Emphysematous Pancreatitis as a Life-Threatening Condition: A Case Report and Review of the Literature.

Emphysematous pancreatitis represents the presence of gas within or around the pancreas on the ground of necrotizing pancreatitis due to superinfection with gas-forming bacteria. This entity is diagnosed on clinical grounds and on the basis of radiologic findings. Computed tomography is the preferred imaging modality used to detect this life-threating condition. The management of emphysematous pancreatitis consists of conservative measures, image-guided percutaneous catheter drainage or endoscopic therapy, and surgical intervention, which is delayed as long as possible and undertaken only in patients who continue to deteriorate despite conservative management. Due to its high mortality rate, early and prompt recognition and treatment of emphysematous pancreatitis are crucial and require individualized treatment with the involvement of a multidisciplinary team. Here, we present a case of emphysematous pancreatitis as an unusual occurrence and discuss disease features and treatment options in order to facilitate diagnostics and therapy.

Emphysematous pyelonephritis with progression to necrotising fasciitis of the posterior cervical region and the retropharyngeal space.

A man in his 50s with diabetes presented with backache, left flank pain and fever. On evaluation, he was found to have emphysematous pyelonephritis of the left kidney with a paranephric abscess extending into the posterior abdominal wall and superiorly up to the posterior chest wall and inferiorly extending up to the posterior superior iliac spine. The management involved the initiation of broad-spectrum antibiotics and percutaneous drainage of the abscess. However, as he continued to worsen symptoms-wise, he underwent computed-enhanced CT of the abdomen and thorax. The imaging revealed the presence of a purulent collection in the left lumbar region with an extension along the posterior cervical region and the retropharyngeal space. He underwent a fasciotomy of the lumbar region. The occurrence of emphysematous pyelonephritis along with necrotising fasciitis is uncommon and requires early aggressive management with broad-spectrum antibiotics and adequate drainage. This emphasises the need for early reimaging if the patient does not settle with antibiotics or percutaneous drainage.

Multifocal emphysematous osteomyelitis, a do not miss diagnosis for the emergency radiologist: a case report with literature review.

Emphysematous osteomyelitis (EO) is an uncommon fatal condition with high morbidity and mortality. Simultaneous involvement of the axial and appendicular skeleton with multifocal disease is even rarer, with only a few cases being reported in the literature. We present a case of multifocal emphysematous osteomyelitis in a 56-year-old woman with concurrent emphysematous pyelonephritis complicated by psoas and epidural abscesses. The causative organism in our patient was Escherichia coli. Emergency radiologists should be aware of this condition and differentiate it from other benign entities that can present with intraosseous gas. Prompt diagnosis is important given the high morbidity and mortality with this condition. This case report emphasizes the specific pattern of intraosseous gas seen with EO, which can help diagnose EO with confidence.

Machine learning slice-wise whole-lung CT emphysema score correlates with airway obstruction.

OBJECTIVES: Quantitative CT imaging is an important emphysema biomarker, especially in smoking cohorts, but does not always correlate to radiologists' visual CT assessments. The objectives were to develop and validate a neural network-based slice-wise whole-lung emphysema score (SWES) for chest CT, to validate SWES on unseen CT data, and to compare SWES with a conventional quantitative CT method. MATERIALS AND METHODS: Separate cohorts were used for algorithm development and validation. For validation, thin-slice CT stacks from 474 participants in the prospective cross-sectional Swedish CArdioPulmonary bioImage Study (SCAPIS) were included, 395 randomly selected and 79 from an emphysema cohort. Spirometry (FEV1/FVC) and radiologists' visual emphysema scores (sum-visual) obtained at inclusion in SCAPIS were used as reference tests. SWES was compared with a commercially available quantitative emphysema scoring method (LAV950) using Pearson's correlation coefficients and receiver operating characteristics (ROC) analysis. RESULTS: SWES correlated more strongly with the visual scores than LAV950 (r = 0.78 vs. r = 0.41, p < 0.001). The area under the ROC curve for the prediction of airway obstruction was larger for SWES than for LAV950 (0.76 vs. 0.61, p = 0.007). SWES correlated more strongly with FEV1/FVC than either LAV950 or sum-visual in the full cohort (r = - 0.69 vs. r = - 0.49/r = - 0.64, p < 0.001/p = 0.007), in the emphysema cohort (r = - 0.77 vs. r = - 0.69/r = - 0.65, p = 0.03/p = 0.002), and in the random sample (r = - 0.39 vs. r = - 0.26/r = - 0.25, p = 0.001/p = 0.007). CONCLUSION: The slice-wise whole-lung emphysema score (SWES) correlates better than LAV950 with radiologists' visual emphysema scores and correlates better with airway obstruction than do LAV950 and radiologists' visual scores. CLINICAL RELEVANCE STATEMENT: The slice-wise whole-lung emphysema score provides quantitative emphysema information for CT imaging that avoids the disadvantages of threshold-based scores and is correlated more strongly with reference tests than LAV950 and reader visual scores. KEY POINTS: • A slice-wise whole-lung emphysema score (SWES) was developed to quantify emphysema in chest CT images. • SWES identified visual emphysema and spirometric airflow limitation significantly better than threshold-based score (LAV950). • SWES improved emphysema quantification in CT images, which is especially useful in large-scale research.

Deep Learning-Based Kernel Adaptation Enhances Quantification of Emphysema on Low-Dose Chest CT for Predicting Long-Term Mortality.

OBJECTIVES: The aim of this study was to ascertain the predictive value of quantifying emphysema using low-dose computed tomography (LDCT) post deep learning-based kernel adaptation on long-term mortality. MATERIALS AND METHODS: This retrospective study investigated LDCTs obtained from asymptomatic individuals aged 60 years or older during health checkups between February 2009 and December 2016. These LDCTs were reconstructed using a 1- or 1.25-mm slice thickness alongside high-frequency kernels. A deep learning algorithm, capable of generating CT images that resemble standard-dose and low-frequency kernel images, was applied to these LDCTs. To quantify emphysema, the lung volume percentage with an attenuation value less than or equal to -950 Hounsfield units (LAA-950) was gauged before and after kernel adaptation. Low-dose chest CTs with LAA-950 exceeding 6% were deemed emphysema-positive according to the Fleischner Society statement. Survival data were sourced from the National Registry Database at the close of 2021. The risk of nonaccidental death, excluding causes such as injury or poisoning, was explored according to the emphysema quantification results using multivariate Cox proportional hazards models. RESULTS: The study comprised 5178 participants (mean age ± SD, 66 ± 3 years; 3110 males). The median LAA-950 (18.2% vs 2.6%) and the proportion of LDCTs with LAA-950 exceeding 6% (96.3% vs 39.3%) saw a significant decline after kernel adaptation. There was no association between emphysema quantification before kernel adaptation and the risk of nonaccidental death. Nevertheless, after kernel adaptation, higher LAA-950 (hazards ratio for 1% increase, 1.01; P = 0.045) and LAA-950 exceeding 6% (hazards ratio, 1.36; P = 0.008) emerged as independent predictors of nonaccidental death, upon adjusting for age, sex, and smoking status. CONCLUSIONS: The application of deep learning for kernel adaptation proves instrumental in quantifying pulmonary emphysema on LDCTs, establishing itself as a potential predictive tool for long-term nonaccidental mortality in asymptomatic individuals.

Sex-specific emphysematous changes evaluated by a three-dimensional computed tomography volumetric analysis among patients with smoking histories who underwent resection for lung cancer.

PURPOSE: The present study evaluated the sex-specific susceptibility to the development of emphysema in patients with smoking histories who underwent lung cancer surgeries. METHODS: Lung cancer patients with smoking histories who underwent lung resection at the University of Tsukuba Hospital, Japan, were enrolled. Radiologic emphysematous changes were analyzed using three-dimensional computed tomography (3D-CT). The volume proportion of emphysematous lung per unit of smoking and the relationship between emphysematous change and clinicopathologic factors were evaluated. RESULTS: Radiologic emphysematous changes analyzed using 3D-CT per pack-year smoked, defined as the Smoking-Emphysema Index (SEI), were greater in females than males. The difference was more profound in adenocarcinoma patients than in non-adenocarcinoma patients (0.70 ± 2.30 vs. 0.21 ± 0.28, P = 0.037). CONCLUSION: Female lung cancer patients are more susceptible to smoking-induced emphysema than males. The SEI may be an effective indicator for evaluating smoking-induced emphysema.

Application of 3D computed tomography in emphysematous parenchyma patients scheduled for bronchoscopic lung volume reduction.

Bronchoscopic lung volume reduction (BLVR) is a feasible, safe, effective and minimally invasive technique to significantly improve the quality of life of advanced severe chronic obstructive pulmonary disease (COPD). In this study, three-dimensional computed tomography (3D-CT) automatic analysis software combined with pulmonary function test (PFT) was used to retrospectively evaluate the postoperative efficacy of BLVR patients. The purpose is to evaluate the improvement of lung function of local lung tissue after operation, maximize the benefits of patients, and facilitate BLVR in the treatment of patients with advanced COPD. All the reported cases of advanced COPD patients treated with BLVR with one-way valve were collected and analysed from 2017 to 2020. Three-dimensional-CT image analysis software system was used to analyse the distribution of low-density areas <950 Hounsfield units in both lungs pre- and post- BLVR. Meanwhile, all patients performed standard PFT pre- and post-operation for retrospective analysis. We reported six patients that underwent unilateral BLVR with 1 to 3 valves according to the range of emphysema. All patients showed a median increase in forced expiratory volume in 1 second (FEV1) of 34%, compared with baseline values. Hyperinflation was reduced by 16.6% (range, 4.9%-47.2%). The volumetric measurements showed a significant reduction in the treated lobe volume among these patients. Meanwhile, the targeted lobe volume changes were inversely correlated with change in FEV1/FEV1% in patients with heterogeneous emphysematous. We confirm that 3D-CT analysis can quantify the changes of lung volume, ventilation and perfusion, to accurately evaluate the distribution and improvement of emphysema and rely less on the observer.

Emphysematous osteomyelitis: a rare and aggressive disease.

Emphysematous osteomyelitis is an extremely rare entity consisting of the presence of intraosseous gas that can extend to the joints and adjacent soft tissues. It is an aggressive infectious process associated with high mortality, especially in patients with risk factors such as tumors or diabetes mellitus. Because early diagnosis and immediate treatment are crucial to prevent the potentially devastating consequences of this condition, imaging tests such as computed tomography play a fundamental role in its diagnosis and management. Therefore, radiologists must be aware that intraosseous gas is a rare but alarming sign that is pathognomonic of emphysematous osteomyelitis, especially in the axial skeleton.

Emphysematous Cystitis: A Rare Urologic Emergency.

BACKGROUND Emphysematous cystitis is a rare urologic condition typically characterized by abdominal pain, hematuria, and dysuria. In some cases, complications such as bladder rupture, necrosis, and septic shock have been reported. Emphysematous cystitis has been associated with several predisposing medical conditions, such as diabetes mellitus, recurrent urinary tract infections, and immunosuppression, but can also infrequently present in an undifferentiated fashion without these aforementioned risk factors, such as in our patient's case. CASE REPORT We describe a rare case of emphysematous cystitis in a 67-year-old woman presenting to the Emergency Department with hematuria. The patient's presenting symptoms also included severe lower abdominal pain and dysuria. Examination revealed suprapubic tenderness and gross hematuria. Imaging revealed gas within the bladder lumen and throughout the bladder wall. Radiography showed concerns for emphysematous cystitis, without evidence of bladder fistula formation with adjacent bowel loops or cysto-vaginal fistula. After consultation with the Urology Department, the patient was admitted for serial examinations, intravenous antibiotics, and continued monitoring. The patient was discharged in good condition after a 3-day hospitalization. CONCLUSIONS Clinicians evaluating patients for acute urologic symptoms should be alert to the possible diagnosis of emphysematous cystitis, given the potential for deterioration and concomitant complications. Although our patient's presentation included no traditional risk factors for emphysematous cholecystitis, she required hospitalization to ensure progressive improvement. Therefore, prompt management along with appropriate consultation with specialists are crucial to mitigate the risk of adverse outcomes in this rare urologic emergency.

Quantifying the spatial clustering characteristics of radiographic emphysema explains variability in pulmonary function.

Quantitative assessment of emphysema in CT scans has mostly focused on calculating the percentage of lung tissue that is deemed abnormal based on a density thresholding strategy. However, this overall measure of disease burden discards virtually all the spatial information encoded in the scan that is implicitly utilized in a visual assessment. This simplification is likely grouping heterogenous disease patterns and is potentially obscuring clinical phenotypes and variable disease outcomes. To overcome this, several methods that attempt to quantify heterogeneity in emphysema distribution have been proposed. Here, we compare three of those: one based on estimating a power law for the size distribution of contiguous emphysema clusters, a second that looks at the number of emphysema-to-emphysema voxel adjacencies, and a third that applies a parametric spatial point process model to the emphysema voxel locations. This was done using data from 587 individuals from Phase 1 of COPDGene that had an inspiratory CT scan and plasma protein abundance measurements. The associations between these imaging metrics and visual assessment with clinical measures (FEV[Formula: see text], FEV[Formula: see text]-FVC ratio, etc.) and plasma protein biomarker levels were evaluated using a variety of regression models. Our results showed that a selection of spatial measures had the ability to discern heterogeneous patterns among CTs that had similar emphysema burdens. The most informative quantitative measure, average cluster size from the point process model, showed much stronger associations with nearly every clinical outcome examined than existing CT-derived emphysema metrics and visual assessment. Moreover, approximately 75% more plasma biomarkers were found to be associated with an emphysema heterogeneity phenotype when accounting for spatial clustering measures than when they were excluded.

Recurrent idiopathic pancreatitis complicating as emphysematous pancreatitis and gastroduodenal artery pseudoaneurysm: A rare case report.

Emphysematous pancreatitis (EP) is a rare and potentially fatal condition of the pancreas. It is associated with gas-forming bacteria and is characterized by the presence of gas in or around the pancreas. It is identified by a computed tomography scan of the abdomen. Although predisposing factors are not precisely known, diabetes mellitus, which predisposes to gas gangrene, is seen to be commonly associated with patients of EP. EP being potentially fatal requires immediate management. Surgery is generally indicated in EP. However, EP can also managed conservatively. In our case, the patient developed recurrent pancreatitis, the cause being idiopathic, and the second episode of acute pancreatitis was complicated by EP and gastroduodenal artery pseudoaneurysm.

Résumé La pancréatite emphysémateuse (EP) est une condition rare et potentiellement mortelle du pancréas. Il est associé à des bactéries de formation de gaz et se caractérise par la présence de gaz dans ou autour du pancréas. Il est identifié par une tomodensitométrie calculée de l'abdomen. Bien que les facteurs prédisposants ne soient pas précisément connus, le diabète sucré, qui prédispose à la gangrène du gaz, est considéré comme communément associé aux patients du PE. EP étant potentiellement mortel nécessite une gestion immédiate. La chirurgie est généralement indiquée dans EP. Cependant, EP peut également gérer de manière conservatrice. Dans notre cas, le patient a développé une pancréatite récurrente, la cause étant idiopathique, et le deuxième épisode de pancréatite aiguë a été compliqué par l'EP et le pseudo-anévrisme de l'artère gastroduodénale. Mots-clés: Pancréatite emphysémateuse, pseudo-anévrisme gastroduodénal, pancréatite.