Prevalence and prognostic meaning of interstitial lung abnormalities in remote CT scans of patients with interstitial lung disease treated with antifibrotic therapy.

OBJECTIVES: To describe the prevalence and characteristics of interstitial lung abnormalities (ILA) in CT scans performed prior to the initiation of antifibrotics in a series of patients with interstitial lung disease (ILD), and to identify characteristics apparent on early CT scans that could help to predict outcomes. METHODS: We conducted a retrospective observational study. The original cohort consisted of 101 patients diagnosed with ILD and treated with antifibrotics in a tertiary hospital. Patients were included if they had a thoracic CT scan performed at least one year before initiation of therapy. They were classified radiologically in three groups: without ILA, with radiological ILA and extensive abnormalities. ILA were classified as subpleural fibrotic, subpleural non-fibrotic and non-subpleural. The initial scan and the latest CT scan performed before treatment were read for assessing progression. The relationship between CT findings of fibrosis and the radiological progression rate and mortality were analyzed. RESULTS: We included 50 patients. Only 1 (2%) had a normal CT scan, 25 (50%) had extensive alterations and 24 (48%) had radiological criteria for ILA, a median of 98.2 months before initiation of antifibrotics, of them 18 (75%) had a subpleural fibrotic pattern. Significant bronchiectasis and obvious honeycombing in the lower zones were associated with shorter survival (p = 0.04). Obvious honeycombing in the lower zones was also significantly (p < 0.05) associated with a faster progression rate. CONCLUSIONS: Fibrotic ILAs are frequent in remote scans of patients with clinically relevant ILD, long before they require antifibrotics. Findings of traction bronchiectasis and honeycombing in the earliest scans, even in asymptomatic patients, are related to mortality and progression later on.

Pulmonary CT angiography in the first wave of the COVID-19 pandemic: Comparison between patients with and without infection and with a pre-pandemic series.

BACKGROUND AND AIMS: To analyze the diagnostic performance of pulmonary CT angiography and to compare different D-dimer cutoffs for the diagnosis of acute pulmonary embolism in patients with and without SARS-CoV-2 infections. MATERIALS AND METHODS: We retrospectively analysed all consecutive pulmonary CT angiography studies done for suspected pulmonary embolism in a tertiary hospital during two time periods: the first December 2020 through February 2021 and the second December 2017 through February 2018. D-dimer levels were obtained less than 24 h before the pulmonary CT angiography studies. We analysed the sensitivity, specificity, positive and negative predictive values, area under the receiver operating curve (AUC), and pattern of pulmonary embolism for six different values of D-dimer and the extent of the embolism. During the pandemic period, we also analysed whether the patients had COVID-19. RESULTS: After excluding 29 poor-quality studies, 492 studies were analysed; 352 of these were done during the pandemic, 180 in patients with COVID-19 and 172 in patients without COVID-19. The absolute frequency of pulmonary embolism diagnosed was higher during the pandemic period (34 cases during the prior period and 85 during the pandemic; 47 of these patients had COVID-19). No significant differences were found in comparing the AUCs for the D-dimer values. The optimum values calculated for the receiver operating characteristic curves differed between patients with COVID-19 (2200 mcg/l), without COVID-19 (4800 mcg/l), and diagnosed in the prepandemic period (3200 mcg/l). Peripheral distribution of the emboli was more common in patients with COVID-19 (72%) than in those without COVID-19 and than in those diagnosed before the pandemic [OR 6.6, 95% CI: 1.5-24.6, p < 0.05 when compared to central distribution]. CONCLUSIONS: The number of CT angiography studies and the number of pulmonary embolisms diagnosed during the pandemic increased due to SARS-CoV-2 infection. The optimal d-dimer cutoffs and the distribution of the pulmonary embolisms differed between the groups of patients with and without COVID-19.

Angio-TC pulmonar durante la pandemia de COVID-19: comparación en pacientes con y sin la infección y con una serie prepandémica / Pulmonary CT angiography in the first wave of the COVID-19 pandemic: comparison between patients with and without infection and with a pre-pandemic series

Antecedentes y objetivo: Analizar el rendimiento diagnóstico de la angio-TC pulmonar y comparar distintos valores de corte del dímero-D para el diagnóstico de tromboembolia pulmonar (TEP) aguda en pacientes con y sin infección por SARS-CoV-2.Materiales y métodos: Análisis retrospectivo de todas las angio-TC pulmonares realizadas consecutivamente por sospecha de TEP en un hospital de tercer nivel durante 2 periodos distintos. El primero de diciembre del 2020 a febrero del 2021 y el segundo de diciembre del 2017 a febrero del 2018. Se recogieron los resultados del dímero-D durante las 24h previas a la realización de las angio-TC pulmonares, así como el resultado de estas últimas para todos los pacientes incluidos. Se analizaron la sensibilidad, especificidad, valores predictivos, área bajo la curva (AUC) y patrón de tromboembolia para 6 valores distintos del dímero-D y la extensión del tromboembolia. Durante el periodo de la pandemia se registró si los pacientes tenían enfermedad por SARS-CoV-2. Resultados: Tras desestimar 29 estudios de baja calidad, se incluyeron 492 para el análisis. De ellos, 352 fueron realizados durante la pandemia; 180 en enfermos con COVID-19 y 172 sin la enfermedad. La frecuencia absoluta de TEP diagnosticados durante la pandemia fue mayor (34 durante el periodo previo a la pandemia y 85 durante la pandemia, correspondiendo 47 de este último grupo a pacientes con COVID-19). No se encontraron diferencias significativas al comparar el AUC para los valores del dímero-D. Los valores óptimos calculados a partir de las curvas ROC fueron distintos (2.200, 4.800 y 3.200μg/l en pacientes con COVID-19, sin COVID-19 y en diagnosticados durante el periodo prepandemia, respectivamente).(AU)

Background and aims: To analyze the diagnostic performance of pulmonary CT angiography and to compare different D-dimer cutoffs for the diagnosis of acute pulmonary embolism in patients with and without SARS-CoV-2 infections. Materials and methods: We retrospectively analyzed all consecutive pulmonary CT angiography studies done for suspected pulmonary embolism in a tertiary hospital during two time periods: the first December 2020 through February 2021 and the second December 2017 through February 2018. D-dimer levels were obtained less than 24hours before the pulmonary CT angiography studies. We analyzed the sensitivity, specificity, positive and negative predictive values, area under the receiver operating curve (AUC), and pattern of pulmonary embolism for six different values of D-dimer and the extent of the embolism. During the pandemic period, we also analyzed whether the patients had COVID-19. Results: After excluding 29 poor-quality studies, 492 studies were analyzed; 352 of these were done during the pandemic, 180 in patients with COVID-19 and 172 in patients without COVID-19. The absolute frequency of pulmonary embolism diagnosed was higher during the pandemic period (34 cases during the prior period and 85 during the pandemic; 47 of these patients had COVID-19). No significant differences were found in comparing the AUCs for the D-dimer values. The optimum values calculated for the receiver operating characteristic curves differed between patients with COVID-19 (2200 mcg/L), without COVID-19 (4800 mcg/L), and diagnosed in the prepandemic period (3200 mcg/L). Peripheral distribution of the emboli was more common in patients with COVID-19 (72%) than in those without COVID-19 and than in those diagnosed before the pandemic [OR 6.6, 95% CI:1.5?24.6, p<0.05 when compared to central distribution].(AU)

[Pulmonary CT angiography in the first wave of the COVID-19 pandemic: comparison between patients with and without infection and with a pre-pandemic series]. / Angio-TC pulmonar durante la pandemia de COVID-19: comparación en pacientes con y sin la infección y con una serie prepandémica.

Background and aims: To analyze the diagnostic performance of pulmonary CT angiography and to compare different D-dimer cutoffs for the diagnosis of acute pulmonary embolism in patients with and without SARS-CoV-2 infections. Materials and methods: We retrospectively analyzed all consecutive pulmonary CT angiography studies done for suspected pulmonary embolism in a tertiary hospital during two time periods: the first December 2020 through February 2021 and the second December 2017 through February 2018. D-dimer levels were obtained less than 24 hours before the pulmonary CT angiography studies. We analyzed the sensitivity, specificity, positive and negative predictive values, area under the receiver operating curve (AUC), and pattern of pulmonary embolism for six different values of D-dimer and the extent of the embolism. During the pandemic period, we also analyzed whether the patients had COVID-19. Results: After excluding 29 poor-quality studies, 492 studies were analyzed; 352 of these were done during the pandemic, 180 in patients with COVID-19 and 172 in patients without COVID-19. The absolute frequency of pulmonary embolism diagnosed was higher during the pandemic period (34 cases during the prior period and 85 during the pandemic; 47 of these patients had COVID-19). No significant differences were found in comparing the AUCs for the D-dimer values. The optimum values calculated for the receiver operating characteristic curves differed between patients with COVID-19 (2200 mcg/L), without COVID-19 (4800 mcg/L), and diagnosed in the prepandemic period (3200 mcg/L). Peripheral distribution of the emboli was more common in patients with COVID-19 (72%) than in those without COVID-19 and than in those diagnosed before the pandemic [OR 6.6, 95% CI:1.5?24.6, p< 0.05 when compared to central distribution]. Conclusions: The number of CT angiography studies and the number of pulmonary embolisms diagnosed during the pandemic increased due to SARS-CoV-2 infection. The optimal D-dimer cutoffs and the distribution of the pulmonary embolisms differed between the groups of patients with and without COVID-19.

Organizing pneumonia.

Organizing pneumonia is a nonspecific pathologic pattern of response to lung damage. It can be idiopathic, or it can occur secondary to various medical processes, most commonly infections, connective tissue disease, and pharmacological toxicity. Although there is no strict definition of the pattern of organising pneumonia as in other idiopathic interstitial pneumonias, the characteristic pattern of this disease could be considered to include patchy consolidations and ground-glass opacities in the peribronchial and subpleural areas of both lungs. Moreover, studies of the course of the disease show that these lesions respond to treatment with corticoids, migrate with or without treatment, and tend to recur when treatment is decreased or withdrawn. Other manifestations of organising pneumonia include nodules of different sizes and shapes, solitary masses, nodules with the reverse halo sign, a perilobular pattern, and parenchymal bands.

Extrathoracic manifestations of COVID-19 in adults and presentation of the disease in children.

In March 2020, the World Health Organization declared a global pandemic of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); epidemic conditions continue in nearly all countries today. Although the symptoms and imaging manifestations of COVID-19 predominantly involve the respiratory system, it is fundamental to know the manifestations of the disease and its possible complications in other organs to help in diagnosis and orient the prognosis. To improve the diagnostic process without increasing the risk of contagion unnecessarily, it is crucial to know when extrathoracic imaging tests are indicated and which tests are best in each situation. This paper aims to provide answers to these questions. To this end, we describe and illustrate the extrathoracic imaging manifestations of COVID-19 in adults as well as the entire spectrum of imaging findings in children.

[Extrathoracic manifestations of COVID-19 in adults and presentation of the disease in children]. / Manifestaciones extratorácicas de la COVID-19 en adultos y presentación de la enfermedad en niños.

In March 2020, the World Health Organization declared a global pandemic of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); epidemic conditions continue in nearly all countries today. Although the symptoms and imaging manifestations of COVID-19 predominantly involve the respiratory system, it is fundamental to know the manifestations of the disease and its possible complications in other organs to help in diagnosis and orient the prognosis. To improve the diagnostic process without increasing the risk of contagion unnecessarily, it is crucial to know when extrathoracic imaging tests are indicated and which tests are best in each situation. This paper aims to provide answers to these questions. To this end, we describe and illustrate the extrathoracic imaging manifestations of COVID-19 in adults as well as the entire spectrum of imaging findings in children.

When pneumonia is not COVID-19. / Cuando la neumonía no es COVID-19.

During the COVID-19 epidemic, the prevalence of the disease means that practically any lung opacity on an X-ray could represent pneumonia due to infection with SARS-CoV-2. Nevertheless, atypical radiologic findings add weight to negative microbiological or serological tests. Likewise, outside the epidemic wave and with the return of other respiratory diseases, radiologists can play an important role in decision making about diagnoses, treatment, or preventive measures (isolation), provided they know the key findings for entities that can simulate COVID-19 pneumonia. Unifocal opacities or opacities located in upper lung fields and predominant airway involvement, in addition to other key radiologic and clinical findings detailed in this paper, make it necessary to widen the spectrum of possible diagnoses.

Computed tomography protocols used in staging bronchopulmonary carcinoma: results of a national survey. / Protocolos de tomografía computarizada empleados en la estadificación del carcinoma broncopulmonar: resultados de una encuesta a nivel nacional.

OBJECTIVES: To know the protocols used for staging bronchopulmonary carcinoma by computed tomography in Spain. MATERIAL AND METHODS: Radiologists in 129 hospitals were sent email questionnaires about the organization of their department, scanner type and manufacturer, study extension, techniques employed, and protocol for administering contrast material. RESULTS: A total of 109 hospitals responded with data from 91 teams. Most hospitals were affiliated with a university, and most departments were organized by organ-systems. Scanners were from four manufacturers, and 68% had either 16 or 64 detectors. In 61% of the hospitals, the dose of contrast agent is modified only in patients with extreme body weights, and in 22% the dose is not individualized. Most hospitals do contrast-enhanced studies of the chest and upper abdomen, 42.4% through a single thoracoabdominal acquisition and 55.9% through independent chest and abdominal acquisitions; there was a significant association between these approaches and the scanner manufacturer's protocols and whether the hospital was affiliated with a university. The most commonly used technical parameters were 120kV with dose modulation and variable milliamperage. CONCLUSION: There is very little variability among hospitals in the type of scanner used, the study extension, and the technical parameters used to stage bronchopulmonary carcinoma. Most centers individualize the dose of contrast agent only in extreme weights. There is a broad division between using one or two acquisitions to image the thorax and abdomen, and the number of acquisitions is related to the scanner manufacturer and whether the hospital is affiliated with a university.

Sonographically guided percutaneous biopsy of gastrointestinal tract lesions.

OBJECTIVE: Our objective was to evaluate the role and safety of sonographically guided percutaneous biopsy in the diagnosis of digestive tract lesions when the lesions are not suitable to biopsy by endoscopy and safely reachable by sonography. MATERIALS AND METHODS: We performed 42 biopsies in 41 patients (age range, 14-81 years; mean age, 57.5 years). We performed biopsies with real-time sonographic guidance using graded compression, with a 3.5-5-MHz microconvex transducer. In 39 biopsies, core specimens were obtained with an 18-gauge automatic needle gun; fine-needle aspiration biopsy was obtained in 28 patients with a 22-gauge needle and in the other four patients with a 21-gauge needle. In the remaining three patients, a coaxial technique with 20- and 22-gauge needles for cytology was used. RESULTS: In 40 (95.2%) of 42 core biopsies performed, a specific diagnosis was obtained. A positive diagnosis was obtained in 16 (45.7%) of 35 fine-needle aspirations. The lesions were located from the pharynx to the sigmoid colon. Twenty-eight patients had malignant lesions, and 13 had benign lesions. Only one serious complication, bile peritonitis, was observed. CONCLUSION: Percutaneous biopsy with sonographic guidance can be used safely and efficiently to diagnose digestive tract lesions that can be visualized on sonography and are not accessible endoscopically.

Large choledochocoele: difficulties in radiological diagnosis.

BACKGROUND: A choledochocoele is a dilatation of the intramural portion of the distal common bile duct within the duodenal wall. It usually presents with recurrent crises of right upper quadrant pain, hyperamylasaemia or jaundice. MATERIALS AND METHODS: We present a 12-year-old boy with a choledochocoele that was missed on several US examinations despite its large size. RESULTS: Findings on US, IV cholangiography, upper gastrointestinal contrast studies, ERCP and surgery are shown. The histological findings as well as the usual differential diagnosis are discussed.

[Levels of lipoprotein(a), other lipids and lipoproteins in adolescents from the health area of Alcoy]. / Niveles de lipoproteína (a), otros lípidos y lipoproteínas en adolescentes del área sanitaria de Alcoy.

Several epidemiological and necroscopic evidences suggest that, despite that the ischemic cardiopathy (IC) can be generally detected only since the fourth decade of life, it starts during the first years of life and adolescence. We have studied 278 teen-agers, with 13-14 years of age, attending the 8th school year (primary education) in five schools of Alcoy. 117 were males and 161 females. Levels of lipoprotein (a) (Lp[a]), total cholesterol (TC), cholesterol linked to high density lipoproteins (C-HDL) and its subfractions (C-HDL2 and C-HDL3), triglycerides (TG), apoproteins A-I and B (Apo A and Apo B) were determined. Cholesterol linked to low density lipoproteins (C-LDL) was calculated using the Friedewald-Fredrickson's equation. Mean values and standard deviation were: Lp(a) = 29.99 +/- 33.61 mg/dl., TC = 160.4 +/- 25.4 mg/dl., C-HDL = 54.0 +/- 12.3 mg/dl., C-HDL2 = 8.7 +/- 6.5 mg/dl., C-HDL3 = 46.2 +/- 18.6 mg/dl., TG = 72.6 +/- 26.8 mg/dl., C-LDL = 91.6 +/- 22.0 mg/dl., Apo A = 136.4 +/- 24.2 mg/dl., Apo B = 60.7 +/- 21.7 mg/dl. 38% teen-agers had Lp(a) levels higher than 30 mg/dl., 7.5% had levels of TC higher than 200 mg/dl., 12.8% had levels of C-HDL equal or higher than 40 mg/dl. and 4.7% had levels of C-LDL equal or higher than 130 mg/dl. From our study, we can conclude that, despite that the levels of TC, C-LDL and C-HDL in these teen-agers are within relatively normal limits, there is a high percentage with levels of Lp(a) actually considered as a risk factor.