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OBJECTIVES: To describe imaging and laboratory findings of confirmed PE diagnosed in COVID-19 patients and to evaluate the characteristics of COVID-19 patients with clinical PE suspicion. Characteristics of patients with COVID-19 and PE suspicion who required admission to the intensive care unit (ICU) were also analysed. METHODS: A retrospective study from March 18, 2020, until April 11, 2020. Inclusion criteria were patients with suspected PE and positive real-time reverse-transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2. Exclusion criteria were negative or inconclusive RT-PCR and other chest CT indications. CTPA features were evaluated and severity scores, presence, and localisation of PE were reported. D-dimer and IL-6 determinations, ICU admission, and previous antithrombotic treatment were registered. RESULTS: Forty-seven PE suspicions with confirmed COVID-19 underwent CTPA. Sixteen patients were diagnosed with PE with a predominant segmental distribution. Statistically significant differences were found in the highest D-dimer determination in patients with PE and ICU admission regarding elevated IL-6 values. CONCLUSION: PE in COVID-19 patients in our series might predominantly affect segmental arteries and the right lung. Results suggest that the higher the D-dimer concentration, the greater the likelihood of PE. Both assumptions should be assessed in future studies with a larger sample size. KEY POINTS: ⢠On CT pulmonary angiography, pulmonary embolism in COVID-19 patients seems to be predominantly distributed in segmental arteries of the right lung, an assumption that needs to be approached in future research. ⢠Only the highest intraindividual determination of d-dimer from admission to CT scan seems to differentiate patients with pulmonary embolism from patients with a negative CTPA. However, interindividual variability calls for future studies to establish cut-off values in COVID-19 patients. ⢠Further studies with larger sample sizes are needed to determine whether the presence of PE could increase the risk of intensive care unit (ICU) admission in COVID-19 patients.
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COVID-19 , Embolia Pulmonar , Humanos , Embolia Pulmonar/diagnóstico por imagen , Estudios Retrospectivos , SARS-CoV-2 , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The objectives of this article are to review the imaging findings of left ventricular noncompaction (LVNC) at echocardiography, cardiac MRI, and MDCT; to discuss diagnostic criteria for and the advantages and limitations of these imaging techniques; and to describe pitfalls that can lead to misinterpretation of findings of LVNC. CONCLUSION: LVNC is a cardiac disease of emerging importance, and imaging has a key role in its diagnosis. Accordingly, radiologists should be familiar with LVNC imaging findings to realize an accurate diagnosis.
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Diagnóstico por Imagen , No Compactación Aislada del Miocardio Ventricular/diagnóstico , Diagnóstico Diferencial , HumanosRESUMEN
The rapid spread of the severe acute respiratory syndrome coronavirus 2 led to a global overextension of healthcare. Both Chest X-rays (CXR) and blood test have been demonstrated to have predictive value on Coronavirus Disease 2019 (COVID-19) diagnosis on different prevalence scenarios. With the objective of improving and accelerating the diagnosis of COVID-19, a multi modal prediction algorithm (MultiCOVID) based on CXR and blood test was developed, to discriminate between COVID-19, Heart Failure and Non-COVID Pneumonia and healthy (Control) patients. This retrospective single-center study includes CXR and blood test obtained between January 2017 and May 2020. Multi modal prediction models were generated using opensource DL algorithms. Performance of the MultiCOVID algorithm was compared with interpretations from five experienced thoracic radiologists on 300 random test images using the McNemar-Bowker test. A total of 8578 samples from 6123 patients (mean age 66 ± 18 years of standard deviation, 3523 men) were evaluated across datasets. For the entire test set, the overall accuracy of MultiCOVID was 84%, with a mean AUC of 0.92 (0.89-0.94). For 300 random test images, overall accuracy of MultiCOVID was significantly higher (69.6%) compared with individual radiologists (range, 43.7-58.7%) and the consensus of all five radiologists (59.3%, P < .001). Overall, we have developed a multimodal deep learning algorithm, MultiCOVID, that discriminates among COVID-19, heart failure, non-COVID pneumonia and healthy patients using both CXR and blood test with a significantly better performance than experienced thoracic radiologists.
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COVID-19 , Aprendizaje Profundo , Insuficiencia Cardíaca , Neumonía , Masculino , Humanos , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , COVID-19/diagnóstico , Prueba de COVID-19 , Estudios Retrospectivos , Radiografía Torácica/métodosRESUMEN
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is increasingly considered a heterogeneous condition. It was hypothesised that COPD, as currently defined, includes different clinically relevant subtypes. METHODS: To identify and validate COPD subtypes, 342 subjects hospitalised for the first time because of a COPD exacerbation were recruited. Three months after discharge, when clinically stable, symptoms and quality of life, lung function, exercise capacity, nutritional status, biomarkers of systemic and bronchial inflammation, sputum microbiology, CT of the thorax and echocardiography were assessed. COPD groups were identified by partitioning cluster analysis and validated prospectively against cause-specific hospitalisations and all-cause mortality during a 4 year follow-up. RESULTS: Three COPD groups were identified: group 1 (n=126, 67 years) was characterised by severe airflow limitation (postbronchodilator forced expiratory volume in 1 s (FEV(1)) 38% predicted) and worse performance in most of the respiratory domains of the disease; group 2 (n=125, 69 years) showed milder airflow limitation (FEV(1) 63% predicted); and group 3 (n=91, 67 years) combined a similarly milder airflow limitation (FEV(1) 58% predicted) with a high proportion of obesity, cardiovascular disorders, diabetes and systemic inflammation. During follow-up, group 1 had more frequent hospitalisations due to COPD (HR 3.28, p<0.001) and higher all-cause mortality (HR 2.36, p=0.018) than the other two groups, whereas group 3 had more admissions due to cardiovascular disease (HR 2.87, p=0.014). CONCLUSIONS: In patients with COPD recruited at their first hospitalisation, three different COPD subtypes were identified and prospectively validated: 'severe respiratory COPD', 'moderate respiratory COPD', and 'systemic COPD'.
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Enfermedad Pulmonar Obstructiva Crónica/clasificación , Anciano , Métodos Epidemiológicos , Femenino , Volumen Espiratorio Forzado/fisiología , Hospitalización/estadística & datos numéricos , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Presión Parcial , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Clase Social , España/epidemiologíaRESUMEN
INTRODUCTION: Transbronchial needle aspiration (TBNA) is a bronchoscopic technique that has been shown to be useful for sampling enlarged mediastinal lymph nodes. The yield of this technique can be increased by using endobronchial ultrasound (EBUS) to guide needle placement. The aim of the present study was to compare the yield of radial EBUS-guided TBNA to that of conventional TBNA in the analysis of mediastinal lymph nodes. PATIENTS AND METHODS: All patients undergoing either EBUS-guided or conventional TBNA for the diagnosis of mediastinal lymph nodes between January 2006 and May 2007 were studied consecutively. Histology results were used as a reference standard in the patients treated surgically. In cases in which surgery was not indicated, the results of cytology or of clinical follow-up of at least 6 months duration were used. RESULTS: TBNA was performed in 117 patients, and a total of 143 lymph nodes were punctured (mean shortest [SD] diameter, 17.9 [8]mm). The samples obtained were diagnostic in 58 patients (49.6%) and in 70 lymph nodes (49.0%). For paratracheal and hilar stations, the yield of radial EBUS-guided TBNA was superior to that of conventional TBNA (59.2% compared to 34.1%, P=.02). CONCLUSIONS: Radial EBUS guidance increases the diagnostic yield of TBNA in paratracheal and hilar lymph node stations.
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Biopsia con Aguja/métodos , Broncoscopía , Metástasis Linfática/patología , Mediastino/patología , Ultrasonografía Intervencional , Anciano , Biopsia con Aguja/estadística & datos numéricos , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática/diagnóstico por imagen , Masculino , Mediastino/diagnóstico por imagen , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
We report a case of pleural effusion, pericardial thickening, and pulmonary involvement in a patient with dry cough, dyspnea, edema, and changes in the skin of the lower limbs. Treatment with cabergoline (Sogilen) had been started 4 months earlier. Pleural effusion, pericardial thickening, and impaired pulmonary function (airflow obstruction, increased airway resistance, and reduced carbon monoxide diffusing capacity) were observed. The Naranjo scale pointed to a probable relationship between cabergoline and these adverse effects. We report on outcome after 2 months of follow-up, during which time there was a slow and incomplete improvement in respiratory function. This is the first case in our practice setting of early pleuropulmonary toxicity associated with cabergoline.
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Antiparkinsonianos/efectos adversos , Ergolinas/efectos adversos , Enfermedades Pulmonares/inducido químicamente , Derrame Pleural/inducido químicamente , Anciano , Cabergolina , Humanos , Masculino , Factores de TiempoRESUMEN
Lung cancer (LC) is a major public health issue. Despite recent advances in treatment, primary prevention and early diagnosis are key to reducing the incidence and mortality of this disease. A recent clinical trial demonstrated the efficacy of selective screening by low-dose computed tomography (LDCT) in reducing the risk of both lung cancer mortality and all-cause mortality in high-risk individuals. This article contains the reflections of an expert group on the use of LDCT for early diagnosis of LC in high-risk individuals, and how to evaluate its implementation in Spain. The expert group was set up by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM).
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Neoplasias Pulmonares/diagnóstico por imagen , Tamizaje Masivo/métodos , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Detección Precoz del Cáncer , Femenino , Humanos , Neoplasias Pulmonares/epidemiología , Masculino , Tamizaje Masivo/economía , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Años de Vida Ajustados por Calidad de Vida , Riesgo , Sensibilidad y Especificidad , Nódulo Pulmonar Solitario/diagnóstico por imagen , España/epidemiología , Tomografía Computarizada por Rayos X/economíaRESUMEN
BACKGROUND: Occupational exposure to dusts, gases and fumes has been associated with reduced FEV1 and sputum production in COPD patients. The effect of occupational exposure on other characteristics of COPD, especially those reflecting emphysema, has not been studied in these patients. METHODS: We studied 338 patients hospitalized for a first exacerbation of COPD in 9 Spanish hospitals, obtaining full occupational history in a face-to-face interview; job codes were linked to a job exposure matrix for semi-quantitative estimation of exposure to mineral/biological dust, and gases/fumes for each job held. Patients underwent spirometry, diffusing capacity testing and analysis of gases in stable conditions. Quality of life, dyspnea and chronic bronchitis symptoms were determined with a questionnaire interview. A high- resolution CT scan was available in 133 patients. RESULTS: 94% of the patients included were men, with a mean age of 68(8.5) years and a mean FEV1% predicted 52 (16). High exposure to gases or fumes was associated with chronic bronchitis, and exposure to mineral dust and gases/fumes was associated with higher scores for symptom perception in the St. George's questionnaire. No occupational agent was associated with a lower FEV1. High exposure to all occupational agents was associated with better lung diffusion capacity, in long-term quitters. In the subgroup with CT data, patients with emphysema had 18% lower DLCO compared to those without emphysema. CONCLUSIONS: In our cohort of COPD patients, high exposure to gases or fumes was associated with chronic bronchitis, and high exposure to all occupational agents was consistently associated with better diffusion capacity in long-term quitters.
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Bronquitis/inducido químicamente , Bronquitis/complicaciones , Polvo , Gases/efectos adversos , Exposición Profesional/efectos adversos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Anciano , Difusión , Femenino , Hospitalización , Humanos , Masculino , Fumar/efectos adversos , Resultado del TratamientoRESUMEN
Chest ultrasonography is a useful tool for assessing disease activity in the peripheral lung parenchyma, pleura, chest wall, diaphragm, and mediastinum. Ultrasound imaging also provides highly useful guidance in invasive diagnostic and therapeutic procedures. The main advantages of this imaging technology are the absence of ionizing radiation and the possibility of real-time bedside applications. The chief indications and limitations of chest ultrasonography and the principal sonographic signs are reviewed.
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Enfermedades Torácicas/diagnóstico por imagen , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pleurales/diagnóstico por imagen , UltrasonografíaRESUMEN
UNLABELLED: The diaphragm is the principal respiratory muscle. Its special characteristics have made it difficult to design instruments capable of performing a non-invasive evaluation of its structure and function in humans. The present study was designed to evaluate the potential use of echography as a non-invasive method to fulfil these objectives. METHODS: The study consisted of three phases: (1) echographic study in autopsy samples (n=10) of a segment of the thoracic-abdominal wall, from the bottom to the parietal peritoneum (i.e., thoracic wall, diaphragm, pleura and peritoneum structures), (2) static echographic study of the previous structures and the diaphragm in healthy subjects (n=10) to standardised lung volumes; and (3) dynamic echographic study of the contraction-relaxation of the diaphragm in the same subjects, calculating its maximum velocity of relaxation (MVrdi, mm/sec) during a specific inspiratory resistance test. RESULTS: The echography enabled the pleural and peritoneal limits of the diaphragm to be identified, and quantitate its thickness (Tdi), both ex-vivo and in-vivo, in all cases. The dynamic study of the Tdi showed a linear increase directly associated with the lung volume measurement, as well as a cyclical increase during inspiratory movements at rest. In the resistance test, the MVrdi was maximal with low loads and gradually decrease until reaching a minimum nadir (Δ≈-70% of the initial value) in claudication (fatigue). The MVrdi has a high precision in diagnosing claudication. CONCLUSIONS: Transthoracic echography of the diaphragm is a non-invasive method that gives promising results in the structural and functional evaluation (i.e. fatigue risk) of that muscle. These findings are of pathophysiological interest and could be of use in the clinical care context.
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Diafragma/anatomía & histología , Diafragma/fisiología , Ecocardiografía , Adulto , Estudios Transversales , Diafragma/diagnóstico por imagen , Ecocardiografía/métodos , Humanos , Masculino , Fatiga Muscular/fisiología , Pruebas de Función RespiratoriaRESUMEN
BACKGROUND: The potential role of decreased respiratory muscle mass, if any, in mediating the susceptibility to exacerbation in COPD patients has not been determined. We hypothesized that a decrease in respiratory muscle mass is associated with increased risk of multiple hospital admissions due to acute exacerbations of the disease. METHODS: Eligible cases and controls (n=20) were identified from records of our department's pulmonary clinic. Ten subjects diagnosed with COPD (males, 66+/-7yr, Body Mass Index (BMI)=26+/-4kg/m(2)) were identified as fragile patients. Fragility was defined as four or more admissions in the previous year due to severe exacerbations of the disease. Fragile patients were matched with 10 non-fragile controls, defined as COPD patients who had required only one admission due to exacerbation of the disease. Criteria for 1:1 matching included ethnicity, gender, age, BMI, degree of airflow obstruction (i.e., FEV(1)), comorbidity and chronic treatment. Multiple computed tomography (CT) scan slices were obtained to assess area and attenuation coefficients of multiple upper limb, thorax, abdomen and lower limb muscles. RESULTS: CSA of intercostal and abdominal muscles was significantly decreased in fragile COPD patients (right side intercostals, mean relative difference (MRD)=-14%, p=0.010; OR (95% CI)=2.2 (1.1-4.8), p=0.021; left side, MRD=-13%, p=0.007; OR=2.2 (1.1-4.5), p=0.027). CSA and attenuation coefficients of all other muscle compartments showed no statistical differences between the two study groups but showed the same trend. Strength of the inspiratory and expiratory muscles did not differ between the two study groups. CONCLUSIONS: This study shows that the risk for multiple admissions due to a COPD exacerbation associates with a marked decrease in the CSA of the intercostal muscle compartment.
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Músculos Intercostales/fisiopatología , Atrofia Muscular/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Músculos Abdominales/diagnóstico por imagen , Músculos Abdominales/fisiopatología , Anciano , Índice de Masa Corporal , Broncodilatadores/uso terapéutico , Estudios de Casos y Controles , Estudios Transversales , Progresión de la Enfermedad , Tolerancia al Ejercicio , Humanos , Músculos Intercostales/diagnóstico por imagen , Masculino , Atrofia Muscular/diagnóstico por imagen , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Radiografía , Factores de Riesgo , Resultado del TratamientoAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias Óseas/patología , Húmero/patología , Neoplasias Pulmonares/secundario , Neumotórax/inducido químicamente , Sarcoma Sinovial/secundario , Tomografía Computarizada por Rayos X , Adulto , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/cirugía , Terapia Combinada , Dacarbazina/administración & dosificación , Dacarbazina/efectos adversos , Dacarbazina/análogos & derivados , Resultado Fatal , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Masculino , Recurrencia Local de Neoplasia/tratamiento farmacológico , Neumotórax/diagnóstico por imagen , Rotura Espontánea , Sarcoma Sinovial/tratamiento farmacológico , Sarcoma Sinovial/cirugía , TemozolomidaRESUMEN
PURPOSE: Polymorphisms in DNA repair genes can influence response to radiotherapy. We analyzed single-nucleotide polymorphisms (SNP) in nine DNA repair genes in 108 patients with head-and-neck cancer (HNSCC) who had received radiotherapy only. METHODS AND MATERIALS: From May 1993 to December 2004, patients with Stage I and II histopathologically confirmed HNSCC underwent radiotherapy. DNA was obtained from paraffin-embedded tissue, and SNP analysis was performed using a real-time polymerase chain reaction allelic discrimination TaqMan assay with minor modifications. RESULTS: Patients were 101 men (93.5%) and 7 (6.5%) women, with a median age of 64 years (range, 40 to 89 years). Of the patients, 76 (70.4%) patients were Stage I and 32 (29.6%) were Stage II. The XPF/ERCC1 SNP at codon 259 and XPG/ERCC5 at codon 46 emerged as significant predictors of progression (p = 0.00005 and 0.049, respectively) and survival (p = 0.0089 and 0.0066, respectively). Similarly, when variant alleles of XPF/ERCC1, XPG/ERCC5 and XPA were examined in combination, a greater number of variant alleles was associated with shorter time to progression (p = 0.0003) and survival (p = 0.0002). CONCLUSIONS: Genetic polymorphisms in XPF/ERCC1, XPG/ERCC5, and XPA may significantly influence response to radiotherapy; large studies are warranted to confirm their role in HNSCC.