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Early and accurate diagnosis of pulmonary tuberculosis (TB) is key to effective outbreak management, and in humans thoracic radiography is used extensively for screening purposes. In wildlife TB radiography is a relatively accessible diagnostic tool, particularly in under-resourced settings, however its use is limited by body size. Sun bears are susceptible to human-associated TB, and their small body size makes thoracic radiography feasible. However, there are no established guidelines on normal thoracic radiographs or radiographic manifestations of TB in this species. We provide a first description of thoracic radiographs from healthy and TB affected sun bears at a bear rescue sanctuary, including correlation with postmortem results for a subset of bears. Findings of two veterinary radiologists, blinded to clinical information, revealed high agreement on broad categorization of radiographic studies as normal, abnormal, or needing correlation with further information. Agreement was lower for the presence of specific lung patterns, reflecting inherent subjectivity when classifying these features. Very few studies were identified as definitively normal, however definitively abnormal studies were significantly associated with TB cases. Diffuse bronchial and/or bronchointerstitital lung patterns were commonly reported, with a high proportion needing correlation with age and/or clinical signs to further interpret. Interstitial, interstitial-to-alveolar, alveolar and nodular lung patterns, along with radiographic signs of lymphadenomegaly and pleural fluid, were almost exclusively found in TB cases, however the sensitivity of the presence of any of these changes for detecting TB was below 70%. Radiographic reporting of thoracic lymph node enlargement detected at postmortem was low (4/17; 23%), and aortic outflow tract dilation and positional atelectasis were differential diagnoses for radiographic changes that could also represent TB. Together these findings demonstrate the importance of developing species-specific criteria for interpretation, to differentiate between common findings and manifestations of TB, and to highlight areas where radiographic techniques can be optimized to assist this. Given TB remains a global health challenge in humans and other animals (wild or domestic), and detection is key to control, we recommend development of standardized approaches to radiographic studies and their interpretation to bolster diagnostic pathways for detecting TB in sun bears, and other novel or understudied hosts. [ABSTRACT FROM AUTHOR]

Early and accurate diagnosis of pulmonary tuberculosis (TB) is key to effective outbreak management, and in humans thoracic radiography is used extensively for screening purposes. In wildlife TB radiography is a relatively accessible diagnostic tool, particularly in under-resourced settings, however its use is limited by body size. Sun bears are susceptible to human-associated TB, and their small body size makes thoracic radiography feasible. However, there are no established guidelines on normal thoracic radiographs or radiographic manifestations of TB in this species. We provide a first description of thoracic radiographs from healthy and TB affected sun bears at a bear rescue sanctuary, including correlation with postmortem results for a subset of bears. Findings of two veterinary radiologists, blinded to clinical information, revealed high agreement on broad categorization of radiographic studies as normal, abnormal, or needing correlation with further information. Agreement was lower for the presence of specific lung patterns, reflecting inherent subjectivity when classifying these features. Very few studies were identified as definitively normal, however definitively abnormal studies were significantly associated with TB cases. Diffuse bronchial and/or bronchointerstitital lung patterns were commonly reported, with a high proportion needing correlation with age and/or clinical signs to further interpret. Interstitial, interstitial-to-alveolar, alveolar and nodular lung patterns, along with radiographic signs of lymphadenomegaly and pleural fluid, were almost exclusively found in TB cases, however the sensitivity of the presence of any of these changes for detecting TB was below 70%. Radiographic reporting of thoracic lymph node enlargement detected at postmortem was low (4/17; 23%), and aortic outflow tract dilation and positional atelectasis were differential diagnoses for radiographic changes that could also represent TB. Together these findings demonstrate the importance of developing species-specific criteria for interpretation, to differentiate between common findings and manifestations of TB, and to highlight areas where radiographic techniques can be optimized to assist this. Given TB remains a global health challenge in humans and other animals (wild or domestic), and detection is key to control, we recommend development of standardized approaches to radiographic studies and their interpretation to bolster diagnostic pathways for detecting TB in sun bears, and other novel or understudied hosts.

Cui-Ping Li,1,* Lei Li,2,* Lin-Ming Su,3,* Shu-Sheng Zhu,4 Meng-Jie Li5 1Department of Pathology, Renmin Hospital of Qingxian, Cangzhou, People’s Republic of China; 2Department of the First Surgery, Wuhan Jin-Yin-Tan Hospital, Wuhan, People’s Republic of China; 3Department of Radiology, Renmin Hospital of Qingxian, Cangzhou, People’s Republic of China; 4Department of Thoracic Surgery, Taizhou Hospital of Traditional Chinese Medicine, Taizhou, People’s Republic of China; 5Department of Respiratory Oncology, Renmin Hospital of Qingxian, Cangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shu-Sheng Zhu; Meng-Jie Li, Email lwb421223@163.com; lmjnkdf@163.comAbstract: Schwannomas are benign slow-growing tumors arising from the embryonic neural crest cells of the nerve sheaths of peripheral and cranial nerves, and they are a rare type of soft tissue mass that is usually always solitary. Generally, it grows in the head, neck, and flexor portions of the limbs, where many nerves are located. Schwannomas of the lung are extremely rare. Fewer than ten cases of schwannomas in this organ region have been reported in the existing literature. In this case report, a 40-year-old male non-smoker was hospitalized with occasional chest pain. His chest computed tomographic scan revealed a 3.8 cm space occupying lesion in the upper lobe of the right lung. This lesion has clear boundaries and uneven internal density. And it was concluded as a benign lesion possibility, it is preferred to be considered as a haematoma. This space occupying lesion was eventually confirmed as a schwannoma by needle biopsy tissues. Due to the presence in rare locations, such as the lung, the clinical presentation of this space occupying lesion is non-specific, making diagnosis difficult. The data presented in this case report can help clinicians to obtain information on the identification of this disease, which highlighted lung schwannoma as a differential diagnosis for patients with intermittent pain. It can also alert clinicians and radiologists to observe every detail of the radiology imaging findings.Keywords: diagnosis, schwannoma, lung cancer, thoracic radiology, solitary pulmonary nodule

Chest radiographs are the most performed radiographic procedure, but suboptimal technical factors can impact clinical interpretation. A deep learning model was developed to assess technical and inspiratory adequacy of anteroposterior chest radiographs. Adult anteroposterior chest radiographs (n = 2375) were assessed for technical adequacy, and if otherwise technically adequate, for adequacy of inspiration. Images were labelled by an experienced radiologist with one of three ground truth labels: inadequate technique (n = 605, 25.5 %), adequate inspiration (n = 900, 37.9 %), and inadequate inspiration (n = 870, 36.6 %). A convolutional neural network was then iteratively trained to predict these labels and evaluated using recall, precision, F1 and micro-F1, and Gradient-weighted Class Activation Mapping analysis on a hold-out test set. Impact of kyphosis on model accuracy was assessed. The model performed best for radiographs with adequate technique, and worst for images with inadequate technique. Recall was highest (89 %) for radiographs with both adequate technique and inspiration, with recall of 81 % for images with adequate technique and inadequate inspiration, and 60 % for images with inadequate technique, although precision was highest (85 %) for this category. Per-class F1 was 80 %, 81 % and 70 % for adequate inspiration, inadequate inspiration, and inadequate technique respectively. Weighted F1 and Micro F1 scores were 78 %. Presence or absence of kyphosis had no significant impact on model accuracy in images with adequate technique. This study explores the promising performance of a machine learning algorithm for assessment of inspiratory adequacy and overall technical adequacy for anteroposterior chest radiograph acquisition. With further refinement, machine learning can contribute to education and quality improvement in radiology departments. [ABSTRACT FROM AUTHOR]

Rasmussen's aneurysm is a pseudoaneurysm caused by tuberculosis, when cavitation occurs adjacent to a pulmonary artery, which can be lethal. It is a rare complication usually affecting adults. This is a case of an 9-year-old boy initially admitted for pneumonia that developed hemoptysis during admission. Chest X-ray done after this episode showed development of a left hilar mass not present in the previous studies. A chest CT with contrast subsequently revealed a saccular aneurysm arising from the left lower lobe pulmonary artery adjacent to a cavity, a Rasmussen's aneurysm. The patient was treated conservatively with continuation of anti-TB medication and serial monitoring due to the size of the aneurysm being less than 6 cm and spontaneous resolution of the hemoptysis. This report stresses that a Rasmussen's aneurysm should always be in the differential diagnosis of a hilar mass in a patient with hemoptysis, regardless of the patient's age.

The objective of this article is to automatically segment organs at risk (OARs) for thoracic radiology in computed tomography (CT) scan images. The OARs in the thoracic anatomical region during the radiotherapy treatment are mainly the neighbouring organs such as the esophagus, heart, trachea, and aorta. The dataset of 40 patients was used in the proposed work by splitting it into three parts: training, validation, and test sets. The implementation was performed on the Google Colab Pro+ framework with 52 GB of RAM and 265 GB of storage space. An ensemble model was evolved for the automatic segmentation of four OARs in thoracic CT images. U-Net with InceptionV3 as the backbone was used, and different hyperparameters were used during the training of the model. The proposed model achieved precise accuracy for OARs segmentation with an average dice coefficient of 0.9413, Hausdorff value of 0.1838, sensitivity of 0.9783, and specificity of 0.9895 on the Test dataset. An ensembled U-Net InceptionV3 model has been proposed, improving the segmentation results compared with the state-of-the-art techniques such as U-Net, ResNet, Vgg16, etc. The results of the experiments revealed that the proposed model effectively improved the performance of the segmentation of the esophagus, heart, trachea, and aorta. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were to describe the radiographic features of cardiogenic pulmonary oedema (CPE) in a large group of cats with left-sided cardiac disease, and to determine the association between the radiographic features of CPE and the underlying cardiac disease. Methods: Thoracic radiographs of cats with CPE and echocardiographic evidence of left-sided cardiac disease and left atrial enlargement (LAE) were reviewed, and cardiac silhouette, pulmonary vessels and pulmonary parenchyma evaluation were performed. Interstitial and/or alveolar patterns were classified according to their distribution (ie, diffuse, multifocal or focal) and location (ie, craniodorsal, cranioventral, caudodorsal, caudoventral and perihilar). A Student's t -test and Mann–Whitney U-test, or the two-proportion z-test, were used to compare continuous or categorical variables, respectively, between cats affected by the two most represented cardiac diseases, namely hypertrophic cardiomyopathy (HCM) and restrictive cardiomyopathy (RCM). Results: Seventy-one cats were included; among them, 46 (64.7%) and 13 (18.3%) had presented for HCM and RCM, respectively. Subjective and objective cardiomegaly, and subjective and objective LAE were detected in 97.2% and 91.9% of cats and in 80.3% and 40.6% of cats, respectively. Pulmonary artery abnormalities, in particular caudal pulmonary artery dilation, were found in 77.5% of cats. Pulmonary artery to pulmonary vein ratio = 1 was found in 71.8% and 55% cats on right lateral and ventrodorsal or dorsoventral views, respectively. Interstitial (57.8%) and mixed interstitial–alveolar (38%) pattern, multifocal (84.5%) and symmetrical (75%) distribution with prevalent ventrocaudal (65.6% of cats) and ventrocranial (60.9% of cats) locations were most frequently observed. No difference was found for any of these radiographic features between cats with HCM and RCM. Conclusions and relevance: Moderate-to-severe cardiomegaly and LAE, caudal pulmonary artery and vein dilation, as well as a ventral, multifocal and symmetrical interstitial pulmonary pattern, were the main radiographic features of CPE in evaluated cats. Underlying cardiac disease did not influence the aforementioned radiographic features. [ABSTRACT FROM AUTHOR]

A wide spectrum of pathology, both congenital and acquired, can affect the pulmonary arteries. While some of these are commonly seen in everyday clinical practice, some are rare. These entities may be discovered incidentally at imaging for other reasons in an asymptomatic patient, however patients may go on to develop symptoms over the course of their lifetime. Although an enlarged pulmonary artery can be visualized on chest X-ray (CXR), for the most part, CXR is insensitive for detecting abnormalities of the pulmonary arteries. Contrast-enhanced chest CT (CECT) is a better test to evaluate the pulmonary arteries as it is readily available, quick to perform, able to provide multiplanar reformatted images, and noninvasive. CECT is not only able to assess the lumen and wall of the pulmonary artery, but also provides a detailed evaluation of the entire thorax, including the heart, mediastinal structures, and lungs, often times picking up associated findings, and is the mainstay for evaluating disorders of the pulmonary vasculature. MRI allows for detailed evaluation of the vessel wall which can be especially helpful in cases where malignancy or vasculitis are suspected, and is also able to provide useful physiologic data such as quantification of flow. It is important for the radiologist to be aware of the many conditions which affect the pulmonary arteries, as some may require urgent treatment. This article will review normal pulmonary artery anatomy and physiology, as well as the various imaging findings of pulmonary vascular pathologies. • Pulmonary artery pathology is commonly encountered in the radiology practice. • Some rare diseases of the pulmonary arteries may not be frequently reviewed during radiology training. • Radiologists need to be proficient in diagnosing common and rare pulmonary artery pathology to better aid in patient management. [ABSTRACT FROM AUTHOR]

Thoracic radiology is a primary field where artificial intelligence (AI) has been extensively researched. Recent advancements in AI demonstrate potential improvements in radiologists' performance. AI facilitates the detection and classification of abnormalities, as well as the quantification of both normal and abnormal anatomical structures. Furthermore, it enables prognostication based on these quantitative values. In this review article, the recent achievements of AI in thoracic radiology will be reviewed, mainly focused on deep learning, and the current limitations and future directions of this cutting-edge technique will be discussed.

Metastatic sarcomatoid renal cell carcinoma (sRCC) is a significant therapeutic and diagnostic challenge due to its rarity and aggressiveness, which contribute to its poor prognosis. This case report presents the case of a 47-year-old Caucasian man with shortness of breath and right-sided abdominal pain. History revealed an extensive smoking history, a left renal mass diagnosed two months ago with inconclusive results, and an enlarged mass on computed tomography (CT) scan one week ago in an emergency department (ED) visit that showed signs consistent with metastatic disease. CT scan on presentation revealed a right posterolateral chest wall mass measuring 8.5×3.5 cm between the 10th and 11th ribs, as well as multiple bilateral pulmonary metastases. CT scan of the head revealed a soft tissue mass anterior to the epiglottis within the vallecula. Left renal pole mass was also consistent with neoplasm, with stable surrounding mass-like densities consistent with adenopathy and involvement of the adrenal gland. Histopathological examination of the 11 cm right chest wall mass biopsy revealed sRCC due to the visualization of spindle to epithelioid tumor with focal clear cell morphology and a prominent vascular network leading to a nested appearance. Management of his symptoms included thoracocentesis of the pleural effusion, nasal cannula due to low partial pressure of oxygen (PO2), pleurodesis, and trending down of the hypercalcemia. Oncology confirmed the spindle cell neoplasm due to stage IV renal cancer; the patient was transferred to hematology-oncology for further evaluation, but soon after succumbed to the complexities of metastatic disease. This case highlights the challenges of the management and diagnosis of metastatic sRCC over a three-week inpatient service, ultimately revealing a poor prognosis due to the aggressiveness and time of diagnosis, emphasizing the need for early detection methods and personalized treatment strategies. Further research is needed to explore novel therapeutic approaches to tackle this rare and aggressive variant of RCC., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ehsan et al.)

Rationale and Objectives: The burden of coronavirus disease 2019 (COVID-19) airspace opacities is time consuming and challenging to quantify on computed tomography. The purpose of this study was to evaluate the ability of a deep convolutional neural network (dCNN) to predict inpatient outcomes associated with COVID-19 pneumonia.Materials and Methods: A previously trained dCNN was tested on an external validation cohort of 241 patients who presented to the emergency department and received a chest computed tomography scan, 93 with COVID-19 and 168 without. Airspace opacity scoring systems were defined by the extent of airspace opacity in each lobe, totaled across the entire lungs. Expert and dCNN scores were concurrently evaluated for interobserver agreement, while both dCNN identified airspace opacity scoring and raw opacity values were used in the prediction of COVID-19 diagnosis and inpatient outcomes.Results: Interobserver agreement for airspace opacity scoring was 0.892 (95% CI 0.834-0.930). Probability of each outcome behaved as a logistic function of the opacity scoring (25% intensive care unit admission at score of 13/25, 25% intubation at 17/25, and 25% mortality at 20/25). Length of hospitalization, intensive care unit stay, and intubation were associated with larger airspace opacity score (p = 0.032, 0.039, 0.036, respectively).Conclusion: The tested dCNN was highly predictive of inpatient outcomes, performs at a near expert level, and provides added value for clinicians in terms of prognostication and disease severity. [ABSTRACT FROM AUTHOR]

BackgroundIn chronic obstructive pulmonary disease, both smaller and larger airways are affected. FEV1 mainly reflects large airways obstruction, while the later fraction of forced exhalation reflects reduction in terminal expiratory flow. In this study, the objective was to evaluate the relationship between spirometric ratios, including the ratio of forced expiratory volume in 3 and 6 seconds (FEV3/FEV6), and small airways measures and gas trapping at quantitative chest CT scanning, and clinical outcomes in the Genetic Epidemiology of COPD (COPDGene) cohort.MethodsSeven thousand eight hundred fifty-three current and ex-smokers were evaluated for airflow obstruction by using recently defined linear iteratively derived equations of Hansen et al to determine lower limit of normal (LLN) equations for prebronchodilator FEV1/FVC, FEV1/FEV6, FEV3/FEV6, and FEV3/FVC. General linear and ordinal regression models were applied to the relationship between prebronchodilator spirometric and radiologic and clinical data.ResultsOf the 10,311 participants included in the COPDGene phase I study, participants with incomplete quantitative CT scanning or relevant spirometric data were excluded, resulting in 7,853 participants in the present study. Of 4,386 participants with FEV1/FVC greater than or equal to the LLN, 15.4% had abnormal FEV3/FEV6. Compared with normal FEV3/FEV6 and FEV1/FVC, abnormal FEV3/FEV6 was associated with significantly greater gas trapping; St. George's Respiratory Questionnaire score; modified Medical Research Council dyspnea score; and BMI, airflow obstruction, dyspnea, and exercise index and with shorter 6-min walking distance (all P < .0001) but not with CT scanning evidence of emphysema.ConclusionsCurrent and ex-smokers with prebronchodilator FEV3/FEV6 less than the LLN as the sole abnormality identifies a distinct population with evidence of small airways disease in quantitative CT scanning, impaired indexes of physical function and quality of life otherwise deemed normal by using the current spirometric definition.

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A 52-year-old man presented with a one-year history of episodic unilateral facial numbness, jaw weakness, ptosis, and hoarseness. Brain imaging was unremarkable and an 11.5cm right lower thoracic mass was discovered on chest x-ray, which was further evaluated by CT and MRI radiology. The lesion was biopsied, and histopathological examination revealed a thymoma. A diagnosis of ectopic thymoma with paraneoplastic myasthenia gravis was supported by positive anti-acetylcholine receptor and anti-titin serum antibodies. Paraneoplastic syndromes are rarely reported in association with ectopic thymoma, making this case unusual. We discuss the nuances of diagnosis, classification, and staging of this rare case, as well as the patient's subsequent management by cardiothoracic surgery and neurology specialists., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Guerin et al.)

Background The use of computational technology in medicine has allowed for an increase in the accuracy of clinical diagnosis, reducing errors through additional layers of oversight. Artificial intelligence technologies present the potential to further augment and expedite the accuracy, quality, and efficiency at which diagnosis can be made when used as an adjunctive tool. Such techniques, if found to be accurate and reliable in their diagnostic acuity, can be implemented to foster better clinical decision-making, improving patient quality of care while reducing healthcare costs. Methodology This study implemented convolution neural networks to develop a deep learning model capable of differentiating normal chest X-rays from those indicating pneumonia, tuberculosis, cardiomegaly, and COVID-19. There were 3,063 normal chest X-rays, 3,098 pneumonia chest X-rays, 2,920 COVID-19 chest X-rays, 2,214 chest X-rays, and 554 tuberculosis chest X-rays from Kaggle that were used for training and validation. The model was trained to recognize patterns within the chest X-rays to efficiently recognize these diseases within patients to be treated on time. Results The results indicated a success rate of 98.34% incorrect detections, exemplifying a high degree of accuracy. There are limitations to this study. Training models require hundreds to thousands of samples, and due to potential variability in image scanning equipment and techniques from which the images are sourced, the model could have learned to interpret external noise and unintended details which can adversely impact accuracy. Conclusions Further studies that implement more universal database-sourced images with similar image scanning techniques, assess diverse but related medical conditions, and the utilization of repeat trials can help assess the reliability of the model. These results highlight the potential of machine learning algorithms for disease detection with chest X-rays., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Goswami et al.)

Ectopic thyroid tissue (ETT) is a rare finding on mediastinoscopy which could be attributed to a defect early in thyroid gland embryogenesis, as the glandular tissue makes its way to a pre-tracheal position. The more distal the location of the ectopic tissue from typically neighboring structures, such as the recurrent laryngeal nerves or the superior thyroid artery, the greater the likelihood for issues such as hyperthyroidism, compression of nearby neurovascular structures, and malignancy. Depending on the exact anatomical location and hormonal activity of the tissue, management can range from administration of iodine to surgical resection. This report discusses a case of ETT discovered during the resection of an anterior mediastinal mass, possible treatment, and management plans., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Wayne State University Institutional Review Board issued approval 2024 108. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Elashmawy et al.)

Lung cancer is currently the most common malignancy in the world. A lobectomy is the standard of care for most patients with operable lung cancer and accounts for 60% to 70% of lung resection. The chest radiograph may appear normal after a lobectomy, particularly in uncomplicated cases. However, lobectomy usually involves leaving surgical staples at the bronchial stump and causes various changes in the intra- and extrapulmonary thoracic structures on plain radiographs. These changes may differ according to the resected lobe. We retrospectively evaluated the plain radiographic appearances of the postlobectomy chest, free of postoperative complications or recurrent/metastatic lung cancer. On the basis of our observations, the changes that occur in pulmonary and extrapulmonary anatomy can differ according to the resected lobe. Recognition of these changes will make it easier to identify which lobe has been removed surgically. [ABSTRACT FROM AUTHOR]

Although echocardiography is the gold standard for the diagnosis of cardio‐structural disease, thoracic radiography is a rapid, cost‐effective, and widely accessible method for evaluating cardiac size in dogs. The vertebral heart score (VHS) and the vertebral left atrial size (VLAS) are established as objective measures of cardiomegaly on thoracic radiographs. However, several studies have shown significant variations in the VHS among different breeds. The Chihuahua is predisposed to both congenital and acquired cardiac diseases. The aim of this prospective, single‐center, cross sectional study was thus to evaluate the VHS and the VLAS in healthy adult Chihuahua dogs. A total of 30 Chihuahuas were included. The VHS values in our sample population of Chihuahuas were 10.0 ± 0.6 (95% range, 8.9‐11.0). This was significantly greater than the canine reference value of 9.7 ± 0.5 established by Buchanan and Bücheler (P =.002). The VLAS of Chihuahuas in our study was 1.8 ± 0.2 (95% range, 1.3‐2.1). This was significantly lower than the values previously reported by Malcolm et al (2.07 ± 0.25; P =.0004). The VHS and the VLAS were not influenced by sex, body weight, short or long hair, and body condition score in normal Chihuahuas. Our results indicated that breed‐specific reference values for radiographic VHS and VLAS are needed. In Chihuahuas, the values found in this study can be used as a normal reference in order to help avoid overinterpretation of cardiomegaly in these dogs. [ABSTRACT FROM AUTHOR]

Electromagnetic navigational bronchoscopy (ENB) has emerged as an innovative technique for diagnosing peripheral and central nodules, offering an improved diagnostic yield compared to conventional bronchoscopy with fewer complications. That being said, pneumothorax remains a frequent complication. This retrospective study conducted at Castle Hill Hospital, UK, analysed ENB procedures over four years to assess the diagnostic yield and pneumothorax rates, exploring learning curves and procedural improvements specifically focusing on the diagnostic yield and pneumothorax rate as markers of change. A total of 246 patients underwent 358 peripheral lung biopsies, revealing an overall diagnostic yield of 61.3%. The diagnostic yield increased from 58.2% in 2020-2021 to 66.0% in 2022-2023 while the pneumothorax rate decreased significantly from 9.8% to 3.4% (p = 0.021*). The majority of pneumothorax cases occurred following upper lobe procedures. The study depicts the importance of procedural experience in improving outcomes, suggesting a learning curve effect. Additionally, it emphasizes the potential for technological advancements, such as robotic assistance, to mitigate operator-dependent variability and improve reproducibility in ENB procedures. These findings contribute to optimizing diagnostic pathways for lung lesions and improving patient safety in ENB interventions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mwesigwa et al.)

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a rare and potentially life-threatening autoimmune disease characterized by antineutrophil cytoplasmic antibody (ANCA)-associated vasculature inflammation. It presents as a systemic autoimmune disease with necrotizing granulomatous inflammation and pauci-immune small vessel vasculitis. This case initially posed a diagnostic challenge due to its atypical presentation and was misdiagnosed as hypersensitivity pneumonitis. The avian precipitin screening assay was positive in our patient, which may be consistent with bird breeder's lung disease or a non-specific reactivity of the chicken antigen test. However, the presence of positive c-ANCA was pivotal for the GPA diagnosis. Here, we describe in detail the clinical manifestations, diagnostic approach, and treatment of GPA in a 54-year-old female who presented with alveolar hemorrhage, but no renal involvement. Treatment involved the use of high-dose corticosteroids to suppress the autoimmune response. Finally, we discuss the striking response of this unique form of granulomatosis with polyangiitis to corticosteroid treatment and emphasize the importance of early initiation of treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Rachid et al.)

We depict a unique case of a 34-year-old woman who presents to the emergency department with complaints of dyspnea and chest pain for the past month. A chest x-ray (CXR) from an earlier urgent care visit was concerning for large fluid opacity in the left lung and follow-up imaging revealed a cystic mass suspicious of a pulmonary cystic abscess. The patient underwent complete lobectomy and resection. Post-surgical biopsy confirmed pulmonary hydatid cystic mass and signs of rupture or seeding to liver tissue. The patient was discharged with adjuvant therapy and recommended imaging follow-up for the next decade. The diagnosis, treatment, and maintenance guidelines are discussed in this report which reveals controversy between experts given the lack of complete literature regarding echinococcosis. Our purpose in putting forward this case is to present a rare diagnosis of pulmonary echinococcosis in the United States and to emphasize the importance of early imaging and diagnosis to prevent cystic rupture and secondary organ dissemination., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Zhang et al.)

Empyema necessitans is characterized by an empyema that extends from the lung pleura into the chest wall and underlying tissue. We present a rare case of Streptococcus agalactiae (Group B) empyema necessitans in an adult male. This case highlights the diagnosis and management of empyema necessitans in the modern era., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Lakhana et al.)

Introduction Despite the fact that smoking has been identified as a risk factor for respiratory diseases and lung infections, the relationship between smoking and coronavirus severity remains ambiguous. It is believed that smoking is a risk factor for pulmonary infections. However, the effect of smoking on COVID-19 patients is still controversial. Objective The aim of the study was to identify and analyze the distinct radiological features in COVID-19 patients with different smoking statuses. Additionally, the study sought to examine the association between smoking and the severity of pulmonary changes. Methods A retrospective cohort study of 111 patients who were referred to Al-Salt/Hussein Hospital, Al-Salt, Jordan, from January to June 2021, with a confirmed COVID-19 diagnosis and smoking status recorded. Patients' demographics, medical history, age, gender, comorbidity, and length of hospitalization were obtained from their medical records. Results Study groups were similar in median age, prevalence of chosen chronic diseases, and median length of hospital stay. Based on the median scores of the radiological findings in each lung lobe, no statistically significant differences were found between the scores and smoking status (p-values of >0.05; Mann-Whitney test). Conclusion Smoking is an independent risk factor for the severity of COVID-19. Smoking has no noticeable impact on interstitial manifestation in COVID-19 patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hasweh et al.)

Patients with an unexplained pleural effusion often require urgent investigation. Clinical practice varies due to uncertainty as to whether an effusion should be drained completely before diagnostic imaging. We performed a retrospective study of patients undergoing medical thoracoscopy for an unexplained effusion. In 110 patients with paired (pre- and post-drainage) chest X-rays and 32 patients with paired computed tomography scans, post-drainage imaging did not provide additional information that would have influenced the clinical decision-making process. [ABSTRACT FROM AUTHOR]

Bronchocutaneous fistula (BCF) is a pathologic communication between the bronchus and the subcutaneous tissue. Its diagnosis is made mainly by chest imaging, and bronchoscopy can help in accurately localizing the fistula. Treatment options include conservative and non-conservative approaches. We report a case of iatrogenic bronchocutaneous fistula occurring after traumatic chest tube placement in an 81-year-old man, treated efficiently with conservative management., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mallat et al.)

Computed tomography (CT)-guided percutaneous core needle biopsy of the lung is a frequently performed interventional radiological procedure. Most complications are minor and self-resolving. However, a rare but potentially fatal complication is that of systemic air embolism, especially when to the cerebral or coronary arteries. This study reports a case of delayed (12 hours after initial biopsy) air embolism in the cerebral arteries that resulted from an otherwise uncomplicated biopsy of a lung nodule. It is vital for early diagnostic confirmation and appropriate treatment if possible, though maximal efforts at prevention are still recommended., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Yang et al.)

Purpose: The rate of thoracic biopsies overall and by type of biopsy from 1998 to 2010 is not known. The aim of this study was to examine the utilization rate of various types of thoracic biopsies within the Medicare population. Methods: Source data was obtained from the CMS Physician/Supplier Procedure Summary Master Files from 1998 to 2010. Allowed primary claims submitted for percutaneous thoracic biopsy, bronchoscopic thoracic biopsy, and surgical thoracic biopsy were extracted. Annual volume and utilization rates were calculated and analyzed by biopsy type and provider type. Results: Total thoracic biopsy volume in 1998 was 176,125 and in 2010 was 167,911 (−4.7%). The utilization rate for all thoracic biopsies decreased from 5.47 per 1,000 in 1998 to 4.76 per 1,000 (−13.0%) in 2010. The percutaneous biopsy utilization rate increased 3.6% from 1998 to 2010, while the rate for surgical biopsy decreased by 20.9% and the rate of bronchoscopic biopsy decreased by 19.6% during the same time period. In 2010, radiologists performed 96.4% (58,679) of all percutaneous biopsies. Radiologists' thoracic biopsy market share increased from 26.2% (46,084 of 176,125) in 1998 to 35.0% (58,700 of 167,911) in 2010 (+33.6%). Conclusions: The overall rate of thoracic biopsy decreased from 1998 to 2010, with fewer biopsies being performed surgically and bronchoscopically and more biopsies being performed percutaneously. Radiologists are responsible for an increasing role in thoracic diagnosis, as they have increased market share of thoracic biopsies. These findings may be the result of changing trends toward less invasive procedures, changing patterns of reimbursement, and increased availability of percutaneous biopsy. [Copyright &y& Elsevier]

Background Documentation of lower respiratory tract infection has relied on microbiologic and cytologic findings in airway fluid, but there is no gold standard for making a definitive diagnosis. Objective To report cytologic and microbiologic findings in dogs diagnosed with lower respiratory tract infection through evaluation by bronchoscopy and bronchoalveolar lavage. Animals A total of 105 dogs with spontaneous respiratory disease. Methods Retrospective case review of all dogs identified through the electronic medical record database that had bronchoscopy with bronchoalveolar lavage performed between 2001 and 2011. Results of bronchoalveolar lavage cytology and microbiology were evaluated in 510 dogs, and 105 cases with septic, suppurative inflammation or bacterial growth from cultures were examined further. Results Bacteria were isolated from 89/105 aerobic cultures, 18/104 anaerobic cultures, and 30/99 Mycoplasma spp. cultures. The most common isolate was Mycoplasma spp. followed by Pasteurella sp., Bordetella sp, Enterobacteriaceae, and anaerobes. A single bacterial species was cultured from 44/99 dogs (44%) and multiple bacterial species were isolated from 55/99 dogs (56%). Suppurative inflammation with intracellular bacteria was identified cytologically in 78 of 105 dogs (74%). In 27 dogs that lacked cytologic evidence of sepsis, mixed (n = 18) and neutrophilic (n = 9) inflammation was reported, and Mycoplasma spp. (13/27) or Bordetella spp. (7/27) were most commonly isolated. Most aerobic bacteria were susceptible to routinely used antimicrobial drugs. Conclusions and Clinical Importance Confirmation of lower respiratory tract infection in dogs is challenging and organisms can be isolated from dogs in which bacteria are not detected on cytologic examination. [ABSTRACT FROM AUTHOR]

Summary: Haemoptysis is a common complication in cystic fibrosis (CF), occurring in approximately 9% of the population. Massive haemoptysis is associated with older patients, more severe disease and carries a high mortality rate. Despite this there are few robust published studies of effective treatments and knowledge of the precise pathogenesis is limited. Current guidelines for treatment from the Cystic Fibrosis Foundation (CFF) are based on consensus opinion of experts. Patients with massive haemoptysis who do not respond to initial medical treatments should undergo bronchial artery embolization. This will control the bleeding in the majority of cases but recurrence rates are high and there are little data to support long-term improved outcomes. Surgery is a last resort in patients with CF. [ABSTRACT FROM AUTHOR]

Background Cytologic results from bronchoscopic BAL in cats with naturally occurring respiratory disease have not been reported, and the clinical utility of multisegment lavage has not been evaluated. Hypothesis BAL cytology from 2 separate lung segments in cats will have similar cell counts, cytologic interpretation, or both. Animals Eighty-seven cases in 85 cats (2 examined twice) with naturally occurring lower respiratory disease. Methods A combined prospective/retrospective evaluation of all cats with multisegment BAL was performed. BAL fluid was evaluated for total nucleated cell counts, differential cell counts, and cytologic characteristics at each lavage site. BAL fluid was categorized as eosinophilic, neutrophilic, lymphocytic, hypercellular, or mixed. Radiographs were assessed for diffuse or focal disease. Results Clinical diagnoses included inflammatory airway disease (n = 63), pneumonia (n = 15), neoplasia (n = 6), and undetermined (n = 3). Total nucleated cell counts varied between sites regardless of radiographic evidence of focal or diffuse radiographic disease. In 28/87 cases (32%), cell counts differed between lavage sites by 2.2-40 fold. BAL yielded similar cytologic interpretation of inflammation in 45/87 (52%) cases. In 8/14 cases that had BAL performed at the site of a focal radiographic infiltrate, as well as at a site of diffuse infiltrates, the same inflammatory interpretation was made at each site. Conclusions and clinical importance Total and differential cell counts in BAL fluid often differ between lung segments in cats with lower respiratory disease, and caution is warranted when using a single BAL cytology to define the inflammatory response in cats with spontaneously occurring lower respiratory tract disease. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The morbidity and mortality for pneumonectomy in patients has been reported to be as high as 24%. To determine if a subset of patients undergoing pneumonectomy for a malignancy would have similar complication rates and appearances, we performed a review of the radiographic findings of patients at our institution. Method: A retrospective review of a thoracic surgery database was performed at our institution for patients who underwent pneumonectomy between January 2001 and April 2004. All images were reviewed on the institutional patient archive communication system, by two experienced, fellowship trained, thoracic radiologists. Results: There were 144 patients (112 men and 32 women) with a mean age of 52 years (range 21–83 years). Of the 144 patients, thoracic complications were present in 52 (36%) patients consisting of pneumonia in 19 (13%), empyema/pleural space infection in 9 (6%), adult respiratory distress syndrome (ARDS) in 8 (6%), bronchopleural fistula in 7 (5%), gortex graft failure/organ herniation in 4 (3%), chylothorax/chyle leak in 2 (1%), pulmonary embolus in 2 (1%), pulmonary hemorrhage in 1 (<1%). Conclusion: In oncologic patients, post-pneumonectomy complications occur in over a third of patients and can be life threatening. The presentations are similar to other pneumonectomy patients and are often radiographically detectable. Therefore it is important for radiologist to be aware of the radiographic manifestations of these complications so that appropriate immediate treatment is instituted. [Copyright &y& Elsevier]

The article discusses the study which determines the radiation exposure associated with computed tomography (CT) scans in a population of patients with cystic fibrosis (CF). It states that the full parameters of the examination were available for 185 thoracic CT scans allowing the effective dose (ED) and organ doses to be calculated. Thus, the lifetime ED of radiation received by cystic fibrosis (CF) patients warranted long-term follow-up.

The article presents information on a study which analyzes the common chest radiograph (CXR) patterns in adult patients with cystic fibrosis (CF), and tries to find the correlation of disease distribution on CXRs with genotype, age, and gender. It involved one hundred nine CF patients who were divided into different groups with diffuse bilateral (DB), unilateral, upper lobe (UL) or lower lobe (LL) disease.

The vertebral heart size (VHS) method by Buchanan is based on anatomic landmarks. A potential source of variation among observers is differences in the selection of measurement points. The objective was to test variability between observers with different levels of training in thoracic radiology and small animal clinical practice. Fifty sets of thoracic radiographs of cavalier King Charles spaniels, were divided into five groups; (Normal) normal cardiopulmonary structures, (I) slight cardiomegaly, (II) moderate cardiomegaly, (II+) moderate cardiomegaly with congestive heart failure, and (III+) severe cardiomegaly with congestive heart failure. Cardiomegaly was confirmed by echocardiography to be caused by mitral regurgitation because of myxomatous mitral valve disease. Sixteen observers representing four levels of experience (four observers/level) evaluated the radiographs; (1) European Diplomates in Veterinary Diagnostic Imaging, (2) Experienced small animal clinicians, (3) Trainees in small animal clinical practice (4) Veterinary students. Almost identical mean VHS values were found among the four experience levels for each of the five groups of radiographs with a low coefficient of variation, range 1.5–3.2%. Mean difference among the 16 observers was 1.05±0.32 vertebrae (v). Mean difference among individuals in each observer group was approximately 0.5 v for all but the groups of trainees were the difference was 0.6–0.9 v. The conclusion is that VHS method for heart size is independent of observer experience but dependent of individual observers selection of reference points and transformation of long and short axis dimensions into VHS units. [ABSTRACT FROM AUTHOR]

Although many of the thoracic infections endemic to Africa are also present around the world, this article focuses on entities that are emerging or disproportionately affect populations living in sub-Saharan Africa. Important emerging or reemerging viral and bacterial diseases that commonly affect the lung include dengue fever, plague, leptospirosis, and rickettsioses. Most parasitic infections endemic to Africa can also manifest within the thorax, including malaria, amebiasis, hydatid disease, schistosomiasis, paragonimiasis, ascariasis, strongyloidiasis and cysticercosis. Level of sanitation, interaction between humans and host animals, climate change, political instability, and global travel all affect the distribution and burden of these diseases., Competing Interests: Disclosure C. E. Rydzak and A. S. Lima: No disclosures. G.S.P. Meirelles Chief Medical Officer at Alliar Group, Partner at Ambra Saude, Datalife.ai and Bright Photomedicine, President at I2A2, Speaker and member of the advisory board of Boehringer-Ingelheim., (Copyright © 2022 Elsevier Inc. All rights reserved.)