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Guo J, Ou Y, Liu Q, Zeng K, Huang Y, Yan F, Cai M, Lyu G. Hydrochloric Acid-Induced Acute Lung Injury Models: Dynamic Change and Quantitative Analysis of Modified Lung Ultrasound Scoring System and High-Resolution Computed Tomography. Ultrasound Med Biol 2024; 50:946-953. [PMID: 38514364 DOI: 10.1016/j.ultrasmedbio.2024.03.002] [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] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 02/07/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Acute lung injury (ALI) has become a research hotspot due to its significant public health impact. To explore the value of the use of modified lung ultrasound (MLUS) scoring system for evaluating ALI using a rabbit model of ALI induced by hydrochloric acid (HCl) and investigate its correlation with high-resolution computed tomography (HRCT) and histopathological scores. METHODS Twenty New Zealand laboratory rabbits were randomly assigned to control group (N = 5) and 3 experimental groups (N = 5 each). The control group received instillation of physiological saline, while the 3 experimental groups received 2 mL/kg of different doses of HCl instillation (mild group: pH 1.5, moderate group: pH 1.2, and severe group: pH 1.0) through the trachea under ultrasound guidance. Pulmonary ultrasound (using Mindray Reason9 linear array probes with frequency of 6-15 mHz) and HRCT examinations were performed before modeling (0H) and at 1H, 2H, 4H, 8H, 12H after modeling. The experimental rabbits were sacrificed at 12H for examination of gross lung morphology and hematoxylin-eosin-stained histopathological sections. The correlation of MLUS scores with HRCT/histopathological scores was assessed. RESULTS All rabbits in the experimental groups showed oxygenation index PaO₂/FiO₂<300. Successful establishment of ALI model was proven by autopsy (successful modeling rate: 100%). The pathological damage increased with increase in HCl dosage. MLUS scores showed a positive correlation with HRCT scores/pathological severity. There was a strong positive correlation between MLUS scores and histopathological scores (r = 0.963, p < 0.05) as well as between HRCT scores and histopathological scores (r = 0.932, p < 0.05). CONCLUSION Transtracheal injection of different dosages of HCl under ultrasound guidance induced different degrees of ALI. The MLUS scoring system can be used for semiquantitative evaluation of ALI, and is suitable as a screening tool.
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Affiliation(s)
- Jingyi Guo
- Department of Ultrasound, Jinjing Municipal Hospital (Shanghai Sixth People's Hospital Fujian), NO.16, Luoshan Section, Jinguang Road, Jinjiang, Quanzhou, Fujian
| | - Youkuan Ou
- Department of Radiology, Jinjing Municipal Hospital (Shanghai Sixth People's Hospital Fujian), NO.16, Luoshan Section, Jinguang Road, Jinjiang, Quanzhou, Fujian
| | - Qiuyue Liu
- Department of Pathology, Jinjing Municipal Hospital (Shanghai Sixth People's Hospital Fujian), NO.16, Luoshan Section, Jinguang Road, Jinjiang, Quanzhou, Fujian
| | - Kunzhang Zeng
- Department of Ultrasound, Jinjing Municipal Hospital (Shanghai Sixth People's Hospital Fujian), NO.16, Luoshan Section, Jinguang Road, Jinjiang, Quanzhou, Fujian
| | - Yijun Huang
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, No. 34 Zhongshan North Road, Licheng District, Quanzhou, Fujian
| | - Fuqiang Yan
- Department of Ultrasound, Jinjing Municipal Hospital (Shanghai Sixth People's Hospital Fujian), NO.16, Luoshan Section, Jinguang Road, Jinjiang, Quanzhou, Fujian
| | - Mingli Cai
- Department of Ultrasound, Jinjing Municipal Hospital (Shanghai Sixth People's Hospital Fujian), NO.16, Luoshan Section, Jinguang Road, Jinjiang, Quanzhou, Fujian
| | - Guorong Lyu
- Department of Ultrasound, Jinjing Municipal Hospital (Shanghai Sixth People's Hospital Fujian), NO.16, Luoshan Section, Jinguang Road, Jinjiang, Quanzhou, Fujian; Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, No. 34 Zhongshan North Road, Licheng District, Quanzhou, Fujian; Quanzhou Medical College, No. 2 Anji Road, Luojiang District, Quanzhou, Fujian.
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Speck KE, Kulaylat AN, Baerg JE, Acker SN, Baird R, Beres AL, Chang H, Derderian SC, Englum B, Gonzalez KW, Kawaguchi A, Kelley-Quon L, Levene TL, Rentea RM, Rialon KL, Ricca R, Somme S, Wakeman D, Yousef Y, St Peter SD, Lucas DJ. Evaluation and Management of Primary Spontaneous Pneumothorax in Adolescents and Young Adults: A Systematic Review From the APSA Outcomes & Evidence-Based Practice Committee. J Pediatr Surg 2023; 58:1873-1885. [PMID: 37130765 DOI: 10.1016/j.jpedsurg.2023.03.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/15/2023] [Accepted: 03/31/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Controversy exists in the optimal management of adolescent and young adult primary spontaneous pneumothorax. The American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee performed a systematic review of the literature to develop evidence-based recommendations. METHODS Ovid MEDLINE, Elsevier Embase, EBSCOhost CINAHL, Elsevier Scopus, and Wiley Cochrane Central Register of Controlled Trials databases were queried for literature related to spontaneous pneumothorax between January 1, 1990, and December 31, 2020, addressing (1) initial management, (2) advanced imaging, (3) timing of surgery, (4) operative technique, (5) management of contralateral side, and (6) management of recurrence. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. RESULTS Seventy-nine manuscripts were included. Initial management of adolescent and young adult primary spontaneous pneumothorax should be guided by symptoms and can include observation, aspiration, or tube thoracostomy. There is no evidence of benefit for cross-sectional imaging. Patients with ongoing air leak may benefit from early operative intervention within 24-48 h. A video-assisted thoracoscopic surgery (VATS) approach with stapled blebectomy and pleural procedure should be considered. There is no evidence to support prophylactic management of the contralateral side. Recurrence after VATS can be treated with repeat VATS with intensification of pleural treatment. CONCLUSIONS The management of adolescent and young adult primary spontaneous pneumothorax is varied. Best practices exist to optimize some aspects of care. Further prospective studies are needed to better determine optimal timing of operative intervention, the most effective operation, and management of recurrence after observation, tube thoracostomy, or operative intervention. LEVEL OF EVIDENCE Level 4. TYPE OF STUDY Systematic Review of Level 1-4 studies.
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Affiliation(s)
- K Elizabeth Speck
- Mott Children's Hospital, University of Michigan, Division of Pediatric Surgery, Ann Arbor, MI, USA.
| | - Afif N Kulaylat
- Penn State Children's Hospital, Division of Pediatric Surgery, Hershey, PA, USA
| | - Joanne E Baerg
- Presbyterian Health Services, Division of Pediatric Surgery, Albuquerque, NM, USA
| | | | - Robert Baird
- British Columbia Children's Hospital, Vancouver, Canada
| | - Alana L Beres
- St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Henry Chang
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | | | - Brian Englum
- University of Maryland Children's Hospital, Baltimore, MD, USA
| | | | | | | | | | - Rebecca M Rentea
- Children's Mercy-Kansas City, Department of Surgery, Kansas City, MO, USA
| | | | - Robert Ricca
- University of South Carolina, Greenville, SC, USA
| | - Stig Somme
- Children's Hospital Colorado, Aurora, CO, USA
| | | | - Yasmine Yousef
- Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Shawn D St Peter
- Children's Mercy-Kansas City, Department of Surgery, Kansas City, MO, USA
| | - Donald J Lucas
- Division of Pediatric Surgery, Naval Medical Center San Diego, CA, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Martínez de Alegría Alonso A, Bermúdez Naveira A, Uceda Navarro D, Domínguez Robla M. Expiratory CT scan: When to do it and how to interpret it. Radiologia (Engl Ed) 2023; 65:352-361. [PMID: 37516488 DOI: 10.1016/j.rxeng.2023.01.008] [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] [Received: 10/27/2022] [Accepted: 01/22/2023] [Indexed: 07/31/2023]
Abstract
Expiratory CT scan is a complementary technique of inspiratory CT that provide valuable physiological information and may be more sensitive to detect air trapping than pul-monary function tests. It is useful in many obstructive airway diseases, including obliterative bronchiolitis, asthma, Swyer-James syndrome, tracheomalacia, hypersensitivity pneumonitis and sarcoidosis. In obliterative bronchiolitis, expiratory CT scan may be the only imaging technique that shows abnormalities in the early phase of disease. In order to obtain a good quality study, we should explain the procedure to the patient, use precise instructions and do some practice before image acquisition. Here we describe strategies to optimize the techni-que and propose an algorithm that help in interpretation of imaging findings in patients with obstructive airway disease.
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Affiliation(s)
| | - A Bermúdez Naveira
- Servicio de Radiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - D Uceda Navarro
- Servicio de Radiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - M Domínguez Robla
- Servicio de Radiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
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Chen Z, Wang G, Wu H, Wu M, Wu X, Xu M, Xie M. [Establishment and Verification of Benign and Malignant Prediction Model of
Subcentimeter Pulmonary Ground Glass Nodules Based on HRCT]. Zhongguo Fei Ai Za Zhi 2023; 26:377-385. [PMID: 37316447 DOI: 10.3779/j.issn.1009-3419.2023.101.15] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Pre-operative accuracy of subcentimeter ground glass nodules (SGGNs) is a difficult problem in clinical practice, but there are few clinical studies on the benign and malignant prediction model of SGGNs. The aim of this study was to help identify benign and malignant lesions of SGGNs based on the imaging features of high resolution computed tomography (HRCT) and the general clinical data of patients, and to build a risk prediction model. METHODS This study retrospectively analyzed the clinical data of 483 patients with SGGNs who underwent surgical resection and were confirmed by histology from the First Affiliated Hospital of University of Science and Technology of China from August 2020 to December 2021. The patients were divided into the training set (n=338) and the validation set (n=145) according to 7:3 random assignment. According to the postoperative histology, they were divided into adenocarcinoma group and benign lesion group. The independent risk factors and models were analyzed by univariate analysis and multivariate Logistic regression. The receiver operator characteristic (ROC) curve was constructed to evaluate the model differentiation, and the calibration curve was used to evaluate the model consistency. The clinical application value of the decision curve analysis (DCA) evaluation model was drawn, and the validation set data was substituted for external verification. RESULTS Multivariate Logistic analysis screened out patients' age, vascular sign, lobular sign, nodule volume and mean-CT value as independent risk factors for SGGNs. Based on the results of multivariate analysis, Nomogram prediction model was constructed, and the area under ROC curve was 0.836 (95%CI: 0.794-0.879). The critical value corresponding to the maximum approximate entry index was 0.483. The sensitivity was 76.6%, and the specificity was 80.1%. The positive predictive value was 86.5%, and the negative predictive value was 68.7%. The benign and malignant risk of SGGNs predicted by the calibration curve was highly consistent with the actual occurrence risk after sampling 1,000 times using Bootstrap method. DCA showed that patients showed a positive net benefit when the predictive probability of the predicted model probability was 0.2 to 0.9. CONCLUSIONS Based on preoperative medical history and preoperative HRCT examination indicators, the benign and malignant risk prediction model of SGGNs was established to have good predictive efficacy and clinical application value. The visualization of Nomogram can help to screen out high-risk groups of SGGNs, providing support for clinical decision-making.
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Affiliation(s)
| | - Gaoxiang Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of University of
Science and Technology of China, Hefei 230001, China
| | - Hanran Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of
Science and Technology of China, Hefei 230001, China
| | - Mingsheng Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of
Science and Technology of China, Hefei 230001, China
| | - Xianning Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of
Science and Technology of China, Hefei 230001, China
| | - Meiqing Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of
Science and Technology of China, Hefei 230001, China
| | - Mingran Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of University of
Science and Technology of China, Hefei 230001, China
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Kacprzak A, Burakowska B, Kurzyna M, Fijałkowska A, Florczyk M, Wieteska-Miłek M, Darocha S, Torbicki A, Szturmowicz M. Predictive value of chest HRCT for survival in idiopathic pulmonary arterial hypertension. Respir Res 2021; 22:293. [PMID: 34789251 DOI: 10.1186/s12931-021-01893-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/20/2021] [Accepted: 11/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background Little attention has been paid to chest high resolution computed tomography (HRCT) findings in idiopathic pulmonary arterial hypertension (IPAH) patients so far, while a couple of small studies suggested that presence of centrilobular ground-glass opacifications (GGO) on lung scans could have a significant negative prognostic value. Therefore, the aims of the present study were: to assess frequency and clinical significance of GGO in IPAH, and to verify if it carries an add-on prognostic value in reference to multidimensional risk assessment tool recommended by the 2015 European pulmonary hypertension guidelines. Methods Chest HRCT scans of 110 IPAH patients were retrospectively analysed. Patients were divided into three groups: with panlobular (p)GGO, centrilobular (c)GGO, and normal lung pattern. Association of different GGO patterns with demographic, functional, haemodynamic, and biochemical parameters was tested. Survival analysis was also performed. Results GGO were found in 46% of the IPAH patients: pGGO in 24% and cGGO in 22%. Independent predictors of pGGO were: positive history of haemoptysis, higher number of low-risk factors, and lower cardiac output. Independent predictors of cGGO were: positive history of haemoptysis, younger age, higher right atrial pressure, and higher mixed venous blood oxygen saturation. CGGO had a negative prognostic value for outcome in a 2-year perspective. This effect was not seen in the longer term, probably due to short survival of cGGO patients. Conclusions Lung HRCT carries a significant independent prognostic information in IPAH, and in patients with cGGO present on the scans an early referral to lung transplantation centres should be considered.
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Céspedes-Cruz AI, Carranza-Muleiro RA, López-Rojas EL, Cruz-Domínguez MP, Espinosa-Gan H, Ramírez-Pérez J, Moreno-Martínez JM, Moysén-Ramírez S, Zeferino-Cruz M, Torres-Jiménez AR, Ordoñez-González I, Medina G. Pulmonary involvement in patients with juvenile systemic sclerosis. Bol Med Hosp Infant Mex 2021; 78:385-394. [PMID: 34570747 DOI: 10.24875/bmhim.20000301] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Pulmonary involvement in juvenile systemic sclerosis (JSSc) is rare in children and contributes to morbimortality. This study aimed to describe the pulmonary function and clinical, radiologic, and tomographic findings in JSSc. Methods Patients with JSSc between 5-14 years of age were included. Clinical, functional, and imaging characteristics were assessed. Patients were excluded if they showed lung disease not associated with JSSc: mixed connective tissue disease, overlap syndrome, or acute cardiopulmonary failure at the time of the study. All patients underwent physical examination, electrocardiogram, spirometry, chest X-ray, high-resolution computed tomography (HRCT) of the chest, echocardiography, lung function tests, and the 6-minute walk test (6-MWT). Descriptive statistics were employed for data analysis. Results We studied 15 patients with the following characteristics: median age, 11 years; median since symptoms onset, 6 years; median since JSSc diagnosis and the finding of pulmonary involvement, 2 years. Lung disease was detected in 73%, interstitial lung disease (ILD) the most common affection (67%); pulmonary hypertension was found in 6.6%. 6-MWT was positive in 26.6%, forced vital capacity (FVC) was abnormal in 26.6%. No pulmonary involvement was found in four patients. Conclusions The most frequent pulmonary affection in JSSc was ILD. Thus, early JSSc detection and periodic lung monitoring are mandatory to avoid further complications once JSSc is diagnosed.
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Affiliation(s)
- Adriana I Céspedes-Cruz
- Departamento de Reumatología Pediátrica, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social (IMSS), Mexico City. Mexico.,Universidad Nacional Autónoma de México, Mexico City. Mexico
| | - Rosa A Carranza-Muleiro
- División de Investigación en Salud, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City. Mexico.,Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City. Mexico
| | | | - María P Cruz-Domínguez
- Universidad Nacional Autónoma de México, Mexico City. Mexico.,División de Investigación en Salud, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City. Mexico
| | - Héctor Espinosa-Gan
- Departamento de Cardiología Pediátrica, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City. Mexico
| | - Jorge Ramírez-Pérez
- Departamento de Radiología, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City. Mexico
| | - Juan M Moreno-Martínez
- Departamento de Radiología, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City. Mexico
| | - Silvia Moysén-Ramírez
- Departamento de Neumología, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City. Mexico
| | - Maritza Zeferino-Cruz
- Hospital General Gaudencio González Garza, Centro Médico La Raza, IMSS, Mexico City. Mexico
| | | | | | - Gabriela Medina
- Universidad Nacional Autónoma de México, Mexico City. Mexico.,División de Investigación en Salud, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City. Mexico.,Unidad de Investigación en Medicina Traslacional, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City. Mexico
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Yıldırım F, Gulhan PY, Diken ÖE, Capraz A, Simsek M, Yildirim BB, Taysi MR, Ozturk SY, Demirtas N, Ergil J, Dirican A, Uzar T, Karaman I, Ozkaya S. Role of serological rapid antibody test in the management of possible COVID-19 cases. World J Exp Med 2021; 11:44-54. [PMID: 34616666 PMCID: PMC8462010 DOI: 10.5493/wjem.v11.i4.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/26/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the detection of viral particles by reverse transcription polymerase chain reaction (RT-PCR) is the gold standard diagnostic test for coronavirus disease 2019 (COVID-19), the false-negative results constitute a big challenge.
AIM To examine a group of patients diagnosed and treated as possible COVID-19 pneumonia whose multiple nasopharyngeal swab samples were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by RT-PCR but then serological immunoglobulin M/immunoglobulin G (IgM/IgG) antibody against SARS-CoV-2 were detected by rapid antibody test.
METHODS Eighty possible COVID-19 patients who had at least two negative consecutive COVID-19 RT-PCR test and were subjected to serological rapid antibody test were evaluated in this study.
RESULTS The specific serological total IgM/IgG antibody against SARS-CoV-2 was detected in twenty-two patients. The mean age of this patient group was 63.2± 13.1-years-old with a male/female ratio of 11/11. Cough was the most common symptom (90.9%). The most common presenting chest computed tomography findings were bilateral ground glass opacities (77.2%) and alveolar consolidations (50.1%). The mean duration of time from appearance of first symptoms to hospital admission, to hospital admission, to treatment duration and to serological positivity were 8.6 d, 11.2 d, 7.9 d, and 24 d, respectively. Compared with reference laboratory values, serologically positive patients have shown increased levels of acute phase reactants, such as C-reactive protein, ferritin, and procalcitonin and higher inflammatory markers, such as erythrocyte sedimentation rate, lactate dehydrogenase enzyme, and fibrin end-products, such as D-dimer. A left shift on white blood cell differential was observed with increased neutrophil counts and decreased lymphocytes.
CONCLUSION Our study demonstrated the feasibility of a COVID-19 diagnosis based on rapid antibody test in the cases of patients whose RT-PCR samples were negative. Detection of antibodies against SARS-CoV-2 with rapid antibody test should be included in the diagnostic algorithm in patients with possible COVID-19 pneumonia.
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Affiliation(s)
- Fatma Yıldırım
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences Diskapi Yildirim Beyazit Research and Education Hospital, Ankara 06110, Turkey
| | - Pinar Yildiz Gulhan
- Department of Pulmonary Medicine, Düzce University, Faculty of Medicine, Düzce 81100, Turkey
| | - Özlem Ercen Diken
- Department of Chest Diseases, Adana Research and Education Hospital, University of Health Sciences, Adana 01230, Turkey
| | - Aylin Capraz
- Department of Pulmonary Medicine, Amasya University Sabuncuoglu Serefeddin Research and Education Hospital, Amasya 05200, Turkey
| | - Meltem Simsek
- Medical Intensive Care Unit, University of Health Sciences Diskapi Yildirim Beyazit Research and Education Hospital, Ankara 06110, Turkey
| | - Berna Botan Yildirim
- Department of Pulmonology, Research and Education Hospital of Baskent University, Konya 42030, Turkey
| | - Muhammet Ridvan Taysi
- Department of Infectious and Clinical Microbiology, University of Health Sciences Diskapi Yildirim Beyazit Research and Education Hospital, Ankara 06110, Turkey
| | - Sakine Yilmaz Ozturk
- Department of Pulmonary Medicine, Vezirkopru State Hospital, Samsun 55090, Turkey
| | - Nurcan Demirtas
- Department of Pulmonary Medicine, Kumluca State Hospital, Antalya 07070, Turkey
| | - Julide Ergil
- Department of Anaesthesiology and Reanimation, Diskapi Yildirim Beyazit Research and Education Hospital, University of Health Sciences, Ankara 06110, Turkey
| | - Adem Dirican
- Department of Pulmonary Medicine, Samsun Medicalpark Hospital, Samsun 55090, Turkey
| | - Tugce Uzar
- Medical Student/Intern, Bahcesehir University Faculty of Medicine, Istanbul 34734, Turkey
| | - Irem Karaman
- Medical Student/Intern, Bahcesehir University Faculty of Medicine, Istanbul 34734, Turkey
| | - Sevket Ozkaya
- Department of Pulmonary Medicine, Bahcesehir University, Faculty of Medicine, Istanbul 34734, Turkey
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Wang R, Zhang H, Ding Y, Zhao J, Yuan XY, Huang LR, Cui A. [Transthoracic ultrasonographic features of typical high-resolution computed tomography signs of interstitial lung diseases]. Zhonghua Jie He He Hu Xi Za Zhi 2020; 43:564-570. [PMID: 32629555 DOI: 10.3760/cma.j.cn112147-20200319-00366] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the accuracy of bedside transthoracic lung ultrasonography (TLU) in different typical high resolution computed tomography (HRCT) signs of interstitial lung diseases (ILDs). Methods: Fifty patients first diagnosed with ILDs were enrolled from January 2016 to December 2018. There were 21 males and 29 females. The mean age was (56±14) years(rang 42-73 years). TLU was performed in inspiration for the characters of A-lines and B-lines as well as pleural at anterior, lateral and dorsal chest walls, respectively. HRCT was selected at three levels according to the upper, middle, and lower lung fields. The range of each level needing to be evaluated corresponded to the TLU scanning field one by one, and recording the signs of HRCT. Early change of ILDs was definite as the HRCT score was no more than 1 and no honeycomb was present. The correlation between A-lines, B-lines, pleural abnormal and HRCT signs was evaluted. Spearman's correlation coefficient was used to evaluate the relationship between B-lines and HRCT score. Results: The sensitivity and specificity of A-lines for HRCT normality were 83.9% and 84.9%, respectively. Coincidence rate was 84.6%. The sensitivity and specificity of B-lines for HRCT abnormality were 84.9% and 83.9%, respectively. Coincidence rate was 84.6%. Interlobular septal thickening shadow had fewer B-lines and narrower interval than other HRCT signs, while the other HRCT signs had no differences in B-lines. And the sensitivity and specificity of B-lines for detection the early change of HRCT in ILDs were 89.5% and 89.2%, respectively. Coincidence rate was 89.3%. A positive correlation was found between the number of B-lines and HRCT scores (R=0.827, P<0.001), and the width of B-lines and HRCT score (R=0.951, P<0.001). Meanwhile, a negative correlation was found between the interval of B-lines and HRCT score (R=-0.831, P<0.001). The sensitivity and specificity of TLU for HRCT pleural abnormality were 100.0% and 90.0%, respectively. Coincidence rate was 93.6%. Conclusions: TLU showed high sensitivity and specificity in finding interstitial changes of the lung. It gives a new view on the diagnostic possibilities of ILDs and may be used to evaluate the severity and the therapeutic effect of treatment. However, TLU could not differentiate HRCT signs of ILDs.
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Affiliation(s)
- R Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
| | - H Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
| | - Y Ding
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - J Zhao
- Department of Respiratory and Critical Care Medicine, Qinghai Provincial People's Hospital, Xining 810000, China
| | - X Y Yuan
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
| | - L R Huang
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
| | - A Cui
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
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Salaffi F, Carotti M, Tardella M, Di Carlo M, Fraticelli P, Fischetti C, Giovagnoni A, Gabrielli A. Computed tomography assessment of evolution of interstitial lung disease in systemic sclerosis: Comparison of two scoring systems. Eur J Intern Med 2020; 76:71-75. [PMID: 32089425 DOI: 10.1016/j.ejim.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/29/2020] [Accepted: 02/11/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate and compare the internal and external responsiveness of a computed-aided method (CaM) with a conventional visual reader-based score (CoVR) to measure interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) on high resolution computed tomography (HRCT). METHODS Forty-five patients were evaluated in this retrospective cohort. HRCTs were collected at baseline and after 1 year. HRCT abnormalities were evaluated according to a CoVR (Warrick's method) and a quantitative CaM. Internal 1-year responsiveness was tested with a standardized mean response (SRM). Analyses of the receiver operating characteristic curves (ROCs) evaluated the sensitivity and specificity of the two methods to discriminate between clinically relevant progression and no relevant progression, using expert judgment as the gold standard (external responsiveness). RESULTS In one year, lung involvement was stable/improved in 17 of the 45 patients (37.8%) and worsened in 28 patients (62.2%). HRCT scores changed moderately over the follow-up period. Using SFM, CaM was significantly more responsive in detecting changes due to treatment than the CoVR method. Likewise, in the analysis of the ROC curve, CaM scores showed the highest performance (AUC ROC CaM vs. CoVR, 0.951 vs. 0.807; p = 0.0065). CONCLUSION Quantitative analysis of CaM was more responsive than the CoVR method to accurately evaluate and monitor SSc-ILD progression or response to therapy.
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Affiliation(s)
- Fausto Salaffi
- Rheumatological Clinic, Ospedale Carlo Urbani Jesi, Università Politecnica delle Marche, Ancona, Italy.
| | - Marina Carotti
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Italy.
| | - Marika Tardella
- Rheumatological Clinic, Ospedale Carlo Urbani Jesi, Università Politecnica delle Marche, Ancona, Italy.
| | - Marco Di Carlo
- Rheumatological Clinic, Ospedale Carlo Urbani Jesi, Università Politecnica delle Marche, Ancona, Italy.
| | - Paolo Fraticelli
- Department of Internal Medicine, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
| | - Colomba Fischetti
- Department of Internal Medicine, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
| | - Andrea Giovagnoni
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Italy.
| | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
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10
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Stefano A, Gioè M, Russo G, Palmucci S, Torrisi SE, Bignardi S, Basile A, Comelli A, Benfante V, Sambataro G, Falsaperla D, Torcitto AG, Attanasio M, Yezzi A, Vancheri C. Performance of Radiomics Features in the Quantification of Idiopathic Pulmonary Fibrosis from HRCT. Diagnostics (Basel) 2020; 10:E306. [PMID: 32429182 PMCID: PMC7277964 DOI: 10.3390/diagnostics10050306] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 04/09/2020] [Revised: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Our study assesses the diagnostic value of different features extracted from high resolution computed tomography (HRCT) images of patients with idiopathic pulmonary fibrosis. These features are investigated over a range of HRCT lung volume measurements (in Hounsfield Units) for which no prior study has yet been published. In particular, we provide a comparison of their diagnostic value at different Hounsfield Unit (HU) thresholds, including corresponding pulmonary functional tests. METHODS We consider thirty-two patients retrospectively for whom both HRCT examinations and spirometry tests were available. First, we analyse the HRCT histogram to extract quantitative lung fibrosis features. Next, we evaluate the relationship between pulmonary function and the HRCT features at selected HU thresholds, namely -200 HU, 0 HU, and +200 HU. We model the relationship using a Poisson approximation to identify the measure with the highest log-likelihood. RESULTS Our Poisson models reveal no difference at the -200 and 0 HU thresholds. However, inferential conclusions change at the +200 HU threshold. Among the HRCT features considered, the percentage of normally attenuated lung at -200 HU shows the most significant diagnostic utility. CONCLUSIONS The percentage of normally attenuated lung can be used together with qualitative HRCT assessment and pulmonary function tests to enhance the idiopathic pulmonary fibrosis (IPF) diagnostic process.
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Affiliation(s)
- Alessandro Stefano
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (A.S.); (A.C.); (V.B.)
| | - Mauro Gioè
- Department of Economics, Business, and Statistics (DSEAS), University of Palermo, 90133 Palermo, Italy; (M.G.); (M.A.)
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (A.S.); (A.C.); (V.B.)
| | - 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.); (G.S.); (D.F.); (A.G.T.)
| | - Sebastiano Emanuele Torrisi
- Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (S.E.T.); (C.V.)
| | - Samuel Bignardi
- Laboratory of Computational Computer Vision (LCCV), School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (S.B.); (A.Y.)
| | - 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.); (G.S.); (D.F.); (A.G.T.)
| | - Albert Comelli
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (A.S.); (A.C.); (V.B.)
- Ri.Med Foundation, 90133 Palermo, Italy
| | - Viviana Benfante
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (A.S.); (A.C.); (V.B.)
| | - Gianluca Sambataro
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology Unit I, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy; (S.P.); (A.B.); (G.S.); (D.F.); (A.G.T.)
- Artroreuma S.R.L., Rheumatology Outpatient Clinic Associated with the National Health System, 95030 Mascalucia (Catania), Italy
| | - Daniele Falsaperla
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology Unit I, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy; (S.P.); (A.B.); (G.S.); (D.F.); (A.G.T.)
| | - Alfredo Gaetano Torcitto
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology Unit I, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy; (S.P.); (A.B.); (G.S.); (D.F.); (A.G.T.)
| | - Massimo Attanasio
- Department of Economics, Business, and Statistics (DSEAS), University of Palermo, 90133 Palermo, Italy; (M.G.); (M.A.)
| | - Anthony Yezzi
- Laboratory of Computational Computer Vision (LCCV), School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (S.B.); (A.Y.)
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (S.E.T.); (C.V.)
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11
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Vaid S, Vaid N, Kiran AS. Deossification of the Otic Bone in High Pressure CSF Otorhinorrhea: A New Radiological Finding. Indian J Otolaryngol Head Neck Surg 2020; 72:385-391. [PMID: 32728551 DOI: 10.1007/s12070-019-01777-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/24/2019] [Indexed: 10/25/2022] Open
Abstract
To highlight a new radiological feature in a patient with labyrinthine malformation presenting with bilateral spontaneous high pressure cerebrospinal fluid (CSF) otorhinorrhea. Study design-retrospective case review. Setting-academic, tertiary cochlear implant center. A cochlear implantee with Incomplete Partition Defect (Type 1) presented with meningitis and CSF otorhinorrhea for which she initially underwent medical treatment. High resolution computed tomography (HRCT) of the temporal bone with CT cisternography was performed for identifying the site of the CSF leak. HRCT and CT cisternography revealed a defect in the region of the stapes foot plate and marked thinning/deossification of the cochlear promontory. These two findings were absent in the pre-implant imaging of the patient done 3 years ago. Surgery by endaural approach was undertaken to close the site of CSF leak. Intraoperatively, marked thinning of the cochlear promontory was observed, corresponding to 'blue lining' of the labyrinth in otologic surgery. This intraoperative finding indicating high intralabyrinthine CSF pressure correlated well with the imaging findings. Primary surgical repair resulted in successful CSF leak closure followed by theco-peritoneal shunting to prevent recurrence of the leak. The patient is using her cochlear implant and doing well with auditory verbal therapy. She is asymptomatic till date. Thinning and deossification of the otic capsule on HRCT is an important indicator of high CSF pressure in patients with labyrinthine malformations. Our case study highlights the need for heightened radiological and clinical vigilance in this subgroup of patients to predict complications and ensure prompt intervention.
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Affiliation(s)
- Sanjay Vaid
- Division of Head and Neck Imaging, Star Imaging and Research Centre, Pune, India.,Pune, Maharashtra 411007 India
| | - Neelam Vaid
- Department of Otorhinolaryngology, K.E.M. Hospital, Pune, India
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12
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Whyte MP, McAlister WH, Zhang F, Bijanki VN, Nenninger A, Gottesman GS, Lin EL, Huskey M, Duan S, Dahir K, Mumm S. New explanation for autosomal dominant high bone mass: Mutation of low-density lipoprotein receptor-related protein 6. Bone 2019; 127:228-243. [PMID: 31085352 DOI: 10.1016/j.bone.2019.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 01/10/2023]
Abstract
LRP5 encodes low-density lipoprotein receptor-related protein 5 (LRP5). When LRP5 with a Frizzled receptor join on the surface of an osteoblast and bind a member of the Wnt family of ligands, canonical Wnt/β-catenin signaling occurs and increases bone formation. Eleven heterozygous gain-of-function missense mutations within LRP5 are known to prevent the LRP5 inhibitory ligands sclerostin and dickkopf1 from attaching to LRP5's first β-propeller, and thereby explain the rare autosomal dominant (AD) skeletal disorder "high bone mass" (HBM). LRP6 is a cognate co-receptor of LRP5 and similarly controls Wnt signaling in osteoblasts, yet the consequences of increased LRP6-mediated signaling remain unknown. We investigated two multi-generational American families manifesting the clinical and routine laboratory features of LRP5 HBM but without an LRP5 defect and instead carrying a heterozygous LRP6 missense mutation that would alter the first β-propeller of LRP6. In Family 1 LRP6 c.602C>T, p.A201V was homologous to LRP5 HBM mutation c.641C>T, p.A214V, and in Family 2 LRP6 c.553A>C, p.N185H was homologous to LRP5 HBM mutation c.593A>G, p.N198S but predicting a different residue at the identical amino acid position. In both families the LRP6 mutation co-segregated with striking generalized osteosclerosis and hyperostosis. Clinical features shared by the seven LRP6 HBM family members and ten LRP5 HBM patients included a broad jaw, torus palatinus, teeth encased in bone and, reportedly, resistance to fracturing and inability to float in water. For both HBM disorders, all affected individuals were taller than average for Americans (Ps < 0.005), but with similar mean height Z-scores (P = 0.7606) and indistinguishable radiographic skeletal features. Absence of adult maxillary lateral incisors was reported by some LRP6 HBM individuals. In contrast, our 16 patients with AD osteopetrosis [i.e., Albers-Schönberg disease (A-SD)] had an unremarkable mean height Z-score (P = 0.9401) lower than for either HBM group (Ps < 0.05). DXA mean BMD Z-scores in LRP6 HBM versus LRP5 HBM were somewhat higher at the lumbar spine (+7.8 vs +6.5, respectively; P = 0.0403), but no different at the total hip (+7.9 vs +7.7, respectively; P = 0.7905). Among the three diagnostic groups, only the LRP6 HBM DXA BMD values at the spine seemed to increase with subject age (R = +0.7183, P = 0.0448). Total hip BMD Z-scores were not significantly different among the three disorders (Ps > 0.05), and showed no age effect (Ps > 0.1). HR-pQCT available only for LRP6 HBM revealed indistinct corticomedullary boundaries, high distal forearm and tibial total volumetric BMD, and finite element analysis predicted marked fracture resistance. Hence, we have discovered mutations of LRP6 that cause a dento-osseous disorder indistinguishable without mutation analysis from LRP5 HBM. LRP6 HBM seems associated with generally good health, providing some reassurance for the development of anabolic treatments aimed to enhance LRP5/LRP6-mediated osteogenesis.
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Affiliation(s)
- Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - William H McAlister
- Mallinckrodt Institute of Radiology, Washington University School of Medicine at St. Louis Children's Hospital, St. Louis, MO 63110, USA.
| | - Fan Zhang
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA.
| | - Vinieth N Bijanki
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA.
| | - Angela Nenninger
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA.
| | - Gary S Gottesman
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA.
| | - Elizabeth L Lin
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - Margaret Huskey
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - Shenghui Duan
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - Kathryn Dahir
- Department of Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Steven Mumm
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
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13
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Abstract
Idiopathic Pulmonary Fibrosis (IPF) is a most common progressive interstitial lung disease (ILD) of unknown etiology, although majority of patients are elderly male smokers. The main pathogenesis is aberrant recovery of epithelial injury and collagen deposition. Fibrotic nonspecific interstitial pneumonia, connective tissue disease (CTD) especially rheumatoid arthritis (RA) associated ILD, and chronic hypersensitivity pneumonia(CHP) are important differential diagnosis. Main symptoms are non-productive cough and progressive exertional dyspnea. Crucial physical findings are scalene muscle hypertrophy, bibasilar fine crackles, and finger clubbing. The serum markers such as lactate dehydrogenase (LDH) and Krebs von den Lungen-6 (KL-6) are sensitive for ILD detection and activity. Both pulmonary function test (PFT) and the 6-minute walk test (6MWT) are useful tool for evaluation of disease progression of IPF. Serial changes of forced vital capacity (FVC) and 6MWT distance predict mortality in IPF effectively. Recently published international IPF guidelines highlight the importance of chest high resolution computed tomography (HRCT) findings such as honeycombing, traction bronchiectasis (TBE), and sub-pleural reticular opacity. IPF is chronic and progressive; therefore, tracking disease behavior is crucial. Unifying clinical, physiological, and imaging information over time is useful. With regard to its management, two anti-fibrotic drugs such as pirfenidone and nintedanib have been available. These drugs can slow the decline of FVC and prevent acute exacerbation (AE). In this review, I outline the clinical characteristics of IPF, physiological, imaging, pathological findings and review diagnosis process and management.
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Affiliation(s)
- Tomoo Kishaba
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Miyazato 281, Uruma City, Okinawa 〒904-2293, Japan.
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14
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Olesen WH, Andersen PE, Licht PB. Reply to Bertolaccini et al. Eur J Cardiothorac Surg 2019; 55:594-595. [PMID: 30256924 DOI: 10.1093/ejcts/ezy315] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Peter Bjørn Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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15
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Cowman SA, Jacob J, Obaidee S, Andres Floto R, Wilson R, Haworth CS, Loebinger MR. Latent class analysis to define radiological subgroups in pulmonary nontuberculous mycobacterial disease. BMC Pulm Med 2018; 18:145. [PMID: 30170572 PMCID: PMC6119278 DOI: 10.1186/s12890-018-0675-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 12/13/2017] [Accepted: 06/13/2018] [Indexed: 11/17/2022] Open
Abstract
Background Nontuberculous mycobacterial (NTM) pulmonary disease has conventionally been classified on the basis of radiology into fibrocavitary and nodular-bronchiectatic disease. Whilst being of great clinical utility, this may not capture the full spectrum of radiological appearances present. The aim of this study was to use latent class analysis (LCA) as an unbiased method of grouping subjects with NTM-pulmonary disease based on their CT features and to compare the clinical characteristics of these groups. Methods Individuals with NTM-pulmonary disease were recruited and a contemporaneous CT scan obtained. This was scored using an NTM-specific scoring system. LCA was used to identify groups with common radiological characteristics. The analysis was then repeated in an independent cohort. Results Three classes were identified in the initial cohort of 85 subjects. Group 1 was characterised by severe bronchiectasis, cavitation and aspergillomas, Group 2 by relatively minor radiological changes, and Group 3 by predominantly bronchiectasis only. These findings were reproduced in an independent cohort of 62 subjects. Subjects in Group 1 had a lower BMI and serum albumin, higher serum CRP, and a higher mortality. Conclusions These findings suggest that NTM-pulmonary may be divided into three radiological subgroups, and that important clinical and survival differences exist between these groups. Electronic supplementary material The online version of this article (10.1186/s12890-018-0675-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven A Cowman
- National Heart and Lung Institute, Imperial College London, London, UK. .,Host Defence Unit, Royal Brompton Hospital, London, UK.
| | - Joseph Jacob
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Radiology, Royal Brompton Hospital, London, UK
| | - Sayed Obaidee
- Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
| | - R Andres Floto
- Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Robert Wilson
- National Heart and Lung Institute, Imperial College London, London, UK.,Host Defence Unit, Royal Brompton Hospital, London, UK
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Michael R Loebinger
- National Heart and Lung Institute, Imperial College London, London, UK.,Host Defence Unit, Royal Brompton Hospital, London, UK
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16
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Balko R, Edriss H, Nugent K, Test V. Pulmonary veno-occlusive disease: An important consideration in patients with pulmonary hypertension. Respir Med 2017; 132:203-209. [PMID: 29229098 DOI: 10.1016/j.rmed.2017.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 09/11/2017] [Accepted: 10/20/2017] [Indexed: 11/16/2022]
Abstract
Pulmonary veno-occlusive disease is a rare subcategory of pulmonary arterial hypertension (WHO Group 1). The disease is poorly understood and difficult to diagnose; it has no definitive cure to date. These patients present with nonspecific symptoms, including dyspnea, exercise intolerance, and weakness. Chest x-rays sometimes differ from idiopathic pulmonary arterial hypertension and may demonstrate alveolar infiltrates and pleural effusions. High resolution computed tomography scans reveal ground glass opacities, interlobular septal thickening, and lymphadenopathy. Echocardiography can estimate the level of pulmonary artery pressures; right heart catheterization is needed for complete hemodynamic characterization of these patients. Lung biopsies demonstrate remodeling of the venules and small veins with intimal and adventitial fibrosis. This can result in total venous occlusion and subsequent recanalization. Similar changes occur in the small arteries and arterioles but are less pronounced than the venous changes. There is no effective medical therapy for these patients, and treatment with the pulmonary arterial hypertension specific medications often causes acute deterioration with pulmonary edema. The recent discovery of the biallelic mutations of the EIF2AK4 gene as an etiology for heritable form of pulmonary veno-occlusive disease increases our understanding of the disease pathogenesis and potentially identifies a future approach to treatment. Without definitive treatment, the prognosis is very poor, and the life expectancy of these patients is much shorter than patients with pulmonary arterial hypertension. These patients need early referral to transplantation centers.
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Affiliation(s)
- Ryan Balko
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Hawa Edriss
- Division of Pulmonary and Critical Care, Texas Tech University Health Science Center, Lubbock, TX, USA.
| | - Kenneth Nugent
- Division of Pulmonary and Critical Care, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Victor Test
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
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17
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Salisbury ML, Tolle LB, Xia M, Murray S, Tayob N, Nambiar AM, Schmidt SL, Lagstein A, Myers JL, Gross BH, Kazerooni EA, Sundaram B, Chughtai AR, Martinez FJ, Flaherty KR. Possible UIP pattern on high-resolution computed tomography is associated with better survival than definite UIP in IPF patients. Respir Med 2017; 131:229-235. [PMID: 28947036 PMCID: PMC5679475 DOI: 10.1016/j.rmed.2017.08.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/28/2017] [Accepted: 08/24/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease of unknown etiology. Inter-society consensus guidelines on IPF diagnosis and management outline radiologic patterns including definite usual interstitial pneumonia (UIP), possible UIP, and inconsistent with UIP. We evaluate these diagnostic categories as prognostic markers among patients with IPF. METHODS Included subjects had biopsy-proven UIP, a multidisciplinary team diagnosis of IPF, and a baseline high-resolution computed tomography (HRCT). Thoracic radiologists assigned the radiologic pattern and documented the presence and extent of specific radiologic findings. The outcome of interest was lung transplant-free survival. RESULTS IPF patients with a possible UIP pattern on HRCT had significantly longer Kaplan-Meier event-free survival compared to those with definite UIP pattern (5.21 and 3.57 years, respectively, p = 0.002). In a multivariable Cox proportional hazards model adjusted for baseline age, gender, %-predicted FVC, and %-predicted DLCO via the GAP Stage, extent of fibrosis (via the traction bronchiectasis score) and ever-smoker status, possible UIP pattern on HRCT (versus definite UIP) was associated with reduced hazard of death or lung transplant (HR = 0.42, CI 95% 0.23-0.78, p = 0.006). CONCLUSIONS Radiologic diagnosis categories outlined by inter-society consensus guidelines is a widely-reported and potentially useful prognostic marker in IPF patients, with possible UIP pattern on HRCT associated with a favorable prognosis compared to definite UIP pattern, after adjusting for relevant covariates.
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Affiliation(s)
| | - Leslie B Tolle
- Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Meng Xia
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, United States
| | - Susan Murray
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, United States
| | - Nabihah Tayob
- University of Texas, MD Anderson Cancer Center, Department of Biostatistics, Houston, TX, United States
| | - Anoop M Nambiar
- University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System, San Antonio, TX, United States
| | | | - Amir Lagstein
- University of Michigan Health System, Ann Arbor, MI, United States
| | - Jeffery L Myers
- University of Michigan Health System, Ann Arbor, MI, United States
| | - Barry H Gross
- University of Michigan Health System, Ann Arbor, MI, United States
| | - Ella A Kazerooni
- University of Michigan Health System, Ann Arbor, MI, United States
| | | | - Aamer R Chughtai
- University of Michigan Health System, Ann Arbor, MI, United States
| | | | - Kevin R Flaherty
- University of Michigan Health System, Ann Arbor, MI, United States
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18
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Zhang RB, Yuan F, Tan XY, He QY. Evaluation of symptoms and risks in stable chronic obstructive pulmonary disease patients with radiographic bronchiectasis. Chronic Dis Transl Med 2017; 3:176-180. [PMID: 29063074 PMCID: PMC5643783 DOI: 10.1016/j.cdtm.2017.02.007] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To investigate the presence of previously undiagnosed radiographic bronchiectasis in stable chronic obstructive pulmonary disease (COPD) patients using high resolution computed tomography (HRCT) and to evaluate the effect of radiographic bronchiectasis on the symptoms and risks in stable COPD patients. METHODS From May 2012 to April 2014, there were 347 patients enrolled in COPD database. Data describing the general conditions, the frequency of acute exacerbations the year before, COPD assessment test, modified medical research council (mMRC) score, spirometric classification, and HRCT were collected. COPD patients were classified into two groups: COPD with bronchiectasis and COPD without bronchiectasis. The clinical characteristics of both groups were compared. RESULTS Bronchiectasis was presented in 18.4% (n = 64). The proportion of smokers, smoking index, and forced expiratory volume in 1 second predicted value were 62.5%, 27.3 ± 13.2, 48.2 ± 26.4, respectively, in the bronchiectasis group, which were lower than those of the group without bronchiectasis (82.0%, 32.6 ± 17.6, and 57.9 ± 18.8) (P < 0.05). Complications, COPD assessment test (CAT) and the rate of CAT ≥ 10 in the bronchiectasis group were 2.8 ± 1.7,13.6 ± 7.4 and 26.6%, respectively, which were higher than those of the group without bronchiectasis (2.3 ± 1.5,11.3 ± 6.0, and 11.7%) (P < 0.05). The proportion of type D (high-risk more-symptoms) in the bronchiectasis group was 50.0%; it was significantly higher than that of 35.7% in the group without bronchiectasis (P < 0.05). CONCLUSIONS COPD with bronchiectasis is associated with more complications, symptoms, and risks. More attention should be paid to the treatment of COPD with bronchiectasis to reduce the frequency of exacerbation and improve the health status.
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Affiliation(s)
| | | | | | - Quan-Ying He
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
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Kanzara T, Virk JS. Diagnostic performance of high resolution computed tomography in otosclerosis. World J Clin Cases 2017; 5:286-291. [PMID: 28798924 PMCID: PMC5535320 DOI: 10.12998/wjcc.v5.i7.286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/02/2017] [Accepted: 05/31/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To determine the sensitivity and specificity of high resolution computed tomography (HRCT) in the diagnosis of otosclerosis.
METHODS A systematic literature review was undertaken to include Level I-III studies (Oxford Centre for Evidenced based Medicine) that utilised HRCT to detect histology confirmed otosclerosis. Quantitative synthesis was then performed.
RESULTS Based on available level III literature, HRCT has a relatively low sensitivity of 58% (95%CI: 49.4-66.9), a high specificity, 95% (95%CI: 89.9-98.0) and a positive predictive value of 92% (95%CI: 84.1-95.8). HRCT is better at diagnosing the more prevalent fenestral form of otosclerosis but remains vulnerable to inframillimetre, retrofenestral and dense sclerotic lesions, despite the advent of more advanced CT scanners with improved collimation.
CONCLUSION Whilst the diagnosis of otosclerosis remains largely clinical, HRCT remains the gold standard imaging of choice for the middle ear and serves as a useful adjunct to the clinician, helping to delineate extent of disease and exclude other causes.
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Dai J, Cai HR, Li Y, Meng FQ, Wu JQ. [Follicular bronchiolitis: report of 3 cases and literature review]. Zhonghua Jie He He Hu Xi Za Zhi 2017; 40:457-462. [PMID: 28592030 DOI: 10.3760/cma.j.issn.1001-0939.2017.06.012] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To improve understanding of the characteristics of follicular bronchiolitis(FB). Methods: The clinical data of 3 patients with FB confirmed by thoracoscopic lung biopsy were retrospectively analyzed. A literature search was performed with "follicular bronchiolitis" as the key word in China Knowledge Resource Integrated Database, Wanfang and PubMed, Ovid Database. The time interval was from January 1947 to December 2015. Related articles of FB were retrieved and the clinical, radiographic characteristics and prognosis were analyzed. Results: Among the 3 patients, 1 was male and 2 were female, aging 32-55 years. Two patients were asymptomatic, and 1 patient presented with fever, cough and dyspnea. Two patients showed normal pulmonary ventilatory function with decreased diffusive function, and 1 patient showed normal pulmonary function. The predominant HRCT findings were bilateral multiple small nodules and cystic opacities, patchy ground-glass opacities, reticular opacities and traction bronchiectasis. The pathological examination by thoracoscopic biopsy revealed bronchiolar and peribronchiolar lymphoid follicles. All patients were treated with corticosteroids, with 2 patients receiving immunosuppressants. Follow-up HRCT after 1-2 months showed no improvement, and further follow-up HRCT after 2-4 years revealed no change in 2 patients while the other patient had increased pulmonary nodules and cystic opacities. Seventeen articles concerning FB with complete records were included in the literature review. A total of 64 patients were reported in these articles. The typical images were bilateral multiple small nodules and ground-glass opacities, reticular opacities, and cystic opacities. The majority of patients improved after treatment of corticosteroids and (or) immunosuppressants. But our 3 cases showed no improvement. Conclusions: FB is a rare small airway disease which has non-specific clinical manifestations and pulmonary function. The most common imaging findings are bilateral multiple small nodules, with cystic opacities, ground-glass opacities, and reticular opacities. Surgical thoracoscopic biopsy can get ideal specimen which is useful for diagnosis. The curative effects of corticosteroids or immunosuppressants on FB need to be further clinically investigated.
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Affiliation(s)
- J Dai
- Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Bennett D, Mazzei MA, Squitieri NC, Bargagli E, Refini RM, Fossi A, Volterrani L, Rottoli P. Familial pulmonary fibrosis: Clinical and radiological characteristics and progression analysis in different high resolution-CT patterns. Respir Med 2017; 126:75-83. [PMID: 28427553 DOI: 10.1016/j.rmed.2017.03.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Familial pulmonary fibrosis (FPF) is defined as an idiopathic diffuse parenchymal lung disease affecting two or more members of the same primary biological family. The aim of the present study was to contribute to the clinical, functional and radiological characterisation of FPF with particular regards to disease progression and survival. METHODS Baseline clinical, functional and radiological data of a FPF population (n = 46 patients) were retrospectively collected and analysed according to the 2011 IPF guidelines HRCT classification. A PFT follow-up after 1-year and survival analysis was conducted among to different HRCT patterns. RESULTS 22 female and 24 male patients (age at diagnosis 58.5 ± 9.7 years-old), belonging to 30 families, were included in this study. Radiological analysis demonstrated the presence of a UIP pattern at HRCT in 54.3% of patients, Poss-UIP in 21.8% and Incon-UIP in 23.9%. Incon-UIP patients were younger and more frequently female. Pulmonary function tests showed a restrictive ventilatory defect in patients with UIP and Incon-UIP patterns, while Poss-UIP patients had normal volumes with only a mild reduction of DLCO. BAL composition revealed increased lymphocytes percentage in Incon-UIP patients. Respiratory functional 1-year follow-up showed a significant worsening in UIP patients only. HRCT pattern progression was only demonstrated from Poss-UIP to UIP (18% of patients). Median survival was not statistically different among the 3 HRCT groups, although Poss-UIP patients presented a better outcome. CONCLUSIONS FPF has been confirmed to be a complex condition with poor prognosis. The present study firstly analysed functional and radiological follow-up data of patients with FPF, showing that it may manifests with several HRCT patterns with different rates of progression, in which Possible UIP and UIP could be considered phases of the same disease and Inconsistent UIP patients may represent a different clinical and radiological condition.
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Affiliation(s)
- David Bennett
- Respiratory Diseases and Lung Transplantation Unit, AOUS - Department of Medical, Surgical and Neurological Sciences, University of Siena, Italy.
| | - Maria Antonietta Mazzei
- Diagnostic Imaging Unit, AOUS - Department of Medical, Surgical and Neurological Sciences, University of Siena, Italy
| | - Nevada Cioffi Squitieri
- Diagnostic Imaging Unit, AOUS - Department of Medical, Surgical and Neurological Sciences, University of Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation Unit, AOUS - Department of Medical, Surgical and Neurological Sciences, University of Siena, Italy
| | - Rosa Metella Refini
- Respiratory Diseases and Lung Transplantation Unit, AOUS - Department of Medical, Surgical and Neurological Sciences, University of Siena, Italy
| | - Antonella Fossi
- Respiratory Diseases and Lung Transplantation Unit, AOUS - Department of Medical, Surgical and Neurological Sciences, University of Siena, Italy
| | - Luca Volterrani
- Diagnostic Imaging Unit, AOUS - Department of Medical, Surgical and Neurological Sciences, University of Siena, Italy
| | - Paola Rottoli
- Respiratory Diseases and Lung Transplantation Unit, AOUS - Department of Medical, Surgical and Neurological Sciences, University of Siena, Italy
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Deepak D, Prasad A, Atwal SS, Agarwal K. Recognition of Small Airways Obstruction in Asthma and COPD - The Road Less Travelled. J Clin Diagn Res 2017; 11:TE01-TE05. [PMID: 28511478 DOI: 10.7860/jcdr/2017/19920.9478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 12/11/2016] [Indexed: 11/24/2022]
Abstract
The small airways, once regarded as the silent zone in the air conducting system of the lungs are now known to be one of the initial sites of involvement in diseases like asthma and Chronic Obstructive Pulmonary Disease (COPD). Identification of the involvement of distal airways in these diseases is often difficult to assess, clinically as well as by conventional pulmonary function tests and therefore, usually remains undiscovered in early stages. Early recognition of their involvement in asthma and COPD and timely management may reduce long term morbidity in these conditions. This article aims to highlight the relatively lesser recognized facts about small airways involvement in asthma and COPD and role of imaging and newer modalities for detection.
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Affiliation(s)
- Desh Deepak
- Chief Medical Officer, Department of Medicine, Respiratory Division, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Akhila Prasad
- Associate Professor, Department of Radiodiagnosis, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Swapndeep Singh Atwal
- Ex-Senior Resident, Department of Radiodiagnosis, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Kshitij Agarwal
- Consultant, QRG Health City, Faridabad SR, Respiratory Medicine, VP Chest Institute, New Delhi, India
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Lieberman S, Gleason JB, Ilyas MIM, Martinez F, Mehta JP, Savage EB. Assessing the Safety and Clinical Impact of Thoracoscopic Lung Biopsy in Patients with Interstitial Lung Disease. J Clin Diagn Res 2017; 11:OC57-OC59. [PMID: 28511438 DOI: 10.7860/jcdr/2017/20281.9626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 03/21/2016] [Accepted: 07/15/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The clinical relevance of surgical lung biopsy in Interstitial Lung Disease (ILD) is supported in the literature. Yet most reports reflect institutional or personal bias. AIM To evaluate the validity of radiologic diagnosis and clinical impact of lung biopsy to help clarify which patient benefit most from biopsy. MATERIALS AND METHODS We performed a retrospective analysis of a prospectively managed database. All patients who had a surgical lung biopsy for ILD within a period of four year (2009 to 2013) were included. Data included patient demographics, peri-operative variables and outcomes. Preoperative Computed Tomography (CT) imaging was reviewed by a thoracic radiologist blinded to the original report and pathologic information. RESULTS A total of 47 patients were included. Lung tissue was obtained via a thoracoscopic approach in all but two that had mini-thoracotomy. Mean operating time was 51.1 minutes (18-123), median hospital stay was two days (1-18). Most (87.2%) of the patients were discharged within 72 hours. Thirty day mortality for elective surgery was 4.5% (2/44). Post-operative complications occurred in about one third of the patients. Complications in elective procedures included pneumothorax (10.4%), re-intubation (5.4%) and prolonged intubation (2.7%). Full concordance of radiographic diagnosis with the final diagnosis was significantly higher when reviewed by a cardiothoracic radiologist (60.5% vs. 21.3%). The preoperative clinical diagnosis was fully concordant with the final diagnosis in only 28.2% of cases. In 13.0% of patients the preoperative diagnosis was incorrect. Malignancy was the final diagnosis in two (4.3%) patients. In 51.1% of the patients, results of the biopsy did alter therapy. CONCLUSION Diagnosis of specific ILD by a cardiothoracic radiologist is more specific and accurate and will probably lead to more appropriate therapy. Elective thoracoscopic surgical lung biopsy is a safe procedure, leads to a more accurate diagnosis of ILD and impacts therapy.
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Affiliation(s)
- Scott Lieberman
- Fellow Physician, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Florida, USA
| | - James Benjamin Gleason
- Fellow Physician, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Florida, USA
| | | | - Felipe Martinez
- Attending Physician, Department of Radiology, Cleveland Clinic, Florida, USA
| | - Jinesh P Mehta
- Attending Physician, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Florida, USA
| | - Edward B Savage
- Attending Physician, Department of Cardiothoracic Surgery, Cleveland Clinic, Florida, USA
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Abstract
BACKGROUND AND OBJECTIVES: Pleuropulmonary (PP) involvement in rheumatoid arthritis (RA) is associated with high morbidity and mortality. Nevertheless, limited data are available regarding lung complications in the Middle East, especially in Saudi Arabia. The objectives of the current study were to determine the prevalence of PP manifestations and to identify the associated risk factors. METHODS: This was a retrospective study involving 419 patients diagnosed at a tertiary center over a 12.5-year period. The frequency of pulmonary manifestations was recorded based on combined results from chest X-rays, pulmonary function tests, and high-resolution computed tomography scan of the chest. RESULTS: The overall frequency of lung involvement was 25.8%. Pneumonia, bronchiectasis, and interstitial lung disease were the most common abnormalities (36%, 35%, and 23%, respectively). The presence of comorbid illness (odds ratio [OR]: 3.19; 95% confidence interval [CI]: 2.02–5.1), male gender (OR: 2.4; 95% CI: 1.3–4.24), and the presence of extra-articular manifestations of RA (ExRA) (OR: 2.35; 95% CI: 0.4–4.01) were predictive of lung involvement. CONCLUSIONS: Pneumonia, bronchiectasis, and interstitial lung disease were the most common abnormalities seen in RA patients. The presence of comorbidity, male gender, and ExRA was significantly associated with lung involvement.
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Affiliation(s)
- Omer S B Alamoudi
- Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Suzan Mansour Attar
- Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Salisbury ML, Xia M, Murray S, Bartholmai BJ, Kazerooni EA, Meldrum CA, Martinez FJ, Flaherty KR. Predictors of idiopathic pulmonary fibrosis in absence of radiologic honeycombing: A cross sectional analysis in ILD patients undergoing lung tissue sampling. Respir Med 2016; 118:88-95. [PMID: 27578476 DOI: 10.1016/j.rmed.2016.07.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/20/2016] [Accepted: 07/25/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) can be diagnosed confidently and non-invasively when clinical and computed tomography (CT) criteria are met. Many do not meet these criteria due to absence of CT honeycombing. We investigated predictors of IPF and combinations allowing accurate diagnosis in individuals without honeycombing. METHODS We utilized prospectively collected clinical and CT data from patients enrolled in the Lung Tissue Research Consortium. Included patients had no honeycombing, no connective tissue disease, underwent diagnostic lung biopsy, and had CT pattern consistent with fibrosing ILD (n = 200). Logistic regression identified clinical and CT variables predictive of IPF. The probability of IPF was assessed at various cut-points of important clinical and CT variables. RESULTS A multivariable model adjusted for age and gender found increasingly extensive reticular densities (OR 2.93, CI 95% 1.55-5.56, p = 0.001) predicted IPF, while increasing ground glass densities predicted a diagnosis other than IPF (OR 0.55, CI 95% 0.34-0.89, p = 0.02). The model-based probability of IPF was 80% or greater in patients with age at least 60 years and extent of reticular density one-third or more of total lung volume; for patients meeting or exceeding these clinical thresholds the specificity for IPF is 96% (CI 95% 91-100%) with 21 of 134 (16%) biopsies avoided. CONCLUSIONS In patients with suspected fibrotic ILD and absence of CT honeycombing, extent of reticular and ground glass densities predict a diagnosis of IPF. The probability of IPF exceeds 80% in subjects over age 60 years with one-third of total lung having reticular densities.
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Affiliation(s)
- Margaret L Salisbury
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, 1500 E Medical Center Drive 3916, Taubman Center, Ann Arbor, MI, 48109, United States.
| | - Meng Xia
- Department of Biostatistics, University of Michigan, M4515 SPH II 1415 Washington Heights, Ann Arbor, MI, 48109, United States.
| | - Susan Murray
- Department of Biostatistics, University of Michigan, M4515 SPH II 1415 Washington Heights, Ann Arbor, MI, 48109, United States.
| | - Brian J Bartholmai
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States.
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, 1500 E Medical Center Drive SPC 5868, Ann Arbor, MI, 48109, United States.
| | - Catherine A Meldrum
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, 1500 E Medical Center Drive 3916, Taubman Center, Ann Arbor, MI, 48109, United States.
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cornell Medical College, 525 East 68th Street, Box 130, New York, NY, 10065, United States.
| | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, 1500 E Medical Center Drive 3916, Taubman Center, Ann Arbor, MI, 48109, United States.
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Çakir Edis E, Hatipoğlu ON, Pamuk ÖN, Mutlucan Eraslan R, Aktöz M, Tuncel SA. Effectiveness of Thoracic Ultrasonography in the Evaluation of the Severity of Pulmonary Involvement in Patients With Systemic Sclerosis. Arch Rheumatol 2016; 31:364-70. [PMID: 30375580 DOI: 10.5606/ArchRheumatol.2016.5849] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 02/15/2016] [Indexed: 02/08/2023] Open
Abstract
Objectives This study aims to investigate the effectiveness of thoracic ultrasonography (USG) in a single session in the evaluation of the severity of pulmonary involvement in systemic sclerosis. Patients and methods A total of 48 consecutive systemic sclerosis patients (2 males, 46 females; mean age 50.8±11.9 years; range 21 to 76 years) followed-up in our center were included. A thoracic USG using a linear probe was performed for each patient to evaluate the parenchymal involvement by two pulmonary disease specialists. The number of B-lines (B-lines described USG sign of interstitial lung fibrosis) was recorded. Systolic pulmonary artery pressure was measured by means of using a phase probe to evaluate pulmonary hypertension in the same sequence. The same day, pulmonary function tests were conducted. Warrick score was calculated according high resolution computed tomography (HRCT) images which were evaluated independently from each other by a radiologist and a pulmonary disease specialist. Medsger severity scale was calculated for each patient according to the results of HRCT findings, pulmonary function test, and systolic pulmonary artery pressure. Results The number of B-lines detected on thoracic USG was correlated with the Warrick score (r=0.89; p=0.0001) and Medsger disease scale (r=0.55; p=0.0001) and negatively correlated with diffusing capacity of carbon monoxide (r= -0.56; p=0.0001) and forced vital capacity (r= -0.46; p=0.001). When HRCT was accepted as the gold standard; the sensitivity, specificity, positive predicted value, and negative predicted value for thoracic USG were 100%, 84.2%, 90.6%, and 100%, respectively. If thoracic USG was used instead of HRCT for the evaluation of Medsger scale, the results changed in only one of the 48 patients. Conclusion Thoracic USG showed good correlation with HRCT findings for the evaluation of pulmonary parenchymal involvement in systemic sclerosis. Therefore, USG might be a noninvasive and useful tool for the long-term follow-up of systemic sclerosis patients after initial examination with USG and HRCT.
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Gorska K, Korczynski P, Mierzejewski M, Kosciuch J, Zukowska M, Maskey-Warzechowska M, Krenke R. Comparison of endobronchial ultrasound and high resolution computed tomography as tools for airway wall imaging in asthma and chronic obstructive pulmonary disease. Respir Med 2016; 117:131-8. [PMID: 27492523 DOI: 10.1016/j.rmed.2016.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/03/2016] [Accepted: 06/08/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Airway remodeling in asthma and chronic obstructive pulmonary disease (COPD) results in bronchial wall thickening. Bronchial wall thickness (BWT) can be assessed in high-resolution computed tomography (HRCT) and endobronchial ultrasound (EBUS). AIMS To compare BWT measured by EBUS and HRCT in patients with mild-to-moderate asthma and COPD, and to evaluate the relationship between the BWT and pulmonary function. METHODS The study included patients with mild-to-moderate asthma (n = 24), COPD (n = 36) and controls (n = 12). Bronchoscopy with EBUS (radial probe) and HRCT were performed to measure the BWT in the segmental bronchus. RESULTS Good overall agreement between EBUS and HRCT measurements of BWT was demonstrated. Median HRCT-BWT did not reveal any significant differences between individuals with asthma and COPD, and control subjects: 1.56 (1.27-1.70) mm, 1.62 (1.45-1.90) mm, and 1.63 (1.41-1.77) mm, respectively (p = 0.315). In contrast, median BWT measured by EBUS was significantly higher in asthma and COPD groups when compared to controls: 1.20 (1.02-1.41) mm, 1.19 (1.10-1.48) mm, and 0.99 (0.90-1.08) mm, respectively (p = 0.006). There were no differences in BWT in mild-to-moderate asthma and COPD or significant correlations between BWT and the results of pulmonary function tests. CONCLUSIONS The use of EBUS to assess BWT in asthma and COPD is feasible and it shows good compatibility with HRCT. A tendency towards lower BWT values in EBUS when compared to HRCT was observed. The finding that EBUS measurements demonstrated the differences between BWT in patients with obstructive lung diseases and controls, may suggest that EBUS is a more sensitive method to study the BWT than HRCT.
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Papaioannou AI, Kostikas K, Manali ED, Papadaki G, Roussou A, Kolilekas L, Borie R, Bouros D, Papiris SA. Combined pulmonary fibrosis and emphysema: The many aspects of a cohabitation contract. Respir Med 2016; 117:14-26. [PMID: 27492509 DOI: 10.1016/j.rmed.2016.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 03/20/2016] [Accepted: 05/05/2016] [Indexed: 12/12/2022]
Abstract
Combined pulmonary fibrosis and emphysema (CPFE) is a clinical entity characterized by the coexistence of upper lobe emphysema and lower lobe fibrosis. Patients with this condition experience severe dyspnea and impaired gas exchange with preserved lung volumes. The diagnosis of the CPFE syndrome is based on HRCT imaging, showing the coexistence of emphysema and pulmonary fibrosis both in varying extent and locations within the lung parenchyma. Individual genetic background seem to predispose to the development of the disease. The risk of the development of pulmonary hypertension in patients with CPFE is high and related to poor prognosis. CPFE patients also present a high risk of lung cancer. Mortality is significant in patients with CPFE and median survival is reported between 2.1 and 8.5 years. Currently, no specific recommendations are available regarding the management of patients with CPFE. In this review we provide information on the existing knowledge on CPFE regarding the pathophysiology, clinical manifestations, imaging, complications, possible therapeutic interventions and prognosis of the disease.
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Affiliation(s)
- Andriana I Papaioannou
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Konstantinos Kostikas
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Effrosyni D Manali
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Georgia Papadaki
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Aneza Roussou
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Likurgos Kolilekas
- 7th Department of Pneumonology, "Sotiria" Chest Diseases Hospital, Athens, Greece.
| | - Raphaël Borie
- APHP, Hôpital Bichat, DHU FIRE Service de Pneumologie A, Centre de compétence des maladies pulmonaires rares, INSERM, Unité 1152, Université Paris Diderot, Paris, France.
| | - Demosthenis Bouros
- 1st Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Medical School, National and Kapodistrian University of Athens, Greece.
| | - Spyridon A Papiris
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
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Tepper LA, Caudri D, Rovira AP, Tiddens HAWM, de Bruijne M. The development of bronchiectasis on chest computed tomography in children with cystic fibrosis: can pre-stages be identified? Eur Radiol 2016; 26:4563-4569. [PMID: 27108295 PMCID: PMC5101271 DOI: 10.1007/s00330-016-4329-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 06/25/2015] [Revised: 03/08/2016] [Accepted: 03/11/2016] [Indexed: 11/28/2022]
Abstract
Objective Bronchiectasis is an important component of cystic fibrosis (CF) lung disease but little is known about its development. We aimed to study the development of bronchiectasis and identify determinants for rapid progression of bronchiectasis on chest CT. Methods Forty-three patients with CF with at least four consecutive biennial volumetric CTs were included. Areas with bronchiectasis on the most recent CT were marked as regions of interest (ROIs). These ROIs were generated on all preceding CTs using deformable image registration. Observers indicated whether: bronchiectasis, mucus plugging, airway wall thickening, atelectasis/consolidation or normal airways were present in the ROIs. Results We identified 362 ROIs on the most recent CT. In 187 (51.7 %) ROIs bronchiectasis was present on all preceding CTs, while 175 ROIs showed development of bronchiectasis. In 139/175 (79.4 %) no pre-stages of bronchiectasis were identified. In 36/175 (20.6 %) bronchiectatic airways the following pre-stages were identified: mucus plugging (17.7 %), airway wall thickening (1.7 %) or atelectasis/consolidation (1.1 %). Pancreatic insufficiency was more prevalent in the rapid progressors compared to the slow progressors (p = 0.05). Conclusion Most bronchiectatic airways developed within 2 years without visible pre-stages, underlining the treacherous nature of CF lung disease. Mucus plugging was the most frequent pre-stage. Key Points • Development of bronchiectasis in cystic fibrosis lung disease on CT. • Most bronchiectatic airways developed within 2 years without pre-stages. • The most frequently identified pre-stage was mucus plugging. • This study underlines the treacherous nature of CF lung disease. Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4329-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leonie A Tepper
- Department of Pediatric Pulmonology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Daan Caudri
- Department of Pediatric Pulmonology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Adria Perez Rovira
- Department of Pediatric Pulmonology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.,Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Department of Pediatric Pulmonology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands. .,Department of Radiology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands. .,Department of Pediatric Pulmonology and Radiology, Erasmus Medical Center, Sophia Children's Hospital, Dr. Molewaterplein 60, room SP-3464, 3015 GJ, Rotterdam, The Netherlands.
| | - Marleen de Bruijne
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, Rotterdam, The Netherlands.,Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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Daimiel Naranjo I, Alonso Charterina S. What can happen after lung transplantation and the importance of the time since transplantation: radiological review of post-transplantation complications. Radiologia 2016; 58:257-67. [PMID: 27017046 DOI: 10.1016/j.rx.2016.02.001] [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] [Received: 08/16/2015] [Revised: 02/10/2016] [Accepted: 02/13/2016] [Indexed: 11/18/2022]
Abstract
Lung transplantation is the best treatment option in the final stages of diseases such as cystic fibrosis, pulmonary hypertension, chronic obstructive pulmonary disease, or idiopathic pulmonary fibrosis. Better surgical techniques and advances in immunosuppressor treatments have increased survival in lung transplant recipients, making longer follow-up necessary because complications can occur at any time after transplantation. For practical purposes, complications can be classified as early (those that normally occur within two months after transplantation), late (those that normally occur more than two months after transplantation), or time-independent (those that can occur at any time after transplantation). Many complications have nonspecific clinical and radiological manifestations, so the time factor is key to narrow the differential diagnosis. Imaging can guide interventional procedures and can detect complications early. This article aims to describe and illustrate the complications that can occur after lung transplantation from the clinical and radiological viewpoints so that they can be detected as early as possible.
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Affiliation(s)
- I Daimiel Naranjo
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España.
| | - S Alonso Charterina
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
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Newbigin K, Souza CA, Torres C, Marchiori E, Gupta A, Inacio J, Armstrong M, Peña E. Fat embolism syndrome: State-of-the-art review focused on pulmonary imaging findings. Respir Med 2016; 113:93-100. [PMID: 26895808 DOI: 10.1016/j.rmed.2016.01.018] [Citation(s) in RCA: 40] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fat embolism syndrome (FES) is a rare but potentially fatal complication of trauma or orthopedic surgery, which presents predominantly with pulmonary symptoms. Modern intensive care has improved the mortality rates, however diagnosis remains difficult, relying predominantly on a combination of a classic triad of symptoms and non-specific, but characteristic radiological features. The aim of this review is to describe the main clinical and imaging aspects of FES, ranging from pathophysiology to treatment with emphasis on pulmonary involvement. METHODS We reviewed the currently published literature on the main characteristics of FES. RESULTS In a hypoxic patient with recent trauma or orthopedic surgery, the presence of diffuse, well-demarcated ground glass opacities or ill-defined centrilobular nodules on computed tomography (CT) of the chest are suggestive of FES. CONCLUSIONS Combination of the classic clinical syndrome in the appropriate clinical setting, together with the characteristic imaging findings on chest CT, can help to achieve the correct diagnosis. Management remains predominantly supportive care, and the benefit of medical therapies such as corticosteroids and heparin remains unclear.
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Affiliation(s)
| | | | | | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Joao Inacio
- The Ottawa Hospital, Ottawa, Ontario, Canada.
| | | | - Elena Peña
- The Ottawa Hospital, Ottawa, Ontario, Canada.
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Oikonomou A, Mintzopoulou P, Tzouvelekis A, Zezos P, Zacharis G, Koutsopoulos A, Bouros D, Prassopoulos P. Pulmonary fibrosis and emphysema: Is the emphysema type associated with the pattern of fibrosis? World J Radiol 2015; 7:294-305. [PMID: 26435780 PMCID: PMC4585953 DOI: 10.4329/wjr.v7.i9.294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/06/2015] [Accepted: 08/17/2015] [Indexed: 02/07/2023] Open
Abstract
AIM: To investigate whether the predominant emphysema type is associated with the high resolution computed tomography (HRCT) pattern of fibrosis in combined pulmonary fibrosis and emphysema (CPFE).
METHODS: Fifty-three smokers with upper lobe emphysema and lower lobe pulmonary fibrosis on - HRCT - were retrospectively evaluated. Patients were stratified into 3 groups according to the predominant type of emphysema: Centrilobular (CLE), paraseptal (PSE), CLE = PSE. Patients were also stratified into 3 other groups according to the predominant type of fibrosis on HRCT: Typical usual interstitial pneumonia (UIP), probable UIP and nonspecific interstitial pneumonia (NSIP). HRCTs were scored at 5 predetermined levels for the coarseness of fibrosis (Coarseness), extent of emphysema (emphysema), extent of interstitial lung disease (TotExtILD), extent of reticular pattern not otherwise specified (RetNOS), extent of ground glass opacity with traction bronchiectasis (extGGOBx), extent of pure ground glass opacity and extent of honeycombing. HRCT mean scores, pulmonary function tests, diffusion capacity (DLCO) and systolic pulmonary arterial pressure were compared among the groups.
RESULTS: The predominant type of emphysema was strongly correlated with the predominant type of fibrosis. The centrilobular emphysema group exhibited a significantly higher extent of emphysema (P < 0.001) and a lower extent of interstitial lung disease (P < 0.002), reticular pattern not otherwise specified (P < 0.023), extent of ground glass opacity with traction bronchiectasis (P < 0.002), extent of honeycombing (P < 0.001) and coarseness of fibrosis (P < 0.001) than the paraseptal group. The NSIP group exhibited a significantly higher extent of emphysema (P < 0.05), total lung capacity (P < 0.01) and diffusion capacity (DLCO) (P < 0.05) than the typical UIP group. The typical UIP group exhibited a significantly higher extent of interstitial lung disease, extent of reticular pattern not otherwise specified, extent of ground glass opacity with traction bronchiectasis, extent of honeycombing and coarseness of fibrosis (0.039 > P > 0.000). Although the pulmonary arterial pressure was higher in typical UIP group relative to the NSIP group, the difference was not statistically significant.
CONCLUSION: In CPFE patients, paraseptal emphysema is associated more with UIP-HRCT pattern and higher extent of fibrosis than centrilobular emphysema.
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Vaid S, Vaid N, Manikoth M, Zope A. Role of HRCT and MRI of the Temporal Bone in Predicting and Grading the Degree of Difficulty of Cochlear Implant Surgery. Indian J Otolaryngol Head Neck Surg 2015; 67:150-8. [PMID: 26075170 PMCID: PMC4460095 DOI: 10.1007/s12070-015-0858-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/27/2015] [Indexed: 11/30/2022] Open
Abstract
This study proposes a grading system based on a 10-point scoring chart of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) imaging findings in patients being assessed preoperatively for cochlear implantation. This system helps in objectively assessing the degree of difficulty of the surgical procedure and alerts the surgeons to any potential intraoperative complications. This is a prospective study carried out at a tertiary referral center where 55 patients with bilateral profound sensorineural hearing loss were evaluated by HRCT and MRI and subsequently underwent cochlear implantation. HRCT examinations were performed on a 64 slice multidetector CT scanner. MRI examinations were performed on a 3.0 Tesla MRI scanner. A 10-point scoring chart was devised based on specific imaging findings and all patients were assigned potential difficulty scores (PDS) based on HRCT and MRI findings. Surgical times were documented in each case and each imaging point on the scoring chart was correlated with the surgical times. Eight out of theó ten points in the scoring chart proved to be statistically significant in predicting the degree of difficulty of the surgical procedure. After grading the pre-operative imaging examinations based on the 10-point scoring chart we concluded that patients who have PDS between 0 and 3 (Grade 1) have uneventful and uncomplicated surgery with the lowest intraoperative times. Patients with PDS between 4 and 7 alert the surgeon to moderate surgical difficulty and longer intraoperative times. PDS of 8 and above indicate prolonged and difficult surgery.
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Affiliation(s)
- Sanjay Vaid
- />Head Neck & ENT Imaging Division, Star Imaging and Research Center, Pune, 411001 India
- />2, National Hsg Society, Baner Road, Aundh, Pune, Maharashtra 411007 India
| | - Neelam Vaid
- />Department of Otorhinolaryngology, K.E.M. Hospital, Rastapeth, Pune, 411011 India
| | - Manoj Manikoth
- />Dr. Manoj’s Multispeciality ENT Hospital, Calicut, Kerala India
| | - Amit Zope
- />Department of Diagnostic Imaging and Radiology, Grant Medical Foundation, Pune, 411001 India
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Søyseth V, Aaløkken TM, Mynarek G, Naalsund A, Strøm EH, Scott H, Kolbenstvedt A. Diagnosis of biopsy verified usual interstitial pneumonia by computed tomography. Respir Med 2015; 109:897-903. [PMID: 26028484 DOI: 10.1016/j.rmed.2015.05.008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/21/2015] [Accepted: 05/05/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To identify the combination of clinical data and high resolution computed tomography (HRCT) features that best identified biopsy verified usual interstitial pneumonia (UIP). METHODS The study included 91 patients with a tentative diagnosis of interstitial lung disease. All underwent clinical investigation, surgical lung biopsy and HRCT. Two independent readers assessed the HRCT images for the extent and pattern of abnormality. On the basis of the biopsy result the patients were categorized in three groups: 1) Usual interstitial pneumonia, 2) Other idiopathic interstitial pneumonias (IIPs) and hypersensitivity pneumonitis and 3) Other interstitial lung diseases. The diagnostic value of HRCT was investigated using likelihood ratio to estimate the post-test probability of UIP. RESULTS We found that UIP was associated with significantly higher scores for reticular pattern and for bronchiectasis than the remaining patients (p < 0.001). Moreover, these scores showed a steeper cranial-caudal increase in patients with histologically verified UIP than in the remaining patients (p < 0.001). UIP was associated with lower scores for ground glass opacities (p < 0.001). Using Bayes theorem and likelihood ratio estimation we found that UIP could be diagnosed with 90% certainty in patients 60 years or older and restrictive pattern in spirometry provided that HRCT demonstrated at least 15% reticular pattern and no ground glass opacities. CONCLUSION In older patients with a restrictive spirometry in whom HRCT demonstrates a reticular pattern without ground glass opacities surgical lung biopsy is not warranted for the diagnosis of UIP.
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Affiliation(s)
- Vidar Søyseth
- Department of Medicine, Faculty Division Akershus University Hospital, University of Oslo, N-1478 Lørenskog, Norway.
| | | | - Georg Mynarek
- Department of Radiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Anne Naalsund
- Department of Pulmonology, Oslo University Hospital Rikshospitalet, Norway
| | - Erik H Strøm
- Department of Pathology, Oslo University Hospital Rikshospitalet, Norway
| | - Helge Scott
- Department of Pathology, Oslo University Hospital Rikshospitalet, Norway
| | - Alf Kolbenstvedt
- Department of Radiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
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Fernandes L, Vadala R, Mesquita AM, Vaideeswar P. Rare interstitial lung disease: Pulmonary Langerhans Cell Histiocytosis in a young non smoking Indian female. Indian J Tuberc 2015; 62:46-9. [PMID: 25857566 DOI: 10.1016/j.ijtb.2015.02.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Adult Pulmonary Langerhans Cell Histiocytosis (PLCH) is a rare interstitial lung disease which occurs almost exclusively in smokers. A marked male predominance was initially reported, but recent studies show both men and women are equally affected due to the increasing smoking habits in women. The natural history is variable with 25% of patients having asymptomatic disease while 10-20% progress rapidly to respiratory insufficiency and death. The diagnosis is not easily recognized by clinicians or pathologists. Awareness of the clinical presentation and classical HRCT findings helps in early diagnosis and management of this disease. We report a rare case of severe PLCH in a young non smoking female with a short history who progressed rapidly to respiratory failure and died.
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Affiliation(s)
- Lalita Fernandes
- Professor, Department of Pulmonary Medicine, Goa Medical College, India.
| | - Rohit Vadala
- Junior Resident, Department of Pulmonary Medicine, Goa Medical College, India
| | | | - Pradeep Vaideeswar
- Professor (Additional), Department of Pathology, Seth GS Medical College, Mumbai, India
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Farrokh D, Abbasi B, Fallah-Rastegar Y, Mirfeizi Z. The Extrapulmonary Manifestations of Systemic Sclerosis on Chest High Resolution Computed Tomography. Tanaffos 2015; 14:193-200. [PMID: 26858765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Systemic sclerosis (SS) is a collagen vascular disease of unknown etiology that is characterized by connective tissue abnormalities. This study aimed to evaluate the extra-pulmonary manifestations of SS on chest high resolution computed tomography (HRCT). MATERIALS AND METHODS The medical records of patients with SS who presented to our hospital in a 10-year period were retrospectively reviewed. Forty patients with SS were included in this study. The extra pulmonary manifestations of SS were evaluated in these patients, including esophageal involvement, pulmonary arterial dilatation, pleural abnormalities, pericardial disease and mediastinal lymph node involvement. RESULTS The most common extra-pulmonary manifestation was esophageal dilatation, which was detected in 70% of the cases followed by pleural involvement. Pulmonary arterial dilatation was seen in 20%, pleural involvement in 40%, pericardial involvement in 40% and mediastinal lymphadenopathy in 30%. The most common pleural abnormality was diffuse pleural thickening and the most common pericardial abnormality was pericardial effusion. There was an association between the severity of lung fibrosis with the incidence of esophageal dilatation and pulmonary arterial hypertension (PAH) in our series. Patients with SS and interstitial lung disease (ILD) who had PAH, had more severe lung fibrosis than those without PAH. CONCLUSION Patients with SS may have a variety of extra-pulmonary manifestations, which can be detected using HRCT. Our study evidenced that HRCT was useful for detecting extra-pulmonary findings of SS such as esophageal dysmotility and dilatation, enlargement of main pulmonary artery and PAH, pleuropericardial involvement and mediastinal lymphadenopathy.
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Staats P, Kligerman S, Todd N, Tavora F, Xu L, Burke A. A comparative study of honeycombing on high resolution computed tomography with histologic lung remodeling in explants with usual interstitial pneumonia. Pathol Res Pract 2015; 211:55-61. [PMID: 25433993 DOI: 10.1016/j.prp.2014.08.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 08/09/2014] [Accepted: 08/18/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is little information comparing high-resolution computed tomography (HRCT) findings in UIP with different components that make up remodeling histologically. DESIGN We compared histologic features with HRCT scans from 69 explants with UIP. The extent of 7 histologic features were semi-quantitated: respiratory-lined cysts, bronchiolectasis, pulmonary interstitial emphysema (PIE), lobular remodeling, areas resembling non-specific interstitial pneumonia (NSIP), desquamative interstitial pneumonia (DIP)-like pattern, and mucus pooling within cysts extending into surrounding parenchyma. Subpleural cystic spaces and areas of lobular remodeling were measured morphometrically. Histologic features were compared to three findings on HRCT: diagnostic pattern (UIP, probable UIP, or inconsistent with UIP pattern), degree of honeycombing, and degree of ground-glass opacities. RESULTS Histologically, respiratory-lined cysts were observed in 78%, bronchiolectasis in 83%, interstitial emphysema in 22%, lobular remodeling in 96%, NSIP-like areas in 87%, DIP-like reaction in 10%, and mucin extravasation in 78%. Morphometrically, cysts of PIE measured 6.2±2.9 mm, respiratory-lined cysts 3.5±2.4 mm, and bronchiolectatic cysts 3.3±1.5 mm. Remodeled lobules measured 3.6±1.1 mm. UIP pattern on CT correlated strongly with histologic extent of bronchiolectasis (p=0.001). HRCT honeycombing showed a positive correlation with histologic bronchiolectasis (p=0.001) and respiratory-lined cysts (p=0.001). GGO was positively associated with NSIP-like areas (p=0.02) and extravasated mucus (p=0.05). CONCLUSIONS HRCT findings typical of UIP and HRCT honeycombing correlate best with bronchiolectasis histologically. NSIP pattern is common, and is associated with CT finding of GGO.
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Gong WX, Gong RZ, Zhao B. HRCT and MRI findings in X-linked non-syndromic deafness patients with a POU3F4 mutation. Int J Pediatr Otorhinolaryngol 2014; 78:1756-62. [PMID: 25175280 DOI: 10.1016/j.ijporl.2014.08.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/10/2014] [Accepted: 08/11/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to analyze HRCT and MRI findings in patients with X-linked non-syndromic deafness and a POU3f4 mutation. METHODS HRCT and MRI data of four patients (males, 2-19 years old) with a POU3f4 mutation were collected and a retrospective review was performed. Cochlea, internal auditory canal (IAC), vestibule, semicircular canals, vestibular aqueduct, nerve canals in the IAC fundus, stapes and cochlear nerve were evaluated on 2D images (multi-planner reformation, MPR) and cochlear foramen on 3D images (CT virtual endoscopy, CTVE). Ten cases with normal hearing subjected to CT and MR exams served as controls. RESULTS Inner ear malformations were bilateral and symmetrical. Cochlear malformation was shown to consist of as a relatively normal outer coat shape, absence of a cochlear modilous, and a direct intercommunication between the IAC and cochlear inner cavity. The lateral portion of the IAC was dilated. A spiral cochlear inner cavity was observed with CTVE images versus a helical cochlear nerve foramen as seen in controls. The labyrinthine facial nerve canal and superior vestibular nerve canal were enlarged. The Bill's bar was hypertrophic and partially pneumatized. A thickened stapes footplate was present and a fissura ante fenestram was absent in seven ears examined. A column shaped stapes was observed in one ear. CONCLUSIONS The absence of a cochlear modilous with a dilated lateral IAC and thickened stapes footplate were the remarkable features observed with imaging these in X-linked non-syndromic deafness patients with a POU3F4 mutation. Preoperative recognition of the image features in these patients is important because it precludes stapedectomy and indicates the risks in the surgery of cochlear implantation including CSF gusher and electrode insertion into IAC.
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Affiliation(s)
- Wu-Xian Gong
- Shandong Medical Imaging Research Institute, Shandong University, Jinan 250012, China.
| | - Ruo-Zhen Gong
- Shandong Medical Imaging Research Institute, Shandong University, Jinan 250012, China
| | - Bin Zhao
- Shandong Medical Imaging Research Institute, Shandong University, Jinan 250012, China
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Atwal SS, Puranik S, Madhav RKV, Ksv A, Sharma BB, Garga UC. High Resolution Computed Tomography Lung Spectrum in Symptomatic Adult HIV-Positive Patients in South-East Asian Nation. J Clin Diagn Res 2014; 8:RC12-6. [PMID: 25121043 DOI: 10.7860/jcdr/2014/9397.4518] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/20/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pulmonary infections remain a leading cause of morbidity and mortality and one of the most frequent causes of hospital admission in HIV infected people worldwide. HRCT may be useful in the evaluation of patients with suspected pulmonary disease. The aim of given study was to determine the High Resolution Computed Tomography spectrum of lung parenchymal and interstitial imaging findings in HIV infected patients presented with chest symptoms. MATERIALS AND METHODS This study was conducted in a tertiary health care centre, New Delhi, India. The study consisted of 45 patients. A thorough clinical history of all the HIV positive patients presenting with suspicion of pulmonary disease was taken. General physical and respiratory system examination of all patients was done. HRCT scans of the chest were done in all the cases taken in the study. RESULTS Maximum number of patients was in age group 31-40 years (24 cases). Out of 45 patients included in our study, 32 (71%) were male and 13 (29%) were female. In our series of 45 patients, 62.2% of patients were diagnosed as having pulmonary tuberculosis, followed by bacterial infection in 20% cases and Pneumocystis jiroveci pneumonia (PJP) in 8.9% patients, while 8.9% of the study did not reveal any significant abnormality. Maximum number (22/28) of patients with pulmonary tuberculosis were indentified to have nodular opacities. The most common HRCT finding in bacterial infection was lobar consolidation. The most common HRCT finding in patients with PCP was diffuse ground glass opacities in mosaic pattern of distribution. CONCLUSION HRCT is a highly sensitive tool for detecting lung parenchymal and interstitial lesions and allows better characterization of the lesions. HRCT findings should always be correlated with clinical findings, CD4 counts and other available investigations before arriving at a diagnosis or differential diagnosis.
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Affiliation(s)
- Swapndeep Singh Atwal
- Senior Resident, Department of Radiology, PGIMER and Dr. Ram Manohar Lohia Hospital , New Delhi, India
| | - Swapnil Puranik
- Post Graduate, Department of Radiology, Government Medical College , Kota (Rajasthan), India
| | | | - Abhinetri Ksv
- Post Graduate, Department of Radiology, PGIMER and Dr. Ram Manohar Lohia Hospital , New Delhi, India
| | - B B Sharma
- Associate Professor, Department of Radiology, PGIMER and Dr. Ram Manohar Lohia Hospital , New Delhi, India
| | - Umesh Chand Garga
- Professor and Head of Department, Department of Radiology, PGIMER and Dr. Ram Manohar Lohia Hospital , New Delhi, India
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Asma A, Abdul Fatah AW, Hamzaini AH, Mazita A. The Correlation Between Pre and Postoperative Hearing Level with High Resolution Computed Tomography (HRCT) Findings in Congenital Canal Atresia (CAA) Patients. Indian J Otolaryngol Head Neck Surg 2013; 65:526-31. [PMID: 24427708 DOI: 10.1007/s12070-011-0438-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 12/20/2011] [Indexed: 10/14/2022] Open
Abstract
In managing patient with congenital congenital aural atresia (CAA), preoperative high resolution computed tomography (HRCT) scan and hearing assessment are important. A grading system based on HRCT findings was first introduced by Jahrsdoefer in order to select appropriate candidates for operation and to predict the postoperative hearing outcome in CAA patients. The score of eight and more was considered as a good prognostic factor for hearing reconstruction surgery. However previously in our center this score was not used as the criteria for surgical procedure. This study was conducted at Center A to evaluate the correlation between pre and postoperative hearing level with HRCT based on a Jahrsdoefer grading system in patients with CAA. All records and HRCT films with CAA from January 1997 until December 2007 at Center A were evaluated. The demographic data, operative records, pre and post operative hearing levels and HRCT findings were analyzed. Hearing level in this study was based on a pure tone average of air-bone gap at 500 Hz, 1 kHz and 2 kHz or hearing level obtained from auditory brainstem response eudiometry. This study was approved by Research Ethics Committee (code number, FF-197-2008). Thirty-two ears were retrospectively evaluated. The postoperative hearing level of 30 dB and less was considered as successful hearing result postoperatively. Of the six ears which underwent canalplasty, three had achieved successful hearing result. However, there was no significant correlation between preoperative hearing level (HL) with HRCT score and postoperative HL with HRCT score at 0.05 significant levels (correlation coefficient = -0.292, P = 0.105 and correlation coefficient = -0.127, P = 0.810) respectively. Hearing evaluation and HRCT temporal bone are two independent evaluations for the patients with CAA before going for hearing reconstructive surgery.
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Ch'ng LS, Bux SI, Liam CK, Rahman NA, Ho CY. Sandstorm appearance of pulmonary alveolar microlithiasis incidentally detected in a young, asymptomatic male. Korean J Radiol 2013; 14:859-62. [PMID: 24043987 PMCID: PMC3772273 DOI: 10.3348/kjr.2013.14.5.859] [Citation(s) in RCA: 3] [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] [Received: 12/12/2012] [Accepted: 06/27/2013] [Indexed: 11/21/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare chronic disease with paucity of symptoms in contrast to the imaging findings. We present a case of a 24-year-old Malay man having an incidental abnormal pre-employment chest radiograph of dense micronodular opacities giving the classical "sandstorm" appearance. High-resolution computed tomography of the lungs showed microcalcifications with subpleural cystic changes. Open lung biopsy showed calcospherites within the alveolar spaces. The radiological and histopathological findings were characteristic of PAM.
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Affiliation(s)
- Li Shyan Ch'ng
- Department of Biomedical Imaging, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur 50603, Malaysia
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Lynrah ZA, Bakshi J, Panda NK, Khandelwal NK. Aggressiveness of pediatric cholesteatoma. Do we have an evidence? Indian J Otolaryngol Head Neck Surg 2013; 65:264-8. [PMID: 24427579 PMCID: PMC3696163 DOI: 10.1007/s12070-012-0548-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 03/11/2012] [Indexed: 10/28/2022] Open
Abstract
To compare pediatric and adult patients, affected by cholesteatoma for the clinical presentation, disease extent and final outcome. This is a prospective study in which 60 cases of unsafe chronic suppurative otitis media with cholesteatoma were included. These cases were divided into two groups of 30 cases each on the basis of age. All patients were subjected to detailed clinical examination. A high resolution computed tomography of the temporal bone was done in all the cases. An innovative grading system was devised to grade the disease. The patients were subjected to canal wall down mastoidectomy and were evaluated postoperatively for resolution of the symptoms, hearing and cavity problems. Granulation tissue along with cholesteatoma was more common among children (p < 0.01), whereas cholesteatoma alone was more common among adults. There was excellent correlation between the radiological and surgical findings. It was seen that higher the grade of the disease, the greater was the risk of complications and recidivism (p < 0.05). Recidivism was significantly higher in children (p < 0.05) whereas complications were equally common in both the groups. Hearing improvement was equivocal in both groups. Presence of granulation tissue along with cholesteatoma in children causes more aggressive disease with higher recidivism rate.
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Affiliation(s)
- Zareen A. Lynrah
- />Department of Otolaryngology, Head & Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaimanti Bakshi
- />Department of Otolaryngology, Head & Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh K. Panda
- />Department of Otolaryngology, Head & Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - N. K. Khandelwal
- />Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Mirfeizi Z, Farrokh D, Javanbakht A, Raufi E. Chest high resolution computed tomography findings in connective tissue diseases. Tanaffos 2013; 12:49-52. [PMID: 25191473 PMCID: PMC4153259] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 07/29/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Lung disorders are important for prognosis of connective tissue disease (CTD). Thus, chest radiography, High Resolution Computed Tomography (HRCT) of the chest and ultrasonic echocardiogram are suggested after the diagnosis of these conditions. The purpose of this study was to evaluate chest HRCT findings in patients with CTD. MATERIALS AND METHODS In this descriptive cross-sectional study, we evaluated HRCT findings in patients with (CTD) hospitalized in Imam Reza Hospital in Mashhad from 2006 - 2011. Patients' age, sex, type of rheumatic disease and HRCT results were collected and analyzed by SPSS version 16.0 software. RESULTS Out of 75 patients (78.67% females, 21.33% males with a mean age of 41.6 years), 56% had respiratory symptoms. Scleroderma was the most common disease (38.6%) followed by rheumatoid arthritis (26.6%) and systemic lupus erythematosus (14.6%). Interstitial tissue involvement of the lung was the most frequent finding in patients with scleroderma, dermatomyositis, polymyositis and Sjogren's syndrome (48.3%, 57.1%, 60% and 66.7%, respectively). Pleural thickening was the most common finding in patients with rheumatoid arthritis (45%). Pleural effusion was the most frequent finding in patients with systemic lupus erythematosus (45.4%). Lymphadenopathy and bronchiectasis had the lowest prevalence (1.3%). CONCLUSION Our data shows that interstitial tissue involvement, pleural thickening and pleural effusion are common in patients with rheumatic diseases which is consistent with some previous studies.
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Affiliation(s)
- Zahra Mirfeizi
- Rheumatic Diseases Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences
| | | | - Aida Javanbakht
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elahe Raufi
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Koito H. Pulmonary arterial hypertension due to pulmonary veno-occlusive disease in systemic sclerosis: Importance of early diagnosis and cautious use of pulmonary vasodilator therapy. J Cardiol Cases 2012; 5:e175-e178. [PMID: 30532934 PMCID: PMC6265377 DOI: 10.1016/j.jccase.2012.03.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hitoshi Koito
- Misugikai Otokoyama Hospital, 2nd Department of Internal Medicine, Knasai Medical University, 19 Otokoyama-Izumi, Yawata, Kyoto 614-8366, Japan
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Agarwal R, Khan A, Garg M, Aggarwal AN, Gupta D. Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis. World J Radiol 2012; 4:141-50. [PMID: 22590668 PMCID: PMC3351682 DOI: 10.4329/wjr.v4.i4.141] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/21/2012] [Accepted: 02/28/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-naïve allergic bronchopulmonary aspergillosis (ABPA) patients.
METHODS: This is a prospective observational study and includes 60 consecutive glucocorticoid-naïve patients with ABPA who underwent chest radiography and HRCT of the chest (1.25 mm every 10 mm) in the routine diagnostic workup for ABPA.
RESULTS: Chest radiographs were normal in 50% of cases. Of the remainder, most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis. Consolidation was detected in 17 cases but in the majority, the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities. Chest HRCT was normal in 22 patients, while central bronchiectasis (CB) was demonstrated in the remaining 38 patients. Bronchiectasis extended to the periphery in 33%-43% depending on the criteria used for defining CB. The other findings observed on HRCT were mucoid impaction, centrilobular nodules and high-attenuation mucus in decreasing order of frequency.
CONCLUSION: Patients with ABPA can present with normal HRCT chest scans. Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed. Consolidation is an uncommon finding in ABPA.
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