Subpleural Regions Research Articles

Evaluation of Progressive Architectural Distortion in Idiopathic Pulmonary Fibrosis Using Deformable Registration of Sequential CT Images.

Monitoring the progression of idiopathic pulmonary fibrosis (IPF) using CT primarily focuses on assessing the extent of fibrotic lesions, without considering the distortion of lung architecture. To evaluate three-dimensional average displacement (3D-AD) quantification of lung structures using deformable registration of serial CT images as a parameter of local lung architectural distortion and predictor of IPF prognosis. Patients with IPF evaluated between January 2016 and March 2017 who had undergone CT at least twice were retrospectively included (n = 114). The 3D-AD was obtained by deformable registration of baseline and follow-up CT images. A computer-aided quantification software measured the fibrotic lesion volume. Cox regression analysis evaluated these variables to predict mortality. The 3D-AD and the fibrotic lesion volume change were significantly larger in the subpleural lung region (5.2 mm (interquartile range (IQR): 3.6-7.1 mm) and 0.70% (IQR: 0.22-1.60%), respectively) than those in the inner region (4.7 mm (IQR: 3.0-6.4 mm) and 0.21% (IQR: 0.004-1.12%), respectively). Multivariable logistic analysis revealed that subpleural region 3D-AD and fibrotic lesion volume change were independent predictors of mortality (hazard ratio: 1.12 and 1.23; 95% confidence interval: 1.02-1.22 and 1.10-1.38; p = 0.01 and p < 0.001, respectively). The 3D-AD quantification derived from deformable registration of serial CT images serves as a marker of lung architectural distortion and a prognostic predictor in patients with IPF.

Cone-Beam Computed Tomography Improves Location of Transbronchial Cryobiopsy in Interstitial Lung Disease with Limited Extent

Introduction: Transbronchial lung cryobiopsy has been recommended as an acceptable alternative to surgical approach for making a histopathological diagnosis in patients with interstitial lung disease (ILD) of undetermined type. In limited diseases (especially if distributed along the subpleural region), sampling the specific area in which the pathological process is more represented could be challenging. Aim of the study was to determine the potential benefit of utilizing cone-beam computed tomography-guided cryobiopsy in patients with limited extent of ILD on CT scan and determine the single impact of each sequential biopsy progressively increasing the total number of biopsies. Methods: This study is a prospective analysis of patients with undetermined ILD and CT scan extent <15% undergoing cone-beam CT-guided cryobiopsy. Each biopsy sample was collected and processed individually and pathologic interpretations were performed sequentially with the pathologist reformulating a new report with the addition of each sample (cumulative yield). Results: Thirty six patients were enrolled. Pathological diagnostic yield was >90%, with almost 80% of diagnostic samples being the first one; when a second biopsy was performed, mean diagnostic yield increased with only a moderately significant difference. No severe adverse events were observed; pneumothorax was documented in 27.8% of the cases. Conclusion: Sequential individual collection and pathologic interpretation of each biopsy sample has confirmed the possibility of obtaining a diagnostic specimen at the first pass if transbronchial cryobiopsy is performed under cone-beam CT.

A Minimally Invasive Robotic Tissue Palpation Device.

Robot-assisted minimally invasive surgery remains limited by the absence of haptic feedback, which surgeons routinely rely on to assess tissue stiffness. This limitation hinders surgeons' ability to identify and treat abnormal tissues, such as tumors, during robotic surgery. To address this challenge, we developed a robotic tissue palpation device capable of rapidly and non-invasively quantifying the stiffness of soft tissues, allowing surgeons to make objective and data-driven decisions during minimally invasive procedures. We evaluated the effectiveness of our device by measuring the stiffness of phantoms as well as lung, heart, liver, and skin tissues obtained from both rats and swine. Results demonstrated that our device can accurately determine tissue stiffness and identify tumor mimics. Specifically, in swine lung, we determined elastic modulus (E) values of 9.1 ± 2.3, 16.8 ± 1.8, and 26.0 ± 3.6 kPa under different internal pressure of the lungs (PIP) of 2, 25, and 45 cmH2O, respectively. Using our device, we successfully located a 2-cm tumor mimic embedded at a depth of 5 mm in the lung subpleural region. Additionally, we measured E values of 33.0 ± 5.4, 19.2 ± 2.2, 33.5 ± 8.2, and 22.6 ± 6.0 kPa for swine heart, liver, abdominal skin, and muscle, respectively, which closely matched existing literature data. Results suggest that our robotic palpation device can be utilized during surgery, either as a stand-alone or additional tool integrated into existing robotic surgical systems, to enhance treatment outcomes by enabling accurate intraoperative identification of abnormal tissue.

CT Quantification of Interstitial Lung Abnormalities and Changes of Agerelated Pathomorphology.

Interstitial lung abnormalities (ILA) are associated with further disease progression, increased mortality risk, and decline in lung function in the elderly, which deserves enough attention. The objective of this study was to quantify the extent of interstitial lung abnormalities (ILA) in a non-smoking asymptomatic urban cohort in China using low-dose CT (LDCT) and to analyze the age-related pathological changes. We retrospectively analyzed clinical data and chest LDCT images from a cohort of 733 subjects who were categorized into 3 groups: 18-39, 40-59, and ≥60 years old according to age. Furthermore, we selected 40 cases of wax-embedded lung tissue blocks archived after pulmonary bullectomy and the same age groups were categorized. Four representative CT signs of ILA, including interlobular septal thickening (ILST), intralobular interstitial thickening (ILIT), ground-glass opacity (GGO), and reticular shadow (RS), were semi-quantified based on the percentage of the affected area. The scores and distribution of four CT signs of ILA were compared between different sex and age groups. The age-related pathological changes were analyzed. The ILA findings were found predominantly in the lower lobes and the subpleural region. The semi-quantitative scores of four CT signs in all subjects under 40 were 0. However, in subjects over 40 years old, the scores gradually increased with age, although most of them remained low. The size of the alveoli increased, the number of alveoli decreased, the alveolar septum became thinner, and the number of ATII cells increased with age. A statistically significant difference was observed among the different age groups (χ2=50.624, P=0.033; χ2=80.000, P=0.043; χ2=33.833, P=0.000; χ2=13.525, P=0.031). The macrophage population and the percentage of collagen fibers in the alveolar septum increased, while the percentage of elastic fibers decreased with age. There was no significant difference among the different age groups (χ2=19.817, P=0.506; χ2=52.419, P=0. 682; χ2=54.868, P=0.518). When the four CT signs mentioned above are in the upper central area, and the score has a medium or high score, it is crucial to determine the underlying pathological causes. ILA may be the result of chronic lung injury.

Lung ultrasound in the diagnosis of COVID-19-associated pneumonia

Over the past decades, lung ultrasound in the diagnosis of lung diseases has become widespread. Ultrasound examination has a number of advantages (no radiation exposure, real-time imaging, clear visualization of the subpleural lung regions and costophrenic angles), which make it possible to use ultrasound to monitor the dynamics of pneumonia in children and pregnant women. Currently, in the context of the COVID-19 pandemic, lung ultrasound is widely used due to its high diagnostic efficiency, which is comparable with classical radiography and X-ray computed tomography (CT) by a number of parameters.The article describes the method of lung ultrasound and the radiographic pattern of COVID-19-associated pneumonia. It also provides a review of the literature, according to which the severity of pneumonia was determined, depending on the radiographic pattern, and the need for a lung ultrasound was identified.The article indicates that information on assessment of the radiographic pattern of the lungs at runtime in different variants of the course of coronavirus infection, as well as many methodological issues, including the frequency of second-look lung ultrasound, has not been sufficiently studied.

Pulmonary alveolar microlithiasis: A case report from Morocco with review of literature

Background: Pulmonary alveolar microlithiasis (PAM) is a rare infiltrative chronic lung disease characterized by deposition of spherical calcium phosphate microliths called calcospherites within the alveoli with predominance in lower and mid zones. Etiology and pathogenesis is not fully understood. Case presentation: We report a case of 58 year old female patient presenting with progressive shortness of breath and chronic bronchitis over a period of 4 years. Physical examination revealed she had signs of chronic respiratory failure. Chest radiograph showed dense micronodular opacities giving classical sandstorm appearance. High resolution computed tomography showed diffuse microcalcifications, bilateral ground glass attenuation and septal thickening with calcification along the interlobar septa and subpleural regions. Conclusion: According to our research this is the 15th case of PAM that has been declared in Morocco. Given the rarity of this entity, the purpose of this study was to increase knowledge of this disease among pulmonologists, in order to provide timely diagnosis.

Arsenicum album as a treatment for pneumonia in snakes: serial cases

&#x0D; Abstract&#x0D; Introduction: two Python bivittatus were received at Project Selva Viva, zoo in Taubaté, Brazil, both presented respiratory noises and oro-nasal discharge. In view of the fact, a thoracic ultrasonographic examination was performed for evaluation on February 25, 2022, which diagnosed the presence of multiple vertical hyperechoic artefacts emerging from the pleural line, coalescing in some of the fields evaluated, and the presence of a hypoechoic structure located in the subpleural region. Another serpent, a species of Boa constrictor, arrived in same zoo, unhistorical individual, collected from an apprehension, showed a low body score and during a thoracic ultrasonographic evaluation, carried out on April 1, 2022, was also found to have B waves emerging from the line pleural. Methodology: Authorized story, by responsible of zoo. In all the patients, homeopathic therapy was initiated with 2 globules of Arsenicum album 30 cH/BID, after diagnosis of the respiratory condition by ultrasonographic examination, the medication was chosen through the similarity with the symptoms. Accompaniment with ultrassoms of Python bivittatus foram carried out weekly for accompaniment of the respiratory picture. Results: On March 04, it was observed that both coils showed a reduction in respiratory noise and were more active. Ars 30 cH was maintained BID. On March 25, both presented significant improvement in ultrasound, which made visible only lines A, compatible with a healthy lung, in both individuals and the treatment was suspended. The treatment of the Boa constrictor was started on April 1. On April 8, ultrasonographic examination was performed, which only observed lines A, indicating improvement of the picture. Conclusion: Given these results, it is considered that the homeopathic treatment is an option to be considered not treating the respiratory condition in snakes, however, there is variation in the duration of the therapy through the stage and chronicity of the disease.

Desquamation of the subpleural lung parenchyma caused by empyema after pulmonary embolism: A case report.

Key messageSubpleural peripheral lung regions are mainly nourished by pulmonary arteries. Herein, we report a case in which pleural infection after pulmonary embolism caused circulation failure in the subpleural lung parenchyma (SLP) and massive desquamation of the SLP.

Radiological Semiotics of Different Types of Nontuberculous Pulmonary Mycobacterioses

Objective: to determine, evaluate, and describe different radiological patterns of microbiologically identified nontuberculous pulmonary mycobacterioses (NTPM) based on multislice computed tomography data. Material and methods. The study included 102 patients with radiological signs of lung disease and different types of NTPM. Slowly growing types of NTPM were detected in 62 (60.8 %) patients, and rapidly growing NTPM – in 40 (39.2 %). The diagnosis was established considering a patient’s complaints, a specified case history, radiological and clinical laboratory data including microscopic studies of sputum from 63 (61.8 %) patients, bronchoalveolar lavage and different types of bronchial biopsies data from 19 (18.6 %) patients, samples of lung video-assisted thoracoscopic surgery from 17 (16.7%) patients, pleural fluid samples from 2 (1.9 %) patients, and oropharyngeal wash samples from 1 (1 %) patient. We used the Somatom Emotion 16 multislice computed tomograph (Siemens) and the high-resolution algorithm (HRCT) with 0.8 mm slice thickness and 1.5 mm slice increment. Results. The HRCT data were highly polymorphic and showed interstitial focal changes, different calibre bronchiectasis, conglomerates or cavities, involvements of vessels or pleural layers. In some patients, changes in the axial interstitium were accompanied by single small focal consolidations located either discretely or in small groups. Peribronchovascular spread of dissemination foci in NTPM was detected by HRCT as irregular infiltration of the axial interstitium (vasculitis type). Changes in the bronchial tree in NTPM were characterized by bronchiolitis symptoms (extensive thickening of bronchial walls, bronchioles) with development of the tree-in-bud sign predominantly in the subpleural lung regions. In some cases, bronchiectatic changes formed conglomerate consolidations of sublobular or lobular extent. Changes of the bronchial tree were detected by HRCT predominantly as signs of deforming bronchitis, cylindrical, varicose, or cystic bronchiectasis, either restricted or spread. Changes might be accompanied by single multi-dimensional cystic bronchiectatic cavities. Conclusion. Typical HRCT signs of NTPM are endobronchial and peribronchovascular spread of foci, development of multi-dimensional conglomerates, deforming bronchitis, bronchiectasis, and presence of single multi-dimensional cystic bronchiectatic cavities.

Carbamazepine-induced hypersensitivity pneumonitis in a patient with neuromyelitis optica: A case report

A 36-year-old female with serum anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD) on carbamazepine (CBZ) therapy for paroxysmal tonic spasms (PTS) developed Type 1 respiratory failure. High-resolution computed tomography chest showed diffuse ground-glass opacities in both lungs predominantly in bilateral perihilar region sparing subpleural regions and predominantly upper lobes with a smooth interlobular septal thickening. A transbronchial lung biopsy was consistent with hypersensitivity pneumonitis and following withdrawal of the CBZ and treatment with steroids her respiratory symptoms resolved. After stopping CBZ, PTS recurred, which was successfully treated with lacosamide. This is the first described biopsy-proven case of CBZ-induced hypersensitivity pneumonitis in the NMOSD patient.

Progressive pulmonary fibrosis in a murine model of Hermansky-Pudlak syndrome

BackgroundHPS-1 is a genetic type of Hermansky-Pudlak syndrome (HPS) with highly penetrant pulmonary fibrosis (HPSPF), a restrictive lung disease that is similar to idiopathic pulmonary fibrosis (IPF). Hps1ep/ep (pale ear) is a naturally occurring HPS-1 mouse model that exhibits high sensitivity to bleomycin-induced pulmonary fibrosis (PF). Traditional methods of administering bleomycin as an intratracheal (IT) route to induce PF in this model often lead to severe acute lung injury and high mortality rates, complicating studies focusing on pathobiological mechanisms or exploration of therapeutic options for HPSPF.MethodsTo develop a murine model of HPSPF that closely mimics the progression of human pulmonary fibrosis, we investigated the pulmonary effects of systemic delivery of bleomycin in Hps1ep/ep mice using a subcutaneous minipump and compared results to oropharyngeal delivery of bleomycin.ResultsOur study revealed that systemic delivery of bleomycin induced limited, acute inflammation that resolved. The distinct inflammatory phase preceded a slow, gradually progressive fibrogenesis that was shown to be both time-dependent and dose-dependent. The fibrosis phase exhibited characteristics that better resembles human disease with focal regions of fibrosis that were predominantly found in peribronchovascular areas and in subpleural regions; central lung areas contained relatively less fibrosis.ConclusionThis model provides a preclinical tool that will allow researchers to study the mechanism of pulmonary fibrosis in HPS and provide a platform for the development of therapeutics to treat HPSPF. This method can be applied on studies of IPF or other monogenic disorders that lead to pulmonary fibrosis.

Mechanical Tension‐induced Vascular and Alveolar Morphogenesis during Lung Regeneration

Mechanical forces altered after unilateral pneumonectomy (PNX) control post‐PNX vascular and alveolar morphogenesis. This study aims to understand the mechanosensitive mechanism of lung vascular and alveolar regeneration in the post‐PNX mouse lungs. Vascular formation is stimulated at the subpleural region in the remaining mouse lung after unilateral PNX, where mechanical stretch is enhanced, while inhibition of mechanical tension by insertion of prosthesis attenuates these effects. The focal adhesion protein, paxillin senses mechanical stretch after PNX and the levels of paxillin are upregulated in SPB‐positive alveolar epithelial type II (ATII) cells and endothelial cells (ECs), which stimulates the expression of angiogenic factor angiopoietin‐1 (Ang1) in ATII cells and Ang2 in ECs to induce EC directional motility to the subpleural region. Cellular stretching increases the expression of paxillin, which induces expression of Ang2 in ECs and Ang1 in ATII cells in vitro. Post‐PNX lung growth and vascular formation toward the subpleural region are suppressed in Pxnfl/fl‐Sftpc‐CreERT2 mouse lungs, in which paxillin expression is attenuated in ATII cells. Structure of lamellar bodies that control surfactant homeostasis is also disrupted in post‐PNX Pxnfl/fl‐Sftpc‐CreERT2 mouse lung ATII cells. These results suggest that cooperative action of mechanosensitive paxillin signaling in ECs and ATII cells mediates vascular and alveolar epithelial formation during post‐PNX lung growth.

Pattern and prevalence of different findings in high resolution computed tomography images in patients with coronavirus disease and kidney injury; a pilot study

Introduction: Since December 2019, an outbreak of pneumonia caused by a new coronavirus has emerged. The standard diagnostic method for COVID-19 infection is the real-time reverse transcriptase-polymerase chain reaction (RT-PCR). High-resolution computed tomography (HRCT) has been proven as a sensitive, feasible and accessible test in Iran. In addition to respiratory system, other organs could also be involved in this disease. The exact mechanism of renal involvement is unknown; however, acute kidney injury (AKI) occurs in almost 5-15% of cases. Different HRCT patterns might be associated with AKI presence and severity of the disease. Objectives: To investigate patterns and prevalence of different HRCT findings in COVID-19 patients with concurrent AKI. Patients and Methods: In this retrospective study, we reviewed all hospitalized patients with COVID-19 infection, from February to April 2020 in Razi hospital, Rasht. Twenty-two cases who had AKI were enrolled. The HRCT findings of the patients were reviewed independently by two radiologists. Percentage and prevalence of HRCT findings were analyzed in SPSS 21 software. Results: All 22 cases had multifocal distribution on HRCT. Around 95.5% had peripheral involvement, 86.4% had central zones opacity while 72.2% of cases had peribronchovascular pattern. Bilateral lung involvement was found in 90.9%, but only 9.1% had unilateral involvement. There was 59.1% of lower lobe predominance for COVID-19 involvement since sub-pleural regions were spared in 18.2% of individuals. All the patients’ HRCTs showed ground glass opacity. Reticular pattern (81.8%), consolidation (77.3%), vascular enlargement in involved zones (68.2%) and airway changes (68.2%) were the next more prevalent findings. Half of the subjects showed crazy paving, 45.5% had pleural effusion and 13.6% had also lymphadenopathy. We found 40.9% of the patients had arcade-like sign. Less frequent findings were nodular opacities (13.6%), halo sign (9.1%) and reverse-halo sign (9.1%), respectively. Conclusion: This study demonstrated that atypical patterns are likely to be more common in COVID-19 patients with kidney injury.

Study on the correlations of different clinical types with imaging findings at initial diagnosis and clinical laboratory indexes in COVID-19 patients.

Objectives:To investigate the correlations of initial lab and imaging findings in COVID-19 patients of different clinical types.Methods:We retrospective analyzed patients confirmed with COVID-19 in the Fifth Medical Center of the People’s Liberation Army (PLA) General Hospital between February to April 2020, selected a total of 58 (N) patients with lab and imaging examinations that met the study criteria, using Artificial intelligence (AI) software to calculate the percentage of COVID-19 lesions in the volume of the whole lung, then the correlations of general information, initial chest CT examination after admission and laboratory examinations were analyzed.Results:The 58 (N) COVID-19 patients were divided into mild group [41(n) cases]: and severe group [17(n) cases]: according to patient’s condition. CT findings of the severe group and mild group mainly included single or multiple ground glass opacity (GGO), with lesions mainly distributed in the periphery of lungs or GGO mixed with consolidation, with lesions involved in peripheral and central areas of both lungs, accompanied other signs. A significant difference in CRP, IL-6, D-D, GGT was observed between the two groups (p < 0.05). The ratios regarding lymphocyte abnormality and neutrophil abnormality in the severe group were higher than those in the mild group (p < 0.05).Conclusion:The CT features at initial diagnosis of COVID-19 were mainly characterized by multiple GGO with or without partial consolidation in both lungs, with the lesions mainly distributed at the subpleural regions. Some lab test indexes were correlated with the clinical types of COVID-19.

Клинические особенности течения новой коронавирусной инфекции у ВИЧ-позитивного пациента на фоне хронического гепатита С

In view of the global pandemic caused by the novel coronavirus disease, HIV-infected people fall into a higher risk group, as they have a weakened immune system and underlying health conditions. Currently, much research focuses on the clinical characteristics of the coronavirus infection in various population groups with comorbidities, including HIV-positive patients. The article describes the clinical course of the novel coronavirus diseases in a male patient, 44 years of age, newly diagnosed with HIV at the time of hospitalization, who also had chronic hepatitis C with low specific enzyme levels. The chest CT scans demonstrated multiple polygonal sites of increased attenuation of the lung parenchyma (ground glass opacities) in segments S2, S3, S4, S5, S6–S10 of the right lung and in S3, S6–S10 segments of the left lung; these changes were more pronounced in the right lung. Most of the sites were detected in the subpleural region and close to the lung roots. The absence of highly active antiretroviral therapy resulted in a severe immunosuppression — during patient’s stay at the hospital the number of leucocytes decreased from 3.62×109/l to 2.54×109/l. However, in the entire period of illness, his condition remained stable (moderate severity), and no complications were reported. KEYWORDS: HIV-infection, chronic hepatitis C, COVID-19, novel coronavirus infection. FOR CITATION: Matyazh I.A., Ivakhnenko E.V., Grokhotova A.V. Clinical characteristics of the novel coronavirus infection in HIV- positive patient with underlying chronic hepatitis C. Russian Medical Inquiry. 2022;6(11):656–658 (in Russ.). DOI: 10.32364/2587- 6821-2022-6-11-656-658.

Three-Dimensional Whole-Organ Characterization of the Regional Alveolar Morphology in Normal Murine Lungs.

Alveolar architecture plays a fundamental role in the processes of ventilation and perfusion in the lung. Alterations in the alveolar surface area and alveolar cavity volume constitute the pathophysiological basis of chronic respiratory diseases such as pulmonary emphysema. Previous studies based on micro-computed tomography (micro-CT) of lung samples have allowed the geometrical study of acinar units. However, our current knowledge is based on the study of a few tissue samples in random locations of the lung that do not give an account of the spatial distributions of the alveolar architecture in the whole lung. In this work, we combine micro-CT imaging and computational geometry algorithms to study the regional distribution of key morphological parameters throughout the whole lung. To this end, 3D whole-lung images of Sprague–Dawley rats are acquired using high-resolution micro-CT imaging and analyzed to estimate porosity, alveolar surface density, and surface-to-volume ratio. We assess the effect of current gold-standard dehydration methods in the preparation of lung samples and propose a fixation protocol that includes the application of a methanol-PBS solution before dehydration. Our results show that regional porosity, alveolar surface density, and surface-to-volume ratio have a uniform distribution in normal lungs, which do not seem to be affected by gravitational effects. We further show that sample fixation based on ethanol baths for dehydration introduces shrinking and affects the acinar architecture in the subpleural regions. In contrast, preparations based on the proposed dehydration protocol effectively preserve the alveolar morphology.

A CASE OF PULMONARY THROMOEMBOLISM OCCURRED IMMEDIATELY AFTER THE FIRST DOSE OF CHADOX1 NCOV- 19 VACCINATION.

In the recent studies, COVID-19 vaccines, especially Covishield has been associated with the reports of Vaccine-Induced pulmonary thromboembolism. pulmonary thromboembolism is a complication that can occur after the rst dose of the vaccine causing the thrombosis in veins at specic sites like lungs, Brain and Deep Veins and Arteries. It presents commonly as the Pulmonary Embolism (PE), within 7-10 days of vaccination. Patients taking vaccinations under the age of 45 presents at the high risk. Mortality rate in such post vaccination thrombosis is considered to be 50% in some cases. Thus, it is far more important to understand and identify the early signs and symptoms for early diagnosis, proper treatment and interventions. In the following case presented. A 29-year-old male patient was presented with the complaints of High Fever, Cough and Extreme Breathlessness after receiving the rst dose of ChADOx1 nCoV-19 Vaccination against the Corona Virus Disease 2019 (COVID-19). He had history of Exertional Dyspnoea for 2-3 weeks. He was diagnosed to have Pulmonary Embolism with severe PAH. 2D ECHO was done which showed Severe Pulmonary Hypertension Likely Pulmonary Thromboembolism, Good biventricular systolic function, Mild TR. CT Chest with Pulmonary Angiography was done which showed Eccentric lling defect seen in bilateral arteries at hila with extension in lower lobe segment branches- likely thrombus. CT Scan of Thorax (Plain &amp; Contrast) was also done which showed bilateral small patchy ground glass haze with superimposed Reticular thickening mainly in Subpleural region. He was immediately thrombolysed with Intrapulmonary TNK after doing Check angiography. He was then managed with Oxygen support, NIV support, Inj. Fondaparinux, Anti biotics, Anti-coagulant, diuretics, Pulmonary vasodilators, Anti-hypertensive, and other supportive drugs. He responded well to the given treatment and was gradually weaned off NIV and oxygen support. Serial D-dimer, CBC, Chest X ray monitoring was done. Repeat CT chest was done in view of fresh lesions on Chest X ray which showed cavitatory lesion in Right mid zone with moderate Pleural effusion. Chest Physician consultation was taken and advice followed accordingly. He was discharged after 19 days, later he was then taken up for follow up every 2 weeks

A quantitative analysis of extension and distribution of lung injury in COVID-19: a prospective study based on chest computed tomography

BackgroundTypical features differentiate COVID-19-associated lung injury from acute respiratory distress syndrome. The clinical role of chest computed tomography (CT) in describing the progression of COVID-19-associated lung injury remains to be clarified. We investigated in COVID-19 patients the regional distribution of lung injury and the influence of clinical and laboratory features on its progression.MethodsThis was a prospective study. For each CT, twenty images, evenly spaced along the cranio-caudal axis, were selected. For regional analysis, each CT image was divided into three concentric subpleural regions of interest and four quadrants. Hyper-, normally, hypo- and non-inflated lung compartments were defined. Nonparametric tests were used for hypothesis testing (α = 0.05). Spearman correlation test was used to detect correlations between lung compartments and clinical features.ResultsTwenty-three out of 111 recruited patients were eligible for further analysis. Five hundred-sixty CT images were analyzed. Lung injury, composed by hypo- and non-inflated areas, was significantly more represented in subpleural than in core lung regions. A secondary, centripetal spread of lung injury was associated with exposure to mechanical ventilation (p < 0.04), longer spontaneous breathing (more than 14 days, p < 0.05) and non-protective tidal volume (p < 0.04). Positive fluid balance (p < 0.01), high plasma D-dimers (p < 0.01) and ferritin (p < 0.04) were associated with increased lung injury.ConclusionsIn a cohort of COVID-19 patients with severe respiratory failure, a predominant subpleural distribution of lung injury is observed. Prolonged spontaneous breathing and high tidal volumes, both causes of patient self-induced lung injury, are associated to an extensive involvement of more central regions. Positive fluid balance, inflammation and thrombosis are associated with lung injury.Trial registration Study registered a priori the 20th of March, 2020. Clinical Trials ID NCT04316884.

Novel folliculin gene mutations in Polish patients with Birt\u2013Hogg\u2013Dub\xe9 syndrome

BackgroundBirt–Hogg–Dubé syndrome (BHDS) is a rare, autosomal dominant, inherited disease caused by mutations in the folliculin gene (FLCN). The disease is characterised by skin lesions (fibrofolliculomas, trichodiscomas, acrochordons), pulmonary cysts with pneumothoraces and renal tumours. We present the features of Polish patients with BHDS.Materials and methodsThe first case of BHDS in Poland was diagnosed in 2016. Since then, 15 cases from 10 families have been identified. Thirteen patients were confirmed via direct FLCN sequencing, and two according to their characteristic clinical and radiological presentations.ResultsBHDS was diagnosed in 15 cases (13 women and 2 men) from 10 families. The mean ages at the time of first pneumothorax and diagnosis were 38.4 ± 13.9 and 47.7 ± 13 years, respectively. Five patients (33%) were ex-smokers (2.1 ± 1.37 packyears), and 10 (67%) had never smoked cigarettes. Twelve patients (83%) had a history of recurrent symptomatic pneumothorax. Three patients had small, asymptomatic pneumothoraces, which were only detected upon computed tomography examination. All patients had multiple bilateral pulmonary cysts, distributed predominantly in the lower and middle, peripheral, and subpleural regions of the lungs. Generally, patients exhibited preserved lung function. Skin lesions were seen in four patients (27%), one patient had renal angiomyolipoma, and one had bilateral renal cancer. Different mutations of the FLCN gene were identified (mainly in exon 6), with two novel heterozygous variants: c.490delA p.(Arg164GlyTer13) and c.40delC p.(His14ThrsfTer41).ConclusionsAll analysed patients with BHDS presented with lung lesions and with less frequent skin and renal lesions than previously reported in other populations. In addition, more frequent mutations located in exon 6 were detected, and two novel FLCN gene mutations were identified.

Pulmonary Findings of [18F]FDG PET/CT Images on Asymptomatic COVID-19 Patients.

During the coronavirus disease 2019 (COVID-19) pandemic, several case studies demonstrated that many asymptomatic patients with COVID-19 underwent fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) examination for various indications. However, there is a lack of literature to characterize the pattern of [18F]FDG PET/CT imaging on asymptomatic COVID-19 patients. Therefore, a systematic review to analyze the pulmonary findings of [18F]FDG PET/CT on asymptomatic COVID-19 patients was conducted. This systematic review was performed under the guidelines of PRISMA. PubMed, Medline, and Web of Science were used to search for articles for this review. Articles with the key words: “asymptomatic”, “COVID-19”, “[18F]FDG PET/CT”, and “nuclear medicine” were searched for from 1 January 2020 to 20 May 2021. Thirty asymptomatic patients with COVID-19 were included in the eighteen articles. These patients had a mean age of 62.25 ± 14.85 years (male: 67.71 ± 12.00; female: 56.79 ± 15.81). [18F]FDG-avid lung lesions were found in 93.33% (28/30) of total patients. The major lesion was [18F]FDG-avid multiple ground-glass opacities (GGOs) in the peripheral or subpleural region in bilateral lungs, followed by the consolidation. The intensity of [18F]FDG uptake in multiple GGOs was 5.605 ± 2.914 (range from 2 to 12) for maximal standardized uptake value (SUVmax). [18F]FDG-avid thoracic lymph nodes (LN) were observed in 40% (12/40) of the patients. They mostly appeared in both mediastinal and hilar regions with an SUVmax of 5.8 ± 2.93 (range from 2.5 to 9.6). The [18F]FDG uptake was observed in multiple GGOs, as well as in the mediastinal and hilar LNs. These are common patterns in PET/CT of asymptomatic patients with COVID-19.