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Chen C, Weng S, Chen Z, Chen Y, Yao G, Huang X, Gu X, Lin C. The association between high jugular bulb and mastoid pneumatization in adults. Front Neurol 2024; 14:1331604. [PMID: 38259651 PMCID: PMC10800961 DOI: 10.3389/fneur.2023.1331604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose The purpose of this study was to analyze the relationship between the degree of high jugular bulb (HJB) and mastoid pneumatization using high-resolution computed tomography (HRCT). Methods Between April 2019 and June 2022, HRCT of the temporal bone was retrospectively analyzed in 1,025 patients. By excluding the other coexistent pathologies, 113 patients with HJBs were recruited for the study. The degree of the HJBs were defined as follows: Grade I, JB situated between inferior annulus of tympanic membrane and cochlear basal turn (CBT). Grade II, JB situated between CBT and lateral semicircular canal (LSC). Grade III, JB situated above LSC. The volume of mastoid pneumatization was based on HRCT images using a 3D reconstruction. Results There were 32 male and 81 female subjects (mean age, 41.2 ± 14.0 years; age range, 18-80 years). The male group included 16 Grade I, 28 Grade II and 6 Group III HJB subjects. The female group included 38 Grade I, 62 Grade II and 31 Group III HJB cases. In the different groups of HJB, the mastoid cell volume differences were also not statistically significant (p = 0.165). In the classification, Grade II was most common (90/181, 49.7%). Conclusion This study found no correlation between mastoid air cell volume and HJB, suggesting that HJB may not affect the mastoid air cell development and disease occurrence. These data must be considered exploratory, requiring more extensive cross-sectional studies.
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Affiliation(s)
- Chenyu Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Clinical Medical Research Center for Ear, Nose and Throat Difficulty Diseases, Fuzhou, China
- Fujian Branch of National Clinical Medical Research Center for Otorhinolaryngologic Diseases, Fuzhou, China
- Fujian Institute of Otorhinolaryngology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Simin Weng
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhifeng Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yuqing Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Guangnan Yao
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiying Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xi Gu
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Clinical Medical Research Center for Ear, Nose and Throat Difficulty Diseases, Fuzhou, China
- Fujian Branch of National Clinical Medical Research Center for Otorhinolaryngologic Diseases, Fuzhou, China
- Fujian Institute of Otorhinolaryngology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Chang Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Clinical Medical Research Center for Ear, Nose and Throat Difficulty Diseases, Fuzhou, China
- Fujian Branch of National Clinical Medical Research Center for Otorhinolaryngologic Diseases, Fuzhou, China
- Fujian Institute of Otorhinolaryngology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Khan Raja S, Rafique Shiekh R, Arshad Abbasi MA, Tariq S, Saleem H, Tariq M, Akbar A, Jadoon SK, Tasneem S, Saleem Khan M. Exploring the Relationship of Comorbidities, Smoking Status, HRCT Findings With COVID-19 Disease Severity and Outcomes. Cureus 2024; 16:e52937. [PMID: 38406150 PMCID: PMC10893976 DOI: 10.7759/cureus.52937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is a serious illness that can affect multiple organs including the lungs. The COVID-mortality risk is attributed to the quick transmission of the virus, the severity of disease, and preclinical risk factors, such as the presence of comorbidities. High-resolution computed tomography (HRCT) can predict disease severity in COVID-19 patients. METHODOLOGY This was a retrospective cohort study in which data were obtained from COVID centers at tertiary care hospitals in Azad Jammu and Kashmir. Details of clinical characteristics and HRCT findings along with details of smoking and comorbid history were obtained. RESULTS Fever at hospital admission, HRCT findings, and having a partner predicted disease severity showed a significant p-value of <0.05. Old age and living in a combined household were associated with severe outcomes (p<0.05). Symptoms of shortness of breath (SOB) on hospital admission could predict the need for ICU admission in COVID-19 patients. CONCLUSION HRCT has a good predictive value for disease severity in patients with COVID-19, and old age is a risk factor. Although, limited associations were established in the analysis, in this study hyperlipidemia and hypertension significantly affected the course of disease. Further studies should be done to explore the relationship.
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Affiliation(s)
- Sohail Khan Raja
- Pulmonology, Azad Jammu Kashmir Medical College, Muzaffarabad, PAK
| | | | | | - Samia Tariq
- Medicine, Women Medical and Dental College Abbottabad, Abbottabad, PAK
| | | | - Maham Tariq
- Radiology, Gujranwala Teaching Hospital, Gujranwala, PAK
| | - Amna Akbar
- Emergency and Accident, District Headquarters Hospital (DHQ), Jhelum, PAK
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Singh P, Verma AK, Pandey G. Diffuse cystic lung diseases: Imaging spectrum and diagnostic approach using high-resolution computed tomography. Lung India 2022; 39:553-561. [PMID: 36629235 PMCID: PMC9746275 DOI: 10.4103/lungindia.lungindia_44_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/29/2022] [Indexed: 01/12/2023] Open
Abstract
The lung cyst is an air-containing lucent area surrounded by thin imperceptible walls. Other lucent lung lesions like centrilobular emphysema, cavity, cystic bronchiectasis, honeycomb cyst, and pneumatoceles are close mimics of a lung cyst on high-resolution computed tomography (HRCT). Various diseases with multiple lung cysts throughout both the lungs are classified as diffuse cystic lung diseases (DCLDs). HRCT is considered the imaging of choice for diagnosis of such diffuse cystic lung diseases. Common DCLDs like lymphangioleiomyomatosis, Birt-Hogg-Dubé syndrome (BHS), Langerhans cell histiocytosis (LCH), lymphocytic interstitial pneumonia (LIP), and desquamative interstitial pneumonia (DIP) can be confidently diagnosed on HRCT without further requirement of histopathological confirmation. The imaging also helps in differentiation of uncommon DCLDs and exclusion of the mimics. This review describes a simple algorithmic approach for DCLDs on HRCT based on scrutinizing the cyst's distribution, size, and shape, background parenchymal changes, and its correlation with clinical features and extrapulmonary imaging findings.
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Affiliation(s)
- Priya Singh
- Department of Radiodiagnosis, King George Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Amit K. Verma
- Department of Radiodiagnosis, King George Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Gaurang Pandey
- Department of Radiodiagnosis, King George Medical University (KGMU), Lucknow, Uttar Pradesh, India
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Polat G, Özdemir Ö, Ermin S, Unat DS, Şahin GV, Türk MA, Güldaval F, Susam S, Kıraklı C. Factors Affecting the Risk of Interstitial Lung Disease Development in Hospitalized Patients With COVID-19 Pneumonia. Respir Care 2022; 67:1272-1281. [PMID: 35790396 PMCID: PMC9994322 DOI: 10.4187/respcare.09816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) related chronic lung changes secondary to severe disease have become well known. The aim of this study was to determine the risk factors that affect the development of interstitial lung disease in subjects with COVID-19 pneumonia who were hospitalized. METHODS Patients hospitalized with COVID-19 pneumonia between June 2020 and March 2021 were retrospectively analyzed. Smoking histories, comorbidities, reverse transcriptase polymerase chain reaction test results, laboratory parameters at the time of the diagnosis, oxygen support, the use of corticosteroids with dosage and duration data, the need for ICU care were recorded. High-resolution computed tomographies (HRCT) were obtained for study population in their 3-6 months follow-up visit. The subjects were classified as having residual parenchymal lung disease if a follow-up HRCT revealed parenchymal abnormalities except pure ground-glass opacities (the residual disease group). The control group consisted of the subjects with normal chest radiograph or HRCT in their follow-up visit or the presence of pure ground-glass opacities. Two groups were compared for their demographic and clinical abnormalities, laboratory parameters, treatment regimens, and the need for ICU care. RESULTS The study included 446 subjects. The mean ± SD age was 58.4 ± 13.87 years, with 257 men (57.6%). Although 55 subjects had normal HRCT features on their follow-up HRCT, 157 had abnormal lung parenchymal findings. Univariate logistic regression analysis revealed statistically significant results for age, sex, corticosteroid treatment, and the need for ICU care for predicting interstitial lung disease development (P < .001, P = .003, P < .001, and P < .001, respectively). Also, the residual disease group had significantly higher leukocyte and neutrophil counts and lower lymphocyte counts (P < .001, P < .001, P = .004, respectively). Correlated with these findings, neutrophil-to-lymphocyte ratios and platelet-to-lymphocyte ratios were significantly higher in the residual disease group (P < .001 and P = .008, respectively). CONCLUSIONS Residual parenchymal disease was observed 3-6 months after discharge in one third of the subjects hospitalized with COVID-19 pneumonia. It was observed that interstitial lung disease developed more frequently in older men and in those subjects with more-severe disease parameters.
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Affiliation(s)
- Gülru Polat
- Department of Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Konak, Izmir, Turkey.
| | - Özer Özdemir
- Department of Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Konak, Izmir, Turkey
| | - Sinem Ermin
- Department of Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Konak, Izmir, Turkey
| | - Damla Serçe Unat
- Department of Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Konak, Izmir, Turkey
| | - Görkem Vayisoğlu Şahin
- Department of Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Konak, Izmir, Turkey
| | - Merve Ayık Türk
- Department of Chest Diseases, Bozyaka Training and Research Hospital, Karabağlar, Izmir, Turkey
| | - Filiz Güldaval
- Department of Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Konak, Izmir, Turkey
| | - Seher Susam
- Department of Radiology, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Konak, Izmir, Turkey
| | - Cenk Kıraklı
- Department of Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Konak, Izmir, Turkey
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Lugarà M, Tamburrini S, Coppola MG, Oliva G, Fiorini V, Catalano M, Carbone R, Saturnino PP, Rosano N, Pesce A, Galiero R, Ferrara R, Iannuzzi M, Vincenzo D, Negro A, Somma F, Fasano F, Perrella A, Vitiello G, Sasso FC, Soldati G, Rinaldi L. The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management. Diagnostics (Basel) 2022; 12:diagnostics12081856. [PMID: 36010207 PMCID: PMC9406504 DOI: 10.3390/diagnostics12081856] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/24/2022] [Accepted: 07/27/2022] [Indexed: 12/22/2022] Open
Abstract
Purpose: We aimed to assess the role of lung ultrasound (LUS) in the diagnosis and prognosis of SARS-CoV-2 pneumonia, by comparing it with High Resolution Computed Tomography (HRCT). Patients and methods: All consecutive patients with laboratory-confirmed SARS-CoV-2 infection and hospitalized in COVID Centers were enrolled. LUS and HRCT were carried out on all patients by expert operators within 48−72 h of admission. A four-level scoring system computed in 12 regions of the chest was used to categorize the ultrasound imaging, from 0 (absence of visible alterations with ultrasound) to 3 (large consolidation and cobbled pleural line). Likewise, a semi-quantitative scoring system was used for HRCT to estimate pulmonary involvement, from 0 (no involvement) to 5 (>75% involvement for each lobe). The total CT score was the sum of the individual lobar scores and ranged from 0 to 25. LUS scans were evaluated according to a dedicated scoring system. CT scans were assessed for typical findings of COVID-19 pneumonia (bilateral, multi-lobar lung infiltration, posterior peripheral ground glass opacities). Oxygen requirement and mortality were also recorded. Results: Ninety-nine patients were included in the study (male 68.7%, median age 71). 40.4% of patients required a Venturi mask and 25.3% required non-invasive ventilation (C-PAP/Bi-level). The overall mortality rate was 21.2% (median hospitalization 30 days). The median ultrasound thoracic score was 28 (IQR 20−36). For the CT evaluation, the mean score was 12.63 (SD 5.72), with most of the patients having LUS scores of 2 (59.6%). The bivariate correlation analysis displayed statistically significant and high positive correlations between both the CT and composite LUS scores and ventilation, lactates, COVID-19 phenotype, tachycardia, dyspnea, and mortality. Moreover, the most relevant and clinically important inverse proportionality in terms of P/F, i.e., a decrease in P/F levels, was indicative of higher LUS/CT scores. Inverse proportionality P/F levels and LUS and TC scores were evaluated by univariate analysis, with a P/F−TC score correlation coefficient of −0.762, p < 0.001, and a P/F−LUS score correlation coefficient of −0.689, p < 0.001. Conclusions: LUS and HRCT show a synergistic role in the diagnosis and disease severity evaluation of COVID-19.
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Affiliation(s)
- Marina Lugarà
- U.O.C. Internal Medicine, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (M.G.C.); (G.O.)
- Correspondence:
| | - Stefania Tamburrini
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Maria Gabriella Coppola
- U.O.C. Internal Medicine, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (M.G.C.); (G.O.)
| | - Gabriella Oliva
- U.O.C. Internal Medicine, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (M.G.C.); (G.O.)
| | - Valeria Fiorini
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Marco Catalano
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Roberto Carbone
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Pietro Paolo Saturnino
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Nicola Rosano
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Antonella Pesce
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80121 Naples, Italy; (R.G.); (R.F.); (F.C.S.); (L.R.)
| | - Roberta Ferrara
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80121 Naples, Italy; (R.G.); (R.F.); (F.C.S.); (L.R.)
| | - Michele Iannuzzi
- Department of Anesthesia and Intensive care Medicine, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy;
| | - D’Agostino Vincenzo
- U.O.C. Neurodiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (D.V.); (A.N.); (F.S.); (F.F.)
| | - Alberto Negro
- U.O.C. Neurodiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (D.V.); (A.N.); (F.S.); (F.F.)
| | - Francesco Somma
- U.O.C. Neurodiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (D.V.); (A.N.); (F.S.); (F.F.)
| | - Fabrizio Fasano
- U.O.C. Neurodiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (D.V.); (A.N.); (F.S.); (F.F.)
| | - Alessandro Perrella
- Infectious Diseases at Health Direction, AORN A. Cardarelli, 80131 Naples, Italy;
| | - Giuseppe Vitiello
- Healt Direction, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy;
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80121 Naples, Italy; (R.G.); (R.F.); (F.C.S.); (L.R.)
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound Unit, Valle del Serchio General Hospital, Castelnuovo Garfagnana, 55032 Lucca, Italy;
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80121 Naples, Italy; (R.G.); (R.F.); (F.C.S.); (L.R.)
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Xu X, Liu L, Xu X, Ma Q, Teng L, Zhou H, Yang L, Lu M. Etiologic Profile of Older Children With Diffuse Radiological Changes in Eastern China. Front Pediatr 2022; 10:823350. [PMID: 35586823 PMCID: PMC9108256 DOI: 10.3389/fped.2022.823350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To analyze the etiology of chest diffuse radiological changes (DRC) in children older than 2 years. METHODS A retrospective study was conducted on a primary cohort of children with DRC underwent high resolution computed tomography (HRCT). RESULTS DRC mainly included bronchial wall thickening, interlobular septal thickening, pleural thickening, ground glass opacity, mosaic perfusion, reticular & linear opacities, nodular opacity, and tree-in-bud. Of the identified 457 children with DRC, 83 of children older than 2 years with DRC were included in the present study. Ground glass opacity (53, 63.9%) and reticular & linear opacities (44, 53.0%) were frequently identified findings of HRCT, and no tree-in-bud pattern was observed. By contrast, among children with DRC by M. pneumoniae (n = 64), bronchial wall thickening (33, 51.6%), and mosaic perfusion (17, 26.6%) were common patterns of HRCT in addition to ground glass opacity (36, 56.3%). Most of etiologies were connective tissue disease (24, 28.9%), followed by diffuse alveolar hemorrhage syndrome (9, 10.8%), Langerhans cell histiocytosis (7, 8.4%), and recurrent aspiration (6, 7.2%). CONCLUSIONS This study adds further insights into the role of HRCT in diagnosing childhood interstitial lung diseases, indirectly reflecting disease compositions.
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Affiliation(s)
- Xuefeng Xu
- Department of Rheumatology Immunology and Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lingke Liu
- Department of Rheumatology Immunology and Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xuchen Xu
- Department of Rheumatology Immunology and Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qian Ma
- Department of Rheumatology Immunology and Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Liping Teng
- Department of Rheumatology Immunology and Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Haichun Zhou
- Department of Radiology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Li Yang
- Department of Radiology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Meiping Lu
- Department of Rheumatology Immunology and Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Secchi T, Baselli LA, Russo MC, Borzani IM, Carta F, Lopopolo MA, Foà M, La Vecchia A, Agostoni C, Agosti M, Dellepiane RM. Multiple Breath Washout for Early Assessment of Pulmonary Complications in Patients With Primary Antibody Deficiencies: An Observational Study in Pediatric Age. Front Pediatr 2022; 10:773751. [PMID: 35656375 PMCID: PMC9152221 DOI: 10.3389/fped.2022.773751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In primary antibody deficiencies (PADs), pulmonary complications are the main cause of morbidity, despite immunoglobulin substitutive therapy, antibiotic treatment of exacerbations, and respiratory physiotherapy. Current Italian recommendations for surveillance of PADs respiratory complications include an annual assessment of spirometry and execution of chest high-resolution computed tomography (HRCT) every 4 years. OBJECTIVE This study aimed to evaluate the effectiveness of the lung clearance index (LCI) as an early marker of lung damage in patients with PADs. LCI is measured by multiple breath washout (MBW), a non-invasive and highly specific test widely used in patients with cystic fibrosis (CF). METHODS Pediatric patients with PADs (n = 17, 10 male, 7 female, and age range 5-15 years) underwent baseline assessment of lung involvement with chest HRCT, spirometry, and multiple breath nitrogen washout. Among them, 13 patients were followed up to repeat HRCT after 4 years, while performing pulmonary function tests annually. Their baseline and follow-up LCI and forced expiratory volume at 1 s (FEV1) values were compared, taking HRCT as the gold standard, using logistic regression analysis. RESULTS Lung clearance index [odds ratio (OR) 2.3 (confidence interval (CI) 0.1-52) at baseline, OR 3.9 (CI 0.2-191) at follow-up] has a stronger discriminating power between altered and normal HRCT rather than FEV1 [OR 0.6 (CI 0.2-2) at baseline, OR 1.6 (CI 0.1-13.6) at follow-up]. CONCLUSION Within the context of a limited sample size, LCI seems to be more predictive of HRCT alterations than FEV1 and more sensitive than HRCT in detecting non-uniform ventilation in the absence of bronchiectasis. A study of a larger cohort of pediatric patients followed longitudinally in adulthood is needed to challenge these findings.
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Affiliation(s)
| | - Lucia Augusta Baselli
- Pediatric Intermediate Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Chiara Russo
- Cystic Fibrosis Regional Reference Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Maria Borzani
- Radiology Unit-Pediatric Division, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Carta
- Cystic Fibrosis Regional Reference Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Amalia Lopopolo
- Pediatric Rehabilitation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michaela Foà
- Pediatric Rehabilitation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Carlo Agostoni
- Pediatric Intermediate Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Massimo Agosti
- Woman and Child Department, Ospedale "Filippo Del Ponte," University of Insubria, Varese, Italy
| | - Rosa Maria Dellepiane
- Pediatric Intermediate Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Fayadoglu M, Ekinci İB, Fayadoglu E, Arslan H, Uzunkulaoğlu T. Analysis and classification of radiological results and epidemiology of patients with COVID-19 pneumonia. Medicine (Baltimore) 2021; 100:e28154. [PMID: 34941065 PMCID: PMC8701962 DOI: 10.1097/md.0000000000028154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/18/2021] [Indexed: 01/05/2023] Open
Abstract
The coronavirus disease-2019 (COVID-19) pneumonia which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) virus is the current urgent issue world over. According to the Health Ministry of Turkey, the first COVID-19 patient was diagnosed on March 11, 2020. Since then, approximately 5.5 million patients have been confirmed to be positive SARS CoV-2 virus. In this retrospective study, we aimed at analyzing the epidemiological and radiological findings of COVID-19 cases at the Hospital of Grand National Assembly of Turkey from April 1, 2020 to December 31, 2020.A total of 130 patients (84 male, 25-87 years) were diagnosed as positive with High Resolution Computed Tomography (HRCT) scans and 71 of them confirmed with positive Real Time Polymerase Chain Reaction using the patients' nasopharyngeal and throat samples.HRCT scans were classified into 4 stages. Stage I (39.2%) patients' group; the HRCT results were found to be mosaic perfusion, whereas Stage II (39.2%) were found to be Ground Glass Opacity. Also, consolidation was detected in Stage III (20%). Finally, Stage IV, considered the most severe lung findings, and named as a crazy paving pattern was determined in 2 patients (1.53%). Furthermore, 20% of patients were found to be positive using IgG antibody against to SARS CoV-2 virus.Our findings showed that HRCT could be most prominent technique compared to real time polymerase chain reaction for the diagnosis of COVID-19 pneumonia. The novel classification of HRCT findings will be helpful to early diagnosis of the disease, time saving and eventually cost-effective.
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Affiliation(s)
- Mustafa Fayadoglu
- Health Institutes of Turkey, Hospital of Grand National Assembly of Turkey COVID-19 Diagnosis Center, Çankaya, Ankara, Turkey
- Eskişehir Technical University, Faculty of Advanced Technology, Department of Biotechnology, Tepebaşi, Eskişehir, Turkey
- Contributed equally
| | - İlksen Berfin Ekinci
- Health Institutes of Turkey, Hospital of Grand National Assembly of Turkey COVID-19 Diagnosis Center, Çankaya, Ankara, Turkey
- Contributed equally
| | - Elif Fayadoglu
- Health Institutes of Turkey, Hospital of Grand National Assembly of Turkey COVID-19 Diagnosis Center, Çankaya, Ankara, Turkey
- Contributed equally
- Eskişehir Technical University, Faculty of Science, Department of Molecular Biology, Tepebaşi, Eskişehir, Turkey
| | - Hüseyin Arslan
- Hospital of Grand National Assembly of Turkey, Çankaya, Ankara, Turkey
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Gargani L, Romei C, Bruni C, Lepri G, El-Aoufy K, Orlandi M, D'Errico L, Bandini G, D'Angelo G, Guiducci S, Dagna L, Falaschi F, Matucci-Cerinic M, Moggi-Pignone A. Lung ultrasound B-lines in systemic sclerosis: cut-off values and methodological indications for interstitial lung disease screening. Rheumatology (Oxford) 2021; 61:SI56-SI64. [PMID: 34698807 DOI: 10.1093/rheumatology/keab801] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Lung ultrasound (LUS), through assessment of B-lines and pleural line alterations, is able to evaluate interstitial lung disease (ILD), a frequent complication of systemic sclerosis (SSc). Different scanning schemes and counting methods have been proposed, but no clear cut-off values have been indicated for screening. We aimed to evaluate the accuracy of different LUS methodological approaches to detect ILD, compared with high resolution computed tomography (HRCT) as gold standard. METHODS Sixty-nine SSc patients underwent LUS and chest HRCT on the same day. Both exams were scored by expert readers. The accuracy of different scanning schemes and counting methods was assessed, and clinical and functional data were compared with imaging findings. RESULTS B-lines were more numerous in patients with the diffuse skin subset and Scl70 autoantibody positivity. The number of B-lines correlated with the Scleroderma Lung Study (SLS) I HRCT score (R = 0.754, p< 0.0001). A total number >10 B-lines on the whole chest or > 1 B-line on the postero-basal chest showed 97% sensitivity for detecting even very early ILD signs (corresponding to SLS I score =1). Sensitivity increased to 100% when pleural line alterations were included in the analysis. CONCLUSIONS LUS has a very high sensitivity in detecting SSc-related ILD. A cut-off value of > 10 B-lines on the whole chest or > 1 B-line on the postero-basal chest can be used for the screening of SSc-ILD. Assessing only the postero-basal chest seems mostly effective to combine high sensitivity with a less time-consuming approach.
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Affiliation(s)
- Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Chiara Romei
- Second Radiology Unit, University Hospital of Pisa, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Rheumatology & Scleroderma Unit AOUC, Florence, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Rheumatology & Scleroderma Unit AOUC, Florence, Italy
| | - Khadija El-Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Rheumatology & Scleroderma Unit AOUC, Florence, Italy
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Rheumatology & Scleroderma Unit AOUC, Florence, Italy
| | | | - Giulia Bandini
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Medicine AOUC, Florence, Italy
| | - Gennaro D'Angelo
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Rheumatology & Scleroderma Unit AOUC, Florence, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy & Rare Diseases, IRCCS San Raffaele Hospital, Milano, Italy
| | - Fabio Falaschi
- Second Radiology Unit, University Hospital of Pisa, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Rheumatology & Scleroderma Unit AOUC, Florence, Italy.,Royal Papworth Hospital NHS Foundation Trust
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Medicine AOUC, Florence, Italy
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10
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Baratella E, Ruaro B, Marrocchio C, Starvaggi N, Salton F, Giudici F, Quaia E, Confalonieri M, Cova MA. Interstitial Lung Disease at High Resolution CT after SARS-CoV-2-Related Acute Respiratory Distress Syndrome According to Pulmonary Segmental Anatomy. J Clin Med 2021; 10:3985. [PMID: 34501430 DOI: 10.3390/jcm10173985] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 12/25/2022] Open
Abstract
Background: The purpose of this study was to evaluate High-Resolution CT (HRCT) findings in SARS-CoV-2-related ARDS survivors treated with prolonged low-dose methylprednisolone after hospital discharge. Methods: A total of 44 consecutive patients (M: 32, F: 12, average age: 64), hospitalised in our department from April to September 2020 for SARS-CoV-2-related ARDS, who had a postdischarge CT scan, were enrolled into this retrospective study. We reviewed the electronic medical charts to collect laboratory, clinical, and demographic data. The CT findings were evaluated and classified according to lung segmental distribution. The imaging findings were correlated with spirometry results and included ground glass opacities (GGOs), consolidations, reticulations, bronchiectasis/bronchiolectasis, linear bands, and loss of pulmonary volume. Results: Alterations in the pulmonary parenchyma were observed in 97.7% of patients at HRCT (median time lapse between ARDS diagnosis and HRCT: 2.8 months, range 0.9 to 6.7). The most common findings were linear bands (84%), followed by GGOs (75%), reticulations (34%), bronchiolectasis (32%), consolidations (30%), bronchiectasis (30%) and volume loss (25%). They had a symmetric distribution, and both lower lobes were the most affected areas. Conclusions: A reticular pattern with a posterior distribution was observed 3 months after discharge from severe COVID-19 pneumonia, and this differs from previously described postCOVID-19 fibrotic-like changes. We hypothesized that the systematic use of prolonged low-dose of corticosteroid could be the main reason of this different CT scan appearance.
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11
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Manfredi A, Cassone G, Luppi F, Atienza-Mateo B, Cavazza A, Sverzellati N, González-Gay MA, Salvarani C, Sebastiani M. Rheumatoid arthritis related interstitial lung disease. Expert Rev Clin Immunol 2021; 17:485-497. [PMID: 33779447 DOI: 10.1080/1744666x.2021.1905524] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Interstitial lung disease (ILD) represents a frequent extra-articular manifestation of rheumatoid arthritis (RA) deeply impacting both quality of life and overall prognosis. Areas covered: A literature search was performed including PubMed, Embase, Scopus, and Web of Science. Many retrospective studies investigated the possible risk factors for RA-related ILD (RA-ILD), aiming to identify patients at risk. Among them, males, smokers, positivity of anti-citrullinated peptide antibodies have been associated with RA-ILD, such as some genetic haplotypes. Usual interstitial pneumonia is the histologic and radiologic pattern most frequently observed, followed by nonspecific interstitial pneumonia. Since lung involvement can represent the RA onset, an early differential diagnosis with idiopathic interstitial pneumonia can be difficult or sometimes impossible. High-resolution computed tomography represents the gold standard for ILD diagnosis, while multidisciplinary discussion should be required to assess disease staging, severity and progression. Expert opinion: Management of RA-ILD patients is challenging due to the lack of evidence-based data regarding both assessment and treatment. Moreover, the high variability of clinical presentation and evolution makes it difficult to establish the correct therapeutic strategy. Currently, multidisciplinary approach, including at least rheumatologists, pulmonologists, and radiologists, is desirable to define therapy and follow-up strategies.
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Affiliation(s)
- Andreina Manfredi
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Di , Modena, Italy
| | - Giulia Cassone
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Di , Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Luppi
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.,Department of Medicine and Surgery, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Belen Atienza-Mateo
- Department of Rheumatology, Hospital Universitario Marques De Valdecilla, IDIVAL, University of Cantabria Santander, Santander, Spain
| | - Alberto Cavazza
- Pathology Unit, IRCCS Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Nicola Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (Dimec), University of Parma, Parma, Italy
| | - Miguel A González-Gay
- Department of Rheumatology, Hospital Universitario Marques De Valdecilla, IDIVAL, University of Cantabria Santander, Santander, Spain
| | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Di , Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Rheumatology Unit, IRCCS Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Sebastiani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Di , Modena, Italy
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12
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Szturmowicz M, BaraŃska I, Skoczylas A, JĘdrych ME, Demkow U. Correlation of bronchoalveolar lavage lymphocyte count with the extent of lung fibrosis and with plethysmographic lung volumes in patients with newly recognized hypersensitivity pneumonitis. Cent Eur J Immunol 2020; 45:276-82. [PMID: 33437179 DOI: 10.5114/ceji.2020.101246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/30/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Hypersensitivity pneumonitis (HP) is an increasingly recognized interstitial lung disease, presenting with elevated total cell counts and high percentage of lymphocytes in bronchoalveolar lavage fluid (BALF). Despite many publications, there is no consensus in the literature concerning BALF cellular composition in patients with prolonged course of HP. Aim The aim of the present retrospective study was to investigate the influence of disease duration, smoking habits, and the extent of lung fibrosis on BALF cells’ population in patients with newly recognized HP. Material and methods In total, 94 patients (49 females, 45 males), mean age 52 (±12) years, with HP recognized according to recently proposed criteria, were enrolled into the present study. Chest CT scans were retrospectively reviewed by two independent radiologists. BALF evaluation was performed as a part of routine diagnostics according to recent recommendations. Results Percentage of lymphocytes in BALF was significantly lower in patients with lung fibrosis (stage 1 and 2) comparing to those without lung fibrosis (stage 0). Significant correlation was also found between the percentage of BALF lymphocytes and plethysmographic lung volumes, but not with lung transfer capacity for carbon monoxide (TLCO% pred). Smoking did not influence BALF results in our study group. Conclusions BALF lymphocytosis correlated with the presence and the extent of lung fibrosis on chest CT as well as with plethysmographic lung volumes but did not with TLCO and smoking habits in newly recognized HP pneumonitis.
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Kashyape R, Jain R. The utility of HRCT in the initial diagnosis of COVID-19 pneumonia-An Indian perspective. Indian J Radiol Imaging 2021; 31:S178-S181. [PMID: 33814779 PMCID: PMC7996707 DOI: 10.4103/ijri.ijri_944_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022] Open
Abstract
A total of 1,499 patients who underwent High Resolution Computed tomography (HRCT) chest in the duration of 2 months for suspected COVID-19 pneumonia were included. Subjects included were those who had tested positive for the virus on RT-PCR, those with symptoms suspicious for COVID-19 infection awaiting results for the RT-PCR test or with negative result but strong clinical suspicion as well as those with exposure to proven patients based on contact tracing. Thus, both symptomatic as well as asymptomatic patients were included. The positive predictive value of HRCT was 85%, sensitivity was 73% for all patients. Overall, accuracy was 68%. There was no significant difference in these values for symptomatic and asymptomatic individuals. These results were also independent of the time of scan from the onset of symptoms or contact. Thus, we propose that HRCT is an excellent adjunct for initial diagnosis of COVID-19 pneumonia in both symptomatic and asymptomatic individuals in addition to the role of prognostic indicator for COVID-19 pneumonia.
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Affiliation(s)
| | - Richa Jain
- Aster CMI Hospital New Airport Road, NH-7, Outer Ring Rd, Sahakar Nagar, Bengaluru, Karnataka, India
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14
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Comelli A, Coronnello C, Dahiya N, Benfante V, Palmucci S, Basile A, Vancheri C, Russo G, Yezzi A, Stefano A. Lung Segmentation on High-Resolution Computerized Tomography Images Using Deep Learning: A Preliminary Step for Radiomics Studies. J Imaging 2020; 6:125. [PMID: 34460569 PMCID: PMC8321165 DOI: 10.3390/jimaging6110125] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this work is to identify an automatic, accurate, and fast deep learning segmentation approach, applied to the parenchyma, using a very small dataset of high-resolution computed tomography images of patients with idiopathic pulmonary fibrosis. In this way, we aim to enhance the methodology performed by healthcare operators in radiomics studies where operator-independent segmentation methods must be used to correctly identify the target and, consequently, the texture-based prediction model. METHODS Two deep learning models were investigated: (i) U-Net, already used in many biomedical image segmentation tasks, and (ii) E-Net, used for image segmentation tasks in self-driving cars, where hardware availability is limited and accurate segmentation is critical for user safety. Our small image dataset is composed of 42 studies of patients with idiopathic pulmonary fibrosis, of which only 32 were used for the training phase. We compared the performance of the two models in terms of the similarity of their segmentation outcome with the gold standard and in terms of their resources' requirements. RESULTS E-Net can be used to obtain accurate (dice similarity coefficient = 95.90%), fast (20.32 s), and clinically acceptable segmentation of the lung region. CONCLUSIONS We demonstrated that deep learning models can be efficiently applied to rapidly segment and quantify the parenchyma of patients with pulmonary fibrosis, without any radiologist supervision, in order to produce user-independent results.
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Affiliation(s)
- Albert Comelli
- Ri.MED Foundation, 90133 Palermo, Italy;
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (V.B.); (G.R.); (A.S.)
| | | | - Navdeep Dahiya
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (N.D.); (A.Y.)
| | - Viviana Benfante
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (V.B.); (G.R.); (A.S.)
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology Unit I, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy; (S.P.); (A.B.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology Unit I, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy; (S.P.); (A.B.)
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy;
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (V.B.); (G.R.); (A.S.)
| | - Anthony Yezzi
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (N.D.); (A.Y.)
| | - Alessandro Stefano
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (V.B.); (G.R.); (A.S.)
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15
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Mulkoju R, Saka VK, Rajaram M, Kumari R, Negi VS, Mohanty Mohapatra M, Govindaraj V, Dwivedi DP, Mahesh Babu V. Pulmonary Manifestations in Systemic Sclerosis: Hospital-Based Descriptive Study. Cureus 2020; 12:e8649. [PMID: 32685316 PMCID: PMC7366045 DOI: 10.7759/cureus.8649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Prevalence of systemic sclerosis (SSc)-related organ injury is difficult to estimate as it occurs early in SSc, even though patients are often asymptomatic. As the patients with organ damage have a poor prognosis, all the patients should be carefully evaluated and followed‑up in the initial periods. This facilitates the early identification and initiation of appropriate therapy. This study emphasizes on different clinical manifestations and early predictors of lung involvement by using clinical, radiological, and pulmonary function tests in a tertiary care centre. Materials and methods A total of 53 SSc cases, who satisfied American College of Rheumatology (ACR) 2013 criteria, without any overlap syndromes were included in the study. All patients underwent thorough clinical examination along with Modified Rodnan Scoring (MRS) assessment, nailfold capillaroscopy (NFC), chest X-ray (CXR), HRCT thorax, 2D-echocardiography, spirometry and diffusion lung study by carbon monoxide (DLco). Results Out of 53 patients, four were male and 49 were female. Twenty-one patients had limited SSc (lcSSc) and 32 had diffuse SSc (dcSSc). Eighty-three per cent of subjects presented with skin manifestations and 34% with respiratory complaints. Reticulonodular opacities and ground glassing were the predominant radiological abnormalities suggestive of non-specific interstitial pneumonia (NSIP) followed by usual interstitial pneumonia (UIP). Pulmonary hypertension was predominant in patients with lcSSc. Thirty-eight patients had a restrictive pattern of spirometry. Forty-four patients showed deranged DLco, among which two patients showed an isolated decrease in DLco. Thirty-seven patients had abnormal NFC among which dropout pattern was predominant. MRS was significantly correlated with pulmonary involvement by DLco and HRCT. Conclusions SSc can affect the lungs even before developing obvious clinical pulmonary manifestations. DLco and HRCT play a critical role in detecting early lung involvement and predicting the outcomes in SSc. Higher modified Rodnan’s score, which has a significant correlation with DLco and HRCT can be used to predict early visceral involvement in resource-limited settings.
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Affiliation(s)
- Ravindrachari Mulkoju
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Vinod Kumar Saka
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Manju Rajaram
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Rashmi Kumari
- Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, IND
| | - Vir S Negi
- Internal Medicine: Rheumatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | | | - Vishnukanth Govindaraj
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Dharm Prakash Dwivedi
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Vemuri Mahesh Babu
- Internal Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Sambataro D, Sambataro G, Pignataro F, Maglione W, Malatino L, Vancheri C, Colaci M, Del Papa N. Quantification of Ground Glass Opacities Can Be Useful to Describe Disease Activity in Systemic Sclerosis. Diagnostics (Basel) 2020; 10:E225. [PMID: 32316226 DOI: 10.3390/diagnostics10040225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 01/21/2023] Open
Abstract
Interstitial lung disease (ILD) is the main cause of death in systemic sclerosis (SSc) patients. Usually, patients have lung involvement characterized by ground glass opacities (GGOs), but honeycombing (HC) is also possible. The Wells score is a semi-quantitative index, which is able to assess ILD by distinguishing its main components. The aim of this work is to evaluate the Wells score in relation to the disease activity (DA) index. We enrolled 40 consecutive SSc-ILD patients (26 diffuse cutaneous form, dcSSc, and 14 limited form, lcSSc). All patients were evaluated by the European Scleroderma Study Group (ESSG) index, high-resolution computed tomography, transthoracic echocardiogram, pulmonary function tests (PTSs), and nailfold videocapillaroscopy for the number of microhemorrhages (NEMO) score. In our study, the total extent of ILD (TE-ILD), fibrosis and GGOs correlated with dyspnea (p = 0.03, 0.01 and 0.01 respectively), but not with the ESSG index. Considering only the dcSSc patients, TE-ILD and GGOs correlated with the ESSG index (r = 0.5 p = 0.009), while fibrosis grade correlated with disease duration and systolic pulmonary artery pressure. In conclusion, our data suggest that GGO correlates with DA, while fibrosis may be a sign of disease damage. The quantification of pulmonary involvement using the Wells score can be a useful tool for assessing the appropriate treatment in SSc patients.
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17
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Veselis CA, Steiner RM, Dass C. Bronchoscopic Lung Volume Reduction Using Endobronchial Valves: Imaging Appearance. Chronic Obstr Pulm Dis 2020; 7:60-63. [PMID: 31999903 PMCID: PMC7182386 DOI: 10.15326/jcopdf.7.1.2019.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Clinton A. Veselis
- Lewis Katz School of Medicine, Temple University and Temple University Hospital, Philadelphia, Pennsylvania
| | | | - Chandra Dass
- Lewis Katz School of Medicine, Temple University and Temple University Hospital, Philadelphia, Pennsylvania
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18
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Abstract
PURPOSE OF REVIEW Systemic sclerosis (SSc) is a heterogeneous disease with a variable disease course. Interstitial lung disease (ILD) is one of the leading causes of morbidity and mortality in patients with SSc. The present review highlights recent advances in the classification, diagnosis, and early detection of SSc-associated ILD (SSc-ILD). RECENT FINDINGS Risk stratification through measurement of disease extent on high-resolution computed tomography (HRCT) of the chest, longitudinal declines in pulmonary function tests (PFTs), and mortality prediction models have formed the basis for classifying clinically significant ILD. HRCT may be preferred over PFTs for screening, as PFTs lack sensitivity and have a high false-negative rate. Novel imaging modalities and biomarkers hold promise as adjunct methods for assessing the presence and severity of SSc-ILD, and predicting risk for progressive disease. Further validation is required prior to their use in clinical settings. SUMMARY Classification of SSc-ILD has shifted to a personalized approach that considers an individual patient's probability of progressive disease through identification of risk factors, measurement of disease extent on HRCT, longitudinal declines in PFTs, and mortality prediction models. There remains an unmet need to develop screening guidelines for SSc-ILD.
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Affiliation(s)
- Daniel J DeMizio
- Division of Rheumatology, Department of Medicine, Vagelos College of Physicians and Surgeons - Columbia University Irving Medical Center, New York, New York, USA
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19
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Ovcharenko SI, Son EA, Kapustina VA. Multidisciplinary approach in the diagnosis of idiopathic nonspecific interstitial pneumonia. TERAPEVT ARKH 2019; 91:101-106. [PMID: 31094467 DOI: 10.26442/00403660.2019.03.000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The article provides a modern classification of interstitial lung diseases. The focus is on the poorly studied and difficult to diagnose idiopathic nonspecific interstitial pneumonia, isolated in a separate nosological form and included in the classification only in 2002. The paper presents the features of the clinical, radiological, histological picture of idiopathic nonspecific interstitial pneumonia in comparison with idiopathic pulmonary fibrosis. The presented materials are based on the results of the largest study conducted by the working group of the American Thoracic Society, which shows the importance of the interaction of specialists in the diagnosis of idiopathic nonspecific interstitial pneumonia. A comprehensive assessment of the examination of patients conducted in collaboration with the clinician and radiologist, after their cooperative discussion, in many cases can help to avoid lung biopsy, and the study of morphological material is more often necessary only in difficult diagnostic situations.
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Affiliation(s)
- S I Ovcharenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - E A Son
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - V A Kapustina
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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Tardella M, Di Carlo M, Carotti M, Filippucci E, Grassi W, Salaffi F. Ultrasound B-lines in the evaluation of interstitial lung disease in patients with systemic sclerosis: Cut-off point definition for the presence of significant pulmonary fibrosis. Medicine (Baltimore) 2018; 97:e0566. [PMID: 29718851 PMCID: PMC6392694 DOI: 10.1097/md.0000000000010566] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to establish the cut-off point of ultrasound (US) B-lines number for detecting the presence of significant interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) (SSc-ILD) in relation to high-resolution computed tomography (HRCT) findings.Consecutive SSc-ILD patients underwent chest HRCT, lung US (LUS), pulmonary function test, and clinical assessment. Exclusion criteria were represented by the presence of a coexisting congestive heart failure and a clinical history suggestive of lung or pleural diseases. HRCT images were scored for the presence of ILD by 2 readers, in accordance with the Warrick scoring system. US assessment was performed by a US skilled rheumatologist, blinded to HRCT results and clinical data, and included the bilateral evaluation of 14 lung intercostal spaces (LIS). In each LIS, the number of B-lines was recorded and summed. To test discriminant validity, we used the receiver operating characteristic (ROC) curve analysis applying a Warrick score of 7 as external criterion for the presence of SSc-ILD.Forty patients completed the study. The US B-lines number and the Warrick score confirmed excellent correlation (Spearman rho: 0.958, P = .0001). The ROC curve analysis revealed that the presence of 10 US B-lines is the cut-off point with the greatest positive likelihood ratio (12.52) for the presence of significant SSc-ILD.The detection of 10 B-lines is highly predictive for the HRCT presence of significant SSc-ILD. In SSc patients, the LUS assessment as first imaging tool may represent an effective model to improve the correct timing of chest HRCT.
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Affiliation(s)
- Marika Tardella
- Rheumatological Clinic, Università Politecnica delle Marche, Jesi
| | - Marco Di Carlo
- Rheumatological Clinic, Università Politecnica delle Marche, Jesi
| | - Marina Carotti
- Radiology Department, Università Politecnica delle Marche, Ancona, Italy
| | | | - Walter Grassi
- Rheumatological Clinic, Università Politecnica delle Marche, Jesi
| | - Fausto Salaffi
- Rheumatological Clinic, Università Politecnica delle Marche, Jesi
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Bhaskar R, Singh S, Singh P. Characteristics of COPD phenotypes classified according to the findings of HRCT and spirometric indices and its correlation to clinical characteristics. Afr Health Sci 2018; 18:90-101. [PMID: 29977262 PMCID: PMC6016982 DOI: 10.4314/ahs.v18i1.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION In recent years, there has been increasing interest in diagnosing various components of chronic obstructive pulmonary disease (COPD) using high-resolution computed tomography (HRCT). The present study was undertaken to evaluate HRCT features in patients with COPD. MATERIALS AND METHODS Fifty patients of COPD (confirmed on Spirometry as per the GOLD guidelines 2014 guidelines) were enrolled, out of which 35 patients got a HRCT done. The Philips computer program for lung densitometry was used with these limits (-800/-1, 024 Hounsfield unit [HU]) to calculate densities, after validating densitometry values with phantoms. We established the area with a free hand drawing of the region of interest, then we established limits (in HUs) and the computer program calculated the attenuation as mean lung density (MLD) of the lower and upper lobes. RESULTS There was a significant correlation between smoking index and anteroposterior tracheal diameter (P = 0.036). Tracheal index was found to be decreasing with increasing disease severity which was statistically significant (P = 0.037). A mild linear correlation of pre-forced expiratory volume in the first second (FEV1) was observed with lower lobe and total average MLD while a mild linear correlation of post-FEV1 was observed with both coronal (P = 0.042) and sagittal (P = 0.001) lower lobes MLD. In addition, there was a linear correlation between both pre (P = 0.050) and post (P = 0.024) FEV1/forced vital capacity with sagittal lower lobe MLD. CONCLUSION HRCT may be an important additional tool in the holistic evaluation of COPD.
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Affiliation(s)
- Ravi Bhaskar
- Department of Pulmonary Medicine, Career Institute of Medical Sciences, Lucknow, (UP) India
| | - Seema Singh
- Department of Pulmonary Medicine, Career Institute of Medical Sciences, Lucknow, (UP) India
| | - Pooja Singh
- Department of Pulmonary Medicine, Career Institute of Medical Sciences, Lucknow, (UP) India
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Abstract
Mounier-Kuhn syndrome, also referred to as tracheobronchomegaly, is a rare idiopathic clinical and radiologic disorder characterized by significant tracheobronchial dilation. It results in recurrent lower respiratory tract infections and bronchiectasis. In severe cases, patients may present with acute respiratory distress requiring hospital admission and ventilatory support. Clinical examination and chest radiography may be misleading in these patients as tracheobronchomegaly is easily overlooked on radiographs. We present an interesting report of our patient who presented with acute shortness of breath. A diagnosis of acute pulmonary thromboembolism was suggested by initial evaluation. Computed tomography pulmonary angiography was negative for thromboembolism; however, it revealed diagnosis of this rare disorder.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Bhawna S, Ojha UC, Kumar S, Gupta R, Gothi D, Pal RS. Spectrum of high resolution computed tomography findings in occupational lung disease: experience in a tertiary care institute. J Clin Imaging Sci 2013; 3:64. [PMID: 24605259 PMCID: PMC3935267 DOI: 10.4103/2156-7514.124097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 08/20/2013] [Indexed: 11/12/2022] Open
Abstract
Objective: To study the spectrum of high resolution computed tomography (HRCT) findings in occupational lung disease in industrial workers and to assess the utility of International classification of HRCT for occupational and environmental respiratory diseases (ICHOERD). Materials and Methods: Retrospective analysis of radiological data (radiographs and computed tomography chest scans) gathered over a period of 3 years (January 2010- December 2012) of industrial workers in an organised sector who presented with respiratory complaints. The HRCT findings were evaluated using ICHOERD. Results: There were 5 females and 114 males in the study, with a mean age of 49 years. These workers were exposed to different harmful agents including silica, asbestos, cotton dust, metal dust, iron oxide, organic dust, rubber fumes, plastic fumes, acid fumes, and oil fumes. There were 10 smokers in the study. The radiograph of chest was normal in 53 patients. 46% of these normal patients (21.8% of total) demonstrated positive findings on HRCT. When the radiograph was abnormal, HRCT provided more accurate information and excluded the other diagnosis. The HRCT findings were appropriately described using the ICHOERD. Bronchiectasis was the most common finding (44.5%) with mild central cylindrical bronchiectasis as the most common pattern. Pleural thickening was seen in 41 patients (34.5%). Enlarged hilar or mediastinal lymphnodes were seen in 10 patients (8.4%) with egg-shell calcification in 1 patient exposed to silica. Bronchogenic carcinoma was seen in 1 patient exposed to asbestos. Conclusions: Occupational lung disease is a common work related condition in industrial workers even in the organized sector. Though chest radiograph is the primary diagnostic tool, HRCT is the undisputed Gold Standard for evaluation of these patients. Despite the disadvantage of radiation exposure, low dose CT may serve as an important tool for screening and surveillance. The ICHOERD is a powerful and reliable tool not only for diagnosis, but also for quantitative and analytical measurement of disease, thereby contributing to assessing the medical epidemiology of lung disease. It should always be used while evaluating HRCT of a patient with occupational lung disease.
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Affiliation(s)
- Satija Bhawna
- Department of Radiodiagnosis, Delhi State Cancer Institute, Employee's State Insurance Hospital and Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
| | - U C Ojha
- Institute of Occupational Health, Education and Research, Employee's State Insurance Hospital and Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
| | - Sanyal Kumar
- Department of Radiodiagnosis, Employee's State Insurance Hospital and Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
| | - Rajiv Gupta
- Department of Pulmonary Medicine, Employee's State Insurance Hospital and Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
| | - Dipti Gothi
- Department of Pulmonary Medicine, Employee's State Insurance Hospital and Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
| | - R S Pal
- Department of Pulmonary Medicine, Employee's State Insurance Hospital and Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
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Gomaa MA, Abdel Karim ARA, Abdel Ghany HS, Elhiny AA, Sadek AA. Evaluation of temporal bone cholesteatoma and the correlation between high resolution computed tomography and surgical finding. Clin Med Insights Ear Nose Throat 2013; 6:21-8. [PMID: 24179410 PMCID: PMC3791954 DOI: 10.4137/cment.s10681] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Acquired cholesteatomas are commonly seen in patients less than 30 years. There is a typical history of recurrent middle ear infections with tympanic membrane perforation. The diagnosis of cholesteatoma is usually made on otologic examination. OBJECTIVE The aim of the work was to study the role of high resolution computed tomography (HRCT) in detecting, evaluating, and diagnosing middle ear cholesteatoma. PATIENTS AND METHODS This was a prospective study that included 56 consecutive patients with chronic suppurative otitis media, unsafe type cholesteatomas. Each patient was subjected to full clinical evaluation, and HRCT examination. Intravenous contrast media was used in some patients with suspected intracranial complication. Preoperative radiological data were correlated with data related to surgical findings. RESULTS The study showed that a high incidence of cholesteatoma in the third decade of life. The scutum and lateral attic wall were the most common bony erosions in the middle ear bony wall (64.3%), and the incus was the most eroded ossicle in the middle ear (88.2%). Sclerosing of mastoid air cells were encountered in 60.7% of patients and the lateral semicircular canal was affected in 9%, while facial canal erosion was found in 21.4%. Temporal bone complications are more common than intracranial complications. HRCT findings were compared with operative features; the comparative study included the accuracy and sensitivity of HRCT in detecting cholesteatoma (92.8%), its location and extension (96.4%), ossicular chain erosion (98%), labyrinthine fistula and intracranial complications (100%). CONCLUSION The important role of HRCT scannig lies on the early detection of cholesteatoma, and more conservative surgical procedures can be used to eradicate the disease.
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Affiliation(s)
- Mohammed A Gomaa
- Department of Otorhinolaryngology, Faculty of Medicine, Minia University, Egypy
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Fragkandrea I, Kouloulias V, Mavridis P, Zettos A, Betsou S, Georgolopoulou P, Sotiropoulou A, Gouliamos A, Kouvaris I. Radiation induced pneumonitis following whole breast radiotherapy treatment in early breast cancer patients treated with breast conserving surgery: a single institution study. Hippokratia 2013; 17:233-238. [PMID: 24470733 PMCID: PMC3872459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Hypofractionated Radiotherapy (RT) regimens for breast cancer, although reduce cost and time for patients and health care systems, could have a negative impact on normal underlying lung tissue. We studied and compared lung function and the post-RT radiological changes using High-Resolution Computed Tomography (HRCT) in early breast cancer patients, treated with 3-Dimentional conformal whole breast radiotherapy (WBRT) using either conventional or hypofractionated regime. PATIENTS AND METHODS Between 2008 and 2009, 61 early breast cancer patients (T1-2N0M0) were randomised into two groups .Group A (n=31) received standard radiotherapy with 50Gy/25f/5w plus boost 10Gy/5f/1w to tumour bed. Group B (n=30) received 43.2Gy/16f/22d plus boost 10Gy/5f/1w to tumour bed. Patients of both groups were subjected to dynamic lung testing, using spirometry and gas diffusion tests on Day 0 (D0, before RT), during RT and after completion of RT at 3 and 6 months. HRCT scans were performed in all patients at baseline, and 3,6,12 months after completion of RT. Respiratory symptoms were recorded at 3 and 6 months post completion of RT. Dosimetric factors, such as Central Lung Dose (CLD), lung Volume receiving more 20 Gy (V20), D25 and Mean Lung Dose (MLD) were calculated for all patients. RESULTS At 3 months after RT, the pulmonary changes were classified at HRCT as follows: 91.8 % were Grade 0, 8.19 % Grade 1, and 0 % Grade 2. At 6 months, 86.98 % were Grade 0, 11.47 % Grade 1, and 1.6 % Grade 2. At 12 months, 88.52 % were Grade 0, 9.19 % Grade 1 and 3.27% Grade 2. Univariate analysis showed strong association between radiation pneumonitis, age and all dosimetric parameters. There was no association between fractionation type and incidence of RN. FEV1, FVC, FEV 25, FEV 50 and DLCO showed no statistically significant reduction in both treatment groups in 3 and 6 months following completion of RT, compared to baseline. Multivariate analysis showed no relation between HRCT findings and other variables (age, smoking, chemotherapy, hormonotherapy, V20). CONCLUSION Lung toxicity, as assessed with HRCT and PFTs, was minimal in both treatment arms and our results are in consistency with other published data. Hypofractionated RT was a safe modality and well tolerated by the majority of the patients. Longer follow-up is required for robust assessment of incidence of late lung fibrosis in our series.
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Affiliation(s)
- I Fragkandrea
- The Neurooncology Department, The Royal Marsden Hospital, London, UK
| | - V Kouloulias
- Radiotherapy Department, Attikon Hospital, Athens, Greece
| | - P Mavridis
- Paediatric Department, Hippokrateion Hospital, Thessaloniki, Greece
| | - A Zettos
- Lung Unit, St Savvas Oncology Hospital Athens, Greece
| | - S Betsou
- Radiotherapy Physics Department, St Savvas Oncology Hospital, Athens, Greece
| | - P Georgolopoulou
- Radiotherapy Physics Department, St Savvas Oncology Hospital, Athens, Greece
| | - A Sotiropoulou
- Radiotherapy Physics Department, St Savvas Oncology Hospital, Athens, Greece
| | - A Gouliamos
- Academic Radiology Department, Aretaieion Hospital, Kapodistriakon University, Athens, Greece
| | - I Kouvaris
- Academic Radiology Department, Aretaieion Hospital, Kapodistriakon University, Athens, Greece
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Camera L, Campanile F, Imbriaco M, Ippolito R, Sirignano C, Santoro C, Galderisi M, Salvatore M. Idiopathic pulmonary fibrosis complicated by acute thromboembolic disease: chest X-ray, HRCT and multi-detector row CT angiographic findings. J Thorac Dis 2013; 5:82-6. [PMID: 23372953 DOI: 10.3978/j.issn.2072-1439.2012.12.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 12/10/2012] [Indexed: 11/14/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic diffuse interstitial disease characterized by a predominant reticular pattern of involvement of the lung parenchyma which can be well documented by High Resolution Computed Tomography (HRCT). While almost half of the patients with IPF may develop pulmonary arterial hypertension, the occurrence of superimposed acute thrombo-embolic disease is rare.We describe a case of an 87 yrs old female who was found to have IPF complicated by acute pulmonary thrombo-embolism during the clinical and radiological investigation of a rapidly worsening dyspnea. While chest x-ray findings were initially considered consistent with a congestive heart failure, a bed side echocardiography revealed findings suggestive of pulmonary arterial hypertension and right ventricular failure with enlargement of both right cavities and associated valvular regurgitations. An acute thrombo-embolic disease was initially ruled out by a perfusion lung scintigraphy and subsequently confirmed by contrast-enhanced multi-detector CT which showed an embolus at the emergency of the right inter-lobar artery with associated signs of chronic pulmonary hypertension. However, unenhanced scans performed with both conventional and high resolution techniques also depicted a reticular pattern of involvement of lung parenchyma considered suggestive of IPF despite a atypical upper lobe predominance. IPF was later confirmed by further clinical, serological and instrumental follow-up.
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Affiliation(s)
- Luigi Camera
- Department of Radiology - University "Federico II" - Naples, Italy ; Institute of Biostructures - University "Federico II" - Naples, Italy
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Tiwari RR. Agreement between chest radiography and high-resolution computed tomography in diagnosing dust-related interstitial lung fibrosis. Toxicol Ind Health 2013; 31:235-8. [PMID: 23293132 DOI: 10.1177/0748233712471703] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although it has been suggested that high-resolution computed tomography (HRCT) scans can be obtained when plain radiographs are equivocal for the presence of interstitial lung fibrosis (ILF) caused by inhalation of dust, such as silica, asbestos fibres, etc., the specificity of the findings remains in question. The present study was carried out to compare the relative efficacy of chest radiography by conventional method and HRCT in evaluating ILF which included 22 workers exposed to fibrogenic dust, who were subjected to clinical examination, pulmonary function testing, posteroanterior chest radiography and HRCT. In the six subjects who had findings suggestive of ILF on HRCT, four had normal chest x-ray (CXR) while one each has been diagnosed as having tuberculosis and ILF on CXR. The agreement analysis between HRCT and CXR suggests that there was a poor agreement between HRCT and CXR (kappa = 0.34).
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Anthony M, Singham S, Soans B, Tyler G. Diffuse panbronchiolitis: not just an Asian disease: Australian case series and review of the literature. Biomed Imaging Interv J. 2009;5:e19. [PMID: 21610988 PMCID: PMC3097723 DOI: 10.2349/biij.5.4.e19] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 05/01/2009] [Accepted: 05/01/2009] [Indexed: 02/06/2023] Open
Abstract
Diffuse panbronchiolitis is a disease of obscure aetiology that is traditionally associated with Asian ethnicity. We propose that this disease also occurs in Caucasians and the incidence in this population is greater than currently recognised. We further propose that high resolution computed tomography (HRCT) and response to macrolide therapy should be relied upon to make this diagnosis without verification by lung biopsy. In most circumstances, obtaining a biopsy for histopathology is not practical, and the disease may then be mistaken for other more common airway diseases. Accuracy of diagnosis is important as untreated disease is associated with a poor prognosis, and effective treatment is available. We report four out of a series of cases as evidence that DPB is in fact more common in the Western population than is currently understood.
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Siddiqui S, Brightling CE. Differences in airway wall remodelling in asthma and EB. Thorax 2006; 61:547; author reply 547. [PMID: 16738049 PMCID: PMC2111214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Abstract
Air-space disease is typical in severe acute respiratory syndrome (SARS) and may be indistinguishable from pneumonia of other causes. In the majority of patients, ground glass opacities on chest radiographs progress rapidly to focal, multifocal or diffuse consolidation. Unilateral involvement is common in the early acute phase, becoming bilateral at maximal lung involvement. Generally, radiographic opacities peak between 8 and 10 days after onset of illness, with radiographic scores reflecting temporal changes in clinical and laboratory parameters such as oxygen saturation (SaO2) and liver transaminases. Pleural effusions, cavitating consolidation and mediastinal lymphadenopathy are not typical radiographic features. Pneumomediastinum and pneumothoraces are complications that are associated with extensive disease, with or without assisted ventilation. The utility of high resolution computed tomography (HRCT) and CT scans lies in the confirmation of airspace opacities in cases with normal initial chest radiographs that have strong contact history and signs and symptoms highly suspicious of SARS during the outbreak, allowing early treatment and prompt isolation. The characteristic HRCT feature in the acute phase is ground-glass opacities with smooth interlobular septal thickening, sometimes with consolidation in a subpleural location, which progress rapidly to involve other areas of the lungs. Temporal lung changes documented on HRCT suggest that some residual opacities found may not be reversible.
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Affiliation(s)
- Gaik Cheng Ooi
- Department of Diagnostic Radiology, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China.
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