Search

Background: Computed tomography (CT) is a routine procedure for diagnosing using ionization radiation which has hazardous effects especially on sensitive organs. Objective: The aim of this study was to quantify the dose reduction effect of lead apron shielding on the testicular region during routine chest CT scans. Material and Methods: In this measurement study, the routine chest CT examinations were performed for 30 male patients with common lead aprons folded and positioned in testis regions. The patient’s mean body mass index (BMI) was 26.2 ± 4.6 kg/m2. To calculate the doses at testis region, three thermoluminescent dosimeters (TLD-100) were attached at the top surface of the apron as an indicator of the doses without shielding, and three TLDs under the apron for doses with shielding. The TLD readouts were compared using SPSS software (Wilcoxon test) version 16. Results: The radiation dose in the testicular regions was reduced from 0.46 ± 0.04 to 0.20 ± 0.04 mGy in the presence of lead apron shielding (p < 0.001), the reduction was equal to 56%. Furthermore, the heritable risk probability was obtained at 2.0 ×10-5 % and 4.6 ×10-5 % for the patients using the lead apron shield versus without shield, respectively. Conclusion: Applying common lead aprons as shielding in the testis regions of male patients undergoing chest CT scans can reduce the radiation doses significantly. Therefore, this shield can be recommended for routine chest CT examinations.

The novel coronavirus outbreak has spread worldwide, causing respiratory infections in humans, leading to a huge global pandemic COVID-19. According to World Health Organization, the only way to curb this spread is by increasing the testing and isolating the infected. Meanwhile, the clinical testing currently being followed is not easily accessible and requires much time to give the results. In this scenario, remote diagnostic systems could become a handy solution. Some existing studies leverage the deep learning approach to provide an effective alternative to clinical diagnostic techniques. However, it is difficult to use such complex networks in resource constraint environments. To address this problem, we developed a fine-tuned deep learning model inspired by the architecture of the MobileNet V2 model. Moreover, the developed model is further optimized in terms of its size and complexity to make it compatible with mobile and edge devices. The results of extensive experimentation performed on a real-world dataset consisting of 2482 chest Computerized Tomography scan images strongly suggest the superiority of the developed fine-tuned deep learning model in terms of high accuracy and faster diagnosis time. The proposed model achieved a classification accuracy of 96.40%, with approximately ten times shorter response time than prevailing deep learning models. Further, McNemar’s statistical test results also prove the efficacy of the proposed model.

Abstract Background In December 2019, SARS-CoV-2 was identified as the causative agent of pneumonia cases in China. This virus is spread by coughing or sneezing and can infect other persons by on contacting mucous membranes. SARS-Cov-2 most frequent serious manifestation is pneumonia. Chest computed tomography in COVID-19 patients usually shows ground-glass opacities that may be accompanied by consolidation lesions. Early diagnosis of the disease and rapid isolation of the patient is of great importance. So far, confirmation of COVID-19 infection is made by RT-PCR of nasopharyngeal or respiratory specimens. Recent research reported that the sensitivity of computed tomography in diagnosing COVID-19 is 98% while RT-PCR sensitivity is 71%. Herein, we compare the sensitivity of both chest CT and RT-PCR in diagnosing COVID-19 at initial patient presentation through a meta-analysis study. Main body Using MEDLINE database a systematic literature search was conducted to identify relevant published studies within from November 2019 to April 2020. Only articles with full text were examined to determine eligibility and extract data by two reviewers. It was decided to include studies mentioning sensitivity of chest CT scan and sensitivity of RT-PCR and both done at the same time. Results Potentially relevant 15,300 studies were identified in our search in MEDLINE whose titles were quickly reviewed. Potentially eligible studies missing any of the forementioned inclusion criteria were excluded. This process left 7 eligible articles that fulfilled the inclusion criteria and were thus included in the meta-analysis and used for further analyses. Conclusion The meta-analysis study showed that chest CT may be beneficial in early detection of cases of COVID-19. Imaging, in adjunct to clinical and laboratory findings, should be used for monitoring of disease course, until further evidence is available.

Purpose Based on the recent literature, chest computed tomography (CT) examination could aid for management of patients during COVID-19 pandemic. However, the role of chest CT in management of COVID-19 patients is not exactly the same for medical or surgical specialties. In orthopaedic or trauma emergency, abdomen, pelvis, cervical, dorsal, and lumbar spine CT are performed to investigate patients; the result is a thoracic CT scan incorporating usually the thorax; however, information about lung parenchyma can be obtained on this thorax CT, and manifestations of COVID-19 can be diagnosed. The objective of our study was to evaluate this role in orthopedic patients to familiarize orthopaedists with the value and limits of thoracic CT in orthopaedic surgery. Materials and methods Among the 1397 chest CT scans performed during the pandemic period from 1 March 2020 to 10 May 2020, in two centres with orthopaedic surgery, we selected all the 118 thoracic or chest CT performed for patients who presented to the Emergency Department of the hospital with a diagnosis of trauma for orthopaedic surgical treatment. Thirty-nine of these 118 patients were tested with PCR for the diagnosis of COVID-19 infection. Depending on clinical status (symptomatic or non-symptomatic), the information useful for the orthopaedist surgeon and obtained from the Chest CT scan according to the result of the PCR (gold standard) was graded from 0 (no or low value) to 3 (high value). The potential risks of chest CT as exposure to radiation, and specific pathway were analyzed and discussed. A group of patients treated during a previous similar period (1 March 2018 to 15 April 2018) was used as control for evaluation of the increase of CT scanning during the COVID-19 pandemic. Results Among the 118 patients with chest CT, there were 16 patients with positive COVID-19 chest CT findings, and 102 patients with negative chest CT scan. With PCR results as reference, the sensitivity, specificity, positive predictive value of chest CT in indicating COVID-19 infection were 81%, 93%, and 86%, respectively (p = 0.001). A useful information for the orthopaedic surgeon (graded as 1 for 71 cases, as 2 for 5 cases, and as 3 for 11 cases) was obtained from 118 chest CT scans for 87 (74%) patients, while the CT was no value in 30 (25%) cases, and negative value in one (1%) case. Roughly 20% of the total number of CT scanner performed over the pandemic period was dedicated to COVID-19, but only 2% were for orthopaedic or trauma patients. However, this was ten times higher than during the previous control period of comparison. Conclusion Although extremely valuable for surgery management, these results should not be overstated. The CT findings studied are not specific for COVID-19, and the positive predictive value of CT will be low unless disease prevalence is high, which was the case during this period.

Background Coronavirus disease 2019 acute respiratory distress syndrome (COVID‐19 ARDS) is a disease that often requires invasive ventilation. Little is known about COVID‐19 ARDS sequelae. We assessed the mid‐term lung status of COVID‐19 survivors and investigated factors associated with pulmonary sequelae. Methods All adult COVID‐19 patients admitted to the intensive care unit from 25th February to 27th April 2020 were included. Lung function was evaluated through chest CT scan and pulmonary function tests (PFT). Logistic regression was used to identify predictors of persisting lung alterations. Results Forty‐nine patients (75%) completed lung assessment. Chest CT scan was performed after a median (interquartile range) time of 97 (89–105) days, whilst PFT after 142 (133–160) days. The median age was 58 (52–65) years and most patients were male (90%). The median duration of mechanical ventilation was 11 (6–16) days. Median tidal volume/ideal body weight (TV/IBW) was 6.8 (5.71–7.67) ml/Kg. 59% and 63% of patients showed radiological and functional lung sequelae, respectively. The diffusion capacity of carbon monoxide (DLCO) was reduced by 59%, with a median per cent of predicted DLCO of 72.1 (57.9–93.9) %. Mean TV/IBW during invasive ventilation emerged as an independent predictor of persistent CT scan abnormalities, whilst the duration of mechanical ventilation was an independent predictor of both CT and PFT abnormalities. The extension of lung involvement at hospital admission (evaluated through Radiographic Assessment of Lung Edema, RALE score) independently predicted the risk of persistent alterations in PFTs. Conclusions Both the extent of lung parenchymal involvement and mechanical ventilation protocols predict morphological and functional lung abnormalities months after COVID‐19.

Background This study was performed to analyze the clinical manifestations, imaging features, and prognosis of Takayasu’s arteritis (TA) with pulmonary arteritis (PA). Methods In total, 51 of 815 patients with TA were diagnosed with PA at the Peking Union Medical College Hospital from 1986 to 2015. The patients’ medical records and radiographic data were retrospectively reviewed. Results The patients comprised 39 women and 12 men with a median age of 33 years (range, 14–67 years). The most common symptoms were dyspnea (70.6%), cough (66.7%), hemoptysis (47.1%), and chest pain (45.1%). Computed tomography (CT) pulmonary angiography, pulmonary arteriography, and pulmonary perfusion imaging showed pulmonary artery stenosis or occlusion in 44 patients. A total of 82.4% of patients had lung parenchyma lesions on CT scans, indirectly indicating pulmonary artery involvement. Additionally, 58.8% of patients had pulmonary hypertension (PH) by echocardiography. Compared with the PH group, the non-PH group was characterized by a shorter disease duration; more symptoms such as fever, chest pain, and hemoptysis; an increased erythrocyte sedimentation rate; and a higher incidence of subpleural wedge-shaped shadows on chest CT (P Conclusions The clinical manifestations of TA with PA are nonspecific. PH often complicates PA and is associated with a poor prognosis. Early clinical manifestations such as repeated fever, chest pain, hemoptysis, and recurrence of subpleural wedge-shaped shadows on chest CT should arouse suspicion of PA in patients with TA and prompt further investigations. This may allow PA to be diagnosed before the occurrence of PH. Trial registration ClinicalTrials, NCT03189602. Date of registration: June 16, 2017. Retrospectively registered.

The Coronavirus Disease 2019 (COVID-19) which first emerged in Wuhan, China in late December, 2019, has now spread to all the countries in the world. Conventional testing methods such as the antigen test, serology tests, and polymerase chain reaction tests are widely used. However, the test results can take anything from a few hours to a few days to reach the patient. Chest CT scan images have been used as alternatives for the detection of COVID-19 infection. Use of CT scan images alone might have limited capabilities, which calls attention to incorporating clinical features. In this paper, deep learning algorithms have been utilized to integrate the chest CT scan images obtained from patients with their clinical characteristics for fast and accurate diagnosis of COVID-19 patients. The framework uses an ANN to obtain the probability of the patient being infected with COVID-19 using their clinical information. Beyond a certain threshold, the chest CT scan of the patient is classified using a deep learning model which has been trained to classify the CT scan with 99% accuracy.

Early recognition of cardiac arrest has been linked traditionally to clinical signs and telemetry findings. Few case reports have presented normal telemetry findings in patients with cardiac arrest where a contrast enhanced CT scan of the chest was able to identify the diagnosis. The early recognition of a cardiac arrest whether by telemetry monitoring or CT scan is important to improve the clinical outcomes. This case report presents a patient who was hypertensive and unresponsive upon arrival to the emergency department. A chest CT scan to rule out aortic dissection showed no contrast in the pulmonary arteries, aorta, and the rest of the heart chambers although normal telemetry findings were present. Resuscitation was initiated, and patient survived with poor neurological recovery. Keywords: Cardiac arrest, Chest CT scan, Telemetry findings, Pulseless electrical activity

As COVID-19 has spread rapidly, detection of the COVID-19 infection from radiology and radiography images is probably one of the quickest ways to diagnose the patients. Many researchers found the necessity to utilize chest X-ray and chest computed tomography imaging to diagnose COVID-19 infection. In this paper, our objective is to minimize the false negatives and false positives in the detection process. Reduction in the number of false negatives minimizes community spread of the COVID-19 pandemic. Reducing false positives help people avoid mental trauma and wasteful expenses. This paper proposes a novel weighted consensus model to minimize the number of false negatives and false positives without compromising accuracy. In the proposed novel weighted consensus model, the accuracy of individual classification models is normalized. While predicting, different models predict different classes, and the sum of the normalized accuracy for a particular class is then considered based on a predefined threshold value. We used traditional Machine Learning classification algorithms like Linear Regression, Support Vector Machine, k-Nearest Neighbours, Decision Tree, and Random Forest for the weighted consensus experimental evaluation. We predicted the classes, which provided better insights into the condition. The proposed model can perform as well as the existing state-of-the-art technique in terms of accuracy (99.64%) and reduce false negatives and false positives.

Background: Pulmonary artery enlargement (PAE) detected using chest computed tomography (CT) is associated with poor outcomes in chronic obstructive pulmonary disease (COPD). It is unknown whether nocturnal hypoxemia occurring in smokers, with or without COPD, obstructive sleep apnoea (OSA) or their overlap, may be associated with PAE assessed by chest CT. Methods: We analysed data from two prospective cohort studies that enrolled 284 smokers in lung cancer screening programs and completing baseline home sleep studies and chest CT scans. Main pulmonary artery diameter (PAD) and the ratio of the PAD to that of the aorta (PA:Ao ratio) were measured. PAE was defined as a PAD ≥ 29 mm in men and ≥27 mm in women or as a PA:Ao ratio &gt, 0.9. We evaluated the association of PAE with baseline characteristics using multivariate logistic models. Results: PAE prevalence was 27% as defined by PAD measurements and 11.6% by the PA:Ao ratio. A body mass index ≥ 30 kg/m2 (OR 2.01, 95%CI 1.06–3.78), lower % predicted of forced expiratory volume in one second (FEV1) (OR 1.03, 95%CI 1.02–1.05) and higher % of sleep time with O2 saturation &lt, 90% (T90) (OR 1.02, 95%CI 1.00–1.03), were associated with PAE as determined by PAD. However, only T90 remained significantly associated with PAE as defined by the PA:Ao ratio (OR 1.02, 95%CI 1.01–1.03). In the subset group without OSA, only T90 remains associated with PAE, whether defined by PAD measurement (OR 1.02, 95%CI 1.01–1.03) or PA:Ao ratio (OR 1.04, 95%CI 1.01–1.07). Conclusions: In smokers with or without COPD, nocturnal hypoxemia was associated with PAE independently of OSA coexistence.

Background The aim of this study was to highlight the typical and atypical chest CT imaging features at first presentation in 120 patients who were proved to be COVID-19 by PCR and to correlate these findings with the need for ICU admission, ventilation, and mortality. We retrospectively included 120 patients 71 males (59.2%) and 49 females (40.8%) with a mean age of 47.2 ± 14.4 years. Patients subjected to clinical assessment, CBC, PCR for COVID-19, and non-contrast CT chest at first presentation. Typical and atypical imaging findings were reported and correlated with the clinical findings of the patients, the need for ICU admission, ventilation, and mortality. Results Clinically, fever was seen in 112 patients followed by dry cough in 108 patients and malaise in 35 patients. The final outcome was complete recovery in 113 cases and death in 7 cases. Typical CT findings included bilateral peripheral ground-glass opacities (GGO) in 74.7%, multilobar affection in 92.5% while atypical findings such as homogeneous consolidation, pleural effusion, mediastinal lymphadenopathy, and single lobar affection were found in 13.4, 5, 6.7, and 7.5% respectively. A statistically significant association between the presence of white lung, pleural effusion, peripheral GGO, and the need for ICU admission as well as mechanical ventilation was noted. The death was significantly higher among elderly patients; however, no significance was found between the imaging features and mortality. Conclusion CT features at first presentation can predict the need for ICU admission and the need for ventilation but cannot predict the mortality outcome of the patients.

PurposeThe long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health care institutions when patients return to elective surgery.MethodsA retrospective review of the first adult elective cases performed between May 18, 2020 and June 14, 2020, after the end of lockdown was analysed in Belgium to answer the following questions: (1) for the 236 cancelled patients during the outbreak, how easy was rescheduling? (2) How useful was universal RT-PCR testing and chest CT scan for the 211 orthopaedic and trauma admissions? (3) How were surgical difficulty category, number of operations and complications different when compared to the pre-COVID period? (4) How would patients balance the benefit of surgery against the unknown risk of developing COVID-19?ResultsBefore surgery, blood tests for anaesthesiology and imaging related to the surgical procedure were scheduled prior to universal testing (COVID-19 PCR and chest CT) performed 72–120 hours before surgery. Among the 211 asymptomatic patients who were tested before surgery, six had positive PCR, while no abnormality was found on the chest CT scan of all the patients. With this timing for tests, the 104 patients included in the current study for elective surgery were free of disease before undergoing surgery and remained without COVID-19 after surgery. Among the 366 cancelled patients during the outbreak, only 12% of the patients accepted to proceed with rescheduling immediately. Therefore, this resulted in a 70% reduction for elective surgery and in a 50% reduction for arthroplasties as compared to pre-COVID period. The rate of complications was not increased during the post-COVID period. A portion of patients have confused idea of screening and have difficulty to perceive the new rules of health organization.ConclusionsResumption of elective surgical procedures appears more difficult for patients than for surgeons with a low percentage of cancelled patients accepting to reschedule surgery. Universal testing allowed securing patients; however, surgeons must explore better patient perceptions regarding COVID-19 to facilitate a fully informed decision in the current period., info:eu-repo/semantics/published

Aim To observe the clinical course of symptomatic pregnant women diagnosed with or suspected of having COVID‐19. Methods This study analyzed the clinical and laboratory results of 27 patients with real‐time polymerase chain reaction (RT‐PCR)‐confirmed COVID‐19 and 25 patients with a suspected COVID‐19 diagnosis based on their symptoms and chest computed tomography (CT) findings. The patients' coagulation parameters and acute‐phase reactants were evaluated both before and after treatment. The maternal and neonatal outcomes were also reviewed. Results The mean duration of hospitalization was 6.1 ± 3 days. The gestational age of the patients ranged from 6w2d to 40w2d. Thirty‐five patients' CT scan findings suggested viral pneumonia. Four patients delivered vaginally, and 10 patients underwent a cesarean section during the study period. Four of the cesarean deliveries were indicated due to COVID‐19 hypoxemia‐related fetal distress. Four patients were admitted to the intensive care unit (ICU) after the cesarean section. Conclusion Early hospitalization and medical treatment can alleviate symptoms, improve the clinical course and reduce the need for ICU in symptomatic pregnant patients with suspected or confirmed COVID‐19. Chest CT scans are a suitable option for suspected but unconfirmed COVID‐19 infection.

Introducción y objetivos El papel fundamental de la tomografía computarizada (TC) de tórax para el diagnóstico y el pronóstico de la enfermedad por coronavirus-2019 (COVID-19) sigue siendo un campo abierto por explorar. Este estudio se realizó para evaluar las características de la TC en los casos confirmados con COVID-19. Materiales y métodos De forma retrospectiva, se revisaron los datos de la TC torácica inicial de 363 casos confirmados con COVID-19. Todos los sujetos se estratificaron en tres grupos en función de los resultados clínicos de los pacientes; grupo no crítico (n=194), grupo crítico (n=65), y grupo de muerte (n=104). Los detalles de los hallazgos de la TC se obtuvieron de las historias clínicas de los pacientes y posteriormente se evaluaron para cada grupo. Además, se utilizó la regresión logística multinomial para analizar los factores de riesgo según los hallazgos de la TC en tres grupos de pacientes con COVID-19. Resultados En comparación con el grupo no crítico, las opacidades mixtas en vidrio esmerilado (GGO, por sus siglas en inglés) y la lesión de consolidación, la lesión de derrame pleural, la presencia de opacidad difusa en los casos, más de 2 lóbulos afectados y las puntuaciones de opacidad fueron significativamente mayores en los grupos crítico y de muerte (P

Highlights • We evaluated the immunochromatographic (IC) assay and chest CT scan for COVID-19. • IC assay had 29.7 % sensitivity in symptomatic cases. • The combination of CT scan and IC assay had 82.4 % sensitivity in symptomatic cases. • IC assay alone is not recommended for initial test of COVID-19 because of low sensitivity. • If RT-qPCR is not available, the combination of chest CT and IC assay may be useful., Background We evaluated the clinical performance of an immunochromatographic (IC) IgM/IgG antibody assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) and chest computed tomography (CT) for the diagnosis of Coronavirus disease 2019 (COVID-19). Methods We examined 139 serum specimens collected from 112 patients with COVID-19 and 48 serum specimens collected from 48 non-COVID-19 patients. The presence of IgM/IgG antibody for SARS-COV2 was determined using the One Step Novel Coronavirus (COVID-19) IgM/IgG Antibody Test. Chest CT was performed in COVID-19 patients on admission. Findings Of the139 COVID-19 serum specimens, IgM was detected in 27.8 %, 48.0 %, and 95.8 % of the specimens collected within 1 week, 1–2 weeks, and >2 weeks after symptom onset and IgG was detected in 3.3 %, 8.0 %, and 62.5 %, respectively. Among the 48 non-COVID-19 serum specimens, 1 generated a false-positive result for IgM. Thirty-eight of the 112 COVID-19 patients were asymptomatic, of whom 15 were positive for IgM, and 74 were symptomatic, of whom 22 were positive for IgM and 7 were positive for IgG. The diagnostic sensitivity of CT scan alone and in combination with the IC assay was 57.9 % (22/38) and 68.4 % (26/38) for the asymptomatic patients and 74.3 % (55/74) and 82.4 % (61/74) for the symptomatic patients, respectively. Conclusion The IC assay had low sensitivity during the early phase of infection, and thus IC assay alone is not recommended for initial diagnostic testing for COVID-19. If RT-qPCR is not available, the combination of chest CT and IC assay may be useful for diagnosing COVID-19.

Background: There is sparse information to describe the clinical features and outcomes of patients infected with coronavirus disease 2019 (COVID-19) Methods: In a single-center retrospective observational study, 50 patients infected with COVID-19 were studied Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed Outcomes of critically ill patients and noncritically ill patients were compared Results: The mean age of the patients was 48 8 years, with male predominance Dry cough, fever, and dyspnea were the most complaining symptoms on admission Chronic medical illnesses before admission were present in 56% of the patients The most common laboratory abnormalities were lymphopenia, neutrophilia, thrombocytopenia, increased aspartate aminotransferase, high serum creatinine level, elevated lactate dehydrogenase, and increasing ESR and CRP levels Bilateral mixed ground-glass opacity and consolidation were observed in chest CT scan of most patients Some patients required supplemental oxygen and some needed invasive mechanical ventilation Blood oxygen saturation was different between survivors and nonsurvivors 10% of patients died, of whom 60% were men 40% of dead cases had chronic medical illnesses;60% underwent invasive mechanical ventilation Conclusion: Among the patients diagnosed with COVID-19 infection, the frequent clinical presentation was with a wide range of signs and symptoms The laboratory changes suggest that COVID-19 infection may be related to cellular immune deficiency, myocardial, hepatic, and kidney injury Additional research is needed to elucidate COVID-19 pathogenesis © 2021 Iran University of Medical Sciences

Objective We retrospectively analyzed the data of 32 hemodialysis patients with COVID-19 to clarify the epidemiological characteristics of this special population. Method The data of 32 hemodialysis patients with COVID-19, including epidemiological, demographic, clinical, laboratory, and radiological, were collected from the Blood Purification Department of Wuhan Fourth Hospital from February 3 to 16, 2020. Results Of the 32 patients, 23 were male, and the median age was 58 years; the median dialysis vintage was 33 months. Two groups were divided according to the patient’s primary renal disease: group 1 (16 patients with diabetic nephropathy), group 2 (12 patients with primary glomerulonephritis, 2 with obstructive kidney disease, 1 with hypertensive renal damage, and 1 with polycystic kidney). No significant differences were observed between the two groups in epidemiological characteristics, blood cell counts, and radiological performance. Hemodialysis patients are susceptible to COVID-19 at all ages, and patients with diabetes may be a high-risk population (50%). Common symptoms included fever (15 cases), cough (21 cases), and fatigue (7 cases). The blood lymphocyte count decreased in 84.6% of the patients (median: 0.765 × 109/L). Chest CT revealed ground-glass-like lesions in 18 cases, unilateral lung patchiness in 7 cases, bilateral lung patchiness in 7 cases, and pleural effusion in 2 cases. Conclusion Only 46.875% of the hemodialysis patients with COVID-19 had fever in the early stage; and diabetics may be the most susceptible population. A decrease in blood lymphocyte count and ground-glass opacity on chest CT scan is beneficial in identifying the high-risk population.

Objective the pandemic of coronavirus disease 2019 (COVID-19), hospitals worldwide are at risk of nosocomial infection. Preoperative identification of COVID-19 in patients who are scheduled to be admitted to the hospital is essential to preventing the collapse of medical facility. In Japan, the preoperative observation and screening tests with the RT-PCR testing for the new coronavirus (SARS-CoV-2) and chest CT scan are recommended for head and neck cancer surgery during the COVID-19 pandemic. Method We conducted surveys of the current situation in Japan through the internet. Results Chest CT scan was fully performed (90%), but the RT-PCR testing was not adequately performed (51%). Conclusion Although the current screening system can be considered effective to a certain extent, we recommend further widespread use of pre-admission RT-PCR testing not only for patients with head and neck cancer surgery but also for all the hospitalized patients, in order to promote safer treatments, during the COVID-19 pandemic.

The new coronavirus disease (COVID-19) has been declared a pandemic since March 2020 by the World Health Organization. It consists of an emerging viral infection with respiratory tropism that could develop atypical pneumonia. Experts emphasize the importance of early detection of those who have the COVID-19 virus. In this way, patients will be isolated from other people and the spread of the virus can be prevented. For this reason, it has become an area of interest to develop early diagnosis and detection methods to ensure a rapid treatment process and prevent the virus from spreading. Since the standard testing system is time-consuming and not available for everyone, alternative early screening techniques have become an urgent need. In this study, the approaches used in the detection of COVID-19 based on deep learning (DL) algorithms, which have been popular in recent years, have been comprehensively discussed. The advantages and disadvantages of different approaches used in literature are examined in detail. We further present the databases and major future challenges of DL-based COVID-19 detection. The computed tomography of the chest and X-ray images gives a rich representation of the patient's lung that is less time-consuming and allows an efficient viral pneumonia detection using the DL algorithms. The first step is the preprocessing of these images to remove noise. Next, deep features are extracted using multiple types of deep models (pretrained models, generative models, generic neural networks, etc.). Finally, the classification is performed using the obtained features to decide whether the patient is infected by coronavirus or it is another lung disease. In this study, we also give a brief review of the latest applications of cough analysis to early screen the COVID-19 and human mobility estimation to limit its spread.

Rheumatoid pneumoconiosis, also known as Caplan's syndrome is defined as the association between silicosis and rheumatoid arthritis (RA). It is a rare and usually diagnosed in an advanced stage of RA course. It affects generally patients with long exposure to silica. In this article, we report a case of Caplan's syndrome. Keywords: Caplan syndrome, Rheumatoid arthritis, Silicosis, Chest CT scan, Rituximab

Background: We aimed to assess the management and outcome of occult pneumothorax and to determine the factors associated with failure of observational management in patients with blunt chest trauma (BCT). Methods: Patients with BCT were retrospectively identified from the trauma database over 4 years. Data were analyzed and compared on the basis of initial management (conservative vs. tube thoracostomy). Results: Across the study period, 1928 patients were admitted with BCT, of which 150 (7.8%) patients were found to have occult pneumothorax. The mean patient age was 32.8 ± 13.7 years, and the majority were male (86.7%). Positive-pressure ventilation (PPV) was required in 32 patients, and bilateral occult pneumothorax was seen in 25 patients. In 85.3% (n = 128) of cases, occult pneumothorax was managed conservatively, whereas 14.7% (n = 22) underwent tube thoracostomy. Five patients had failed observational treatment requiring delayed tube thoracostomy. Pneumonia was reported in 12.8% of cases. Compared with those who were treated conservatively, patients who underwent tube thoracostomy had thicker pneumothoraxes and a higher rate of lung contusion, rib fracture, pneumonia, prolonged ventilatory days, and prolonged hospital length of stay. Overall mortality was 4.0%. The deceased had more polytrauma and were treated conservatively without a chest tube. Patients who failed conservative management had a higher frequency of lung contusion, greater pneumothorax thickness, higher Injury Severity Scores (ISS), and required more PPV. Conclusions: Occult pneumothorax is not uncommon in BCT and can be successfully managed conservatively with a close clinical follow-up. Intervention should be limited to patients who have an increase in size of the pneumothorax on follow-up or become symptomatic under observation. Patients who fail conservative management may have a greater pneumothorax thickness and higher ISS. However, large prospective studies are warranted to support these findings and to establish the institutional guidelines for the management of occult pneumothorax.

La tuberculose est une maladie due à une infection par le bacille tuberculeux, tous les organes peuvent être touchés, la tuberculose pulmonaire représente un peu plus de 50% des atteintes, elle constitue un problème de santé publique dans le monde entier et particulièrement dans les pays en voie de développement. La tuberculose broncho-pulmonaire pseudo-tumorale est une forme de présentation particulière de la tuberculose chez le sujet immunocompétent, elle peut revêtir la forme d'une lésion bronchique ou pulmonaire évocatrice d'une pathologie néoplasique, que ce soit sur une TDM thoracique ou lors d'une endoscopie bronchique. Cette similitude avec la pathologie néoplasique est source de confusion pour le clinicien et rend difficile l'établissement du diagnostic positif, elle nécessite le recours à des moyens diagnostiques souvent invasifs, puisque les moyens classiques sont généralement mis à défaut, ce qui alourdit la prise en charge et retarde la mise sous traitement. L'objectif de cet article est de sensibiliser le clinicien vis-à-vis de cette forme particulière de présentation de la tuberculose, certes peu fréquente, mais à évoquer de principe devant un aspect radiologique compatible d'autant plus que le pays de résidence est de forte endémicité. Le traitement de cette forme demeure le même que celui des présentations habituelles, que ce soit en matière de médicaments ou de durée.

International audience; Objective: The aim was to create and validate a community-acquired pneumonia (CAP) diagnostic algorithm to facilitate diagnosis and guide chest computed tomography (CT) scan indication in patients with CAP suspicion in Emergency Departments (ED).Methods: We performed an analysis of CAP suspected patients enrolled in the ESCAPED study who had undergone chest CT scan and detection of respiratory pathogens through nasopharyngeal PCRs. An adjudication committee assigned the final CAP probability (reference standard). Variables associated with confirmed CAP were used to create weighted CAP diagnostic scores. We estimated the score values for which CT scans helped correctly identify CAP, therefore creating a CAP diagnosis algorithm. Algorithms were externally validated in an independent cohort of 200 patients consecutively admitted in a Swiss hospital for CAP suspicion.Results: Among the 319 patients included, 51% (163/319) were classified as confirmed CAP and 49% (156/319) as excluded CAP. Cough (weight = 1), chest pain (1), fever (1), positive PCR (except for rhinovirus) (1), C-reactive protein ≥50 mg/L (2) and chest X-ray parenchymal infiltrate (2) were associated with CAP. Patients with a score below 3 had a low probability of CAP (17%, 14/84), whereas those above 5 had a high probability (88%, 51/58). The algorithm (score calculation + CT scan in patients with score between 3 and 5) showed sensitivity 73% (95% CI 66-80), specificity 89% (95% CI 83-94), positive predictive value (PPV) 88% (95% CI 81-93), negative predictive value (NPV) 76% (95% CI 69-82) and area under the curve (AUC) 0.81 (95% CI 0.77-0.85). The algorithm displayed similar performance in the validation cohort (sensitivity 88% (95% CI 81-92), specificity 72% (95% CI 60-81), PPV 86% (95% CI 79-91), NPV 75% (95% CI 63-84) and AUC 0.80 (95% CI 0.73-0.87).Conclusion: Our CAP diagnostic algorithm may help reduce CAP misdiagnosis and optimize the use of chest CT scan.

Objective To study non-enhanced computer tomographic features of chest imaging in 302 patients with Corona Virus Disease 2019 (COVID-19) in Jordan. Material and method A retrospective analysis of non-enhanced computer tomographic scans has been performed in the main center for patients diagnosed with COVID-19 in Prince Hamzah Hospital for those scanned from 13th of March 2020 to 13th of May 2020. Included scans were routinely performed during 24-hs of admission apart from having respiratory complaint. CT protocol included non-enhanced 1 mm slice thickness by Philips Brilliance Big Bore scanner (Philips; Amsterdam, Netherlands). All computer tomographic scans were reviewed by two senior radiologists with more than 8 years of experience each and senior registrar. Several factors have been thoroughly studied including patient age, gender, positive versus negative pulmonary findings, laterality of lung involvement, lobar distribution, pattern of pulmonary changes on initial and follow-up scans. Results The total number of patients evaluated was 302. There were 188 men and 114 women studied. Among the totally studied 302 cases; 181 cases (59.9 %) showed no pulmonary changes. Positive findings were present in 121 patients with a total number of 191 computer tomographic scans including initial and follow-up scans. Positive findings were present in 51 female and 70 male patients (age range, 12–87 years; mean age ± standard deviation, 46.1 ± 16.5). Bilateral disease was more frequently encountered presented in 86 cases (71.1 %), while unilateral disease showed two times more predilection for the right lung compared to the left. The incidence of lobar involvement in descending order: right lower (75.2 %), left lower (71.9 %), right upper (62.8 %), left upper (60.3 %) and right middle (50.4 %). The incidence of the affected lobes on the initial scans were as follow: one lobe (24 %), two lobes (10.7 %), three lobes (9.1 %), four lobes (16.5 %) five lobes (36.4 %). In cases with single lobar involvement (24 %); the left upper and right middle lobes showed lowest incidence of involvement accounting for 10.3 % & 13.8 %, respectively; on the other hand, in cases with four lobar involvement (16.5 %); the right middle lobe was most commonly spared in two third of cases (63.2 %). Several initial patterns of the pulmonary changes resulting from Corona Virus Disease 2019 (COVID-19) were present with a descending order; ground-glass pattern (96.7 %), lenticular pattern (32.2 %), Halo sign (15.7 % %), rounded (14.9 %), nodular (10.7 %), ground-glass with consolidation (8.3 %), tree-in-bud (1.7 %) and pleural effusion (1.7 %). Pathologically-enlarged lymph node was not a feature of COVID-19. The total number of patients with positive findings having follow-up scans was 57 including single (45 patients) versus two (12 patients) follow-up scans. Initial follow up scans showed regression and progression of the pulmonary changes in 35 and 22 patients, respectively. A remarkable pattern was seen in almost all regressed cases that showed patchy reticular pattern changes with septal thickening which was referred to “pulmonary synapses” (34 patients) with only one patient showed complete resolution of the parenchymal changes. Patterns seen in progressed cases were lenticular ground-glass (63.6 %) vs patchy ground-glass (36.4 %) patterns. Conclusion Computer tomographic scan of the chest is a principal diagnostic measure for Corona Virus Disease 2019 (COVID-19). The pulmonary changes showed more propensity being bilateral disease and affecting the lower lobes, while the right middle lobe was the least likely involvement. Several pattern of pulmonary changes can be seen on initial scans including ground glass, consolidation, Halo sign, lenticular, nodular, pleural effusion and tree-in-bud patterns. The tree-in-bud is first-time described pattern of COVID-19 in the current article and thought to be an excluding criterion. In follow-up scans; the lenticular and patchy ground-glass patterns were present in cases with disease progression, compared with “pulmonary synapses” pattern encountered in cases with disease regression.

Introduction Lipoid pneumonia is a clinical condition that may be initially asymptomatic or confused with an infectious or malignant lung disease. Objectives We report four cases of this pathological condition. Methods The first case concerned an 85-year old woman with bilateral confluent pulmonary opacities, ground-glass type. Diagnosis was based on the cytology of the bronchoalveolar lavage (BAL) fluid followed by its ultrastructural examination. The second case was a 47-year-old man with an isolated pulmonary nodule, which was surgically removed; the diagnosis of lipoid pneumonia was formulated on the basis of the histological and electron microscopy examination. The third case concerned a 73-year-old woman, with bilateral hypodense areas at the bases of the lungs where FDG PET/CT scan showed an increased uptake. Diagnosis was formulated by BAL cytology and electron microscopy examination. The fourth case was a 69-year-old man, who performed a virtual colonoscopy for diverticulosis putting in evidence a round mass (3 cm in diameter) with two small peripheral nodules, located in the pulmonary left lower lobe. The histopathological examination of transthoracic biopsy confirmed a lipoid pneumonia. Results and conclusion In all four cases, it was put in evidence a prolonged use of a nasal decongestant containing mineral oils. In literature, the most cases described are characterized by a subclinical evolution and were presented as ground glass opacities which evolve, in the later phases, in an interstitial involvement or in a peripheral mass, simulating a lung tumour.

A mosaic pattern of lung attenuation on chest computed tomography (CT) may be due to various etiologies. There is limited published data on CT results when used to evaluate pulmonary hypertension (PH). We retrospectively studied the frequency of mosaic pattern in patients with PH and the cause of the PH by diagnostic group, as well as the correlation between the mosaic pattern and the following: demographics, severity of the PH, main pulmonary artery (PA) size, PA/aorta (PA/Ao) ratio, pulmonary function tests (PFT), and ventilation perfusion scan results. Overall, 18% of the cohort had CT mosaic pattern (34/189). Mosaic pattern was present in 17/113 (15%) in Group 1 pulmonary arterial hypertension, 5/13 (28%) in Group 2 pulmonary venous hypertension and 8/50 (16%) in Group 3 PH. Conversely, Group 4 chronic thromboembolic PH was more prevalent in 4/8 (50%). Main PA size, PA/Ao ratio, and segmental perfusion defect were positively associated with mosaic pattern. In contrast, factors such as age, gender, body mass index, functional class, hemodynamic data, and PFT values were not associated with mosaic pattern. Mosaic pattern is not specific as an isolated finding for distinguishing the subtype of PH.

No abstract available. Article truncated at 150 words. Clinical History: A 38-year-old non-smoking woman presented with complaints of intermittent dry cough, occasional vomiting, and dyspnea, occasionally with fever and chills. She indicated that she has suffered recurrent bouts of bronchitis and pneumonia annually over the previous 10 years. The patient had a history of upper arm localized melanoma resection 10 years earlier. She had smoked for 10 years, but quit one year prior to presentation. Her past medical and surgical histories were otherwise unremarkable. Frontal and lateral chest radiography (Figure 1) was performed. Which of the following statements regarding the chest radiograph is most accurate? 1. The chest radiograph shows asymmetric pulmonary vascularity ; 2. The chest radiograph shows bilateral linear and reticular opacities and diminished lung volumes suggesting fibrotic lung disease; 3. The chest radiograph shows mild, bilateral, streaky central opacities, possibly reflecting airway thickening; 4. The chest radiograph shows numerous small nodules; 5. The chest radiograph ...

No abstract available. Article truncated after first page. Clinical History: A 66-year-old woman presented with complaints of cough worsening over the previous several months. Her prior medical history was largely otherwise unremarkable. Frontal chest radiography (Figure 1) was performed for evaluation. Which of the following statements regarding the chest radiograph is most accurate? 1. The chest radiograph shows a solitary pulmonary nodule; 2. The chest radiograph shows multifocal airway thickening and bronchiectasis; 3. The chest radiograph shows multifocal, bilateral cavitary nodules and consolidation; 4. The chest radiograph shows multifocal, somewhat basal predominant linear opacities within diminished lung volumes, suggesting fibrosis; 5. The chest radiograph shows multiple small nodules, suggesting a miliary pattern ...

No abstract available. Article truncated after first page. A 67-year-old man with a history of hypertension and chronic lymphocytic leukemia (CLL), the latter diagnosed 10 years earlier, in remission until recently, presented with complaints of weight loss, not eating much, lethargy, and shortness of breath. His CLL had recurred and he was treated with rituximab, and bendamustine (a nitrogen mustard alkylating agent) and intravenous immunoglobulin. Frontal chest radiography (Figure 1) was performed. Which of the following statements regarding the chest radiograph is most accurate? 1. The chest radiograph shows basal predominant linear opacities suggesting fibrosis 2. The chest radiograph shows large lung volumes with cystic change 3. The chest radiograph shows multifocal ground-glass opacity and cavitary consolidation 4. The chest radiograph shows multifocal ground-glass opacity and consolidation associated with linear and reticular abnormalities 5. The chest radiograph shows multiple nodules

In haematological malignancies, the development of lung disease is a common source of significant morbidity and mortality for this population of patients. There is a wide range of infectious and non-infectious aetiologies that can be responsible for such complications. It is a major challenge to make an early diagnosis of aetiology in order to choose the most suitable treatment. Computed tomography (CT) of the chest has undeniably become a crucial tool in diagnosing these cases of lung disease. Although it is not possible to make a definitive diagnosis of aetiology based solely on analysing CT scan findings in these complex patients, there are some abnormalities that are highly suspicious for particular diagnoses. CT, therefore, allows the clinician to put forward and prioritise possible diagnoses that may then be considered in view of clinical information and laboratory study results. There must be multidisciplinary involvement in the management of lung disease patients and there must be an ongoing dialogue between the radiologist and the clinician.

Acute aortic dissection usually presents with severe chest and/or back pain but may have a varied presentation ranging from syncope, stroke, and heart failure to shock or tamponade. We present classic chest computed tomography images of a case of type A aortic dissection presenting with cardiac tamponade.Keywords: aortic dissection; cardiac tamponade; clinical image; chest CT scan(Published: 25 November 2014)Citation: Journal of Community Hospital Internal Medicine Perspectives 2014, 4: 25449 - http://dx.doi.org/10.3402/jchimp.v4.25449

Lung disease in cystic fibrosis (CF) starts early, with studies identifying abnormalities on chest computed tomography (CT) scan even in infancy. In this retrospective study, abnormal chest CT was the main outcome; body mass index (BMI) z score and forced expiratory volume percent predicted (FEV1%) predicted at age 6 to 7 years were secondary outcomes. Pseudomonas aeruginosa infection prior to 12 months of age was the main explanatory variable. There was no association between early P aeruginosa infection and abnormal CT after adjustment for CFTR (cystic fibrosis transmembrane conductance regulator) functional mutation class, gender, and other pathogens (odds ratio = 0.30; 95% confidence interval = 0.07-1.35; P = .11). No significant associations were demonstrated for BMI z score and FEV1% predicted. Children with class I-III CFTR mutations had increased risk of abnormal CT findings (odds ratio = 11.67; 95% confidence interval = 1.11-115.06; P = .035) and lower FEV1% predicted ( P = .04). In the current era, early-life P aeruginosa infection in CF might not influence the severity of lung disease in school age as much as previously. Larger studies are needed to confirm this finding.

No abstract available. Article truncated at 150 words. A 63-year-old man with a past history significant for hypertension, low back pain and polysubstance abuse (tobacco and marijuana) presented with shortness of breath and hemoptysis for the last 8 days prior to admission. His initial exam showed elevated jugular venous pressure and bilateral basal crackles with reduced air entry on the right lower lung zone. The patient was found to be in atrial fibrillation with a rapid ventricular response. His initial chest X-ray showed a moderate right-sided pleural effusion. Immediate bedside echo was concerning for bilateral ventricular dysfunction with concerns of right-sided heart pressure and volume overload. A chest CT angiogram was obtained and showed acute lower lobe pulmonary embolism, with possible distal infarct, moderate right sided pleural effusion, and filling defects in both atrial appendages concerning for thrombi (Figure 1, Panels A & B). The patient was started on therapeutic anticoagulation and underwent therapeutic thoracentesis, gentle diuresis, and ...

Pleural effusion is commonly seen associated with pneumonia. When this progresses to empyema, directed therapy is frequently required. Chest radiographic and computed tomography findings can help distinguish empyema from a transudative pleural effusion. Keywords: chest x-ray; pneumonia; empyema; chest tube; chest CT scan (Published: 17 April 2013) Citation: Journal of Community Hospital Internal Medicine Perspectives 2013, 3 : 20503 - http://dx.doi.org/10.3402/jchimp.v3i1.20503

No abstract available. Article truncated at 150 words. A 65 year old man presented with mild increase in shortness of breath. He had a past medical history of diabetes mellitus, hypertension, and severe malnutrition with percutaneous endoscopic gastrostomy (PEG) placement after a colectomy and end ileostomy for sigmoid volvulus. CXR (Figure 1) suggested a pneumomediastinum with subsequent chest CT (Figure 2) confirming moderate sized pneumomediastinum. He had a chronic cough from chronic obstructive pulmonary disease (COPD) as well as aspiration and chest CT also demonstrated emphysema with small blebs. He denied any significant chest pain. He was followed conservatively with imaging and discharged in stable condition. Pneumomediastinum can be caused by trauma, esophageal rupture after vomiting (Boerhaave’s syndrome) and can be a spontaneous event if no obvious precipitating cause is identified (1). Valsalva maneuvers such as cough, sneeze, vomiting and childbirth, can all cause pneumomediastinum. Risk factors include asthma, COPD, interstitial lung disease and inhalational recreational drug use. …

Background: To prospectively apply an automated, quantitative three-dimensional approach to imaging and airway analysis to assess airway remodeling in asthma patients.Methods: Using quantitative software (Pulmonary Workstation, version 0.139; VIDA Diagnostics; Iowa City, IA) that enables quantitative airway segment measurements of low-close, thin-section (0.625 to 1.25 mm), multidetector-row CT (MDCT) scans, we compared airway wall thickness (WT) and wall area (WA) in 123 subjects participating in a prospective multicenter cohort study, the National Institutes of Health Severe Asthma Research Program (patients with severe asthma, n = 63; patients with mild-to-moderate asthma, n = 35); and healthy subjects, n = 25). A subset of these subjects underwent fiberoptic bronchoscopy and endobronchial biopsies (n = 32). WT and WA measurements were corrected for total airway diameter and area: WT and WA, respectively.Results: Subjects with severe asthma had a significantly greater WT% than patients with mild-to-moderate asthma and healthy, subjects (17.2 +/- 1.5 vs 16.5.+/- 1.6 [p = 0.014] and 16.3 +/- 1.2 [p = 0.031], respectively) and a greater WA percentage (WA%) compared to patients with mild-to-moderate asthma and healthy subjects (56.6 +/- 2.9 vs 54.7 +/- 3.3 [p = 0.005] and 54.6 +/- 2.4 [p = 0.003], respectively). Both WT% and WA% were inversely correlated with baseline FEV, percent predicted (r = -0.39, p Conclusion: Patients with severe asthma have thicker airway walls Lis measured on MDCT scan than do patients with mild asthma or health), subjects, which correlates with pathologic measures of remodeling and the degree of airflow obstruction. MDCT scanning may be a useful technique for assessing airway remodeling in asthma patients, but overlap among the groups limits the diagnostic value in individual subjects. (CHEST 2008; 134:1183-1191)

A 33-year-old man presented to the emergency department with shortness of breath and hemoptysis. He was discharged two days prior after hospitalization for a motor vehicle accident, in which he suffered a fracture of the shaft of the right femur. He had undergone open reduction and internal fixation of the fracture four days prior to this admission. He had diffuse parenchymal disease on his admission chest x-ray. A CT scan of the chest demonstrated multilobar ground glass opacities (Figure 1). Bronchoscopy demonstrated progressively bloody BAL aliquots in two different lobes, consistent with diffuse alveolar hemorrhage (DAH). His workup for other etiologies was negative, and he was given a diagnosis of DAH secondary to fat embolism syndrome.

Summary Objective To assess the association between primary spontaneous pneumothorax (PSP) recurrence and pulmonary CT scan findings, and other variables pertaining to clinical presentation and management. Methods Consecutive patients hospitalized for the first episode of PSP and treated by various strategies including chest tube or pleurocatheter drainage and, in persistent pneumothorax, by chemical or surgical pleurodesis. All patients had a pulmonary CT scan examination in the week following hospital discharge in order to calculate a score combining distribution, number and size of dystrophic pulmonary abnormalities. This score as well as other pertinent clinical and therapeutic parameters were compared between patients who ultimately experienced PSP recurrence and those who did not. Results Eighty patients (mean age: 27±7yr) were admitted for PSP and had a chest drainage with either a drain or pleurocatheter. Chest drainage and hospitalization durations were 4.7±3.2 and 6.2±3.5 days, respectively. Sixteen patients required chemical pleurodesis. Dystrophic bullae were present in CT scans in 72.5% patients. After a mean follow up of 34±20 months, 15 out of the 80 patients (19%) had a PSP recurrence. Multivariate statistical analysis disclosed the use of pleurocatheter ( OR = 5 ; 95% CI: 1.4–20; P = 0.02 ) and of chemical pleurodesis ( OR = 8 ; 95% CI: 1.5–47; P = 0.015 ) as independent predictors of PSP recurrence. The severity of dystrophic lesions inferred from the dystrophic score was not statistically associated with the risk of recurrence. Conclusion Dystrophic lesions are frequently present in PSP. They are not associated with an increased risk of recurrence.