Pulmonary Opacities Research Articles

Exosomal miRNAs targeting NLRP3 inflammasome platform are associated with radiologic sequelae in survivors of COVID-19-associated acute respiratory distress syndrome

Background: There is limited understanding of the pathophysiology of post-acute pulmonary sequelae in COVID-19-associated acute respiratory distress syndrome (ARDS). We aimed at investigating the association of circulating microRNAs (miRNAs) involved in post-transcriptional regulation of NLRP3-inflammasome pathways and lung radiological features among COVID-19- associated ARDS survivors. Methods: We evaluated COVID-19-associated ARDS survivors at 4±2 months from clinical recovery. Patients were selected based on imaging pattern evolution according to chest high-resolution computerized tomography (HRCT) findings into “fully recovered” (FR), “pulmonary opacities” (PO) and “fibrosis-like lesions” (FL) according to radiological appearance. Plasma miRNA profiling was performed using real time quantitative polymerase chain reaction (RT-qPCR). The exosomal expression of NLRP3 inflammasome related miRNAs (miR-17-5p, miR-223-3p, miR-146a-5p) was evaluated. Results: 31 patients (33% men, mean age 60±6 years, mean BMI 31.1±6.6 Kg/m2) were selected for the present study. No statistically significant differences between FR, PO and FL patterns were observed according to clinical features. NLRP3-inflammasome-related miRNAs such as miR-17-5p, miR-223-3p and miR-146a-5p were significantly up-regulated in patients with PO when compared to patients with FL. miR-146a-5p was also up-regulated in patients with FL than in FR. Conclusions: In patients with long-term pulmonary radiological sequelae following COVID71 19- associated ARDS, a down-regulation of miRNAs inhibiting NLRP3 (miR-17-5p, miR-146a72 3p and miR-223-3p) correlated to fibrosis development in patients showing persistent hyper-reactivity to inflammatory stimulation. NLRP3-Inflammasome-related miRNAs could be a possible therapeutic target to prevent the fibrotic evolution of COVID-19-associated ARDS.

A rare cause of dysphagia in children: Squamous cell carcinoma of the esophagus: A case report and review of literature

Globally, an estimated 572 000 cases occurred in 2018 of malignant tumors of the esophagus but in children and adolescents, this cancer is a rare disease. Through this case report, i tried to analyze the clinical, paraclinical, therapeutic and prognostic profile of squamous cell carcinoma of the esophagus in children. This 10 years old female school child is presented with a complaint of worsening of difficulty of swallowing of 01 week duration. She had Symptoms complex of TB for the last 3 months. FNAC from right axillary, bilateral inguinal LNs, discrete with pus oozing sinus tract about 2x2 cm Microscopy shows caseous necrotic material= suggestive of TB. SAM (NE) + Severe Pneumonia + R/O Diss TB (Lung, LN) + Tungiasis was considered and anti TB was started but the patient was deteriorating. After one month course in the hospital the patient condition was deteriorating, the dysphagia become worsened. CHEST CT SCAN of the child was taken and the Finding: there is multifocal coalescing tree in bud opacity in posterior segment of the right upper lobe and superior segment of the lower lobe on the same side. There is consolidation with bronchiectasis changes on the left lower lobe. Multiple enlarged Para tracheal, sub carinal and Para esophageal nodes noted. There is circumferential wall thickening of the mid and part of proximal esophagus with no fat plane from the enlarged adjacent nodes. Calcified right axillary nodes visualized. the Impression was Bilateral pulmonary opacities with mediastinal LAPs (likely 2ry to TB) + circumferential wall thickening of mid and part of proximal esophagus DDx: Esophageal malignant mass with mediastinal nodal deposits and aspiration pneumonia- so needs clinical correlation and endoscopic study. Esophageal biopsy was taken and section shows nests and single cells of malignant squamous cells having high N/C ratio hyper chromatic nucleo and dense eosinophilic cytoplasm along with keratin pearls along with monocular infiltration and atypical mitosis invading in to desmoplastic stroma. Conclusion: Squamous cell carcinoma The child was transferred to oncology ward for chemotherapy and radiotherapy after one week of ward stay the patient passed away. Malignant esophageal tumors in children and adolescents are extremely rare conditions. The ingestion of caustic products and smoking are currently the most well-known risk factors for this disease, factors not found in our patient. Dysphagia is the main clinical sign of squamous cell carcinoma of the esophagus. Thus, in the event of dysphagia in children or adolescents, a mediastinal process should be considered, and a paraclinical assessment should be carried out. Since squamous cell carcinoma of the esophagus is a rare malignant tumor in children, the interest of this case report is to underline the importance of evoking a malignant esophageal process in children who present a notion of dysphagia to solids then to liquids, associated with an alteration of the general condition and anemia.

Mechanical extraction of a pulmonary valve vegetation in a patient with endocarditis.

A 44-year-old male known with small ventricular septal defect, but no previous history of intravenous drug abuse presented to an outside hospital with fever, chills, and back pain. A chest computed tomography showed multifocal nodular and consolidative pulmonary opacities with borderline enlarged mediastinal lymph nodes (Panel, A). Blood cultures grew Staphylococcus lugdunensis; given suspicion of infective endocarditis causing septic pulmonary emboli, he was transferred to our hospital. Transoesophageal echocardiography (TEE) on admission showed highly mobile masses attached to the native tricuspid (B) and to the sub-pulmonary area of the right ventricular outflow tract along with posterior leaflet perforation of the tricuspid valve with mild-to-moderate regurgitation (C). The sub-pulmonary lesion was in the path of the high-velocity left-to-right jet through the ventricular septal defect (D; Supplementary data online, Video S1), explaining the unusual location. Patient had persistent bacteremia despite appropriate antibiotic therapy and eventually developed haemoptysis and acute respiratory failure requiring intubation. At repeat TEE showed interval increase in the size of the sub-pulmonic vegetations. In the absence of haemodynamically significant lesions, the multidisciplinary team recommended percutaneous transcatheter mechanical vegectomy rather than surgical intervention.

Simultaneous Super-Resolution and Classification of Lung Disease Scans

Acute lower respiratory infection is a leading cause of death in developing countries. Hence, progress has been made for early detection and treatment. There is still a need for improved diagnostic and therapeutic strategies, particularly in resource-limited settings. Chest X-ray and computed tomography (CT) have the potential to serve as effective screening tools for lower respiratory infections, but the use of artificial intelligence (AI) in these areas is limited. To address this gap, we present a computer-aided diagnostic system for chest X-ray and CT images of several common pulmonary diseases, including COVID-19, viral pneumonia, bacterial pneumonia, tuberculosis, lung opacity, and various types of carcinoma. The proposed system depends on super-resolution (SR) techniques to enhance image details. Deep learning (DL) techniques are used for both SR reconstruction and classification, with the InceptionResNetv2 model used as a feature extractor in conjunction with a multi-class support vector machine (MCSVM) classifier. In this paper, we compare the proposed model performance to those of other classification models, such as Resnet101 and Inceptionv3, and evaluate the effectiveness of using both softmax and MCSVM classifiers. The proposed system was tested on three publicly available datasets of CT and X-ray images and it achieved a classification accuracy of 98.028% using a combination of SR and InceptionResNetv2. Overall, our system has the potential to serve as a valuable screening tool for lower respiratory disorders and assist clinicians in interpreting chest X-ray and CT images. In resource-limited settings, it can also provide a valuable diagnostic support.

Spectrum of CT-Scan Findings in Symptomatic and Asymptomatic Patients of SARS-CoV-2 Disease: An African Series

In this paper, we studied retrospectively the Chest CT-scan chest of 118 SARS-CoV-2 disease cases confirmed by Polymerase Chain Reaction (PCR). We identified and characterized the most common CT findings, and compared such findings in the asymptomatic patients with those patients that presented with findings in patients with mild form of the disease. Bilateral pulmonary parenchyma ground-glass and consolidative pulmonary opacities, sometimes with a rounded morphology and a peripheral lung distribution were the most common CT findings. These were often associated with reticular and crazy paving pattern. Pleural and pericardial effusions were rare and mainly present in diffuse lung involvement. Most of our patient showed minimal lung involvement. There was no statistical significant difference in CT findings between asymptomatic patients and those with mild symptoms.

Post-COVID recurrent dyspnoea

Rationale: Post-COVID symptoms need aggressive evaluation. Patient’s Concern: A 29-year-old male patient who had suffered from COVID-19 eight weeks earlier, presented with an acute onset of breathlessness and right-sided chest pain due to pneumothorax. Emergency tube thoracostomy was performed. However, it failed to improve hypoxia. Diagnosis: High-resolution computed tomography of the thorax with computed tomography pulmonary angiography revealed pulmonary arterial thrombosis, ground-glass opacities, and bilateral pneumatoceles. Interventions: Hospital admission and treatment with low molecular weight heparin at a dose of 1.5 mg/kg every 24 h. Outcomes: The large pneumatocele showed significant resolution after three months of follow-ups. Lessons: Being increasingly reported after having a SARS-CoV-2 infection, pneumatocele formation, due to post-COVID lung scarring and late vascular thrombotic events, is a peculiar sequela and can present as acute dyspnoea. Long-term preventive anticoagulants after recovery from COVID-19 are necessary. Breathing exercises during recovery should be done with caution.

Facilitating combined biopsy and percutaneous microwave ablation of pulmonary ground-glass opacities using lipiodol localisation.

Whether preoperative localisation is necessary and valuable for the microwave ablation (MWA) of small pulmonary lesions with ground-glass opacity (GGO) remains unclear. This study aimed to explore the role of the Chiba needle and lipiodol localisation techniques in facilitating MWA and biopsy. This retrospective before-after study included patients with GGOs who underwent conventional MWA and biopsy treatment in our hospital between January 2018 and December 2019 (group A) or who underwent the Chiba needle and lipiodol localisation treatment before MWA and biopsy between January 2020 and December 2020 (group B). The characteristics of each patient and GGO lesion were collected and analysed to evaluate the safety and effectiveness of the localisation technique. A total of 122 patients with 152 GGOs and 131 patients with 156 GGOs underwent MWA and biopsy in groups A and B, respectively. The primary technique efficacy rate of MWA differed significantly between the two groups (A vs. B: 94.1% vs. 99.4%; p = 0.009). The positive biopsy rate in the two groups was determined by the difference (A vs. B: 93.4% vs. 98.1%; p = 0.042). The incidence of complications did not increase in group B. Compared with the unmarked group, the Chiba needle and lipiodol localisation technique improved the positive rate of biopsy and the initial effective rate of MWA, without significantly increasing the complication rate. • The localisation of the Chiba needle and lipiodol could improve the positive biopsy rate and the initial effective rate of MWA. • The localisation of the Chiba needle and lipiodol does not affect the subsequent MWA and biopsy and does not increase the incidence of pneumothorax and haemorrhage.

Multiple pulmonary opacities. An alarming sign?

Multiple pulmonary opacities. An alarming sign?

Total Anomalous Pulmonary Venous Return.

Supplemental material is available for this article.

Noncardiogenic pulmonary edema in small animals.

To review various types of noncardiogenic pulmonary edema (NCPE) in cats and dogs. NCPE is an abnormal fluid accumulation in the lung interstitium or alveoli that is not caused by cardiogenic causes or fluid overload. It can be dueto changes in vascular permeability, hydrostatic pressure in the pulmonary vasculature,or a combination thereof.Possiblecausesinclude inflammatory states within the lung or in remote tissues (acute respiratory distress syndrome [ARDS]), airway obstruction (post-obstructive pulmonary edema), neurologic disease such as headtraumaor seizures (neurogenic pulmonary edema), electrocution,after re-expansion of a collapsed lung orafter drowning. Diagnosis of NCPE is generally based on history, physical examination, and diagnostic imaging. Radiographic findings suggestive of NCPE are interstitial to alveolar pulmonary opacities in the absence of signs of left-sided congestive heart failure or fluid overload such as cardiomegaly or congested pulmonary veins. Computed tomography and edema fluid analysis may aid in the diagnosis, while some forms of NCPE require additional findings to reach a diagnosis. The goal of therapy for all types of NCPE is to preserve tissue oxygenation and reduce the work of breathing. This may be achieved by removing the inciting cause (eg, airway obstruction) and cage rest in mild cases and supplemental oxygen in moderate cases and may require mechanical ventilation in severe cases. Prognosis is generally good for most causes of veterinary NCPE except for ARDS, although data are scarce for some etiologies of NCPE.

Assessment of preoperative anxiety and depression in patients with pulmonary ground-glass opacities: Risk factors and postoperative outcomes.

A large number of patients with pulmonary ground-glass opacities (GGOs) have anxiety and depression. However, the contributing factors and effects of anxiety and depression on postoperative outcomes are still unclear. Clinical data for patients undergoing surgical resection for pulmonary GGOs were collected. We prospectively evaluated levels and risk factors for anxiety and depression in patients with GGOs before surgery. The relationship between psychological disorders and postoperative morbidity was evaluated. Quality of life (QoL) was also assessed. A total of 133 patients were enrolled. Prevalence rates of preoperative anxiety and depression were 26.3% (n = 35) and 18% (n = 24), respectively. Multivariate analysis revealed depression [odds ratio(OR) = 16.27, p < 0.001] and multiple GGOs (OR = 3.146, p = 0.033) to be risk factors for preoperative anxiety. Anxiety (OR = 52.166, p < 0.001), age > 60 (OR = 3.601, p = 0.036), and unemployment (OR = 8.248, p = 0.006) were identified as risk factors for preoperative depression. Preoperative anxiety and depression were associated with lower QoL and higher postoperative pain scores. Our results also revealed that the incidence of postoperative atrial fibrillation was higher in patients with than in those without anxiety. In patients with pulmonary GGOs, comprehensive psychological assessment and appropriate management are required before surgery to improve QoL and reduce postoperative morbidity.

A Super-resolution-based Approach for the Detection of Covid—19 Infection From Chest X-ray Images

X-ray is the most accessible imaging modality for detecting Covid-19 infection. However, X-ray image resolution depends on the amount of radiation dose. The Lesser the dosage, the lower the resolution, the higher the noise and patient safety. Detecting Covid-19 infection would be more precise with high-resolution chest X-ray images. The current article explores an edge-preserving single-scale residual learning-based super-resolution method to enhance low-resolution chest X-ray images. We used unsharp masking to preserve small, medium, and high-scale details while super-resolving the given image. The method produces a clear view of the pulmonary opacities in chest X-ray images after super-resolution reconstruction. Statistical feature metrics of first and second-order showed superior quality reconstruction by the proposed method for the given Covid-19 chest X-ray images. Further, to measure the effectiveness of super-resolution, we used an Inception v3 based deep learning model to classify chest X-ray images of Covid-19, pneumonia, and normal class. The performance of the classification model with super-resolved chest X-ray images was tested against 400 images belonging to two different classes at a time. We obtained increased precision of 94% and 96% accuracy in detecting Covid-19 infection in chest X-ray images after super-resolution compared to 64% precision and 68% accuracy before super-resolution.

GROUND GLASS OPACITIES IN LUNG CANCER PATIENTS POSITIVE FOR COVID-19

This study was designed to evaluate radiological features of COVID-19 and early lung cancer through High-resolution computed tomography (HRCT) and demonstrated the disparity between them. A retrospective was conducted in the COVID-19 ward, Oncology &amp; Radiology ward of CH&amp; UCHS Lahore &amp; Shifa International Hospital Islamabad &amp; NMU &amp; H Multan from October 14, 2019, to October 14, 2020. A total of 100 COVID-19 patients and 300 patients with pulmonary ground-glass opacities undergoing lung surgery (control group) were included in the study. After propensity score-matched analysis, patients were divided into two groups with 80 matched pairs each. Both groups' clinical, pathological, epidemiological, and radiological characteristics (evaluated through HRCT) were compared. It was observed that COVID-19 patients presented more definite symptoms, were mostly younger men, and had higher BMI (body-mass index). After the radiological analysis of the matched patients, it was revealed that single-lesion patients constituted 17% of COVID-19 cases and 89% of lung cancer cases. Patients in both groups mainly presented peripheral lesions. COVID-19 lesions had more lobes and segments and had various types with patchy forms. On the other hand, lung cancer tended to have only one type and had an oval form. Both COVID-19 and lung cancer showed ground-glass opacities with similar but independent characteristics. These characteristics, combined with pathogen detection, short-term CT examination, and laboratory tests, will aid in improved diagnosis.

Colinet–Caplan Syndrome: History of an Outbreak of Autoimmune Disease in Scouring Powder Workers

The first modern description linking rheumatoid arthritis to occupational dust exposure is generally attributed to the British physician Anthony Caplan. In 1953, Caplan reported on a “peculiar” nodular pattern on chest radiographs of Welsh coal miners with rheumatoid arthritis that differed from the typical coal workers' pneumoconiosis. However, as early as 1950, the Belgian rheumatologist Émile Colinet described a similar case of rheumatoid arthritis and concomitant pulmonary opacities in a 30-year-old woman with silica exposure. Soon after, he published a second case. Although this condition initially was called Colinet–Caplan syndrome in the Francophone biomedical literature, Colinet's name was later dropped from the eponym. Because Colinet never clearly described the specific occupational context of his cases, Caplan syndrome has been misconstrued as uniquely a disease of coal miners. We attempted to reconstruct the working conditions of Colinet's patients and found that they were packing Vim, a silica-based scouring powder, at the Savonneries Lever Frères factory in Brussels, Belgium. Colinet's cases were only the first 2 in a series of reports of rheumatoid arthritis and other autoimmune diseases, mainly among young women, in those who worked in the production of silica-based scouring powder between the 1930s and 1980s across Europe. The largest outbreak involved 32 cases of autoimmune disease among 50 former workers of a Spanish scouring powder manufacturing facility. After silica in scouring powders was replaced with less hazardous materials later in the 20th century, no further cases have been reported. Although scouring powder disease is a historical phenomenon, autoimmune disorders linked to occupational exposure to silica and coal dust have not disappeared but instead are reemerging among those who work with silica-based artificial stone and in other dusty trades.

Pulmonary nodular elastosis: The intraparenchymal counterpart of pulmonary apical caps?

We have studied six cases in which focal consolidative pulmonary opacities observed on imaging studies led to surgical resection due to the suspicion of malignancy and showed on histopathologic examination a benign process characterized by an expansile tumor-like nodular accumulation of elastotic material. The patients were five women and one man aged 46 to 67 years (mean: 61 years). All lesions were found incidentally on imaging studies done for a variety of reasons, including surveillance for metastatic carcinoma in four patients. The lesions presented as solid nodules within lung parenchyma with irregular borders and spiculated margins and measured between 0.6 and 4.6 cm in diameter. Histological examination showed dense deposits of elastic tissue without evidence of malignancy, similar to those seen in pulmonary apical caps. Clinical follow-up between 5 and 16 years (mean: 10 years) showed that all patients were alive and well without evidence of disease. Pulmonary nodular elastosis is a localized intraparenchymatous process that may be confused clinically and radiographically for a malignant neoplasm and needs to be distinguished from other nodular lesions of the lung. To the best of our knowledge, tumor-forming lesions within lung parenchyma that are predominantly or almost exclusively composed of accumulation of elastic fibers have not been previously described.

Aortic Dissection and COVID-19 Pneumonia in a Pregnant Woman at 34 Weeks of Gestation

Between 0.1% and 0.3% of all aortic dissections occur during pregnancy. Arterial hypertension, connective tissue disorders, and congenital cardiovascular anomalies-including bicuspid aortic valves-are well-known risk factors. The causality between pregnancy and aortic dissection is unclear, but there have been some observations that COVID-19 illness may increase the risk. This report describes a pregnant woman at 34 weeks of gestation who had a bicuspid aortic valve and experienced an acute aortic dissection while ill with COVID-19 pneumonia. Computed tomography confirmed a type A aortic dissection and bilateral patchy pulmonary opacities. Cesarean delivery was performed, followed by replacement of the aortic valve with a mechanical aortic prosthesis and reconstruction of the ascending aorta and hemiarch. The intraoperative course was uneventful, and the patient was successfully weaned from mechanical ventilation after 51 hours. COVID-19 during pregnancy seems to increase the risk for aortic dissection, although there is no evidence base for an association. Because guidelines for diagnosis and treatment in such complex cases are lacking, care from a multidisciplinary team is crucial for successful outcomes.

Role of Fine Needle Aspiration Cytology in the Rapid Diagnosis of Pulmonary Infections in Renal Allograft Recipients with Respiratory Failure.

Renal transplantation is the treatment of choice in patients with end-stage renal disease. However, allograft recipients are at a higher risk of infection due to immunosuppressive therapies. This study aimed to analyze the utility of fine needle aspiration cytology (FNAC) lung in the etiological diagnosis of pulmonary infections in renal allograft recipients with respiratory failure. This is a retrospective study done in post-renal transplant patients presenting with pulmonary infections and respiratory failure in the past 7 years, in whom image-guided lung FNAC was done for diagnosis. A total of 35 renal allograft recipients presenting with respiratory failure and having focal or diffuse pulmonary opacities (lesions) on radiological imaging were subjected to lung FNAC. The mean age of the patients was 41.1 ± 11.8 years (range 19-72), with the majority being males (n = 28, 80%); six (17.1%) of them were on invasive ventilation. The diagnostic yield of FNAC in our cohort was 77.1% (27 out of 35). Microorganisms were isolated in 21 cases (60%), with Nocardia being the most common (nine cases, 25.7%), Mycobacterial tuberculosis identified in six patients (17.1%), Aspergillus in three (8.6%), and one (2.9%) each had atypical Mycobacterium, zygomycetes, and Cryptococcus. FNAC suggested viral cytopathic effect in five patients, and cytomegalovirus (CMV) quantitative polymerase chain reaction test was found positive in four of these. One case was diagnosed as adenocarcinoma lung. Lung FNAC is a useful for establishing the etiological diagnosis of pulmonary lesions in renal transplant patients with respiratory failure.

Comparative study on Various Tube Voltages and Contrast Media Doses in CT Pulmonary Angiography to detect Pulmonary Thromboembolism

Background: Lowering the amount of iodinated contrast material and tube voltage may increase pulmonary artery opacification and thrombus identification without compromising picture quality. Objectives: To explore the efficiency of using lower tube voltage and a lower contrast medium dose for conducting computed tomography for pulmonary angiography (CTPA) aiming to increase its accuracy in detecting pulmonary thromboembolism (PTE). Subjects and Methods:100 patients scheduled for CTPA with a preoperative diagnosis of PTE were grouped into two: group A, (50 patients) got 1 mL/kg at 120 kV and group B, (50 patients) received 0.5 mL/kg at 80 kV.The technique of bolus tracking was implemented.Values of midpoint of multiple pulmonary artery divisions were used to assess attenuation.Significant values are those that exceed 300 Hounsfield units (HU). The dosage of radiation received by the patient, defined as the effective dose, was compared between groups. Results: Total mean attenuationdata for the pulmonary arteries have shown to be substantially greater in group-B compared to group-A (39110.4HU vs. 335.97.9HU, P=0.001). Moreover, total dose length product (DLP) values were substantially lower in group-B (934.9 mGy.cm vs. 384.443 mGy.cm, P=0.001). While effective dose values have shown to be significantly lower in group-B (2.90.3 mSv vs. 13.21.8 mSv, P 0.001). Conclusion: Low-kilovoltage technique and low quantity of iodinated contrast are useful in conducting (CTPA) with high accuracy in detection of pulmonary thromboembolism.

Evaluation of Follow-Up CT Scans in Patients with Severe Initial Pulmonary Involvement by COVID-19.

To investigate the predictive factors of residual pulmonary opacity on midterm follow-up CT scans in patients hospitalized with COVID-19 pneumonia. This prospective study was conducted in a tertiary referral university hospital in Iran, from March 2020 to December 2020. Patients hospitalized due to novel coronavirus pneumonia with bilateral pulmonary involvement in the first CT scan were included and underwent an 8-week follow-up CT scan. Pulmonary involvement (PI) severity was assessed using a 25-scale semiquantitative scoring system. Density of opacities was recorded using the Hounsfield unit (HU). The chest CT scans of 50 participants (mean age = 54.4 ± 14.2 years, 72% male) were reviewed, among whom 8 (16%) had residual findings on follow-up CT scans. The most common residual findings were faint ground-glass opacities (GGOs) (14%); fibrotic-like changes were observed in 2 (4%) patients. Demographic findings, underlying disease, and laboratory findings did not show significant association with remaining pulmonary opacities. The total PI score was significantly higher in participants with remaining parenchymal involvement (14.5 ± 6.5 versus 10.2 ± 3.7; P=0.02). On admission, the HU of patients with remaining opacities was significantly higher (-239.8 ± 107.6 versus -344.0 ± 157.4; P=0.01). Remaining pulmonary findings were more frequently detected in patients who had received antivirals, steroid pulse, or IVIG treatments (P=0.02, 0.02, and 0.001, respectively). Only the PI score remained statistically significant in multivariate logistic regression with 88.1% accuracy (OR = 1.2 [1.01-1.53]; P=0.03). Pulmonary opacities are more likely to persist in midterm follow-up CT scans in patients with severe initial pulmonary involvement.

Knowledge mapping visualization of the pulmonary ground-glass opacity published in the web of science.

With low-dose computed tomography(CT) lung cancer screening, many studies with an increasing number of patients with ground-glass opacity (GGO) are published. Hence, the present study aimed to analyze the published studies on GGO using bibliometric analysis. The findings could provide a basis for future research in GGO and for understanding past advances and trends in the field. Published studies on GGO were obtained from the Web of Science Core Collection. A bibliometric analysis was conducted using the R package and VOSviewer for countries, institutions, journals, authors, keywords, and articles relevant to GGO. In addition, a bibliometric map was created to visualize the relationship. The number of publications on GGO has been increasing since 2011. China is ranked as the most prolific country; however, Japan has the highest number of citations for its published articles. Seoul National University and Professor Jin Mo Goo from Korea had the highest publications. Most top 10 journals specialized in the field of lung diseases. Radiology is a comprehensive journal with the greatest number of citations and highest H-index than other journals. Using bibliometric analysis, research topics on "prognosis and diagnosis," "artificial intelligence," "treatment," "preoperative positioning and minimally invasive surgery," and "pathology of GGO" were identified. Artificial intelligence diagnosis and minimally invasive treatment may be the future of GGO. In addition, most top 10 literatures in this field were guidelines for lung cancer and pulmonary nodules. The publication volume of GGO has increased rapidly. The top three countries with the highest number of published articles were China, Japan, and the United States. Japan had the most significant number of citations for published articles. Most key journals specialized in the field of lung diseases. Artificial intelligence diagnosis and minimally invasive treatment may be the future of GGO.