Risk factors for clinically significant diffuse parenchymal lung abnormalities persisting after severe COVID-19 pneumonia

Background & objectives: The risk factors for clinically significant diffuse parenchymal lung abnormalities (CS-DPLA) persisting after severe coronavirus disease 2019 (COVID-19) pneumonia remain unclear. The present study was conducted to assess whether COVID-19 severity and other parameters are associated with CS-DPLA. Methods: The study participants included patients who recovered after acute severe COVID-19 and presented with CS-DPLA at two or six month follow up and control group (without CS-DPLA). Adults volunteers without any acute illness, chronic respiratory illness and without a history of severe COVID-19 were included as healthy controls for the biomarker study. The CS-DPLA was identified as a multidimensional entity involving clinical, radiological and physiological pulmonary abnormalities. The primary exposure was the neutrophil-lymphocyte ratio (NLR). Recorded confounders included age, sex, peak lactate dehydrogenase (LDH), advanced respiratory support (ARS), length of hospital stay (LOS) and others; associations were analyzed using logistic regression. The baseline serum levels of surfactant protein D, cancer antigen 15-3 and transforming growth factor-? (TGF-?) were also compared among cases, controls and healthy volunteers. Results: We identified 91/160 (56.9%) and 42/144 (29.2%) participants with CS-DPLA at two and six months, respectively. Univariate analyses revealed associations of NLR, peak LDH, ARS and LOS with CS-DPLA at two months and of NLR and LOS at six months. The NLR was not independently associated with CS-DPLA at either visit. Only LOS independently predicted CS-DPLA at two months [adjusted odds ratios (aOR) (95% confidence interval [CI]), 1.16 (1.07-1.25); P<0.001] and six months [aOR (95% CI) and 1.07 (1.01-1.12); P=0.01]. Participants with CS-DPLA at six months had higher baseline serum TGF-? levels than healthy volunteers. Interpretation and conclusions: Longer hospital stay was observed to be the only independent predictor of CS-DPLA six months after severe COVID-19. Serum TGF-? should be evaluated further as a biomarker.

A concise review of diagnosis and evaluation of interstitial lung abnormalities / 中华劳动卫生职业病杂志

Interstitial lung abnormalities (ILAs) refer to the subtle or mild signs of ILAs pulmonary parenchyma on chest HRCT scans, which are not yet sufficient to diagnose a certain interstitial lung disease, may be potentially compatible an early stage of the diseases. The signs of ILAs usually includes ground-glass opacities, reticular abnormakicies, honeycombing, traction bronchiectasis or non-emphysematous cysts. This article reviews the research progreses in the definition and classification, risk factors, prognosis, comorbidities and management of ILAs in combination with domestic and foreign literatures.

Persistent interstitial lung abnormalities in post-COVID-19 patients: a case series

A new concept of multisystem disease has emerged as a long-term condition following mild-severe COVID-19 infection. The main symptoms of this affection are breathlessness, chest pain, and fatigue. We present here the clinical case of four COVID-19 patients during hospitalization and 60 days after hospital discharge. Physiological impairment of all patients was assessed by spirometry, dyspnea score, arterial blood gas, and 6-minute walk test 60 days after hospital discharge, and computed tomographic scan 90 days after discharge. All patients had fatigue, which was not related to hypoxemia or impaired spirometry values, and interstitial lung alterations, which occurred in both mechanically ventilated and non-mechanically ventilated patients. In conclusion, identifying the prevalence and patterns of permanent lung damage is paramount in preventing and treating COVID-19-induced fibrotic lung disease. Additionally, and based on our preliminary results, it will be also relevant to establish long-term outpatient programs for these individuals.

Congenital pulmonary airway malformation / 中华实用儿科临床杂志

Congenital pulmonary airway malformation (CPAM),which was previously known as congenital cystic adenomatoid malformation,is one of the most common congenital lung abnormalities.In recent years,more and more reports about the disease have been published and its classifications also have new changes.This article introduces the concept of CPAM,classification,clinical manifestations,differential diagnosis,and treatment strategies.

Congenital lung abnormalities / 中华实用儿科临床杂志

Congenital lung anomalies (CLA) are a group of malformations that include bronchopulmonary anomalies,vascular anomalies,and combined lung and vascular anomalies.With the advances in fetal ultrasonography and magnetic resonance imaging,and multi-detector computer tomography,CLA are increasingly being detected during both antenatal and postnatal periods,in turn influence patient counselling and management stratification.This paper focus on congenital lung abnormalities and congenital lobar emphysema.

Unusual Presentation of Extralobar Pulmonary Sequestration: A Case Report

Extralobar pulmonary sequestration, a rare form of bronchopulmonary sequestration, is a congenital anomaly in which a portion of nonfunctioning lung tissue is surrounded by its own pleura and is supplied by a systemic artery. We describe a case of extralobar pulmonary sequestration with unusual features. CT scanning of the chest demonstrated a non-enhancing, hyperdense mass within the right major fissure, and thoracotomy revealed that the mass received blood from a branch of the right pulmonary artery and drained into the left atrium. The pathologic diagnosis was extralobar pulmonary sequestration.

Percutaneous Transthoracic Biopsy for Thoracic Lesions: Comparison of the Utility of Fine Needle Aspiration (FNA), Percutaneous Cutting Needle Biopsy (PCNB) and Combination of Both Methods

PURPOSE: To assess the diagnostic role of FNA, PCNB, and a combination of both methods in patients who underwent percutaneous transthoracic biopsy for a malignant or benign intrathoracic lesion. MATERIALS AND METHODS: We retrospectively reviewed the findings of 213 patients with an intrathoracic mass or consolidation who underwent FNA (Group A, n=98), PCNB (Group B, n=31) or a combination of both methods (Group C, n=84). Under fluoroscopic guidance, diagnoses were based on the findings of surgery, biopsy at another site or clinical and radiologic follow-up. In the differential diagnosis of benign and malignant disease, and in the diagnosis of small-cell lung cancer, pulmonary tuberculosis, non-tuberculous infectious disease and benign mass, sensitivity, specificity and accuracy were statistically analysed in each group. RESULTS: Among 213 patients, lesions were malignant in 134 and benign in 79. In group A, sensitivity and specificity were 90.1% and 100% for malignant lesions, and 91.5% and 90.1% for benign, while in group B, the corresponding findings were 90.4% and 100%, and 90.0% and 90.1%. In group C, corresponding rates of 95.1% and 100% (p<0.05) and 100% and 92% (p<0.05) were recorded. In group C, accuracy and sensitivity were higher than in group A or (p<0.05). Post-procedural pneumothorax occurred in 15.3% of group A, 13.3% of group B, and 20.6% of group C, while hemoptysis was found in 7.1% of group A, 13.3% group B, and 2.9% of group C. Among the three groups, the complication rate showed no statistically significant variation (p<0.05). In the specific diagnosis of small-cell lung cancer, the sensitivity and specificity of FNA and PCNB were, respectively, 100% and 98.5%, and 90.0% and 98.0% (p<0.05) ; for tuberculosis, the corresponding figures were 35.0% and 100%, and 20.0% and 97.2 (p<0.05). FNA was better in the diagnosis of non-tuberculous infectious disease, while PCNB was better in the specific diagnosis of benign masses, without statistical significance. Conclusion: FNA is superior to PCNB in the diagnosis of tuberculosis and the differentiation of small cell lung cancer, and is thus the indicated initial approach for the majority of patients who are to undergo transthoracic bigosy. A combination of FNA and PCNB can provide more accurate differentiation between malignant and benign thoracic disease, without increasing the complication rate, than can one method used alone.

Unilateral Hyperlucency of the Lung: A Systematic Approach to Accurate Radiographic Interpretation

The radiographic appearance of a unilateral hyperlucent lung is related to various conditions, the accurate radiographic interpretation of which requires a structured approach as well as an awareness of the spectrum of these entities. Firstly, it is important to determine whether a hyperlucent hemithorax is associated with artifacts resulting from rotation of the patient, grid cutoff, or the heel effect. The second step is to determine whether or not a hyperlucent lung is abnormal. Lung that is in fact normal may appear hyperlucent because of diffusely increased opacity of the opposite hemithorax. Thirdly, thoracic wall and soft tissue abnormalities such as mastectomy or Poland syndrome may cause hyperlucency. Lastly, abnormalities of lung parenchyma may result in hyperlucency. Lung abnormalities can be divided into two groups: a) obstructive or compensatory hyperinflation; and b) reduced vascular perfusion of the lung due to congenital or acquired vascular abnormalities. In this article, we describe and illustrate the imaging spectrum of these causes and outline a structured approach to accurate radiographic interpretation.

Aspergilloma within Pulmonary Sequestration: A Case Report

Routine chest radiography in a 21-year-old man revealed the presence of an asymptomatic mass at the right lower lung field. Chest radiographs showed multiple cysts with air-fluid level and air-meniscus within the consolidation at the right lower lung field. Chest CT scans demonstrated a non-enhancing solid mass, with air-meniscus, within a thin walled cavity, and multiple cysts with fluid or air-fluid level at the posterior portion of the right lower lobe. An abnormal artery was seen at the level of the 12th thoracic vertebra. Thoracic aortography revealed a feeding artery arising from the descending thoracic aorta and supplying the parenchymal lesion. We report the typical radiologic findings of intralobar pulmonary sequestration with aspergilloma, a condition confirmed by surgery and the pathologic findings.

Intralobar Pulmonary Sequestration, Supplied from Left Gastric Artery: A Case Report

Pulmonary sequestration is a relatively rare anomaly. Arterial supply is usually derived from the aorta or its major branches, or very rarely from the left gastric artery. We present a case of intralobar sequestration in which blood was supplied by the left gastric artery.

Communicating Bronchopulmonary Foregut Malformation: A Case Report

Communicating bronchopulmonary foregut malformations are rare tracheobronchial anomalies characterized by a fistula between an isolated portion of respiratory tissue and the esophagus or stomach. We describe a case of CBFM in which chest radiography revealed total haziness in the right lung field. The diagnosis was confirmed by esophagography.

Simple Pulmonary Eosinophilia (Loeffler's Syndrome): Chest Radiographic and CT Findings

PURPOSE: The purpose of our study is to describe the chest radiographic and CT findings of simple pulmonary eosinophilia. MATERIALS AND METHODS: Twenty-six patients with simple pulmonary eosinophilia under went chest radiography and CT scanning; the results were analyzed retrospectively by two chest radiologists, focusing on the patterns and distribution of the parenchymal abnormalities. RESULTS: The chest radiographs were normal in eight patients (31%), while among the remaining 18 patients, they showed subtle opacity (n=9), nodules (n=8), consolidation (n=2), and mass (n=1). Fo l l ow-up chest radiographs (n=18) demonstrated com-plete (n=16) or partial (n=1) resolution of parenchymal lesions or migratory lesions (n=1). On CT, nodule(s) (n=19) were most commonly seen, followed by ground-glass opacity (n=16), consolidation (n=3), and mass (n=1). A peripheral halo surrounding a nodule or an area of consolidation was seen in 18 patients. The nodules(s) (n=19) were subpleural (n=13) or random (n=6). Areas of ground-glass opacity (n=16) were subpleural (n=13), random (n=2), or central (n=1). All lesions were patchy ratherthan diffuse. Fo l l ow-up CT in nine patients showed complete (n=7) or partial (n=2) resolution of parenchymal lesions. CONCLUSION: Chest radiographs of patients with simple pulmonary eosinophilia often r eveal no abnormality. The most common finding is subtle opacity or nodule(s), while CT reveals transient nodule(s) with a surrounding halo or transient areas of ground-glass opacity.

Cytomegalovirus Pneumonia: High - Resolution CT Findings in Ten Non-AIDS Immunocompromised Patients

OBJECTIVE: To describe the HRCT findings of cytomegalovirus (CMV) pneumonia in non-AIDS immunocompromised patients. MATERIALS AND METHODS: This retrospective study involved the ten all non-AIDS immunocompromised patients with biopsy-proven CMV pneumonia and without other pulmonary infection encountered at our Medical Center between January 1997 and May 1999. HRCT scans were retrospectively analysed by two chest radiologists and decisions regarding the findings were reached by consensus. RESULTS: The most frequent CT pattern was ground-glass opacity, seen in all patients, with bilateral patchy (n = 8) and diffuse (n = 2) distribution. Other findings included poorly-defined small nodules (n = 9) and consolidation (n = 7). There was no zonal predominance. The small nodules, bilateral in eight cases and unilateral in one, were all located in the centrilobular region. Consolidation (n = 7), with patchy distribution, was bilateral in five of seven patients (71%). Pleural effusion and bilateral areas of thickened interlobular septa were seen in six patients (60%). CONCLUSION: CMV pneumonia in non-AIDS immunocompromised patients appears on HRCT scans as bilateral mixed areas of ground-glass opacity, poorly-defined centrilobular small nodules, and consolidation. Interlobular septal thickening and pleural effusion are frequently associated.

Cytomegalovirus Pneumonia: High - Resolution CT Findings in Ten Non-AIDS Immunocompromised Patients

OBJECTIVE: To describe the HRCT findings of cytomegalovirus (CMV) pneumonia in non-AIDS immunocompromised patients. MATERIALS AND METHODS: This retrospective study involved the ten all non-AIDS immunocompromised patients with biopsy-proven CMV pneumonia and without other pulmonary infection encountered at our Medical Center between January 1997 and May 1999. HRCT scans were retrospectively analysed by two chest radiologists and decisions regarding the findings were reached by consensus. RESULTS: The most frequent CT pattern was ground-glass opacity, seen in all patients, with bilateral patchy (n = 8) and diffuse (n = 2) distribution. Other findings included poorly-defined small nodules (n = 9) and consolidation (n = 7). There was no zonal predominance. The small nodules, bilateral in eight cases and unilateral in one, were all located in the centrilobular region. Consolidation (n = 7), with patchy distribution, was bilateral in five of seven patients (71%). Pleural effusion and bilateral areas of thickened interlobular septa were seen in six patients (60%). CONCLUSION: CMV pneumonia in non-AIDS immunocompromised patients appears on HRCT scans as bilateral mixed areas of ground-glass opacity, poorly-defined centrilobular small nodules, and consolidation. Interlobular septal thickening and pleural effusion are frequently associated.

Mosaic Pattern of Lung Attenuation on Thin-Section CT: Review of 31 Cases

PURPOSE: To correlate radiologic findings with clinical findings in patients with a mosaic patten of lungattenuation, as seen on thin-section CT. MATERIALS AND METHODS: Thirty-one cases in which a mosaic pattern oflung attenuation was detected on combined expiratory and inspiratory scans of thin-section CT were retrospectivelyanalyzed. Cases involving infiltrative lung disease were excluded. Both thin-section CT and clinical findings wereanalyzed and the relationship between the extent of the area of hyperlucency -as seen on expiratory scan- andphysiologic parameters was evaluated. The subjects were 10 men and 21 women ranged in age from 25 to 76 (mean 50)years. RESULT: Twenty-nine patients with small airway disease, [chronic bronchitis and/or bronchiolitis(n=11),bronchiectasis(n=8), bronchial asthma(n=8), mycoplasmic pneumonitis(n=1) and hypersensitive pneumonitis(n=1),] andtwo patients with pulmonary vascular disease, [chronic pulmonary thromboembolism(n=1) and stenosis of the leftupper pulmonary artery(n=1)] were included in our study. Commonly associated thin-section CT findings in the casesinvolving small airway disease(n=29) were bronchial wall thickening(n=25), nodular opacity(n=25), bronchial andbronchiolar dilatation(n=20) and small branching opacity(n=16). These findings were not observed in two patientswith pulmonary vascular disease, though bronchial wall thickening was seen in the patient with chronic pulmonarythromboembolism. At expiratory scan level, there was statistical correlation between FEV1/FVC and the number ofpulmonary segments(r= 0.982, p0.05). CONCLUSION: The mosaic pattern of lung attenuation seen on thin-section CT isindicative of various diseases, involving small airways such as bronchiolitis, bronchitis, bronchiectasis andbronchial asthma, and vascular lung disease. Bronchial wall thickening and nodular opacity can be associated withsmall airway diseases.

Lung parenchymal change after the resolution of Adenovirus Pneumonia: Chest Radiographs and High-resolution CTfindings

PURPOSE: To evaluate lung parenchymal change as seen on chest radiographs and high-resolution CT (HRCT) afterthe resolution of adenovirus pneumonia (a common cause of lower respiratory infection in infants and children),and the usefulness of HRCT during follow-up. MATERIAL AND METHODS: Four to 13(mean, 8) months after recovery, tenpatients infected with adenovirus pneumonia underwent HRCT and chest radiographs. Eight were boys and two weregirls, and their mean age was 26(range, 14-45) monthes. Adenovirus pneumonia had been confirmed by viral isolationin culture or serologic test. CT scanning was performed during quiet breathing ; collimation was 2mm and theinterval from apex to diaphragm was 5-10mm. Lung settings were 1600 HU (window width) and -700 HU(level). CTfindings were assessed and compared with chest radiographs by two chest radiologists, who reached a consensus. Thepatients were clinically followed up for one year. RESULT: On chest radiographs, hyperlucent lung was seen in 8of 10 patients (80%) ; in one other there was partial collapse, and in one, findings were normal. The most commonHRCT finding was a mosaic pattern of lung attenuation with decreased pulmonary vascularity in the area of lowerattenuation ; this was seen in 8 of 10 patients (80%). Other findingss were partial collapse, bronchiectasis, andbronchial wall thickening, each seen in two patients, and reticulonodular density, seen in one. In two patientsHRCT findings were normal ; in one of these, chest findings were noraml but a mosaic pattern of lung attenuationwas found in all lobes. During follow-up, three patients wheezed continously. CONCLUSION: In cases of adenoviruspneumonia, HRCT demonstrated more specific parenchymal change than did chest radiographs ; a mosaic pattern oflung attenuation was seen, with decreased pulmonary vascularity in areas of lower attenuation ; bronchiectasis,bronchial wall thickening, and reticulo-odular density were also noted. These findings were presumably due tobronchiolitis obliterans, a well known complication of adenovirus pneumonia, and are prognostically helpful.

Unilateral Pulmonary Agenesis Associated with Tracheal Stenosis: A Case Report

Unilateral pulmonary agenesis is a rare congenital anomaly and is frequently associated with other congenitalanomalies. We report a case of left pulmonary agenesis associated with congenital tracheal stenosis in a newborn infant. Simple chest radiographs showed an overinflated right lung and mediastinal shifting to the left side.Chest CT and reconstructed three-dimensional images showed left pulmonary agenesis and tracheal stenosis. Theseanomalies of the tracheobronchial system were confirmed by bronchography.

Prediction of Bronchopulmonary Dysplasia by Chest Radiographic Scoring System at Seven Days of Age

PURPOSE: Recent trials of preventive dexamethasone therapy in preterm neonates at high risk of developing bronchopulmonary dysplasia(BPD) have required the objective criteria for prediction of BPD in the early neonatal period. The purpose of this study is to determine whether a chest radiographic scoring system at 7 days of age can be used to predict BPD. MATERIALS AND METHODS: Chest radiographs taken at 7 days and 28 days of age in 59 preterm neonates(gestational age of less than 33 weeks) were scored prospectively according to the consensus of two radiologists. The 7-day radiographs were scored according to a system derived from Yuksel's method : endotracheal tube insertion, degree of lung inflation, lung opacification, interstitial changes and cardiomegaly were measured. The radiographs taken at 28 days were scored according to a modification of Toce's method. The BPD group was defined as consisting of patients who needed oxygen therapy for more than 28 days and showed abnormality on chest radiographs. Scores were analysed to determine whether there were any statistical differences between the BPD and non-BPD groups, whether there was a significant correlation between scores at 7 days and 28 days, and whether there was any relationship between scores at 7 days of age and the development of BPD. We tried to determine which factors, as indicated by the scores at 7 days, significantly contributed to the development of BPD. RESULTS: The mean scores at 7 days of age in the BPD group (n=18) were 4.3+/-1.5 (2-7), and those in the non-BPD group (n=41) were 2.2+/-1.2 (0-4). The differences were statistically significant(p<.0001). Significant correlation was found between scores at 7 days and at 28 days of age (r:0.57, p<.0001). Analysis showed that endotracheal tube insertion, cardiomegaly, and degree of interstitial change, as seen on radiographs at 7 days, were factors which significantly contributed to the development of BPD(p<0.05 each). All neonates with a score of 5 or more developedBPD(7/7), while those with a score of less than 2 did not (0/11). CONCLUSION: The chest radiographic scoring system used at 7 days of age can be helpful in predicting the development of BPD. We believe that this system can be used to indicate the need for early preventive steroid therapy.

Prediction of Bronchopulmonary Dysplasia by Chest Radiographic Scoring System at Seven Days of Age

PURPOSE: Recent trials of preventive dexamethasone therapy in preterm neonates at high risk of developing bronchopulmonary dysplasia(BPD) have required the objective criteria for prediction of BPD in the early neonatal period. The purpose of this study is to determine whether a chest radiographic scoring system at 7 days of age can be used to predict BPD. MATERIALS AND METHODS: Chest radiographs taken at 7 days and 28 days of age in 59 preterm neonates(gestational age of less than 33 weeks) were scored prospectively according to the consensus of two radiologists. The 7-day radiographs were scored according to a system derived from Yuksel's method : endotracheal tube insertion, degree of lung inflation, lung opacification, interstitial changes and cardiomegaly were measured. The radiographs taken at 28 days were scored according to a modification of Toce's method. The BPD group was defined as consisting of patients who needed oxygen therapy for more than 28 days and showed abnormality on chest radiographs. Scores were analysed to determine whether there were any statistical differences between the BPD and non-BPD groups, whether there was a significant correlation between scores at 7 days and 28 days, and whether there was any relationship between scores at 7 days of age and the development of BPD. We tried to determine which factors, as indicated by the scores at 7 days, significantly contributed to the development of BPD. RESULTS: The mean scores at 7 days of age in the BPD group (n=18) were 4.3+/-1.5 (2-7), and those in the non-BPD group (n=41) were 2.2+/-1.2 (0-4). The differences were statistically significant(p<.0001). Significant correlation was found between scores at 7 days and at 28 days of age (r:0.57, p<.0001). Analysis showed that endotracheal tube insertion, cardiomegaly, and degree of interstitial change, as seen on radiographs at 7 days, were factors which significantly contributed to the development of BPD(p<0.05 each). All neonates with a score of 5 or more developedBPD(7/7), while those with a score of less than 2 did not (0/11). CONCLUSION: The chest radiographic scoring system used at 7 days of age can be helpful in predicting the development of BPD. We believe that this system can be used to indicate the need for early preventive steroid therapy.

Pulmonary Arteriovenous Malformation Treatment with Detachable Balloon: A Case Report

Pulmonary arteriovenous malformation(PAVM) are associated with substantial risks if left untreated. The literature reports a 40-50% incidence of paradoxical embolization. Percutaneous arterial embolization has become the standard treatemtn for PAVM. We report a case of pulmonary arteriovenous malformation successfully treated bytranscatheter embolization using detachable balloons and we also demonstrate long-term follow up CT findings.