Radiologic manifestations of pulmonary tuberculosis in patients of intensive care units

Tuberculosis [TB] is a serpent disease with various pulmonary manifestations, and timely diagnosis of the disease is paramount, since delayed treatment is associated with severe morbidity, particularly in intensive care units [ICU]. Therefore, it is imperative that intensivists understand the typical distribution, patterns, and imaging manifestations of TB. To describe different manifestations of pulmonary TB in patients in the ICU. In a retrospective study, all patients with a clinical and a laboratory-confirmed diagnosis of TB who were admitted to the ICU were entered in the study. All patients had a confirmatory laboratory diagnosis of TB including positive smears. The patterns of parenchymal lesions, involved segments and presence of cavity, bronchiectasis and bronchogenic spread of the lesions with computed tomography [CT] and chest/X-ray [CXR] were recorded and analyzed. Data of 146 patients with TB were entered in the study. The most common finding in CT was acute respiratory distress syndrome [ARDS]-like radiologic manifestations [17.1%], followed by parenchymal nodular infiltration [13.6%] and cavitation [10.9%], consolidation [10.2%], interstitial involvement [9.5%], calcified parenchymal mass [8.3%], ground-glass opacities [7.5%], and pleural effusion or thickening [6.9%]. Radiologic evidence of lymphadenopathy was seen in up to 43% of adults. Miliary TB was observed in 2.3% of patients, mostly in those older than 60 years of age. ARDS-like [64.5%] manifestations on CT and miliary TB [85.5%] had the highest mortality rates among other pulmonary manifestations. ARDS, interstitial involvement, and Parenchymal nodular infiltration are the most common manifestations of pulmonary TB. Various features of TB in ICU patients could be misleading for intensivists

correlation of brody high resolution computed tomography scoring system with clinical status and pulmonary function test in patients with cystic fibrosis

To reduce the mortality and morbidity rates of cystic fibrosis [CF] patients, and to have an effective clinical management, it is important to monitor the progression of the disease. The aim of this study was to evaluate the progression of lung disease in CF patients by means of assessing the correlation of the CT scoring system with clinical status and pulmonary function test at the Pediatric Pulmonary Ward of Masih Daneshvari Hospital in 2008. Pulmonary high resolution computed tomography [HRCT] was performed in 23 CF patients using the Brody's scoring system. Morphologic signs as well as the extent and severity of each sign were scored, and the total sore was calculated. The correlation of HRCT scores[total score as well as the score for each parameter] with Shwachman Kuczycki scoring system and pulmonary function test were examined. The study included 9 female and 14 male patients with an age range of 5-23 years [mean: 13.42 years]. Bronchiectasis [100%] and peribronchial wall thickening [100%] were the most frequent CT abnormalities. Mucus plugging, air trapping and parenchymal involvements were respectively seen in 95.7%, 91.3% and 47.8% of patients. The overall CT score for all patients was 57.6 +/- 24.2 [means +/- SD]. The results of pulmonary function test showed a restrictive pattern; however, in 5.3% of the patients PFT was normal. The overall Shwachman-Kulczycki score was 53.48 +/- 13.8. There was a significantly [P=0.015] negative correlation between the total CT score and Shwachman-Kulczycki score; however, there was no significant correlation between total CT score and the results of PFT [P=0.481]. The Brody's scoring system for high resolution computed tomography seems to be a sensitive and efficient method to evaluate the progression of CF, and can be more reliable when we combine the CT scores with clinical parameters

Is mining the main cause of silicosis? case series

Silicosis is an irreversible progressive lung disease which leads to ultimate death. This study aimed to describe characteristics of individuals affected by silicosis, evaluate the prevalence of silicosis in miners and also introduce preventive policies. Cases with pathologic diagnosis of silicosis were retrieved from archive of pathology department of national research institute of tuberculosis and lung disease [NRITLD] during 2000-2009. All hematoxylin and eosin stained slides were reviewed by two pathologists independent of clinical and imaging findings. Occupational history, clinical information, imaging findings, history of associated disease, method of biopsy and pathologic diagnosis were reviewed. During 2000 and 2009, 29 cases had pathologic diagnosis of silicosis, 4 of them were excluded due to unavailable occupational history. The disease presented among patients in the age range of 22-80 years. The most common occupation was sandblasting while mining was in the second position. The male patients who were miners were old except for one who was a 28-year old car painter whose previous job was mining. Most sandblasters were young except one who was 55. The most prevalent radiologic finding was pulmonary nodules. Restrictive pattern was the most common finding in pulmonary function test [PFT]. Of patients, 28% had current tuberculosis. Transbronchial lung biopsy was the method of choice in 14 cases. The most prevalent pathologic finding was early silicotic nodules. Our study demonstrated that mining was not the main occupational history in our understudy cases. We also observed the change in the age range of patients suffering from silicosis which may be due to the prevalence of sandblasting and job demands in young patients. It is recommended that protective measures be applied not only in mining industries, but also in small workshops and studios. It is also necessary that working conditions in these workplaces be evaluated regularly by the occupational safety and health administration

Predictive accuracy of revised Geneva score in the diagnosis of pulmonary embolism

Revised Geneva score is a clinical prediction rule used in determining the pre-test probability of pulmonary embolism [PE]. It has been recently introduced and is independent of the doctor's experience applying the rule. This study aimed to evaluate the predictive accuracy of revised Geneva score in the diagnostic protocol of pulmonary embolism and its role in decreasing the need for pulmonary imaging studies. In this study, we evaluated the medical records of 242 patients suspected for pulmonary embolism who underwent CT scan of the lung as part of their diagnostic protocol from October 2007 to February 2009. Six patients were excluded from the study due to their indeterminate CT scan results. The mean age of patients was 58 yrs and 62% of patients were males. The overall prevalence of pulmonary embolism was 24%. By increased scoring, the clinical probability of pulmonary embolism increased as well [P=0.011]. According to the classification of revised Geneva score, clinical probability of pulmonary embolism was evaluated to be low in 25% of patients, intermediate in 72% and high in 2%. Prevalence of pulmonary embolism based on the CT scan results was 7.7% ranged [0.5-14.9] in the low probability category, 22.5% ranged [15.6-29.4] in the intermediate, and 50% ranged [0.01-0.99] in the high-probability category which were comparable with the rates reported in the derivation set except for the prevalence rate for high probability patients [9%, 27.5% and 71.7%, respectively]. The area under the ROC curve was calculated based on continuous scoring to be 0.675. Revised Geneva score had an acceptable predictive accuracy in low and intermediate-probability groups. We could not reach a conclusion regarding high probability patients due to the small number of such cases in this study