A screening study for COVID-19-associated pulmonary aspergillosis in critically ill patients during the third wave of the pandemic.

BACKGROUND: COVID-19-associated pulmonary aspergillosis (CAPA) has been reported as an important cause of mortality in critically ill patients with an incidence rate ranging from 5% to 35% during the first and second pandemic waves. OBJECTIVES: We aimed to evaluate the incidence, risk factors for CAPA by a screening protocol and outcome in the critically ill patients during the third wave of the pandemic. PATIENTS/METHODS: This prospective cohort study was conducted in two intensive care units (ICU) designated for patients with COVID-19 in a tertiary care university hospital between 18 November 2020 and 24 April 2021. SARS-CoV-2 PCR-positive adult patients admitted to the ICU with respiratory failure were included in the study. Serum and respiratory samples were collected periodically from ICU admission up to CAPA diagnosis, patient discharge or death. ECMM/ISHAM consensus criteria were used to diagnose and classify CAPA cases. RESULTS: A total of 302 patients were admitted to the two ICUs during the study period, and 213 were included in the study. CAPA was diagnosed in 43 (20.1%) patients (12.2% probable, 7.9% possible). In regression analysis, male sex, higher SOFA scores at ICU admission, invasive mechanical ventilation and longer ICU stay were significantly associated with CAPA development. Overall ICU mortality rate was higher significantly in CAPA group compared to those with no CAPA (67.4% vs 29.4%, p < .001). CONCLUSIONS: One fifth of critically ill patients in COVID-19 ICUs developed CAPA, and this was associated with a high mortality.

Pleuroparenchymal fibroelastosis in systemic sclerosis-associated interstitial lung disease.

BACKGROUND: To explore the frequency and clinical associations of radiologic pleuroparenchymal fibroelastosis (PPFE) in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD). METHODS: In this single-center retrospective study, high resolution computed tomography (HRCT) images of 105 patients with SSc-ILD were examined for the presence of PPFE. Demographic, clinical, laboratory, and pulmonary function test (PFT) data of patients with and without PPFE were compared. RESULTS: PPFE was detected in 19 (18.1%) patients ('definite PPFE' in 13 and 'consistent with PPFE' in 6 patients). Patients with PPFE had higher age and longer disease duration than PPFE (-) patients (p < 0.05 for both). Radiologic usual interstitial pneumoniae (UIP) pattern was more frequent (26.3% vs. 4.7%, p = 0.01) and median force vital capacity (FVC) was lower in patients with PPFE (64% vs. 82%, p = 0.005). Spontaneous pneumothorax developed in one patient with PPFE. More deaths occured in PPFE (+) group during follow-up (31% vs. 11%, p = 0.04).

Immunoglobulin G4-related thoracic disease: clinical and radiological findings of a Turkish cohort.

BACKGROUND AND AIM: Thoracic involvement of Immunoglobulin G4-related disease (IgG4-RD) is relatively rare and may be disregarded at the time of initial diagnosis due to its asymptomatic nature. This study aimed to ascertain the prevalence and patterns of thoracic involvement in a retrospective cohort of Turkish patients with IgG4-RD. METHODS: A total of 90 patients (47 males and 43 females, with a mean age of 57.7±15.5 years) diagnosed with IgG4-RD were reviewed retrospectively. All computed tomography (CT) scans were re-evaluated by two thoracic radiologists and IgG4-related thoracic disease was assessed on four compartments: The mediastinum, pulmonary parenchyma, airways, and pleura. IgG4-related thoracic disease was categorized as: definite, highly probable, probable or possible. RESULTS: There were 64 patients who had undergone at least one thorax CT examination, and 18 (28%) were diagnosed with IgG4-related thoracic disease. The rate of IgG4-related thoracic disease increased by 20% and reached a ratio of 48.4% (n=31) after a thorough reevaluation of registry data specifically to thoracic findings. The mediastinum was the most frequently involved compartment, affecting 16 (51.6%) patients, followed by pulmonary parenchyma in 14 (45.2%) patients, and airways and pleura in 10 (32.3%) patients each. Other organ involvements were more prevalent and IgG4 levels were higher in patients with thoracic involvement. Eosinophils were significantly elevated in patients with thoracic involvement (p=0.023). CONCLUSIONS: IgG4-related thoracic disease is heterogeneous and likely to be more prevalent than currently recognized. The mediastinum is the most frequently involved compartment. It is important to assess IgG4-related thoracic disease at the time of initial diagnosis. Elevated levels of serum IgG4 and eosinophils, as well as a greater number of organ involvements may serve as indicators of thoracic involvement.

Splenic anomalies of shape, size, and location: pictorial essay.

Spleen can have a wide range of anomalies including its shape, location, number, and size. Although most of these anomalies are congenital, there are also acquired types. Congenital anomalies affecting the shape of spleen are lobulations, notches, and clefts; the fusion and location anomalies of spleen are accessory spleen, splenopancreatic fusion, and wandering spleen; polysplenia can be associated with a syndrome. Splenosis and small spleen are acquired anomalies which are caused by trauma and sickle cell disease, respectively. These anomalies can be detected easily by using different imaging modalities including ultrasonography, computed tomography, magnetic resonance imaging, and also Tc-99m scintigraphy. In this pictorial essay, we review the imaging findings of these anomalies which can cause diagnostic pitfalls and be interpreted as pathologic processes.

Pigment epithelium-derived factor increases in type 2 diabetes after treatment with metformin.

OBJECTIVE: Pigment epithelium-derived factor (PEDF) has anti-angiogenic, immunomodulatory and anti-inflammatory properties. In addition to the significant role it plays in reducing diabetic complications, PEDF is now used in the treatment of certain cancers. It possibly plays a role in insulin resistance cases, too. However, whether metformin treatment has any significant effects on PEDF levels is not known. In this study, we investigated the regulation of PEDF in type 2 diabetes in relation to fat mass and insulin resistance before and after the use of metformin for treatment. DESIGN: Prospective cohort study. SUBJECTS: Thirty-six patients with newly diagnosed type 2 diabetes and 33 healthy individuals. MEASUREMENTS: Baseline weight, waist circumference (WC), fasting (FPG) and postprandial (PPPG) glucose, insulin, HbA1c, HOMA, PEDF and total/truncal fat mass were determined both in the diabetic and control subjects. Procedures were repeated in the diabetic group after a 6-month metformin treatment. RESULTS: Baseline FPG, PPPG, HbA1c, HOMA, weight, WC and truncal fat mass were higher in patients with diabetes whereas PEDF levels were found to be comparable with the controls. We completed the study with 31 of the 36 patients with diabetes we had selected for the study. We observed a decrease in the weight, WC, FPG, PPPG, HOMA, total and truncal fat mass of the patients while there was a significant rise in the PEDF levels (P = 0·002) after the metformin treatment. On the other hand, no significant correlation was observed between the change in PEDF levels and the clinical and laboratory findings. CONCLUSION: Our study is the first to identify a metformin-related increase in PEDF levels in diabetes. The increase observed in PEDF levels after the metformin treatment does not seem to be related to the changes in insulin resistance, fat mass or glycemic control. Hence, our results suggest that further investigation is necessary to determine the direct effects of metformin on PEDF gene and protein expression in vitro.

Predictors of mortality in rheumatoid arthritis-associated lung disease: A retrospective study on ten years.

OBJECTIVES: Rheumatoid arthritis (RA)-associated lung involvement is a cause of mortality. This study aimed to evaluate mortality rate and mortality-associated factors in RA patients with high-resolution computed tomography (HRCT)-proven lung involvement. METHODS: Patients followed-up for RA between 2010 and 2018 were evaluated regarding HRCT-proven lung involvement. The present study was designed as a single-centre, retrospective and descriptive study. The HRCT reports of patients were re-evaluated for three major patterns: UIP, nonspecific interstitial pneumonia (NSIP), and isolated airway disease (AD). Mortality rates and its associated factors (demographic characteristics, RA-related factors and lung-involvement-related factors) were determined. RESULTS: The study included 156 patients (females, 68.3%) with radiologically confirmed RA-associated lung disease. The mean age was 55.5 (12.1) years at RA diagnosis and 62.7 (9.7) years at the diagnosis of lung involvement. The patterns of lung involvement on HRCT were UIP in 89 (57.0%) patients, NSIP in 51 (32.7%) patients, and isolated AD in 16 (10.3%) patients. The RA patients were followed-up for a mean of 10.2 (7.4) years and they were followed-up for a mean of 4.5 (3.7) years after interstitial lung disease (ILD) diagnosis. Overall, 40 (25.6%) patients died. The 5-year survival rate was 78%. Multivariate analysis revealed UIP pattern (log-rank test, P<0.01), pleural effusion (log-rank test, P<0.05), and a shorter time interval (<3 years) between the diagnoses of RA and RA-ILD (log-rank test, P<0.01) to be independent predictors of mortality. CONCLUSIONS: In addition to the UIP, a known risk factor, pleural effusion and the short time between the diagnoses of RA and ILD were also found to be associated with mortality.

Mesenteric arterial variations detected at MDCT angiography of abdominal aorta.

OBJECTIVE: The purposes of this essay are to outline MDCT angiographic techniques for the evaluation of the mesenteric arterial vasculature and to review anatomic variants depicted on MDCT angiograms. CONCLUSION: MDCT angiography has distinct advantages over conventional angiography in imaging of the mesenteric arterial vasculature.

Multidetector CT and MRI findings in periportal space pathologies.

Periportal region is an anatomic space around portal vein comprising hepatic artery, bile duct, nerves, lymphatics and a potential space. Periportal pathologies may involve any of these structures diffusely or focally with characteristic radiologic findings. Radiologic findings can be helpful in differential diagnosis of pathologies of periportal structures including periportal cavernomatous transformation, hepatic artery aneurysm, biliary diseases, neurofibromatosis, lymphoma, langerhans' cell histiocytosis, periportal fatty infiltration and other causes of periportal halo in adult and pediatric patients. Lobar/segmental intrahepatic involvement can be seen in neurofibromatosis, cavernomatous transformation, fatty infiltration and periportal edema. In this review, we discuss CT and MRI findings of periportal pathologies which can be in the form of diffuse or segmental/lobar involvement.

Rare presentation of pseudosequestration in childhood: CT and CT angiography findings.

Anomalous systemic arterial supply to the lungs with normal bronchial branching and pulmonary arterial supply is an unusual variant of the sequestration spectrum. Pseudosequestration is referred as the combination of systemic arterial supply to lung with normal bronchial connection. Thorax computed tomography (CT) and CT angiography are non-invasive and useful techniques in making the definitive diagnosis. Herein, we report two paediatric patients with anomalous systemic arterial supply to normal basal segments of the lower lobes.

Low dose CT: practices and strategies of radiologists in university hospitals.

PURPOSE: We surveyed the practices and policies of the radiology departments of academic institutions in Turkey regarding the use of low dose CT in daily practice. MATERIALS AND METHODS: Surveys were mailed electronically to radiology departments of 40 university hospitals. Information gathered included modifications of standard protocols for dose reduction according to body parts being examined or depending on specific patient groups such as children, pregnant, or slim patients. RESULTS: Thirty-three radiology departments (82%) responded. Twenty-eight (85%) reported that they modify CT scanning parameters in order to reduce the patient dose. Of these, 5 (18%) reported that they always modulate the scan parameters, 10 (36%) often, 11 (39%) sometimes, and 2 (7%) seldom. Reduced dose CT is applied mostly in pediatric and pregnant patients, reported by 93% and 57% of respondents, respectively. The most common body part for the application of low dose CT was chest examination followed by imaging of paranasal sinuses, abdomen, and CT-guided interventions. The most common modification for dose reduction is using low mA, followed by increasing the pitch value. CONCLUSION: Most respondents are aware of low dose CT, but the frequency of application varies considerably in routine practice. Reduced mA and increased pitch are the most commonly used modifications.

Evaluation of breast microcalcifications according to Breast Imaging Reporting and Data System criteria and Le Gal's classification.

INTRODUCTION/OBJECTIVE: Our aim was to evaluate the positive predictive value (PPV) of the analysis of breast microcalcifications according to Breast Imaging Reporting and Data System (BI-RADS) and Le Gal's classification in identification of malignancy, and to assess the interobserver agreement using these criteria. METHODS AND MATERIAL: Eighty-two patients with breast microcalcifications on their screening mammograms underwent surgical excision after a needle localization at our institution between July 1993 and June 2000. The mammograms were examined by two experienced mammographers retrospectively and independently. Each observer noted the morphology, distribution, associated findings, final assessment categories of microcalcifications according to BI-RADS criteria and the morphologic type of microcalcifications according to Le Gal's classification. The PPVs for each radiologist and the interobserver agreement were determined by using these data and histologic findings. RESULTS: Histopathologic results yielded malignancy in 25 (30%) cases. The evaluation of microcalcifications according to BI-RADS criteria revealed PPVs of 17% and 25% for category 4 lesions, and 68% and 44% for category 5 lesions. In the assessment of microcalcifications according to Le Gal's classification, the PPV of type 4 lesions was 45% (for both observers), whereas the PPVs of type 5 lesions were 70% and 50%. The interobserver agreement was fair in evaluation of morphology of microcalcifications (kappa:0.31), distribution of microcalcifications (kappa:0.29), final assessment categories (kappa:0.27), and moderate in evaluation of associated findings (kappa:0.48) by using BI-RADS lexicon. It was higher for the assessment of milk of calcium and round microcalcifications than other typically benign microcalcifications, and for fine linear or fine linear branching microcalifications than other probably malignant calcifications. There was a fair interobserver agreement (kappa:0.30) in the description of the morphologic type of microcalcifications according to Le Gal's classification. DISCUSSIONS AND CONCLUSION: In our study, both BI-RADS lexicon and Le Gal's classification did not succeed expectedly in reducing the ambiguity in assessment of breast microcalcifications. Further studies and perhaps development of new methods are required to improve accuracy and standardization in mammographic interpretation.

Bilateral multiple pulmonary tuberculous nodules mimicking metastatic disease.

We present CT findings of a young woman who has bilateral pulmonary nodules mimicking metastases. Clinical presentation with active multiple pulmonary macronodules without cavitation responsive to treatment is an atypical manifestation of pulmonary tuberculosis. We reviewed the causes of multiple pulmonary nodules, role of radiological findings in differential diagnosis and parenchymal manifestations of pulmonary tuberculosis in this report.

Breast abscess mimicking malignant mass due to retained penrose drain: diagnosis by mammography and MRI.

We report a breast mass associated with a foreign body mimicking malignancy on mammography. Although retained penrose drains have been reported in other parts of the body, our case is the first report of a retained penrose drain in breast diagnosed by mammography. Mammography can be used if there is suspicion of a retained penrose drain during the course of breast abscess treatment.

Metastatic endodermal sinus tumor: CT appearances.

A one-week-old boy had undergone resection of a sacrococcygeal benign cystic teratoma. At the age of 12 months, he had a serum alpha-fetoprotein level of 139,000 IU/ml and a recurrent pelvic mass which was removed, and the microscopic examination revealed endodermal sinus tumor. Postoperatively, massively enlarged inguinal lymph nodes and abdominal distention developed. Computerized tomography displayed enlarged inguinal lymph nodes, metastatic lesions in the liver, and a pelvic recurrent mass. He received BEP (bleomycin, etoposide, cisplatin) chemotherapy regimen, and a complete remission was achieved with a normal serum alpha-fetoprotein. Close follow-up and serum alpha-fetoprotein monitoring are mandatory after the resection of a sacrococcygeal teratoma.

Chronic eosinophilic leukemia with monosomy 8 in a five-year-old girl: a rare case.

A 5-year-old girl was admitted to our hospital due to fatigue and fever lasting for six months. She had systolic murmur in the mesocardiac and apex regions and hepatosplenomegaly. Laboratory evaluation revealed leukocyte and eosinophil counts of 176 and 144.32 x 10(9)/L, 3.4% blasts in bone marrow and monosomy 8. She developed pulmonary, cardiac, nervous system, ocular and bone involvement. Upon diagnosis of "chronic eosinophilic leukemia, not otherwise specified" (WHO 2008 classification), she received methylprednisolone, vincristine, cytarabine and 6-thioguanine. After hematopoietic stem cell transplantation from a full-matched sibling was performed, the patient expired due to graft failure and septicemia.

Long-term results of disodium etidronate treatment in pulmonary alveolar microlithiasis.

Pulmonary alveolar microlithiasis (PAM) is a rare disease with alveolar microliths mainly composed of calcium phosphate. The gene responsible for the disease is SLC34A2, which encodes a type-IIb sodium phosphate cotransporter, has been described recently. Treatment of this disease is not clearly defined. Disodium etidronate is a member of bisphonates and it has been administered in these patients due to its inhibitory effect on the precipitation of hydroxyapatite microcrystals. Here, clinical and radiological improvement of two patients with PAM who were treated with disodium etidronate for 9 and 11 years, respectively, are presented. The pathogenetic mechanism of this treatment on the genetic basis of disease is discussed.

Acute dyspnea in an adolescent girl after physical exertion: a case report and review of the literature.

Dyspnea is a common symptom of cardiac and pulmonary diseases. We present a 15-year-old girl with acute dyspnea, chest pain, cough, and difficulty in swallowing whose initial diagnosis was psychogenic dyspnea. The etiology of acute dyspnea is discussed and reported cases are reviewed in this case report.

Retrotracheal aberrant left brachiocephalic vein: CT findings.

We present a child with double aberrant left brachiocephalic vein (ALBCV) that was an incidental finding on CT. The anterior and thin branch was above the aortic arch and behind the truncus brachiocephalicus and drained into the superior vena cava (SVC). The posterior and thick branch of the ALBCV coursed posterior to the trachea and oesophagus and joined with the azygos vein before draining into the SVC. To our knowledge, retrotracheal ALBCV has not been previously described.

PVOD suggested by MDCT and clinical findings in a pregnant woman.

Pulmonary hypertension secondary to pulmonary venoocclusive disease (PVOD) is increasingly recognized (Wagenvoort, Chest 69:82-86, [20]; Scully et al., N Engl J Med 308:823-834, [21]). The clinical presentation is usually progressive pulmonary hypertension. It should be kept in mind when there is pulmonary arterial hypertension, pulmonary edema, and a normal pulmonary artery wedge pressure. Importance of diagnosing this condition is to protect patient from fatal pulmonary edema when using prostacyclins that are effective for treatment of primary pulmonary hypertension. Herein, we present multidetector computed tomography findings of PVOD in a pregnant woman that presented with pulmonary hypertension.

Forearm bone mineral density measurements in thoracic outlet syndrome.

Denervation of sensory and sympathetic nerve fibers and reduced blood flow result in decreased bone mineral density (BMD). In this study, we aim to detect the effect of compression of brachial plexus and subclavian vessels on the forearm BMD in patients with thoraric outlet syndrome (TOS). Twenty-three patients with TOS (17 females and 6 males) were enrolled in the study. Thirty-three extremities of the patients with TOS were classified as true neurogenic (1), vascular (15) and disputed neurogenic TOS (17). Thirty upper extremities of 15 age- and sex-matched healthy subjects were evaluated as controls. Electrophysiological testings and Doppler ultrasonography were performed. Comparisons of the dominant and the non-dominant forearm BMD between patients and controls, and between the involved and the non-involved sides in TOS patients revealed no significant differences (P < 0.05). In conclusion, intermittent compression of brachial plexus and subclavian vessels in patients with disputed and vascular TOS does not seem to affect forearm BMD. Further studies are needed to detect the effect of persistent neurovascular compression in TOS.