Methodological evaluation of systematic reviews based on the use of artificial intelligence systems in chest radiography.

INTRODUCTION: In recent years, systems that use artificial intelligence (AI) in medical imaging have been developed, such as the interpretation of chest X-ray to rule out pathology. This has produced an increase in systematic reviews (SR) published on this topic. This article aims to evaluate the methodological quality of SRs that use AI for the diagnosis of thoracic pathology by simple chest X-ray. MATERIAL AND METHODS: SRs evaluating the use of AI systems for the automatic reading of chest X-ray were selected. Searches were conducted (from inception to May 2022): PubMed, EMBASE, and the Cochrane Database of Systematic Reviews. Two investigators selected the reviews. From each SR, general, methodological and transparency characteristics were extracted. The PRISMA statement for diagnostic tests (PRISMA-DTA) and AMSTAR-2 were used. A narrative synthesis of the evidence was performed. Protocol registry: Open Science Framework: https://osf.io/4b6u2/. RESULTS: After applying the inclusion and exclusion criteria, 7 SRs were selected (mean of 36 included studies per review). All the included SRs evaluated "deep learning" systems in which chest X-ray was used for the diagnosis of infectious diseases. Only 2 (29%) SRs indicated the existence of a review protocol. None of the SRs specified the design of the included studies or provided a list of excluded studies with their justification. Six (86%) SRs mentioned the use of PRISMA or one of its extensions. The risk of bias assessment was performed in 4 (57%) SRs. One (14%) SR included studies with some validation of AI techniques. Five (71%) SRs presented results in favour of the diagnostic capacity of the intervention. All SRs were rated "critically low" following AMSTAR-2 criteria. CONCLUSIONS: The methodological quality of SRs that use AI systems in chest radiography can be improved. The lack of compliance in some items of the tools used means that the SRs published in this field must be interpreted with caution.

Imaging findings of the postoperative chest: What the radiologist should know.

Thoracic surgical procedures are increasing in recent years, and there are different types of lung resections. Postsurgical complications vary depending on the type of resection and the time elapsed, with imaging techniques being key in the postoperative follow-up. Multidisciplinary management of these patients throughout the perioperative period is essential to ensure an optimal surgical outcome. This pictorial review will review the different thoracic surgical techniques, normal postoperative findings and postsurgical complications.

Hallazgos imagenológicos torácicos en seguimiento de pacientes con síndrome PostCovid-19 / Thoracic imagenological findings in follow-up of patients with Post-Covid-19 syndrome

Objetivo: Describir los hallazgos imagenológicos en radiografías de tórax y ecografías pulmonares de pacientes con síndrome post-COVID-19. Métodos: estudio descriptivo, prospectivo y transversal que incluyó pacientes con síndrome post-COVID-19, sometidos a radiografías de tórax y ecografías pulmonares en el Servicio de Neumonología Clínica del Hospital Dr. José Ignacio Baldo, entre enero y octubre de 2022, con la finalidad de establecer su evolución imagenológica pulmonar. Se utilizó estadística descriptiva, chi-cuadrado de Pearson y prueba kappa de concordancia, considerando significativo un valor de p < 0,05. Resultados: La muestra consistió en 58 pacientes con una edad media de 55 ± 13 años, predominando el sexo femenino (58,6%). El 60,3% mostró alteraciones en la radiografía de tórax; un 74,3% con patrón intersticial bilateral y un 25,7% con patrón intersticial unilateral. La ecografía reveló patrón intersticial en el 43,1% de los casos y se observaron dos microconsolidaciones subpleurales. Conclusiones: Las radiografías de tórax y las ecografías pulmonares son herramientas imagenológicas eficaces, accesibles y económicas para detectar alteraciones en pacientes con síndrome post-COVID-19. (AU)

Objective: To describe imaging findings in chest radiographs and lung ultrasounds of patients with post-COVID-19 syndrome. Methods: A descriptive, prospective, and cross-sectional study was carried out that included patients with post-COVID-19 syndrome, who underwent chest radiographs and lung ultrasounds at the Clinical Pneumonology Service of Dr. José Ignacio Baldo Hospital, between January and October 2022. Descriptive statistics, Pearson's chi-square, and kappa concordance test were used, considering a p-value < 0.05 significant. Results: The sample consisted of 58 patients with an average age of 55 ± 13 years, with a predominance of females (58.6%). 60.3% showed alterations in the chest radiograph; 74.3% with a bilateral interstitial pattern and 25.7% with a unilateral interstitial pattern. The ultrasound revealed an interstitial pattern in 43.1% of the cases and two subpleural microconsolidations were observed. Conclusions: Chest radiographs and lung ultrasounds are effective, accessible, and economical imaging tools to detect alterations in patients with post-COVID-19 syndrome. (AU)

Utility of artificial intelligence for detection of pneumothorax on chest radiopgraphs done after transthoracic percutaneous transthoracic biopsy guided by computed tomography.

OBJETIVE: To assess the ability of an artificial intelligence software to detect pneumothorax in chest radiographs done after percutaneous transthoracic biopsy. MATERIAL AND METHODS: We included retrospectively in our study adult patients who underwent CT-guided percutaneous transthoracic biopsies from lung, pleural or mediastinal lesions from June 2019 to June 2020, and who had a follow-up chest radiograph after the procedure. These chest radiographs were read to search the presence of pneumothorax independently by an expert thoracic radiologist and a radiodiagnosis resident, whose unified lecture was defined as the gold standard, and the result of each radiograph after interpretation by the artificial intelligence software was documented for posterior comparison with the gold standard. RESULTS: A total of 284 chest radiographs were included in the study and the incidence of pneumothorax was 14.4%. There were no discrepancies between the two readers' interpretation of any of the postbiopsy chest radiographs. The artificial intelligence software was able to detect 41/41 of the present pneumothorax, implying a sensitivity of 100% and a negative predictive value of 100%, with a specificity of 79.4% and a positive predictive value of 45%. The accuracy was 82.4%, indicating that there is a high probability that an individual will be adequately classified by the software. It has also been documented that the presence of Port-a-cath is the cause of 8 of the 50 of false positives by the software. CONCLUSIONS: The software has detected 100% of cases of pneumothorax in the postbiopsy chest radiographs. A potential use of this software could be as a prioritisation tool, allowing radiologists not to read immediately (or even not to read) chest radiographs classified as non-pathological by the software, with the confidence that there are no pathological cases.

Trauma cerrado de aorta torácica, desde el servicio de urgencias hasta el quirófano: revisión narrativa / Blunt trauma of the thoracic aorta, from the emergency department to the operating room: narrative review / Trauma contuso da aorta torácica: do pronto-socorro ao centro cirúrgico, uma revisão narrativa

El trauma es la principal causa de muerte de la población en edad productiva. El abordaje del trauma torácico cerrado todavía es un desafío para el médico de urgencias. Aunque no es una entidad frecuente, se asocia con una alta mortalidad y resultados adversos. El diagnóstico del trauma cerrado de aorta torácica (LCAT) requiere un alto índice de sospecha, dado que los signos y síntomas no son específicos de esta enfermedad (dolor torácico, dolor interescapular, disnea, disfagia, estridor, disfonía). Es importante resaltar que la ausencia de inestabilidad hemodinámica no debe descartar una lesión aórtica. Para su diagnóstico imagenológico se debe tener en cuenta que los rayos X de tórax no tienen el rendimiento adecuado, el patrón de referencia es la angiotomografía y el ecocardiograma transesofágico (ETE) constituye una opción diagnóstica. El manejo incluye líquidos endovenosos y antihipertensivos como medida transitoria, manejo quirúrgico definitivo y, en algunos casos, manejo expectante o diferido. Los pacientes inestables o con signos de ruptura inminente deben ser llevados de manera inmediata a cirugía. El manejo quirúrgico temprano ha impactado en la mortalidad. A pesar de los avances en las técnicas quirúrgicas, la técnica quirúrgica abierta documenta mayor tasa de mortalidad que el manejo endovascular, el cual tiene numerosas ventajas al ser poco invasivo. Esta es una revisión narrativa que destaca algunos aspectos clave sobre los mecanismos de lesión, diagnóstico y manejo inicial del trauma cerrado aorta torácica. Por último, se propone un algoritmo de abordaje de trauma de aorta.

Trauma is the leading cause of death in the productive-age population. Addressing blunt chest trauma is still a challenge for the emergency physician. Although it is not a common entity, it is associated with high mortality and adverse outcomes. The diagnosis of blunt thoracic aortic trauma (LCAT) requires a high index of suspicion, given that the signs and symptoms are not specific to this disease (chest pain, interscapular pain, dyspnea, dysphagia, stridor, dysphonia). It is important to highlight that the absence of hemodynamic instability should not rule out aortic injury. For its imaging diagnosis, it must be taken into account that chest X-rays do not have adequate performance; the reference standard is angiotomography and transesophageal echocardiography (TEE) is a diagnostic option. Management includes intravenous fluids and antihypertensives as a temporary measure, definitive surgical management and, in some cases, expectant or deferred management. Unstable patients or patients with signs of imminent ruptura should be taken immediately to surgery. Early surgical management has impacted mortality. Despite advances in surgical techniques, the open surgical technique documents a higher mortality rate than endovascular management, which has numerous advantages as it is minimally invasive. This is a narrative review that highlights some key aspects about the mechanisms of injury, diagnosis and initial management of blunt thoracic aortic trauma. Finally, an algorithm for addressing aortic trauma is proposed.

O trauma é a principal causa de morte na população em idade produtiva. Abordar o trauma torácico contuso ainda é um desafio para o médico emergencista. Embora não seja uma entidade comum, está associada a alta mortalidade e resultados adversos. O diagnóstico de trauma fechado de aorta torácica (TACE) requer alto índice de suspeição, visto que os sinais e sintomas não são específicos desta doença (dor torácica, dor interescapular, dispneia, disfagia, estridor, disfonia). É importante ressaltar que a ausência de instabilidade hemodinâmica não deve descartar lesão aórtica. Para seu diagnóstico por imagem deve-se levar em consideração que a radiografia de tórax não apresenta desempenho adequado; o padrão de referência é a angiotomografia e a ecocardiografia transesofágica (ETE) é uma opção diagnóstica. O manejo inclui fluidos intravenosos e anti-hipertensivos como medida temporária, manejo cirúrgico definitivo e, em alguns casos, manejo expectante ou diferido. Pacientes instáveis ou com sinais de ruptura iminente devem ser encaminhados imediatamente para cirurgia. O manejo cirúrgico precoce impactou a mortalidade. Apesar dos avanços nas técnicas cirúrgicas, a técnica cirúrgica aberta documenta maior taxa de mortalidade do que o manejo endovascular, que apresenta inúmeras vantagens por ser minimamente invasivo. Esta é uma revisão narrativa que destaca alguns aspectos-chave sobre os mecanismos de lesão, diagnóstico e manejo inicial do trauma contuso da aorta torácica. Finalmente, é proposto um algoritmo para tratar o trauma aórtico.

Comparison between Injury Severity Score (ISS) and New Injury Severity Score (NISS) in predicting mortality of thoracic trauma in a tertiary hospital / Comparação entre o Injury Severity Score (ISS) e o New Injury Severity Score (NISS) na predição da mortalidade de traumas torácicos atendidos em um hospital terciário

ABSTRACT Introduction: measuring the severity of traumatic injuries is crucial for predicting clinical outcomes. Whereas the Injury Severity Score (ISS) has limitations in assigning scores to injuries at the same site, the New Injury Severity Score (NISS) corrects for this problem by taking into account the three most severe injuries regardless of the region of the body. This study seeks to comprehend the clinical and epidemiological profile of trauma patients while comparing the effectiveness of scales for predicting mortality. Methods: a descriptive, observational and retrospective study using records of patients who underwent thoracotomy at the Hospital das Clínicas of the Federal University of Triângulo Mineiro between 2000 and 2019. Demographic data, mechanisms of injury, affected organs, length of stay and mortality were analyzed. Injury severity was assessed using the ISS and NISS, and statistical analyses were conducted using MedCalc and SigmaPlot. Results: 101 patients were assessed, on average 29.6 years old, 86.13% of whom were men. The average duration of hospitalization was 10.9 days and the mortality rate was 28.7%. The ROC curve analysis revealed a sensitivity of 68.97%, specificity of 80.56% and area under the curve of 0.837 for the ISS, and 58.62%, 94.44% and 0.855 for the NISS, respectively. The Youden index was 0.49 for the ISS and 0.53 for the NISS. Conclusion: the study demonstrated comparable efficacy of NISS and ISS in predicting mortality. These findings hold significance in the hospital setting. Professionals must be familiar with these scales to utilize them competently for each patient.

RESUMO Introdução: a medição da gravidade das lesões traumáticas é essencial para prever os desfechos clínicos. Enquanto o Injury Severity Score (ISS) tem limitações ao atribuir pontuações às lesões no mesmo local, o New Injury Severity Score (NISS) corrige esse problema ao considerar as três lesões mais graves independentemente da região corporal. Este estudo visa entender o perfil clínico-epidemiológico dos pacientes traumatizados, comparando a eficácia das escalas para prever mortalidade. Métodos: estudo descritivo, observacional e retrospectivo utilizando registros de pacientes submetidos à toracotomia no Hospital das Clínicas da Universidade Federal do Triângulo Mineiro entre 2000 e 2019. Dados demográficos, mecanismos de lesão, órgãos afetados, tempo de internação e mortalidade foram analisados. A gravidade das lesões foi avaliada usando o ISS e NISS, e as análises estatísticas foram conduzidas no MedCalc e SigmaPlot. Resultados: Foram avaliados 101 pacientes, em média com 29,6 anos, sendo 86,13% homens. A média da internação foi de 10,9 dias e a taxa de mortalidade foi de 28,7%. A análise da curva ROC revelou uma sensibilidade de 68,97%, especificidade de 80,56% e área sob a curva de 0,837 para o ISS, e 58,62%, 94,44% e 0,855 para o NISS, respectivamente. O índice de Youden indicou 0,49 para o ISS e 0,53 para o NISS. Conclusão: o estudo demonstrou semelhante eficácia entre o NISS e o ISS na previsão de mortalidade. Esses resultados geram implicações importantes na aplicação dessas escalas no ambiente hospitalar. É essencial que os profissionais conheçam tais escalas para aplica-las adequadamente no contexto de cada paciente.

The role of chest X-ray in the early diagnosis and staging of sarcoidosis: Is it really should be done? / El papel de la radiografía de tórax en el diagnóstico precoz y estadificación de la sarcoidosis: ¿realmente se debe hacer?

Background: Sarcoidosis is a chronic granulomatous disease characterized by non-caseating granuloma. The conventional chest X-ray (CXR) has important role in the diagnosis, staging and follow-up of disease. Computed tomography (CT) is a second-line imaging method used to determine the extent, complications and differential diagnosis of sarcoidosis. Objectives: To determine the role of CXR in the early diagnosis and staging of sarcoidosis and to compare with CT imaging. Methods: One hundred and nine sarcoidosis patients followed at a single center were included in the study. Demographic, radiological, and clinical data of 81 patients were obtained from a total of 109 patients, and the record data of these 81 patients were evaluated. Patients who could not be reached for all tests were excluded from the study. CXR and CT imaging taken at diagnosis were evaluated retrospectively independently from two radiologists and one rheumatologist. Results: Among 109 patients, eighty-one patients CXR and CT imaging taken at the same center has been reached. Among 81 sarcoidosis patients 23 (28.4%) were male, 58 (71.6%) were female. The mean patients age was 46.4 years and the mean disease duration was 3.8 years. CXR is regarded as normal at diagnosis in 30 patients (37%), while all of these patients had findings consistent with sarcoidosis on CT imaging. CT imaging are more superior than CXR in the early diagnosis and staging of sarcoidosis (p=0.001). Also CT imaging is more superior for detection of disease extent and complications. Conclusions: In this study, we observed that CT imaging outperforms CXR in terms of early detection and staging of sarcoidosis. The use of CT imaging is important for early diagnosis and staging of sarcoidosis. The low performance of CXR is a condition that requires the discussion of this method. Multicenter prospective study is needed in this regard.(AU)

Antecedentes: La sarcoidosis es una enfermedad granulomatosa crónica caracterizada por un granuloma no caseificante. La radiografía de tórax convencional (CXR) tiene un papel importante en el diagnóstico, estadificación y seguimiento de la enfermedad. La tomografía computarizada (TC) es un método de imagen de segunda línea que se utiliza para determinar la extensión, las complicaciones y el diagnóstico diferencial de la sarcoidosis. Objetivos: Determinar el papel de la radiografía de tórax en el diagnóstico temprano y la estadificación de la sarcoidosis y compararlo con la tomografía computarizada. Métodos: Se incluyeron en el estudio 109 pacientes con sarcoidosis seguidos en un solo centro. Se obtuvieron datos demográficos, radiológicos y clínicos de 81 sujetos de un total de 109 pacientes, y se evaluaron los datos de registro de estos 81 individuos. Los pacientes que no pudieron ser contactados para todas las pruebas fueron excluidos del estudio. Las imágenes de CXR y CT tomadas en el momento del diagnóstico fueron evaluadas retrospectivamente de forma independiente por 2 radiólogos y un reumatólogo. Resultados: De un total de 109 pacientes se han obtenido imágenes de CXR y CT, tomadas en el mismo centro, de 81 individuos. De esos 81 pacientes con sarcoidosis 23 (28,4%) eran hombres y 58 (71,6%) eran mujeres. La edad media de los pacientes fue de 46,4 años y la duración media de la enfermedad fue de 3,8 años. La CXR se considera normal en el momento del diagnóstico en 30 pacientes (37%), mientras que todos estos pacientes tenían hallazgos consistentes con sarcoidosis en la TC. La TC es superior a la radiografía de tórax en el diagnóstico temprano y la estadificación de la sarcoidosis (p=0,001) y en la detección de la extensión de la enfermedad y las complicaciones. Conclusiones: En este estudio observamos que la TC supera a la radiografía de tórax en términos de detección temprana y estadificación de la sarcoidosis...(AU)

The role of chest X-ray in the early diagnosis and staging of sarcoidosis: Is it really should be done?

BACKGROUND: Sarcoidosis is a chronic granulomatous disease characterized by non-caseating granuloma. The conventional chest X-ray (CXR) has important role in the diagnosis, staging and follow-up of disease. Computed tomography (CT) is a second-line imaging method used to determine the extent, complications and differential diagnosis of sarcoidosis. OBJECTIVES: To determine the role of CXR in the early diagnosis and staging of sarcoidosis and to compare with CT imaging. METHODS: One hundred and nine sarcoidosis patients followed at a single center were included in the study. Demographic, radiological, and clinical data of 81 patients were obtained from a total of 109 patients, and the record data of these 81 patients were evaluated. Patients who could not be reached for all tests were excluded from the study. CXR and CT imaging taken at diagnosis were evaluated retrospectively independently from two radiologists and one rheumatologist. RESULTS: Among 109 patients, eighty-one patients CXR and CT imaging taken at the same center has been reached. Among 81 sarcoidosis patients 23 (28.4%) were male, 58 (71.6%) were female. The mean patients age was 46.4 years and the mean disease duration was 3.8 years. CXR is regarded as normal at diagnosis in 30 patients (37%), while all of these patients had findings consistent with sarcoidosis on CT imaging. CT imaging are more superior than CXR in the early diagnosis and staging of sarcoidosis (p=0.001). Also CT imaging is more superior for detection of disease extent and complications. CONCLUSIONS: In this study, we observed that CT imaging outperforms CXR in terms of early detection and staging of sarcoidosis. The use of CT imaging is important for early diagnosis and staging of sarcoidosis. The low performance of CXR is a condition that requires the discussion of this method. Multicenter prospective study is needed in this regard.

Hallazgos por tomografía en pacientes confirmados con SARS-CoV-2 y síndrome de distrés respiratorio agudo / Tomography findings in patients confirmed with SARS-CoV-2 and acute respiratory distress syndrome

Resumen Objetivos: Describir los patrones tomográficos de afectación pulmonar en pacientes con SARS-CoV2 y SDRA. Materiales y Métodos: Estudio retrospectivo, transversal y analítico. Pacientes atendidos en Hospital Regional de Alta Especialidad de Ciudad Victoria "Bicentenario 2010" (HRAEV), con diagnóstico confirmado de COVID-19 por RT-PCR y que contaran con tomografía computarizada de tórax realizada en la institución en el periodo comprendido de 1 marzo de 2020 a 31 julio de 2020. Se realizó un análisis descriptivo y analítico. Resultados: Se analizaron estudios de tomografía de 44 pacientes hospitalizados en HRAEV que cursaron con SDRA y requirieron IOT, de los cuales el 72.7% fueron del sexo masculino, la edad promedio fue de 64 años, de los cuales 47.7% cursaba con Diabetes Mellitus, 63.6 % con Hipertensión Arterial Sistémica 43.1% y con algún grado de sobrepeso u obesidad. Conclusiones: El hallazgo tomográfico característico de los pacientes con SDRA fue mixto de tipo vidrio despulido y consolidación con una afectación severa y generalizada.

Abstract Objective: Describe the tomographic patterns of lung involvement in patients with SARS-CoV2 and ARDS. Materials and methods: Retrospective, cross-sectional and analytical study. Patients treated at the Regional High Specialty Hospital of Ciudad Victoria "Bicentenario 2010" (HRAEV), with a confirmed diagnosis of COVID-19 by RT-PCR and who had a chest computed tomography performed at the institution in the period from March 1, 2020 to July 31, 2020. A descriptive and analytical analysis was carried out. Results: Tomography studies of 44 patients hospitalized in HRAEV who had ARDS and required IOT were analyzed, of which 72.7% were male, the average age was 64 years, of which 47.7% had Diabetes Mellitus, 63.6% with Systemic Arterial Hypertension and 43.1% with some degree of overweight or obesity. Conclusions: The characteristic tomographic finding of patients with ARDS was a mixed type of ground glass and consolidation with severe and generalized involvement. A high mortality rate was observed in these patients with OTI up to 70%.

Prognostic Effect of Chest Computed Tomography Scan in COVID-19: a Retrospective Study / Efeito Prognóstico da Tomografia Computadorizada de Tórax na COVID-19: um Estudo Retrospectivo

The number of COVID-19 disease cases and deaths reached the scale of millions worldwide. Determining risk and prognosis factors are fundamental to allow the development of personalized management strategies. The aim of this study was to correlate lung computed tomographic (CT) findings in patients affected by COVID-19 with the clinical staging of the disease and laboratory findings, and to evaluate whether these findings were effective in predicting disease evolution. Then, laboratory findings and chest CT scans of 309/616 COVID-19 positive patients were analyzed and classified according to the degree of extension of pulmonary involvement. Ground glass opacities predominated in earlyphase, while crazy-paving pattern, consolidation, and fibrosis characterized late-phase disease. CT findings were significantly higher among late than early stages (p<0,05), although the indeterminate patterns were significantly associated with early-phase disease(p=0.00216). The groundglass pattern was significantly associated with TTPA (p=0,0234), and elevated leukocyte counting (p=0,008) and D-dimer levels(p=0.001). ROC curve analysis showed an area of 0.57(95% CI 0·890­0.0623) to early disease stage, 0.764(95%CI 0.817­0.764) to the progressive stage, and 0.816(0.717­0.915) to later stages, suggesting a relevance role of chest CT findings to this disease diagnosis. The data strongly suggested the potential role of chest CT as a technique for enhancing qPCR COVID-19 positiveness capacity by speeding-up diagnosis in symptomatic cases, and predicting the outcome of SARS CoV2 infected patients. The CT findings were also correlated with laboratory findings and disease severity, and may be of great prognostic value for stratifying the evolution of this infectious disease in hospitalized patients. (AU)

O número de casos e mortes pela COVID-19 atingiu a escala de milhões em todo o mundo. A determinação de fatores de risco e prognóstico ainda são de fundamental importância para permitir o desenvolvimento de estratégias de manejo personalizadas. O objetivo foi correlacionar achados tomográficos (TC) pulmonares em pacientes acometidos por COVID-19 com o estadiamento clínico da doença e os achados laboratoriais, e avaliar se os mesmos são efetivos para a predição da evolução da doença. Então, os achados laboratoriais e resultados de TC de tórax de 309/616 pacientes positivos para COVID-19 foram analisados e associados, e classificados de acordo com o grau de extensão do acometimento pulmonar. Opacidades em vidro fosco predominaram na fase inicial da doença, enquanto o padrão de pavimentação em mosaico, consolidação e fibrose caracterizaram a doença na fase tardia. Os achados tomográficos foram significativamente maiores para os estágios tardios em relação aos iniciais (p<0,05), embora os padrões indeterminados tenham sido significativamente associados com a doença em estágio inicial (p=0,00216). O padrão em vidro fosco estava significativamente associado com o TTPA (p=0,0234), a contagem elevada de leucócitos (p=0,008) e os níveis elevados de dímero D (p=0,001). A análise da curva ROC mostrou uma área de 0,57 (95% CI 0,890­0,0623) para o estágio inicial da doença, 0,764 (95% CI 0,817­0,764) para o estágio progressivo e 0,816 (0,717­0,915) para os estágios tardios, sugerindo uma relevância dos achados da TC de tórax para o diagnóstico efetivo dessa doença. Os dados fortemente sugerem o papel potencial da TC de tórax como uma técnica a ser associada ao teste de qPCR positivo para a COVID-19, a fim de acelerar o diagnóstico em casos sintomáticos e prever o desfecho de pacientes infectados. Os achados tomográficos também foram correlacionados com os achados laboratoriais e a gravidade da doença, se mostrando de importante valor prognóstico para estratificar a evolução dessa doença infecciosa em pacientes hospitalizados. (AU)

Utilización del ultrasonido como herramienta para el diagnóstico y tratamiento en cirugía de tórax / Use of ultrasound as a diagnostic and therapeutic tool in thoracic surgery / Uso da ultrassonografia como ferramenta de diagnóstico e tratamento em cirurgia de tórax

Objetivo: presentar la utilización de la guía ecográfica en el tórax para realizar biopsias y colocación de drenajes, ya sean pleurales o pericárdicos. Material y método: se realizaron 124 procedimientos ecoguiados en el Instituto del Tórax del Hospital Maciel, desde enero de 2014 hasta agosto de 2022. Resultados: se evaluaron franja etaria, tipo de procedimiento y rentabilidad diagnóstica en los procedimientos ecoguiados. Se realizaron 69 punciones con fines diagnósticos, 48 colocaciones de drenajes pleurales bajo apoyo ecográfico y 7 drenajes pericárdicos. Conclusión: la realización de procedimientos ecoguiados en el tórax es una herramienta diagnóstica y terapéutica segura, con buen rendimiento y mínimas complicaciones.

Objective: To present the use of ultrasound guidance to perform thorax biopsies and place drainages, whether pleural or pericardial. Method: A total of 124 ultrasound-guided procedures were performed at the Thoracic Institute, Maciel Hospital, from January 2014 to August 2022. Results: The results were assessed based on age group, type of procedure, and diagnostic yield in the ultrasound-guided procedures. There were 69 diagnostic punctures, 48 ultrasound-guided pleural drainage placements, and 7 pericardial drainages. Conclusions: The performance of ultrasound-guided thoracic procedures are a safe diagnostic and therapeutic tool with excellent efficacy and minimal complications.

Objetivo: fica no tórax para realização de biópsias e colocação de drenos pleurais ou pericárdicos. Materiais e métodos: foram realizados 124 procedimentos guiados por ultrassom no Instituto del Tórax do Hospital Maciel no período de janeiro de 2014 a agosto de 2022. Resultados: foram avaliadas faixa etária, tipo de procedimento e rentabilidade diagnóstica em procedimentos guiados por ultrassom. Foram realizadas 69 punções para fins diagnósticos, 48 colocações de drenos pleurais sob suporte ultrassonográfico e 7 drenos pericárdicos. Conclusão: a realização de procedimentos guiados por ultrassom no tórax é uma ferramenta diagnóstica e terapêutica segura, com bom desempenho e complicações mínimas.

Perioperative analysis of patients undergoing liver transplantation at the Hospital de Clínicas da Unicamp in the context of the SARS-CoV-2 pandemic / Análise perioperatória dos pacientes submetidos a transplante hepático no Hospital de Clínicas da Unicamp no contexto da pandemia de SARS-CoV-2

Introduction: SARS-CoV-2 began in 2020 and caused important changes in the number of transplants performed in hospitals and in the protocols for admitting candidates to perform the procedure. The Brazilian Association of Organ Transplantation (ABTO) recommends not performing transplants from donors with active COVID-19 infection, positive test results or with Severe Acute Respiratory Syndrome. The hepatic repercussions related to COVID-19 are presented in some reports in the medical literature. Liver changes resulting from other corona viruses such as SARS-CoV and MERS-CoV are well documented. The Hospital de Clínicas of the State University of Campinas is a tertiary center that performs solid organ transplants. Objectives: To carry out a perioperative, retrospective, descriptive analysis of liver transplants in the context of the SARS-CoV-2 pandemic carried out at the Hospital das Clínicas of the State University of Campinas from March 2020 to July 2021. Materials and Methods: Retrospective, descriptive, longitudinal cohort study based on the review of medical records of patients undergoing liver transplantation in the context of the SARS-CoV-2 pandemic from March 2020 to July 2021 at the clinical hospital of the State University of Campinas. Results: Retrospective analysis was performed on 57 patients in the period. Only 1 patient needed to be excluded because he was under 18 years old. Of the 56 patients, 52 underwent RT-PCR laboratory testing and chest tomography (CT). Of these 52 patients, only 2 tested positive, one pre-transplant (TX) and one post-operatively (post-op). Regarding chest CT scans, none of them showed typical changes for COVID pre-TX, in the post-op 4 patients presented typical chest CT scans. The average age was 55.86 years. The mortality rate was 38% and no deaths were attributed to COVID 19. The average MELD-Na scale was 20.94. Conclusion: The present study carried out at the Hospital de Clínicas da Unicamp analyzed the clinical, laboratory and radiological association to better elucidate the variables determined by COVID-19 in its diagnosis and in-hospital management. It is concluded that the SARS-CoV-2 pandemic had an impact on the routine of liver transplantation worldwide and on the service in which the study was carried out.

Introdução: A pandemia causada pelo SARS-CoV-2 teve início no ano de 2020 e ocasionou mudanças importantes no número de transplantes realizados nos hospitais e nos protocolos de admissão de candidatos para realização do procedimento. A Associação Brasileira de Transplante de Orgãos (ABTO) recomendava não realizar transplante de doadores com infecção COVID-19 ativa, teste positivo ou com Síndrome Respiratória Aguda Grave. As repercussões hepáticas relacionadas a COVID-19 são apresentadas em alguns relatos presentes na literatura médica. Estão bem documentadas as alterações hepáticas decorrentes de outros coronavírus tais como SARS-CoV e MERS-CoV. O Hospital de Clínicas da Universidade Estadual de Campinas é um centro terciário que realiza transplantes de órgãos sólidos. Objetivos: Realizar a análise retrospectiva descritiva perioperatória dos transplantes hepáticos no contexto da pandemia por SARS-CoV-2 realizados no hospital das clínicas da Universidade Estadual de Campinas no período de Março de 2020 a Julho de 2021. Materiais e Métodos: Estudo retrospectivo, descritivo de coorte longitudinal baseado na revisão dos prontuários dos pacientes submetidos ao transplante hepático no contexto da pandemia por SARS-CoV-2 no período de Março de 2020 a Julho de 2021 no hospital de clínicas da Universidade Estadual de Campinas. Resultados: A análise retrospectiva foi realizada em 57 pacientes no período. Apenas 1 paciente precisou ser excluído por ter menos de 18 anos. Dos 56 pacientes, 52 realizaram coleta do exame laboratorial RT-PCR e tomografia (TC) de tórax. Desses 52 pacientes apenas 2 positivaram o exame, um pré transplante (TX) e um no pós-operatório (pós-op). Em relação às TC de tórax nenhuma apresentava alterações típicas para COVID pré TX, no pós-op 4 pacientes apresentaram TC típicas. A média de idade foi de 55,86 anos. A taxa de mortalidade foi de 38% e nenhum óbito foi atribuído ao COVID 19. A escala de MELDNa média foi de 20,94. Conclusão: O presente estudo realizado no Hospital de Clínicas da Unicamp analisou a associação clínica, laboratorial e radiológica para melhor elucidar as variáveis determinadas pela COVID-19 no seu diagnóstico e manejo intra-hospitalar. Conclui-se que a pandemia por SARS-CoV-2 teve impacto na rotina de realização do transplante hepático mundialmente e no serviço no qual o estudo foi realizado.

Mielolipoma primario mediastinal / Primary mediastinal myelolipoma

Resumen El mielolipoma es un tumor benigno no funcional, la mayoría de ellos son asintomáticos y descubiertos de forma incidental a través de estudios de imagen o en es tudios de autopsia. Aun cuando la mayoría de los casos se presenta en la glándula suprarrenal, también se han informado en sitios extra-adrenales. Presentamos el caso de una mujer de 65 años de edad con un mielolipoma primario mediastinal. La tomografía computarizada de tórax mostró un tumor ovoide de bordes bien definidos de 6.5 × 4.2 cm, localizado en el mediastino posterior. Se realizó biopsia transtorácica de la lesión y el estudio microscópico reveló elementos hematopoyéticos y tejido adiposo maduro. Aun cuando los estudios de imagen como la tomografía computarizada y la resonancia mag nética son efectivos en el diagnóstico del mielolipoma primario mediastinal, la evaluación histopatológica es esencial para el diagnóstico definitivo.

Abstract Myelolipoma is a benign non-functional tumor. Most of them are asymptomatic and discovered incidentally, either through imaging studies or at autopsy. While it most commonly occurs in the adrenal gland, it has also been reported at extra-adrenal sites. We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computer tomographic scan of the thorax showed an ovoid tumor with well-defined borders of 6.5 × 4.2 cm, located in the posterior mediastinum. A transthoracic biopsy of the lesion was made, and the microscopic observation revealed hematopoietic cells and mature adipose tissue. Although computed tomo graphy and magnetic resonance imaging are effective in diagnosing mediastinal myelolipoma, histopathological examination is essential for the definitive diagnosis.

Rendimiento diagnóstico y morbimortalidad de las biopsias pulmonares quirúrgicas en enfermedad pulmonar intersticial difusa

Introducción: Se denomina Enfermedad Pulmonar Intersticial Difusa (EPID) a un conjunto heterogéneo de patologías caracterizadas por inflamación y fibrosis pulmonar. El diagnóstico basado en patrones clínicos o radiológicos puede, ocasionalmente, ser insuficiente para iniciar un tratamiento. La biopsia pulmonar quirúrgica es una alternativa cuando se requiere aumentar la precisión diagnóstica luego de discusión multidisciplinaria. Objetivo: Describir el rendimiento diagnóstico, morbilidad y mortalidad de las biopsias quirúrgicas pulmonares en un hospital público chileno. Pacientes y Método: Cohorte retrospectiva de todos los pacientes a quienes se realizó biopsia quirúrgica por diagnóstico de EPID entre los años 2010 y 2020, indicada por un comité multidisciplinario. Se excluyen procedimientos similares o biopsias con diagnóstico de EPID como hallazgo incidental. Resultados: 38 pacientes intervenidos, mediana de edad de 63 años, 47% femenino. Solo 1 (2,6%) paciente operado de urgencia, y 34 (89,5%) por videotoracoscopía. 5 (13,1%) pacientes presentaron morbilidad, en 4 de ellos fuga aérea, ninguno requiriendo intervención adicional. No hubo rehospitalización, reoperación ni mortalidad a 90 días. En el 95% de los casos se alcanzó un diagnóstico preciso de la EPID tras discusión multidisciplinaria. Discusión: Se observa un alto rendimiento diagnóstico y una baja morbimortalidad en los pacientes estudiados. La baja frecuencia de procedimientos de urgencia y la adecuada indicación en comité multidisciplinario puede haber contribuido a la baja morbilidad. Conclusión: La biopsia pulmonar quirúrgica en un hospital general tiene un alto rendimiento diagnóstico cuando se discute en comité multidisciplinario para precisar el diagnostico en EPID, con una baja morbimortalidad si se seleccionan adecuadamente los pacientes.

Background: Interstitial Lung Disease (ILD) is a heterogeneous group of diseases characterized by inflammation and fibrosis of the lung. Diagnosis based exclusively on clinical or radiologic patterns may be inaccurate, and if a reliable diagnosis cannot be made, surgical lung biopsy can be strongly considered to increase the diagnostic yield after multidisciplinary committee. Objective: To review the diagnostic results, morbidity, and mortality of surgical biopsies in a chilean public health institution. Patients and Method: Retrospective cohort of patients operated for diagnostic purposes for ILD between 2010 - 2020. Surgical biopsies done for other diagnoses were excluded. Results: 38 patients were included, with a median age of 63 years, 47% were female. Only 1 patient (2.6%) underwent emergency surgery and 89.5% underwent minimally invasive surgery techniques. 5 patients had some morbidity (13.1%), 4 of them being air leak. All complications were successfully managed conservatively. We had no readmission, reoperations, or 90-day mortality in this cohort. In 95% of the cases an accurate diagnosis of ILD was reached after multidisciplinary discussion. Discussion: In our experience surgical lung biopsy has a high diagnostic yield and a low morbidity and mortality. A low number of emergency procedures and accurate surgical indication by an expert committee could explain the low morbidity. Conclusion: Surgical lung biopsy in a general hospital reach a high diagnostic performance when discussed in a multidisciplinary committee to specify the diagnosis in ILD, with low morbidity and mortality if patients are properly selected.

Resección completa en dos tiempos de teratoma quístico gigante del mediastino que debuta con compromiso vital

Objetivo: Describir resolución quirúrgica de teratoma de mediastino en dos tiempos que debuta en paciente con urgencia vital. Materiales y Métodos: Revisión de caso clínico y descripción retrospectiva del manejo quirúrgico realizado. Resultados: Estudio imagenológico evidenció tumor con contenido quístico que comprometía ambos hemitórax. Dado compromiso vital del paciente, se realiza quistocentesis descompresiva en pabellón, seguido de videotoracoscopía que demuestra origen mediastínico y quistectomía parcial por toracotomía. En un segundo tiempo quirúrgico, se reseca remanente vía esternotomía media. Discusión: Los teratomas mediastínicos son extremadamente infrecuentes, reportándose 44 casos en literatura mundial, sin registros a nivel nacional. Afecta a jóvenes sanos, la mayoría asintomáticos, siendo su hallazgo tardío e incidental. El compromiso de estructuras mediastínicas y de vía aérea pueden ocasionar riesgo vital. Conclusión: La descompresión perioperatoria del contenido quístico del teratoma fue fundamental para mantener fuera de riesgo vital al paciente durante el acto quirúrgico.

Objective: To describe the successful surgical resolution of a giant teratoma of the mediastinum that presents with a vital emergency. Clinical Case: Male patient, 30 years old, with no known history, consulted for a 1-year history of dyspnea on minimal exertion, associated with weight loss without dietary restriction. Imaging study showed tumor with cystic content that compromised both hemithorax. Given the patient's vital commitment, decompressive cystocentesis was performed, followed by video-assisted thoracoscopy that showed mediastinal origin and partial cystectomy by thoracotomy. In a second surgical time, resection of the remnant was performed via median sternotomy. Discussion: Mediastinal teratomas are extremely rare, reporting 44 cases in the world literature, with no national registry. They usually affect healthy young people, most of them asymptomatic and therefore, their discovery is late and incidental. In this case, due to the compression of noble structures, perioperative cystic decompression was essential. Conclusion: Perioperative decompression of the cystic content of the teratoma was essential to maintain stable hemodynamics and subsequent surgical resection.

Neumonía redonda unilateral en pediatría: informe de caso y revisión de la literatura / Unilateral round pneumonia in pediatrics: case report and review of the literature

Antecedentes: La neumonía redonda es una enfermedad que se presenta comúnmente en niños menores de 8 años, Streptococcus pneumoniae es el agente más frecuente que causa este tipo característico de neumonía. Tiene una incidencia que representa menos del 1% de las lesiones de monedas. Este es el primer caso documentado de neumonía redonda en Honduras. Descripción del caso clínico: Se reporta el caso de una paciente preescolar con historia de 7 días de presentar tos húmeda sin predominio de horario, acompañada de fiebre de 5 días de evolución, por lo que solicita atención médica en la Sala de Emergencia del Hospital de Occidente. Al examen físico: paciente en buen estado general, con frecuencia respiratoria 32 respiraciones por minuto, saturación de oxígeno 95%, sin dificultad respiratoria y pulmones bien ventilados. Fue ingresada a Sala de Pediatría, ya que presentaba un hemograma con leucocitosis y neutrofilia. En radiografía de tórax se observó radiopacidad homogénea en lóbulo inferior en pulmón izquierdo, motivo por el cual se decidió realizar tomografía computarizada de tórax en la cual se concluyó diagnóstico de neumonía redonda. Posteriormente después de terapia antibiótica con ampicilina se realizó radiografía control donde se observó resolución del consolidado neumónico. Conclusiones: El conocimiento de esta patología permitirá al médico reconocer que se trata de una enfermedad que tiene un curso benigno. Se recomienda siempre sospecharla en el contexto de un cuadro indicativo de infección respiratoria más un consolidado neumónico esférico de bordes definidos para evitar pruebas diagnósticas innecesarias...(AU)

Hérnia torácica traumática associada a laceração de lobo pulmonarcaudal em cão / Traumatic thoracic hernia associated with laceration of the caudal lung lobe in a dog

Traumas torácicos são comuns em pacientes traumatizados e incluem principalmente contusão pulmonar, laceração pulmonar, pneumotórax, hemotórax, fraturas de costela e esterno e hérnia diafragmática. As principais causas são acidentes automobilísticos, quedas e mordeduras. Taquipneia ou dispneia são possíveis sinais clínicos, associados a choque hipovolêmico e sinais gastrointestinais. Lesões torácicas podem ser negligenciadas quando lesões distrativas, como fratura de membros, estão presentes. Assim, o exame clínico minucioso é obrigatório e os animais com insuficiência respiratória podem necessitar de estabilização e cirurgia de emergência. Considerando a importância do trauma torácico na prática clínica, o objetivo deste manuscrito é relatar o caso de hérnia espúria torácica associada a laceração traumática de lobo pulmonar caudal em uma cadela apresentando dispneia intensa após trauma automobilístico. Após uma avaliação emergencial e exames radiográficos, foi diagnosticado tórax instável, fraturas de costelas, contusão pulmonar e pneumotórax grave. Após estabilização clínica, foi realizado tratamento cirúrgico para estabilização do tórax instável. Durante a cirurgia, observou-se herniação e laceração do lobo caudal esquerdo do pulmão, sendo realizadas suturas para correção da laceração pulmonar e estabilização do gradil costal, além da toracostomia para controle do pneumotórax. Nos casos de tórax instável e encarceramento lobar, o tratamento cirúrgico é fundamental, como realizado neste caso, com o objetivo de reparar e reposicionar o lobo pulmonar e estabilizar o tórax instável. A herniação pulmonar traumática é um possível diagnóstico diferencial no tórax instável pós-traumático, assim como a reparação do lobo e a estabilização das costelas por meio de suturas são técnicas eficazes de tratamento cirúrgico.

Thoracic traumas are common in trauma patients and mainly include pulmonary contusion, pulmonary laceration, pneumothorax, hemothorax, rib and sternum fractures and diaphragmatic hernia. The main causes are car accidents, falls and bites. Tachypnea or dyspnea are possible clinical signs, associated with hypovolemic shock and gastrointestinal signs. Thoracic injuries may be overlooked when distracting injuries, such as limb fractures, are present. Thus, thorough clinical examination is mandatory and animals with respiratory failure may require stabilization and emergency surgery. Considering the importance of thoracic trauma in clinical practice, the manuscript aimed to report the case of spurious thoracic hernia associated with traumatic laceration of the caudal lung lobe in a bitch with severe dyspnea after car trauma. After an emergency evaluation and radiographic examinations, a flail chest, rib fractures, pulmonary contusion and severe pneumothorax were diagnosed. After clinical stabilization, surgical treatment was performed to stabilize the flail chest. During surgery, herniation and laceration of the left caudal lobe of the lung were observed, and sutures were performed to correct the pulmonary laceration and stabilize the rib cage, in addition to thoracostomy to control the pneumothorax. In cases of flail chest and lobar entrapment, surgical treatment is essential, as in this case, with the aim of repairing and repositioning the pulmonary lobe and stabilizing the flail chest. Traumatic pulmonary herniation is a possible differential diagnosis in post-traumatic flail chest, as well as repairing the lobe and stabilizing the ribs using sutures are effective surgical treatment techniques.

Hallazgos en tomografía de tórax en el seguimiento a 4, 8 y 12 meses después de una neumonía grave por COVID-19 / Chest Tomography Findings in Follow-Up at 4, 8 and 12 Months after Severe COVID-19 Pneumonia

Introducción: el SARS-CoV-2 causa daño multiorgánico, con predilección al epitelio respiratorio. Los estudios de imagen en tórax han sido determinantes en muchas patologías y, durante la reciente pandemia, no fue excepción. En el seguimiento con tomografía de tórax post COVID-19 en varias series, se ha observado persistencia de lesiones al egreso y a lo largo de varios meses. El objetivo del trabajo fue describir los hallazgos tomográficos en pacientes con seguimiento hasta un año post egreso hospitalario por COVID-19 moderado-grave. Material y métodos: estudio retrospectivo, observacional, de pacientes hospitalizados por COVID-19 moderado-grave de marzo 2020 a marzo 2022 en el hospital del ISSSTE, Chiapas-México; con prueba RT-PCR SARS-CoV-2 positiva, TC de hospitalización y de seguimiento posterior al egreso (0-4 meses; 4-8 meses; 8-12 meses). Se utilizó la terminología de la sociedad Fleischner. Además, se evaluó la extensión por lóbulo afectado (>75%, 75-50%, 50-25%, <25%). Resultados: Se estudiaron 27 pacientes, 74% hombres, edad promedio 56 años. El patrón tomográfico predominante al ingreso fue el mixto con 56% y extensión pulmonar >75%; vidrio despulido 30% y 11% consolidación. Al cuarto y octavo mes el patrón mixto fue el más frecuente, al doceavo mes persistía en el 33% de los pacientes y en el 30% de los casos la tomografía fue normal. Conforme pasaron los meses, la extensión del daño fue limitándose. Conclusión: el seguimiento con tomografía en COVID-19 moderado-grave es indiscutible. Permite identificar con precisión el patrón tomográfico en los diferentes momentos de la enfermedad, optimizar el tratamiento y disminuir las secuelas.

Augmentation mammoplasty and autologous fat transplantation: an alternative for the treatment of hypomastia and mild pectus excavatum - Case report / Mamoplastia de aumento e transplante de gordura autóloga: uma alternativa para o tratamento da hipomastia e pectus excavatum leve - Relato de caso

Pectus excavatum(PE) is a congenital chest deformity characterized by deep depression in the sternum. Autologous fat transplantation has been used for aesthetic purposes, mainly on the face, and has recently gained relevance in thoracic and breast surgeries. The present study aims to present a case of mild PE associated with hypomastia. A 24-year-old female patient attended the consultation for breast augmentation due to hypomastia, but the clinical examination also revealed an associated mild PE that the patient did not notice. Surgical planning included breast augmentation and autologous fat transfer. A 260ml silicone breast implant was used, and 250ml of fat was injected in the sternal region and the lower medial contour of the breasts. There were no complications during the 12-month follow-up period. The combination of augmentation mammoplasty and fat transplantation in treating PE deformity proved to be a minimally invasive, good, safe option with high patient satisfaction.

Pectus excavatum (PE) é uma deformidade torácica congênita, caracterizada como uma depressão profunda no esterno. O transplante autólogo de gordura tem sido utilizado para fins estéticos, principalmente na face, e recentemente ganhou relevância nas cirurgias torácica e das mamas. O objetivo do presente estudo é apresentar um caso de PE leve associado a hipomastia. Uma paciente de 24 anos compareceu à consulta para mamoplastia de aumento por hipomastia, mas o exame clínico também revelou um PE leve associado que não foi percebido pela paciente. O planejamento cirúrgico incluiu a mamoplastia de aumento e a transferência de gordura autóloga. Foi utilizado um implante mamário de silicone de 260ml, e uma quantidade total de 250ml de gordura foi injetada na região esternal e no contorno medial inferior das mamas. Não houve complicações durante o período de acompanhamento de 12 meses. A associação de mamoplastia de aumento e transplante de gordura no tratamento da deformidade de PE revelou-se uma opção minimamente invasiva, boa, segura e com alta satisfação da paciente.

Rendimiento diagnóstico de algoritmos de inteligencia artificial para detección de compromiso pulmonar por COVID-19 basados en radiografía portátil / Diagnostic performance of artificial intelligence algorithms for detection of pulmonary involvement by COVID-19 based on portable radiography

Introducción y objetivo: Evaluar el rendimiento diagnóstico de diferentes algoritmos de inteligencia artificial (IA) para la identificación de compromiso pulmonar por SARS-CoV-2 basados en radiografía (Rx) de tórax portátil.Material y métodoEstudio observacional prospectivo que incluyó pacientes ingresados por sospecha de infección por COVID-19 en un hospital universitario entre julio y noviembre de 2020. El patrón de referencia de compromiso pulmonar por SARS-CoV-2 comprendió una PCR positiva y síntomas respiratorios bajos.ResultadosSe incluyeron 493 pacientes, 140 (28%) con PCR positiva y 32 (7%) con neumonía por SARS-CoV-2. El algoritmo AI-B tuvo el mejor rendimiento diagnóstico (áreas bajo la curva ROC AI-B 0,73 vs. AI-A 0,51 vs. AI-C 0,57). Utilizando un umbral de detección superior al 55%. AI-B presentó mayor precisión que el especialista (área bajo la curva de 0,68 [IC 95%: 0,64-0,72] vs. 0,54 [IC 95%: 0,49-0,59]).ConclusiónLos algoritmos de IA basados en Rx portátiles permiten una precisión diagnóstica comparable a la humana para la detección de compromiso pulmonar por SARS-CoV-2. (AU)

Introduction and objectives: To evaluate the diagnostic performance of different artificial intelligence (AI) algorithms for the identification of pulmonary involvement by SARS-CoV-2 based on portable chest radiography (RX).Material and methodsProspective observational study that included patients admitted for suspected COVID-19 infection in a university hospital between July and November 2020. The reference standard of pulmonary involvement by SARS-CoV-2 comprised a positive PCR test and low-tract respiratory symptoms.Results493 patients were included, 140 (28%) with positive PCR and 32 (7%) with SARS-CoV-2 pneumonia. The AI-B algorithm had the best diagnostic performance (areas under the ROC curve AI-B 0.73, vs. AI-A 0.51, vs. AI-C 0.57). Using a detection threshold greater than 55%, AI-B had greater diagnostic performance than the specialist [(area under the curve of 0.68 (95% CI 0.64-0.72), vs. 0.54 (95% CI 0.49-0.59)].ConclusionAI algorithms based on portable RX enabled a diagnostic performance comparable to human assessment for the detection of SARS-CoV-2 lung involvement. (AU)