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1.
Gan To Kagaku Ryoho ; 47(10): 1493-1495, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130748

RESUMO

A 76-year-old female was followed up for rheumatoid arthritis-associated interstitial lung disease(RA-ILD). Consolidation and ground-glass opacities were observed in the right lung. When the corticosteroid was restarted due to a relapse of RA-ILD, most of the shadows disappeared. However, ground-glass nodules remained in the apex of the right lung. Thoracoscopic segmentectomy was performed, and lung cancer was diagnosed. Patients with rheumatoid arthritis suffer from complications such as RA-ILD, drug-induced pneumonia, pulmonary infections, and malignancies. A careful assessment of treatment response should be made in case of a differential diagnosis.


Assuntos
Artrite Reumatoide , Doenças Pulmonares Intersticiais , Neoplasias Pulmonares , Corticosteroides/uso terapêutico , Idoso , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Feminino , Humanos , Doenças Pulmonares Intersticiais/induzido quimicamente , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Recidiva Local de Neoplasia
2.
Sarcoidosis Vasc Diffuse Lung Dis ; 37(2): 136-147, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33093777

RESUMO

Background: Interstitial lung disease (ILD) is a common complication of primary Sjögren's syndrome (pSS). Because there is a paucity of literature on the management of pSS-associated ILD (pSS-ILD), this retrospective cohort study assessed the efficacy of azathioprine and mycophenolate therapy in adult patients with pSS-ILD. Methods: A retrospective cohort study was performed using electronic health records to identify adults meeting the 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for pSS. The presence of pSS-ILD was confirmed by characteristic high-resolution computed tomography and/or histopathology findings. Sociodemographic, clinical, and pulmonary function test (PFT) data were abstracted for patients meeting the criteria and followed longitudinally from the date of their ILD diagnosis. PFT values were anchored on time of treatment start, and linear mixed-effects modeling was used to analyze changes in diffusion capacity for carbon monoxide (DLCO) and forced vital capacity (FVC) before and after treatment initiation. Results: We identified 19 subjects who had pSS-ILD, of whom seven were treated with azathioprine and seven were treated with mycophenolate. Within the azathioprine treated group, FVC% slope change trended toward improvement from a rate of -9.8% per month pre-treatment to 2.1% per month post-treatment (p = 0.13). Within the mycophenolate treated group, FVC% slope change improved from a rate of 1.5% per month pre-treatment to 4.3% per month post-treatment (p = 0.02) and DLCO% slope changed from a rate of -3.8% to -1.3% per month (p = 0.01) after therapy start. Conclusions: Mycophenolate treatment was associated with significant improvement in PFTs of pSS-ILD patients over time, and azathioprine treatment followed a similar non-significanttrend. Additional prospective studies are needed to further evaluate these findings. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 136-147).


Assuntos
Azatioprina/uso terapêutico , Imunossupressores/uso terapêutico , Doenças Pulmonares Intersticiais/tratamento farmacológico , Pulmão/efeitos dos fármacos , Ácido Micofenólico/uso terapêutico , Síndrome de Sjogren/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Azatioprina/efeitos adversos , Registros Eletrônicos de Saúde , Feminino , Humanos , Imunossupressores/efeitos adversos , Pulmão/diagnóstico por imagem , Pulmão/imunologia , Pulmão/fisiopatologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/imunologia , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/efeitos adversos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/imunologia , Fatores de Tempo , Resultado do Tratamento
3.
Emergencias ; 32(5): 340-344, 2020 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33006834

RESUMO

OBJECTIVES: To assess the diagnostic yield of point-of-care ultrasound imaging in patients suspected of having noncritical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but no apparent changes on a chest radiograph. MATERIAL AND METHODS: Cross-sectional analysis of a case series including patients coming to an emergency department in March and April 2020 with mild-moderate respiratory symptoms suspected to be caused by SARS-CoV-2. A point-of-care ultrasound examination of the lungs was performed on all participants as part of routine clinical care. Ultrasound findings were compared according to the results of SARS-CoV-2 test results. RESULTS: Fifty-eight patients with a median (interquartile range) age of 44.5 (34-67) years were enrolled; 42 (72.4%) were women. Twenty-seven (46.5%) had confirmed SARS-CoV-2 infection. Ultrasound findings were consistent with interstitial pneumonia due to coronavirus disease 2019 (COVID-19) in 33 (56.9%). Most were in cases with testconfirmed COVID-19 (100% vs 22.2% of cases with no confirmation; P < .001). The most common ultrasound findings in confirmed COVID-19 cases were focal and confluent B-lines in the basal and posterior regions of the lung (R1, 85.2%; R2, 77.8%; L1, 88.9%; and L2, 88.9%) and associated pleural involvement (70.4%, 70.4%, 81.5%, and 85.2%, respectively). The sensitivity of point-of-care ultrasound in the diagnosis of COVID-19 was 92.6% (95% CI, 75.7%-99.1%). Specificity was 85.2% (95% CI, 66.3%-95.8%); positive predictive value, 75.8% (95% CI, 59.6%- 91.9%); negative predictive value, 92% (95% CI, 74.0%-99.0%); and positive and negative likelihood ratios, 6.2 (95% CI, 6.0-6.5) and 0.1 (95% CI, 0.1-0.1), respectively. CONCLUSION: Point-of-care lung ultrasound could be useful for the diagnosis of noncritical SARS-CoV-2 infection when chest radiographs are inconclusive.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Adulto , Idoso , Infecções por Coronavirus/diagnóstico , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Design de Software , Ultrassonografia
4.
Zhonghua Zhong Liu Za Zhi ; 42(8): 665-669, 2020 Aug 23.
Artigo em Chinês | MEDLINE | ID: mdl-32867459

RESUMO

Objective: To investigate the CT features and dynamic changes of new developed lung cancer in patients with connective tissue disease-related interstitial lung disease (CTD-ILD). Methods: A series of chest CT images of 58 CTD-ILD patients during follow-up were collected. The CT features of interstitial lung disease, the initial appearance time of lung cancer, the time of diagnosis of lung cancer, the morphological characteristics (location, shape, size) of lung cancer lesions and the dynamic changes of CT features were analyzed. Results: Among 58 patients, rheumatoid arthritis was the most common (31 cases). Chest CT images showed coexistence of two or more interstitial CT signs. During the follow-up, a total of 59 lung cancer lesions were found. The median time of lung cancer lesion occurred was 289 days. The median delay in diagnosis was 43 days. There were 44 cases of non-small cell lung cancer (including 23 cases of squamous cell carcinoma and 19 cases of adenocarcinoma), 12 cases of small cell lung cancer. Forty-three (72.9%) lesions were located in the lower lobes and 41 (69.5%) lesions were located in the area of pulmonary interstitial fibrosis. According to CT morphological characteristics of lung cancer, nodular type (37 cases), inflammatory consolidation (12 cases) and intra-honeycomb type (10 cases) were identified. Conclusions: The chest CT features of patients with CTD-ILD are complex. New developed lung cancer is easily missed or misdiagnosed in the early stage. Pay attention to the special CT characteristics of CTD-ILD with lung cancer is helpful for early diagnosis.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Doenças do Tecido Conjuntivo/complicações , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Neoplasias Pulmonares/complicações , Tomografia Computadorizada por Raios X/métodos , Doenças do Tecido Conjuntivo/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/diagnóstico por imagem
5.
Am J Case Rep ; 21: e926781, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32952147

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, SARS-CoV-2, and is associated with severe respiratory disease. There are extensive publications on the chest computed tomography (CT) findings of COVID-19 pneumonia, with ground-glass opacities (GGO) and mixed GGO and consolidation being the most common findings. Those with interstitial thickening manifesting as reticular opacities typically show superimposed ground-glass opacities, giving a crazy-paving pattern. CASE REPORT We report the case of a 77-year-old man with a background of asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) who presented with progressive cough and shortness of breath for 2 days. He was in close contact with a confirmed COVID-19 case. Reverse-transcription polymerase chain reaction analysis of a nasopharyngeal swab was positive for SARS-CoV-2. The initial chest radiograph was negative for lung consolidation and ground-glass opacities. During admission, he had worsening shortness of breath with desaturation, prompting a chest CT examination, which was performed on day 14 of illness. The chest CT revealed an atypical finding of predominant focal subpleural interstitial thickening in the right lower lobe. He was provided supportive treatment along with steroid and antibiotics. He recovered well and subsequently tested negative for 2 consecutive swabs. He was discharged after 34 days. CONCLUSIONS Interstitial thickening or reticular pattern on CT has been described in COVID-19 pneumonia, but largely in association with ground-glass opacity or consolidation. This case demonstrates an atypical predominance of interstitial thickening on chest CT in COVID-19 pneumonia on day 14 of illness, which is the expected time of greatest severity of the disease.


Assuntos
Infecções por Coronavirus/diagnóstico , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Pneumonia Viral/diagnóstico , Intensificação de Imagem Radiográfica , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Corticosteroides/administração & dosagem , Idoso , Antibacterianos/administração & dosagem , Técnicas de Laboratório Clínico , Meios de Contraste , Infecções por Coronavirus/complicações , Tosse/diagnóstico , Tosse/etiologia , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Seguimentos , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/terapia , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Medição de Risco , Síndrome Respiratória Aguda Grave/virologia , Resultado do Tratamento
6.
Clin Rheumatol ; 39(11): 3171-3175, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32844364

RESUMO

We treated two patients with severe respiratory failure due to coronavirus disease 2019 (COVID-19). Case 1 was a 73-year-old woman, and Case 2 was a 65-year-old-man. Neither of them had a history of autoimmune disease. Chest computed tomography scans before the antiviral therapy showed bilateral multiple patchy ground-glass opacities (GGO) consistent with COVID-19 pneumonia. The GGO regressed over the course of the antiviral treatment; however, new non-segmental patchy consolidations emerged, which resembled those of interstitial lung disease (ILD), specifically collagen vascular disease-associated ILD. We tested the patients' sera for autoantibodies and discovered that both patients had high anti-SSA/Ro antibody titers. In Case 1, the patient recovered with antiviral therapy alone. However, in Case 2, the patient did not improve with antiviral therapy alone but responded well to corticosteroid therapy (methylprednisolone) and made a full recovery. The relationship between some immunological responses and COVID-19 pneumonia exacerbation has been discussed previously; our discovery of the elevation of anti-SSA/Ro antibodies suggests a contribution from autoimmunity functions of the immune system. Although it is unclear whether the elevation of anti-SSA/Ro antibodies was a cause or an outcome of aggravated COVID-19 pneumonia, we hypothesize that both patients developed aggravated the COVID-19 pneumonia due to an autoimmune response. In COVID-19 lung injury, there may be a presence of autoimmunity factors in addition to the known effects of cytokine storms. In patients with COVID-19, a high level of anti-SSA/Ro52 antibodies may be a surrogate marker of pneumonia severity and poor prognosis.


Assuntos
Anticorpos Antinucleares/imunologia , Infecções por Coronavirus/imunologia , Doenças Pulmonares Intersticiais/imunologia , Pneumonia Viral/imunologia , Insuficiência Respiratória/imunologia , Idoso , Amidas/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Guanidinas/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/etiologia , Masculino , Metilprednisolona/uso terapêutico , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/tratamento farmacológico , Pregnenodionas/uso terapêutico , Pirazinas/uso terapêutico , Recuperação de Função Fisiológica , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/imunologia , Insuficiência Respiratória/etiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
7.
Medicine (Baltimore) ; 99(30): e21473, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791765

RESUMO

RATIONALE: Lymphoid interstitial pneumonia is a rare benign pulmonary lymphoproliferative disorder usually presenting with a sub-acute or chronic condition and frequently associated with autoimmune disorders, dysgammaglobulinemia, or infections. PATIENT CONCERNS: A 74-year-old woman with no past medical history presented with acute dyspnea, nonproductive cough, hypoxemia (room air PaO2: 48 mmHg) and bilateral alveolar infiltrates with pleural effusion. Antibiotics and diuretics treatments did not induce any improvement. No underlying condition including cardiac insufficiency, autoimmune diseases, immunodeficiency, or infections was found after an extensive evaluation. Bronchoalveolar lavage revealed a lymphocytosis (60%) with negative microbiological findings. High-dose intravenous corticosteroids induced a mild clinical improvement only, which led to perform a surgical lung biopsy revealing a lymphoid interstitial pneumonia with no sign of lymphoma or malignancies. DIAGNOSES: Acute severe idiopathic lymphoid interstitial pneumonia. INTERVENTIONS: Ten days after the surgical lung biopsy, the patient experienced a dramatic worsening leading to invasive mechanical ventilation. Antibiotics and a new course of high-dose intravenous corticosteroids did not induce any improvement, leading to the use of rituximab which was associated with a dramatic clinical and radiological improvement allowing weaning from mechanical ventilation after 10 days. OUTCOMES: Despite the initial response to rituximab, the patient exhibited poor general state and subsequent progressive worsening of respiratory symptoms leading to consider symptomatic palliative treatments. The patient died 4 months after the diagnosis of lymphoid interstitial pneumonia. LESSONS: Idiopathic lymphoid interstitial pneumonia may present as an acute severe respiratory insufficiency with a potential transient response to rituximab.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Doenças Pulmonares Intersticiais/tratamento farmacológico , Pulmão/patologia , Rituximab/uso terapêutico , Idoso , Evolução Fatal , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/patologia , Tomografia Computadorizada por Raios X
8.
J Comput Assist Tomogr ; 44(5): 667-672, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842066

RESUMO

OBJECTIVE: The aim of the study was to compare the prevalence of diffuse pulmonary ossification (DPO) in idiopathic pulmonary fibrosis (IPF), systemic sclerosis (SSc)-related interstitial lung disease (ILD), and chronic hypersensitivity pneumonitis (HP). METHODS: High-resolution computed tomography (HRCT) from 71 IPF, 67 SSc-ILD, and 75 HP cases were independently evaluated by 2 thoracic radiologists blinded to patient data. Studies were assessed for the presence of DPO, HRCT scanning pattern, stigmata of granulomatous infection, and honeycombing. RESULTS: The prevalence of DPO was significantly higher in cases of IPF and SSc compared with HP, although there was no significant difference in prevalence between the IPF and SSc groups, even when accounting for the presence of prior granulomatous infection. Interobserver agreement for the presence of DPO was substantial. CONCLUSIONS: Although prevalence DPO on HRCT varies between some forms of ILD, the use of DPO to influence characterization of ILD should be considered with caution.


Assuntos
Fibrose Pulmonar Idiopática/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Ossificação Heterotópica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Fibrose Pulmonar Idiopática/patologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/patologia , Escleroderma Sistêmico/complicações , Adulto Jovem
9.
J Comput Assist Tomogr ; 44(5): 656-666, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842067

RESUMO

The aim of this work is to review interstitial lung fibrosis Imaging Reporting and Data System (ILF-RADS) that was designed for reporting of interstitial lung fibrosis (ILF). Findings include pulmonary and extrapulmonary findings and is subsequently designed into 4 categories. Pulmonary findings included lung volume, reticulations, traction bronchiectasis, honeycomb, nodules, cysts, ground glass, consolidation, mosaic attenuation and emphysema, and distribution of pulmonary lesions; axial (central, peripheral and diffuse), and zonal distribution (upper, middle, and lower zones). Complications in the form of acute infection, acute exacerbation, and malignancy were also assessed. Extrapulmonary findings included mediastinal, pleural, tracheal, and bone or soft tissue lesions. The lexicon of usual interstitial pneumonia (UIP) was classified into 4 categories designated as belonging in 1 of 4 categories. Lexicon of ILF-RADS-1 (typical UIP), ILF-RADS-2 (possible UIP), ILF-RADS-3 (indeterminate for UIP), and ILF-RADS-4 (inconsistent with UIP).


Assuntos
Doenças Pulmonares Intersticiais , Sistemas de Informação em Radiologia , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/patologia , Masculino , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/patologia , Radiologistas
10.
J Vis Exp ; (160)2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32744514

RESUMO

Early diagnosis of systemic sclerosis-related interstitial lung disease (SSc-ILD) is important to enable treatment to be administered with minimal delay. However, diagnosing SSc-ILD is challenging because key symptoms are non-specific. High-resolution computed tomography (HRCT) of the chest is recognized as a sensitive imaging method for diagnosing and assessing SSc-ILD. Exposure of patients to ionizing radiation may be considered as a limitation, although methodological steps may be taken to moderate this. We present practical recommendations for performing HRCT scans and interpreting the results. Key features of SSc-ILD on HRCT include a non-specific interstitial pneumonia (NSIP) pattern with peripheral ground-glass opacities and extensive traction bronchiectasis. Despite similarities between SSc-ILD and idiopathic pulmonary fibrosis (IPF), HRCT can be used to differentiate between these conditions: in SSc-ILD compared with IPF, there is a greater proportion of ground-glass opacity and fibrosis is less coarse. A dilated, air-filled esophagus with diameter >10 mm, suggestive of esophageal dysmotility is commonly seen in SSc-ILD. Pulmonary artery size greater than the adjacent ascending aorta suggests coexistent pulmonary hypertension. Nodules must be monitored due to the increased risk of lung cancer. A large extent of disease on HRCT (≥20%) or a high fibrosis score suggests an increased risk of mortality. HRCT is central to diagnosing SSc-ILD, and serial assessments can be helpful in monitoring disease progression or treatment response.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Escleroderma Sistêmico/diagnóstico por imagem , Fibrose , Humanos , Pulmão/patologia , Doenças Pulmonares Intersticiais/etiologia , Escleroderma Sistêmico/complicações , Tomografia Computadorizada por Raios X
11.
Med Sci Monit ; 26: e924582, 2020 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-32653890

RESUMO

In December 2019, an outbreak of coronavirus infection emerged in Wuhan, Hubei Province of China, which is now named Coronavirus Disease 2019 (COVID-19). The outbreak spread rapidly within mainland China and globally. This paper reviews the different imaging modalities used in the diagnosis and treatment process of COVID-19, such as chest radiography, computerized tomography (CT) scan, ultrasound examination, and positron emission tomography (PET/CT) scan. A chest radiograph is not recommended as a first-line imaging modality for COVID-19 infection due to its lack of sensitivity, especially in the early stages of infection. Chest CT imaging is reported to be a more reliable, rapid, and practical method for diagnosis of COVID-19, and it can assess the severity of the disease and follow up the disease time course. Ultrasound, on the other hand, is portable and involves no radiation, and thus can be used in critically ill patients to assess cardiorespiratory function, guide mechanical ventilation, and identify the presence of deep venous thrombosis and secondary pulmonary thromboembolism. Supplementary information can be provided by PET/CT. In the absence of vaccines and treatments for COVID-19, prompt diagnosis and appropriate treatment are essential. Therefore, it is important to exploit the advantages of different imaging modalities in the fight against COVID-19.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico por imagem , Pandemias , Pneumonia Viral/diagnóstico por imagem , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Diagnóstico Diferencial , Progressão da Doença , Seguimentos , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Pneumonia/diagnóstico por imagem , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Radiografia Torácica , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/etiologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Ultrassonografia
12.
Medicine (Baltimore) ; 99(28): e20930, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664089

RESUMO

Surgical lung biopsy is regarded as the golden standard for the diagnosis of idiopathic interstitial pneumonias (IIPs). Here, we attempted to show the diagnostic accuracy of multidisciplinary classifications based on transbronchial pathology including transbronchial lung cryobiopsy (TBLC) , bronchoalveolar lavage fluid (BALF) and endobronchial ultrasound-guided transbronchial needle aspiration biopsy (EBUS-TBNA).Patients with suspected interstitial lung diseases admitted from June 1, 2016 to December 31, 2018 were involved. Patients with known causes of interstitial lung diseases and typical idiopathic pulmonary fibrosis diagnosed through clinical, radiological information were excluded. Patients with atypical idiopathic pulmonary fibrosis and possible IIPs accepted transbronchial pathological evaluation. Initial multidisciplinary diagnosis (MDD) classifications were made depending on clinical, radiological and transbronchial pathological information by a multidisciplinary team (MDT). The final MDD classifications were confirmed by subsequent therapeutic effects. All patients were followed up for at least 6 months.A total of 70 patients were finally involved. The samples of lung parenchyma extracted through TBLC were enough for confirmation of pathological diagnoses in 68.6% (48/70) cases. Samples of 6 cases were extracted by EBUS-TBNA. Bacteriological diagnoses were positive in 1 case by BALF. Pathological diagnoses of 77.1% (54/70) cases were achieved through TBLC, EBUS-TBNA and BALF. During the follow up study, the pulmonary lesions of 60% patients were improved, 11.43% were relapsed when glucocorticoid was reduced to small dose or withdrawal, 14.29% were leveled off and 8.57% were progressed. The diagnoses of 4 patients with progressed clinical feature were revised. As a result, 94.3% initial MDD classifications based on transbronchial pathology were consistent with the final MDD, and the difference of diagnostic yield wasn't significant between initial and final MDD (Z = -1.414, P = .157).Classifications of IIPs based on transbronchial pathology were useful and quite agreed with final MDD.


Assuntos
Broncoscopia/métodos , Pneumonias Intersticiais Idiopáticas/classificação , Pneumonias Intersticiais Idiopáticas/patologia , Biópsia Guiada por Imagem/métodos , Idoso , Biópsia/tendências , Líquido da Lavagem Broncoalveolar/microbiologia , Broncoscopia/efeitos adversos , Broncoscopia/tendências , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Hospitalização , Humanos , Pneumonias Intersticiais Idiopáticas/diagnóstico por imagem , Pneumonias Intersticiais Idiopáticas/tratamento farmacológico , Fibrose Pulmonar Idiopática/patologia , Comunicação Interdisciplinar , Pulmão/diagnóstico por imagem , Pulmão/patologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Recidiva , Tomografia Computadorizada por Raios X/métodos
13.
Lancet Respir Med ; 8(7): 726-737, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32649920

RESUMO

The term interstitial lung abnormalities refers to specific CT findings that are potentially compatible with interstitial lung disease in patients without clinical suspicion of the disease. Interstitial lung abnormalities are increasingly recognised as a common feature on CT of the lung in older individuals, occurring in 4-9% of smokers and 2-7% of non-smokers. Identification of interstitial lung abnormalities will increase with implementation of lung cancer screening, along with increased use of CT for other diagnostic purposes. These abnormalities are associated with radiological progression, increased mortality, and the risk of complications from medical interventions, such as chemotherapy and surgery. Management requires distinguishing interstitial lung abnormalities that represent clinically significant interstitial lung disease from those that are subclinical. In particular, it is important to identify the subpleural fibrotic subtype, which is more likely to progress and to be associated with mortality. This multidisciplinary Position Paper by the Fleischner Society addresses important issues regarding interstitial lung abnormalities, including standardisation of the definition and terminology; predisposing risk factors; clinical outcomes; options for initial evaluation, monitoring, and management; the role of quantitative evaluation; and future research needs.


Assuntos
Detecção Precoce de Câncer , Achados Incidentais , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Humanos , Doenças Pulmonares Intersticiais/etiologia , Neoplasias Pulmonares/patologia
14.
Telemed J E Health ; 26(10): 1304-1307, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32654656

RESUMO

Purpose: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is an acute respiratory illness. Although most infected persons are asymptomatic or have only mild symptoms, some patients progress to devastating disease; such progression is difficult to predict or identify in a timely manner. COVID-19 patients who do not require hospitalization can self-isolate at home. Calls from one disease epicenter identify the need for homebased isolation with telemedicine surveillance to monitor for impending deterioration. Methodology: Although the dominant approach for these asymptomatic/paucisymptomatic patients is to monitor oxygen saturation, we suggest additionally considering the potential merits and utility of home-based imaging. Chest computed tomography is clearly impractical, but ultrasound has shown comparable sensitivity for lung involvement, with major advantages of short and simple procedures, low cost, and excellent repeatability. Thoracic ultrasound may thus allow remotely identifying the development of pneumonitis at an early stage of illness and potentially averting the risk of insidious deterioration to severe pneumonia and critical illness while in home isolation. Conclusions: Lung sonography can be easily performed by motivated nonmedical caregivers when directed and supervised in real time by experts. Remote mentors could thus efficiently monitor, counsel, and triage multiple home-based patients from their "control center." Authors believe that this approach deserves further attention and study to reduce delays and failures in timely hospitalization of home-isolated patients.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Monitorização Fisiológica/métodos , Saúde do Trabalhador , Pneumonia Viral/diagnóstico por imagem , Consulta Remota/métodos , Ultrassonografia Doppler/métodos , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Doenças Pulmonares Intersticiais/fisiopatologia , Doenças Pulmonares Intersticiais/virologia , Masculino , Tutoria/métodos , Pandemias , Segurança do Paciente , Pneumonia Viral/epidemiologia , Melhoria de Qualidade , Síndrome Respiratória Aguda Grave/diagnóstico por imagem
15.
Ann Rheum Dis ; 79(9): 1210-1217, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32606043

RESUMO

OBJECTIVE: To prospectively investigate whether differences in pulmonary vasculature exist in systemic sclerosis (SSc) and how they are distributed in patients with different pulmonary function. METHODS: Seventy-four patients with SSc undergoing chest CT scan for interstitial lung disease (ILD) screening or follow-up were prospectively enrolled. A thorough clinical, laboratory and functional evaluation was performed the same day. Chest CT was spirometry gated at total lung capacity and images were analysed by two automated software programs to quantify emphysema, ILD patterns (ground-glass, reticular, honeycombing), and pulmonary vascular volume (PVV). Patients were divided in restricted (FVC% <80, DLco%<80), isolated DLco% reduction (iDLco- FVC%≥80, DLco%<80) and normals (FVC%≥80, DLco%≥80). Spearman ρ, Mann-Whitney tests and logistic regressions were used to assess for correlations, differences among groups and relationships between continuous variables. RESULTS: Absolute and lung volume normalised PVV (PVV/LV) correlated inversely with functional parameters and positively with all ILD patterns (ρ=0.75 with ground glass, ρ=0.68 with reticular). PVV/LV was the only predictor of DLco at multivariate analysis (p=0.007). Meanwhile, the reticular pattern prevailed in peripheral regions and lower lung thirds, PVV/LV prevailed in central regions and middle lung thirds. iDLco group had a significantly higher PVV/LV (2.2%) than normal (1.6%), but lower than restricted ones (3.8%). CONCLUSIONS: Chest CT in SSc detects a progressive increase in PVV/LV as DLco decreases. Redistribution of perfusion to less affected lung regions rather than angiogenesis nearby fibrotic lung may explain the results. Further studies to ascertain whether the increase in PVV/LV reflects a real increase in blood volume are needed.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Pulmão/irrigação sanguínea , Escleroderma Sistêmico/diagnóstico por imagem , Espirometria/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Feminino , Humanos , Modelos Logísticos , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Testes de Função Respiratória , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/fisiopatologia , Espirometria/métodos , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital
16.
J Crit Care ; 59: 149-155, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32674001

RESUMO

PURPOSE: Pathological data of critical ill COVID-19 patients is essential in the search for optimal treatment options. MATERIAL AND METHODS: We performed postmortem needle core lung biopsies in seven patients with COVID-19 related ARDS. Clinical, radiological and microbiological characteristics are reported together with histopathological findings. MEASUREMENT AND MAIN RESULTS: Patients age ranged from 58 to 83 years, five males and two females were included. Time from hospital admission to death ranged from 12 to 36 days, with a mean of 20 ventilated days. ICU stay was complicated by pulmonary embolism in five patients and positive galactomannan on bronchoalveolar lavage fluid in six patients, suggesting COVID-19 associated pulmonary aspergillosis. Chest CT in all patients showed ground glass opacities, commonly progressing to nondependent consolidations. We observed four distinct histopathological patterns: acute fibrinous and organizing pneumonia, diffuse alveolar damage, fibrosis and, in four out of seven patients an organizing pneumonia. None of the biopsy specimens showed any signs of invasive aspergillosis. CONCLUSIONS: In this case series common late histopathology in critically ill COVID patients is not classic DAD but heterogeneous with predominant pattern of organizing pneumonia. Postmortem biopsy investigations in critically COVID-19 patients with probable COVID-19 associated pulmonary aspergillosis obtained no evidence for invasive aspergillosis.


Assuntos
Infecções por Coronavirus/patologia , Doenças Pulmonares Intersticiais/patologia , Pulmão/patologia , Pneumonia Viral/patologia , Aspergilose Pulmonar/patologia , Síndrome do Desconforto Respiratório do Adulto/patologia , Idoso , Idoso de 80 Anos ou mais , Autopsia , Betacoronavirus , Biópsia , Biópsia com Agulha de Grande Calibre , Líquido da Lavagem Broncoalveolar/química , Coinfecção , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Estado Terminal , Feminino , Humanos , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Masculino , Mananas/metabolismo , Pessoa de Meia-Idade , Pandemias , Fenótipo , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/diagnóstico por imagem , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/etiologia , Tomografia Computadorizada por Raios X
17.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(7): 564-570, 2020 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-32629555

RESUMO

Objective: To investigate the accuracy of bedside transthoracic lung ultrasonography (TLU) in different typical high resolution computed tomography (HRCT) signs of interstitial lung diseases (ILDs). Methods: Fifty patients first diagnosed with ILDs were enrolled from January 2016 to December 2018. There were 21 males and 29 females. The mean age was (56±14) years(rang 42-73 years). TLU was performed in inspiration for the characters of A-lines and B-lines as well as pleural at anterior, lateral and dorsal chest walls, respectively. HRCT was selected at three levels according to the upper, middle, and lower lung fields. The range of each level needing to be evaluated corresponded to the TLU scanning field one by one, and recording the signs of HRCT. Early change of ILDs was definite as the HRCT score was no more than 1 and no honeycomb was present. The correlation between A-lines, B-lines, pleural abnormal and HRCT signs was evaluted. Spearman's correlation coefficient was used to evaluate the relationship between B-lines and HRCT score. Results: The sensitivity and specificity of A-lines for HRCT normality were 83.9% and 84.9%, respectively. Coincidence rate was 84.6%. The sensitivity and specificity of B-lines for HRCT abnormality were 84.9% and 83.9%, respectively. Coincidence rate was 84.6%. Interlobular septal thickening shadow had fewer B-lines and narrower interval than other HRCT signs, while the other HRCT signs had no differences in B-lines. And the sensitivity and specificity of B-lines for detection the early change of HRCT in ILDs were 89.5% and 89.2%, respectively. Coincidence rate was 89.3%. A positive correlation was found between the number of B-lines and HRCT scores (R=0.827, P<0.001), and the width of B-lines and HRCT score (R=0.951, P<0.001). Meanwhile, a negative correlation was found between the interval of B-lines and HRCT score (R=-0.831, P<0.001). The sensitivity and specificity of TLU for HRCT pleural abnormality were 100.0% and 90.0%, respectively. Coincidence rate was 93.6%. Conclusions: TLU showed high sensitivity and specificity in finding interstitial changes of the lung. It gives a new view on the diagnostic possibilities of ILDs and may be used to evaluate the severity and the therapeutic effect of treatment. However, TLU could not differentiate HRCT signs of ILDs.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pleura
18.
Arch Cardiol Mex ; 90(Supl): 15-18, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-595911

RESUMO

The SARS-CoV-2 infection has as a clinical manifestation the disease known as COVID-19. Although knowledge of the nature of the disease is dynamic, with dozens of scientific articles being published every day about new features of COVID-19, the typical presentation is that of interstitial pneumonia. Despite the large amount of information that has been developed in recent weeks, it has been estimated that this disease can have up to 72% underdiagnosis, which requires clinical tools that are simple, easily accessible, and increase the detection of cases in a feasible way and that yield information with prognostic value. Given this need, some proposals have emerged to be able to diagnose, monitor and respond to the treatment of patients with COVID-19, such as pulmonary ultrasound (USP). It is worth mentioning that the USP has proven to be an efficient and easily reproducible technique for diagnosing heart failure and pleuro-pulmonary pathologies, especially in critically ill patients. Evidence of the usefulness of USP in COVID-19 is still scarce, although preliminary, it seems to be a sensitive technique whose findings have a high gold standard. In this brief review we will emphasize its technical aspects, the advantages and disadvantages, and finally a proposal for the approach in this type of patient.


Assuntos
Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Estado Terminal , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/virologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Reprodutibilidade dos Testes , Ultrassonografia/métodos
19.
Cancer Invest ; 38(6): 365-371, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32559143

RESUMO

Immunotherapy is standard first-line therapy for advanced non-small cell lung cancer (NSCLC) either alone or in combination with chemotherapy. Despite significant benefits, immune checkpoint inhibitors (ICI) can cause toxicities within any organ, termed immune related adverse events. Pneumonitis is a potentially life-threatening complication of ICIs. Currently, there are no established guidelines for use of ICIs in patients with underlying autoimmune or interstitial lung disease (ILD) and few studies have been published. We present a case of first-line ICI-chemotherapy in a patient with metastatic NSCLC and ILD who suffered treatment related lung toxicity and acute worsening ILD, which lead to his death.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Imunoterapia/efeitos adversos , Doenças Pulmonares Intersticiais/mortalidade , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico por imagem , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/genética , Humanos , Doenças Pulmonares Intersticiais/induzido quimicamente , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Receptor de Morte Celular Programada 1/imunologia , Tomografia Computadorizada por Raios X
20.
Medicine (Baltimore) ; 99(24): e20505, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541472

RESUMO

INTRODUCTION: X-linked hyper-IgM syndrome is a type of primary combined immunodeficiency disorder caused by mutations in CD40 ligand. Opportunistic infections caused by P jirovecii, cytomegalovirus (CMV), or fungi are frequently the first presenting symptom of the patients with X-linked hyper-IgM syndrome. PATIENT CONCERNS: Here, we report a 10-month-old infant who presented with cyanosis and shortness of breath. The infant exhibited no medical or birth history indicating a primary immune deficiency and was first diagnosed with interstitial pneumonia and acute respiratory failure on admission. DIAGNOSES: The infant was diagnosed with Pneumocystis jirovecii pneumonia combined with CMV and fungal infection through gene sequencing by nasopharyngeal swab and G-test. Whole-exome sequencing from a blood sample was performed and identified a functional mutation across the CD40 ligand gene (NM_000074;exon1;C.86_87del) resulting in an amino acid change (P.T29Sfl*18) attributed to X-linked hyper IgM syndrome. INTERVENTIONS: The infant received continuous positive airway pressure ventilation treatment combined with trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia, ganciclovir for CMV, voriconazole for fungal infection and substitution of high-dose immunoglobulin. OUTCOMES: Six months after discharge from our hospital, the infant remained well. CONCLUSION: Opportunistic infections should be suspected in infants presenting with severe interstitial pneumonia. Primary immune deficiency diseases should also be considered in infants diagnosed with opportunistic infections.


Assuntos
Ligante de CD40/genética , Síndrome de Imunodeficiência com Hiper-IgM Tipo 1/complicações , Doenças Pulmonares Intersticiais/genética , Humanos , Síndrome de Imunodeficiência com Hiper-IgM Tipo 1/diagnóstico por imagem , Lactente , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X
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