Pulmonary fibrosis secondary to COVID-19: a narrative review.

Introduction: Coronavirus disease 2019 (COVID-19) is still increasing worldwide, and as a result, the number of patients with pulmonary fibrosis secondary to COVID-19 will expand over time. Risk factors, histopathological characterization, pathophysiology, prevalence, and management of post-COVID-19 pulmonary fibrosis are poorly understood, and few studies have addressed these issues.Areas covered:This article reviews the current evidence regarding post-COVID-19 pulmonary fibrosis, with an emphasis on the potential risk factors, histopathology, pathophysiology, functional and tomographic features, and potential therapeutic modalities. A search on the issue was performed in the MEDLINE, Embase, and SciELO databases and the Cochrane library between 1 December 2019, and 25 January 2021. Studies were reviewed and relevant topics were incorporated into this narrative review. Expert opinion: Pulmonary sequelae may occur secondary to COVID-19, which needs to be included as a potential etiology in the current differential diagnosis of pulmonary fibrosis. Therefore, serial clinical, tomographic, and functional screening for pulmonary fibrosis is recommended after COVID-19, mainly in patients with pulmonary involvement in the acute phase of the disease. Further studies are necessary to determine the risk factors, markers, pathophysiology, and appropriate management of post-COVID-19 pulmonary fibrosis.

High-Resolution Computed Tomography in the Diagnosis of Diffuse Parenchymal Lung Diseases: Is it Possible to Improve Radiologist's Performance?

OBJECTIVE: The aims of this study were to assess the concordance between high-resolution computed tomography (HRCT) diagnostic hypotheses (DH) and final diagnosis in patients with diffuse lung disease and to evaluate whether clinical data or the radiologist's degree of certainty influence concordance. METHODS: Concordances between first and any one of radiologists' DH and final diagnosis were assessed before and after access to clinical data, with study of importance of degree of certainty in the DH formulated. RESULTS: Concordances of HRCT DH and final diagnosis were 48% and 76%, respectively, considering first or any of the DH without access to clinical data. Accessing clinical data improved concordance especially for hypersensitivity pneumonitis. Diagnostic hypotheses formulated with high degree of confidence were correct in 69% of cases. CONCLUSIONS: First HRCT DH was concordant with final diagnosis in approximately half of cases, increasing to approximately 75% when considering any 1 of the 3 DH. Radiologists' knowledge of clinical data or increased degree of certainty improved concordance of HRCT DH and the final diagnosis.

Hemangioendotelioma hepático multifocal e metastático: relato de caso e revisão da literatura / Multifocal and metastatic hepatic hemangioendothelioma: case report and literature review

O hemangioendotelioma epitelioide é uma neoplasia rara de origem vascular, cujo acometimento de órgãos como o pulmão, o baço, o osso, a mama e o fígado já foi relatado. O quadro clínico e o prognóstico deste tumor são bastante variáveis. A partir de um relato de caso, procuramos contribuir com os dados existentes na literatura, revisando características clínicas e radiológicas que podem ser úteis para inseri-lo no diagnóstico diferencial das lesões hepáticas.

Epithelioid hemangioendothelioma is a rare neoplasm of vascular origin whose involvement of organs such as lung, spleen, bone, breast and liver has already been reported. The clinical signs and the prognosis of this tumor are quite variable. From the present case report, the authors have sought to contribute with literature data, by reviewing clinical and radiological features which may be useful to include such a condition in the differential diagnosis of liver lesions.

Does graft mass impact on pediatric kidney transplant outcomes?

BACKGROUND: The aim of this study is to assess the evolution of renal size and function in pediatric transplant patients according to the graft mass/recipient size ratio. METHODS: Fifty pediatric renal transplant recipients were followed over 2 years. Grafts were weighed, and three different graft mass/m(2) ratios were determined: (1) low graft mass (58 g/m(2), range 31-57 g/m(2)), (2) median (142 g/m(2), range 59-141 g/m(2)) and high (267 g/m(2), range 143-353 g/m(2)). Patients underwent repeated ultrasound Doppler scans and repeated measurements of estimated glomerular filtration rate (eGFR; 1 week and 1, 6, 12 and 24 months), urinary retinol-binding protein (RBP) and proteinuria (1 week and 6, 12 and 24 months). RESULTS: The volume of renal tissue increased by 12 ± 5.6 cm(3) at 24 months (p = 0.035) in the low graft mass and decreased by -14 ± 7 cm(3) (p = 0.046) in the high graft mass. The eGFR increased when either low (30 ± 5 ml/min/1.73 m(2), p < 0.001) or median (19 ± 4 ml/min/1.73 m(2), p < 0.001) graft mass was transplanted but remained stable when high graft mass was transplanted. The resistive index (RI) presented a significant decrease throughout early follow-up in the transplants involving low and median graft mass, whereas a slight rise was observed in those involving high graft mass. A significant difference was apparent 6 months post-transplant. Transplants of low and median graft mass were associated with an initial higher urinary RBP. No significant differences in proteinuria were detected. CONCLUSIONS: Small kidneys undergo increases in volume and function without escalation of either proteinuria or urinary RBP, characterizing an adequate adaptation to the recipient. Children receiving larger kidneys present a reduction in volume, stable GFR and higher RI at 6 months.

Multifocal and metastatic hepatic hemangioendothelioma: case report and literature review.

Epithelioid hemangioendothelioma is a rare neoplasm of vascular origin whose involvement of organs such as lung, spleen, bone, breast and liver has already been reported. The clinical signs and the prognosis of this tumor are quite variable. From the present case report, the authors have sought to contribute with literature data, by reviewing clinical and radiological features which may be useful to include such a condition in the differential diagnosis of liver lesions.

O hemangioendotelioma epitelioide é uma neoplasia rara de origem vascular, cujo acometimento de órgãos como o pulmão, o baço, o osso, a mama e o fígado já foi relatado. O quadro clínico e o prognóstico deste tumor são bastante variáveis. A partir de um relato de caso, procuramos contribuir com os dados existentes na literatura, revisando características clínicas e radiológicas que podem ser úteis para inseri-lo no diagnóstico diferencial das lesões hepáticas.

Swine-origin influenza A (H1N1) viral infection: thoracic findings on CT.

OBJECTIVE: The purpose of this article is to illustrate and describe various CT manifestations of swine-origin influenza A (H1N1) viral infection. CONCLUSION: The imaging findings seen in patients with H1N1 infection include consolidations, ground-glass opacities, interlobular septal thickening, small nodules, and findings suggestive of small airways disease, among others. Definitive diagnosis is based on correlation of the CT findings with the clinical symptoms and laboratory test results.

Observer agreement in the diagnosis of interstitial lung diseases based on HRCT scans.

OBJECTIVE: To determine the interobserver and intraobserver agreement in the diagnosis of interstitial lung diseases (ILDs) based on HRCT scans and the impact of observer expertise, clinical data and confidence level on such agreement. METHODS: Two thoracic radiologists and two general radiologists independently reviewed the HRCT images of 58 patients with ILDs on two distinct occasions: prior to and after the clinical anamnesis. The radiologists selected up to three diagnostic hypotheses for each patient and defined the confidence level for these hypotheses. One of the thoracic and one of the general radiologists re-evaluated the same images up to three months after the first readings. In the coefficient analyses, the kappa statistic was used. RESULTS: The thoracic and general radiologists, respectively, agreed on at least one diagnosis for each patient in 91.4% and 82.8% of the patients. The thoracic radiologists agreed on the most likely diagnosis in 48.3% (kappa = 0.42) and 62.1% (kappa = 0.58) of the cases, respectively, prior to and after the clinical anamnesis; likewise, the general radiologists agreed on the most likely diagnosis in 37.9% (kappa = 0.32) and 36.2% (kappa = 0.30) of the cases. For the thoracic radiologist, the intraobserver agreement on the most likely diagnosis was 0.73 and 0.63 prior to and after the clinical anamnesis, respectively. That for the general radiologist was 0.38 and 0.42.The thoracic radiologists presented almost perfect agreement for the diagnostic hypotheses defined with the high confidence level. CONCLUSIONS: Interobserver and intraobserver agreement in the diagnosis of ILDs based on HRCT scans ranged from fair to almost perfect and was influenced by radiologist expertise, clinical history and confidence level.

Observer agreement in the diagnosis of interstitial lung diseases based on HRCT scans / Concordância entre observadores no diagnóstico das doenças pulmonares intersticiais por imagens de TCAR

OBJECTIVE: To determine the interobserver and intraobserver agreement in the diagnosis of interstitial lung diseases (ILDs) based on HRCT scans and the impact of observer expertise, clinical data and confidence level on such agreement. METHODS: Two thoracic radiologists and two general radiologists independently reviewed the HRCT images of 58 patients with ILDs on two distinct occasions: prior to and after the clinical anamnesis. The radiologists selected up to three diagnostic hypotheses for each patient and defined the confidence level for these hypotheses. One of the thoracic and one of the general radiologists re-evaluated the same images up to three months after the first readings. In the coefficient analyses, the kappa statistic was used. RESULTS: The thoracic and general radiologists, respectively, agreed on at least one diagnosis for each patient in 91.4 percent and 82.8 percent of the patients. The thoracic radiologists agreed on the most likely diagnosis in 48.3 percent (κ = 0.42) and 62.1 percent (κ = 0.58) of the cases, respectively, prior to and after the clinical anamnesis; likewise, the general radiologists agreed on the most likely diagnosis in 37.9 percent (κ = 0.32) and 36.2 percent (κ = 0.30) of the cases. For the thoracic radiologist, the intraobserver agreement on the most likely diagnosis was 0.73 and 0.63 prior to and after the clinical anamnesis, respectively. That for the general radiologist was 0.38 and 0.42.The thoracic radiologists presented almost perfect agreement for the diagnostic hypotheses defined with the high confidence level. CONCLUSIONS: Interobserver and intraobserver agreement in the diagnosis of ILDs based on HRCT scans ranged from fair to almost perfect and was influenced by radiologist expertise, clinical history and confidence level.

OBJETIVO: Determinar a concordância interobservador e intraobservador no diagnóstico de doenças pulmonares intersticiais (DPIs) por TCAR e o impacto da experiência dos observadores, dos dados clínicos e do grau de confiança nessas concordâncias. MÉTODOS: Dois radiologistas torácicos e dois gerais independentemente avaliaram imagens de TCAR de 58 pacientes com DPIs em dois momentos: antes e após da anamnese clínica. Os observadores selecionaram até três hipóteses diagnósticas para cada paciente e definiram o grau de confiança dessas hipóteses. Um dos radiologistas torácicos e um dos gerais reavaliaram as mesmas imagens até três meses após a primeira leitura. As análises estatísticas foram feitas utilizando o coeficiente kappa. RESULTADOS: Os radiologistas torácicos e os gerais, respectivamente, concordaram com uma ou mais hipóteses diagnósticas em 91,4 por cento e 82,8 por cento dos pacientes. Os radiologistas torácicos concordaram com o diagnóstico mais provável em 48,3 por cento (κ = 0,42) e 62,1 por cento (κ = 0,58) dos casos, respectivamente, antes e após a anamnese clínica; de forma semelhante; os radiologistas gerais concordaram com o diagnóstico mais provável em 37,9 por cento (κ = 0,32) e 36,2 por cento (κ = 0,30). A concordância intraobservador do radiologista torácico no diagnóstico mais provável foi de 0,73 e 0,63, antes e após da anamnese clínica, respectivamente; para o radiologista geral, essa foi de 0,38 e 0,42. Os radiologistas torácicos apresentaram graus de concordância quase perfeitos nas hipóteses diagnósticas definidas com o grau de confiança alto. CONCLUSÕES: A concordância interobservador e intraobservador no diagnóstico das DPIs por TCAR variaram de regular a quase perfeita, tendo sido influenciadas pela experiência do radiologista, pela história clínica e pelo grau de confiança.

Manifestações da infecção pelo novo vírus influenza A (H1N1) na tomografia computadorizada de tórax / Manifestations of infection by the novel influenza A (H1N1) virus at chest computed tomography

OBJETIVO: Descrever as alterações na tomografia computadorizada de tórax de casos comprovados de infecção pelo novo vírus influenza A (H1N1). MATERIAIS E MÉTODOS: Três observadores avaliaram, em consenso, nove tomografias computadorizadas de pacientes com infecção pelo vírus influenza A (H1N1) comprovada laboratorialmente. A idade dos pacientes variou de 14 a 64 anos (média de 40 anos), sendo cinco do sexo masculino e quatro do sexo feminino. Quatro pacientes eram previamente hígidos, quatro eram transplantados renais e uma era gestante à época do diagnóstico. Foram avaliadas a presença, a extensão e a distribuição de: a) opacidades em vidro fosco; b) nódulos centrolobulares; c) consolidações; d) espessamento de septos interlobulares; e) derrame pleural; f) linfonodomegalias. RESULTADOS: As alterações mais frequentemente encontradas foram opacidades em vidro fosco, nódulos centrolobulares e consolidações, presentes em nove (100 por cento), cinco (55 por cento) e quatro (44 por cento) dos casos, respectivamente. Derrames pleurais e linfonodomegalias foram menos comuns, ocorrendo em apenas dois (22 por cento) dos casos estudados. CONCLUSÃO: Os achados mais comuns nos casos de infecção pelo novo vírus influenza A (H1N1) foram opacidades em vidro fosco, nódulos centrolobulares e consolidações. Estas alterações não são típicas ou únicas a este agente, podendo ocorrer também em outras infecções virais ou bacterianas.

OBJECTIVE: The objective of this study was to describe chest computed tomography findings in confirmed cases of infection by the novel influenza A (H1N1) virus. MATERIALS AND METHODS: Computed tomography studies of nine patients with laboratory-confirmed infection by the novel influenza A (H1N1) virus were consensually evaluated by three observers. The sample of the present study included five male and four female patients with ages ranging from 14 to 64 years (mean, 40 years). Four of the patients were previously healthy, four were kidney transplant recipients and one was pregnant at the time of diagnosis. Presence, extent and distribution of the following findings were evaluated: a) ground-glass opacities; b) centrilobular nodules; c) consolidation; d) interlobular septa thickening; e) pleural effusion; f) lymphadenopathy. RESULTS: The most frequent findings were ground-glass opacities, centrilobular nodules and consolidations, present in nine (100 percent), five (55 percent) and four (44 percent) of cases, respectively. Pleural effusions and lymphadenopathy were less common findings, occurring in only two (22 percent) of the cases. CONCLUSION: Ground-glass opacities, centrilobular nodules and consolidation were the most frequent findings in cases of infection by the novel influenza A (H1N1) virus. These changes are not typical or unique to this agent and may also occur in other viral or bacterial infections.