Apport du scanner thoracique dans le dépistage des cas suspects de COVID-19 au Service d'imagerie médicale du Centre Hospitalier et Universitaire (CHU) de Libreville - Gabon / Contribution of chest ct-scan in the screening of suspected cases of COVID-19 at the Medical Imaging Department

Objectifs.Evaluer l'apport de la TDM thoracique dans le diagnostic de la COVID-19 chez les patients suspects en prenant comme référence le Test RT ­PCR et secondairement déterminer les anomalies scanographiques caractéristiques associés au Test RT ­PCR.Matériels etméthodes.Il s'est agi d'une étude rétrospective, descriptive à visée analytique, menée au service d'imagerie du CHU de Libreville. Aux vues de la disponibilité des dossiers nous avons exploité ceux de la période d'activité de mars à juin 2020, soit une période quatre mois. Cette étude a inclus tous les patients ayant une infection à COVID-19 confirmée par la réaction de polymérase en chaine en temps réel (RT ­PCR), après écouvillonnages nasal et/ou pharyngé et / ou les signes typiques de la pneumonie à COVID-19. Pour déterminer les anomalies scanographiques caractéristiques de la COVID-19 associées au test RT ­PCR nous avons comparé 25 patients avec un test RT ­PCR négatifs et 119 patients avec un test RT ­PCR positifs. Une valeur de p < 0,05 était considérée comme significative. La sensibilité de la TDM thoracique a été calculée à l'aide de la relation, Sensibilité=VP/ (VP+FN), (VP : vrai positif de la TDM : TDM positive et test RT PCR positif ; et le FN : Faux négatif de la TDM : TDM négative et test RT PCR positif). L'analyse statistique a été rendu possible grâce au logiciel SPSS 25. Résultats. En régression logistique multivariée, les anomalies scanographiques caractéristiques de la COVID-19 positivement associés à un test RT ­PCR positif étaient :verre dépoliOR = 33,236, IC95% [6,939 ­59,192], p=0,0001), la condensation alvéolaire (OR = 8,093 [1,488 ­44,013]; p=0,016). La sensibilité du scanner thoracique pour le diagnostic de la COVID-19, chez les patients suspects était de 93,2%, la spécificité de 64,2% avec une valeur prédictive positive de 90,2% et une valeur prédictive négative de 73,0%.Conclusion.Le diagnostic scanographique de la COVID-19 chez les patients suspects est aisé avec une bonne sensibilité et spécificité. La présence des anomalies scanographiques caractéristiques à type de verre dépoli et de condensation alvéolaire est associéeà un test RT ­PCR positif

Objective. Evaluate the contribution of Thoracic CT in the diagnosis of COVID-19 in suspected patients by taking the RT ­PCR Test as a reference and secondarily determine the impact of the RT ­PCR Test on characteristic scan abnormalities, in the service of thoracic imaging at Libreville University Hospital.Materials and methods. This was a retrospective, descriptive study with an analytical aim. In view of the availability of files, we used those from the period of activity from March to June 2020, i.e. a four-month period. To determine the impact of the RT ­PCR test on characteristic scan abnormalities, we compared 25 patients with negative RT ­PCR and 119 patients with negative RT ­PCR. A value of p < 0.05 was considered significant. The sensitivity of chestCT was calculated using the relationship, Sensitivity=VP/(VP+FN), (VP: true positive of CT: positive CT and positive RT PCR test; and FN: False negative CT: negative CT and positive RT PCR test). Statistical analysis was made possible using SPSS 25 software.Results. In multivariate logistic regression, CT abnormalities characteristic of COVID-19 were positively associated with a positive RT ­PCR: ground glass, (OR = 33.236, 95% CI [6.939 ­59.192], p = 0.0001), condensation alveolar (OR = 8.093 [1.488 ­44.013]; p = 0.016). The sensitivity of chest CT for the diagnosis of COVID-19 in suspected patients was 93.2%, the specificity of 64.2% with a positive predictive value of 90.2% and a negative predictive value of 73. 0%.Conclusion. CT diagnosis of COVID-19 in suspected patients is easy with good sensitivity and specificity. The presence of characteristic scan abnormalities such as ground glass and alveolar condensation is associated with a positive RT ­PCR tes

Sífilis secundaria con compromiso pulmonar / Secondary syphilis with pulmonary involvement

La sífilis es una enfermedad de transmisión sexual causada por una espiroqueta, Treponema palidum. Presentamos el caso de una mujer de 62 años de edad, que consultó por fiebre de 38°, dolor torácico en puntada de costado y lesiones pruriginosas en piel. Se realizó examen de laboratorio de sangre periférica, radiografía y tomografía de tórax. Recibió tratamiento antibiótico y fue diagnosticada como neumonía aguda de la comunidad. Debido a la respuesta parcial de los síntomas y persistencia de lesiones pruriginosas se realizó biopsia de piel que informó Treponema palidum, el cual fue confirmado con test serológico VDRL y FtA-abs positivo. La paciente recibió 4 dosis de penicilina G benzatínica con favorable evolución de las lesiones en piel y mejoría de las imágenes radiológicas.

We present the case of a 62-year-old woman who consulted for fever (38°), stabbing thoracic pain (on one side), and pruritic skin lesions. She underwent peripheral blood tests, chest X-rays and CT. Her symptoms were interpreted as severe community-acquired pneumonia. After a treatment with antibiotics, her skin lesions persisted, and other symptoms were only partially relieved. A skin biopsy was performed, which revealed Treponema pallidum. Such finding was confirmed through positive serum VDRL and FTA-ABS tests. The patient received 4 doses of benzathine penicillin G with favorable evolution of skin lesions and improvement of radiological images.

Survey of Thoracic CT Protocols and Technical Parameters in Korean Hospitals: Changes before and after Establishment of Thoracic CT Guideline by Korean Society of Thoracic Radiology in 2008

We retrospectively reviewed the thoracic CT scan protocols and technical parameters obtained from hospitals in Korea, one group during May 2007 (n = 100) and the other group during January 2012 (n = 173), before and after the establishment of the thoracic CT Guideline in 2008. Each group was also divided into two subgroups according to the health care delivery level, i.e. the "A" subgroup from primary and the "B" subgroup from secondary and tertiary care hospitals. When comparing the data from 2007 and 2012, the tube current decreased from 179.1 mAs to 137.2 mAs. The scan interval decreased from 6.4 mm to 4.8 mm. Also, the insufficient scan range decreased from 19.0% to 8.7%, and the suboptimal quality scans decreased from 33.0% to 5.2%. Between groups A and B, group B had lower tube voltages, smaller scan thicknesses, and smaller scan intervals. However, group B had more phase numbers. In terms of the suboptimal quality scans, a decrease was seen in both groups. In conclusion, during the five-year time period between 2007 and 2012, a reduction in the tube current values was seen. And the overall image quality improved over the same time period. We assume that these changes are attributed to the implementation of the thoracic CT guideline in 2008.

Conferencia Dr. Hernán Alessandri R. 2011: historia del cáncer pulmonar: otro monstruo creado por el hombre / Hernán Alessandri lecture 2011: history of lung cancer: another monster created by mankind

In Profesor Alessandri's days lung cancer cases in Chile and all over the world were very few. In German medical papers in the third decade of XXth century some relationship between lung cancer and smoking habits was reported but only in the middle of the century medical literature reported evidences about this relationship. Smoking habit become universal in the XXth century. Medical community and public opinion were formally informed about the danger of smoking, for the first time in USA, in 1964 in the first Report of General Surgeon. Nowadays lung cancer is the cause of death of2,500 Chileans a year and over one million all over the world. Thoracic X rays and rigid bronchoscopy were for long time the only diagnostic methods in lung cancer. Today we have a lot of sophisticated tools that are mentioned in this paper. Surgery was and continues being the principal therapeutic weapon against the disease. The first surgical intervention performed was a pneumonectomy whose history is related in this review. Several other therapies are available in our days for the disease. A section of this paper is reserved to analyse patients and the disease. A very touching testimony of a poet written when he suffered from the disease is quoted in the text. The paper finishes with a light of hope based on the new immunological and molecular methods for treatment and the radiological approaches for early diagnosis that are available today.

En los tiempos del Prof. Alessandri los casos de cáncer pulmonar eran muy pocos en Chile y en el resto del mundo. La literatura médica alemana de la tercera década del siglo XX, observó cierta relación entre el hábito tabáquico y el cáncer pulmonar, pero sólo 20 años después la literatura médica evidenció esta relación. El hábito tabáquico se hizo universal en el siglo XX. La comunidad médica y el público general fueron advertidos por primera vez del peligro del tabaquismo en 1964 en el primer informe para el Cirujano General de EE.UU. Hoy día mueren al año 2.500 chilenos y 1 millón de personas en el mundo por la enfermedad. La radiografía de tórax y la broncoscopía rígida fueron por largo tiempo los únicos métodos diagnósticos en cáncer pulmonar. Hoy tenemos muchos métodos diagnósticos sofisticados que se revisan en este artículo. La cirugía era y continúa siendo la principal arma terapéutica contra la enfermedad. La primera intervención quirúrgica fue la neumonectomía cuya historia es relatada en esta publicación. Hoy día tenemos muchas otras armas terapéuticas disponibles. En el artículo se reserva una sección para analizar los pacientes y la enfermedad. Se cita un conmovedor testimonio de un poeta que lo escribió mientras sufría de la enfermedad. El artículo termina con una luz de esperanza en relación a nuevos métodos inmunológicos y moleculares de diagnóstico y radiológicos de diagnóstico precoz, disponibles hoy en día.

Presentación de un caso de secuestro pulmonar intralobar / A case presentation of intralobar pulmonary sequestrum

Las malformaciones pulmonares congénitas se muestran con una incidencia de 2,2 por ciento. La mayoría son malformaciones del intestino anterior y las más frecuentes son los quistes broncogénicos, la malformación quística adenomatoide y el secuestro pulmonar. Se presentó un caso de secuestro pulmonar intralobar en un paciente de 15 años de edad, resuelto mediante acto quirúrgico. Se exponen datos clínicos y estudios imaginológicos. Se revisó el tema

The congenital pulmonary malformations showed an incidence of the 2,2 percent. Most of anterior intestine malformations and the more frequent ones are: bronchogenic cysts, the adenomatoide cystic malformation and the pulmonary sequestrum. This is the case of a patient aged 15 presenting with intralobar pulmonary sequestrum operated on. Clinical data and imaging studies are exposed. There was a subject review

A Case of Thoracic Spinal Canal Stenosis

A compression of spinal cord or nerve roots is commonly seen sequale of acquired or congenital stenosis of the cervical of lumbar portions of the spine. The authors have treated a case of thoracic myelopathy associated with thoracic canal stenosis, which was diagnosed with thoracic myelography and thoracic C-T scan. The pathological findings was thickened ligament flavum, hypertrophied articular processes, narrow spinal canal and compression of spinal cord. It is suggested that the syndrome should be considered in any patient who has a thoracic myelopathy.