RESUMO
This document from the European Society of Thoracic Imaging (ESTI) and the European Society of Radiology (ESR) discusses the role of imaging in the long-term follow-up of COVID-19 patients, to define which patients may benefit from imaging, and what imaging modalities and protocols should be used. Insights into imaging features encountered on computed tomography (CT) scans and potential pitfalls are discussed and possible areas for future review and research are also included. KEY POINTS: ⢠Post-COVID-19 pneumonia changes are mainly consistent with prior organizing pneumonia and are likely to disappear within 12 months of recovery from the acute infection in the majority of patients. ⢠At present, with the longest series of follow-up examinations reported not exceeding 12 months, the development of persistent or progressive fibrosis in at least some individuals cannot yet be excluded. ⢠Residual ground glass opacification may be associated with persisting bronchial dilatation and distortion, and might be termed "fibrotic-like changes" probably consistent with prior organizing pneumonia.
Assuntos
COVID-19 , Pneumonia , Radiologia , Humanos , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVES: Immunocompromised B-cell-depleted patients are at risk of developing protracted COVID-19, a clinical syndrome characterized by prolonged viral shedding and respiratory symptoms that can lead to hypoxemic pneumonia. Our aim is to describe this unusual condition and its treatment. PATIENTS AND METHODS: This monocentric retrospective study reports six cases of severe organizing pneumonia that developed during the clinical course of protracted COVID-19. RESULTS: All patients developed organizing pneumonia (OP) in the setting of protracted COVID. Clinical improvement was obtained after several treatment lines including specific antiviral agents and occurred simultaneously with control of the viral load. CONCLUSION: As it was the most frequent presentation of protracted COVID-19 in our survey, we believe that this specific form of organizing pneumonia warrants increased awareness. Furthermore, specific antiviral therapy seems to control this condition.
Assuntos
COVID-19 , Pneumonia em Organização , Pneumonia , Humanos , COVID-19/complicações , Estudos RetrospectivosRESUMO
Infiltrative lung lesions are not always linked to infectious processes or cancers. An interesting entity, the OP (Organizing Pneumonia) or COP (Cryptogenic Organizing Pneumonia)--formerly BOOP (Bronchiolitis Obliterans Organizing Pneumonia)--is discussed through observations repor. ted in this article. We provide some keys to allow the astute observer to target this often curable disease.
Assuntos
Pneumonia em Organização Criptogênica/diagnóstico , Pneumonia em Organização Criptogênica/tratamento farmacológico , Idoso , Lavagem Broncoalveolar , Pneumonia em Organização Criptogênica/etiologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia TorácicaRESUMO
The present study reports a case of biopsy-proven pulmonary veno-occlusive disease as a cause of severe pulmonary hypertension in a patient suffering from a chronic myeloproliferative disorder. The pulmonary disease evolved favourably under treatment with defibrotide, a pro-fibrinolytic medication used in hepatic veno-occlusive disease.
Assuntos
Transtornos Mieloproliferativos/complicações , Pneumopatia Veno-Oclusiva/diagnóstico , Pneumopatia Veno-Oclusiva/etiologia , Idoso , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Transtornos Mieloproliferativos/patologia , Polidesoxirribonucleotídeos/uso terapêutico , Pneumopatia Veno-Oclusiva/tratamento farmacológicoRESUMO
We report a case of pneumopericardium occuring after cardiac surgery. Pneumopericardium is a rare condition; trauma is the most frequent etiology. Nontraumatic causes include fistulae in relationship with the bronchial tree or oesophagus and intrapericardial gazeous production due to bacterial pericarditis. Pericardiocentesis is indicated in case of air tamponade and local infection.
Assuntos
Pneumopericárdio/diagnóstico , Esterno/microbiologia , Deiscência da Ferida Operatória/complicações , Idoso , Ponte de Artéria Coronária/efeitos adversos , Humanos , Masculino , Pneumopericárdio/etiologia , Infecções Estafilocócicas/complicações , Deiscência da Ferida Operatória/microbiologiaRESUMO
The present study reports a case of percutaneous sclerotherapy of a giant mediastinal cystic lymphangioma using Ethibloc (Ethicon, Norderstedt, Germany) and absolute ethanol in a 59-yr-old female. The tumour, situated predominantly in a retrocardiac location, caused dyspnoea and dysphagia by compression and was considered unresectable. Follow-up computed tomography 3 yrs after treatment showed a 90% volume reduction of the tumour. The patient is currently asymptomatic. To the best of the present authors' knowledge, percutaneous transthoracic sclerotherapy of a mediastinal lymphangioma has not previously been reported in the literature available in English.
Assuntos
Diatrizoato/uso terapêutico , Ácidos Graxos/uso terapêutico , Linfangioma Cístico/terapia , Neoplasias do Mediastino/terapia , Propilenoglicóis/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Zeína/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Linfangioma Cístico/patologia , Imageamento por Ressonância Magnética , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Tomografia Computadorizada EspiralRESUMO
We report the case of a 67-year-old patient who presented with a myelodysplastic syndrome and who developed a pulmonary mucormycosis with a rare extension to the dorsal spine. A decompressive laminectomy was attempted after failure of broad-spectrum antifungal treatment (Cancidas, V-Fend). The diagnosis was obtained after surgical biopsy. The scheduled lobectomy could not be performed because of altered clinical condition. The patient eventually died despite adapted antifungal treatment (Abelcet, Posaconazole). Pulmonary mucormycosis is a rare cause of mycotic infection that reaches most of the time immunocompromised patients. The pathogenic agent is part of zygomyces that have angio-invasive ability. Perineural propagation was recently described. Immunodepression, late diagnosis and lack of response to new generation antifungal drugs (V-Fend, Cancidas) are responsible for therapeutic failure in this disease. This case emphasizes the risk inherent to empirical antifungal treatment and the need of early biopsy in cases that do not respond to treatment.
Assuntos
Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/complicações , Mucormicose/complicações , Síndromes Mielodisplásicas/complicações , Doenças da Coluna Vertebral/microbiologia , Vértebras Torácicas , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Quimioterapia Combinada , Evolução Fatal , Humanos , Laminectomia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/terapia , Masculino , Mucormicose/diagnóstico , Mucormicose/terapia , Síndromes Mielodisplásicas/diagnóstico , Síndromes Mielodisplásicas/terapia , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/terapia , Triazóis/uso terapêuticoRESUMO
Recently a new computed tomography semiology of the pulmonary adenocarcinoma was highlighted. Studies on ground-glass nodule and on mixed nodule showed the relation between these radiological images and the different anatomopathological forms of lung adenocarcinoma. Ground-glass opacity can correspond to precancerous lesions and morphological characteristics of nodules are correlated with the prognosis. The presence of spiculation, pleural retraction and air bronchogram is significantly more important in neoplasic lesions. The presence or the apparition of a solid component inside the nodule or the presence of indentation is highly suggestive of adenocarcinoma. A lesion smaller than 20 mm and persistant after 1 month must be, either followed up, or removed by a limited surgical resection. Lesions larger than 20 mm or associated with a solid component must be treated by conventional surgery.
Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia por Emissão de PósitronsRESUMO
Cardiac imaging has always been a challenge because of the continuous movement of the heart. Cardiac computed tomography (CT) has undergone an accelerated progression over the past decade, due to the combination of the high-speed rotation of the X-ray tube, the ECG-gating technique and the infra-millimeter spatial resolution. Multidetector CT allows visualisation of the coronary artery lumen and the detection of coronary stenosis after intravenous injection of contrast medium. Studies have demonstrated a high negative predictive value of CT coronary angiography (CTCA). CTCA may be reasonably used for the assessment of symptomatic patients, especially in the setting of equivocal treadmill or functional testing. Also, CTCA allows assessment of coronary bypass graft patency and recognition of aberrant coronary arteries. Limitations in the use of this technique exist: atrial fibrillation and other cardiac arrhythmias remain a contraindication; severe calcifications are the most frequent reason for impaired assessment of coronary arteries. High radiation doses prohibit the use of this test as a screening tool for asymptomatic patients.
Assuntos
Angiografia Coronária/métodos , Tomografia Computadorizada por Raios X/métodos , Arritmias Cardíacas/complicações , Fibrilação Atrial/complicações , Calcinose/diagnóstico por imagem , Contraindicações , Meios de Contraste , Ponte de Artéria Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Eletrocardiografia , Teste de Esforço , Humanos , Processamento de Imagem Assistida por Computador/métodos , Valor Preditivo dos Testes , Doses de Radiação , Intensificação de Imagem Radiográfica/métodos , Grau de Desobstrução VascularRESUMO
We report the case of a patient treated by chemotherapy for a diagnosis of mesothelioma. A quickly progressive dyspnea developed which was due to compression of the right main bronchus by mediastinal extension of the tumor. This obstruction was treated by interventionnal bronchoscopy and stenting.
Assuntos
Broncopatias/etiologia , Mesotelioma/complicações , Neoplasias Pleurais/complicações , Constrição Patológica/etiologia , Dispneia/etiologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
We report the case of a 52 year old man who was hospitalized within a context of a persistent deterioration of his general condition. He was suspected of having a chronic inflammatory colitis. A pulmonary radiography revealed the presence of voluminous bilateral excavated masses with hydro-aerical levels. After having refuted among others a suspicion of tuberculosis, the results of a thoracic percutaneous transpleural lung aspiration by needle under tomodensitometric control steered our diagnosis towards a vascularitis of the Wegener disease type. A treatment with corticotherapy in large doses completed with cyclophosphamid allowed for clinical, biological and radiological improvement. Wegener's granulomatosis usually starts in an insidious manner with febrile episodes and an impairment of the general condition associated with inflammatory biological signs, as observed in our patient. After these warning symptoms, come ORL and/or pulmonary and/or renal impairment, which represent the classical triad of diffused GW. However a certain number of particularities unusual for that diagnosis characterized our patient and prompted the discussion of this case.
Assuntos
Colite Ulcerativa/complicações , Granulomatose com Poliangiite/complicações , Doença Aguda , Granulomatose com Poliangiite/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The observation of a primary chest wall desmoid tumor discovered incidentally in a young patient is an opportunity to review the nosology, diagnosis and treatment of this uncommon pathology. Surgical intervention should aim at resecting completely the lesion with sufficient margins. Subsequent reconstruction of the bony thorax uses synthetic materials and muscle or myocutaneous flaps.
Assuntos
Neoplasias Torácicas/cirurgia , Parede Torácica/cirurgia , Adulto , Humanos , Masculino , Neoplasias Torácicas/diagnóstico , Parede Torácica/patologiaRESUMO
Radiation-induced lung disease (RILD) is frequent after therapeutic irradiation of thoracic malignancies. Many technique-, treatment-, tumor- and patient-related factors influence the degree of injury sustained by the lung after irradiation. Based on the time interval after the completion of the treatment RILD presents as early and late features characterized by inflammatory and fibrotic changes, respectively. They are usually confined to the radiation port. Though the typical pattern of RILD is easily recognized after conventional two-dimensional radiation therapy (RT), RILD may present with atypical patterns after more recent types of three- or four-dimensional RT treatment. Three atypical patterns are reported: the modified conventional, the mass-like and the scar-like patterns. Knowledge of the various features and patterns of RILD is important for correct diagnosis and appropriate treatment. RILD should be differentiated from recurrent tumoral disease, infection and radiation-induced tumors. Due to RILD, the follow-up after RT may be difficult as response evaluation criteria in solid tumours (RECIST) criteria may be unreliable to assess tumor control particularly after stereotactic ablation RT (SABR). Long-term follow-up should be based on clinical examination and morphological and/or functional investigations including CT, PET-CT, pulmonary functional tests, MRI and PET-MRI.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Pulmão/efeitos da radiação , Lesões por Radiação/diagnóstico por imagem , Pneumonite por Radiação/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Terapia Combinada , Diagnóstico Diferencial , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia/diagnóstico por imagem , Estadiamento de Neoplasias , Neoplasias Induzidas por Radiação/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Radioterapia/métodosRESUMO
PURPOSE: Cardiac perforations due to pacing and implantable defibrillator lead displacement are rare and their detection may be difficult. The goal of this study was to review the clinical and imaging presentation of cardiac perforation related to pacing lead displacement. PATIENTS AND METHODS: The clinical and imaging files of four patients (two men and two women) who experienced cardiac perforation related to pacing lead displacement were reviewed. The four patients were investigated in our radiology department over a 24-month-period. RESULTS: Two patients had clinical symptoms at the time lead displacement was detected and the other two were free of symptoms. In all patients, lead displacement was visible on imaging examinations in retrospect but was not detected prospectively. CONCLUSION: Radiologists should pay attention to the position of the tips of the leads on chest X-ray and CT, even late after the implantation and in asymptomatic patients.
Assuntos
Desfibriladores Implantáveis/efeitos adversos , Falha de Equipamento , Traumatismos Cardíacos/etiologia , Marca-Passo Artificial/efeitos adversos , Falha de Prótese , Adulto , Idoso , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
The major lung resections are the pneumonectomies and lobectomies. The sublobar resections are segmentectomies and wedge resections. These are performed either through open surgery through a thoracotomy or by video-assisted mini-invasive surgery for lobectomies and sublobar resections. Understanding the procedures involved allows the normal postoperative appearances to be interpreted and these normal anatomical changes to be distinguished from potential postoperative complications. Surgery results in a more or less extensive physiological adaptation of the chest cavity depending on the lung volume, which has been resected. This adaptation evolves during the initial months postoperatively. Chest radiography and computed tomography can show narrowing of the intercostal spaces, a rise of the diaphragm and shift of the mediastinum on the side concerned following major resections.
Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Complicações Pós-Operatórias/diagnóstico , Cirurgia Torácica Vídeoassistida/métodos , Toracostomia/métodos , Toracotomia/métodos , Adenocarcinoma/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Pulmão/patologia , Pulmão/cirurgia , Masculino , Pessoa de Meia-Idade , Pneumonectomia/instrumentação , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Instrumentos Cirúrgicos , Cirurgia Torácica Vídeoassistida/instrumentação , Toracostomia/instrumentação , Toracotomia/instrumentação , Tomografia Computadorizada por Raios XRESUMO
Exogenous lipoid pneumonia is a poorly known pathology. It results from aspiration of mineral, vegetal or animal oily substances. It is usually iatrogenic and clinical presentation is not specific. Main investigations which allow the diagnosis are: tomodensitometry which is the reference diagnosis modality, chest X-Ray which may be used for follow-up and MR which may contribute to the diagnosis. The treatment is not systematized. Stopping intake of the causal agent is essential. Some patients are treated with success by broncho-alveolar lavage, corticotherapy and oxygenotherapy. An exogenous lipoid pneumonia must be considered in all cases of non resolving pneumonia.
Assuntos
Pneumonia Lipoide/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Humanos , MasculinoRESUMO
We report the case of a 69-year-old man who presented with a rounded atelectasis (RA). During a 10-year follow-up by Computed Tomography (CT), the lobe showed a progressive shrinkage, and a moderate increase in size of the lesion led to a percutaneous biopsy which confirmed the diagnosis. RA is an unusual form of lung consolidation. The major cause of RA is asbestosis. RA is usually asymptomatic and may simulate a pulmonary neoplasm on chest Xray. The diagnosis is made by CT, demonstrating the pathognomonic "comet tail sign". No treatment is required.
Assuntos
Atelectasia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Through the presentation of a classical case of intrapulmonary pulmonary sequestration, the nosology of congenital lung malformations is reviewed. The histology, imaging, and surgical treatment of this congenital anomaly are briefly discussed.
Assuntos
Sequestro Broncopulmonar/patologia , Adulto , Sequestro Broncopulmonar/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Radiografia TorácicaRESUMO
BACKGROUND: A 57-year-old patient was admitted for high-grade fever, asthenia, sweating, dry cough and diffuse arthro-myalgias. Two years earlier, elevated titers of anticytoplasmic antibodies (ANCA) of anti-proteinase 3 specificity and renal biopsy led to a diagnosis of granulomatosis with polyangiitis (GPA) with lung and renal involvement. GPA was treated by steroids, cyclophosphamide and rituximab with subsequent clinical and biological remission. The current chest CT scan was performed for a lung opacity that eventually was proved to be an organising pneumonia. CT also showed an unsuspected pattern of the spleen that was compared with a previous chest CT.