Correlating Reiff scores with clinical, functional, and prognostic factors: characterizing noncystic fibrosis bronchiectasis severity: validation from a nationwide multicenter study in Taiwan.

BACKGROUND: Our study aimed to confirm a simplified radiological scoring system, derived from a modified Reiff score, to evaluate its relationship with clinical symptoms and predictive outcomes in Taiwanese patients with noncystic fibrosis bronchiectasis (NCFB). METHODS: This extensive multicenter retrospective study, performed in Taiwan, concentrated on patients diagnosed with NCFB verified through high-resolution computed tomography (HRCT) scans. We not only compared the clinical features of various types of bronchiectasis (cylindrical, varicose, and cystic). Furthermore, we established relationships between the severity of clinical factors, including symptom scores, pulmonary function, pseudomonas aeruginosa colonization, exacerbation and admission rates, and HRCT parameters using modified Reiff scores. RESULTS: Data from 2,753 patients were classified based on HRCT patterns (cylindrical, varicose, and cystic) and severity, assessed by modified Reiff scores (mild, moderate, and severe). With increasing HRCT severity, a significant correlation was found with decreased forced expiratory volume in the first second (FEV1) (p < 0.001), heightened clinical symptoms (p < 0.001), elevated pathogen colonization (pseudomonas aeruginosa) (p < 0.001), and an increased annual hospitalization rate (p < 0.001). In the following multivariate analysis, elderly age, pseudomonas aeruginosa pneumonia, and hospitalizations per year emerged as the only independent predictors of mortality. CONCLUSION: Based on our large cohort study, the simplified CT scoring system (Reiff score) can serve as a useful adjunct to clinical factors in predicting disease severity and prognosis among Taiwanese patients with NCFB.

Risk of Aortic Aneurysm and Dissection in Patients with Tuberculosis: A Nationwide Population-Based Cohort Study.

Tuberculosis (TB) can cause chronic inflammation. The occurrence of aortic aneurysm (AA) and aortic dissection (AD) may be associated with chronic inflammatory disease, but whether TB increases the risk of AA and AD remains to be determined. This study aimed to investigate the association between TB and the development of AA and AD. We conducted a population-based cohort study using data obtained from the Taiwan National Health Insurance Database. We selected 31,220 individuals with TB and 62,440 individuals without TB by matching the cohorts according to age, sex, and index year at a ratio of 1:2. Cox regression analysis revealed that the TB cohort had a 1.711-fold higher risk of AA and AD than the non-TB cohort after adjustment for sex, age, socioeconomic status, and comorbidities (adjusted hazard ratio = 1.711; 95% confidence interval = 1.098-2.666). Patients with pulmonary, extrapulmonary, and miliary TB had a 1.561-, 1.892-, and 8.334-fold higher risk of AA and AD, respectively. Furthermore, patients with TB at <6 months, 6-12 months, and 1-5 years of follow-up had a 6.896-, 2.671-, and 2.371-fold risk of AA and AD, respectively. Physicians should consider the subsequent development of AA and AD while treating patients with TB.

Unusual presentation of Castleman's disease mimicking lung cancer.

Castleman's disease (CD) is an uncommon lymphoproliferative disorder characterized as either unicentric or multicentric presentation based on the involving sites. The most frequent presentation of CD is a solitary mediastinal mass. We reported a patient with a history of heavy smoking with particular image features of CD, which presented as mediastinal lymphadenopathy and peribronchovascular interstitial thickening mimicking lung cancer or sarcoidosis initially.

Spontaneous intracranial hypotension with cerebrospinal fluid leakage at 2 sites treated by epidural blood patch.

PURPOSE: Spontaneous intracranial hypotension (SIH) is a relatively uncommon cause of headache, which usually presents as orthostatic cranial pain and is relieved by recumbency. The precise cause of spontaneous spinal cerebrospinal fluid leakage related SIH remains unknown. CASE REPORT: We report the case of a 32-year-old man who presented with an orthostatic headache. Brain magnetic resonance imaging (MRI) revealed typical pachymeningeal enhancement. Radionuclide cisternography revealed leakages in the cervicothoracic and upper cervical areas. The patient was successfully treated by lumbar epidural blood patch (EBP). CONCLUSION: The diagnosis of SIH involves the assessment of the characteristic clinical presentations and non-invesive neuroimaging studies. The latest diagnostic criteria with more broadened spectrum due to variable manifestations are discussed. EBP is an effective treatment for SIH if conservative management fails.

A case of phlebosclerotic colitis with involvement of the entire colon.

Phlebosclerotic colitis is a rare type of ischemic colitis caused by obstruction of the veins in the intestinal wall and adjacent mesentery, and is most commonly seen in the ascending colon. We report a 56-year-old woman presenting with intermittent abdominal pain and diarrhea for three years. She had a liver abscess and two episodes of pancreatitis during this time and experienced progressive body weight loss. Initial radiologic findings showed multiple tortuous threadlike calcifications in the region of the right side of the colon and transverse colon on plain abdominal radiographs and computed tomography images. A colonoscopy demonstrated brownish-black pigmentation on the right side of the colon with scattered hyperemic patches. The more distal along the colon, the more normal the color of the bowel appeared. Follow-up studies revealed calcifications not only alongside the colonic and mesenteric veins, but also extending into the superior and inferior mesenteric veins. These findings have not been reported previously. As noted in our patient, this disease entity may not be confined to the tributaries of the superior mesenteric vein. The entire colon may be involved in advanced disease.

Assessing myocardial bridging and left ventricular configuration by 64-slice computed tomography in patients with apical hypertrophic cardiomyopathy presenting with chest pain.

OBJECTIVE: We aimed to assess the usefulness of multislice computed tomographic (CT) angiography to detect coronary artery disease (CAD), including myocardial bridging (MB) and left ventricular morphology (LVG), in patients with apical hypertrophic cardiomyopathy (AHCM) who presented with angina and apical asynergy. MATERIALS AND METHODS: Sixty-four-slice CT angiography was performed in 14 patients with echocardiographically diagnosed AHCM who presented with typical or atypical chest pain. Coronary angiography was performed in 7 patients because of either suspected CAD or echocardiographic apical hypokinesia. We assessed the correlations between coronary anatomy, apical thickness, and LV configuration that were determined by echocardiography, LVG, and 64-slice CT angiography. RESULTS: The multislice CT confirmed the diagnosis of AHCM in 14 patients. The LVGs were all compatible between the 64-slice CT angiography and the LVG in the 7 patients who had "ace-of-spades" configurations, apical sequestrations, and an apical aneurysm. Furthermore, 2 significant CADs and 7 MBs were detected by 64-slice CT angiography. CONCLUSIONS: Multislice CT can offer high accuracy for the noninvasive detection of apical wall thickness and left ventricular configuration in patients with AHCM. It also provides additional information about significant coronary stenosis and MB in patients with chest pain. This promising technology has a potential to complement invasive cardiac catheterization in clinical practice.

Metastatic eccrine porocarcinoma detected on FDG PET/CT.

Eccrine porocarcinoma is an uncommon neoplasm of the sweat gland duct and poses a significant risk of cutaneous, regional lymph node, or visceral metastases. A 62-year-old woman with a history of eccrine porocarcinoma in the left flank area underwent an F-18 FDG PET/CT scan, which revealed increased FDG uptake in left pelvic (SUV 6.34) and left axillary regions (SUV 4.02). Wide excision of left axillary and left pelvic lymph nodes was performed, and histopathologic findings were consistent with eccrine porocarcinoma. PET/CT detects metastases accurately and is helpful in the management of patients with eccrine porocarcinoma.

Complex partial status epilepticus as a manifestation of Hashimoto's encephalopathy.

Epileptic seizures are a frequent manifestation of Hashimoto's encephalopathy. However, status epilepticus associated with Hashimoto's encephalopathy are not well characterized in medical literature. We described here a 16-year-old girl who presented with complex partial status epilepticus associated with elevated anti-thyroid antibodies. Ictal EEG showed lateralized high amplitude rhythmic delta waves over the right hemisphere and ictal single-photon emission computed tomography revealed regional hyperperfusion of the right parietal and temporal lobes. The patient was unresponsive to antiepileptic drug therapy but responded to intravenous steroid treatment. Screening of serum anti-thyroid antibodies for unexplained encephalopathy with epileptic seizures is suggested, as early recognition and prompt steroid treatment may lead to a favorable prognosis.

Hypoglossal schwannoma presenting as hemi-atrophy of the tongue.

Schwannoma of the hypoglossal nerve is extremely rare. We report the clinical manifestations of a patient with Schwannoma of the hypoglossal nerve with hemi-atrophy of the tongue and numbness in the lip. Magnetic resonance image study of the brain showed a lobulated mass at the right posterior fossa with an extension to the right upper neck. Surgical intervention was performed with right occipital craniotomy and a partial resection of C1 and occipital condyle. Pathological studies confirmed a Schwannoma with hemorrhages and necrosis.