Rounded Opacities Research Articles

A life-threatening encounter: an uncommon case of ruptured hydatid cyst presenting as anaphylactic shock and respiratory distress in a 12-year-old boy

Introduction and importance: Although rare, the spontaneous rupture of a lung hydatid cyst or its perforation into the pleural cavity can give rise to an abrupt onset of symptoms, including cough, fever, hemoptysis (coughing up blood), and hypersensitivity reactions, and can ultimately lead to respiratory failure. Case presentation: A 12-year-old boy was brought to the emergency room with a loss of consciousness. Symptoms included tachypnea, fever, low blood pressure, and overall respiratory distress. After resuscitation, a chest X-ray revealed a distinct, well-defined round opacity located in the lower region of the right lung, leading to mediastinal displacement. After confirmation of the disease, the child was hospitalized in the ICU care and consequently underwent surgery. Treatment was successful and there was no recurrence on the follow-up. Clinical discussion: Studies have demonstrated that the right lower lobe of the lung is the most frequently affected area of the lung by hydatid cysts. Symptomatic and complicated hydatid cysts are a rare concept in children, and only a small percentage, are diagnosed in patients younger than 16 years. Surgery remains the preferred treatment for the majority of patients with pulmonary hydatid disease. It is important to note that combined surgery and chemotherapy represents the current gold standard in managing pulmonary hydatid cyst. Conclusion: Although anaphylactic shock caused by a ruptured lung hydatid cyst is rare, it should be taken into consideration by physicians as a differential diagnosis in patients who also have respiratory symptoms, particularly in endemic areas.

Fissural Pleural Effusion Presenting As ‘Pseudotumor Lung, Phantom Tumour or Round Pneumonia’ In Primary Pulmonary Tuberculosis: Bronchoscopy is Point of Care Test in Presence of Satellite Nodules in Chest Imaging!

Pulmonary Tuberculosis has diverse radiological presentations such as consolidation, cavitation, airway disease, pleural effusion and lymphadenopathy. Pneumonia-like presentation in tuberculosis is very commonly reported in Pulmonary Tuberculosis. Fissural effusion is common in cardiac failure and isolated fissural effusion is rarely described in literature with etiology as tuberculosis. Round pneumonia is commonly described in pediatric cases with community acquired pneumonia and also frequently reported in childhood pulmonary tuberculosis. Round pneumonia is very infrequently reported in adults with pneumonia and to very few published data as due to tuberculosis. In this case report, a 21-year female, presented with constitutional symptoms for 3 months duration with partial response to medical treatment received in line with pneumonia, bronchial asthma and bronchitis. Radiological investigations documented round opacity in right mid-zone with no adventitious breath sound on clinical examination. Recurrent, progressive and partially responding constitutional symptoms was the reason for referral to our center. We have further evaluated with HRCT thorax and documented loculated right horizontal fissural effusion with subpleural parenchymal opacity in right upper lobe posterior segment and right middle lobe lateral basal segment with peri-consolidation satellite nodules in right posterior segment. We have done bronchoscopy due to negative induced sputum microbiological workup. Bronchoscopy guided BAL microbiological workup documented MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test and negative BAL smear for AFB. Treatment initiated with anti-tuberculosis (ATT) and recorded near complete radiological resolution, bacteriological cure after six months with good compliance. High index of suspicion is required while managing these cases with constitutional symptoms and typical radiological features such as ‘round pneumonia or fissural effusion’ in absence of other causes for the same. Fissural effusion or round pneumonia due to tuberculosis is rare in adults but not uncommon. Bronchoscopy is a gold standard test to confirm etiological diagnosis due inadequate or poor quality of induced sputum sample in cases with round pneumonia and fissural effusion. Isolated Fissural effusion secondary to pulmonary tuberculosis is extremely rare in medical literature and this will be first case reported till date.

Squamous cell carcinoma of lung presenting as “Sunray sign” in chest radiograph

Lung cancer is usually diagnosed at a late stage due to a lack of awareness of symptoms to the patient, absence of screening trends by performing chest imaging, and lack of sensitization to the most common radiological signs of lung malignancy to family physicians. Radiological signs will help in suspecting lung cancer earliest and important role in guiding for a protocolized workup to rule out underlying malignancy. “Sunray sign” in chest radiograph is the first time described in the literature and constitutes hilar mass or radiopacity with inhomogeneous linear opacities spreading toward peripheries like sunrays which is the marker of interstitial lymphatic involvement due to the malignant spread of disease. “Sunray sign” is an indicator of underlying lung malignancy with central airway or mainstem bronchus involvement with lymphatic dissemination in linear opacities. In this case report, we have reported a 51-year male presented with cough and hemoptysis with progressive worsening of shortness of breath. Chest X-ray documented round opacity occupying left hilum with linear opacities emerging toward peripheries in lung parenchyma showing typical “Sunray sign.” Bronchoscopy was done after clinical stabilization and showed endobronchial polypoidal growth in the left mainstem bronchus causing partial occlusion of the bronchial lumen. Endobronchial needle aspiration cytology and forceps-guided histopathology suggestive of “squamous cell” type of lung malignancy for “Sunray sign” in our case. A high index of suspicion is a must to rule out underlying malignancy and Bronchoscopy is a “gold standard” test in cases with Sunray signs to confirm the diagnosis.

Cough, with a sac of marbles in the chest.

A 48-year-old male patient presented with productive cough, dyspnea and abdominal pain of 2 months duration. He was diagnosed with diabetes mellitus 6 months ago and had not been regular with his medications. Clinical examination revealed a respiratory rate of 18 per min with room air saturation of 95%, and a paucity of movements with bronchial breath sounds identified on inspection and auscultation, respectively, over the right hemithorax. Chest skiagram and computed tomography images of his thorax are shown below [Figure 1].Figure 1: (a) shows chest skiagram and (b–d) shows high-resolution computed tomography images of the chest. A description of the images is in the accompanying textQuestion: What is the diagnosis? Answer: Pulmonary and hepatic hydatid disease. DISCUSSION The chest skiagram [Figure 1a] revealed a well-defined round radio-opacity in the right mid zone with a crescentic hyperlucent medial margin, called the crescent sign (white arrow). Figure 1b is a coronal view of high-resolution computed tomography (HRCT) scan of the chest lung window, which shows a large cyst in the right lung, with multiple small rounded opacities with fluid attenuation, some of which appear to be floating within it, appearing like a sac of marbles. This is consistent with a diagnosis of a hydatid cyst with multiple daughter cysts within it. There are pockets of air seen between the outer pericyst and inner endocyst, aptly named ‘air-crescent sign’ (blue arrow) and ‘signet ring sign’ (red arrow), which suggest a ruptured or complicated hydatid cyst. Figure 1c, the sagittal section of the HRCT scan of the chest lung window at the level of the aortic outflow tract, shows the ruptured hydatid cyst in the right lung. The daughter cysts have collected in the dependent area of the larger cyst, with some appearing to ‘rise’ over the rest, or the ‘rising-sun sign’ (blue arrow). Also seen is a small air pocket inferiorly (red arrow) between the pericyst and endocyst, called the ‘air-bubble sign’. The presence of air on either side of the endocyst (red arrowheads) gives the appearance of an ‘onion-peel sign’, or the ‘cumbo sign’. Figure 1d shows a large well-defined homogenous cyst in the right lobe of the liver.[1] Blood investigations revealed uncontrolled blood sugar levels. Armed with the characteristic radiology above, and supplemented by a positive serum latex agglutination test for Echinococcus antigen, he was diagnosed with pulmonary and hepatic hydatid disease. He was started on oral albendazole and subsequently underwent pericystectomy of lung cyst along with partial pericystectomy of cyst in the liver. Post-surgery, he is at present asymptomatic and is on regular follow-up. Hydatid disease is a zoonosis, commonly caused by the accidental ingestion of ova of the tapeworm Echinococcusgranulosus, which subsequently develop into larvae in the host intestine and migrate to other parts of the body where they develop into embryos, with the liver and lung being the most commonly involved organs.[1] Characteristic thoracic radiology should lead clinicians to suspect pulmonary hydatid disease, especially when dealing with patients with non-resolving pneumonia or lung mass. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Case report: Small cell lung cancer presenting as the “sunray sign” in the chest radiograph and recurrent hemoptysis

Lung cancer prognosis has not changed in the last few decades due to diagnosis at an advanced stage. Themajority of cases with early disease are asymptomatic, and whenever clinical presentations with cough, dyspnea,hemoptysis, or chest pain occur, when these cases have progressed to an advanced stage. Lung cancer topsthe list of all causes of cancer-related deaths globally and is ahead of digestive tract malignancies. Small-celllung cancer (SCLC) has the worst outcome, with survival rates in the range of weeks to months from diagnosis.SCLC is usually manifested as an extensive disease due to its delayed presentation, early metastasis, systemicnature, and poor response to available treatment options. “sunray sign” in chest radiographs is first describedin literature and constitutes a hilar mass or radiopacity with inhomogeneous linear opacities spreading towardthe periphery like sunrays, which is a marker of interstitial lymphatic involvement due to malignant spread ofdisease. The “sunray sign” is an indicator of underlying lung malignancy with central airway or main stem bronchusinvolvement and lymphatic dissemination in linear opacities. In this case report, we have reported a 51-year-oldmale who presented with cough and hemoptysis with progressive worsening of shortness of breath. Chest X-raysdocumented round opacities occupying the right hilum with linear opacities emerging toward the periphery in lungparenchyma, showing the typical “sunray sign.” Bronchoscopy was done after clinical stabilization and showedendobronchial polypoidal growth in the right main stem bronchus, causing partial occlusion of the bronchial lumen.Endobronchial needle aspiration (EBNA) cytology and forceps-guided (FB) histopathology are suggestive of “smallcell histological type” lung malignancy for the “sunray sign” in our case. A high index of suspicion is a must to ruleout underlying malignancy, and bronchoscopy is the “gold standard” test in cases with the sunray sign to confirmthe diagnosis.

A Starry Myocardium at CT: Cardiac Cysticercosis.

Supplemental material is available for this article.

Ruptured thoracic aortic aneurysm in young male patient: A rare case report

Thoracic aortic aneurysm (TAA) is the ballooning of the upper aspect of the aorta above the diaphragm. We herein present a rare case of a massive ruptured TAA in a young male patient. A 30-year-old male patient diagnosed with massive descending TAA with rupture Crawford Type I showing widening of the superior mediastinum with homogenous round opacity with regular smooth margins observed in left midzone silhouetting the aortic knuckle causing massive hemothorax with the passive collapse of the lung and mediastinal shift to the right. On color doppler it showed typical yin-yang sign. The patient underwent open chest repair with a graft. This case study demonstrated that TAA warrants an early diagnosis because the majority of patients exhibit no symptoms until the aorta ruptures or is dissected, which worsens patient morbidity and mortality. Furthermore, it prompts the necessity of early intervention like either endovascular stent placement or thoracotomy with grafting on the basis of CT angiography findings.

MO101: Atypical Haemolytic Uremic Syndrome Associated with COVID-19: Case Report

BACKGROUND AND AIMSRenal manifestations are common in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report here the case of a patient with confirmed SARS-CoV-2 infection with the clinical picture of atypical haemolytic uremic syndrome (aHUS).METHODCase reportRESULTSOur case is a 31-year-old man with a nasopharyngeal swab with real-time reverse-transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 positive, who was hospitalized in the Clinic of Infectious Diseases. His medical history had a respiratory illness of 7-day evolution characterized by cough, fever, dyspnoea, muscle pain, nausea, vomiting and non-bloody diarrhoea, and decreased urine output with dark colour urine. The chest computed tomography (CT) scan showed few rounded ground-glass opacities.Laboratory tests at admission revealed the following: (i) acute kidney injury stage 3 with a serum creatinine of 3.85 mg/dL (basal value 0.9 mg/dL); serum urea 221 mg/dL. His urinary volume in the first 24 h of hospitalization was 800 mL. (ii) Severe haemolytic anaemia with haemoglobin (Hgb) level of 3.7 g/dL, and peripheral smear showing large number of schistocytes, haptoglobin <10 mg/dL and indirect bilirubin 9.7 mg/dL, direct coombs testing was negative; reticulocyte count 8.9%. (iii) Severe thrombocytopaenia with platelet count of 25 000/µL, prothrombin time 45%, international normalized ratio 1.7, D-dimer 1082 ng/dL and fibrinogen 880 mg/dL.Increased blood levels of enzymes and inflammatory markers were present: lactate dehydrogenase 1867 U/L and protein C reactive 9.1 mg/dL. Electrolyte disturbances characterized by hyperkalaemia, hyperphosphatemia, hypocalcaemia and severe metabolic acidosis. Dynamic changes of laboratory data are presented in Table 1.Table 1.Dynamic changes of laboratory dataLaboratory dataDay 0Day 3Day 7Day 11Day 15Day 19Total serum bilirubin (mg/dL)16.454.8625.8914.69.74.2PT (%)455867889999LDH (U/L)55218671704768667455Serum urea (mg/dL)22121579635645Serum creatinine (mg/dL)3.851.570.70.60.50.6RBC ×106/µL1.221.611.723.233.763.98Hgb (g/dL)3.75.26.58.99.19.3PLTs (K/µL)2533395698178WBC (K/µL)11.224.522.316.214.511.3D-dimer (ng/dL)108246456893423035001800PCR (mg/dL)8.579.117.625.234.451.62Serum fibrinogjen (mg/dL)880647556550450450PT, prothrombin time; LDH, lactate dehydrogenase; RBC, red blood cell; Hgb, haemoglobin; PLT, platelet cell count; WBC, white blood cell; PCR, protein C reactive.The usual liver panel tests, alkaline phosphatase, γ-glutamyl transferase and albuminemia were normal. Toxic hepatitis was excluded. Hepatobiliary and spleen imaging (ultrasonography) was normal.ELISA serologic tests for HIV, hepatitis B, hepatitis C virus and cytomegalovirus were negative. Serological and virological tests for hepatitis A, B, C, HIV and CMV were negative. Stool was negative for Shiga toxin-producing Escherichia coli (STEC).The results of antinuclear antibodies and anti-smooth-muscle antibodies were negative, C3 serum level was mildly depressed (82 mg/dL; normal range 88–201 mg/dL) and C4 serum level was normal (20 mg/dL; normal range 10–44 mg/dL). ADAMTS13 activity was 90% on day 10.He was treated with broad spectrum antibiotics, intravenous dexamethasone and supportive therapy. One week from admission, renal function recovered, and 1 week after intravascular haemolysis and thrombocytopaenia recovered. The patient was hospitalized for 21 days.CONCLUSIONClose monitoring and early intervention can help for a better outcome of SARS-CoV-2 patients complicated with aHUS.

Volume-based tomography for the diagnosis of incipient silicosis in former gold miners

ObjectiveTo evaluate silicosis diagnosed through CT, with integration of clinical-occupational data, in silica-exposed workers presenting chest X-rays within International Labor Organization (ILO) category 0.MethodsCross-sectional study with 339 former gold miners,...

Hemophagocytic Lymphohistiocytosis and Severe Hypoxemia in a Preterm Infant.

Hemophagocytic Lymphohistiocytosis and Severe Hypoxemia in a Preterm Infant.

A Study Of Imaging Findings On Hrct Thorax In Corona Virus Disease 2019 (covid-19)

INTRODUCTION : In December 2019, a large outbreak of a novel coronavirus infection occurred in wuhan hubei province, china. The disease caused by the virus, named novel coronavirus disease (COVID-19) by the world health organization (WHO) can be spread through human to human contact. In human coronavirus can cause spectrum of diseases ranging from asymptomatic patient, simple cold cough to severe acute respiratory syndrome ( SARS). HRCT is very useful to see the extent of disease spread in lungs and to assess the severity of infection. It also helps in monitoring the response and therapeutic effectiveness and prognosis. AIMS AND OBJECTIVES: 1]To evaluate the various HRCT thorax Findings in RT PCR confirmed patients of covid-19 infection. 2] To correlate the findings of HRCT of thorax with patient’s clinical symptoms. METHODOLOGY: A retro- prospective clinical study was carried out on patients who were referred for HRCT thorax to the Department of Radiodiagnosis, Sheth L.G. general hospital having signs and symptoms of covid-19 and whose RT PCR report was awaited and who had undergone HRCT thorax and only patients who were RT PCR test positive within 72 hours were taken in the study. Total of 250 patients from May 2020 to January 2021, who confirmed covid-19 diagnosis with RT-PCR were taken.RESULTS In our study we found, the most common initial CT findings in COVID-19 pneumonia are bilateral, patchy or rounded ground-glass opacities that most frequently occur bilaterally and in the lung periphery with a subpleural basal predominance in left lower lobe. Most common finding were patchy bilateral ground glass opacity most commonly associated with inter and intralobular septal thickening giving crazy paving pattern. Consolidation was also seen with or without GGO suggesting infective etiology. CONCLUSION:HRCT Thorax may be useful as a standard method for the rapid diagnosis of COVID-19 to optimize the management of severely ill PATIENTS.

Quantitative Progression analysis of Post-Acute Sequelae of COVID-19, Pulmonary Fibrosis (PASC-PF) and Artificial Intelligence driven CT scoring of Lung involvement in Covid-19 infection using HRCT-Chest images

Covid-19 is a contagious respiratory disease caused by SARS-COV-2 coronavirus, continue to spread across the world since Jan'2020. Covid-19 can be diagnosed by Nucleic Acid Testing, Antigens Test and Serology Tests or by Digitized Medical Imaging tools like X-ray and High-Resolution Computed Tomography (HRCT)-Chest images. Advanced computational technologies like Artificial Intelligence (AI) - Deep Learning models can assist the radiologist in quantitative, accurate, infection severity and consistent diagnosis, by training the computational system to learn the features of Covid-19 by feeding practitioner's annotated CT images. Quantitative HRCT assessment of severity of COVID-19 infection was widely appreciated by medical fraternity, various government administrations across the world during the early phase of infection. During digitized HRCT-Chest images analysis, the typical features of COVID-19 like bilateral peripheral Ground Glass Opacities (GGO) and/or consolidation, predominantly involving the lower lobes of lung are analyzed. Bilateral peripheral rounded patchy ground glass opacities have been analyzed. HRCT images analysis helps to identify pre-dominant patterns of lung abnormalities like unilateral, multifocal and peripherally GGOs. Most patients make a complete recovery, few of them continue to experience sequalae long after they recover from the acute infection. The most common sequalae symptoms reported were lost of taste or smell, fatigue, and shortness of breath. This constellation of sequalae symptoms, is called Post-Acute Sequelae of COVID-19 (PASC). A subset of patients recovering from infection continue to have persistent respiratory symptoms and chest imaging abnormalities. Our AI-Deep Learning Model is calculating the extent of lung involvement (% of involvement) which is common in the acute phase of infection, was recognized early in the pandemic. While the GGOs and consolidations slowly improved after Covid-19 recovery, fibrosis was seen considerable percentage of patients on follow-up scans after discharge. Results arriving out from our AI model is very much helpful to focus on the post-acute lung disease in COVID-19. Our Deep Learning model analytics on quantitative HRCT metrics of fibrotic lung disease quickly facilitate a role in the evaluation of post covid symptoms, lung fibrotic changes or pulmonary fibrosis.

Case report: Small cell lung cancer presenting as the “sunray sign” in the chest radiograph and recurrent hemoptysis

Lung cancer prognosis has not changed in the last few decades due to diagnosis at an advanced stage. The majority of cases with early disease are asymptomatic, and whenever clinical presentations with cough, dyspnea, hemoptysis, or chest pain occur, when these cases have progressed to an advanced stage. Lung cancer tops the list of all causes of cancer-related deaths globally and is ahead of digestive tract malignancies. Small-cell lung cancer (SCLC) has the worst outcome, with survival rates in the range of weeks to months from diagnosis. SCLC is usually manifested as an extensive disease due to its delayed presentation, early metastasis, systemic nature, and poor response to available treatment options. “sunray sign” in chest radiographs is first described in literature and constitutes a hilar mass or radiopacity with inhomogeneous linear opacities spreading toward the periphery like sunrays, which is a marker of interstitial lymphatic involvement due to malignant spread of disease. The “sunray sign” is an indicator of underlying lung malignancy with central airway or main stem bronchus involvement and lymphatic dissemination in linear opacities. In this case report, we have reported a 51-year-old male who presented with cough and hemoptysis with progressive worsening of shortness of breath. Chest X-rays documented round opacities occupying the right hilum with linear opacities emerging toward the periphery in lung parenchyma, showing the typical “sunray sign.” Bronchoscopy was done after clinical stabilization and showed endobronchial polypoidal growth in the right main stem bronchus, causing partial occlusion of the bronchial lumen. Endobronchial needle aspiration (EBNA) cytology and forceps-guided (FB) histopathology are suggestive of “small cell histological type” lung malignancy for the “sunray sign” in our case. A high index of suspicion is a must to rule out underlying malignancy, and bronchoscopy is the “gold standard” test in cases with the sunray sign to confirm the diagnosis.

A RARE ASYMPTOMATIC LEFT BOCHDALEK HERNIA IN AN ADULT WITH ALLERGIC RHINOSINUSITIS: A CASE REPORT

Bochdalek hernias are extremely rare in adults with only a few cases known worldwide. This is a case of 50-year-old, male who presented at Ear, Nose and Throat clinic of our hospital with symptoms of odynophagia, sore throat, unproductive cough, sneezing, facial fullness and headache. No associated other systemic symptoms. The nasal examination revealed engorged inferior turbinates in the nose bilaterally with septal spur to the left. Chest X-ray done showed a rounded opacity of a soft tissue mass in left middle to lower zone; middle mediastinum adjacent to left lower heart border. Computerised Tomography scan showed a fairly oval hypodense non-enhancing soft mass seen in the left hemithorax with conclusion of part of omentum in the chest due to Bochdalek hernia. He was given treatment for the allergic rhinosinusitis. Due to non-availability of cardiothoracic surgeon in our hospital, the patient was counselled on the problem and danger that may arise and asked to see a cardiothoracic surgeon in the country’s capital city for possible repair of the defect.

One year of COVID-19 pandemic: what we Radiologists have learned about imaging.

Since its outbreak in December 2019, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) hasinfected more than 151 million people worldwide. More than 3.1 million have died from Coronavirus Disease 2019 (COVID-19), the illness caused by SARS-CoV-2. The virus affects mainly the upper respiratory tract and the lungs causing pneumonias of varying severity. Moreover, via direct and indirect pathogenetic mechanisms, SARS-CoV-2 may lead to a variety of extrapulmonary as well as vascular manifestations. Based on a systematic literature search via PubMed, original research articles, meta-analyses, reviews, and case reports representing the current scientific knowledge regarding diagnostic imaging of COVID-19 were selected. Focusing on the imaging appearance of pulmonary and extrapulmonary manifestations as well as indications for imaging, these data were summarized in the present review article and correlated with basic pathophysiologic mechanisms. Typical signs of COVID-19 pneumonia are multifocal, mostly bilateral, rounded, polycyclic or geographic ground-glass opacities and/or consolidations with mainly peripheral distribution. In severe cases, peribronchovascular lung zones are affected as well. Other typical signs are the "crazy paving" pattern and the halo and reversed halo (the latter two being less common). Venous thromboembolism (and pulmonary embolism in particular) is the most frequent vascular complication of COVID-19. However, arterial thromboembolic events like ischemic strokes, myocardial infarctions, and systemic arterial emboli also occur at higher rates. The most frequent extrapulmonary organ manifestations of COVID-19 affect the central nervous system, the heart, the hepatobiliary system, and the gastrointestinal tract. Usually, they can be visualized in imaging studies as well. The most important imaging modality for COVID-19 is chest CT. Its main purpose is not to make the primary diagnosis, but to differentiate COVID-19 from other (pulmonary) pathologies, to estimate disease severity, and to detect concomitant diseases and complications. · Typical signs of COVID-19 pneumonia are multifocal, mostly peripheral ground-glass opacities/consolidations.. · Imaging facilitates differential diagnosis, estimation of disease severity, and detection of complications.. · Venous thromboembolism (especially pulmonary embolism) is the predominant vascular complication ofCOVID-19.. · Arterial thromboembolism (e. g., ischemic strokes, myocardial infarctions) occurs more frequently as well.. · The most common extrapulmonary manifestations affect the brain, heart, hepatobiliary system, and gastrointestinal system.. · Gross A, Albrecht T. One year of COVID-19 pandemic: what we Radiologists have learned about imaging. Fortschr Röntgenstr 2022; 194: 141 - 151.

The Radiology of COVID-19 Pneumonia

Coronavirus disease 2019 (COVID-19) has reached a pandemic stage in March 2020 and currently more than 220 million patients worldwide are infected. The characteristic findings of COVID-19 pneumonia are bilateral, peripheral, rounded ground-glass opacities (GGO) which are dominantly located in the lower lobes and that may be accompanied by consolidation. The distribution of the parenchymal lesions was reported to be bilateral (88%), multi-lobar (78%) and peripheral (76%), with a tendency to involve the posterior regions of the lungs (80%). Several other chest CT findings, such as interlobular septal thickening, bronchiectasis, “crazy paving” and halo sign, have also been reported but with a lower frequency. &#x0D; RSNA has published consensus statements to reduce report variability among radiologists and defined 4 main categories: typical, indeterminate, atypical, and negative, to provide a relative likelihood that these findings are attributable to COVID-19 pneumonia. &#x0D; It is vital to understand that imaging may be normal in the early stages of COVID-19, and many conditions may present with imaging findings mimicking COVID-19 pneumonia. Chest CT may be also used as a useful tool for better identification of patients who will benefit from more aggressive therapy. In addition, CT may be used to evaluate patency of pulmonary and coronary vascular structures and myocardial damage. &#x0D; Although CT scan is not recommended as a diagnostic and screening tool, it can be helpful to clinician for a fast and accurate decision-making and has a crucial role in the diagnosis, risk stratifying, and follow-up of the progression of COVID-19 pneumonia.

Laparoscopic Retrieval of Migrated Intrauterine Contraceptive Device (IUCD)

Background: IUCD remains a popular, effective and a long-term reversible method of contraception that enjoys wide acceptability globally. One of the most serious complications of its insertion is uterine perforation and its migration into the pelvic/peritoneal cavity including the broad ligament. This rare complication can happen where the insertion was done by an inexperienced health personnel. Case Presentation: A case of a 41 year old multiparous woman who had Mirena intrauterine device insertion in the hands of an inexperienced health personnel, who later developed lower abdominal pain and migration of the Mirena IUD into the pelvic cavity (left broad ligament). The thread of the migrated IUD could not be visualized or felt at pelvic examination. An Abdominopelvic ultrasound scan showed a normal sized uterus with a rounded opacity in the lower uterine portion and also a faint posterior acoustic shadow outside the uterus above the uterine fundus. The myometrial echotexture was normal. She had a 2-port laparoscopy under general anaesthesia and had the Mirena removed. Patient was discharged home the following day with no complications. Conclusions: IUCD remains one of the most effective, safe and widely available long-term contraceptive method. However, rare complication such as uterine perforation can occur especially when inserted by an inexperienced health personnel or where it was inserted in a uterus with anatomic abnormality.

Chest CT performance and features of COVID-19 in the region of Abu Dhabi, UAE: a single institute study.

ObjectiveWe aim to investigate high-resolution CT features of COVID-19 infection in Abu Dhabi, UAE, and to compare the diagnostic performance of CT scan with RT-PCR test.MethodsData of consecutive patients who were suspected to have COVID-19 infection and presented to our hospital were collected from March 2, 2020, until April 12, 2020. All patients underwent RT-PCR test; out of which 53.8% had chest CT scan done. Using RT-PCR as a standard reference, the sensitivity and specificity of the CT scan were calculated. We also analyzed the most common imaging findings in patients with positive RT-PCR results.ResultsThe typical HRCT findings were seen in 50 scans (65.8%) out of total positive ones; 44 (77.2%) with positive RT-PCR results and 6 (31.6%) with negative results. The peripheral disease distribution was seen in 86%, multilobe involvement in 70%, bilateral in 82%, and posterior in 82% of the 50 scans. The ground glass opacities were seen in 50/74 (89.3%) of the positive RT-PCR group. The recognized GGO patterns in these scans were: rounded 50%, linear 38%, and crazy-paving 24%. Using RT-PCR as a standard of reference, chest HRCT scan revealed a sensitivity of 68.8% and specificity of 70%.ConclusionThe commonest HRCT findings in patients with COVID-19 pneumonia were peripheral, posterior, bilateral, multilobe rounded ground-glass opacities. The performance of HRCT scan can vary depending on multiple factors.

The unpredictable diagnosis of pulmonary nodules

Abstract Pulmonary nodules are single or multiple rounded opacities with a size of minimum 1 cm diameter visualised in the lung parenchyma. From an anatomopathological point of view, they can be benign or malignant. Most often, these nodules are asymptomatic or with minimal symptoms. Now, we present the case of a 62-year-old patient, a smoker, with exposure to occupational respiratory noxious (cellulose industry – 10 years and printing industry – 30 years) without significant personal respiratory pathological history. He has dyspnoea on moderate exertion, irritable cough, myalgia, arthralgia and physical asthenia. The physical examination reveals the presence of a right bayonet sign. Biologically, an inflammatory syndrome was present, the urine test shows no pathological changes, but the imaging is intriguing. On the other side, the imagistic workup [chest X-ray and computed tomography (CT) scan] was quite surprising: micro/macronodular opacities with variable wall thickness, irregular contours and a tendency to confluence at the bilateral lower lobes level. A bronchoscopy was also performed with bronchioloalveolar lavage (BAL) in the right upper lobe (RUL) and bronchial biopsy at the level of the right upper ventral. The hypotheses are multiple: pulmonary rheumatoid nodules, polyangiitis with granulomatosis, lymphangitis carcinomatosis and tuberculosis. Thoracic surgery determined the diagnosis.

P02.14 Radiotherapy-Associated CT Imaging as a Potential Screening Tool for COVID-19

COVID-19 is associated with characteristic lung CT findings, such as rounded ground-glass opacities in certain distributions. Diagnosing COVID-19 is a particular concern in oncology care, since cancer patients are a vulnerable population who receive treatment in close proximity to other patients and staff. Radiotherapy patients routinely undergo CT simulation before starting therapy. We hypothesized that simulation CT scans obtained on patients treated during the pandemic would reveal characteristic COVID-19 findings and represent a tool to identify patients with asymptomatic COVID-19.