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Abstract Introduction Ultrasound (US) has become an integral tool for chest assessment as it provides crucial information on pleural pathologies and peripherally located lung lesions. Aim To assess the diagnostic yield of combined fine needle aspiration (FNAB) and core needle biopsy (CNB) versus each technique ultrasound-guided in peripheral lung and pleural lesions. Methodology The present study enrolled 30 patients presenting to Alexandria Main University Hospital, with CT scans showing undiagnosed peripheral lung or parietal pleural lesions with or without effusion. A full ultrasound chest assessment was done covering 12 regions. Assessment of the lesion of interest, vascularity was assessed via color Doppler, locating the safest entry site. Real-time US-guided FNAB was done using a spinal needle 22 gauge. Then real-time US-guided CNB using 18 gauge Trucut needle in the same setting. Duration and complications of each procedure were reported. In FNAB, three smears were prepared, fixed in alcohol, and stained with hematoxylin and eosin stain. The remaining sample was fixed in formalin and centrifuged to prepare cell blocks. On the other hand, Trucut needle biopsy specimens were fixed in formalin and processed as paraffin-embedded blocks. Immunohistochemical staining was done. The results were classified into four categories (inadequate, negative, suspicious, and positive for malignancy. Results The diagnostic yield of combined techniques was 96.7% versus 63.3% using FNAB and 96.7% using CNB. The sensitivity of FNAB was 86% while CNB was 95%. The specificity and positive predictive value of both methods were 100%. The negative predictive value of FNAB was 57% versus 80% for CNB in peripheral lung lesions. Duration of US-guided CNB was statistically significantly longer than that of FNAB in both peripheral lung and pleural lesions. No major complications were reported using either technique. Conclusion Combined FNAB and CNB were not superior to CNB alone regarding diagnostic yield but were superior to FNAB. Ultrasound-guided CNB has a superior diagnostic yield over FNAB, with no statistically significant difference regarding associated complications, both techniques are safe. FNAB provided sufficient material for ancillary molecular testing.

Abstract Peripheral muscle dysfunction is a well-recognized complication of COPD associated with exercise (in)tolerance and worse prognosis. The evaluation of peripheral muscle integrity is an attractive marker in COPD patients. The aim of the study was to identify the correlation between the rectus femoris muscle cross-sectional area (RFCSA) and the severity of airway obstruction in COPD patients using ultrasound. The study enrolled 24 outpatients diagnosed with stable COPD (post-bronchodilator FEV1/FVC

Abstract Background Several clinical studies tested the efficacy of the different COVID-19 vaccinations while very few radiological researches targeted this issue before. Aim of the work To verify the additive role of lung CT-Volumetry in testing the efficacy of three widely distributed COVID-19 vaccinations; namely the "Sinopharm", "Oxford-AstraZeneca", and "Pfizer-BioNTech" vaccinations, with comparative analysis of variance (ANOVA). Results This study was retrospectively conducted on 341 COVID-19 patients during the period between June/2021 and March/2022. Based on the immunization status, they were divided into four groups; group (A) included 156/341 (46%) patients who did not receive any vaccination (control group), group (B) included 92/341 (27%) patients who received "Sinopharm" vaccine, group (C) included 55/341 (16%) patients who received "Oxford-AstraZeneca" vaccine, group (D) included 38/341 (11%) patients who received "Pfizer-BioNTech" vaccine. Every group was subdivided based on the medical history into three groups; group (1) patients without comorbidities, group (2) patients with comorbidities, and group (3) immunocompromised patients. Automated CT volumetry was calculated for the pathological lung parenchyma. Five CT-severity scores were provided (score 0 = 0%, score 1 = 1–25%, score 2 = 25–50%, score 3 = 51–75%, and score 4 = 76–100%). Analysis of variance (ANOVA) including Tukey HSD testing was utilized in comparison to the non-immunized patients. The "Phizer-Biontech" vaccine succeeded to eliminate severity in patients without and with comorbidity, and also decreased severity in immunocompromised patients (from 79 to 17%). The "Oxford-AstraZeneca" vaccine and to a lesser extent "Sinopharm" vaccine also decreased the clinical severity in patients with comorbidities and immunocompromised patients (from 15 to 9% & 10% as well as from 79 to 20% & 50% respectively). Significant variance was proved regarding the use of "Sinopharm", "Oxford-AstraZeneca", and "Phizer-Biontech" vaccines in patients without comorbidities (f-ratio averaged 4.0282, 10.8049, and 8.4404 respectively, also p-value averaged 0.04632, 0.001268, and 0.004294). Significant variance was proved regarding the use of "Oxford-AstraZeneca", and "Phizer-Biontech" vaccines in patients with comorbidities and immunocompromised patients (f-ratio averaged 4.7521, and 4.1682 as well as 11.7811, and 15.6 respectively, also p-value averaged 0.03492, and 0.04857, as well as both 0.003177, and 0.0009394 respectively, all

Abstract Background The new guidelines limited the use of lung biopsy in the evaluation of lung fibrosis because of its hazards. The differential diagnosis of interstitial pulmonary fibrosis (IPF) or usual interstitial pneumonia (UIP) is challenging because of overlapping multi-detector computed tomography (MDCT) morphologic features between interstitial and non-interstitial fibrosing lung diseases. Scar carcinoma is a serious complication that needs to be excluded in certain conditions. Aim of the work: To achieve a multi-disciplinary algorithm for the diagnosis of fibrosing lung diseases to limit the need for lung biopsy by combining the clinico-laboratory and radiological roles. Results This study included two major steps. The first step (prevalence/significance analysis of the contributing parameters for the diagnosis of fibrosing lung diseases) was retrospectively conducted on 150 patients pathologically proved with fibrosing lung disease during the period between January/2016 and April/2018. Based on a P-value

Abstract Background Due to the paucity of scientific evidence, it is unclear among pulmonologists and physicians in critical care units if and when splenomegaly in novel coronavirus disease (2019) (COVID-19) patients is worrisome. This study aims to evaluate the significance of splenic volume during COVID-19 infection with or without cytokine storm and correlates splenic volume to the volume of pathological lung changes through linear regression analysis. Results A retrospective study collected 509 polymerase chain reaction proved COVID-19 patients (399 males, 110 females; mean age 48 years, age range 24–78 years) between June and November 2021, without a history of splenic pathology. A control group of age and sex-matched 509 healthy subjects was used and analyzed according to the splenic volume. Five consulting radiologists evaluated initial and follow-up computed tomography (CT) examinations using lung CT volumetry and splenic volume calculation in consensus. Three consulting pulmonologists correlated the severity of clinical and laboratory findings, including oxygen requirements and interleukin-6 (IL-6) levels. The T test results for comparison between the COVID-19 patients and the healthy subjects control group regarding the splenic volume were significant (T value was − 4.731452 and p value was 0.00002). There was no significant correlation between the severity of the disease and normal-sized spleen (26% of patients, p = 0.916) or splenomegaly (24% of patients, p = 0.579). On the other hand, all patients with a small spleen or progressive splenomegaly during serial follow-up imaging had clinically severe disease with a statistically significant correlation (p = 0.017 and 0.003, respectively). Ninety-seven percent of patients with clinically mild disease and splenomegaly had 0–20% lung involvement (CT-severity score 1) while all patients with clinically severe disease and splenomegaly had 27–73% lung involvement (CT-severity score 2 and 3) (r = 0.305, p = 0.030). Conclusions Splenomegaly is a non-specific sign that may be found during mild and severe COVID-19 infection, it was not statistically correlated with the clinical severity and a weak positive relationship was found between the splenic size and the CT-severity score of the pathological lung volume. On the other hand, the presence of splenic atrophy or progressive splenomegaly was correlated with severe COVID-19 presentation and “cytokine storm”. Therefore, the splenic volume changes should not be overlooked in COVID-19 serial CT examinations, particularly in severe or critically ill patients with cytokine storms.

Abstract Background The importance of thymic CT-grading and presence of thymic rebound hyperplasia during COVID-19 infection were only investigated in a few studies. This multivariate study aims to evaluate the relation between thymus CT-grading and rebound during COVID-19 infection and the following: (1) the patients' age, (2) the patients' blood lymphocytic count, (3) the CT-volumetry of the diseased lung parenchyma, (4) the patient's clinical course and prognosis, and finally (5) the final radiological diagnosis. Results Multicenter retrospective analyses were conducted between March and June 2021 on 325 adult COVID-19 patients with positive PCR results and negative history of malignant or autoimmune diseases. They included 186 males and 139 females (57.2%:42.8%). Their mean age was 40.42 years ± 14.531 SD. Three consulting radiologists performed CT-grading of the thymus gland (grade 0–3) and CT-severity scoring (CT-SS) of the pathological lung changes in consensus. Two consulting pulmonologists correlated the clinical severity and blood lymphocytic count. Pearson correlation coefficient (r) and linear regression analyses were statistically utilized. Sub-involuted thymus (with CT-grade 0:2) was detected in 42/325 patients (12.9%); all of them had a mild clinical course and low CT-SS (0–1). Thymic rebound hyperplasia was the only positive CT-finding in 15/325 patients (4.6%) without pathological lung changes. A weak positive significant correlation was proved between thymic grade and patient's age, clinical course, and CT-SS (r = 0.217, 0.163, and 0.352 with p ≤ 0.0001,

Abstract Background One year has passed since the announcement of COVID-19 as a pandemic and two waves had already stricken Egypt. The authors witnessed several atypical radiological features through the second pandemic wave, either early at the active infective stage or delayed at the post-infectious convalescent period. They believed every radiologist should be familiar with these features. Therefore, they performed this comparative study on 2000 Egyptian patients using multi-slice computed tomography (MSCT) to highlight the radiological differences between the first and second pandemic waves and correlate them to the clinical status. Results This random multi-center comparative study was retrospectively conducted on 2000 COVID-19 Egyptian patients; 1000 patients were registered at the first pandemic wave from April 2020 till September 2020, while the other 1000 patients were registered at the second pandemic wave from October 2020 till March 2020. Follow up CT examinations were performed for 49 and 122 patients through the first and second pandemic waves respectively. MSCT examinations were carefully evaluated by four expert consulting radiologists who came to a consensus. Meanwhile, the correlation with the clinical outcome was performed by two consulting pulmonologists. During the second pandemic wave, the prevalence rate of the “crazy-paving” pattern had significantly increased by 1.3 times (P value = 0.002). Additionally, the prevalence rate of the “air-bubble” sign had significantly increased by 1.9 times (P value = 0.02). Similarly, the presence of enlarged mediastinal lymph nodes (> 1 cm in short-axis diameter) had significantly increased by 1.7 times (P value = 0.036). Furthermore, the prevalence rate of pericardial effusion had significantly increased by 2.5 times (P value = 0.003). The above-mentioned signs were correlated to increased clinical severity and higher rates of hospitalization. Unexpectedly, other atypical radiological signs were only encountered through the second pandemic wave, including bronchiectatic changes (2.5%), “head-cheese” pattern (0.8%), cavitation (0.5%), and “bulls-eye” sign (0.2%). The prevalence rate of post-COVID fibrosis had doubled through the second wave but not in a significant way (P value = 0.234). Secondary fungal infection was only encountered throughout the second pandemic wave in four patients. COVID-19 reinfection was encountered in a single patient only during the second pandemic wave. Conclusion After 1 year from the announcement of COVID-19 as a pandemic, the radiological presentation of COVID-19 patients showed some significant differences between its first and second waves.

Abstract Background While the second wave of COVID-19 pandemic almost reached its climax, unfortunately, new viral strains are rapidly spreading, and numbers of infected young adults are rising. Consequently, chest high-resolution computed tomography (HRCT) demands are increasing, regarding patients’ screening, initial evaluation and follow up. This study aims to evaluate the detection accuracy of ultra-low-dose chest CT in comparison with the routine low-dose chest CT to reduce the irradiation exposure hazards. Results This study was prospectively conducted on 250 patients during the period from 15th December 2020 to 10th February 2021. All of the included patients were clinically suspected of COVID-19 infection. All patients were subjected to routine low-dose (45 mAs) and ultra-low-dose (22 mAs) chest CT examinations. Finally, all patients had confirmatory PCR swab tests and other dedicated laboratory tests. They included 149 males and 101 females (59.6%:40.4%). Their age ranged from 16 to 84 years (mean age 50 ± 34 SD). Patients were divided according to body weight; 104 patients were less than 80 kg, and 146 patients were more than 80 kg. HRCT findings were examined by two expert consultant radiologists independently, and data analysis was performed by other two expert specialist and consultant radiologists. The inter-observer agreement (IOA) was excellent (96–100%). The ultra-low-dose chest CT reached 93.53–96.84% sensitivity and 90.38–93.84% accuracy. The signal-to-noise ratio (SNR) is 12.8:16.1; CTDIvol (mGy) = 1.1 ± 0.3, DLP (mGy cm) = 42.2 ± 7.9, mean effective dose (mSv/mGy cm) = 0.59 and absolute cancer risk = 0.02 × 10-4. Conclusion Ultra-low-dose HRCT can be reliably used during the second wave of COVID-19 pandemic to reduce the irradiation exposure hazards.