The predictive value of chest x-ray and plain chest CT scan as adjunct screening tools for COVID-19 patients in a national tertiary infectious disease hospital from March 1 to November 30, 2020

Background@#COVID-19 is diagnosed via Real Time Reverse Transcription Polymerase Chain Reaction (RT-PCR), with plain chest CT and chest x-ray as adjuncts. In the Philippines, chest x-ray is used as initial screening in assessing potential COVID-19 cases, with plain chest CT scan not routinely used due to higher cost and decreased availability.@*Objective@#This study determined the validity of chest x-ray and plain chest CT as initial screening tools for admitted COVID-19 patients from March 1 to November 30, 2020, at San Lazaro Hospital, comparing these with RT-PCR testing for COVID-19 as initial basis for considering a patient as a possible case of COVID-19.@*Methods@#This was a cross-sectional study of radiographic literature of admitted COVID-19 patients from March 1 to November 30, 2020, at San Lazaro Hospital, all with confirmatory RT-PCR, chest X-rays, and plain chest CTs. Baseline chest x-rays, with initial plain chest CT results, were compared with RT-PCR results. A tally was made, noting radiographic findings on both Chest X-ray and Plain Chest CT most frequently seen among patients with corresponding positive real time RT-PCR results.@*Results@#Chest X-rays done < 2 days from admission revealed involvement of both lungs, with infiltrates located centrally and peripherally, with major predilection for both lower lobes. Plain chest CT was similar, with ground glass opacities as the most common finding, consolidation second. Chest x-ray had a sensitivity of 88.11%, plain chest CT 94.71%. Sensitivity of combined chest x-ray and plain chest CT was 86.78%. Specificity and predictive value were not computed due to non-inclusion of admitted patients with COVID negative RT-PCR swab.@*Conclusion@#Chest X-ray and plain chest CT are useful modalities with high sensitivity in screening patients with fever, cough, and colds on admission. However, initial chest x-ray and plain chest CT scan results do not translate into a prognosis without context of initial diagnostics and management done during confinement.

Impact of COVID-19 on chest CT scan frequency in a general hospital / 中国辐射卫生

@#<b>Objective</b> To explore the effect of coronavirus disease 2019 (COVID-19) on the frequency of chest CT scan. <b>Methods</b> A retrospective study was conducted to extract information on the number of outpatient, emergency, and inpatient visits and patients who had chest CT imaging examination from January 1 to December 31, 2020 and in the same period in 2019 through the hospital’s medical data platform for analysis, and the chi-square test was used to analyze whether the difference in the proportion of patients who had chest CT imaging examination between 2019 and 2020 was statistically significant. <b>Results</b> The proportion of outpatients and emergency patients with chest CT examination was significantly higher in 2020 than in 2019 (2.48% <i>vs</i> 1.47%, <i>χ</i>² = 581.7, <i>P</i> < 0.000). The proportion of inpatients who underwent chest CT examination was significantly higher in 2020 than in 2019 (35.47% <i>vs</i> 28.01%, <i>χ</i>² = 182.0, <i>P</i> < 0.000). <b>Conclusion</b> Under the COVID-19 epidemic, the proportion of chest CT examination in this hospital in 2020 shows a significant upward trend compared with the same period in 2019, which will increase the collective dose due to medical exposure, and the hospital should pay attention to the determination of the legitimacy of chest CT scan.

Correlation of Sterno-Aortic distance with FEV1/ FVC and FEV1 in patients with COPD

Background@#Chronic obstructive pulmonary disease (COPD) is defined by the Global Initiative for Chronic Obstructive Lung Disease as " a disease state characterize by airflow limitation that is not fully reversible". Several qualitative and quantitative CT parameters have been studied in diagnosing patients with COPD. The clinical application of CT scan in quantitative assessment of the morphologic features of airways in patients with COPD has been subjects of numerous investigations. However, studies on sterno-aortic distance as a parameter in assessing morphologic feature of COPD in CT scan has been rare. Hence, this study aims to find a correlation of sterno-aortic distance with pulmonary function test in patients with COPD. @*Methods@#Eighty-one patients diagnosed with COPD who underwent chest CT scan and PFT within the period of one year were included. Sterno-aortic distance were measured and correlated with PFT results and severity of COPD. @*Results@#Most patients enrolled were males with average age of 64 ‡ 11years old. Most of these patients are categorized as mild COPD with 38 % and severe COPD with 38% of the total population. Patients classified as moderate COPD comprise 24 % of the total population. There is significant weak inverse correlation between sterno-aortic distance and PFT results, FEV1 (r = -0.419, p < 0.001) and FEV1/FVC(r = -0.322, p value of 0.003). There is a significant correlation derived between stern aortic distance and severity of COPD (ho = 0.88, p-value of <0.001). @*Conclusions@#Sterno-aortic distance is a valuable parameter in patients with COPD as well as its severity.

A Case of Pulmonary Langerhans Cell Histiocytosis with Pneumothorax

A 41 year-old man had suffered from cough, sputum and febrile sense for several months. On the chest CT scan, small nodules, cystic air spaces, and pneumothorax were observed. Pulmonary Langerhans cell histiocytosis was confirmed by lung biopsy. Pulmonary Langerhans cell histiocytosis in adult is an uncommon granulomatous disease of unknown cause, which affects the lung, either in isolation or in addition to other organ systems. The pulmonary symptoms at the time of presentation were nonspecific, and symptomes by the involvement of other organs ocurr sometimes. Pneumothoraces commonly were complicated the course of pulmonary Langerhans cell histiocytosis and frequently recurred. We report a pulmonary Langerhans cell histiocytosis with pneumothorax in adult.

The Role of Chest CT Scans in the Management of Empyema / 결핵

BACKGROUND: To decide the optimal antibiotics and application of chest tube, examination of pleural fluid is fundamental in the management of empyema. Some criteria for drainage of pleural fluid have been recommended but some controversies have been suggested. Recently, newer radiologic methods including ultrasound and computed tomography scanning, have been applied to the diagnosis and management of pleural effusions. We undertook a retrospective analysis of 30 patients with pleural effusion who had CT scans of the chest in order to apply the criteria of Light et at retrospectively to patients with loculation and to correlate the radiologic appearance of pleural effusions with pleural fluid chemistry. METHOD: We analyzed the records of 30 out of 147 patients with pleural effusion undergoing chest CT scans. RESULTS: 1) Six of the pleural fluid cultures yielded gram negative organisms and three anaerobic bacterias and one Staphylococcus aureus and one non-hemolytic Streptococci. No organism was cultured in nineteen cases(63.0%). 2) The reasons for taking chest CT scans were to rule out malignancy or parenchymal lung disease(46.7%), Poor response to antibiotics(40.0%), hard to aspirate pleural fluid(10.0%) and to decide the site for chest tube insertion(3.3%). 3) There was no significant correlations between ATS stages and loculation but there was a tendency to Inoculate in stage III. 4) There was a significant inverse relationship between the level of pH and loculation(P<0.05) but there appeared to be no relationship between pleural fluid, LDH, glucose, protein, loculation and pleural thickening. 5) In 12 out of 30, therapeutic measures were changed according to the chest CT scan findings. CONCLUSION: We were unable to identify any correlations between the plerual fluid chemistry, ATS stages and loculations except pH, and we suggest that tube thoracotomy should be individualized according to the clinical judgement arid serial observation. All patients with empyema do not need a chest CT scan but a CT scan can provide determination of loculation, guiding and assessing therapy which should decrease morbidity and hospital stay.