Manejo conservador del neumotórax oculto en trauma

Introducción: El neumotórax oculto (NTXO) se encuentra hasta en el 15% de los traumatismos torácicos. Existen antecedentes del manejo conservador de esta patología (sólo observación), aunque su práctica continúa siendo discutida, especialmente, en traumatismos penetrantes. El objetivo de este trabajo es describir nuestra experiencia en el manejo conservador del NTXO. Materiales y Método: Estudio de cohorte retrospectivo realizado durante un período de 3 años en un Hospital de Trauma nivel I. Se incluyeron pacientes con traumatismo torácico (cerrado o penetrante) con NTXO. Se dividieron en dos grupos (conservados o drenados), realizándose una comparación de su evolución. Resultados: En 3 años fueron admitidos con traumatismo torácico 679 pacientes. De 93 pacientes con NTXO, 74 (80%) fueron conservados inicialmente y 19 (20%) tratados con drenaje pleural. Dos (3%) presentaron progresión del neumotórax en el seguimiento radiológico (conservación fallida). No se registraron complicaciones relacionadas con la ausencia de drenaje pleural. Las complicaciones y estancia hospitalaria fueron menores en el grupo de manejo conservador. Conclusión: Pacientes con NTXO por traumatismo de tórax (cerrado o penetrante), sin requerimiento de ventilación asistida y hemodinámicamente estables, pueden manejarse de manera conservadora con un monitoreo cercano durante 24 horas en forma segura, con menor tasa de complicaciones y de estancia hospitalaria.

Background: Occult pneumothorax (OPTX) is found in up to 15% of chest injuries. There is a history of conservative management of this pathology (only observation), although its practice continues to be discussed, especially in penetrating trauma. The objective of this paper is to describe our experience in the conservative management of OPTX. Materials and Method: Retrospective cohort study conducted over a 3-year period at a level I Trauma Center. Patients with thoracic trauma (blunt or penetrating) with OPTX were included. They were divided into two groups (preserved or drained) comparing their evolution. Results: Over a 3-year period 679 patients were admitted with chest trauma. From 93 patients with OPTX, 74 (80%) were initially preserved and 19 (20%) drained. Two patients (3%) presented pneumothorax progression in the follow-up imaging. There were no complications related to the absence of pleural drainage. Complications and hospital stay were lower in the conservative management group. Conclusion: Patients with OPTX due to chest trauma (blunt or penetrating), without requiring assisted ventilation and hemodynamically stable, can be safely conservative managed with close monitoring for 24 hours, with a lower rate of complications and hospital stay.

Radiation dose and fractionation regimen for limited stage small cell lung cancer: a survey of current practice patterns of Chinese radiation oncologists / 中华放射肿瘤学杂志

Objective:To investigate the radiation dose and fractionation regimens for limited stage small cell lung cancer (LS-SCLC) in Chinese radiation oncologists.Methods:Over 500 radiation oncologists were surveyed through questionnaire for radiation dose and fractionation regimens for LS-SCLC and 216 valid samples were collected for further analysis. All data were collected by online questionnaire designed by WJX software. Data collection and statistical analysis were performed by SPSS 25.0 statistical software. The differences in categorical variables among different groups were analyzed by Chi-square test and Fisher's exact test. Results:Among 216 participants, 94.9% preferred early concurrent chemoradiotherapy, 69.4% recommended conventional fractionation, 70.8% preferred a total dose of 60 Gy when delivering conventional radiotherapy and 78.7% recommended 45 Gy when administering hyperfractionated radiotherapy.Conclusions:Despite differences in LS-SCLC treatment plans, most of Chinese radiation oncologists prefer to choose 60 Gy conventional fractionated radiotherapy as the main treatment strategy for LS-SCLC patients. Chinese Society of Clinical Oncology (CSCO), National Comprehensive Cancer Network (NCCN) and Chinese Medical Association guidelines or expert consensus play a critical role in guiding treatment decision-making.

Study on the effect of virtual grid on chest X-ray image quality / 中华放射学杂志

Objective:To explore the image quality and its evaluation method using virtual grid under different tube voltages in the clinical chest X-ray exam.Methods:According to the conditions of chest X-ray photography commonly used in clinical practice, the corresponding thickness of plexiglass (20 cm, including CDRAD phantom) was determined as the experimental object. With a fixed tube loading of 4 mAs and the tube voltage from 60 to 125 kV, the experimental object was imaged in three ways: physical grid, none grid and virtual grid. The common physical parameters (CNR, σ, C, SNR), texture analysis (Angular second moment, texture Contrast, Correlation, Inverse difference moment, Entropy) and CDRAD phantom score (IQF inv) were evaluated. Two-way ANOVA test was used for each group of common physical parameters, and further pairwise comparisons were made. At the same time, applying virtual grids on the obtained images with chest anthropomorphic model and texture indexing the images with and without virtual grids, then rank sum test of paired sample can be conducted. Results:There were differences in image quality among the three groups of grid mode( P<0.05), and the physical grid delivered the best image quality. The tube voltage had an impact on all image quality evaluation indexes ( P<0.05). The tube voltage was positively correlated with CNR, SNR, angular second moment, inverse difference moment and IQF inv ( P<0.05), and negatively correlated with σ, C, texture contrast and entropy ( P<0.05). There was no significant correlation between the tube voltage and Correlation ( P>0.05). The chest anthropomorphic model images were used to evaluate the virtual grids, and the texture indexes (Angle second moment, Contrast, Correlation, Inverse difference moment, Entropy) were statistically significant (P<0.05). Conclusions:The virtual grid can improve the image quality of chest X-ray photography, and the image texture analysis method can be a useful supplement to the image quality evaluation parameters.

Inteligencia artificial explicable, una perspectiva al problema de la clasificación automática de COVID-19 mediante radiografías de tórax

RESUMEN Esta investigación pretende dilucidar, a partir del análisis de técnicas de inteligencia artificial explicables, la robustez y el nivel de generalización de los métodos de visión por computadora propuestos para identificar COVID-19 utilizando imágenes de radiografías de tórax. Asimismo, alertar a los investigadores y revisores sobre el problema del aprendizaje por atajos. En este estudio se siguen recomendaciones para identificar si los modelos de clasificación automática de COVID-19 se ven afectados por el aprendizaje por atajos. Para ello, se revisaron los artículos que utilizan métodos de inteligencia artificial explicable en dicha tarea. Se evidenció que al utilizar la imagen de radiografía de tórax completa o el cuadro delimitador de los pulmones, las regiones de la imagen que más contribuyen a la clasificación aparecen fuera de la región pulmonar, algo que no tiene sentido. Los resultados indican que, hasta ahora, los modelos existentes presentan el problema de aprendizaje por atajos, lo cual los hace inapropiados para ser usados en entornos clínicos.

ABSTRACT This research aims to elucidate, from the analysis of explainable artificial intelligence techniques, the robustness and level of generalization of the proposed computer vision methods to identify COVID-19 using chest X-ray images. Also, alert researchers and reviewers about the problem of learning by shortcuts. In this study, recommendations are followed to identify if the automatic classification models of COVID-19 are affected by shortcut learning. To do this, articles that use explainable artificial intelligence methods were reviewed. It was shown that when using the full chest X-ray image or the bounding box of the lungs, the regions of the image that contribute the most to the classification appear outside the lung region, something that does not make sense. The results indicate that, so far, the existing models present the problem of learning by shortcuts, which makes them inappropriate to be used in clinical settings.

Diagnóstico etiológico de la neumonía: un problema en la práctica clínica pediátrica / Etiological diagnosis of pneumonia: a problem of pediatric clinical practice

Resumen La neumonía en niños es causa frecuente de morbilidad y mortalidad, especialmente en países de bajos ingresos; es indispensable proporcionar una adecuada conducta terapéutica, idealmente orientada por etiología, pues la principal consecuencia de no establecer un diagnóstico etiológico preciso es el abuso de antibióticos. La evaluación clínica y radiológica son los pilares básicos para el diagnóstico de neumonía, y el conocimiento del comportamiento epidemiológico de los gérmenes y los biomarcadores ayudan a su aproximación etiológica. Se revisaron aspectos prácticos sobre el diagnóstico de la neumonía en niños, abordando criterios clínicos y epidemiológicos (edad y género), reactantes de fase aguda, hallazgos radiológicos y modelos de predicción etiológica utilizados como herramientas para la diferenciación de neumonía bacteriana de viral en menores de 18 años, en escenarios donde no se dispone rutinariamente de técnicas más precisas para diagnóstico rápido, como aquellas de tipo inmunológico o moleculares. MÉD.UIS.2020;33(1):39-52.

Abstract Pneumonia in children is a frequent cause of morbidity and mortality, especially in low-income countries. Due to this, it is indispensable to get a right therapeutic behavior, ideally focused by etiology, because the main consequence of not establishing an accurate etiological diagnosis is the abuse of antibiotics. The radiologic and clinic evaluations are basic pillars for pneumonia diagnosis and the knowledge in epidemiological behavior and biomarkers is very useful for an etiological approximation. Practical aspects were reviewed about pneumonia diagnosis in children, addressing clinic and epidemiological criteria (age and gender), acute phase reactants, radiological findings and etiological prediction models used as tools for differentiation between viral and bacterial pneumonia in children under 18 years old, in scenarios where it is not possible to find techniques for a right diagnostic, as those of immunologic and molecular types. MÉD.UIS.2020;33(1):39-52.

Deep-learning based computer aided diagnosis system in detecting fractures on anteroposterior chest DR films / 中国介入影像与治疗学

Objective: To evaluate the efficiency of deep-learning based computer aided diagnosis system (DL-CAD) in detecting fractures on DR chest anteroposterior films, and to explore its capability of assisting the junior radiologist. Methods: ①Experiment 1: A total of 547 DR chest anteroposterior films, including 361 patients with 983 chest fractures and 186 without chest fractures were retrospectively analyzed. The predictive performance of DL-CAD for fracture was evaluated. ②Experiment 2: Totally 397 patients were randomly selected from experiment 1, including 211 cases with 604 chest fractures and 186 cases without chest fractures. The results of DL-CAD alone (group 1), a junior radiology resident alone (group 2), a junior radiology resident aided with DL-CAD (group 3) and a senior radiologist alone (group 4) were recorded and compared, respectively. Results: ①For experiment 1: Among 983 fractures, DL-CAD identified 672 fractures, 641 were correctly identified and 31 were misdiagnosed, with a sensitivity of 65.21% (641/983) and F-measure of 77.46%. Out of a total of 361 fracture cases, DL-CAD identified 314 cases, misdiagnosed 6 cases, with a sensitivity of 86.98% (314/361) and F-measure of 92.22%. ②Experiment 2: The sensitivity of fracture detection was 62.09% (375/604), 61.59% (372/604), 86.75% (524/604) and 83.44% (504/604), and the F-measure was 75.38%, 74.62%, 90.74%, 89.84% for group 1, 2, 3 and 4, respectively. The detection efficacy of group 3 and 4 were both higher than that of group 1 and 2 (all P0.05). Conclusion: DL-CAD software showed good detection effect of fractures on DR chest anteroposterior films, which could effectively improve the diagnostic performance of junior radiologist in fracture detection.

Impact factors of motion artifacts in chest dual-energy X-ray radiography / 中国医学影像技术

Objective: To observe the predilection sites of motion artifacts on chest DR dual-energy subtraction images, and to analyze the impact factors. Methods: Dual-energy subtraction chest images of 128 cases were analyzed. The position of motion artifacts were observed, and the length and width were measured and compared, and the correlations of heart rate and motion artifacts at different sites were analyzed. Results: Among 128 cases of dual-energy subtraction chest images, 115 cases showed black-and-white striped motion artifacts, 87 (75.65%) at left ventricular segment, 82 (71.30%)at aortic arch segment, 60 (52.17%)at right cardiac margin, 42 (36.52%) at diaphragmatic margin, 30 (26.09%)at left atrial auricular pulmonary segment and 27 (23.48%) at superior vena cava. Statistical differences of the mean length and width of motion artifacts were found among left ventricular segment, aortic arch segment and right cardiac margin (F=4.59, 3.46, both P<0.05). Heart rate was positively correlated with motion artifacts at left ventricular segment and aortic arch segment (r=1.00, 0.99, both P<0.05). Conclusion: Cardiac pulsation and breathing exercises can cause occurrence of motion artifacts in chest DR dual-energy subtraction images, mostly located at left ventricular segment and aortic arch segment. The faster the heart rate, the more obvious the motion artifacts.

Severity of lung involvement on chest X-rays in SARS-coronavirus-2 infected patients as a possible tool to predict clinical progression: an observational retrospective analysis of the relationship between radiological, clinical, and laboratory data / Gravidade do comprometimento pulmonar em radiografias de tórax de pacientes infectados por SARS-coronavirus-2 como possível ferramenta para prever a evolução clínica: análise retrospectiva observacional da relação entre dados radiológicos, clínicos e laboratoriais

ABSTRACT Objective: To investigate the diagnostic accuracy of a chest X-ray (CXR) score and of clinical and laboratory data in predicting the clinical course of patients with SARS coronavirus 2 (SARS-CoV-2) infection. Methods: This is a pilot multicenter retrospective study including patients with SARS-CoV-2 infection admitted to the ERs in three hospitals in Italy between February and March of 2020. Two radiologists independently evaluated the baseline CXR of the patients using a semi-quantitative score to determine the severity of lung involvement: a score of 0 represented no lung involvement, whereas scores of 1 to 4 represented the first (less severe) to the fourth (more severe) quartiles regarding the severity of lung involvement. Relevant clinical and laboratory data were collected. The outcome of patients was defined as severe if noninvasive ventilation (NIV) or intubation was necessary, or if the patient died. Results: Our sample comprised 140 patients. Most of the patients were symptomatic (132/138; 95.7%), and 133/140 patients (95.0%) presented with opacities on CXR at admission. Of the 140 patients, 7 (5.0%) showed no lung involvement, whereas 58 (41.4%), 31 (22.1%), 26 (18.6%), and 18 (12.9%), respectively, scored 1, 2, 3, and 4. In our sample, 66 patients underwent NIV or intubation, 37 of whom scored 1 or 2 on baseline CXR, and 28 patients died. Conclusions: The severity score based on CXR seems to be able to predict the clinical progression in cases that scored 0, 3, or 4. However, the score alone cannot predict the clinical progression in patients with mild-to-moderate parenchymal involvement (scores 1 and 2).

RESUMO Objetivo: Investigar a acurácia diagnóstica de um escore de radiografia de tórax (RxT) e também de dados clínicos e laboratoriais na previsão da evolução clínica de pacientes com infecção por SARS coronavirus 2 (SARS-CoV-2). Métodos: Estudo piloto multicêntrico retrospectivo incluindo pacientes com infecção por SARS-CoV-2 internados nos PSs de três hospitais na Itália entre fevereiro e março de 2020. Dois radiologistas avaliaram as RxT iniciais dos pacientes de forma independente utilizando um escore semiquantitativo para determinar a gravidade do comprometimento pulmonar: escore 0 representava ausência de comprometimento pulmonar, enquanto escores de 1 a 4 representavam o primeiro (menos grave) ao quarto (mais grave) quartil de gravidade do comprometimento pulmonar. Coletaram-se dados clínicos e laboratoriais relevantes. O desfecho dos pacientes foi definido como grave se foi necessária ventilação não invasiva (VNI) ou intubação ou se o paciente faleceu. Resultados: Nossa amostra foi composta por 140 pacientes. A maioria era sintomática (132/138; 95,7%), e 133/140 (95,0%) apresentavam opacidades na RxT da admissão. Dos 140 pacientes, 7 (5,0%) não apresentavam comprometimento pulmonar, enquanto 58 (41,4%), 31 (22,1%), 26 (18,6%) e 18 (12,9%), respectivamente, receberam escore 1, 2, 3 e 4. Em nossa amostra, 66 pacientes foram submetidos a VNI ou intubação, 37 dos quais receberam escore 1 ou 2 na RxT inicial, e 28 pacientes faleceram. Conclusões: O escore de gravidade baseado em RxT parece ser capaz de prever a evolução clínica em casos com escore 0, 3 ou 4. No entanto, o escore isoladamente não consegue prever a evolução clínica de pacientes com comprometimento leve a moderado do parênquima (escores 1 e 2).

Association between the radiological presentation and elapsed time for the diagnosis of pulmonary tuberculosis in the emergency department of a university hospital / Associação entre apresentação radiológica e tempo decorrido para o diagnóstico da tuberculose pulmonar no serviço de emergência de um hospital universitário

ABSTRACT Objective: To evaluate the radiological presentation of patients with pulmonary tuberculosis diagnosed in the emergency department and to investigate its association with the time to diagnosis. Methods: This was a prospective observational study involving patients diagnosed with pulmonary tuberculosis in the emergency department of a tertiary university hospital in southern Brazil. Chest X-rays taken on admission were evaluated by a radiologist. The various patterns of radiological findings and locations of the lesions were described. The main study outcome was the total time elapsed between the initial radiological examination and the diagnosis of tuberculosis. Results: A total of 78 patients were included in the study. The median time from chest X-ray to diagnosis was 2 days, early and delayed diagnosis being defined as a time to diagnosis < 2 days and ≥ 2 days, respectively. Sputum smear positivity was associated with early diagnosis (p = 0.005), and positive culture was associated with delayed diagnosis (p = 0.005). Early diagnosis was associated with the presence of sputum (p = 0.03), weight loss (p = 0.047), cavitation (p = 0.001), and consolidation (p = 0.003). Pulmonary cavitation was found to be an independent predictor of early diagnosis (OR = 3.50; p = 0.028). Conclusions: There is a need for tuberculosis-specific protocols in emergency departments, not only to avoid delays in diagnosis and treatment but also to modify the transmission dynamics of the disease.

RESUMO Objetivo: Avaliar a apresentação radiológica de pacientes com tuberculose pulmonar diagnosticada no serviço de emergência e investigar sua associação com o tempo para o diagnóstico. Métodos: Estudo observacional prospectivo envolvendo pacientes diagnosticados com tuberculose pulmonar no serviço de emergência de um hospital universitário terciário no sul do Brasil. As radiografias de tórax realizadas na admissão foram avaliadas por um radiologista. Foram descritos os diferentes padrões de achados radiológicos e as localizações das lesões. O desfecho principal do estudo foi o tempo total decorrido entre o exame radiológico inicial e o diagnóstico de tuberculose. Resultados: Um total de 78 pacientes foi incluído no estudo. A mediana de tempo entre a radiografia de tórax e o diagnóstico foi de 2 dias, sendo os diagnósticos precoce e tardio definidos como tempo para o diagnóstico < 2 dias e ≥ 2 dias, respectivamente. A positividade da baciloscopia de escarro associou-se ao diagnóstico precoce (p = 0,005), e a cultura positiva associou-se ao diagnóstico tardio (p = 0,005). O diagnóstico precoce associou-se à presença de escarro (p = 0,03), perda de peso (p = 0,047), cavitação (p = 0,001) e consolidação (p = 0,003). A cavitação pulmonar foi um preditor independente de diagnóstico precoce (OR = 3,50; p = 0,028). Conclusões: Há necessidade de protocolos específicos para tuberculose nos serviços de emergência, não apenas para evitar atrasos no diagnóstico e no tratamento, mas também para modificar a dinâmica de transmissão da doença.

Initial chest X-ray findings in pediatric patients diagnosed with H1N1 virus infection / Achados iniciais na radiografia de tórax em uma população pediátrica com diagnóstico de infecção viral por H1N1

Abstract Objective: To evaluate chest X-ray findings in pediatric patients diagnosed with influenza A (H1N1) virus infection. Materials and Methods: We retrospectively reviewed chest X-ray findings in 17 cases of pulmonary infection with the H1N1 virus (in 7 males and 10 females) examined between 2012 and 2016. The mean age of the patients was 14 months (range, 2-89 months). The diagnosis was established on the basis of clinical and radiographic criteria, and the virus was detected by polymerase chain reaction. The radiographic findings were categorized by type/pattern of opacity and by lung zone. The patients were divided into two groups: those not requiring ventilatory support; and those requiring ventilatory support or evolving to death. Results: The abnormality most often seen on chest X-rays was that of peribronchovascular opacities, the majority of which affected less than 25% of the lung, the involvement being bilateral and asymmetric. The lung zone most frequently involved was the middle third, with central and peripheral distribution, without pleural effusion. There was a statistically significant difference between the groups in terms of the symmetry of pulmonary involvement, asymmetric findings predominating in the group that required ventilatory support (p = 0.029). Conclusion: In pediatric patients with H1N1 virus infection, the main alterations on the initial chest X-rays are peribronchovascular opacities, nonspecific alveolar opacities, and consolidations. Although the definitive diagnosis of H1N1 virus infection cannot be made on the basis of imaging characteristics alone, using a combination of clinical and radiographic findings can substantially improve the diagnostic accuracy.

Resumo Objetivo: Avaliar os achados na radiografia de tórax de pacientes com diagnóstico de infecção pelo vírus influenza. Materiais e Métodos: Revisamos, retrospectivamente, os achados na radiografia de tórax de 17 casos de infecção pulmonar pelo vírus influenza (7 do sexo masculino e 10 do sexo feminino; idade média de 14 meses, variação de 2 a 89 meses). Os pacientes foram examinados entre 2012 e 2016 e o diagnóstico foi estabelecido por critérios clinicorradiológicos e detecção do vírus por reação em cadeia de polimerase. Os achados radiológicos foram caracterizados por tipo e padrão de opacidade e distribuição por zonas pulmonares. A população estudada foi dividida em dois grupos: sem suporte ventilatório e com suporte ventilatório e/ou óbito. Resultados: A anormalidade encontrada com maior frequência na radiografia de tórax foram as marcas peribroncovasculares, a maioria delas com extensão menor de 25% do pulmão, envolvimento bilateral e assimétrico. A região mais frequentemente envolvida foi o terço médio, com distribuição central e periférica e ausência de derrame pleural. Houve diferença estatisticamente significante na simetria do envolvimento pulmonar, entre os grupos, havendo preponderância de achado assimétrico (p = 0,029) no grupo que necessitou de suporte ventilatório. Conclusão: Pacientes pediátricos com infecção pelo H1N1 apresentam como alterações principais na radiografia do tórax inicial marcas peribroncovasculares, opacidades alveolares inespecíficas e consolidações. Embora o diagnóstico definitivo não possa ser feito com base em imagens características isoladas, uma combinação dos achados clínicos e radiográficos pode melhorar substancialmente a acurácia do diagnóstico nessa doença.

Comparison of chest CT images of patients with acute respiratory distress syndrome and acute cardiogenic pulmonary edema / 中国医师杂志

Objective@#To compare the chest computed tomography (CT) images of patients with acute respiratory distress syndrome (ARDS) and acute cardiogenic pulmonary edema (ACPE).@*Methods@#30 cases of patients with ARDS and 30 cases of patients with ACPE from August 2016 to August 2018 were randomly selected. All patients underwent thoracic CT examination. The distributions of grinded glass density shadow (GGO) in the lungs and changes of extrapulmonary structure were statistically analyzed.@*Results@#The differences of distributions of GGO in the upper lobe, middle lobe, lower lobe and diffuse distribution between patients with ARDS and ACPE were not significant [16.7%(5/30), 0, 16.7%(5/30), 66.7%(20/30) vs 20.0%(6/30), 0, 20.0%(6/30), 60.0%(18/30), P>0.05]. The distributions of GGO in center lung [13.3%(4/30)] was significantly lower than patients with ACPE [46.7%(14/30)] (P<0.05), while the uniform distribution rate [76.7%(23/30)] was significantly higher than patients with ACPE [46.7%(14/30)] (P<0.05), but distribution of GGO in the right side, left side, bilateral even in peripheral distribution of GGO in lung between patients with ARDS and ACPE were not significant [10.0%(3/30), 6.7%(2/30), 16.7%(5/30), 23.3%(7/30), 60.0%(18/30) vs 23.3%(7/30), 16.7%(5/30) and 60.0%(18/30), P>0.05]. The small boundary opacity of patients with ARDS [76.7%(23/30)] was significantly higher than patients with ACPE [26.7%(8/30)] (P<0.05), while the bronchial blood bundle thickening, pulmonary vascular shadow thickening, cardiac shadow enlargement, pericardial effusion were significantly lower than patients with ACPE [33.3% (10/30), 16.7%(5/30), 30.0%(9/30), 23.3%(7/30) vs 23.3%(7/30), 100.0%(30/30), 70.0%(21/30), 73.3%(22/30), 53.3%(16/30), P<0.05].@*Conclusions@#The chest CT images of patients with ARDS and ACPE are different, mainly manifestated in small boundary opacity, bronchial blood bundle thickening, pulmonary vascular opacity, cardiac opacity, pericardial effusion.

Determination of the theoretical personalized optimum chest compression point using anteroposterior chest radiography

OBJECTIVE: There is a traditional assumption that to maximize stroke volume, the point beneath which the left ventricle (LV) is at its maximum diameter (P_max.LV) should be compressed. Thus, we aimed to derive and validate rules to estimate P_max.LV using anteroposterior chest radiography (chest_AP), which is performed for critically ill patients urgently needing determination of their personalized P_max.LV.METHODS: A retrospective, cross-sectional study was performed with non-cardiac arrest adults who underwent chest_AP within 1 hour of computed tomography (derivation:validation=3:2). On chest_AP, we defined cardiac diameter (CD), distance from right cardiac border to midline (RB), and cardiac height (CH) from the carina to the uppermost point of left hemi-diaphragm. Setting point zero (0, 0) at the midpoint of the xiphisternal joint and designating leftward and upward directions as positive on x- and y-axes, we located P_max.LV (x_max.LV, y_max.LV). The coefficients of the following mathematically inferred rules were sought: x_max.LV=α₀*CD-RB; y_max.LV=β₀*CH+γ₀ (α₀: mean of [x_max.LV+RB]/CD; β₀, γ₀: representative coefficient and constant of linear regression model, respectively).RESULTS: Among 360 cases (52.0±18.3 years, 102 females), we derived: x_max.LV=0.643*CD-RB and y_max.LV=55-0.390*CH. This estimated P_max.LV (19±11 mm) was as close as the averaged P_max.LV (19±11 mm, P=0.13) and closer than the three equidistant points representing the current guidelines (67±13, 56±10, and 77±17 mm; all P<0.001) to the reference identified on computed tomography. Thus, our findings were validated.CONCLUSION: Personalized P_max.LV can be estimated using chest_AP. Further studies with actual cardiac arrest victims are needed to verify the safety and effectiveness of the rule.

Comparison of chest CT images of patients with acute respiratory distress syndrome and acute cardiogenic pulmonary edema / 中国医师杂志

Objective To compare the chest computed tomography (CT) images of patients with acute respiratory distress syndrome (ARDS) and acute cardiogenic pulmonary edema (ACPE).Methods 30 cases of patients with ARDS and 30 cases of patients with ACPE from August 2016 to August 2018 were randomly selected.All patients underwent thoracic CT examination.The distributions of grinded glass density shadow (GGO) in the lungs and changes of extrapulmonary structure were statistically analyzed.Results The differences of distributions of GGO in the upper lobe,middle lobe,lower lobe and diffuse distribution between patients with ARDS and ACPE were not significant [16.7％ (5/30),0,16.7％ (5/30),66.7％ (20/30) vs 20.0％ (6/30),0,20.0％ (6/30),60.0％ (18/30),P ＞0.05].The distributions of GGO in center lung [13.3％ (4/30)] was significantly lower than patients with ACPE [46.7％ (14/30)] (P ＜0.05),while the uniform distribution rate [76.7％ (23/30)] was significantly higher than patients with ACPE [46.7％ (14/30)] (P ＜ 0.05),but distribution of GGO in the right side,left side,bilateral even in peripheral distribution of GGO in lung between patients with ARDS and ACPE were not significant [10.0％ (3/30),6.7％ (2/30),16.7％ (5/30),23.3％ (7/30),60.0％ (18/30) vs 23.3％ (7/30),16.7％ (5/30) and 60.0％ (18/30),P ＞ 0.05].The small boundary opacity of patients with ARDS [76.7％ (23/30)] was significantly higher than patients with ACPE [26.7％ (8/30)] (P ＜ 0.05),while the bronchial blood bundle thickening,pulmonary vascular shadow thickening,cardiac shadow enlargement,pericardial effusion were significantly lower than patients with ACPE [33.3％ (10/30),16.7％ (5/30),30.0％ (9/30),23.3％ (7/30) vs 23.3％ (7/30),100.0％ (30/30),70.0％ (21/30),73.3％ (22/30),53.3％ (16/30),P ＜0.05].Conclusions The chest CT images of patients with ARDS and ACPE are different,mainly manifestated in small boundary opacity,bronchial blood bundle thickening,pulmonary vascular opacity,cardiac opacity,pericardial effusion.

Brazilian consensus on non-cystic fibrosis bronchiectasis / Consenso brasileiro sobre bronquiectasias não fibrocísticas

ABSTRACT Bronchiectasis is a condition that has been increasingly diagnosed by chest HRCT. In the literature, bronchiectasis is divided into bronchiectasis secondary to cystic fibrosis and bronchiectasis not associated with cystic fibrosis, which is termed non-cystic fibrosis bronchiectasis. Many causes can lead to the development of bronchiectasis, and patients usually have chronic airway symptoms, recurrent infections, and CT abnormalities consistent with the condition. The first international guideline on the diagnosis and treatment of non-cystic fibrosis bronchiectasis was published in 2010. In Brazil, this is the first review document aimed at systematizing the knowledge that has been accumulated on the subject to date. Because there is insufficient evidence on which to base recommendations for various treatment topics, here the decision was made to prepare an expert consensus document. The Brazilian Thoracic Association Committee on Respiratory Infections summoned 10 pulmonologists with expertise in bronchiectasis in Brazil to conduct a critical assessment of the available scientific evidence and international guidelines, as well as to identify aspects that are relevant to the understanding of the heterogeneity of bronchiectasis and to its diagnostic and therapeutic management. Five broad topics were established (pathophysiology, diagnosis, monitoring of stable patients, treatment of stable patients, and management of exacerbations). After this subdivision, the topics were distributed among the authors, who conducted a nonsystematic review of the literature, giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. The authors reviewed and commented on all topics, producing a single final document that was approved by consensus.

RESUMO Bronquiectasias têm se mostrado uma condição cada vez mais diagnosticada com a utilização da TCAR de tórax. Na literatura, a terminologia utilizada separa as bronquiectasias entre secundárias à fibrose cística e aquelas não associadas à fibrose cística, denominadas bronquiectasias não fibrocísticas neste documento. Muitas causas podem levar ao desenvolvimento de bronquiectasias, e o paciente geralmente tem sintomas crônicos de vias aéreas, infecções recorrentes e alterações tomográficas compatíveis com a condição. Em 2010, foi publicada a primeira diretriz internacional sobre diagnóstico e tratamento das bronquiectasias não fibrocísticas. No Brasil, este é o primeiro documento de revisão com o objetivo de sistematizar o conhecimento acumulado sobre o assunto até o momento. Como para vários tópicos do tratamento não há evidências suficientes para recomendações, optou-se aqui pela construção de um documento de consenso entre especialistas. A Comissão de Infecções Respiratórias da Sociedade Brasileira de Pneumologia e Tisiologia reuniu 10 pneumologistas com expertise em bronquiectasias no Brasil para avaliar criticamente as evidências científicas e diretrizes internacionais, assim como identificar aspectos relevantes à compreensão da heterogeneidade da doença bronquiectásica e a seu manejo diagnóstico e terapêutico. Foram determinados cinco grandes tópicos (fisiopatologia; diagnóstico; monitorização do paciente estável; tratamento do paciente estável; e manejo das exacerbações). Após essa subdivisão, os tópicos foram distribuídos entre os autores, que realizaram uma revisão não sistemática da literatura, priorizando as principais publicações nas áreas específicas, incluindo artigos originais e de revisão, assim como revisões sistemáticas. Os autores revisaram e opinaram sobre todos os tópicos, formando um documento único final que foi aprovado por todos.

Application of chest CT scan in gestational trophoblastic neoplasia with lung metastasis / 中华妇产科杂志

Objective To explore the role of CT scan for the diagnosis of lung metastasis in stage Ⅲ gestational trophoblastic neoplasia (GTN).Methods To figure out the role of CT scan for lung metastasis in GTN initial diagnosis,treatment and follow-up,93 GTN patients with lung metastasis from January,2015 to December,2016 were retrospectively analyzed in Obstetrics and Gynecology Hospital of Fudan University.Results (1) Among 93 GTN patients with lung metastasis,70 patients with the International Federation of Gynecology and Obstetrics (FIGO) score ≤6 were defined as low risk GTN and 23 patients score score ≥7 were defined as high risk GTN.Forty nine patients had negative chest X-ray findings and 39 cases with pulmonary lesions were identified both by chest X-ray compared to CT scan.Five cases were excluded due to no consensus could make for the results of chest X-ray.The true positive rate of chest X-ray for lung metastasis were 41％ (29/70) in low risk GTN and 43％ (10/23) in high risk GTN patients without statistical difference (x2=0.090,P=0.925).For those patients with positive chest CT scan and negative chest X-ray finding,pulmonary lesions in 32 (65％,32/49) cases were blocked by heart,chest wall or diaphragm in chest X-ray.Seventeen (35％,17/49) patients with lung lesions less than 5 mm had negative chest X-ray results due to the lower sensitivity compared to CT scan.(2) In 88 patients with stage Ⅲ,78 patients had successful initial treatment,but 4 of them were recurrence in twelve months follow-up.Ten patients were chemotherapy resistance for the initial treatment.The initial chemotherapy remission rate in low risk GTN patients was higher than that in high risk ones (x2=4.911,P=0.027).In 49 cases with negative chest X-ray,there was no correlation with the rate of remission,chemotherapy resistance and recurrence in stage Ⅲ patients (P＞0.05).(3) For those patients who had poorly response to initial chemotherapy,the diameters of lesions in lung were unchanged or increased during the treatment,form (5.1±4.1) mm to (7.4±2.8) mm.The pulmonary lesions were continuously shrunk from (7.8 ± 5.3) mm to (4.7 ± 4.4) mm for those patients with complete and partial remission including the recurrent GTN patients (Z=-2.713,P=0.007).Conclusions Patients with GTN in stage Ⅲ have down staging if only use chest X-ray for imaging at the initial diagnosis.Chest CT scan is recommended for primary imaging evaluation of FIGO staging in qualified medical organization.For those patients with persistent abnormal serum hCG level and negative chest X-ray,chest CT scan is strongly recommended to identify the persist or resistant lung lesions and follow up.

Clinical analysis on EGFR gene mutation and ALK gene rearrangement in patients with pneumonia-type lung adenocarcinoma / 重庆医学

Objective To investigate the characteristics and clinical significance of epidermal growth factor receptor(EGFR) gene mutation and anaplastic lymphoma kinase(ALK) gene rearrangement in the patients with pneumonia-type lung adenocarcinoma.Methods A total of 154 cases of lung adenocarcinoma definitely diagnosed by histopathology in Xinqiao Hospital from January to August 2016 servedas the research subjects and divided into pheumonia-type lung carcinoma(PTLC,30 cases) and non-pneumonia-type lung carcinoma(non-PTLC,124 cases) according to the imaging manifestations.The EGFR gene detection was performed in 154 cases,among them 87 cases simultaneously conducted the ALK gene rearrangement detection.The EGFR mutation rate andALK gene rearrangement rate were compared between PTLC and non-PTLC,and their clinical characteristics differences were investigated.Results The mutation rate of EGFR,which PTLC occurred less frequently than non-PTLC in lung adenocarcinoma (20.0 ％ vs.47.6 ％,P＜0.05).The age,smoking history,sex,tumor family history,ALK gene rearrangement and TNM stage had no statistical differences between the two groups(P＞0.05).The total mutation rate of EGFR gene was 42.2％ (65/154).The smoking history and sex were related with the EGFR gene mutation,while the age and tumor family history had no obvious relation with EGFR gene mutation.The total ALK gene rearrangement rate was 11.5 ％.The smoking history,tumor family history,sex and age had no obvious relation with the ALK gene rearrangement.Among 87 cases of EGFR and ALK simultaneous gene detection,the co-existence of EGFR gene mutation and ALK rearrangement was not found.Conclusion Imaging findlings of patients with PTLC,it should be conducted to detection that EGFR gene mutation and ALK gene rearrangenment,in order to formulate comprehensive management scheme in the patients with advanced tumor.

Clinical analysis on EGFR gene mutation and ALK gene rearrangement in patients with pneumonia-type lung adenocarcinoma / 重庆医学

Objective To investigate the characteristics and clinical significance of epidermal growth factor receptor(EGFR) gene mutation and anaplastic lymphoma kinase(ALK) gene rearrangement in the patients with pneumonia-type lung adenocarcinoma.Methods A total of 154 cases of lung adenocarcinoma definitely diagnosed by histopathology in Xinqiao Hospital from January to August 2016 servedas the research subjects and divided into pheumonia-type lung carcinoma(PTLC,30 cases) and non-pneumonia-type lung carcinoma(non-PTLC,124 cases) according to the imaging manifestations.The EGFR gene detection was performed in 154 cases,among them 87 cases simultaneously conducted the ALK gene rearrangement detection.The EGFR mutation rate andALK gene rearrangement rate were compared between PTLC and non-PTLC,and their clinical characteristics differences were investigated.Results The mutation rate of EGFR,which PTLC occurred less frequently than non-PTLC in lung adenocarcinoma (20.0 ％ vs.47.6 ％,P＜0.05).The age,smoking history,sex,tumor family history,ALK gene rearrangement and TNM stage had no statistical differences between the two groups(P＞0.05).The total mutation rate of EGFR gene was 42.2％ (65/154).The smoking history and sex were related with the EGFR gene mutation,while the age and tumor family history had no obvious relation with EGFR gene mutation.The total ALK gene rearrangement rate was 11.5 ％.The smoking history,tumor family history,sex and age had no obvious relation with the ALK gene rearrangement.Among 87 cases of EGFR and ALK simultaneous gene detection,the co-existence of EGFR gene mutation and ALK rearrangement was not found.Conclusion Imaging findlings of patients with PTLC,it should be conducted to detection that EGFR gene mutation and ALK gene rearrangenment,in order to formulate comprehensive management scheme in the patients with advanced tumor.

Radiological findings in megaesophagus secondary to Chagas disease: chest X-ray and esophagogram / Alterações radiológicas encontradas no megaesôfago chagásico em radiografias simples de tórax e esofagogramas

Abstract Objective: To identify and classify the radiographic patterns of megaesophagus in Chagas disease, as seen on esophagograms and chest X-rays. Materials and Methods: This was a prospective study of 35 patients diagnosed with esophageal disease via manometry. The changes found on esophagograms were stratified according to Rezende's classification, divided into four categories (grades I through IV) determined by the degree of dilatation and impairement of esophageal motility. We subsequently correlated that ranking with the chest X-ray findings: gastric air bubble; air-fluid level; and mediastinal widening. Results: Among the 35 patients, the esophageal disease was classified as grade I in 9 (25.7%), grade II in 3 (8.6%), grade III in 19 (54.3%), and grade IV in 4 (11.4%). None of the patients with grade I esophageal disease showed changes on chest X-rays. In two of the three patients with grade II disease, there was no gastric air-bubble, although there were no other findings in any of the grade II patients. Of the 19 patients with grade III disease, 15 had abnormal findings on X-rays. All four patients with grade IV disease showed abnormalities. Conclusion: The use of Rezende's classification is feasible, encompassing findings ranging from the subtle changes that characterize the initial phases of esophageal disease to the complete akinesia seen in dolicomegaesophagus. Chest X-ray findings are more common in patients with advanced stages of the disease and indicate the degree of esophageal involvement in Chagas disease.

Resumo Objetivo: Identificar e classificar as alterações radiológicas no megaesôfago chagásico no esofagograma e na radiografia simples de tórax. Materiais e Métodos: Foram estudados 35 pacientes com diagnóstico de esofagopatia na manometria. As alterações encontradas no esofagograma foram estratificadas segundo a classificação de Rezende, dividida em quatro categorias, determinadas pelo grau de dilatação e alteração da motilidade do esôfago. Também foi realizada correlação desta classificação com os achados na radiografia de tórax: presença ou ausência de bolha gástrica, nível líquido e alargamento do mediastino. Resultados: A distribuição encontrada, segundo a classificação de Rezende, foi: grau I - 25,7% (9/35); grau II - 8,6% (3/35); grau III - 54,3% (19/35); grau IV - 11,4% (4/35). Nenhum paciente grau I apresentou alterações na radiografia simples. No grau II, o único achado foi a ausência da bolha gástrica (2/3). No grau III, 15 dos 19 pacientes apresentaram achados anormais na radiografia. Já no grau IV, em todos os quatro pacientes identificaram-se anormalidades no exame simples. Conclusão: A classificação de Rezende é praticável, encontrando-se desde achados sutis caracterizando os graus iniciais até a completa acinesia do dolicomegaesôfago. Os achados na radiografia de tórax são mais frequentes em pacientes com estágios avançados da doença e podem fazer aventar o grau da esofagopatia chagásica.