Lung adenocarcinoma presenting as miliary lung metastasis on imaging.

Intrapulmonary miliary metastasis is a rare presentation of adenocarcinoma of the lung, characterized by the dissemination of cancer cells throughout the lung parenchyma in different patterns. This case report highlights an unusual presentation of adenocarcinoma of the lung with intrapulmonary miliary metastasis, emphasizing the diagnostic challenges and management considerations. Here, we report a case of a 51-year-old female who presented to the emergency department (ED) with a 2-month history of dry cough, which started after a flu illness and was associated with mild shortness of breath, left-sided chest pain, and miliary nodules on chest imaging. During bronchoscopy, a transbronchial biopsy was taken for further pathological assessment. The results showed histopathological evidence of lung adenocarcinoma.

Utility of chest radiograph severity scoring in emergency department for predicting outcomes in COVID-19: A study of 1275 patients.

OBJECTIVE: To measure the reliability and reproducibility of a chest radiograph severity score (CSS) in prognosticating patient's severity of disease and outcomes at the time of disease presentation in the emergency department (ED) with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: We retrospectively studied 1275 consecutive RT-PCR confirmed COVID-19 adult patients presenting to ED from March 2020 through June 2020. Chest radiograph severity score was assessed for each patient by two blinded radiologists. Clinical and laboratory parameters were collected. The rate of admission to intensive care unit, mechanical ventilation or death up to 60 days after the baseline chest radiograph were collected. Primary outcome was defined as occurrence of ICU admission or death. Multivariate logistic regression was performed to evaluate the relationship between clinical parameters, chest radiograph severity score, and primary outcome. RESULTS: CSS of 3 or more was associated with ICU admission (78 % sensitivity; 73.1 % specificity; area under curve 0.81). CSS and pre-existing diabetes were independent predictors of primary outcome (odds ratio, 7; 95 % CI: 3.87, 11.73; p < 0.001 & odds ratio, 2; 95 % CI: 1-3.4, p 0.02 respectively). No significant difference in primary outcome was observed for those with history of hypertension, asthma, chronic kidney disease or coronary artery disease. CONCLUSION: Semi-quantitative assessment of CSS at the time of disease presentation in the ED predicted outcomes in adults of all age with COVID-19.