Radiographic approach to multifocal consolidation

Early Prediction and HRCT Evaluation of Post Covid-19 Related Lung Fibrosis

Background

Early detection of post-COVID-19-related lung fibrosis is very important for the early introduction of treatment and to minimize morbidity and mortality. The aim of this study is the early detection and evaluation of post-COVID-19 fibrosis by high-resolution computed tomography (HRCT).

Methods

This prospective study included 115 patients irrespective of age and sex, who tested positive for the SARS-CoV-2 by nasopharyngeal swab (RT PCR), admitted to the Dhaka North City Corporation (DNCC) dedicated COVID-19 hospital, Dhaka, and discharged after recovery. Patients went through a chest HRCT scan at least once during their hospital stay and another scan during follow-up after hospital discharge and 8 to 12 weeks of negative RT-PCR report.

Result

Among 100 patients 23 patients had >50% of total lung involvement by visual assessment. Thirty-three patients had 25% to 50% of total lung volume involvement. Twenty-seven patients had less than 25% of total lung involvement, whereas 17 patients had no visual fibrotic change on the follow-up HRCT scan. A statistical association was found between age, gender, smoking, and severe form of lung fibrosis (P < .05). Patients with mild CT severity score (⩽8) had a very good prognosis. Patients who were admitted to the hospital for more than 15 days were more prone to developing moderate and severe forms of fibrosis. Patients who received at least 2 doses of the COVID-19 vaccine had less severe forms of fibrosis as well as more cases of complete radiological recovery. On the HRCT scan, most of the patients had bilateral, peripheral (68%), and predominant mid & lower lobar parenchymal involvement.

Conclusion

Early detection and HRCT evaluation of post-COVID-19 related lung fibrosis is very crucial for early management and introduction of anti-fibrotic drugs.

Molecular proof for Lophomonas infection in a patient with history of breast cancer

We report a 52-year-old patient with a history of breast cancer (BC) referred to the clinic of Afzalipour Hospital, in Kerman, eastern Iran, with a 1-week complaint of restless dyspnea. A chest computed tomography scan revealed consolidations in the upper lobes of both lungs. The patient had no history of smoking or underlying diseases that would predispose her to consolidation, including pneumonia. Then, bronchoscopy was performed for the patient, and bronchoalveolar lavage fluid was sent to the Iranian National Registry Center, where the Lophomonas parasite was detected in the sample and confirmed using a polymerase chain reaction test. Finally, her symptoms improved by receiving oral metronidazole three times a day for 3 weeks.

Pulmonary Infections: Imaging with CT

Computed tomography (CT) plays a key role in various kinds of pulmonary infections especially in immunocompromised patients, owing to its much higher sensitivity and specificity than the traditionally performed chest X-ray. CT permits the detection of the main infectious pattern and associated findings with high confidence and allows for the precise assessment of all involved structures, to potentially guide a bronchoalveolar lavage or another diagnostic procedure, and to ensure a reliable follow-up. It may be performed at a carefully chosen dose, which may nearly reach that of a chest X-ray in specific situations. The importance of post-processing tools is undeniable in some conditions, in particular for the evaluation of micronodules in the immunocompromised population. The wide spectrum of features of specific organisms according to the immune status, such as in aspergillosis or tuberculosis, must be known, as well as the potential of atypical presentations in case of Pneumocystis jirovecii (PCP) pneumonia when occurring in non-HIV immunocompromised patients. In all cases, underlying disorders must be considered as well as all the differential diagnoses. Overall, CT definitely helps clinicians to diagnose pulmonary infections and to make treatment decisions, especially in vulnerable patients.

Lung infections: the radiologist's perspective

Imaging plays a key role in lung infections. A CT scan must be carried out when there is a strong clinical suspicion of pneumonia that is accompanied by normal, ambiguous, or nonspecific radiography, a scenario that occurs most commonly in immunocompromised patients. CT allows clinicians to detect associated abnormalities or an underlying condition and it can guide bronchoalveolar lavage or a percutaneous or transbronchial lung biopsy. An organism can vary in how it is expressed depending on the extent to which the patient is immunocompromised. This is seen in tuberculosis in patients with AIDS. The infective agents vary with the type of immune deficiency and some infections can quickly become life-threatening. Clinicians should be aware of the complex radiological spectrum of pulmonary aspergillosis, given that this diagnosis must be considered in specific settings.

CT-guided biopsy of nonresolving focal air space consolidation

OBJECTIVES

To evaluate the diagnostic accuracy of percutaneous computed tomography (CT)-guided coaxial core needle biopsy in patients with nonresolving pulmonary focal air space consolidations and negative fiberoptic bronchoscopy results.

METHODS

From 1997 to 2005, 23 patients (11 woman, 12 men; age range, 45 to 81 y; mean age, 66 y) presenting with nonresolving pneumonia persisting more than 8 weeks (mean, 22 wk; range, 8 to 40 wk) with negative fiberscopic results, underwent coaxial percutaneous biopsy using an automated core needle (18-gauge) under CT guidance. Histologic and bacteriologic evaluations were obtained. The final diagnosis was confirmed by surgical pathology, culture results, or clinical follow-up.

RESULTS

Specimens adequate for histopathologic evaluations were obtained in 20 (87%) cases. Final diagnoses were lung cancer (n=15) and benign diseases (infectious pneumonia, 3; lipoid pneumonia, 1; Erdheim Chester disease: 1; and nonspecific chronic pneumonia, 3). Diagnostic yield of core needle biopsy was 78% (18 of 23). The sensitivity and specificity for malignancy were 87% and 100%, respectively. Immediate pneumothorax was present in 11 patients of cases, but only 2 patients required pleural drainage.

DISCUSSION

CT-guided lung biopsy using a core needle biopsy provides a high degree of diagnostic accuracy and allows specific characterization of nonresolving pulmonary focal air space consolidation.

Primary pulmonary lymphoma

BACKGROUND

Primary pulmonary lymphoma is a rare disease. The clinical characteristics, methods of treatment, and outcomes are not well elucidated.

METHODS

A retrospective review of primary pulmonary lymphoma cases at a single institution from 1990 to 2002 was performed.

RESULTS

Eighteen patients were included, with a mean follow-up of 2.9 years. Fourteen patients had mucosa-associated lymphoid tissue (MALT) lymphoma, 2 had large cell transformation of sheet cells in MALT lymphoma, and 1 each had Hodgkin's disease and follicular lymphoma. Computed tomography-guided biopsy was diagnostic in only two of eight attempts. Eleven patients had disease confined to the pulmonary parenchyma, and 7 had parenchymal disease as well as mediastinal lymphadenopathy. Treatment methods included observation only (n = 1), surgery only (n = 6), surgery plus chemotherapy (n = 8), surgery plus radiotherapy (n = 1), and surgery plus chemotherapy plus radiotherapy (n = 2). Kaplan-Meier estimate of median time to disease recurrence or death was 6 years. Only 1 patient died of disease-related causes. Patients who had bilateral disease were more likely to have recurrent disease or death (p = 0.03).

CONCLUSIONS

A wide range of treatments were used for patients with generally MALT lymphoma, resulting in good outcomes, and recurrent disease was well controlled.