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Diagnosing diffuse infiltrative lung diseases (DILD) using high‐resolution computed tomography (HRCT) is challenging, even for expert radiologists, due to the complex and variable image patterns. Moreover, the imbalances among the six key DILD‐related patterns—normal, ground‐glass opacity, reticular opacity, honeycombing, emphysema, and consolidation—further complicate accurate segmentation and diagnosis. This study presents an enhanced U‐Net‐based segmentation technique aimed at addressing these challenges. The primary contribution of our work is the fine‐tuning of the U‐Net model using image‐level labels from 92 HRCT images that include various types of DILDs, such as cryptogenic organizing pneumonia, usual interstitial pneumonia, and nonspecific interstitial pneumonia. This approach helps to correct the imbalance among image patterns, improving the model's ability to accurately differentiate between them. By employing semantic lung segmentation and patch‐level machine learning, the fine‐tuned model demonstrated improved agreement with radiologists' evaluations compared to conventional methods. This suggests a significant enhancement in both segmentation accuracy and inter‐observer consistency. In conclusion, the fine‐tuned U‐Net model offers a more reliable tool for HRCT image segmentation, making it a valuable imaging biomarker for guiding treatment decisions in patients with DILD. By addressing the issue of pattern imbalances, our model significantly improves the accuracy of DILD diagnosis, which is crucial for effective patient care. [ABSTRACT FROM AUTHOR]

Diffuse alveolar haemorrhage (DAH) is a pulmonary disease where bleeding into alveoli via damaged basement membrane causes respiratory failure. Clinical manifestations are: anaemia, haemoptysis, dyspnea, fever and hypoxic respiratory failure. The origin can be immune-mediated or non-immune-mediated. Auto-immune causes of DAH are considered more serious prognostically. Vasculitis is the most common cause. To decrease mortality DAH needs to be recognized early and requires prompt treatment. Despite major mortality, treatment options are only empirical. One of them is treatment with steroids combined with rituximab/cyclophosphamide. In the most severe cases, plasma exchange therapy, mechanical ventilation or veno-venous extracorporal membrane oxygenation (vv-ECMO) are used. Diffuse alveolar bleeding should be differentiated from coagulophaty, cryptogenic organizing pneumonia (COP), acute interstitial pneumonia (AIP), allergic alveolitis, and acute respiratory distress syndrome (ARDS). [ABSTRACT FROM AUTHOR]

The article discusses synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, a rare autoinflammatory disease that manifests with articular and cutaneous symptoms. The exact cause of SAPHO syndrome is unknown, but it is believed to have a genetic basis and be linked to underlying infections and immune dysfunction. The syndrome is characterized by extra-articular and cutaneous manifestations, including lung and pleural involvement, digestive tract issues, kidney problems, ocular manifestations, nervous system complications, thrombosis, osteoporosis, sarcopenia, and cardiac manifestations. The article highlights the need for further research to understand the diverse clinical manifestations of SAPHO syndrome. [Extracted from the article]

This article discusses the presence of a reversed halo sign (RHS) in patients with melioidosis, a tropical infection, and poorly controlled diabetes. The study presents eight cases of pulmonary melioidosis with RHS, with patients ranging in age from 30 to 80 years. The patients were treated with antibiotics and most recovered well, except for two who died. The article emphasizes the importance of considering melioidosis as a differential diagnosis in patients with RHS and poorly controlled diabetes, particularly in individuals from South Asia. [Extracted from the article]

This article explores the impact of face mask usage on fungal acquisition in lung transplant recipients during the SARS-CoV-2 pandemic. The study found that there was no significant difference in fungal isolation between the periods before and after the mandatory use of face masks. However, there was a lower prevalence of fungal colonization during the period with face mask usage. The study suggests that face masks may have a preventive effect on fungal colonization in lung transplant recipients, but more research is needed to confirm these findings. [Extracted from the article]

The article focuses on interstitial lung disease (ILD), highlighting its increasing prevalence and the importance of early recognition for referral and management. Topics discussed include expanded Pharmaceutical Benefits Scheme (PBS) criteria for antifibrotic therapy, diverse ILD phenotypes, and the complexity of diagnosing ILD due to its various clinical presentations and associated risk factors.

A large number of monkeypox (MPOX) cases have been reported in Europe and North America in 2022, and a new outbreak of this disease was declared. We describe a case of a patient with probable monkeypox during the height of this epidemic in Poland. The patient's symptoms resolved within two weeks, but over the next two months, he developed community-acquired pneumonia requiring hospitalization and, subsequently, non-specific pleuritis. The simultaneous occurrence of such severe infections in a previously healthy young man is not typical and suggests a potential underlying cause. We believe the potential association of these diseases with probable monkeypox virus infection is very likely. Cases of monkeypox pneumonia, both viral and secondary bacterial, have already been reported in the literature. Cases of viral pleuritis in the course of MPOX in animals have also been described; however, to our knowledge, no similar cases have been described in humans to date. Our case indicates that it is important to monitor patients after MPOX in order to respond promptly to potentially life-threatening but, as of yet, not fully understood complications. [ABSTRACT FROM AUTHOR]

Social isolation can have a negative impact on well-being, yet important strengths can emerge in adversity. Our aim was to explore how pre-university students in Singapore responded to the social isolation caused by the COVID-19 pandemic. We conducted a thematic analysis of in-depth semi-structured interviews with six pre-university students (three males and three females). Singaporean pre-university students found a "lack of face-to-face contact" (Theme 1) with friends challenging. However, they utilised "acceptance" (Theme 2), and "adaptability and resilience" (Theme 3) to cope with the changes associated with the COVID-19 restrictions. Educators, counsellors, parents and researchers may better support pre-university students' well-being by discussing how to enhance the students' strengths, rather than solely attempting to alleviate negative mental health outcomes. [ABSTRACT FROM AUTHOR]

The effectiveness of corticosteroids (GCs) varies greatly in interstitial lung diseases (ILDs). In this study, we aimed to compare the gene expression profiles of patients with cryptogenic organizing pneumonia (COP), idiopathic pulmonary fibrosis (IPF), and non-specific interstitial pneumonia (NSIP) and identify the molecules and pathways responsible for GCs sensitivity in ILDs. Three datasets (GSE21411, GSE47460, and GSE32537) were selected. Differentially expressed genes (DEGs) among COP, IPF, NSIP, and healthy control (CTRL) groups were identified. Functional enrichment analysis and protein–protein interaction network analysis were performed to examine the potential functions of DEGs. There were 128 DEGs when COP versus CTRL, 257 DEGs when IPF versus CTRL, 205 DEGs when NSIP versus CTRL, and 270 DEGs when COP versus IPF. The DEGs in different ILDs groups were mainly enriched in the inflammatory response. Further pathway analysis showed that "interleukin (IL)-17 signaling pathway" (hsa04657) and "tumor necrosis factor (TNF) signaling pathway" were associated with different types of ILDs. A total of 10 genes associated with inflammatory response were identified as hub genes and their expression levels in the IPF group were higher than those in the COP group. Finally, we identified two GCs' response-related differently expressed genes (FOSL1 and DDIT4). Our bioinformatics analysis demonstrated that the inflammatory response played a pathogenic role in the progression of ILDs. We also illustrated that the inflammatory reaction was more severe in the IPF group compared to the COP group and identified two GCs' response-related differently expressed genes (FOSL1 and DDIT4) in ILDs. [ABSTRACT FROM AUTHOR]

Objective: Emerging evidence shows that patients with myasthenia gravis (MG) were at a higher risk for the co-occurrence of other autoimmune diseases, which reflects phenotypic heterogeneity in MG. The coexistence of MG and cryptogenic organizing pneumonia (COP) has rarely been reported. The present case is to report the coexistence of triple-seronegative MG and pathology-proven COP in a patient. Methods: The clinical data of the patient were derived from medical records of Nanjing First Hospital, Nanjing Medical University, China. Written informed consent was obtained from the patient. Results: We presented a 56-year-old man with acute respiratory syndrome, who was diagnosed with COP based on the intra-alveolar fibroinflammatory buds (Masson's bodies) in the pathology of bronchoscopy biopsy. Oral prednisone induced dramatic symptomatic improvement and complete resolution of previous lung lesions. After a stable course of no respiratory symptom for 2 months, he was referred to the neurology department with complaints of fluctuating generalized muscle weakness. He was diagnosed with triple-seronegative MG based on fluctuating weakness, neostigmine test-positivity and RNS-positivity. After three-month treatment with pyridostigmine in combination with tacrolimus, the symptoms gradually improved and he achieved minimal symptom expression. Conclusions: This case highlights the rare coexistence of triple-seronegative MG and pathology-proven COP. However, a causal association between COP and MG cannot be explicitly ascertained. In future, more data are needed to clarify the relationship, taking into account the limited number of cases reported with this coexistence of the diseases. [ABSTRACT FROM AUTHOR]

This article from the medical journal Lung India explores the uncertainties and controversies surrounding idiopathic nonspecific interstitial pneumonia (NSIP). NSIP is a condition characterized by inflammation and fibrosis in the alveolar septae. The article discusses the various underlying conditions and associations of NSIP, as well as the challenges in diagnosing the condition. It also mentions a study that found 64% of NSIP cases to be idiopathic, while 36% were secondary to known causes. However, the study had limitations, and the article calls for future research to provide more comprehensive information. [Extracted from the article]

Abstract Background Organizing pneumonia (OP) is a rare interstitial lung disease. Secondary organizing pneumonia (SOP) caused by Mycobacterium tuberculosis (MTB) is extremely rare. Migratory MTB-associated SOP is more deceptive and dangerous. When insidious tuberculosis (TB) is not recognized, SOP would be misdiagnosed as cryptogenic organizing pneumonia (COP). Use of steroid hormone alone leads to the progression of TB foci or even death. Clues of distinguishing atypical TB at the background of OP is urgently needed. Case presentation A 56-year-old female patient was hospitalized into the local hospital because of cough and expectoration for more than half a month. Her medical history and family history showed no relation to TB or other lung diseases. Community-acquired pneumonia was diagnosed and anti-infection therapy was initialized but invalid. The patient suffered from continuous weigh loss. More puzzling, the lesions were migratory based on the chest computed tomography (CT) images. The patient was then transferred to our hospital. The immunological indexes of infection in blood and pathogenic tests in sputum and the bronchoalveolar lavage fluid were negative. The percutaneous lung puncture biopsy and pathological observation confirmed OP, but without granulomatous lesions. Additionally, pathogen detection of the punctured lung tissues by metagenomics next generation sequencing test (mNGS) were all negative. COP was highly suspected. Fortunately, the targeted next-generation sequencing (tNGS) detected MTB in the punctured lung tissues and MTB-associated SOP was definitely diagnosed. The combined therapy of anti-TB and prednisone was administrated. After treatment for 10 days, the partial lesions were significantly resorbed and the patient was discharged. In the follow-up of half a year, the patient was healthy. Conclusions It is difficult to distinguish SOP from COP in clinical practice. Diagnosis of COP must be very cautious. Transient small nodules and cavities in the early lung image are a clue to consider TB, even though all pathogen tests are negative. tNGS is also a powerful tool to detect pathogen, ensuring prompt diagnosis of TB-related SOP. For clinicians in TB high burden countries, we encourage them to keep TB in mind before making a final diagnosis of COP.

Organizing pneumonia, a form of interstitial lung disease, may occur in patients who have recovered from COVID‐19. In this article, we report three cases of post COVID‐19 organizing pneumonia, proven histologically with transbronchial biopsies showing fibroblastic plugs in the alveolar spaces. Our patients received a range of 86–166 days of continuous corticosteroid therapy and all of them made excellent recovery. [ABSTRACT FROM AUTHOR]

College students are vulnerable to psychological distress during COVID-19 due to pandemic-related stressors. In response to psychological distress, college students engage in various coping behaviors, such as self-care behaviors and substance use. The transactional model of stress and coping depicts a cognitive appraisal process in the stress-coping association. Psychological resilience is an essential factor for the cognitive appraisal. This study aimed to investigate the mediation effects of resilience on psycho-behavioral health in response to COVID-19 stressors. Longitudinal data were collected from 1,225 Chinese college students via web-based anonymous surveys at wave 1 (T1, between Jan 31 and Feb 11, 2020) and wave 2 (T2, between Mar 20 and Apr 3, 2020). Participants reported their COVID-19 stressors (T1), resilience (T1), psychological distress (depression and anxiety; T2), and coping behaviors (self-care behaviors, drinking, and smoking; T2). Path analysis was used for data analyses. Resilience mediated the association between COVID-19 stressors and psychological distress. Resilience together with psychological distress mediated the association of COVID-19 stressors with self-care behaviors or drinking. Resilience appears to offer protection that promotes psycho-behavioral health in college students in the face of COVID-19 stressors. Interventions for college students should attend to resilience. [ABSTRACT FROM AUTHOR]

The long-term sequelae of COVID-19 have now become more common and appreciable. The SARS-CoV-2 virus can cause a variety of infectious and non-infectious pulmonary complications. The purpose of this study is to raise awareness about post-COVID-19 pulmonary sequelae, both infectious and non-infectious, in this geographical area. A retrospective study was conducted from July 1st 2020 to December 20th 2020. A total of 1200 patients were evaluated, with 83 suffering from post-COVID-19 pulmonary complications. The patients' mean age was 62 years (IQR 55-69), with 63 (75.9%) being male. The most common co-morbid illnesses were hypertension (49, 59%) and diabetes (45, 54.2%). The majority of them (37, 44.6%) had severe COVID-19, followed by critical COVID-19 (33, 39.8%). There was no statistically significant difference in recurrence of respiratory symptoms or duration of current illness between non-severe, severe, and critical COVID-19 patients. Non-infectious complications were observed in the majority of patients (n=76, 91.5%), including organizing pneumonia/ground glass opacities in 71 (88%) patients, fibrosis in 44 (55%), pulmonary embolism in 10 (12.5%), pneumomediastinum in 6 (7.4%) and pneumothorax in 7 (8.6%). Infective complications (25, 30.1%) included aspergillus infection in 10 (12.0%) and bacterial infection in 5 (8.47%), with more gram-negative infections and one patient developing Mycobacterium tuberculosis. Post-COVID-19 mortality was 11 (13.3%). The long-term pulmonary sequelae of COVID-19 are not rare. Cryptogenic organizing pneumonia, ground glass opacities, and fibrosis were common post-COVID-19 sequelae in our patients. This necessitates frequent close monitoring of these patients in order to initiate early appropriate management and prevent further morbidity and eventual mortality. [ABSTRACT FROM AUTHOR]

Background: Organizing pneumonia (OP) is a rare interstitial lung disease. Secondary organizing pneumonia (SOP) caused by Mycobacterium tuberculosis (MTB) is extremely rare. Migratory MTB-associated SOP is more deceptive and dangerous. When insidious tuberculosis (TB) is not recognized, SOP would be misdiagnosed as cryptogenic organizing pneumonia (COP). Use of steroid hormone alone leads to the progression of TB foci or even death. Clues of distinguishing atypical TB at the background of OP is urgently needed. Case presentation: A 56-year-old female patient was hospitalized into the local hospital because of cough and expectoration for more than half a month. Her medical history and family history showed no relation to TB or other lung diseases. Community-acquired pneumonia was diagnosed and anti-infection therapy was initialized but invalid. The patient suffered from continuous weigh loss. More puzzling, the lesions were migratory based on the chest computed tomography (CT) images. The patient was then transferred to our hospital. The immunological indexes of infection in blood and pathogenic tests in sputum and the bronchoalveolar lavage fluid were negative. The percutaneous lung puncture biopsy and pathological observation confirmed OP, but without granulomatous lesions. Additionally, pathogen detection of the punctured lung tissues by metagenomics next generation sequencing test (mNGS) were all negative. COP was highly suspected. Fortunately, the targeted next-generation sequencing (tNGS) detected MTB in the punctured lung tissues and MTB-associated SOP was definitely diagnosed. The combined therapy of anti-TB and prednisone was administrated. After treatment for 10 days, the partial lesions were significantly resorbed and the patient was discharged. In the follow-up of half a year, the patient was healthy. Conclusions: It is difficult to distinguish SOP from COP in clinical practice. Diagnosis of COP must be very cautious. Transient small nodules and cavities in the early lung image are a clue to consider TB, even though all pathogen tests are negative. tNGS is also a powerful tool to detect pathogen, ensuring prompt diagnosis of TB-related SOP. For clinicians in TB high burden countries, we encourage them to keep TB in mind before making a final diagnosis of COP. [ABSTRACT FROM AUTHOR]

The nursing experience of a case of cardiac cancer patient with cryptogenic organizing pneumonia followed by immunotherapy was summarized. In the process of immune therapy in patients with severe immune-related adverse event, the nursing key points included the strict protective isolation, avoiding cross-infection, specialist nursing and basic nursing interventions such as body position nursing, oxygen inhalation care, maintenance of infusion port, weight management and surveillance, strict drug instruction, skin care for herpes zoster, and paying attention to the psychological changes of patients and mood-stabilizing. After 27 days of treatment and careful nursing, the patient's condition improved significantly, the cryptogenic organizing pneumonia was well controlled, and the patient was discharged from hospital. (本文总结1例贲门癌患者免疫治疗过程中出现隐源性机化性肺炎的护理经验。针对患者在进行免疫治疗过程中出现严重的免疫相关不良反应(隐源性机化性肺炎), 其护理要点包括: 严格的保护性隔离, 避免交叉感染, 体位护理、吸氧护理、输液港的维护、体质量管理和症状监测在内的专科护理和基础护理, 严格药物指导, 用药后出现带状疱疹的皮肤护理, 以及关注患者的心理变化和稳定患者情绪。经过积极治疗和精心护理, 患者病情明显好转, 隐源性机化性肺炎得到了很好的控制, 患者顺利出院。)

Organizing pneumonia (OP) is one of the rare pulmonary manifestations of systemic lupus erythematosus (SLE) which is infrequently reported as a presenting manifestation. Early diagnosis of lupus‐related OP with the help of imaging, can drive to prompt initiation of immunosuppressive therapy leading to a better prognosis. We present a case of a 34‐year‐old young male who presented with fever, myalgia, and a dry cough for 1 month and was later diagnosed as SLE‐related organizing pneumonia. [ABSTRACT FROM AUTHOR]

Transplant-associated thrombotic microangiopathy (TMA) occurs in a significant percentage of patients after allogeneic stem cell transplantation (allo-SCT) and is associated with significant morbidity and mortality. The aim of the present study was to examine the association of serum angiopoetin-2 (Ang2) levels and the presence of antibodies against angiotensin II type 1 (AT1R) and ndothelin A Recreptor (ETAR) with the outcome of patients with TMA and/or graft-versus-host disease (GVHD) after allo-SCT. Analysis of our data showed that elevated serum Ang2 levels at the time of TMA diagnosis are significantly associated with increased non-relapse mortality and decreased overall survival. To our knowledge, this is the first study demonstrating an association between raised Ang2 levels and poor outcomes in patients with TMA. Antibodies against AT1R (AT1R-Abs) and ETAR (ETAR-Abs) were detected in 27% and 23% of the patients, respectively, but there was no association between the presence of autoantibodies and the outcome of patients with TMA. However, a significant finding was the strong positive correlation between the presence of AT1R-Abs with the occurrence of chronic fibrotic GVHD, such as scleroderma and cryptogenic organizing pneumonia, raising the possibility of the contribution of autoantibodies in the pathogenesis of fibrotic GVHD manifestations. [ABSTRACT FROM AUTHOR]

Background: The novel Coronavirus SARS-CoV-2 that broke out in December 2019 became the main source of morbidity and mortality around the world. As efficient vaccines and medicines started to emerge, it became necessary to recognize and proactively deal with the long term respiratory difficulties that arise due to extreme illness. Patients with extreme Coronavirus pneumonia have the tendency of advancing to Interstitial Lung Diseases (ILD) and persistent pulmonary vascular disease. In this paper, we shortly review the pathophysiology of interstitial lung disease (ILD), lung injury resulting from serious Coronavirus disease. We also outline the potential viral and secure intervention processes for stopping the advancement of Post-Coronavirus pulmonary Fibrosis (PCPF). Post-Coronavirus pulmonary fibrosis is presently treated in only symptomatic patients, which is, to a great extent, a neglected perspective. Before this lethal illness can be treated, it has to be fully researched clinically in order to know its danger in Coronavirus survivors. Strong clinical and research biomarkers ought to be considered in order to know the subgroup of patients that will deteriorate or advance to post Coronavirus interstitial lung disease. Customized medication is a decent method that can be used to treat patients with Post Coronavirus interstitial lung diseases. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic caused by the coronavirus SARS‐CoV‐2 has resulted in a global healthcare crisis. The provision of computed tomography (CT) imaging services by radiology departments for COVID‐19 patients poses multiple challenges. Consequently, it is important to explore the clinical need and indications for thoracic CT and whether they subsequently alter patient management. Methods: We report our experience in this single‐centre retrospective cohort study of all confirmed COVID‐19 cases admitted during the peak of the 'Delta' variant wave in Australia, and who underwent a chest CT. Clinical indication and patient management plan pre‐ and post‐CT were ascertained. Results: A total of 92 out of 1403 patients who were admitted with COVID‐19 underwent a thoracic CT (73 CT pulmonary angiogram (CTPA), 14 CT Chest and five high‐resolution CT (HRCT) studies). 72.8% of studies were to evaluate for pulmonary emboli, 16.2% for assessment of COVID‐19 pneumonia complications, 5.4% for tuberculosis and 6.5% for other indications. 21 (23%) of these studies resulted in a change in management with two patients having a major change in management (thrombolysis, CT‐guided aspiration). Management was altered due to diagnosis of pulmonary embolism (PE), pneumonia, cryptogenic organising pneumonia and other reasons. Of 73 CTPA studies, 11 (15%) patients had evidence of PE. Conclusion: In our centre, thoracic CT in COVID‐19 patients were predominantly for the evaluation of PE with other indications being for COVID‐19 complications and other cardiopulmonary pathologies. 23% of studies subsequently altered patient management, suggesting there is good clinical need for CT chests for these indications. [ABSTRACT FROM AUTHOR]

Immunotherapy with immune checkpoint inhibitors (ICI) is administered in different cancer types and can lead to a wide range of immune-related adverse events including toxicity in vital organs such as the lungs, the kidneys, and the heart. The main hypothesis suggests an overactivation of the immune cells in the different organs. Whereas immune-related cardiotoxicity is very rare but life threatening, ICI-induced acute kidney injury and pneumonitis are more frequent but in general less severe. Renal toxicity corresponds in more than 90% to an acute tubulo-interstitial nephritis. Checkpoint inhibitors pneumonitis is diagnosed mainly on respiratory symptoms with new radiological features, especially under the form of a cryptogenic organising pneumonia. Cardiotoxicity is predominantly marked by myocarditis but also pericarditis and arrhythmias, among others. Early recognition, temporary or definitive cessation of ICI therapy and rapid initiation of high-dose corticosteroids are the cornerstones of the management, which must to be multidisciplinary in a specialised center. [ABSTRACT FROM AUTHOR]

This article discusses the imaging feature of active pulmonary tuberculosis known as the Nodular Reverse Halo Sign (NRHS). The case study focuses on a 19-year-old female patient who presented with symptoms of cough, fever, loss of appetite, and weight loss. High-resolution computed tomography (HRCT) of the lungs revealed the NRHS, along with other findings consistent with post-primary pulmonary tuberculosis. The NRHS is associated with active granulomatous infections, particularly pulmonary tuberculosis, and can aid in the early diagnosis and effective management of the disease. [Extracted from the article]

Cryptogenic organizing pneumonia (COP) is a form of idiopathic interstitial pneumonia that results from the pulmonary reaction to various unidentified injuries. Secondary organizing pneumonia is diagnosed when the triggering factor has been identified; it is mainly caused by infections, toxic substance exposure, drugs, connective tissue diseases, malignancies, autoimmune diseases, bone marrow, or organ transplantation, and radiotherapy. There has been an increase in the number of reports of drug-induced organizing pneumonia (OP). New biological therapies, interferon, monoclonal antibodies, anti-interleukin antibodies, and PD1/PDL-1 inhibitors may induce this specific pulmonary reaction. The classical form of COP is usually subacute and does not manifest as severe disease. Patients maintain sufficient respiratory function, and treatment with steroids is usually effective. Several specific forms of OP (e.g., the cicatricial variant or acute fibrinous type) have distinct clinical and histological features, require higher doses of immunosuppressive drugs, and have a worse prognosis. In the era of administering steroid-sparing therapies for the treatment of interstitial lung diseases, connective tissue dases, and other conditions, it is important to emphasize this type of therapy for patients with COP.

Background: Acute respiratory distress syndrome (ARDS) deptics an acute form of lung infjury with often severe respiratory impairment that requires invasive mechanical ventilation. Since ARDS can be caused by several distinct etiologies, correct characterization is desired and frequently challenging. Surgical lung biopsy was previously reported to be of additive value. We describe our institutional experience using transbronchial cryobiopsy (TBCB) for further characterization of severe and unexplained ARDS cases. Case presentation: We retrospectively collected data of TBCB in patients with unexplained ARDS, whether with or without ECMO-support. Between 2019 and 2020 TBCB was performed in eight patients. Decision for the intervention was decided in multidisciplinary discussion. Five patients were treated with ECMO. The median duration of invasive ventilation before TBCB was 24 days. TBCB was performed in one segment, that was prophylactically occluded by Watanabe spigot or swab after the procedure. Histology results and their contribution to further therapeutic decisions were analyzed. Histology revealed five diffuses alveolar damage, one acute fibrinoid organizing pneumonia, one cryptogenic organizing pneumonia and one lung cancer. All results contributed to the decision of further management. While no pneumothorax or severe endobronchial bleeding occurred, two delayed hematothoraces needed surgical treatment. No patients died due to TBCB. Conclusion: TBCB is feasible in ARDS even during ECMO treatment. Histologic results can play a significant role in therapeutic and ethic discussion to guide the patients' care. Side effects should be considered and monitored. [ABSTRACT FROM AUTHOR]

Background/aim: Transbronchial lung cryobiopsy (TBLC) is a minimally invasive technique of the diagnosis of diffuse parenchymal lung diseases (DPLD). The aim of this study is to determine the clinical-radiological and histopathological characteristics of patients in whom cryobiopsy contributes to the diagnosis. Materials and methods: In this retrospective study, we searched for the medical records of patients who underwent TBLC from July 2015 to March 2020 at the pulmonology department of our university hospital clinic. Radiological images were evaluated by a chest radiologist experienced in DPLD. Prediagnosis was indicated by clinical-radiological findings. The final diagnosis was determined by the contribution of histopathological diagnosis. The agreement of pretest/posttest diagnosis and the diagnostic yield of TBLC were calculated. Results: Sixty-one patients with female predominance (59.0%) and current or ex-smoker (49.2%) made up the study population. We found the diagnostic yield of TBLC 88.5%. The most common radiological and clinical-radiological diagnosis was idiopathic pulmonary fibrosis (IPF) (n = 12, 19.6%) while the most common multidisciplinary final diagnosis was cryptogenic organizing pneumonia (COP) (n = 14, %22.9). The concordance of pre/posttests was significant (p < 0.001) with a kappa agreement = 0.485. The usual interstitial pneumonia (UIP) diagnosis was detected in six patients among 12 who were prediagnosed as IPF having also a suspicion of other DPLD by clinical-radiological evaluation (p < 0.001). After the contribution of TBLC, the multidisciplinary final diagnosis of 22(36.1) patients changed. The histopathological diagnosis in which the clinical-radiological diagnosis changed the most was nonspecific interstitial pneumonia (NSIP). Conclusion: We found the overall diagnostic yield of TBLC high. The pretest clinical-radiological diagnosis was often compatible with the multidisciplinary final diagnosis. However, TBLC is useful for the confirmation of clinical radiological diagnosis as well as clinical entities such as NSIP which is difficult to diagnose clinical-radiological. We also suggest that TBLC should be considered in patients whose clinicopathological IPF diagnosis is not precise. [ABSTRACT FROM AUTHOR]

With the ongoing coronavirus disease 2019 (COVID-19) pandemic, there is an increasing interest in the sequelae and care in recovered patients. Although the long-term sequelae of COVID-19 are still unknown, recently published reports suggest that some of the patients have persistent symptoms and show radiologic abnormalities after discharge. Herein, we present cases of four patients with previous COVID-19 infection manifesting pulmonary sequelae, including pulmonary fibrosis or organizing pneumonia pattern with persistent dyspnea after recovery.

Abstract Background Organizing pneumonia (OP) can be diagnosed pathologically, and cryptogenic OP (COP) and secondary OP (SOP) have been classified by cause and particular underlying context. Because it is clinically difficult to differentiate between COP and SOP, this study investigated characteristics that could distinguish between COP and SOP. Methods The medical records of patients who underwent lung biopsy for a diagnosis of OP at a single tertiary hospital from January 2016 to December 2018 were retrospectively reviewed. Results Eighty-five patients had pathologically proven OP, including 16 diagnosed with COP and 69 diagnosed with SOP. The most common cause of SOP was infectious pneumonia, observed in 57 (82.6%) of the 69 patients, followed by cancer and radiation pneumonitis. The pathogens causing infectious pneumonia were identified in 45 (65.2%) patients. There were no differences in age, sex, and lung function between the COP and SOP groups. Median body mass index was significantly lower (P = 0.030), and median time from symptom onset to hospital admission significantly shorter (P = 0.006), in the SOP than in the COP group. Fever was more common in the SOP group (P = 0.024), and CURB 65, an index of pneumonia severity, tended to be higher in the SOP group (P = 0.017). Some laboratory results differed significantly between the two groups. Lymphocyte counts in bronchoalveolar lavage (BAL) fluid were significantly higher in the COP than in the SOP group (P = 0.012). Radiologic findings showed that effusion was more common in the SOP group (P = 0.036). There were no between-group differences in steroid use, 30 day and in-hospital mortality rates, and rates of OP outcomes and recurrences. Pneumonia recurrence rate was significantly higher in SOP patients who were than were not treated with steroids (P = 0.035). Conclusions Infection is the main cause of SOP. Symptom onset is more rapid in patients with SOP than with COP. Some blood and BAL fluid test results differed significantly in the COP and SOP groups. Pleural effusion was more common in the SOP group but there were no differences in clinical course. Recurrence in patients with SOP was more common in those who were than were not treated with steroids.

Objective: Rare disease Background: Antisynthetase syndrome (ASS) is a rare systemic autoimmune disease. The clinical features of ASS include interstitial lung disease (ILD), myositis, arthritis, Raynaud’s phenomenon, mechanic’s hands, and unexplained fever. There is a paucity of reported cases and management guidelines in pregnancy. This report describes the case of a 25-year-old Saudi woman with a 2-year history of ASS with ILD who commenced azathioprine treatment in the third trimester and had a successful birth at term. Case Report: A 25-year-old Saudi primigravida woman with a 2-year history of ASS with ILD presented at 26 weeks of gestation after being lost to prepregnancy follow-up and discontinuing her medications. Azathioprine treatment was commenced, and despite poor prepregnancy follow-up, her pregnancy remained uneventful until 39 weeks, when fetal ultrasonography showed oligohydramnios. Therefore, labor induction was initiated, and she delivered vaginally with no postpartum complications or flare-ups. Conclusions: The multisystem autoimmune disease ASS is a rare condition, and there are no clinical guidelines for its management in pregnant women. This case report highlights some aspects of ASS management and the importance of a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Background: Treatment responsiveness to corticosteroids is excellent for cryptogenic organizing pneumonia (COP) and sarcoidosis, but suboptimal for idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP). We hypothesise that the differential expression of IL-17 contributes to variable corticosteroid sensitivity in different interstitial lung diseases. Objective: To determine the associations among expression of IL-17, glucocorticoid receptor-b and responsiveness to corticosteroid treatment in interstitial lung diseases. Methods: Immunohistochemical (IHC) staining was performed on formalin-fixed paraffinembedded (FFPE) lung tissues obtained by bronchoscopic, CT-guided or surgical biopsies, and quantified by both cell counting (% positive cells) by individuals and by software IHC Profiler plugin of ImageJ (opacity density score). We studied the effect of IL-17 on corticosteroid sensitivity in human fibroblast MRC5 cell line. Results: Compared with specimens from patients with COP (n =13) and sarcoidosis (n =13), those from IPF patients (n = 21) had greater GR-β and IL-17 expression and neutrophil infiltration. Radiographic progression after oral corticosteroid treatment was positively correlated with the expression in IL-17 and GR-β/GR-a ratio in all patients (COP, sarcoidosis and IPF) and also within the IPF subgroup only. IL-17 expression level was positively associated with GR-β and GR-β/GR-α ratio. In MRC5 cells, exogenous IL-17 increased the production of collagen I and up-regulated GR-β expression and dexamethasone's suppressive effect on collagen I production was impaired by IL-17, and silencing IL-17 receptor A gene attenuated the effect of IL-17. Conclusion: Up-regulation of GR-β/GR-α ratio by IL-17 could be associated with the relative corticosteroid-insensitivity of IPF. [ABSTRACT FROM AUTHOR]

Organizing pneumonia (OP), characterized histopathologically by patchy filling of alveoli and bronchioles by loose plugs of connective tissue, may be seen in a variety of conditions. These include but are not limited to after an infection, drug reactions, radiation therapy, and collagen vascular diseases. When a specific cause is responsible for this entity, it is referred to as "secondary OP." When an extensive search fails to reveal a cause, it is referred to as "cryptogenic OP" (previously called "bronchiolitis obliterans with OP"), which is a clinical, radiologic, and pathologic entity classified as an interstitial lung disease. The clinical presentation of OP often mimics that of other disorders, such as infection and cancer, which can result in a delay in diagnosis and inappropriate management of the underlying disease. The radiographic presentation of OP is polymorphous but often has subpleural consolidations with air bronchograms or solitary or multiple nodules, which can wax and wane. Diagnosis of OP sometimes requires histopathologic confirmation and exclusion of other possible causes. Treatment usually requires a prolonged steroid course, and disease relapse is common. The aim of this article is to summarize the clinical, radiographic, and histologic presentations of this disease and to provide a practical diagnostic algorithmic approach incorporating clinical history and characteristic imaging patterns. [ABSTRACT FROM AUTHOR]

We describe the first case of antisynthetase syndrome (ASS) with antibodies to anti‐glycyl tRNA synthetase (EJ‐1) with antiphospholipid syndrome (APLS). A 66‐year‐old man presented with progressive dyspnoea, fever, dry cough and proximal muscle weakness over several months on a background of cryptogenic organizing pneumonia. Examination revealed bibasal fine chest crackles, proximal muscle weakness of the upper and lower limbs, digital skin thickening and facial telangiectasias. Creatine kinase was elevated and autoimmune screening was positive for anti‐EJ‐1, anti‐beta‐2‐glycoprotein, anti‐Ro and anti‐La antibodies. Computed tomography of the chest revealed a usual interstitial pneumonia pattern and a ventilation–perfusion scan demonstrated scintigraphic evidence of bilateral pulmonary emboli. A diagnosis of ASS and APLS was made. Immunosuppressive therapy including pulsed methylprednisolone, rituximab and mycophenolate was commenced with improvement in symptoms. This case highlights the importance of evaluation for ASS in idiopathic interstitial pneumonia, and APLS in ASS patients. [ABSTRACT FROM AUTHOR]

Organizing pneumonia (OP) is interstitial pneumonia with an acute or subacute clinical course and a histological pattern compatible with acute lung injury. It usually arises after a recent infection of the peripheral bronchial system, whereby is called secondary OP. However, often OP arises with no recognizable cause for which it is called cryptogenic organizing pneumonia (COP). From a radiological standpoint, COP exhibits different imaging appearances and this review makes radiologists and clinicians familiar with the entire spectrum of expected disease findings. Successful interpretation of imaging is pertinent for a rapid diagnosis of COP and knowledge of the entire spectrum of imaging findings in COP is mandatory. [ABSTRACT FROM AUTHOR]

Background: The reversed halo sign described in the pre-COVID era in certain pulmonary pathologies, most notably cryptogenic organizing pneumonia, has been reported with varying frequency in coronavirus disease 2019 (COVID-19) pneumonia caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, we aimed to analyze the pattern of the reversed halo sign and its variant, the bullseye sign in patients with COVID-19 pneumonia. Methods: In this study, a retrospective analysis of chest CT scans performed in the CT unit of Al-Imammain Al-Kadhymain Medical City for a three-month duration (from June to August 2020) was done. Of the 490 CT scans performed for patients with COVID-19, 330 had signs of COVID-19 pneumonia. These were evaluated for the presence of reversed halo or bullseye sign, and only obvious signs detected in at least two orthogonal planes were included. The number of these signs in each scan was documented, and an analysis of individual signs was performed. The following features were recorded; size, location, shape, and type of the peripheral rim (whether complete or incomplete, thin or thick, distinct or hazy, and uniform or non-uniform). Results: A total of 26 CT exams were included in the study. The average age of the patients was 44.85 ± 20.14 years, and the total number of typical reversed halo or bullseye sign lesions was 63. The rate of reversed halo/bullseye sign in this study was 7.88%. In 15 patients, the typical sign of reversed halo was seen, the bullseye sign was noted in eight patients, and three patients had both the reversed halo and bullseye signs. Nearly all the patients had other CT findings of COVID-19 pneumonia, except one with only a solitary bullseye lesion. The number of lesions ranged from one to nine with the average number of lesions per patient being 2.42. The mean size of the lesions was 3.39 cm with a size range 1-8.5 cm. Lesions were located in the periphery of the lung in most patients (93.7%). Basal predominance was seen in 76.19% patients, located in the lower lobes. A higher percent of bullseye lesions located in the upper and right middle lobes was observed (n = 12/23) than the typical reversed halo lesions (n = 3/40). Most lesions were oval (52.38%) or rounded (48.86%). In 77.78%, the peripheral rim was incomplete. The thickness of the peripheral rim was variable ranging from 2-19 mm. Most lesions (92.06%) exhibited a thin peripheral rim (,1 cm). The rim was clearly distinct in 53.97% of lesions. It was non-uniform in thickness in most cases (95.24%). Conclusion: The reversed halo sign is not infrequent among CT findings in patients with COVID-19 pneumonia. The typical reversed halo sign is more common than its variant, the bullseye sign. Variability in morphology and size does exist. In patients with COVID-19, these lesions exhibit thin, incomplete peripheral rims and are multiple in most cases. [ABSTRACT FROM AUTHOR]