Internet use time and subjective well-being during the COVID-19 outbreak: serial mediation of problematic internet use and self-esteem.

The coronavirus disease (COVID-19) outbreak is a threat to adolescents' mental health and livelihoods, and lowers their subjective well-being (SWB). Expanding on previous literatures, this study examined whether internet use time was related to SWB and whether this relationship was mediated by problematic internet use (PIU) and self-esteem during the COVID-19 outbreak. In Taiwan, the COVID-19 epidemic broke out in February, 2020. During March 2 to 27, this study recruited a total of 1,060 adolescents from junior high schools by both stratified and cluster sampling, and administered a comprehensive investigation. The results displayed that SWB was significantly and negatively predicted by internet use time. PIU fully mediated the relationship. Moreover, PIU predicted a decrease of self-esteem, which played a full mediation role between PIU and SWB. The results provide evidence in explaining how increased internet use time is associated with a greater level of PIU, which relates to lower self-esteem, correlating with lower SWB in adolescents. This study can provide reference to mental health organizations and educational agencies to design appropriate SWB promotion programs for the junior high school population in terms of epidemic prevention.

Quantitative microbiological risk assessments for Salmonella spp. contaminated taiwanese salty chicken in the taiwanese population.

The aim of the study is to develop Salmonella spp. Quantitative microbial risk assessments (QMRA) and to evaluate the risk of Salmonellosis illness in the Taiwanese population after consumption of Taiwanese salty chicken (TSC). We assume that Salmonella spp. May contaminate the fresh raw chicken used in TSC. After transport to the diner, fresh raw chicken is received, cleaned, and surface-washed by diner staff. The TSC is then cooked and sold to consumers. We set four different cross-contamination scenarios to evaluate the contamination level of Salmonella spp. In TSC. We used a Monte Carlo simulation method, a probabilistic analysis method, and exceedance risk to evaluate the risk of Salmonellosis illness. When the exceedance risk was 5 %, and taking the Taiwanese population above 19 years old as an example, the rate of contracting Salmonellosis from the consumption of TSC will be 2.94 % (2.94 million per 100 million people) if the chef does not clean their hands, knives, or cutting boards. However, if the chef washes their hands, knives, and cutting boards with cold water and soap, the illness rate of Salmonellosis from consuming TSC will be 1.93E-04 % (193 per 100 million people). Sensitivity analysis indicates that the most important risk factor in the QMRAs of TSC is the temperature of the fresh raw chicken during transportation, following which were the Salmonella spp. Residual. If the staff of the diner separates the cooking tools used for raw ingredients and those for cooked food, the illness risk of Salmonellosis will be very low.

Probabilistic benefit-risk analysis of fish: Nutritional benefit versus methylmercury-contaminated risk.

This paper carries out probabilistic approach to quantify the benefit-risk analysis for foods (BRAFO) of omega-3 polyunsaturated fatty acid and methylmercury (MeHg) for the people who eat the mercury-contaminated fish in Taiwan. We applied the hazard quotient (HQ) model to assess the risk of developmental neuropsychological impairment effect and the desirable dose index (DI) model to quantify the health benefits. Besides, we also applied the disability adjusted life years (DALY) model to assess the number of years lost by incidence of affected infants' intelligence quotient (IQ) and coronary heart disease (CHD) or Stroke for adult. The results of this study show that although the risk of cod and scad are higher, Taiwan residents do not need to reduce intake rate based on benefit considerations. Furthermore, according to the benefits of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), this study suggests that more intake of saury and salmon.

Mediating role of depression in the association between alexithymia and nonsuicidal self-injury in a representative sample of adolescents in Taiwan.

BACKGROUND: Nock's (2009) integrated theoretical model suggests that specific intrapersonal vulnerability factors caused by distal risk factors contribute to the development of nonsuicidal self-injury (NSSI). Alexithymia and depression have been found to predict NSSI. Based on Nock's model, alexithymia plays a distal risk factor role to increase the risk of depression-an intrapersonal vulnerability factor-and further increase the risk of NSSI. However, small or unrepresentative samples in past studies limit the generalizability of the results. This study examined the roles of depression and alexithymia in predicting NSSI, as well as the mediating effect of depression in the relation between alexithymia and NSSI in a large representative sample of adolescents in Taiwan. METHODS: Using a cross-sectional study design, a large representative sample of 2,170 senior high school students in Taiwan was assessed by self-report measures of alexithymia, depression, and NSSI. Mediation analyses were performed to examine whether the relation between alexithymia and NSSI was mediated by depression. The questionnaires were administered in classrooms. RESULTS: Results showed that alexithymia positively predicted NSSI (ß = 0.23, p < .001) and depression can also positively predict NSSI (ß = 0.41, p < .001). Additionally, the association between alexithymia and NSSI was fully mediated by depression. CONCLUSIONS: This study data provided evidence for the mediating role of depression between alexithymia and NSSI, which can be explained by Nock's (2009) integrated theoretical model. The implications of the findings for future research and intervention were discussed.

Avoidance/emotion-focused coping mediates the relationship between distress tolerance and problematic Internet use in a representative sample of adolescents in Taiwan: One-year follow-up.

INTRODUCTION: Based on the theoretical frameworks of the Theory of Triadic Influence (TTI), this longitudinal study was designed to examine the mediating role of avoidance/emotion-focused coping in the relationship between distress tolerance and problematic Internet use (PIU) in a large representative sample of senior high school students in Taiwan. METHODS: Through a 1-year follow-up design, 2170 participants were recruited from high schools throughout Taiwan using both stratified and cluster sampling in time 1 (T1), and 1832 students were followed-up 1 year later (T2). RESULTS: Structure equation modeling and bootstrap analyses results showed that after controlling for PIU measured at T1, PIU (T2) was significantly predicted by distress tolerance (T1) and fully mediated through avoidance/emotion-focused coping (T2). CONCLUSIONS: The results not only support the TTI framework, but can also serve as a reference to help educational agencies and mental health organizations create policies and design programs that will help in the prevention of PIU among adolescents. The mediating role of avoidance/emotion-focused coping in the relationship between distress tolerance and PIU was discussed.

Gastronomy Tourism and Well-Being: Evidence from Taiwan and Catalonia Michelin-Starred Restaurants.

In the tourism and hospitality industry, ensuring the well-being of visitors is essential to achieving a competitive tourist destination. This objective is even more pressing in the gastronomy sector. Surprisingly, the scientific literature on this topic is scarce and relies on questionnaire surveys and interviews as a data source. After scrutinizing the 13 articles on gastronomy tourism and well-being indexed in the Web of Science or in Scopus, this study proposes two new lines of research interrelated by the concept of gastronomic image. These exploit the content shared online by consumers in order to assess subjective well-being derived from quality gastronomic experiences. The first is a framework for the customer-perceived image based on Grönroos's service quality model, and the second is a conceptual model based on Morris's semiotics to measure gastronomic image. Through mixed methodologies, i.e., qualitative in the first research line and quantitative in the second, the study applies the theoretical framework to Michelin-starred restaurants in two tourist regions with similar features but with different gastronomic cultures-Taiwan (Asia) and Catalonia (Europe)-using as a data source all the online travel reviews (OTRs) written in English about these restaurants shared on the TripAdvisor portal. Comparing the three categories of restaurants in both regions, the results show branding and marketing problems and significant differences in the popularity of restaurants and the satisfaction and well-being of diners. There is a positive relationship between the category of restaurants according to the number of Michelin stars and their popularity according to the number of OTRs, as well as with the satisfaction and well-being of diners, except for a 3-star restaurant that is the worst-rated. These outcomes from the demand side can be useful to stakeholders to design or improve gastronomic products and services.

Assessment of potential human health risks in aquatic products based on the heavy metal hazard decision tree.

BACKGROUND: Naturally existing and human-produced heavy metals are released into the environment and cannot be completely decomposed by microorganisms, but they continue to accumulate in water and sediments, causing organisms to be exposed to heavy metals. RESULTS: This study designs and proposes heavy metal hazard decision trees for aquatic products, which are divided into seven categories including pelagic fishes, inshore fishes, other fishes, crustaceans, shellfish, cephalopods, and algae. Based on these classifications, representative fresh and processed seafood products are at the root of the heavy metal hazard decision trees. This study uses 2,107 cases of eating 556 cooked fresh or processed seafood product samples. The constructions of the proposed decision trees consist of 12 heavy metals, which include inorganic arsenic (iAs), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), lead (Pb), strontium (Sr), thallium (Tl), and zinc (Zn). The heavy metal concentrations in cooked fresh and processed seafood product samples are subjected to a food safety risk assessment. CONCLUSIONS: The results indicate the relationships among the seven categories of aquatic products, the relationships among 12 heavy metals in aquatic products, and the relationships among potential human health risks. Finally, the proposed heavy metal hazard decision trees for aquatic products can be used as a reference model for researchers and engineers.

Internet addiction and nonsuicidal self-injury in adolescence: Associations with offline and online social support.

OBJECTIVES: Both nonsuicidal self-injury (NSSI) and Internet addiction (IA) are important health issues for adolescents, and social support has been extensively examined as a protective factor for both. This study aims to compare the effect of offline and online social support on IA, and that on NSSI as well. METHOD: A total of 1911 Chinese adolescents (53.27% females, Mage = 16.83 ± 0.37) completed self-report questionnaires assessing offline social support, online social support, IA, and NSSI. RESULTS: The structural equation modeling analysis showed that offline social support was negatively associated with IA and NSSI, while online social support was positively associated with IA and NSSI; IA was positively associated with NSSI. Furthermore, implications for preventions and interventions of IA and NSSI were discussed. The indirect model explained a relatively small variance of NSSI, indicating the possibility of additional factors in the development of NSSI that should be further investigated. CONCLUSION: This study indicated the differences between offline and online social support, and their different associations with IA and NSSI.

Dietary Exposure of the Taiwan Population to Mercury Content in Various Seafood Assessed by a Total Diet Study.

This paper examines the health risks of exposure to methylmercury (MeHg) through the consumption of mercury-contaminated seafood in Taiwan, based on the total diet study (TDS) method. Samples of seafood (n = 140) were purchased at fishing harbors or supermarkets and classified into seven categories (pelagic fish, inshore fish, farmed fish, shellfish, cephalopods, crustaceans, and algae). For each sample, we analyzed raw and cooked versions and compared the concentration difference. Total mercury (THg) was detected at the highest rate and in the highest concentrations in pelagic fish, followed by inshore fish and other farmed fish. The average concentration of THg was higher after cooking. In a 75th percentile scenario, the hazard indices for children aged 1 to 3 years and children aged 4 to 6 years were higher than 100% of the provisional tolerable weekly intake. Taking into consideration the risk assessment results, MeHg concentrations, and the nutritional composition of fish, we have provided weekly consumption advisories for children aged 1 to 3 years, children aged 4 to 6 years, and childbearing women aged 19 to 49 years. The weekly consumption advisories for childbearing women are 35 g/week of pelagic fish and 245 g/week of inshore fish based on the risk results from MeHg and the potential benefits from eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake.

Prevalence and psychosocial risk factors of nonsuicidal self-injury among adolescents during the COVID-19 outbreak.

The research investigated the prevalence of nonsuicidal self-injury (NSSI) during the COVID-19 outbreak and identified the psychosocial risk factors among junior high school students in Taiwan. Cross-sectional design was applied and 1,060 participants (Mage = 14.66, SD = 0.86 years) were recruited into the study. The prevalence of NSSI was found to be 40.9% (95% confidence interval, 37.9%-43.9%) during the COVID-19 outbreak. The results suggested that the self-injurers group were mostly female, and scored significantly higher in neuroticism, depression, impulsivity, alexithymia, virtual social support, dissatisfaction with academic performance, and lower in subjective wellbeing, self-esteem, actual social support, and family function than the non-injurers group. In addition, high neuroticism, low self-esteem, high virtual social support, high impulsivity, and high alexithymia were independently predictive in the logistic regression analysis. The principal results of this study suggested that NSSI was extremely prevalent among adolescents during the COVID-19 outbreak, and in particularly, personality and virtual environment risk factors and enhancing self-esteem should be the focus of NSSI preventive strategies when targeting this age population. Our results provide a reference towards designing NSSI prevention programs geared toward the high school population during the COVID-19 pandemic.

Levels of heavy metal cadmium in rice (Oryza sativa L.) produced in Taiwan and probabilistic risk assessment for the Taiwanese population.

Cadmium (Cd) is a toxic pollutant that is widely spread through industrial production and agricultural practices. Epidemiological data has revealed that lifetime exposure to environmentally relevant levels of Cd increases the risk of developing various organ diseases, including chronic kidney, heart, and lung diseases, as well as nervous tissue disorders. This study assessed Cd levels in rice to determine the health risks associated with rice consumption in various age-gender subgroups in Taiwan. The distribution of Cd concentration, the lifetime average daily dose (LADD), and the hazard index (HI) were estimated by Monte Carlo simulation. In the general population, the 50th percentile LADD of Cd for male rice consumers between the ages of 19-65 years was 0.06 µg/kg body weight per day, and the hazard index (HI) 50th, 90th, and 95th percentiles were 0.16, 0.69, and 1.54, respectively. According to the HI heat map for the exposure of the general population to Cd from rice in Taiwan, the highest exposure to Cd was noted in the Yilan area (HI 0.64). Therefore, rice production in the Yilan area should be further monitored to evaluate the levels of Cd contamination.

A Rare Case of Benign Hamartoma and Malignant Primary Pulmonary Lymphoma Coexisting in a Patient Mimicking Invasive Pulmonary Mycosis: a Case Report and Literature Review.

BACKGROUND: Pulmonary hamartomas are the most common benign tumors of the lungs and can occur anywhere in the lungs, normal hyperplasia, congenital malformation, inflammatory changes, and tumorigenesis are hypothesized to underlie the pathogeny, but the definite etiology remains to be elucidated. Primary pulmonary lymphoma (PPL) refers to clonal lymphoid hyperplasia of one or both lungs in patients who have no detectable extrapulmonary lymphoma or bone marrow involvement at the time of diagnosis and during the subsequent 3 months. It is rare for both diseases to occur in the lungs of the same patient. METHODS: Appropriate laboratory tests, Chest CT scan, bronchoscopy and CT-guided percutaneous lung biopsy. RESULTS: Laboratory tests showed (1-3)-ß-D-glucan was 226.3 pg/mL and sputum culture of Aspergillus niger. Chest Computer Tomography (CT) scan showed multiple flaky high-density shadows in both lungs, proven to be right hamartoma with left lung pulmonary primary lymphoma by bronchoscopy biopsy and CT guided percutaneous needle lung biopsy. CONCLUSIONS: When there are high density shadows or nodules in different parts of one patient's lung, these lesions may not be the same disease. Therefore, it is necessary to conduct biopsies of the lesions in different parts of the lung.

Elevated carcinoembryonic antigen and bronchial obstruction caused by a rotten vegetable leaf mimic lung cancer: A case report.

BACKGROUND: Tracheobronchial foreign body aspiration is a potentially risky medical event, while the condition often requires early detection and rapid intervention to improve respiratory symptoms and prevent major morbidity. Notably, foreign bodies may not be identified and they are likely to be mistaken for neoplastic lesions. However, CEA, as one of tumor markers, presents to be available for assisting in lung cancer diagnosis, especially for non-small-cell lung cancer, while the specificity of CEA is not high. METHODS: Here, we described a case of bronchial opening obstruction with elevated carcinoembryonic antigen (CEA) that was firstly misdiagnosed as lung cancer and proved as foreign body aspiration in the upper lobe bronchus of right lung by bronchoscopy. RESULTS: Carcinoembryonic antigen level increased. CT scan demonstrated a cavitation accompanied by multiple small nodular shadows appeared in the right upper lobe field. Bronchoscopy suggested right upper lobe bronchus was blocked by a brown smooth organism with plenty of purulent materials, which was proved as a rotten vegetable leaf. CONCLUSIONS: Elevated CEA and bronchial obstruction are not typical manifestations of lung cancer. Bronchoscopy is crucial for making a reliable diagnosis.

Prevalence of Internet Addiction during the COVID-19 Outbreak and Its Risk Factors among Junior High School Students in Taiwan.

The coronavirus disease 2019 (COVID-19) outbreak has significantly disrupted normal activities globally. During this epidemic, people around the world were expected to encounter several mental health challenges. In particular, Internet addiction may become a serious issue among teens. Consequently, this study aimed to examine the prevalence of Internet addiction and identify the psychosocial risk factors during the COVID-19 outbreak. This study was constructed using a cross-sectional design with 1060 participants recruited from among junior high school students around Taiwan using stratified and cluster sampling methods. Taiwan's first COVID-19 case was diagnosed on 28 January 2020. New cases exploded rapidly in February, and as a result, participants were surveyed during March 2 through 27 March 2020. The prevalence of Internet addiction was found to be 24.4% during this period. High impulsivity, high virtual social support, older in age, low subjective well-being, low family function, and high alexithymia was all independently predictive in the forward logistic regression analyses. The prevalence rate of Internet addiction was high among junior high school students during the COVID-19 outbreak. Results from this study can be used to help mental health organizations and educational agencies design programs that will help prevent Internet addiction in adolescents during the COVID-19 pandemic.

Serum Procalcitonin, Smoking History Combined Age Established a New Prediction Model for Predicting Dynamic Changes of Chest CT Images in Adult Community-Acquired Pneumonia (CAP) Patients.

BACKGROUND: Chest CT is widely used in clinical diagnosis and efficacy evaluation of CAP. While repeated chest CT examinations to evaluate dynamic changes in chest CT images in a short period of time is a common phenomenon, it causes a lot of waste of medical resources, and due to the large dose of CT radiation, it can cause some harm to the human body. The purpose of this study is to establish a new model to predict the dynamic chest CT image changes of CAP patients by analyzing the age, smoking history, and serum inflammatory markers. METHODS: This is a retrospective study. All patients had received chest CT scan and serum inflammatory indexes were measured, including procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), white blood cell (WBC) and erythrocyte sedimentation rate (ESR). The second chest CT examination was performed after a week of treatment. General information on the medical record was also recorded (including age, smoking history, drinking history, and others). Main outcome measures were the changes of chest CT images, including absorption and non-absorption (including patients with progressive inflammation). Single factor analysis and two-dimensional logistic regression analysis were used to explore the independent risk factors of the new CT image change prediction model for CAP patients. ROC was used to evaluate the sensitivity and specificity of the new model. RESULTS: Among 220 patients with CAP, 150 patients had absorption in chest CT after a week of treatment (150/220), the remaining 70 patients had no absorption or even progression (70/220). Age, PCT, and smoking history were independent risk factors for inflammatory absorption. The AUC of ROC curve was 0.89 (95% CI 0.83 - 0.94), the sensitivity was 88.70%, and the specificity was 80.00%. CONCLUSIONS: A new prediction model consists of serum PCT, age, and smoking history has high specificity and sensitivity in predicting dynamic CT changes in adult CAP patients.

Risk Assessment of the Dietary Phosphate Exposure in Taiwan Population Using a Total Diet Study.

Phosphorus and calcium are essential nutrients for the human body. However, excessive intake of phosphates and a low calcium:phosphorus ratio can lead to disorders in calcium-phosphorus metabolism, kidney disease, or osteoporosis. In this study, a total diet study (TDS) was used. The total phosphorus concentrations of foods were combined with the average dietary consumption to calculate the estimated daily intake, which was compared with the maximum tolerable daily intake (MTDI) to assess the resulting health risk of total phosphorus exposure. The calcium concentration in food and total calcium intake were also analyzed and estimated to calculate the calcium:phosphorus ratio. In conclusion, the phosphate exposure risks for the Taiwanese population are acceptable. However, the calcium:phosphorus ratio in the Taiwanese population (0.51-0.63) is lower than the reference calcium:phosphorus ratio (1.25).

Microbial Risk Assessment of Escherichia coli O157:H7 in Beef Imported from the United States of America to Taiwan.

Outbreaks of foodborne illness caused by pathogenic Escherichia coli (E. coli) O157:H7, which are attributable to the consumption of undercooked beef, have occurred in many countries. In Taiwan, the production of domestic beef accounts for only 5% of the total amount of beef sold. Therefore, we applied different contextual assumptions to develop a quantitative microbial risk assessment of E. coli O157:H7 and evaluated the risk of illness in the Taiwanese population consuming beef imported from the United States of America. The probability distribution showed that, in males aged 19-65 years in the Taiwanese population, for example, when rare beef was consumed 100 servings, there was a 90% probability of randomly intaking seven colony forming units of E. coli O157:H7. When medium beef was consumed 10,000 servings, there was a 90% probability of randomly intaking two colony forming units of E. coli O157:H7. When the exceedance risk was 5%, the rate of foodborne illnesses caused by consuming rare beef contaminated with E. coli O157:H7 was 10-28 cases per 1 million individuals. For medium beef, this rate was 6-13 per 100 million individuals. Sensitivity analyses indicated that the amount of E. coli O157:H7 remaining in beef products after cooking was the most important risk factor, followed by the amount of beef products consumed. Proper cooking of imported beef consumed by the Taiwanese public reduces the incidence of foodborne disease to almost zero, without risk of harm to health.

Serum Procalcitonin, White Blood Cell and Hypersensitive C-reactive Protein Combined with Age Established a New Prediction Model in Predicting ICU Admission in Adult Community-Acquired Pneumonia (CAP) Patients.

BACKGROUND: CAP is the most common cause of death in infectious diseases in developing countries, while also an important cause of death and morbidity in developed countries. In recent years, CURB-65 (or CRB-65) and pneumonia severity index (PSI) scoring systems have been widely used in the prognosis scoring system of CAP. However, each of them has some shortcomings in predicting ICU admission in CAP patients. The aim of this study is to analyze serum inflammatory biomarkers combined age to established a new prediction model in predicting ICU admission in CAP patients. METHODS: This is a retrospective study. The enrolled CAP patients received serum inflammatory biomarker tests, including procalcitonin (PCT), white blood cell count (WBC), hypersensitive C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR). Body temperature and age were also recorded. The main outcome measures were ICU admission. Univariate analysis and binary logistic regression analysis were used to explore the in-dependent risk factors which could be components of a new predicting model for ICU admission in CAP patients. Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of the new model, which consisted of the combination of all independent risk factors in predicting the main outcomes. RESULTS: Initially, 246 CAP patients were admitted to general wards, 61 of whom were subsequently transferred to ICU (61/246). Age, PCT, WBC, and hs-CRP were independent risk factors for subsequent admission to ICU for CAP patients in general wards. The AUC of the ROC curve of new prediction model (the joint model consists of age, PCT, WBC, and hs-CRP) was 0.93 (95% CI 0.85 - 0.96), the sensitivity and specificity were 85.2% and 88.1%, respectively. CONCLUSIONS: Serum inflammatory biomarkers combined age have high specificity and sensitivity in predicting ICU admission in adult CAP patients.

Probabilistic risk assessment of patulin in imported apple juice and apple-containing beverages in Taiwan.

BACKGROUND: In Taiwan, nearly 90% of apples and raw ingredients for apple-based products are imported. Apple juices (137 samples) and apple-containing beverages (35 samples) were collected in Taiwan from imported food and analyzed for patulin content. RESULTS: The results revealed that the incidence levels of patulin for apple juice and apple-containing beverages are 5.84% and 5.71%. The mean contamination levels were 1.7 and 1.4 µg kg-1 for apple juice and apple-containing beverages. One sample exceeded 50 µg kg-1 , the maximum permissible limit according to the Taiwan Sanitation Standard for the Tolerance of Mycotoxins in Foods. The estimated intake of patulin for consumers ranged from 5.4 to 18.0 ng kg-1 body weight per day for apple juice and between 6.1 and 11.2 ng kg-1 body weight for apple-containing beverages. The highest average patulin intake was observed among infants aged 0-3 years, followed by children aged 4-12 years old. Finally, the hazard index (HI) for the 50th, 90th, and 95th percentiles are 0.0186, 0.1201, and 0.2048, respectively, for infants aged 0-3 years. CONCLUSION: The dietary intake of patulin from imported apple juices and apple-containing beverages is well below the safety levels and does not present a risk for adult and children consumers. However, it is important to point out that we only analyzed imported apple juices and apple-containing beverages. More studies are necessary to establish if the HI for patulin will still remain below 1 when other foods and beverages are included in the risk calculations. © 2020 Society of Chemical Industry.

Elevated Leukocytes Combined with Left Lung Consolidation on Chest Computed Tomography (CT) Scan in an Adult Patient Firstly Misdiagnosed as Pneumonia and Finally Diagnosed as Pulmonary Sequestration by Enhanced CT Scan and CT Angiography: a Case Report and Literature Review.

BACKGROUND: Pulmonary sequestration is an uncommon pulmonary disorder. We presented an adult case with recurrent pulmonary infection firstly misdiagnosed as pneumonia, which proved as pulmonary sequestration by enhanced CT scan and CT angiography. METHODS: Appropriate laboratory tests, chest CT scan, bronchoscopy, and CT angiography were performed for diagnosis. RESULTS: The white blood cells detected by routine blood test were 11.8 x 109/L, the plain chest CT scan showed the volume of the lower lobe of the left lung decreased and the density increased. Enhanced CT and maximum intensity projection (MIP) algorithms were used for three-dimensional (3D) reconstruction of the images: no abnormally enhanced shadows were seen in the reduced lower lobe of the left lung, and tortuous vascular shadows were seen in the mediastinum. Bronchoscopy showed a narrowing of the opening in the dorsal segment of the lower lobe of the left lung. Thoracic aortography revealed an abnormal arterial supply to the lower left lung, the pathological results of thoracoscopic resection of the lower left lung were pulmonary sequestration. CONCLUSIONS: Pulmonary consolidation may be more than a simple pulmonary infection. Physicians should consider the possibility of pulmonary sequestration in patients with recurrent or refractory pneumonia. Enhanced CT findings of abnormal blood vessel supply are helpful for pulmonary sequestration diagnosis, and CT angiography is the gold standard for diagnosis.