Pulmonary thromboembolism in hospitalised COVID-19 patients at moderate to high risk by Wells score: a report from Lombardy, Italy.

OBJECTIVES: To present a single-centre experience on CT pulmonary angiography (CTPA) for the assessment of hospitalised COVID-19 patients with moderate-to-high risk of pulmonary thromboembolism (PTE). METHODS: We analysed consecutive COVID-19 patients (RT-PCR confirmed) undergoing CTPA in March 2020 for PTE clinical suspicion. Clinical data were retrieved. Two experienced radiologists reviewed CTPAs to assess pulmonary parenchyma and vascular findings. RESULTS: Among 34 patients who underwent CTPA, 26 had PTE (76%, 20 males, median age 61 years, interquartile range 54-70), 20/26 (77%) with comorbidities (mainly hypertension, 44%), and 8 (31%) subsequently dying. Eight PTE patients were under thromboprophylaxis with low-molecular-weight heparin, four PTE patients had lower-limbs deep vein thrombosis at ultrasound examination (performed in 33/34 patients). Bilateral PTE characterised 19/26 cases, with main branches involved in 10/26 cases. Twelve patients had a parenchymal involvement >75%, the predominant pneumonia pattern being consolidation in 10/26 patients, ground glass opacities in 9/26, crazy paving in 5/26, and both ground glass opacities and consolidation in 2/26. CONCLUSION: COVID-19 patients are prone to PTE. ADVANCES IN KNOWLEDGE: PTE, potentially attributable to an underlying thrombophilic status, may be more frequent than expected in COVID-19 patients. Extension of prophylaxis and adaptation of diagnostic criteria should be considered.

Solid Indeterminate Pulmonary Nodules Less Than or Equal to 250 mm3: Application of the Updated Fleischner Society Guidelines in Clinical Practice.

BACKGROUND: The latest version of the Fleischner Society guidelines for management of incidental pulmonary nodules was published in 2017. The main purpose of these guidelines is to reduce the number of unnecessary computed tomography (CT) examinations during the follow-up of small indeterminate nodules. OBJECTIVE: The present study aimed to evaluate the performance of these guidelines for management of solid indeterminate pulmonary nodules (SIPNs) ≤ 250 mm3. MATERIALS AND METHODS: During a 7-year period, we retrospectively reviewed the chest CT scans of 672 consecutive patients with SIPNs. The study sample was selected according to the following inclusion criteria: solitary SIPN; diameter ≥ 3 mm; volume ≤ 250 mm3; two or more CT scans performed with the same scanner and same acquisition/reconstruction protocol; thin-section 1-mm images in DICOM format; histologic diagnosis or follow-up ≥ 2 years; and no oncological history. Applying these criteria, a total of 27 patients with single SIPNs ≤ 250 mm3 were enrolled. For each SIPN, the volume and doubling time were calculated using semiautomatic software throughout the follow-up period. For each SIPN, we applied the Fleischner Society guidelines, and the recommended management was compared to what was actually done. RESULTS: A significant volumetric increase was detected in 5/27 (18.5%) SIPNs; all growing nodules were observed in high-risk patients. In these SIPNs, a histologic diagnosis of malignancy was obtained. Applying the Fleischner Society recommendations, all five malignant nodules would have been identified. None of the SIPNs < 100 mm3 in low-risk patients showed significant growth during the follow-up period. The application of the new guidelines would have led to a significant reduction in follow-up CT examinations (Hodges-Lehmann median difference, -2 CT scans; p = 0.0001). CONCLUSION: The application of the updated Fleischner Society guidelines has been shown to be effective in the management of SIPNs ≤ 250 mm3 with a significant reduction in radiation dose.

Hilly or mountainous surface: a new CT feature to predict the behavior of pure ground glass nodules?

Persistent pure ground-glass nodules (pGGNs) typically show an indolent course with very slow growth rates. These slow-growing lesions exhibit different growth patterns regardless of their initial computed tomography (CT) features. Therefore, predicting the aggressive behavior of pGGNs on initial CT remains a diagnostic challenge. The literature reports that computerized analysis and various quantitative features have been tested to improve the risk stratification for pGGNs. The present article describes the long-term follow-up of two pGGNs with different behavior and introduces, for the first time, a new computerized method of analysis that could be helpful for predicting the future behavior of pGGNs.

Pulmonary hamartoma mimicking a mediastinal cyst-like lesion in a heavy smoker.

Pulmonary hamartoma (PH) is the most common benign tumor of the lung, typically presenting as a peripheral solitary nodule with round shape and smooth margins. The main computed tomography (CT) features that allow a confident diagnosis of PH are intranodular fat and popcorn-like calcifications. However, the presence of these features within PHs is variable. Thus, a reliable diagnosis of PH cannot be formulated in approximately 30% of cases. Furthermore, PHs may occasionally show atypical CT features. The present article reports the case of a centrally located PH with an extremely rare and previously unreported CT presentation consisting of fluid attenuation, rim enhancement and thick enhancing septa that mimicked a mediastinal cyst-like lesion.

Five mental foramina in the same mandible: CBCT findings of an unusual anatomical variant.

The mental foramen is an important anatomic landmark located on the buccal aspect of the mandible, typically near the apex of the second premolar. Mental foramina exhibit many anatomical variations, including differences in size, shape, position, and number. The most frequent type of variation in number is the presence of double mental foramen, which has a reported incidence ranging from 1.4 to 12.5%. The incidence of triple mental foramen ranges from 0.7 to 1.2%. The frequency of accessory mental foramina varies among ethnic groups, with a low incidence in white Caucasian populations. At present, cone beam computed tomography (CBCT) is the diagnostic tool of choice for examining the maxillofacial region, and the high spatial resolution of CBCT allows accurate three-dimensional analysis of mental foramen variations. The present report describes an unusual case of five mental foramina in a 24-year-old white European male diagnosed by CBCT.

Peripheral osteoma, compound odontoma, focal cemento-osseous dysplasia, and cemento-ossifying fibroma in the same hemimandible: CBCT findings of an unusual case.

Peripheral osteoma is the most common subtype of osteoma that arises most frequently in the craniofacial bones. It may occur at any age with a male-to-female ratio of 2:1. Peripheral osteoma may affect the mandible, particularly the ramus and the condyle. Compound odontoma is a subtype of odontoma that occurs in young subjects without gender predilection. It affects the maxilla more frequently than the mandible. Focal cemento-osseous dysplasia and cemento-ossifying fibroma are 2 benign fibro-osseous lesions with a female predominance that occur most commonly in the posterior region of the mandible. We report the first case involving the simultaneous occurrence of these 4 benign lesions in the same hemimandible diagnosed by CBCT.