Pulmonary function test (PFT) abnormality in cases of ulcerative colitis (UC) has been reported to be 17–55%. Occult pulmonary disease may be diagnosed using variables of the PFT. Hence, we aim to evaluate the frequency and type of pulmonary dysfunction in patients with UC in remission. Methods: Eighty-three patients of UC in remission and 48 controls underwent the PFT including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), Tiffeneau value (FEV1/FVC), and midexpiratory flow (MEF 25–75%) rate with a spirometer. The patients were divided based on the age of onset of UC into A1 (<16 years), A2 (16–40 years), and A3 (>40 years) and based on the extent of disease into E1 (proctitis), E2 (left-sided colitis), and E3 (extensive colitis). Results: Patients with UC had significantly abnormal PFT compared with controls (51 [61.5%] vss. 8 [16.67%]; p = 0.000). Patients with UC commonly had a restrictive pattern (33 [64.47%]) of PFT followed by small airway disease (11 [21.56%]) and obstructive pattern (7 [13.72%]). Pulmonary involvement in cases of UC was more in E3 followed by E2 and E1. Pulmonary involvement was more in the late age of onset of disease. BMI was positively and significantly correlated with FEV1 and FVC. Hemoglobin had a positive and significant correlation with FEV1 while a negative correlation with FEV1/FVC and MEF 25–75%. All predictors except for age were found to contribute in higher risk (OR > 1) for PFT abnormality. Conclusion: Patients with UC have chronic pulmonary inflammation leading to different patterns of lung involvement in the form of restrictive, obstructive airway, and small airway disease. Patients with UC commonly have a restrictive pattern of pulmonary involvement. Impairment of the PFT is related to the disease extent and the age of onset of disease. Assessment of the PFT using a spirometer is a noninvasive, simple, cost-effective, and reliable method for early detection of occult pulmonary involvement in patients of UC.

Novel associations between cytokines and pulmonary involvement in juvenile dermatomyositis - a cross-sectional study of long-term disease.

To examine associations between cytokines and pulmonary involvement in patients with medium- to long-term JDM. In a cross-sectional study, 58 patients examined median (range) 16.8 (6.6-27.0) years after symptom onset were stratified in inactive (JDM-inactive) and active (JDM-active) disease (updated PRINTO criteria); 56 age/sex matched controls were included. Twenty-nine cytokines (in serum) were analysed (Luminex technology/ELISA). Pulmonary function test included forced vital capacity, total lung capacity (TLC) and diffusing capacity for carbon monoxide reported as % of predicted and low forced vital capacity/TLC/diffusing capacity for carbon monoxide. In patients, the presence of clinical pulmonary damage was assessed and high resolution computed tomography scans were scored for interstitial lung disease, chest wall calcinosis and airways disease. Median age of patients was 21 (7-55) years, 59% were female and 36% inactive. In JDM-active and all patients, higher MCP-1, IP-10 and eotaxin correlated with high-resolution computed tomography findings (rs 0.34-0.61; P < 0.05). MCP-1 and eotaxin correlated with pulmonary damage in JDM-active and all patients (rs 0.41-0.49; P < 0.01). Higher TGF-β1 and PDGF (growth factors) were associated with lower lung volumes (forced vital capacity/TLC measures) in all patients; PDGF in JDM-active and TGF-β1 in JDM-inactive patients. IP-10 correlated with TLC% in JDM-active patients. No associations between cytokines and pulmonary function test were found in controls. In JDM, we found a novel association (not previously described in myositis) between eotaxin and pulmonary involvement; we have previously shown an association between eotaxin and cardiac dysfunction. The associations between IP-10/growth factors/MCP-1 and pulmonary involvement are novel in JDM and were mostly seen in JDM-active patients.

1676. Incidence and Outcomes of Pulmonary Involvement in Patients with Scrub Typhus: A Clinical Study from India

BackgroundScrub typhus is a tropical fever caused by orrientia tsutsugamushi and is probably the most under-recognized of all the febrile illnesses leading to hospitalization, especially in India. Although the most common presenting symptoms are fever, myalgia, lymphadenopathy and rash, a significant percentage of patients also present with respiratory complaints.MethodsDecember 2018 at a tertiary care center, in Delhi, India. The primary objective was to determine the incidence of respiratory involvement in patients with scrub typhus on the basis of radiological findings. Secondary objective was to compare the length of hospital stay, clinical presentation, and severity of illness as indicated by transaminitis, thrombocytopenia, inotropic requirement, and lactate levels. Also compared was the difference in mortality between the two groups.ResultsPulmonary involvement was seen in 28.9% (22/76) patients which included varied radiological pictures. 5 patients required mechanical and 2 noninvasive ventilation. Eschar was seen in 44.7% out of which 20 had pulmonary involvement. Patients with pulmonary involvement had a significantly greater length of hospital stay (5.82 days vs. 2.56, P < 0.001), more severe transaminitis (P < 0.001), thrombocytopenia (P < 0.001), hyperlactatemia (P < 0.001), higher ionotropic requirement (P < 0.001) and mortality (P = 0.006).ConclusionPulmonary involvement was seen in almost one-third of the patients with scrub typhus and was associated with higher morbidity and mortality. These patients were sicker, often required intensive care admissions, inotropic support, noninvasive and invasive mechanical ventilation and a significantly prolonged hospitalization. Chest radiographs should be a part of routine evaluation of all patients suspected to have scrub typhus. With such high pulmonary involvement, scrub typhus forms an important differential diagnosis in patients with lung infection residing in endemic areas and in those with a history of travel to such areasDisclosures All authors: No reported disclosures.

A lung abscess caused by secondary syphilis \u2013 the utility of polymerase chain reaction techniques in transbronchial biopsy: a case report

BackgroundIn Japan and other countries, the number of patients with syphilis is increasing year by year. Recently, the cases of the pulmonary involvement in patients with secondary syphilis have been reported. However, it is still undetermined how to obtain a desirable specimen for a diagnosis of the pulmonary involvement, and how to treat it if not cured.Case presentationA 34-year-old man presented with cough and swelling of the right inguinal nodes. A physical examination revealed erythematous papular rash over the palms, soles and abdomen. A 4 cm mass in the right lower lobe of the lung was detected on computed tomography. He was diagnosed as having secondary syphilis, because he was tested positive for the rapid plasma reagin and Treponema pallidum hemagglutination assay. Amoxycillin and probenecid were orally administered for 2 weeks. Subsequently, rash and serological markers were improved, however, the lung mass remained unchanged in size. Transbronchial biopsy (TBB) confirmed the pulmonary involvement of syphilis using polymerase chain reaction techniques (tpp47- and polA-PCR). Furthermore, following surgical resection revealed the lung mass to be an abscess.ConclusionsTo our knowledge, this is the first surgically treated case of a lung abscess caused by syphilis, which was diagnosed by PCR techniques in TBB. This report could propose a useful diagnostic method for the pulmonary involvement of syphilis.

Ultrasound as a potential tool for the assessment of interstitial lung disease in rheumatic patients. Where are we now?

Lung ultrasound (LUS) achieved an intriguing role in the management of pulmonary involvement in patients affected by connective tissues diseases (CTDs). Few studies have been performed to support its usefulness in the evaluation of the presence and the severity of interstitial lung disease (ILD), relating it to the information obtained with chest high-resolution computed tomography (HRCT). These results open up new fields of research in order to demonstrate the utility of LUS as screening tool to evaluate ILD in CTD. The aim of this review is to provide the "state of the art" of the role of LUS in the management of ILD associated with CTD.

Evaluation of Pulmonary Function Test in Patients with Amyotrophic lateral sclerosis and its correlation with the symptoms of the disease

Introduction: Amyotrophic lateral sclerosis (ALS) is a neurogenic progressive disease that leads to muscle atrophy. The purpose of this study was to evaluate pulmonary function test (PFT) in patients with ALS and its correlation with ASL symptoms. Materials and Methods: This cross-sectional study was performed on 32 ALS patients at Ghaem Hospital, Mashhad, Iran. All patients filled out a demographic form and underwent body plethysmography to determine forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), and FEV1/FVC indexes based on their gender and age. Blood samples were also collected to analyze atrial blood gas (ABG) and the levels of oxygen and carbon dioxide. Finally, the data were analyzed by using SPSS20 software. Results: The mean age of the patients was 61.66±13.6 years. The prevalence of ALS was higher in females than in males. The study of the symptoms of the disease (87.1%) of the patients in the study was motor disorder, (0.31%) swallowing disorder, (48.0%) cough and shortness of breath and (40.0%) speech impairment. The results showed that there was a significant relationship between hypercarbia and night oxygen saturation , which the hypercarbia abundance was higher among patients whose night oxygen saturation was SO2 ˂90. But there was no significant relationship between hypercarbia and hypoxemia with symptoms of the disease.. Other results showed that the FEV1 test with swallowing disorder (P = 0.01) and cough and shortness of breath (P = 0.02) the results of FVC test with swallowing disorder (P = 0.01) and cough and shortness of breath (P = 0.02) and Also, there was a significant relationship between FEV1 / FVC test with swallowing disorder (P = 0.01) and cough and shortness of breath (P = 0.01) so that, With the normalization of the Pulmonary Function Test and the improvement of the patients , the symptoms of the disease also decreased. Conclusions: Overall, the results indicate that early detection of pulmonary involvement in patients with ALS can lead to interventions such as oxygen therapy and reduce symptoms and help improve their quality of life.

Pulmonary involvement in rheumatoid arthritis

Pulmonary involvement in patients with rheumatoid arthritis, in particular interstitial lung diseases (RA-ILD) is of great clinical importance. Patients should be asked about symptoms of pulmonary involvement and the lungs should be clinically examined even during the diagnostic procedure and regularly during the course of the disease. Before initiation of a basic pharmacological treatment an X‑ray examination of thoracic organs is obligatory. In cases of conspicuous clinical or radiological findings, extended diagnostic procedures with lung function testing (body plethysmography with diffusion measurement) and high resolution computed tomography (CT) should be performed, depending on the findings. The differential diagnosis of interstitial lung alterations in patients with RA is broad and should consider side effects of the basis medication in addition to infectious causes. The optimal pharmacological treatment of RA-ILD is not sufficiently clarified. The value of methotrexate (MTX) has changed because, in contrast to previous assumptions, a better course could be observed under MTX treatment, at least in mild to moderate courses of RA-ILD. In the case of a clinically relevant RA-ILD, tumor necrosis factor (TNF) blockers should be avoided because a dramatic deterioration of pulmonary function has sometimes been observed. Among biological disease-modifying antirheumatic drugs (DMARD), rituximab and abatacept are currently preferred. The role of Janus kinase (JAK) inhibitors in RA-ILD is currently being discussed but limited data are available. Patients with RA-ILD benefit from aclose collaboration between pulmonologists and rheumatologists.

Computed tomography patterns of pulmonary and pleural involvement in lymphoma

BackgroundPulmonary and pleural involvement is fairly common in patients with lymphoma, especially in the setting of progressive or recurrent disease. Pleuropulmonary involvement in lymphoma may occur as a single pattern or as a combination of multiple patterns which can often mimic unrelated pathologies. MethodsReview of our institutional database from 01 Jan 2015 to 04 Oct 2017 revealed 90 patients with pulmonary and/or pleural lesions attributable to lymphoma. These lesions were classified into various categories, and the pattern of involvement was evaluated. ResultsPulmonary involvement was seen in 17.6% of patients with Hodgkin lymphoma (HL) and in 10.5% of patients with non-Hodgkin lymphoma (NHL), whereas pleural involvement was seen in 6.5% of patients with NHL. Almost all the patients in our study had findings belonging to multiple categories. Pulmonary involvement in patients with HL was seen in the form of nodules (51.6%), masses (51.6%), and direct extension from a mediastinal/hilar mass (45.2%). Patients with NHL had pulmonary involvement in the form of nodules (42.4%), direct extension from a mediastinal/hilar mass (25.4%), pulmonary masses (18.6%), and interstitial pattern (2.4%). Pleural thickening (61.5%), masses (30.8%), and effusion (15.4%) were the three patterns of pleural involvement. ConclusionNodules and masses were the two commonest patterns of pulmonary involvement in patients with HL, whereas nodules were the commonest pattern noted in patients with NHL. Pulmonary masses were seen more commonly in patients with HL than in those with NHL. Pleural involvement was seen exclusively in patients with NHL.

Lung Perfusion Imaging in Tetralogy of Fallot: A Case Report

Congenital heart diseases, such as tetralogy of fallot (TOF), are the most common human birth defects that may cause pulmonary diseases. Lung perfusion scintigraphy (LPS) has an important role in evaluating pulmonary involvement in patients with these defects, both as part of the diagnostic work-up and for follow-up to guide best therapeutic strategy. Herein, we report a 10-year-old female patient with TOF who underwent LPS two years after cardiac surgery. The scan showed hypo-perfusion of the left respect to the right lung and abnormal uptake of Tc-99m-macroaggregated albumin in the kidneys and spleen, revealing the presence of a right-to-left shunt, and the necessity for further cardiac surgery. This case is a demonstrative example of the usefulness of LPS in patients with TOF, allowing an accurate evaluation of the best therapeutic strategy with the benefits of low radiation exposure, lack of side effects, reproducibility, management ease and good patient compliance.

What rheumatologists can learn from pneumologists

Pulmonary involvement in patients with underlying autoimmune diseases poses amajor diagnostic and therapeutic challenge to the treating physician. Due to the associated increased mortality risk, early diagnosis is crucial. The incidence and mortality rate of connective tissue disease-related interstitial lung diseases (CTD-ILD) and pulmonary hypertension (PH) were evaluated in patients with rheumatic disease including clinical aspects, diagnostic procedure, prognosis and treatment recommendations. An analysis of remarkable publications was carried out and guidelines are presented. The CTD-ILD and PH are frequent comorbidities with significantly increased mortality risk, especially in patients with systemic sclerosis (SSc). In primary fibrotic and non-inflammatory CTD-ILD, as occurs especially in patients with rheumatoid arthritis, immunosuppressive therapy is only partially effective. Currently, in some eligible patients only lung transplantation remains as a definitive therapy. The diagnostics and treatment of CTD-ILD and PH in patients with an underlying autoimmune disease requires an interdisciplinary approach. The effectiveness of antifibrotic treatment needs to be evaluated in the future.