Search

Purpose Patients affected by COVID-19 are assumed to be at high risk of developing swallowing disorders. However, to our best knowledge, data on the characteristics and incidence of dysphagia associated with COVID-19 are lacking, especially in non-intubated patients. Therefore, we investigated the onset of swallowing disorders in patients with laboratory-confirmed COVID-19 infection who have not been treated with invasive ventilation, in order to evaluate how the virus affected swallowing function regardless of orotracheal intubation. Methods We evaluated 41 patients admitted to the COVID department of our Hospital when they had already passed the acute phase of the disease and were therefore asymptomatic but still positive for SARS-CoV-2 RNA by RT-PCR. We examined patients’ clinical history and performed the Volume-Viscosity Swallow Test (VVST). Each patient also answered the Swallowing Disturbance Questionnaire (SDQ). After 6 months, we performed a follow-up in patients with swallowing disorders. Results Eight of 41 patients (20%) presented with dysphagia symptoms during hospitalization and 2 of them (25%) still presented a SDQ high score and swallowing disorders with liquid consistency after 6 months. Conclusion Non-intubated patients can experience various grades of swallowing impairment that probably directly related to pulmonary respiratory function alterations and viral direct neuronal lesive activity. Although these symptoms show natural tendency to spontaneous resolution, their impact on a general physical impaired situation should not be underestimated, since it can adversely affect patients’ recovery from COVID-19 worsening health outcomes.

Transthoracic ultrasound (TUS) is an accepted complementary tool in the diagnostic process of several pleuro-pulmonary diseases. However, to the best of our knowledge, TUS findings in patients with severe asthma have never been systematically described.To explore if TUS examination is a useful imaging method in suggesting the presence of a "small airways disease" in patients with severe uncontrolled asthma.Seventy-two consecutive subjects with a diagnosis of severe uncontrolled asthma were enrolled. The presence of a "small airways disease" was assessed through the execution of pulmonary function tests. All the patients underwent a complete TUS examination and a chest high resolution computed tomography (HRCT), which was regarded as the reference standard for comparison with TUS findings.Pulmonary function tests results have confirmed a reduction in expiratory flows relative to the small airways and a condition of hyperinflation in 78% and 82% of our patients, respectively. The main signs observed in the TUS examination were a thickened and/or irregular pleural line and the lack or reduction of the "gliding sign." TUS showed high sensitivity and specificity in suggesting the presence of hyperinflation and distal airways inflammation according to the HRCT scan. K Cohen's coefficients showed substantial agreement between the 2 diagnostic tests.TUS in patients with severe uncontrolled asthma can provide useful information on the state of the peripheral lung, suggesting the execution of a second-line HRCT scan for better assessment of eventual alterations that may represent the underlying causes of nonresponse to treatment.

Adenoid Cystic Carcinoma (ACC) is a rare malignant tumor, accounting for about 1% of head and neck malignancies and 10% of salivary gland cancers. The laryngeal localization of ACC is particularly rare because of the paucity of accessory salivary glands in this anatomical district. Prevalence is highest in the fifth and sixth decade of life with a slight female predilection and aetiology is unknown. Since laryngeal ACC characteristically grows slowly and occurs in the subglottis, the diagnosis, which is based on the combination of physical examination with fiberoscopy and neck-chest Computerized Tomography (CT), is often delayed. Nowadays the debate is still open about which is the best comprehensive therapy of this tumor. We present the case of a laryngeal ACC in a 68 year-old-woman, treated with total laryngectomy together with bilateral neck dissection and a literature review made with the purpose to point out the most recent advancements towards the definition of a gold-standard therapy. Laryngectomy results as the first choice treatment, while chemotherapy has minimal effects on this neoplasm and radiotherapy alone does not show the capacity to lead to complete resolution, but there is still the need of further studies to clarify the usefulness and the role played by neck dissection and postoperative radiotherapy.

The pandemic spread of the new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has raised the necessity to identify an appropriate imaging method for early diagnosis of coronavirus disease 2019 (COVID-19). Chest Computed Tomography (CT) has been regarded as the mainstay of imaging evaluation for pulmonary involvement in the early phase of the pandemic. However, due to the poor specificity of the radiological pattern and the disruption of Radiology Centers functionality linked to an excessive demand for exams, the American College of Radiology (ACR) has advised against CT use for a screening purpose. Lung ultrasound (LUS) is a point-of care imaging tool that is fast available and easy to disinfect. These advantages have determined a “pandemic” increase of its use for early detection of COVID-19 pneumonia in Emergency Departments. However, LUS findings in COVID-19 patients are even less specific than those detectable on CT scan. The scope of this perspective article is to discuss about the great number of diseases and pathologic conditions that may mimic COVID-19 pneumonia on LUS examination.

In the last years, transthoracic ultrasound (TUS) has regained a growing interest from both clinicians and radiologists as a useful and non-invasive diagnostic tool for the study of many pleuro-pulmonary conditions, including interstitial lung diseases. Intraoperative lung ultrasound (ILU) is an ultrasound technique, developed for lung surface assessment during video-assisted thoracoscopic surgery procedures. It has been developed considering ultrasound basic physics principles for images generation and interpretation. Most of the TUS findings are due to the high difference in acoustic impedance between the chest-wall structures and the air in the lungs. In this brief communication, we compared ILU and TUS images in interstitial lung diseases. Most of the TUS artifacts-based diagnostic algorithms should be reappraised.

Introduction There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem.

Background: Transthoracic ultrasound (TU) is a validated complementary technique gold standard for studying pleural effusion, echo-guided thoracentesis, detection and ultrasound guided biopsy of pleural and sub-pleural lesions. We proposed to study patients affected by severe asthma (SA) with TU with the aim of identify eventually typical echografic pattern of this disease. Methods: We enrolled SA patients attended at the accredited outpatient clinic (Chung KF et al. Eur Respir J. 2014). Ultrasound scanner with thoracic set up, with convex probe (3.5-5 MHz) and linear probe (8-12 MHz), was used to perform complete TU scans, while the patient was sitting. The ultrasound signs were compared with thoracic high resolution computed tomography (HRCT) images. Results: We enrolled 30 severe asthmatics. At TU we found a lack of “gliding sign”, “Bar Code” sign in M-mode and presence of lung point in all our patients in middle thoracic anterior e posterior. These patterns mimic ultrasound pneumothorax. Therefore, in all our patients we highlighted a thickening of the hyperechoic pleural line (Figure 1). Conclusions: In TU the lack of “gliding sign” is a typical feature of pneumothorax. Although there are other pathologies that mimic this sign, we have found a new false positive of pneumothorax. Moreover, we may have identified patterns of ultrasound signs which could be used in follow up of SA patients.

Transthoracic Ultrasound (TUS) is a well-established imaging technique, mainly used for pleural and subpleural diseases adherent to the 70% of pleural surface visible by ultrasound [1].

The study by Kiranantawat et al. “Clinical role, safety and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation” highlights how “pulmonary consolidation can be safely evaluated with CT-guided percutaneous needle biopsy”. Even if we agree about the role of CT guidance, we would like to point out how Thoracic Ultrasound could be better than CT for biopsy of subpleural lesions that could easily be detected and reached with this “real-time” and quicker technique.

Transthoracic ultrasound (TUS) is a validate complementary technique widely used in everyday medical practice. TUS is the gold-standard for studying pleural effusion and for echo-guided thoracentesis, moreover, it is employed in detection of pleural and pulmonary lesions adherent to pleural surface and their ccho-guided percutaneous needle biopsy (PTNB). 1 We used TUS technique to study severe asthma patients. We found that several patterns are constant in these patients. One of these patterns, i.e. lack of gliding sign, mimic pneumothorax (PNX). In this study, we attempted an echographic approach to asthma, trying to lay the first stone for the individuation of common ultrasound patterns in this disease.