Pulmonary Scarring Research Articles

HIDROPNEUMOTHORAKS ET CAUSA TB PARU

Hydropneumothorax is a condition where there is air and fluid in the pleural cavity resulting in the collapse of lung tissue. The exact incidence is unknown but it is found that the incidence of pneumothorax ranges from 2.4 to 17.8/100,000 population per year. In this case, a 42-year-old man with complaints of chest pain since 2 weeks before admission to the hospital. The complaints included shortness of breath and continuous coughing. From the examination results obtained BP 120/80, HR: 135x/I, RR: 18 x/I, and temperature: 37oC. Physical examination found asymmetrical chest movements, chest tube in the sinistra thorax, weak vocal fremitus in the basal part of the left hemithorax at the level of posterior ICS XI, hypersonor in the right lung at the level of ICS II-IV and dimmed in the left basal part at the level of ICS V and a decrease in left lung breath sounds. X-ray examination showed an area of lusensi without pulmonary scars in the lateral aspect of the sinistral hemithorax with a ridge in the basal aspect of the sinistral hemithorax accompanied by an air fluid level in the left hemithorax. The patient was diagnosed with hydropneumothorax ec pulmonary tuberculosis with water seal drainage.

Headache, Fever, and Myalgias in an HIV-Positive Male with a History of Tuberculosis: Epstein–Barr Virus Aseptic Meningitis

We describe a case of EBV aseptic meningitis in a patient with HIV with an extensive history of prior infections and exposures. Detailed Case Description: A 35-year-old man with a history of HIV, syphilis, and partially treated tuberculosis presented with headache, fever, and myalgias. He reported recent exposure to dust from a construction site and had sexual contact with a partner with active genital lesions. An initial workup revealed mildly elevated inflammatory markers, significant pulmonary scarring from tuberculosis with a classic "weeping willow sign", and lumbar puncture findings consistent with aseptic meningitis. An extensive evaluation was conducted to identify causes of bacterial and viral meningitis, including syphilis. Immune reconstitution inflammatory syndrome and isoniazid-induced aseptic meningitis were also considered based on his medications. EBV was ultimately isolated through PCR from the patient's peripheral blood. The patient's condition improved, and he was discharged on his home antiretroviral and anti-tuberculous treatment. Central nervous system infections represent unique challenges in patients with HIV. EBV reactivation can present with atypical symptoms and should be considered as a cause of aseptic meningitis in this population.

Idiopathic pulmonary fibrosis and lung cancer: future directions and challenges.

Idiopathic pulmonary fibrosis (IPF) is a progressive disease of pulmonary scarring. New treatments slow disease progression and allow pulmonary fibrosis patients to live longer. Persistent pulmonary fibrosis increases a patient's risk of developing lung cancer. Lung cancer in patients with IPF differs from cancers that develop in the non-fibrotic lung. Peripherally located adenocarcinoma is the most frequent cell type in smokers who develop lung cancer, while squamous cell carcinoma is the most frequent in pulmonary fibrosis. Increased fibroblast foci in IPF are associated with more aggressive cancer behaviour and shorter doubling times. Treatment of lung cancer in fibrosis is challenging because of the risk of inducing an exacerbation of fibrosis. In order to improve patient outcomes, modifications of current lung cancer screening guidelines in patients with pulmonary fibrosis will be necessary to avoid delays in treatment. 2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) computed tomography (CT) imaging can help identify cancer earlier and more reliably than CT alone. Increased use of wedge resections, proton therapy and immunotherapy may increase survival by decreasing the risk of exacerbation, but further research will be necessary.

Imaging characteristics of pulmonary BCG/TB infection in patients with chronic granulomatous disease

In China, tuberculosis (TB) is endemic and the Bacillus Callmette–Güerin (BCG) vaccine is administered to all the newborns, which may lead to BCG infection in patients with chronic granulomatous disease (CGD). Infection of BCG/TB in CGD patients can be fatal and pulmonary is the most affected organ. Our objective was to assess the imaging of pulmonary BCG/TB infection in CGD. We screened 169 CGD patients and identified the patients with pulmonary BCG/TB infection. BCG infection was diagnosis according to the vaccination history, local infection manifestation, acid-fast bacilli staining, specific polymerase chain reaction, and/or spoligotyping. PPD, T-SPOT and acid-fast bacilli staining were used for diagnosis of TB. Totally 58 patients were identified, including TB (n = 7), solely BCG (n = 18), BCG + bacterial (n = 20), and BCG + fungi (n = 13). The onset of BCG disease was much earlier than TB. For those patients only with BCG, lymphadenopathy was the first and most prevalent feature. The most found location was the left axilla, followed by the ipsilateral cervical areas and mediastinal or hilar area. On chest CT, ground-glass opacities, multiple nodules and pulmonary scarring were the most common findings. For TB patients, the pulmonary infections were more serious, including large masses, severe lymphadenopathy, and extensive pulmonary fibrosis. Pulmonary infection of BCG were more common than TB in CGD patients, but much less severe.

115: THE PULMONARY SEQUELAE OF GASTRO-OESOPHAGEAL REFLUX DISEASE

Abstract Background and aim Gastro-oesophageal reflux disease (GORD) and a spectrum of pulmonary diseases, including idiopathic pulmonary fibrosis (IPF) and bronchiectasis have a complex but poorly understood relationship. IPF is characterised by chronic progressive interstitial pneumonia due to the deposition of fibrous tissue in the pulmonary interstitium. It has a median survival time from diagnosis of 2 to 5 years. Bronchiectasis is defined as irreversible dilatation of the bronchial tree, leading to severe pulmonary infections and gradual deterioration in lung function. Chronic micro aspiration of acid and non-acid refluxate leading to airway irritation, repeated lung injury and respiratory tree remodelling has been implicated in the pathophysiology and progression of both diseases. Current studies have shown that patients with severe GORD will demonstrate pulmonary aspiration of refluxate on scintigraphic scanning. We aim to demonstrate the presence of pulmonary aspiration of refluxate on oesophageal scintigraphy and correlate this with changes of fibrosis, scarring, bronchiectatic and ground glass changes on high resolution computed tomography (HRCT) chest imaging. Methods Retrospective data was obtained from 114 patients who underwent oesophageal scintigraphy reflux studies at a single nuclear medicine imaging facility to evaluate for significant GORD or extra-oesophageal symptoms. Scintigraphy results were then compared with HRCT chest studies of the respective patients. Lobar locations of parenchymal changes on CT were correlated with location of isotope in lungs seen during aspiration on scintigraphy. Results 114 of patients demonstrated evidence of pulmonary aspiration on scintigraphy in the delayed study. All patients had intermittent or continuous full column gastro-oesophageal reflux with evidence of tracer in both lungs or the right lung. Of these patients, 35 underwent HRCT chest studies. 23 of the 35 patients had evidence of pulmonary disease on HRCT, demonstrated by fibrosis, scarring, bronchiectatic changes or ground glass opacities. 11 patients showed evidence of pulmonary fibrosis or scarring, and 10 of these demonstrated co-location of pulmonary aspiration on scintigraphy. 10 of 11 patients with bronchiectactic change were co-located with pulmonary aspiration. Conclusion These results demonstrate a likely relationship between GORD, IPF and bronchiectasis, indicating that the current clinical paradigm of GORD and respiratory disease being two separate entities must be re-evaluated.

Localized Pulmonary Vein Scar Promotes Atrial Fibrillation in High Left Atrial Pressure.

BackgroundPulmonary vein (PV) ablation is unsuccessful in atrial fibrillation (AF) patients with high left atrial (LA) pressure. Increased atrial stretch by increased pressure is proarrhythmic for AF, and myocardial scar alters wall deformation. We hypothesized that localized PV scar is proarrhythmic for AF in high LA pressure.MethodsRadiofrequency energy was delivered locally in the right PV of healthy sheep. The sheep recovered for 4 months. Explanted hearts (n = 9 PV scar, n = 9 controls) were perfused with 1:4 blood:Tyrode’s solution in a four-chamber working heart setup. Programmed PV stimulation was performed during low (∼12 mmHg) and high (∼25 mmHg) LA pressure. An AF inducibility index was calculated based on the number of induction attempts and the number of attempts causing AF (run of ≥ 20 premature atrial complexes).ResultsIn high LA pressure, the presence of PV scar increased the AF inducibility index compared with control hearts (0.83 ± 0.20 vs. 0.38 ± 0.40 arb. unit, respectively, p = 0.014). The diastolic stimulation threshold in high LA pressure was higher (108 ± 23 vs. 77 ± 16 mA, respectively, p = 0.006), and its heterogeneity was increased in hearts with PV scar compared with controls. In high LA pressure, the refractory period was shorter in PV scar than in control hearts (178 ± 39 vs. 235 ± 48 ms, p = 0.011).ConclusionLocalized PV scar only in combination with increased LA pressure facilitated the inducibility of AF. This was associated with changes in tissue excitability remote from the PV scar. Localized PV ablation is potentially proarrhythmic in patients with increased LA pressure.

P-Rex1 Cooperates With TGFβR2 to Drive Lung Fibroblast Migration in Pulmonary Fibrosis

Pulmonary fibrosis is a kind of interstitial lung disease with progressive pulmonary scar formation, leading to irreversible loss of lung functions. The TGF-β1/Smad signaling pathway plays a key role in fibrogenic processes. It is associated with the increased synthesis of extracellular matrix, enhanced proliferation of fibroblasts, and transformation of alveolar epithelial cells into interstitial cells. We investigated P-Rex1, a PIP3-Gβγ–dependent guanine nucleotide exchange factor (GEF) for Rac, for its potential role in TGF-β1–induced pulmonary fibrosis. A high expression level of P-Rex1 was identified in the lung tissue of patients with pulmonary fibrosis than that from healthy donors. Using the P-Rex1 knockdown and overexpression system, we established a novel player of P-Rex1 in mouse lung fibroblast migration. P-Rex1 contributed to fibrogenic processes in lung fibroblasts by targeting the TGF-β type Ⅱ receptor (TGFβR2). The RNA-seq analysis for expression profiling confirmed the modulation of P-Rex1 in cell migration and the involvement of P-Rex1 in TGF-β1 signaling. These results identified P-Rex1 as a signaling molecule involved in TGF-β1–induced pulmonary fibrosis, suggesting that P-Rex1 may be a potential target for pulmonary fibrosis treatment.

Pulmonary scarring and its relation to primary lung cancer.

Background Lung scar carcinoma, so called ‘scarcinoma’, is a perceived entity that was originally described by Friedrich in 1939, in which a carcinoma originates from peripheral scarring of lung tissue. In a recent pilot study, there was a strong association between the geographic location of lung cancer and the presence of scarring of the lung. Objectives To investigate this relationship in the largest cohort to date. Methods We reviewed all radiological images of patients (N=917) with confirmed lung cancer from 2013 - 2017 and included all who had at least a staging computed tomography (CT) of the chest and a tissue diagnosis of primary lung cancer. Two pulmonary specialists categorised all patients as no pulmonary scarring, scarring in the same lobe, scarring in the ipsilateral lung, but not lobe, scarring in the contralateral lung and diffuse scarring both lungs. Results Almost 1 in 3 patients had pulmonary scarring. In patients with lung cancer, if scarring was present, the pulmonary scarring was more likely to be found in the same lobe as the cancer compared with any other lobe, including the same lung (p<0.0001). Conclusion Pulmonary scarring was common, and there was a strong association between the geographical location of scarring and primary lung cancer in those with scarring.

Imaging Patterns of Pediatric Pulmonary Blastomycosis.

The objective of our study was to characterize and update the radiologic patterns of pediatric pulmonary blastomycosis, and correlate the radiologic patterns with patient age. Patients 0-18 years old with pulmonary blastomycosis who underwent chest imaging from 2005 to 2016 were included in this study. The following data were collected: age, sex, clinical information, and imaging findings including presence of extrapulmonary involvement and scarring on follow-up examinations. Concordance between radiography and CT was analyzed. Thirty-six patients (28 boys and eight girls) ranging in age from 3 months to 17 years (mean, 10.5 years) were identified. Consolidation was found in 94.4% of patients and was unilateral in 76.5% of cases and bilateral in 23.5%. Upper (70.6%) and middle (47.1%) lobes were more frequently involved. Air bronchograms were identified in 76.5% of patients with consolidations, masslike consolidation was found in 55.9%, cavitation in 38.2%, and bubbly pattern (i.e., multiple small cavities) in 32.4%. In all patients younger than 5 years, consolidations involved multiple lobes. In 67.6% of patients, consolidations were associated with the following additional pulmonary or pleural abnormalities: pulmonary nodules (50% of patients), diffuse patchy opacification (26.5%), reticulonodular pattern (41.2%), atelectasis (5.9%), pleural effusion (20.6%), and hilar lymphadenopathy (23.5%). Pulmonary scarring was found in 70.4% of patients. Five patients had extrapulmonary involvement. The concordance between radiography and CT was excellent for location and extension of consolidation and diagnosis of cavitation, bubbly pattern, and nodules. The most common pattern of lung involvement from pulmonary blastomycosis in our series was a combination of consolidations with bilateral lung nodules and reticulonodular opacification.

Abstract 5298: Lung cancer risk and scarring on imaging and histology in the National Lung Screening Trial

Abstract Background: The contribution of pulmonary scars to lung cancer development and the degree to which lung cancers cause a scarring response are unclear. Also unknown is how lung scarring impacts lung cancer screening. Methods: We evaluated associations between scarring and lung cancer in the National Lung Screening Trial (NLST), a lung cancer screening trial among current or former, heavy smokers, 55-74 years-old. Baseline scarring (presence vs. absence) on screening low dose computed tomography (LDCT) scan was assessed at baseline (T0). Associations of T0 scarring with screen-detected lung cancers and with interval-detected lung cancers missed on screening within 3 years of T0 screen were analyzed using multinomial logistic regression. Cox proportional hazards models were used to analyze the relationship between T0 scarring and incident lung cancers diagnosed &amp;gt;3 years after T0. Regression models included age, sex, race, smoking history, chronic obstructive pulmonary disease, history of pneumonia, and family history of lung cancer. A thoracic pathologist (first author) evaluated lung cancer pathology slides from the Lung Screening Study (LSS) subset of NLST for scar grade (none, sparse, dense) and maturity (none, immature, intermediate, mature). Associations between T0 scarring on LDCT and histological scarring were examined by logistic regression. Results: NLST’s LDCT arm enrolled 26,722 participants (65% from the LSS). T0 scars were present in 132 (22%) screen-detected, 12 (29%) interval-detected, and 94 (26%) incident lung cancer cases. T0 scarring did not increase or decrease screen-detection of cancers [odds ratio (OR) 95% CI: 1.03 (0.84-1.26)]. However, scarring might increase the chance of an interval-detected cancer [OR (95% CI): 1.54 (0.76-3.12)]. After screening stopped, T0 scarring was associated with increased incident lung cancer risk [hazard ratio (HR) (95% CI): 1.27 (1.00-1.62); P=0.048]. Pathology slides were available for 258 (38%) lung cancers in LSS. Lung scarring was found in 172 (67%) of these cancers with 58 (22%) being characterized as mature scars. On microscopic review, scars were found in 80 (66%) ADC, 46 (82%) squamous cell carcinomas, and 20 (51%) bronchioloalveolar carcinomas. Microscopic scarring tended to be more frequent among cases with T0 scarring than those without T0 scarring (75% vs. 64%; P=0.10) [OR (95% CI): 1.89 (0.98-3.86)]. Conclusion: The association between T0 scarring and incident lung cancer over a period of more than 3 years is consistent with an etiologic contribution of scarring to development of lung cancer. The relationship between T0 scarring and scarring on microscopic evaluation suggests that scarring preceded the cancer, further supporting an etiologic relationship. Finally, the borderline association of T0 scarring and interval cancers suggests that scarring may decrease the sensitivity of screening. Citation Format: Alison L. Van Dyke, Christine D. Berg, Neil E. Caporaso, Hormuzd A. Katki, Anil K. Chaturvedi, Eric A. Engels. Lung cancer risk and scarring on imaging and histology in the National Lung Screening Trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5298. doi:10.1158/1538-7445.AM2017-5298

Pulmonary fibrosis requires cell-autonomous mesenchymal fibroblast growth factor (FGF) signaling

Idiopathic pulmonary fibrosis (IPF) is characterized by progressive pulmonary scarring, decline in lung function, and often results in death within 3-5 five years after diagnosis. Fibroblast growth factor (FGF) signaling has been implicated in the pathogenesis of IPF; however, the mechanism through which FGF signaling contributes to pulmonary fibrosis remains unclear. We hypothesized that FGF receptor (FGFR) signaling in fibroblasts is required for the fibrotic response to bleomycin. To test this, mice with mesenchyme-specific tamoxifen-inducible inactivation of FGF receptors 1, 2, and 3 (Col1α2-CreER; TCKO mice) were lineage labeled and administered intratracheal bleomycin. Lungs were collected for histologic analysis, whole lung RNA and protein, and dissociated for flow cytometry and FACS. Bleomycin-treated Col1α2-CreER; TCKO mice have decreased pulmonary fibrosis, collagen production, and fewer α-smooth muscle actin-positive (αSMA+) myofibroblasts compared with controls. Freshly isolated Col1α2-CreER; TCKO mesenchymal cells from bleomycin-treated mice have decreased collagen expression compared with wild type mesenchymal cells. Furthermore, lineage labeled FGFR-deficient fibroblasts have decreased enrichment in fibrotic areas and decreased proliferation. These data identify a cell autonomous requirement for mesenchymal FGFR signaling in the development of pulmonary fibrosis, and for the enrichment of the Col1α2-CreER-positive (Col1α2+) mesenchymal lineage in fibrotic tissue following bleomycin exposure. We conclude that mesenchymal FGF signaling is required for the development of pulmonary fibrosis, and that therapeutic strategies aimed directly at mesenchymal FGF signaling could be beneficial in the treatment of IPF.

Pulmonary scar carcinoma in South Africa.

The association between lung scarring and the subsequent development of cancer remains controversial. South Africa has one of the highest incidences of tuberculosis in the world, and resultant scarring may predispose to malignancy. The country also carries a very high burden of smoking and smoking-related diseases that may be synergistic in malignant transformation. To assess the frequency of pulmonary scarring in patients with lung cancer. All patients with confirmed lung cancer and a staging computed tomography (CT) scan of the chest were included in this 2-year retrospective study. Pulmonary scarring was categorised according to location as present in: (i) the same lobe as the primary tumour, (ii) a different lobe of the same lung, or (iii) the contralateral lung; or (iv) as diffuse. Post-obstructive bronchiectasis and other changes secondary to cancer were considered not to represent scarring. We identified 435 cases of primary lung cancer. In total, 95 patients (21.8%) had CT evidence of pulmonary scarring. Eighty-three of 85 patients (97.6%) had focal scarring in the same lobe as the primary tumour. Of these, 37 (43.5%) also had scarring involving a different lobe of the same lung, whereas only one (1.2%; p&lt;0.001) had scarring isolated to a different lobe of the same lung. Moreover, 21 patients (24.7%) also had scarring of the opposite lung, but only one patient (1.2%; p&lt;0.001) had scarring isolated to the contralateral lung. Ten patients had diffuse scarring, caused by bronchiectasis (n=5), idiopathic pulmonary fibrosis (n=4) and silicosis (n=1). At least one in five patients with lung cancer had scarring, which was significantly more likely to be present in the same lobe as the tumour, suggesting a predisposition to malignancy.

P1.04-020 Management of Lung Cancer in Patients with past Pulmonary Tuberculosis and Their Possible Causative Link

Lung cancer and tuberculosis cause significant morbidity and mortality worldwide. In the past, it was well known that lung cancer is a specific epidemiological successor of pulmonary tuberculosis (PTB) and that it often develops in scars caused by PTB. In recent years, the relevance of the two diseases has drawn attention in terms of the close epidemiological connection and chronic inflammation-associated carcinogenesis. Although studies have found a relationship between PTB and lung cancer, results for the long-term risk and the role of confounding factors remain inconclusive. Therefore, it is important to delineate the relationship between PTB and lung cancer. Clinical files of all patients diagnosed with lung malignancy between 2011 and 2016 were investigated retrospectively in terms of patient characteristics, definite histopathological diagnosis and stage of tumor, operation methods, and associated complications. Mean age was 56.4 years. Past PTB was detected in 3% of operated carcinoma patients and in 6% of all patients diagnosed with lung malignancy. Central lung cancer was diagnosed in 80% of cases and peripheral in 20%. Epidermoid cancer was diagnosed in 51% of cases, adenocarcinoma in 24% and adenoepidermoid carcinoma in 25%. All cases of operable lung cancers were in stage I and II, while inoperable lung cancers were in stage IIIB and IV. Lobectomy was performed in 100% of the operated cases. None of the patients received anti-TB treatment preoperatively or postoperatively because by the time they were diagnosed with lung cancer, their sputum culture for M.Tuberculosis had converted negative. No postoperative mortality or reactivation of TB was seen. PTB is an important risk factor for lung cancer, possibly related to chronic inflammation and shared risk factors. Our study adds to the evidence that implicates chronic inflammation and pulmonary scarring in the etiology of lung cancer. However, further studies are needed to clarify whether there is a direct causative link between PTB and lung cancer. Surgery is the method of choice in treatment of lung cancer in subjects with past PTB history.

Diagnostic accuracy of MIP slice modalities for small pulmonary nodules in paediatric oncology patients revisited: What is additional from the paediatric radiologist approach?

BackgroundMaximum intensity projection (MIP) CT image reconstruction is a beneficial diagnostic tool in paediatric radiology and can help to distinguish between small pulmonary nodules and adjacent vessels or pulmonary scars. ObjectivesThe purpose of this study was to determine the optimal MIP slice thickness and reconstruction plane for pulmonary nodule detection in paediatric patients. Materials and methodsFifty-five paediatric patients with suspected nodules less than 5mm who were diagnosed with extra-pulmonary malignancy and underwent multidetector computed tomography (MDCT) of the thorax were evaluated. Multiplanar CT 5 mm MIP reconstruction (axial-coronal-sagittal), 2mm axial-coronal MIPs, and 1-mm and 5-mm axial source slices, were interpreted independently by three blinded radiologists. The axial -1mm slices were accepted as the gold standard method as the result of retrospective consensus session in order to get comparison with similar studies. The number of nodules, size and location, distance from pleura, overall time taken and confidence were recorded separately for each observer. ResultsReceiver operating characteristic (ROC) analysis showed significant advantages of MIP images over averaged images. With high significance (p<0.001), coronal 5mm MIP reconstructions were found to be most advantageous over conventional reconstruction techniques. Mean reading time was fastest in axial 5mm MIP images. ConclusionsCompared to conventional paediatric chest CT reconstruction techniques, detection of pulmonary nodules with diameters smaller than 5mm was found to be most sensitive in 5mm coronal MIP images.Diagnostic accuracy of MIP slice modalities for small pulmonary nodules in paediatric oncology patients revisited: What is additional from the paediatric radiologist approach?

Sarcoidosis--a multisystem disorder with variable prognosis

Sarcoidosis is a pneumotropic granulomatous inflammatory multisystem disorder of unknown origin and heterogeneous outcome. In most cases the disease is self-limited, others progress or die from organ involvement, which is often associated with extensive pulmonary scarring or relevant extrapulmonary organ involvement. Therefore, patients with sarcoidosis must be staged for multiorgan involvement. Modern treatment strategies appraise a critical awareness for the effect to side-effect-ratio of long-term immunosuppressive medication.

Diagnostic impact of digital tomosynthesis in oncologic patients with suspected pulmonary lesions on chest radiography.

To assess the actual diagnostic impact of digital tomosynthesis (DTS) in oncologic patients with suspected pulmonary lesions on chest radiography (CXR). A total of 237 patients (135 male, 102 female; age, 70.8 ± 10.4years) with a known primary malignancy and suspected pulmonary lesion(s) on CXR and who underwent DTS were retrospectively identified. Two radiologists (experience, 10 and 15years) analysed in consensus CXR and DTS images and proposed a diagnosis according to a confidence score: 1 or 2 = definitely or probably benign pulmonary or extrapulmonary lesion, or pseudolesion; 3 = indeterminate; 4 or 5 = probably or definitely pulmonary lesion. DTS findings were proven by CT (n = 114 patients), CXR during follow-up (n = 105) or histology (n = 18). Final diagnoses included 77 pulmonary opacities, 26 pulmonary scars, 12 pleural lesions and 122 pulmonary pseudolesions. DTS vs CXR presented a higher (P < 0.05) sensitivity (92 vs 15%), specificity (91 vs 9%), overall accuracy (92 vs 12%), and diagnostic confidence (area under ROC, 0.997 vs 0.619). Mean effective dose of CXR vs DTS was 0.06 vs 0.107mSv (P < 0.05). DTS improved diagnostic accuracy and confidence in comparison to CXR alone in oncologic patients with suspected pulmonary lesions on CXR with only a slight, though significant, increase in radiation dose. • Digital tomosynthesis (DTS) improves accuracy of chest radiography (CXR) in oncologic patients. • DTS improves confidence of CXR in oncologic patients. • DTS allowed avoidance of CT in about 50 % of oncologic patients.

Relationship of Ostial Pulmonary Vein Scar with Reduction in Pulmonary Vein Size after Radiofrequency Ablation for the Treatment of Atrial Fibrillation: An Observational Cohort Study.

Background: Radiofrequency (RF) ablation procedures to electrically isolate the pulmonary veins (PV) from the left atrium are frequently used to treat atrial fibrillation. We hypothesized that changes in PV size after RF ablation would correlate with the volume of ostial PV scar as assessed by high resolution late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). Methods: The study cohort included 23 consecutive subjects. Contrast enhanced PV CMR angiography and LGE were obtained before and 42 ± 18 days after RF ablation. Results: A total of 85 PV were analyzed. Imaging after RF ablation demonstrated a reduction in PV diameter (22 ± 7 mm to 21 ± 6 mm, p = 0.001) and a reduction in cross-sectional area (CSA) (285 ± 141 to 246 ± 110, p < 0.001). There was a significant correlation of PV ostial normalized scar volume with the change in PV diameter (r =-0.21, p =0.049) and CSA (r =-0.28, p =0.010) after AF ablation. PV in the highest quartile for PV scar had the greatest reduction in diameter and CSA (p <0.05 for both). Conclusion: PV size decreases significantly after RF ablation for the treatment of AF. The change in PV size is linearly related to the quantity of LGE scar at the PV ostium.

Circulating Markers of Interstitial Lung Disease and Subsequent Risk of Lung Cancer

Inflammation and pulmonary diseases, including interstitial lung diseases, are associated with increased lung cancer risk. Circulating levels of surfactant protein-D (SP-D) and Krebs von Lungren-6 (KL-6) are elevated in interstitial lung disease patients and may be useful markers of processes contributing to lung cancer. We conducted a nested case-control study, including 532 lung cancer cases, 582 matched controls, and 150 additional controls with chest X-ray (CXR) evidence of pulmonary scarring, in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Serum SP-D and KL-6 levels were measured using enzyme immunoassay. Logistic regression was used to estimate the associations of SP-D and KL-6 with lung cancer and CXR scarring. Cases had higher levels than controls for SP-D (median 118.7 vs. 105.4 ng/mL, P = 0.008) and KL-6 (372.0 vs. 325.8 μg/mL, P = 0.001). Lung cancer risk increased with SP-D (P(trend) = 0.0003) and KL-6 levels (P(trend) = 0.005). Compared with the lowest quartile, lung cancer risk was elevated among those with the highest quartiles of SP-D (OR = 1.87, 95% CI: 1.32-2.64) or KL-6 (OR = 1.58, 95% CI: 1.11-2.25). Among controls, participants with CXR scarring were more likely than those without scarring to have elevated levels of SP-D (quartile 4 vs. quartile 1: OR = 1.67, 95% CI: 1.04-2.70, P(trend) = 0.05) but not of KL-6 (OR = 1.04, 95% CI: 0.64-1.68, P(trend) = 0.99). Circulating levels of SP-D and KL-6 are associated with subsequent lung cancer risk. Our findings support a potential role for interstitial lung disease in lung cancer etiology or early detection, but additional research is needed.

Increased risk of lung cancer in men with tuberculosis in the alpha-tocopherol, beta-carotene cancer prevention study.

Lung cancer and tuberculosis cause significant morbidity and mortality worldwide. Tuberculosis may increase lung cancer risk through substantial and prolonged pulmonary inflammation. However, prospective data on tuberculosis and lung cancer risk are limited. Our study included 29,133 Finnish male smokers followed prospectively in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (1985-2005). Lung cancers were identified through linkage with the Finnish Cancer Registry, and hospital-treated tuberculosis cases were ascertained from the National Hospital Discharge Register. We assessed the association between tuberculosis and lung cancer risk with proportional hazards regression models, adjusting for age and cigarette smoking. Forty-four lung cancer cases occurred among 273 men with tuberculosis (incidence rate = 1,786 per 100,000 person-years). Tuberculosis was associated with a two-fold elevation in lung cancer risk (HR = 1.97; 95% CI = 1.46-2.65) with significant associations observed for both incident (HR = 2.05; 95% CI = 1.42-2.96) and prevalent tuberculosis (HR = 1.82; 95% CI = 1.09-3.02). Lung cancer risk was greatest in the 2-year window after tuberculosis diagnosis (HR = 5.01; 95% CI = 2.96-8.48) but remained elevated at longer latencies (HR = 1.53; 95% CI = 1.07-2.20). Though tuberculosis was associated with an increased risk of squamous cell carcinoma (HR = 3.71), adenocarcinoma (HR = 1.71), small cell carcinoma (HR = 1.72), and lung cancer of other (HR = 1.23) and unknown histologies (HR = 1.35), only the association for squamous cell carcinoma was statistically significant. Tuberculosis is associated with increased lung cancer risk in male smokers. Our results add to the growing body of evidence implicating chronic inflammation and pulmonary scarring in the etiology of lung cancer.

Clinical Modalities and Therapeutic Outcomes; Between Ever-Smokers Versus Never-Smokers of Tuberculosis Patients in Penang, Malaysia

Aim: There is consistent evidence that tobacco smoking has been implicated as a risk factor for tuberculosis infection, disease and death. Study was aimed to identify the impact of smoking on Tuberculosis (TB) clinical characteristics and treatment outcome and to emphasize this association thus may be useful in the management of TB cases. Method: The retrospective, observational and cross-sectional cohort survey was done to compare disease characteristic and clinical presentation during treatment of TB. Result: Five hundred twenty four TB patients were consecutively recruited during the period of the study. Of this, 250 [47.7%] were never smokers. Ever smoking TB patients accounted for 274 [52.3%]. There were significant relationships between smoking status of TB patient with race and initial Mantoux test. But there were no significant as sociation between smoking habit and marital status, patients’ identities, history of chronic disease, history of contact to pulmonary TB patients and BCG scar. Ever smoker TB patients’ were four times more likely to have slower smear conversion at two months compared to non-smoker tuberculosis patients’. Conclusion: We found a high risk of death from smoking induce tuberculosis. Treatment outcomes were not statistically significant with/ without smoking. It was seen that smoking is consider as a risk factor for unfavorable outcomes among TB patients registered in DOTS program in term of therapeutic compliance.