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.

Usefulness of chest X-rays for detecting COVID 19 pneumonia during the SARS-CoV-2 pandemic.

OBJECTIVE: To review the prognostic usefulness of chest X-rays in selecting patients with suspected SARS-CoV-2 infection. MATERIAL AND METHODS: This cross-sectional descriptive observational study analyzed 978 patients with suspected SARS-CoV-2 infections who underwent chest X-ray examinations in the emergency department of a tertiary hospital in March 2020. We separately analyzed demographic, clinical, and prognostic variables in two groups of patients: those in whom reverse-transcriptase polymerase chain reaction (RT-PCR) was done (n = 535) and those in whom RT-PCR was not done because of low clinical suspicion (n = 443). RESULTS: In the group of patients with RT-PCR, the prevalence of SARS-CoV-2 was 70.4%, and the sensitivity of chest X-rays was 62.8%. In the group of patients without RT-PCR, chest X-rays were negative in 97.5%, corroborating the low clinical suspicion; these patients were discharged, and 5.6% of them reconsulted with mild forms of the disease. In the group of patients with RT-PCR, we observed no statistically significant differences in the percentage of pathologic chest X-rays between patients hospitalized in the ICU (72.9%) and in those hospitalized in other wards (68.3%) (p = 0.22). CONCLUSION: In the context of the pandemic, patients with low clinical suspicion and negative chest X-rays can be discharged with a low probability of reconsultation or of developing severe COVID19. In patients with RT-PCR positive for SARS-CoV-2, chest X-rays have no prognostic usefulness.

Utilidad de la radiografía de tórax para la detección de neumonía COVID 19 durante la pandemia por SARS-CoV-2 / Usefulness of chest X-rays for detecting COVID 19 pneumonia during the SARS-CoV-2 pandemic

Objetivo: Revisar la utilidad pronóstica de la radiografía de tórax en la selección de pacientes con sospecha de infección por SARS-CoV-2. Material y métodos: Estudio observacional, descriptivo y transversal, realizado en 978 pacientes con sospecha de infección por SARS-CoV-2 a los que se les hizo una radiografía de tórax en el servicio de urgencias de un hospital terciario, en marzo de 2020. Se analizaron variables demográficas, clínicas y pronósticas por separado en pacientes con RT-PCR (reacción en cadena de la polimerasa por transcriptasa inversa) hecha (grupo 1, n=535) o no hecha por baja sospecha clínica (grupo 2, n=443).Resultados: En el grupo 1 se observó una prevalencia de SARS-CoV-2 del 70,4%. La radiografía mostró una sensibilidad del 62,8%. En el grupo 2, la radiografía fue negativa en el 97,5%, corroborando la baja sospecha clínica, y fueron dados de alta; de ellos, el 5,6% volvió a consultar con formas leves de la enfermedad. En el grupo 1 no se observaron diferencias estadísticamente significativas en el porcentaje de radiografías de tórax patológicas entre los pacientes ingresados en plantas hospitalarias (68,3%) y los ingresados en la unidad de cuidados intensivos (72,9%), (p=0,22).Conclusión: En situación de pandemia, los pacientes con baja sospecha clínica y radiografía negativa pueden ser dados de alta con baja probabilidad de volver a consultar o de desarrollar formas graves de la enfermedad. En los pacientes con SARS-CoV-2 positivo, la radiografía de tórax inicial no tiene utilidad pronóstica.(AU)

Objective: To review the prognostic usefulness of chest X-rays in selecting patients with suspected SARS-CoV-2 infection. Material and methods: This cross-sectional descriptive observational study analyzed 978 patients with suspected SARS-CoV-2 infections who underwent chest X-ray examinations in the emergency department of a tertiary hospital in March 2020. We separately analyzed demographic, clinical, and prognostic variables in two groups of patients: those in whom reverse-transcriptase polymerase chain reaction (RT-PCR) was done (n=535) and those in whom RT-PCR was not done because of low clinical suspicion (n=443). Results: In the group of patients with RT-PCR, the prevalence of SARS-CoV-2 was 70.4%, and the sensitivity of chest X-rays was 62.8%. In the group of patients without RT-PCR, chest X-rays were negative in 97.5%, corroborating the low clinical suspicion; these patients were discharged, and 5.6% of them reconsulted with mild forms of the disease. In the group of patients with RT-PCR, we observed no statistically significant differences in the percentage of pathologic chest X-rays between patients hospitalized in the ICU (72.9%) and in those hospitalized in other wards (68.3%) (p=0.22). Conclusion: In the context of the pandemic, patients with low clinical suspicion and negative chest X-rays can be discharged with a low probability of reconsultation or of developing severe COVID19. In patients with RT-PCR positive for SARS-CoV-2, chest X-rays have no prognostic usefulness.(AU)

[Usefulness of chest X-rays for detecting COVID 19 pneumonia during the SARS-CoV-2 pandemic]. / Utilidad de la radiografía de tórax para la detección de neumonía COVID 19 durante la pandemia por SARS-CoV-2.

Objective: To review the prognostic usefulness of chest X-rays in selecting patients with suspected SARS-CoV-2 infection. Material and methods: This cross-sectional descriptive observational study analyzed 978 patients with suspected SARS-CoV-2 infections who underwent chest X-ray examinations in the emergency department of a tertiary hospital in March 2020. We separately analyzed demographic, clinical, and prognostic variables in two groups of patients: those in whom reverse-transcriptase polymerase chain reaction (RT-PCR) was done (n = 535) and those in whom RT-PCR was not done because of low clinical suspicion (n = 443). Results: In the group of patients with RT-PCR, the prevalence of SARS-CoV-2 was 70.4%, and the sensitivity of chest X-rays was 62.8%. In the group of patients without RT-PCR, chest X-rays were negative in 97.5%, corroborating the low clinical suspicion; these patients were discharged, and 5.6% of them reconsulted with mild forms of the disease. In the group of patients with RT-PCR, we observed no statistically significant differences in the percentage of pathologic chest X-rays between patients hospitalized in the ICU (72.9%) and in those hospitalized in other wards (68.3%) (p = 0.22). Conclusion: In the context of the pandemic, patients with low clinical suspicion and negative chest X-rays can be discharged with a low probability of reconsultation or of developing severe COVID19. In patients with RT-PCR positive for SARS-CoV-2, chest X-rays have no prognostic usefulness.

Presentación radiológica mediante TCMD de las metástasis pancreáticas del carcinoma de células renales / MDCT patterns of presentation of pancreatic metastases from renal cell carcinoma

Objetivo. Determinar la frecuencia y las formas de presentación radiológica de las metástasis pancreáticas en los pacientes con carcinoma de células renales estudiados mediante tomografía computarizada multidetector (TCMD) en nuestro hospital durante el año 2007. Material y métodos. Estudio retrospectivo de 133 pacientes con carcinoma de células renales a los que se les realizó estudios mediante TC multidetector en nuestro hospital entre enero y diciembre de 2007, de los cuales 49 presentaban enfermedad metastásica. Análisis de la frecuencia, localización y formas de presentación de la afectación pancreática. Resultados. En 6 pacientes se identificó afectación pancreática. Cuatro pacientes se presentaron con nódulos únicos y dos con nódulos múltiples, identificando así un total de 9 lesiones pancreáticas con unos tamaños que variaron entre los 8 y los 40mm. Todos los nódulos fueron hipercaptantes en fase arterial salvo uno en el contexto de múltiples nódulos, debido a fenómenos de necrosis. Dos casos asociaron dilatación del conducto pancreático. Únicamente se obtuvo comprobación histológica de una de las lesiones. Conclusiones. Las metástasis pancreáticas del carcinoma de células renales se han presentado en nuestro estudio con una frecuencia del 4,5%, ocupando el quinto lugar en frecuencia en los pacientes con enfermedad diseminada. Su forma de presentación sigue un patrón prácticamente constante, lo que ayuda a su diferenciación con el adenocarcinoma primario de páncreas. Por lo tanto, es necesario una fase arterial para su detección(AU)

Objective. To determine the frequency of pancreatic metastasis from renal cell carcinoma in patients studied with MDCT during 2007 and to describe the patterns of presentation on MDCT. Material and methods. We retrospectively studied 133 patients with renal cell carcinoma who underwent MDCT between January and December 2007. Forty-nine patients presented disseminated disease. We analyzed the frequency, location, and patterns of presentation of pancreatic metastases. Results. Pancreatic involvement was identified in six patients. Four patients had isolated pancreatic nodules and two presented multiple nodules. A total of nine pancreatic lesions ranging between 8mm and 40mm were detected. All nodules had increased uptake of contrast material in the arterial phase except for one in a patient with multiple nodules, due to necrosis. Two cases were associated with pancreatic duct dilation. Histology was obtained in only one patient. Conclusion. Pancreatic involvement of renal cell carcinoma was detected in 4.5% of patients, ranking fifth in frequency in patients with disseminated disease. The arterial phase is necessary to detect pancreatic involvement of renal cell carcinoma. The pattern of presentation is nearly constant, helping differentiate pancreatic metastasis from primary pancreatic adenocarcinoma(AU)

[MDCT patterns of presentation of pancreatic metastases from renal cell carcinoma]. / Presentación radiológica mediante TCMD de las metástasis pancreáticas del carcinoma de células renales.

OBJECTIVE: To determine the frequency of pancreatic metastasis from renal cell carcinoma in patients studied with MDCT during 2007 and to describe the patterns of presentation on MDCT. MATERIAL AND METHODS: We retrospectively studied 133 patients with renal cell carcinoma who underwent MDCT between January and December 2007. Forty-nine patients presented disseminated disease. We analyzed the frequency, location, and patterns of presentation of pancreatic metastases. RESULTS: Pancreatic involvement was identified in six patients. Four patients had isolated pancreatic nodules and two presented multiple nodules. A total of nine pancreatic lesions ranging between 8mm and 40 mm were detected. All nodules had increased uptake of contrast material in the arterial phase except for one in a patient with multiple nodules, due to necrosis. Two cases were associated with pancreatic duct dilation. Histology was obtained in only one patient. CONCLUSION: Pancreatic involvement of renal cell carcinoma was detected in 4.5% of patients, ranking fifth in frequency in patients with disseminated disease. The arterial phase is necessary to detect pancreatic involvement of renal cell carcinoma. The pattern of presentation is nearly constant, helping differentiate pancreatic metastasis from primary pancreatic adenocarcinoma.

Tumor fibroso solitario intrapulmonar asociado a hemoptisis: a propósito de un caso / Intrapulmonary solitary fibrous tumor associated with hemoptysis: a case report

El tumor fibroso solitario intrapulmonar es una neoplasia mesenquimal extremadamente rara sobre la que existen muy pocas referencias en la literatura. Presentamos el caso de una mujer joven con hemoptisis que en la radiografía simple de tórax presentó una masa pulmonar, efectuándose a continuación una TCMD con contraste que mostró una tumoración pulmonar sólida, bien definida y con realce heterogéneo. Se realizó resección quirúrgica de dicha lesión y el estudio histológico reveló un tumor fibroso solitario intrapulmonar con un área de degeneración mixoide. A propósito de este caso realizamos una descripción de los hallazgos clínicos, radiológicos e histológicos de esta rara entidad, así como una revisión de la bibliografía (AU)

Intrapulmonary solitary fibrous tumor is an extremely rare mesenchymal neoplasm about which very few references can be found in the literature. We present the case of a young woman with hemoptysis in whom plain-film chest radiographs showed a pulmonary mass. Contrast-enhanced MDCT showed a solid lung tumor with well-defined margins and heterogeneous enhancement. Histological study after surgical resection of the lesion revealed an intrapulmonary solitary fibrous tumor with an area of myxoid degeneration. We describe the clinical, radiological, and histological findings for this rare entity and review the relevant literature (AU)

[Intrapulmonary solitary fibrous tumor associated with hemoptysis: a case report]. / Tumor fibroso solitario intrapulmonar asociado a hemoptisis: a propósito de un caso.

Intrapulmonary solitary fibrous tumor is an extremely rare mesenchymal neoplasm about which very few references can be found in the literature. We present the case of a young woman with hemoptysis in whom plain-film chest radiographs showed a pulmonary mass. Contrast-enhanced MDCT showed a solid lung tumor with well-defined margins and heterogeneous enhancement. Histological study after surgical resection of the lesion revealed an intrapulmonary solitary fibrous tumor with an area of myxoid degeneration. We describe the clinical, radiological, and histological findings for this rare entity and review the relevant literature.

Patología vascular torácica en pacientes oncológicos / Thoracic vascular disease in oncologic patients

La patología oncológica requiere frecuentes controles mediante pruebas de imagen, de forma predominante con tomografía computarizada (TC). En estos pacientes podemos encontrar patología vascular torácica que puede influir en el diagnóstico, el tratamiento y el pronóstico de su enfermedad neoplásica. Los tumores primarios vasculares pueden afectar a los vasos torácicos, como las arterias pulmonares (sarcoma de arteria pulmonar), y la enfermedad neoplásica se puede extender localmente (neoplasia pulmonar) o a distancia hacia los vasos torácicos (embolia pulmonar tumoral y microangiopatía trombótica tumoral pulmonar). El tratamiento oncológico es la causa de múltiples complicaciones sobre los vasos torácicos que en determinados casos llegan a comprometer la vida del paciente. La TC, especialmente con técnica multicorte, permite la evaluación de la enfermedad neoplásica y la patología vascular torácica asociada en el paciente oncológico (AU)

Patients with oncologic disease require frequent imaging tests (predominantly computed tomography) for follow-up. These patients may have thoracic vascular disease that can influence the diagnosis, treatment, and prognosis of their cancer. Primary vascular tumors can involve the thoracic vessels, like the pulmonary arteries (pulmonary artery sarcoma), and the neoplastic disease can extend locally (lung tumor) or remotely to the thoracic vessels (pulmonary tumor embolism and pulmonary tumor thrombotic microangiopathy). Oncologic treatment results in multiple complications that involve the thoracic vessels and can even compromise the patient's life in certain cases. CT, and especially multislice CT, makes it possible to evaluate neoplastic disease and associated thoracic vascular disease in oncologic patients (AU)

[Thoracic vascular disease in oncologic patients]. / Patología vascular torácica en pacientes oncológicos.

Patients with oncologic disease require frequent imaging tests (predominantly computed tomography) for follow-up. These patients may have thoracic vascular disease that can influence the diagnosis, treatment, and prognosis of their cancer. Primary vascular tumors can involve the thoracic vessels, like the pulmonary arteries (pulmonary artery sarcoma), and the neoplastic disease can extend locally (lung tumor) or remotely to the thoracic vessels (pulmonary tumor embolism and pulmonary tumor thrombotic microangiopathy). Oncologic treatment results in multiple complications that involve the thoracic vessels and can even compromise the patient's life in certain cases. CT, and especially multislice CT, makes it possible to evaluate neoplastic disease and associated thoracic vascular disease in oncologic patients.