Association of Lung Function with Serum 25-Hydroxyvitamin D Level according to the Presence of Past Pulmonary Tuberculosis in Korean Adults / 가정의학회지

BACKGROUND: Vitamin D deficiency is associated with an increased risk of pulmonary tuberculosis (PTB) infection and the treatment outcome. The aim of this study was to examine the relationship between the serum 25-hydroxyvitamin D (25[OH]D) level and lung function in Korean adults according to whether or not there is a history of PTB. METHODS: The data for subjects aged 19 years or older from the Korea National Health and Nutrition Examination Survey 2008–2012 who underwent spirometry, chest radiography, and serum 25(OH)D level measurement were analyzed. RESULTS: Evidence of past PTB infection was found in 1,482 (9.6%) of 15,516 subjects. The serum 25(OH)D level was lower in the group with past PTB than in the non-PTB group (P=0.013). Respiratory dysfunction was more common in the past PTB group than in the non-PTB group (restrictive pattern, 14.0% vs. 9.6%; obstructive pattern, 29.6% vs. 8.2%; both P<0.001). After adjusting for age, sex, height, and season, the mean difference in forced expiratory volume in 1 second (FEV1) between the highest and lowest quartiles of 25(OH)D was 100.2 mL (standard error= 49.3 mL, P for trend=0.049) in the past PTB group and 34.7 mL (standard error=13.6 mL, P=0.009) in the non-PTB group. CONCLUSION: FEV1 tended to increase as the vitamin D quartile increased in both study groups. This relationship was more pronounced in subjects with a history of PTB. A higher serum 25(OH)D level might be beneficial in preserving lung function after PTB infection.

Signo de Chilaiditi como hallazgo incidental en un paciente con enfermedad respiratoria: reporte de caso / Chilaiditi sign as an incidental finding in a patient with respiratory disease: a case report

Resumen El signo de Chilaiditi es un hallazgo radiográfico infrecuente que consiste en la interposición de un asa intestinal entre el hígado y el diafragma. No existe etiología claramente establecida; sin embargo, se han planteado varias hipótesis que explican su presencia, entre ellos la hiperlaxitud de los ligamentos suspensorios del hígado, el aumento de la presión intraabdominal y la redundancia colónica. Al asociarse este hallazgo con síntomas gastrointestinales o respiratorios se denomina síndrome de Chilaiditi, y su tratamiento principalmente es sintomático, en casos excepcionales requiere abordaje quirúrgico. Este signo se encuentra usualmente de manera incidental y se ha visto una relación con enfermedad respiratoria crónica; pudiendo afectar su curso clínico, motivando a profundizar en el estudio integral. Se presenta el caso de un paciente adulto mayor, en seguimiento médico por enfermedad pulmonar obstructiva crónica, cuya radiografía de tórax evidencia la interposición de un asa intestinal entre la cúpula diafragmática derecha y el hígado. MÉD.UIS. 2018;31(3):57-61.

Abstract The Chilaiditi sign is a rare radiographic finding, which consists in the interposition of an intestinal handle between the liver and the diaphragm. There is no clear etiology established, however, several hypotheses have been proposed to explain its presence, including the hyper-laxity of the liver suspensory ligaments, an increase on the intra-abdominal pressure and colonic redundancy. When this finding is associated with gastrointestinal or respiratory symptoms is called "Chilaiditi syndrome", and its treatment is mainly symptomatic; in exceptional cases a surgical approach is required. The Chilaiditi sign is usually an incidental finding, and a connection with chronic respiratory disease has been seen, and it could affect this pathology's clinical course, being this a motivation to deepen in an integral study. We present a case of an elder patient, being followed due to chronic obstructive pulmonary disease, whose chest X-ray shows interposition of an intestinal handle between the right diaphragmatic dome and the liver. MÉD.UIS. 2018;31(3):57-61.

The Definition of Past Tuberculosis Affects the Magnitude of Association between Pulmonary Tuberculosis and Respiratory Dysfunction: Korea National Health and Nutrition Examination Survey, 2008–2012

Tuberculosis (TB) is associated with an increased risk of chronic lung impairment. The aim of this study was to compare the clinical characteristics and lung functions according to definition of past TB. We used the population-based, Korea National Health and Nutrition Examination Survey (KNHANES) (2008–2012) to analyze 13,522 subjects age 40 years or older who underwent spirometry and chest X-ray (CXR). Subjects with TB lesions on CXR (with or without a history of TB) were older, more likely to be male, ever smokers, and of low socioeconomic status than subjects with only a history of TB or without evidence of TB. Airflow obstruction (AFO) was associated with only a history of TB (odds ratio [OR] 1.53, 95% confidence interval [CI] 0.95–2.46), only TB lesion on CXR (OR 2.37, 95% CI 1.80–3.12), and both a history and TB lesions on CXR (OR 4.47, 95% CI 3.07–6.51) after adjustment for gender, age, body mass index, education, income, and smoking amount (P for trend < 0.001). Spirometric restriction was associated with only a history of TB (OR 1.29, 95% CI 0.80–2.08), only TB lesions on CXR (OR 2.03, 95% CI 1.49–2.76), and both a history and TB lesions on CXR (OR 2.65, 95% CI 1.74–4.05) after adjustment for the above variables (P for trend < 0.001). How to define past TB in population study affects the magnitude of association between past TB and respiratory dysfunction. Without considering TB lesions on CXR, the association between TB and respiratory dysfunction could be underestimated.

Cryptococcosis, silicosis, and tuberculous pseudotumor in the same pulmonary lobe / Tuberculose pseudotumoral, criptococose e silicose no mesmo lobo pulmonar

Tuberculosis and cryptococcosis are infectious diseases that can result in the formation of single or multiple nodules in immunocompetent patients. Exposure to silica is known to raise the risk of infection with Mycobacterium tuberculosis. We report the case of an elderly man with no history of opportunistic infections and no clinical evidence of immunodeficiency but with a six-month history of dry cough and nocturnal wheezing. A chest X-ray revealed a mass measuring 5.0 × 3.5 cm in the right upper lobe. The diagnostic approach of the mass revealed tuberculosis. The histopathological analysis of the surrounding parenchyma reveled silicosis and cryptococcosis. Cryptococcosis was also found in masses identified in the mediastinal lymph nodes. The surgical approach was indicated because of the degree of pleuropulmonary involvement, the inconclusive results obtained with the invasive and noninvasive methods applied, and the possibility of malignancy. This case illustrates the difficulty inherent to the assessment of infectious or inflammatory pulmonary pseudotumors, the differential diagnosis of which occasionally requires a radical surgical approach. Despite the presence of respiratory symptoms for six months, the first chest X-ray was performed only at the end of that period. We discuss the possible pathogenic mechanisms that might have led to the combination of three types of granulomatous lesions in the same lobe, and we emphasize the need for greater awareness of atypical presentations of pulmonary tuberculosis.

A tuberculose e a criptococose são infecções que podem cursar com a formação de nódulos isolados ou múltiplos em pacientes imunocompetentes. A exposição à sílica reconhecidamente eleva o risco de doença pelo Mycobacterium tuberculosis. Apresentamos o caso de um paciente idoso sem antecedentes de infecções oportunistas, sem evidência clínica atual de imunodeficiência, com história de tosse seca e sibilos, principalmente noturnos, com duração de seis meses, cuja radiografia de tórax evidenciava uma imagem tumoral medindo 5,0 × 3,5 cm em lobo superior do pulmão direito. A abordagem diagnóstica da massa evidenciou tratar-se de tuberculose, e a análise histopatológica do parênquima circunvizinho revelou a presença de criptococose e de silicose. Criptococose foi diagnosticada também em massas linfonodais mediastinais. A conduta cirúrgica foi imposta pelo grau de comprometimento pleuropulmonar localizado, pelo caráter inconclusivo das abordagens diagnósticas invasivas e não invasivas realizadas, assim como pela possibilidade de tratar-se de neoplasia. Este caso ilustra a dificuldade inerente ao diagnóstico diferencial de massas pulmonares de natureza infecciosa ou inflamatória simulando neoplasia, o que ocasionalmente impõe uma conduta cirúrgica radical. Apesar da presença de sintomas respiratórios por seis meses, a primeira radiografia do tórax só foi realizada tardiamente. São discutidos os possíveis mecanismos patogenéticos que possam ter levado a associação de três tipos de granulomatose no mesmo lobo pulmonar e é enfatizada a necessidade de uma maior divulgação das apresentações atípicas da tuberculose pulmonar.

Evaluation of radiation dosage in chest digital tomosynthesis / 中华放射学杂志

Objective To evaluate the feasibility of chest digital tomosynthesis(DTS)for lung lesion screening by comparing the effective dose of chest DTS with chest digital radiography(DR),low-dose MSCT and MSCT examinations.Methods The Fluke lung/chest phantom underwent posterior-anterior (PA),left lateral(LAT)chest DR and DTS with automatic exposure control technique.Using RTI DoseGuard and WinODS,the dose area product(DAP)and effective dose of PA,LAT and total DTS were calculated.CareDose technique was used for MSCT and low-dose MSCT scans,the dose length products (DLP)was acquired.According to the DLP to E(k)conversion coefficient in ICRP 103,the effective dose of low-dose MSCT and MSCT were calculated.Paired t test was used for comparison of the mean effective dose of DTS,DR and low-dose MSCT.Results The mean effective dose was 0.1 3 mSv for chest DR and 0.11 mSv for DTS examination.The mean effective dose of low-dose MSCT and MSCT scans were 1.13 mSv and 6.38 mSv.The effective dose of chest DTS was comparable to that of chest DR,and was approximately 1/10 and 1/60 times lower than that of low-dose MSCT and MSCT scans.There was no statistical difference between chest DTS and DR(t =3.514,P ＞0.01),and there was a significant difference between chest DTS and low-dose MSCT(t =178.769,P ＜0.01).Conclusion DTS is a new X-ray tomography which has the advantage of low radiation dosage in chest examination for lung lesion screening comparing with low-dose MSCT.

Granuloma hialinizante de pulmão recidivante / Recurrent pulmonary hyalinizing granuloma

Relatamos o caso de um paciente de 61 anos, masculino, internado com objetivo de exérese de massa pulmonar para estudo anatomopatológico. O paciente apresentara anteriormente um quadro de febre, tosse seca e dor torácica, associado à presença de massas pulmonares detectadas por radiografia de tórax, tendo sido submetido em duas ocasiões (1976 e 1981) a toracotomia para a investigação diagnóstica, sem diagnóstico anatomopatológico conclusivo. A TC de tórax revelou volumosas massas com áreas de calcificação em ambos os campos pulmonares. O material do estudo anatomopatológico foi compatível com granuloma hialinizante de pulmão. No pós-operatório, o paciente apresentou vários episódios de broncoespasmo que foram revertidos com medicação sintomática. Foi mantido com prednisona na dose de 40 mg/dia com boa evolução clínica até o envio deste relato.

We report the case of a 61-year-old male patient who underwent surgical excision of a lung mass for anatomopathological study. The patient had previously presented with fever, dry cough, and chest pain, together with lung masses detected by chest X-ray, and had undergone thoracotomy for diagnostic investigation on two occasions (1976 and 1981), although a conclusive diagnosis had not been made. A CT scan of the chest revealed large masses with areas of calcification in both lung fields. The anatomopathological study was consistent with pulmonary hyalinizing granuloma. In the postoperative period, the patient experienced several episodes of bronchospasm, which was reversible with the use of symptomatic medication. At this writing, the patient was receiving maintenance therapy with prednisone (40 mg/day) and had shown clinical improvement.

The function of Z-axis tube-current modulation technique with desired noise level to decrease radiation dose in MSCT chest scanning / 中华放射学杂志

Objective Retrospectively evaluate the effect of Z-axis tube-current modulation technique with desired noise level to improve image quality (image noise level) and decrease radiation doses of MSCT (16-slice CT) in chest scanning. Methods Consecutive two hundred patients whose CT scan projection radiographs showed no significant abnormal were randomly divided into two groups by the examination order: Z-axis tube-current modulation (ZTCM) group (odd number, test group) and constant tube-current (CTC) group (even number, contrast group). The desired noise level of ZTCM group was 10HU and the machine automatically set the dynamic tube-current in scanning according to attenuated information of chest acquired in scan projection radiographs, the tubo-current of CTC group was set at 200mA, while the other scan parameters remained totally the same. The maximum tube-current value,CTDIvol, DLP and the tube-current of the slice at the maximum breast level of female patients were recorded respectively. The noise of image at upper lung, aorta arch, left atrium and bottom lung level were measured and compared. The qualities of Images were classified in three levels (excellent, good, poor) with double blind method. Results The mean value of maximum mA, CTDIvol, DLP and mA of the slice at the maximum breast level of ZTCM group were (178.5±125.6) mA, (10.5±3.8) mGy, (231.6±24.3)mGy/cm and (116.0±22.5) mA, those of CTC were 200.0 mA, 12.8 mGy, (274.7±18.4)mGy/cm and 200.0 mA, ZTCM group decreased by 10.8%, 19.9%, 15.7% and 42.0%,respectively, as compared with CTC group. The image quality at upper lung and bottom lung level in ZTCM group was improved significantly (P < 0.05) and the cases of excellent images in ZTCM group was significantly higher than that of CTC group (P < 0.05). Conclusion ZTCM technique not only contributes to more rational distribution of radiation doses but also realizes individuation, decreases the total radiation doses and improves image quality in chest CT scanning. It is valuable and promising in chest CT scan.