Single Chest Research Articles

Aortic arch calcification with pericardial fat mass detected on a single chest X-ray image is closely associated with the predictive variables of future cardiovascular disease.

This study evaluated the associations between aortic arch calcification (AAC) with pericardial fat (PF) mass detected on a single chest X-ray image and predictive variables of future cardiovascular disease (CVD). The subjects were 353 patients treated with at least one of the hypertension, dyslipidemia or diabetes. All subjects were evaluated for AAC; divided into 3 groups with AAC grades of 0, 1, or 2; and examined for the presence of PF. Carotid intima-media thickness (IMT, n = 353), cardio-ankle vascular index (CAVI, n = 218), the Suita score (n = 353), and cardiovascular risk points defined in the Hisayama study (n = 353), an assessment of the risk of future cardiovascular disease, were measured. The relationship of AAC grades, with or without PF, and CVD risks was evaluated. The IMT (1.62 ± 0.74mm, 2.33 ± 1.26, and 2.43 ± 0.89 in patients with AAC grade 0, 1 and 2, respectively, p < 0.001), CAVI (8.09 ± 1.32, 8.71 ± 1.32, and 9.37 ± 1.17, respectively, p < 0.001), the Suita score (46.6 ± 10.7, 51.8 ± 8.3, and 54.2 ± 8.2, respectively, p < 0.001), and cardiovascular risk points (8.5 ± 2.6, 10.6 ± 2.3, and 11.5 ± 2.3, respectively, p < 0.001) were significantly elevated with AAC progression. Multinomial logistic regression analysis adjusted for clinical characteristics showed that the relative risk ratios of the Suita score or cardiovascular risk points were elevated according to the progress of AAC grade with PF. Therefore, aortic arch calcification with pericardial mass detected on a single chest X-ray image is closely associated with the predictive variables of future CVD.

Deep Learning for Detection of Pulmonary Metastasis on Chest Radiographs.

Background A computer-aided detection (CAD) system may help surveillance for pulmonary metastasis at chest radiography in situations where there is limited access to CT. Purpose To evaluate whether a deep learning (DL)-based CAD system can improve diagnostic yield for newly visible lung metastasis on chest radiographs in patients with cancer. Materials and Methods A regulatory-approved CAD system for lung nodules was implemented to interpret chest radiographs from patients referred by the medical oncology department in clinical practice. In this retrospective diagnostic cohort study, chest radiographs interpreted with assistance from a CAD system after the implementation (January to April 2019, CAD-assisted interpretation group) and those interpreted before the implementation (September to December 2018, conventional interpretation group) of the CAD system were consecutively included. The diagnostic yield (frequency of true-positive detections) and false-referral rate (frequency of false-positive detections) of formal reports of chest radiographs for newly visible lung metastasis were compared between the two groups using generalized estimating equations. Propensity score matching was performed between the two groups for age, sex, and primary cancer. Results A total of 2916 chest radiographs from 1521 patients (1546 men, 1370 women; mean age, 62 years) and 5681 chest radiographs from 3456 patients (2941 men, 2740 women; mean age, 62 years) were analyzed in the CAD-assisted interpretation and conventional interpretation groups, respectively. The diagnostic yield for newly visible metastasis was higher in the CAD-assisted interpretation group (0.86%, 25 of 2916 [95% CI: 0.58, 1.3] vs 0.32%, 18 of 568 [95% CI: 0.20, 0.50%]; P = .004). The false-referral rate in the CAD-assisted interpretation group (0.34%, 10 of 2916 [95% CI: 0.19, 0.64]) was not inferior to that in the conventional interpretation group (0.25%, 14 of 5681 [95% CI: 0.15, 0.42]) at the noninferiority margin of 0.5% (95% CI of difference: -0.15, 0.35). Conclusion A deep learning-based computer-aided detection system improved the diagnostic yield for newly visible metastasis on chest radiographs in patients with cancer with a similar false-referral rate. © RSNA, 2021 Online supplemental material is available for this article.

A federated approach for detecting the chest diseases using DenseNet for multi-label classification

Multi-label disease classification algorithms help to predict various chronic diseases at an early stage. Diverse deep neural networks are applied for multi-label classification problems to foresee multiple mutually non-exclusive classes or diseases. We propose a federated approach for detecting the chest diseases using DenseNets for better accuracy in prediction of various diseases. Images of chest X-ray from the Kaggle repository is used as the dataset in the proposed model. This new model is tested with both sample and full dataset of chest X-ray, and it outperforms existing models in terms of various evaluation metrics. We adopted transfer learning approach along with the pre-trained network from scratch to improve performance. For this, we have integrated DenseNet121 to our framework. DenseNets have a few focal points as they help to overcome vanishing gradient issues, boost up the feature propagation and reuse and also to reduce the number of parameters. Furthermore, gradCAMS are used as visualization methods to visualize the affected parts on chest X-ray. Henceforth, the proposed architecture will help the prediction of various diseases from a single chest X-ray and furthermore direct the doctors and specialists for taking timely decisions.

Early discharge after thoracoscopic anatomical pulmonary resection for non-small-cell lung cancer.

Although video-assisted thoracic surgery (VATS) has shortened hospitalization duration for non-small-cell lung cancer (NSCLC) patients, the factors associated with early discharge remain unclear. This study aimed to identify patients eligible for a 72-h stay after VATS anatomical resection. Monocentric retrospective study including all consecutive patients undergoing VATS anatomical resection for NSCLC between February 2010 and December 2019. Two groups were defined according to the discharge: 'early discharge' (within 72 postoperative hours) and 'routine discharge' (at >72 postoperative hours). A total of 660 patients with a median age of 66.5 years (interquartile range 60-73 years) (female/male: 321/339) underwent VATS anatomical pulmonary resection for NSCLC [segmentectomy in 169 (25.6%), lobectomy in 481 (72.9%), bilobectomy in 8 (1.2%) and pneumonectomy in 2 (0.3%) patients]. The cardiopulmonary and Clavien-Dindo III-IV postoperative complication rates were 32.6% and 7.7%, respectively. The median postoperative length of stay was 6 days (interquartile range 4-10 days). In total, 119 patients (18%) could be discharged within 72 h of surgery. On multivariable analysis, the factors significantly associated with an increased likelihood of early discharge were: body mass index >20 kg/m2 [odds ratio (OR) 2.37], absence of prior cardiopathy (OR 2), diffusing capacity of the lung for carbon monoxide >60% (OR 1.82), inclusion in an enhanced recovery after surgery protocol (OR 2.23), use of a single chest tube (OR 5.73) and postoperative transfer to the ward (OR 4.84). Factors significantly associated with a decreased likelihood of early discharge were: age >60 years (OR 0.53), American Society of Anaesthesiologists score >2 (OR 0.46) and use of an epidural catheter (OR 0.41). Readmission rates were not statistically different between both groups (5.9% vs 3.1%; P = 0.17). Age, pulmonary functions and comorbidities may influence discharge after VATS anatomical resection. The early discharge does not increase readmission rates.

ОЦЕНКА РАДИАЦИОННОГО РИСКА ДЛЯ ПАЦИЕНТОВ ПРИ КТ-ДИАГНОСТИКЕ COVID-19 ОРГАНОВ ГРУДНОЙ КЛЕТКИ

Purpose: To assess effective radiation doses for chest CT for the diagnosis of COVID-19 and calculate the radiation risk of the effects of this exposure.&#x0D; Material and methods: We analyzed the results of 1003 CT examinations of the chest performed in patients (6.2 %‒children 12–14 years, 15.3 %‒adolescents 15–19 years, 60.1 %‒adults 20–64 years, 18.4 %‒older persons 65 years and older) with suspected COVID-19 during one week in October 2020 in the city diagnostic center. In each group, the average effective dose (ED, mSv) was calculated.&#x0D; Results: The average ED values and confidence intervals (P=0.05) for patients with a single CT scan were: in children 2.59±0.19 mSv, in adolescents 3.23±0.17 mSv, in adults 3.43±0.08 mSv, in older persons 3.28±0.19 mSv. The maximum radiation risk indicators were observed in groups of children (24.1×10-5) and adolescents (23.3×10-5). For adult patients the means risk was 14.4×10-5. In groups of women radiation risk was 1.3–2.3 twice as high, as in male patients. The risk values in children, adolescents and adults are in the range 10×10-5 – 100×10-5 (low), for the older patients were 2.6×10-5 (very low). &#x0D; Conclusion: Because of the study established effective radiation doses for chest CT of patients with the diagnosis of COVID-19 and the radiation risk for 1-3 times chest CT by age and sex of patients was calculated. It was found that the radiation risk for single, double and triple chest CT for patients under 65 is low, 65 and older is very low. Taking into account the radiation risk during CT is necessary to reduce the long-term consequences of radiation exposure on the population.

Detecting Coronary Artery Calcium on Chest Radiographs: Can We Teach an Old Dog New Tricks?

Detecting Coronary Artery Calcium on Chest Radiographs: Can We Teach an Old Dog New Tricks?

Predicting Prolonged Hospitalization and Supplemental Oxygenation in Patients with COVID-19 Infection from Ambulatory Chest Radiographs using Deep Learning

Rationale and ObjectivesThe clinical prognosis of outpatients with coronavirus disease 2019 (COVID-19) remains difficult to predict, with outcomes including asymptomatic, hospitalization, intubation, and death. Here we determined the prognostic value of an outpatient chest radiograph, together with an ensemble of deep learning algorithms predicting comorbidities and airspace disease to identify patients at a higher risk of hospitalization from COVID-19 infection.Materials and MethodsThis retrospective study included outpatients with COVID-19 confirmed by reverse transcription-polymerase chain reaction testing who received an ambulatory chest radiography between March 17, 2020 and October 24, 2020. In this study, full admission was defined as hospitalization within 14 days of the COVID-19 test for > 2 days with supplemental oxygen. Univariate analysis and machine learning algorithms were used to evaluate the relationship between the deep learning model predictions and hospitalization for > 2 days.ResultsThe study included 413 patients, 222 men (54%), with a median age of 51 years (interquartile range, 39–62 years). Fifty-one patients (12.3%) required full admission. A boosted decision tree model produced the best prediction. Variables included patient age, frontal chest radiograph predictions of morbid obesity, congestive heart failure and cardiac arrhythmias, and radiographic opacity, with an internally validated area under the curve (AUC) of 0.837 (95% CI: 0.791–0.883) on a test cohort.ConclusionDeep learning analysis of single frontal chest radiographs was used to generate combined comorbidity and pneumonia scores that predict the need for supplemental oxygen and hospitalization for > 2 days in patients with COVID-19 infection with an AUC of 0.837 (95% confidence interval: 0.791–0.883). Comorbidity scoring may prove useful in other clinical scenarios.

The financial burden of rib fractures: National estimates 2007 to 2016

BackgroundThe aim of this study is to define the cost of rib fracture hospitalization by single, multiple, and flail type using a nationally representative sample. MethodsThe national inpatient sample (NIS) was used to identify patients with a primary diagnosis of rib fracture hospitalization 2007-2016. International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes were used to characterize patients as having single, multiple, or flail chest rib fractures. Patients with only trauma related diagnosis groups (DRG) at the time discharge were included in the final sample. The cost of hospitalization was obtained by converting reported charges into cost using the all-payer inpatient cost-to-charge ratio (CCR) for all hospitals in the NIS data. The log of cost was modeled using multivariate linear regression. The rib fracture type was the primary predictor in the model. ResultsThere were 373,053 rib fracture admissions during 2007-2016. The average cost per hospitalization was $10,169 (95%Confidence Interval [CI]: 9,942–10,395), which translated into a national expenditure of $3.64 billion over 10 years. The cost of rib fracture hospitalization increased from $209 million in 2007 to $469 million in 2016. Compared to single rib fracture patients, the cost of hospitalization for multiple rib fractures and flail chest was 3% (p = 0.001) and 5% (p=0.02) higher, respectively. Higher injury severity score, total number of body regions injured and longer length of stay were associated with higher rib fracture hospitalization cost. ConclusionsRib fractures affect ~22,000-45,000 people per year in the United States. The cost of rib fractures is over $469 million per year and is increasing over time. Multiple rib fractures and flail chest rib fractures are associated with increased cost. Pathways to improve care in patients with rib fractures should consider the cost of treatment.

Effects of the technique parameters on the imaging performance of the dual-energy chest radiography

Conventional chest-radiography images are the most basic X-ray imaging system for diagnosing lung diseases. However, space-averaging increases due to the overlapping of anatomy structures as three-dimensional information are reduced in two-dimensions. A dual-energy X-ray imaging (DEI) technique for resolve space-averaging is used to increase the conspicuity of the lesion (i.e., lung nodule and calcification) by suppressing anatomical background noise. DEI techniques perform the weighted log-subtraction using the attenuation characteristics of the material for low- and high-kilovoltage-peak (kVp) X-rays. And the weighting factor is calculated to suppressing anatomical background. The objective of this research is to increase the lesion conspicuity in lung regions by optimizing DE technique parameters. DE technique has been applied to three phantoms mimicking the average, thick, and thicker adult chest thicknesses while maintaining the total incident dose equivalent to that used to obtain a single chest radiograph. Investigating DE technique parameters include the added filtration, the low- and high-kVp pair, and the dose allocation between low- and high-kVp setups at the total dose equal to or less than that of the conventional chest radiograph. And the DE image performances investigated through contrast-to-noise ratio, modulation-transfer function, noise-power spectrum, and detective quantum efficiency.

Off-Label Use of T-Tube as Chest Drainage for Uniportal Surgery

Uniportal video-assisted thoracic surgery implies the positioning of a single chest drain at the mid thorax level. Therefore, this tube cannot reach simultaneously the basal and apical regions of the pleural cavity. We propose the off-label use of a T-tube usually utilized in biliary duct surgery. Despite mid thorax insertion, this tube allows effective air and fluid drainage of the entire pleural space. We tested it in 10 patients undergoing uniportal surgery and report satisfactory results. No postoperative chest tube displacement, pleural effusion infection, or subatelectasies occurred. We conclude that the T-tube represents a good alternative in patients at high risk of postoperative effusion undergoing the uniportal approach.

Early Radiologic Diagnosis of Pulmonary Infection in Febrile Neutropenic Patients: A Comparison of Serial Chest Radiography and Single CT Chest.

Objective The purpose of this study is to compare the early radiologic diagnosis of pulmonary infection between serial chest radiography (chest film) and single chest computed tomography (CT chest) in the first seven days of febrile neutropenia. Methods This study included 78 patients with hematologic malignancies who developed 107 episodes of febrile neutropenia from January 2012 to October 2017 and had a chest film performed within the first seven days. Demographic and radiographic data were retrospectively reviewed. Three radiologists independently and blindly evaluated chest films and CT chests. The sensitivity, specificity, and correlation of chest film with absolute neutrophil count were carried out. Results A total of 222 chest films were performed during this period and found thirty-nine episodes (36.4%) of radiographic active pulmonary infection. The diagnosis of clinical positive for pulmonary infection is 44.8% (48/107). Sensitivity, specificity, positive predictive value, and negative predictive value of serial chest film in the early radiologic diagnosis of pulmonary infection are 50%, 74%, 61%, and 64%, respectively. The false-positive rate was 14%, and the false-negative rate was 22%. For single CT chest examinations, twenty-six studies were assessed, and 42.3% was indicative of radiographic active pulmonary infection. Sensitivity, specificity, positive predictive value, and negative predictive value of CT chest in the early radiologic diagnosis of pulmonary infection are 91%, 40%, 53%, and 86%, respectively. The false-positive rate was 60%. The absolute neutrophil count was not useful for predicting radiographic active pulmonary infection. Conclusion Serial chest film for early radiologic diagnosis of pulmonary infection within the first seven days of febrile neutropenia has lower sensitivity with higher specificity as compared to a single CT chest. Conversely, CT chest may not only have a higher sensitivity in determining early pulmonary infection but also has a higher rate of false-positives.

Risks Advantages and Early Workability Diagnosis of CT Lung Cancer of Smokers Contaminated with HIV

Aim: Cellular breakdown in the lungs screening with Chest registered Tomography (CT) is gainful in smokers matured 55 to 74 years. Methods: We considered the dangers, advantages and achievability of ahead of schedule cellular breakdown in the lung’s analysis with CT in HIV-contaminated smokers. French, multicenter, single round chest CT concentrate in France, acknowledged between May 2019 and April 2020. Our current research was conducted at Mayo Hospital, Lahore from October 2019 to September 2020. Patients were HIV-contaminated smokers at any rate 40 years, in any event 23 pack years, with a CD4 þ T-lymphocyte nadir check under 360 cells/ml. Our current research was conducted at Jinnah Hospital, Lahore from May 2019 to April 2020. Single chest CT with a proposed normalized workup calculation of positive pictures. Fundamental result measure: The result was the quantity of histologically demonstrated lung malignancies determined by CT to have a 2-year development. Results: Median age of the 442 included patients was 49.8 years, 81.6% were under 55 a long time, 84% were men, middle smoking was 30 pack-years, middle nadir and last CD4 þ cell tallies were 168 and 574 cells/ml, separately, and 93% of patients had a plasma HIV RNA under 50 duplicates/ml. A positive picture at standard was accounted for in 95 (23%) patients, and 18 (4.5%) patients had 19 intrusive methodologies with no genuine unfriendly occasions. Cellular breakdown in the lungs was analyzed in 12 patients (six at beginning phases), of which nine (3.1%, 96% certainty span: 0.9- 3.9) were CT recognized, and eight in patients under 57 years. Conclusion: Early cellular breakdown in the lung’s analysis with CT in HIV-contaminated smokers was plausible, safe, and yielded a critical number of tumors. Cellular breakdown in the lungs screening of HIV infected smokers with a significant history of immunodeficiency uncovered a considerable number of tumors at more youthful ages than the focused-on reach in everybody

Uniportal surgical biopsy, without orotraqueal intubation, without thoracic drainage in intersticial pulmonary disease: initial results.

interstitial lung disease comprises a group of lung diseases with wide pathophysiological varieties. This paper aims to report the video thoracoscopic surgical biopsy in patients with interstitial lung disease through a single minimal chest incision, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers. this study is a series of 14 cases evaluated retrospectively, descriptively, where patients underwent a pulmonary surgical biopsy from January 2019 to January 2020. The patients included in the study had diffuse interstitial lung disease without a defined etiological diagnosis. none of the patients had transoperative complications, there was no need for chest drainage in the postoperative period, and the patients pain, assessed using the verbal scale, had a mode of 2 (minimum value of 1 and maximum of 4) in the post immediate surgery and 1 (minimum value of 1 and maximum of 3) at the time of hospital discharge. The length of hospital stay was up to 24 hours, with 12 patients being discharged on the same day of hospitalization. therefore, it is concluded in this series of cases that the performance of uniportal video-assisted thoracoscopic surgery procedures to perform lung biopsies, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers, bring benefits to the patient without compromising his safety. Further larger studies are necessary to confirm the safety and efficiency of this method.

Impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms

ObjectivesCoronary microvascular dysfunction (CMD) is considered to cause angina pectoris in a large proportion of women with no obstructive coronary artery disease (CAD). However, data supporting a relation between angina...

The Cost of Living Remotely: Long Distance Travel Associated with Overutilization of Chest Radiography Following Thoracic Surgery

Background: Healthcare overutilization is a crisis in the US. We sought to investigate if travel distance and/or other perioperative factors were associated with the ordering of unnecessary pre-discharge chest x-rays in thoracic surgery patients at a rural institution. Methods: This was a retrospective cohort study of adults admitted after undergoing thoracic surgery with a chest tube placed at a rural, academic center. Prior to discharge, all patients underwent a standard single post-chest tube removal chest x-ray. Our primary outcome was the incidence of an unnecessary repeat (more than the standard one) chest x-ray in an asymptomatic patient. Our primary exposure was travel distance (driving distance from home zip code to hospital), dichotomized at 50 miles (short vs. long). A multivariable analysis was performed to identify if travel distance or other factors were associated with undergoing an unnecessary repeat chest x-ray. Results: Of 241 included patients; 155 (64%) traveled long distance and 86 (36%) traveled short distance. There were no preoperative differences between patients. On multivariable analysis, long distance travel increased the odds of undergoing an unnecessary repeat chest x-ray by almost three-fold compared to short distance travel (Odds Ratio: 2.80, 95% Confidence Interval: 1.32-5.97). A patient’s rural designation, the operating surgeon, and having a postoperative complication were also independently associated with this unnecessary chest x-ray. Conclusions: Long distance travel independently increased the odds of a thoracic surgery patient undergoing an unnecessary pre-discharge chest x-ray. Awareness of this overutilization may improve the efficiency of postoperative care pathways in rural settings.

One-View Chest Radiograph for Initial Management of Most Ambulatory Patients with Rib Pain.

Rib series are frequently ordered for ambulatory patients who complain of rib pain or have suffered chest trauma. However, the utility of rib series has been questioned in previous studies. The objective of this study was to compare the efficacy of rib series to a single view posteroanterior chest radiograph in the clinical management of most ambulatory patients with rib pain. We reviewed all rib series for rib pain performed between January 1, 2016 and December 31, 2016, excluding patients with suspected bony metastasis, chest or rib deformities, and follow-up studies for prior rib series. We recorded any follow-up imaging and/or surgical intervention within 30 ± 7 days, fracture diagnosis, and complications relating to rib fractures. One thousand seven hundred ninety-one rib series were performed during the study period. Of these, 1168 (65.2%) rib series were performed because of trauma as reported in the clinical indication (trauma cohort). Six hundred twenty-three (34.8%) of the rib series were performed for clinical indications which did not specify acute trauma (nontrauma cohort). There were 323 (17.9%) rib series that resulted in a fracture diagnosis and 95 (5.3%) that resulted in a possible fracture diagnosis. There were 50 (2.8%) effusions, 7 (0.4%), pneumothoraces, and 1 (0.1%) hemothorax detected. Two patients, 1 each from the trauma and nontrauma cohorts, underwent subsequent intervention during the follow-up period. In both cases, the findings which led to the subsequent intervention could be seen on the initial posteroanterior chest radiograph. Single-view chest radiograph provides sufficient information for the clinical management of ambulatory patients with rib pain.

Withdrawal: "Single versus double chest drains after pulmonary lobectomy: a systematic review and meta-analysis" Jinzhi You, Hailing Zhang, Wei Li, Ninghuang Dai, Zhongfeng Zheng.

Background Previous randomized controlled trials have compared the efficacy and safety of singe chest drain (SCD) and double chest drains (DCD) in the patients with pulmonary lobectomy, yet the results remain inconsistent. Therefore, we aimed to conduct this present systematic review and meta-analysis to evaluate the role of SCD and DCD in the patients with pulmonary lobectomy. Methods PubMed, Medline, EMBASE, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang, Weipu and China Biomedical Literature databases were searched up to Feb 28, 2020 to identify the potential RCTs on SCD and DCD in the patients with pulmonary lobectomy. The main outcomes including verbal pain score, the duration of drainage(days), the length of hospital stay(days), the incidence of air leak and re-drainage were collected and analyzed. All the data were processed and analyzed with software RevMan 5.3. We calculated and analyzed the odds ratios (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes. Results A total of 11 RCTs with 1214 patients were included, with 589 patients undergone SCD treatment, and 625 patients undergone DCD treatment. The verbal pain score(MD=-0.54, 95%CI (-0.87, -0.21)), the duration of drainage (MD=-0.65, 95%CI (-1.04, -0.26)) and the length of hospital stay(MD=-0.55, 95%CI (-0.80, -0.29)) in SCD group was significantly less than that of DCD group. There were no significant differences on the incidence of air leak (OR=1.35, 95%CI (0.86, 2.11)) and re-drainage (OR=0.88, 95%CI (0.41, 1.90)) among two groups. Conclusions SCD is a safe option, and it has the advantages of less postoperative pain, shortened duration of drain and reduced length of hospital stay when compared with DCD in the patients with pulmonary lobectomy.

Minimally invasive pulmonary valve replacement via left anterior minithoracotomy.

ABSTRACT Pulmonary valve replacement is one of the most common indications for reoperation in adults with congenital heart disease. Finding an alternative to repeat median sternotomy may facilitate recovery and shorten hospital stay. We present our technique of left anterior minithoracotomy for pulmonary valve replacement.

Should computed tomography and bronchoscopy be routine examinations for chronic cough?

Chronic cough is a common symptom of many diseases. Guidelines on cough from different countries recommend chest X-ray as the first-line examination. However, as compared to computerized tomography (CT), chest X-ray is insensitive in the diagnosis of many diseases. We speculate that CT is more helpful in excluding the causes of long-term cough, such as bronchial tumors and pulmonary interstitial diseases, which prevents patients from receiving unnecessary examinations and diagnostic treatments for chronic cough. In addition, a single chest CT is safe and affordable in some regions. Therefore, chest CT may be recommended as a first-line examination for patients with chronic cough. In addition, although bronchoscopy is employed as a further examination for chronic cough, it plays an important role in the diagnosis of chronic cough, especially in rare bronchial diseases such as amyloidosis and foreign body inhalation. Induced sputum cytology was not accepted as a necessary examination for chronic cough, but it becomes a first-line examination until physicians recognize that non-asthmatic eosinophilic bronchitis is a common cause of chronic cough. Therefore, we speculate that the roles of chest CT and bronchoscopy in the identification of causes of chronic cough are increasingly important; in some regions, or for patients suspicious for uncommon causes of chronic cough, CT and bronchoscopy are recommended as first-line examinations.

Chronic pulmonary aspergillosis – chronic cavitary pulmonary aspergillosis: a case report

Background: Chronic pulmonary aspergillosis (CPA) includes several disease manifestations. Almost all cases of CPA are caused by A. fumigatus. There are several underlying diseases that predispose patients to CPA. Treatment is often individualised depending on underlying disease process and the patient’s pulmonary status.Case presentation: A 57-year-old male with a history of renal transplant in the year 2006, routine on immunosuppressants, pulmonary tuberculosis relapse on anti-tuberculosis medications, aspergillosis on long term voriconazole, and DM type 2 presented with dyspnea, massive hemoptysis and productive cough 3 months before admission. Patient was diagnosed with aspergillosis in October 2012 through bronchoscopy. Microbiology result showed Aspergillus flavus. Enhanced thoracal CT result showed a cavitating nodule with soft tissue lesion in upper right lung, with fibrotic changes in the right lung and mild tubular bronchiectasis, with bilateral pleural thickening. Patient was then planned for lung resection due to the persistent pulmonary cavity. However, his clinical condition worsened and the patient passed away a few days before surgery.Conclusion: Diagnosing chronic pulmonary aspergillosis can often be challenging. The diagnosis of CPA can be inferred from a single chest radiograph. Despite this, detailed and sequentially acquired radiographic data may be required to observe both the typical radiographic features and the very slow progression of this disease. Treatment is often individualised. Azoles are the antifungal drug of choice when required.