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2.
Zhonghua Nei Ke Za Zhi ; 58(12): 933-936, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31775462

RESUMO

A 54-year-old man was admitted to respiratory department with chief complaints of recurrent cough and dyspnea. Chest imaging showed multiple patchy shadows and interstitial changes. Evidence of infectious diseases was not definite, and antibiotic treatments were not effective. In the meantime, myelodysplasia syndrome was diagnosed with pancytopenia. The pathologic findings of transbronchoscopic lung biopsyshowed chronic inflammatory interstitial changes, suggesting a clinical diagnosis of organizing pneumonia. After glucocorticoids treatment, his condition aggravated. The second percutaneous lung biopsy showed the infiltration of a large number of neutrophils. Therefore, the final diagnosis of myelodysplasia syndrome with Sweet syndrome was made. Then glucocorticoids and supportive treatment were given This case may improve physicians' understanding of myelodysplasia syndrome complicated with Sweet syndrome.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Pulmão/patologia , Síndromes Mielodisplásicas/diagnóstico , Neutrófilos/patologia , Síndrome de Sweet/diagnóstico , Broncoscopia , Tosse/etiologia , Dispneia/etiologia , Glucocorticoides/uso terapêutico , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/tratamento farmacológico , Pancitopenia/diagnóstico , Pneumonia , Síndrome de Sweet/complicações , Síndrome de Sweet/tratamento farmacológico , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(38): e17088, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567944

RESUMO

An international consensus for rheumatoid arthritis (RA) patients at risk of developing interstitial lung disease (ILD) is still lacking. The aims of study were to evaluate: the prevalence of ILD involvement in RA over high-resolution computed tomography (HRCT); the relationships between pulmonary function tests (PFTs), patient-centered measurements, and ILD; and the potential risk factors contributing to RA-ILD patients.Data regarding the clinical characteristics (age, sex, age at onset of RA), laboratory findings (rheumatoid factor [RF] and anti-citrullinated protein antibodies [ACPA]), respiratory functional assessment (forced vital capacity [FVC] and carbon monoxide diffusion capacity [DLCO]), patient-centred measures of dyspnea (PCMD), Health Assessment Questionnaire-Disability Index (HAQ-DI), and HRCT have collected retrospectively. HRCT abnormalities were evaluated using a conventional visual reader-based score (CoVR) and a computer-aided method (CaM). The relationships between the 2 HRCT scores-PFTs and PCMD-were calculated using Pearson correlation. The area under the receiving-operating characteristic (AUC-ROC) curve was calculated to determine the discriminatory performance of measurements between patients with and without ILD. The multivariate regression model was used to evaluate the association force between ILD and RA characteristics.In all, 151 patients (45 males and 106 females, mean age 53.4 ±â€Š7.6 years) were included. ILD had been detected in 29 patients out of 151 (19.2%). Usual interstitial pneumonia was the most common HRCT. RA-ILD patients were older, and older at RA onset (both P < .01), with a higher HAQ-DI (P < .05) than patients without ILD. ACPA positivity and titer were higher in the RA-ILD group (P = .02). Extent and severity of ILD, and total CoVR and CaM score closely related to DLCO and PCMD (both P < .0001). A reduced DLCO was the most sensitive test for predicting the presence of ILD on HRCT (AUC-ROC 0.811 ±â€Š0.037). Advanced age (P < .0001), age at RA onset (P = .025), ACPA titer (P = .004), and smoking (P = .008) were independent explanatory variables of HRCT damage in multivariate analysis.The RA-ILD is associated with age and older age of RA onset, smoking, and ACPA titer. DLCO seems to be the most sensitive parameter to predict ILD on HRCT, followed by PCMD.


Assuntos
Artrite Reumatoide , Doenças Pulmonares Intersticiais/epidemiologia , Fatores Etários , Idoso , Feminino , Humanos , Itália/epidemiologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Curva ROC , Testes de Função Respiratória , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
5.
Monaldi Arch Chest Dis ; 89(3)2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31505921

RESUMO

Desquamative interstitial pneumonia is a rare disease that is predominantly associated with smoking. Surgical biopsy is usually recommended for the diagnosis of this disorder. Probe-based confocal laser endomicroscopy (pCLE) is a new method of minimally invasive in vivo microscopic image of airways and alveoli. We use this method for desquamative interstitial pneumonia in nonsmoker. The pCLE image shows thickened intra-alveolar septae and clusters of autofluorescent cells within the alveoli, which is unusual for non-smoking patients. We think this pattern can be used for differential diagnosis of desquamative interstitial pneumonia in nonsmokers.


Assuntos
Microscopia Intravital , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Broncoscopia , Feminino , Humanos , Microscopia Intravital/métodos , Microscopia Confocal , Pessoa de Meia-Idade , não Fumantes
6.
Jpn J Radiol ; 37(11): 773-780, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31522385

RESUMO

PURPOSE: To assess inter-observer variability in identifying traction bronchiectasis on computed tomography (CT) using additional criteria for chronic fibrosing interstitial pneumonia. METHODS: Seven experts categorized CT image set representing 39 patients into three groups on the basis of the presence of traction bronchiectasis, using a three-point scale: 3-definitely/probably yes; 2-possibly yes; and 1-definitely/probably no. This scale served as a reference standard. The image set included cases of chronic fibrosing interstitial pneumonia, non-interstitial lung disease, and difficult-to-determine cases. Forty-eight observers similarly assessed the same image set, first according to the Fleischner Society definition, and second with additional criteria, in which traction bronchiectasis was observed exclusively in chronic fibrosing interstitial pneumonia. The agreement level between the reference standard and each observer's evaluation in each session was calculated using weighted kappa values which were compared between the two sessions using a paired t test. RESULTS: The mean weighted kappa value for all observers was significantly higher in the second reading session (mean 0.75) than in the first reading session (mean 0.62) (p < 0.001). CONCLUSION: Inter-observer agreement in identifying traction bronchiectasis improves when using the additional criteria which specify chronic fibrosing interstitial pneumonia as the underlying disease.


Assuntos
Bronquiectasia/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Variações Dependentes do Observador , Doença Crônica , Fibrose/diagnóstico por imagem , Humanos , Tomografia Computadorizada por Raios X/métodos , Tração
7.
BMJ Case Rep ; 12(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31519721

RESUMO

Antisynthetase syndrome is a rare autoimmune disease and represents a distinct entity within the idiopathic inflammatory myopathies. Its variable systemic manifestations are composed of myositis, interstitial lung disease, non-erosive arthritis, fever, Raynaud's phenomenon, hyperkeratotic skin changes and the presence of antibodies against aminoacyl-transfer-RNA-synthetases. Interstitial lung disease is the major determinant of morbidity and mortality. The role of lung biopsy remains controversial but it might be considered on an individual basis and may provide information regarding prognosis and treatment response. An integrated clinical, radiological and pathological approach to interstitial lung disease has to be emphasised. Due to the rarity of the disease, no standardised treatment guidelines for antisynthetase syndrome exist. We discuss a patient with anti-Jo1-autoantibody antisynthetase syndrome with proximal myositis and severe, rapid onset, interstitial lung disease with a histopathological pattern of organising pneumonia on surgical lung biopsy and good response to early combined immunosuppressive treatment with corticosteroids, mycophenolate mofetil and rituximab.


Assuntos
Terapia Combinada/métodos , Doenças Pulmonares Intersticiais/tratamento farmacológico , Ácido Micofenólico/uso terapêutico , Miosite/tratamento farmacológico , Pneumonia/patologia , Administração Intravenosa , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Aminoacil-tRNA Sintetases/imunologia , Autoanticorpos , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Fatores Imunológicos/uso terapêutico , Imunossupressores/uso terapêutico , Pulmão/patologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/imunologia , Doenças Pulmonares Intersticiais/patologia , Pessoa de Meia-Idade , Miosite/imunologia , Miosite/patologia , Pneumonia/etiologia , Rituximab/uso terapêutico , Índice de Gravidade de Doença , Resultado do Tratamento
8.
BMC Pulm Med ; 19(1): 153, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31419981

RESUMO

BACKGROUND: Honeycombing on high-resolution computed tomography (HRCT) is a distinguishing feature of usual interstitial pneumonia and predictive of poor outcome in interstitial lung diseases (ILDs). Although fine crackles are common in ILD patients, the relationship between their acoustic features and honeycombing on HRCT has not been well characterized. METHODS: Lung sounds were digitally recorded from 71 patients with fine crackles and ILD findings on chest HRCT. Lung sounds were analyzed by fast Fourier analysis using a sound spectrometer (Easy-LSA; Fukuoka, Japan). The relationships between the acoustic features of fine crackles in inspiration phases (onset timing, number, frequency parameters, and time-expanded waveform parameters) and honeycombing in HRCT were investigated using multivariate logistic regression analysis. RESULTS: On analysis, the presence of honeycombing on HRCT was independently associated with onset timing (early vs. not early period; odds ratios [OR] 10.407, 95% confidence interval [95% CI] 1.366-79.298, P = 0.024), F99 value (the percentile frequency below which 99% of the total signal power is accumulated) (unit Hz = 100; OR 5.953, 95% CI 1.221-28.317, P = 0.029), and number of fine crackles in the inspiratory phase (unit number = 5; OR 4.256, 95% CI 1.098-16.507, P = 0.036). In the receiver-operating characteristic curves for number of crackles and F99 value, the cutoff levels for predicting the presence of honeycombing on HRCT were calculated as 13.2 (area under the curve [AUC], 0.913; sensitivity, 95.8%; specificity, 75.6%) and 752 Hz (AUC, 0.911; sensitivity, 91.7%; specificity, 85.2%), respectively. The multivariate logistic regression analysis additionally using these cutoff values revealed an independent association of number of fine crackles in the inspiratory phase, F99 value, and onset timing with the presence of honeycombing (OR 33.907, 95% CI 2.576-446.337, P = 0.007; OR 19.397, 95% CI 2.311-162.813, P = 0.006; and OR 12.383, 95% CI 1.443-106.293, P = 0.022; respectively). CONCLUSIONS: The acoustic properties of fine crackles distinguish the honeycombing from the non-honeycombing group. Furthermore, onset timing, number of crackles in the inspiratory phase, and F99 value of fine crackles were independently associated with the presence of honeycombing on HRCT. Thus, auscultation routinely performed in clinical settings combined with a respiratory sound analysis may be predictive of the presence of honeycombing on HRCT.


Assuntos
Auscultação , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Sons Respiratórios/diagnóstico , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Japão , Modelos Logísticos , Doenças Pulmonares Intersticiais/diagnóstico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Curva ROC , Processamento de Sinais Assistido por Computador , Tomografia Computadorizada por Raios X
9.
J Comput Assist Tomogr ; 43(6): 898-905, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31453976

RESUMO

Idiopathic pulmonary fibrosis is the commonest interstitial lung disease. Radiologists play an essential role in making an accurate diagnosis, and this is necessary given its prognostic implications and potential use of antifibrotic therapies. This review highlights the radiologic features and imaging classification of fibrosis with reference to recently updated international guidelines and emphasizing the importance of the multidisciplinary team in idiopathic pulmonary fibrosis diagnosis and, in particular, when pathological sampling is required.


Assuntos
Fibrose Pulmonar Idiopática/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Guias de Prática Clínica como Assunto , Prognóstico , Interpretação de Imagem Radiográfica Assistida por Computador , Tomografia Computadorizada por Raios X
10.
Pol Merkur Lekarski ; 47(277): 25-27, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31385943

RESUMO

Idiopathic pulmonary fibrosis (IPF) is the most common of the idiopathic interstitial pneumonias. The high-resolution tomography (HRCT) is highly recommended among patients with suspected IPF. Usual interstitial pneumonia (UIP) is the histopathological and radiological pattern of IPF. IPF is diagnosed if the appropriate combination of HRCT patterns and histopathological patterns are present. CASE REPORT: The authors present a case of a 49-years-old woman who was hospitalised due to the detection of a focal lesion in the left lung in an X-ray examination. A CT scan of the chest with contrast revealed a solid infiltration of the same area. The histopathology from a transbronchial lung biopsy from this abnormality showed microscopic honeycomb, fibroblast fibrosis, macrophage clusters loaded with hemosiderin and widened bronchioles - an image suggesting Usual Interstitial Pneumonia (UIP). Following that, a HRCT showed considerable differences in the lung image compared to the previous CT examination - no polycyclic lesion in the left lung was detected and the fibrous changes decreased. The patient had substantial formal features of UIP from the histopathological examination from TBLB. Therefore, there was a clinicalradiological discrepancy in the histopathology report. After a multidisciplinary consultation by renowned experts in pulmonology, radiology and histopathology, regardless of the patient's diagnostic path, the primary cause of the disease could not be determined. The analysis of this case strongly suggests that the histopathological examination alone is not sufficient in the diagnosis of IPF.


Assuntos
Fibrose Pulmonar Idiopática , Doenças Pulmonares Intersticiais , Biópsia , Feminino , Humanos , Fibrose Pulmonar Idiopática/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
11.
Radiol Med ; 124(10): 989-999, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31267321

RESUMO

Lung ultrasound (LUS) achieved an intriguing role in the management of pulmonary involvement in patients affected by connective tissues diseases (CTDs). Few studies have been performed to support its usefulness in the evaluation of the presence and the severity of interstitial lung disease (ILD), relating it to the information obtained with chest high-resolution computed tomography (HRCT). These results open up new fields of research in order to demonstrate the utility of LUS as screening tool to evaluate ILD in CTD. The aim of this review is to provide the "state of the art" of the role of LUS in the management of ILD associated with CTD.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Reumáticas/diagnóstico por imagem , Ultrassonografia/métodos , Diagnóstico Diferencial , Humanos , Doenças Pulmonares Intersticiais/etiologia , Doenças Reumáticas/complicações
12.
Medicine (Baltimore) ; 98(26): e16086, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261523

RESUMO

Pleuroparenchymal fibroelastosis (PPFE) is a rare new interstitial lung disease (ILD) characterized by the fibrotic thickening of the visceral pleura and subadjacent parenchymal areas of the upper lobes This study reveals that patients with ILD-SSc associated with chest HRCT evidence of PPFE require close and recurrent follow-up with periodic evaluation of lung function parameters, DLCO and chest HRCT. Rheumatologists should be aware of this new radiological finding which is accompanied by a negative prognosis, especially when associated with a progressive course. Patients with this radiological pattern need to be monitored with particular attention.


Assuntos
Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pleurais/complicações , Doenças Pleurais/diagnóstico por imagem , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico por imagem , Idoso , Feminino , Seguimentos , Humanos , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/terapia , Masculino , Doenças Pleurais/terapia , Prognóstico , Fibrose Pulmonar/complicações , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/terapia , Estudos Retrospectivos , Reumatologistas , Escleroderma Sistêmico/terapia
13.
Respir Res ; 20(1): 154, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307466

RESUMO

BACKGROUND: Acute exacerbation of interstitial pneumonia (AE-IP) is a serious complication of pulmonary surgery in patients with IP. However, little is known about AE-IP after non-pulmonary surgery. The aim of this study was to determine the frequency of AE-IP after non-pulmonary surgery and identify its risk factors. METHODS: One hundred and fifty-one patients with IP who underwent pulmonary surgery and 291 who underwent non-pulmonary surgery were retrospectively investigated. RESULTS: AE-IP developed in 5 (3.3%) of the 151 patients in the pulmonary surgery group and 4 (1.4%) of the 291 in the non-pulmonary surgery group; the difference was not statistically significant. A logistic regression model showed that serum C-reactive protein (CRP) was a predictor of AE-IP in the non-pulmonary surgery group (odds ratio 1.187, 95% confidence interval 1.073-1.344, P = 0.002). CONCLUSIONS: This is the first study to compare the frequency of AE-IP after pulmonary surgery with that after non-pulmonary surgery performed under the same conditions. The results suggest that the frequency of AE-IP after non-pulmonary surgery is similar to that after pulmonary surgery. A high preoperative C-reactive protein level is a potential risk factor for AE-IP after non-pulmonary surgery.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Doença Aguda , Idoso , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
BMC Cancer ; 19(1): 720, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331293

RESUMO

BACKGROUND: Interstitial pneumonitis is a rare reaction in a previously irradiated area of pulmonary or thoracic lesion after treatment with anticancer drugs such as taxanes. CASE PRESENTATION: A 66-year-old man presented with a fever and dyspnea after treatment with cabazitaxel for castration-resistant prostate cancer. He was treated with an intravenous broad-spectrum antimicrobial agent, however he complained of dyspnea and had a pulse oximetric saturation of 80% while breathing room air. The patients had been treated for bone metastases with 37.5 Gy to the thoracic spine (Th 7) as a local radiotherapy. Radiological images showed pulmonary interstitial opacities in the irradiated field of the both lungs. The steroid pulse therapy was started. The patient's dyspnea disappeared and the interstitial opacities had also improved. CONCLUSIONS: This report is a case of interstitial pneumonitis in a castration-resistant prostate cancer patient receiving cabazitaxel after thoracic radiation therapy.


Assuntos
Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Doenças Pulmonares Intersticiais/induzido quimicamente , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Neoplasias de Próstata Resistentes à Castração/radioterapia , Taxoides/efeitos adversos , Taxoides/uso terapêutico , Administração Intravenosa , Idoso , Antineoplásicos/administração & dosagem , Docetaxel/efeitos adversos , Docetaxel/uso terapêutico , Resistencia a Medicamentos Antineoplásicos , Dispneia/tratamento farmacológico , Seguimentos , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/tratamento farmacológico , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Taxoides/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
PLoS One ; 14(6): e0217554, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31158264

RESUMO

INTRODUCTION: Diffuse parenchymal lung diseases (DPLD) constitute a heterogeneous group of disorders, sometimes requiring surgical lung biopsies (SLB) to obtain a definite diagnosis. Transbronchial cryobiopsy (TBCB) is a new promising interventional bronchoscopic method of obtaining lung tissue that is gaining ground against SLB. METHODS: Fifty consecutive patients with indeterminate DPLD (definite/possible UIP excluded), after expert panel review referral, were retrospectively analyzed from January 2016 to August 2018. Patients underwent TBCB under deep sedation with endotracheal intubation and spontaneous breathing at a single, tertiary-care, reference hospital. RESULTS: A total of 110 TBCBs (2.7 per patient, range 1 to 4) were performed. Frequent complications included mild pneumothorax in 5 patients (10%), requiring only oxygen supplementation, and bleeding in 31 patients (62%) that was mild in 19 patients and moderate in 12 patients. No serious bleeding was observed. There was zero mortality and no serious adverse events. Adequate samples for diagnostic purposes were obtained in 46 patients (92%) and pathologic histologic diagnosis was reached in 40 patients (80%). The most frequent histopathological patterns were organizing pneumonia (OP) (25%) and non-specific interstitial pneumonia (NSIP) (15%). After an expert panel review of all cases a final diagnosis was achieved in 38 patients, corresponding to a diagnostic yield of 76% for TBCB. CONCLUSION: Our single center cohort demonstrates that establishing TBCBs as a new technique is safe and feasible after proper training in specialized centers, resulting in low complication rates and adequate diagnostic yields.


Assuntos
Brônquios/patologia , Criocirurgia , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/patologia , Padrões de Prática Médica , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Criocirurgia/efeitos adversos , Feminino , Grécia , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
17.
BMC Med Imaging ; 19(1): 39, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31113389

RESUMO

BACKGROUND: Pulmonary involvement is common in several infectious and non-infectious diagnostic settings. Imaging findings consistently overlap and are therefore difficult to differentiate by chest-CT. The aim of this study was to evaluate the role of CT-textural features(CTTA) for discrimination between atypical viral (respiratory-syncitial-virus(RSV) and herpes-simplex-1-virus (HSV1)), fungal (pneumocystis-jirovecii-pneumonia(PJP)) interstitial pneumonias and alveolar hemorrhage. METHODS: By retrospective single-centre analysis we identified 46 consecutive patients (29 m) with RSV(n = 5), HSV1(n = 6), PJP(n = 21) and lung hemorrhage(n = 14) who underwent unenhanced chest CTs in early stages of the disease between 01/2016 and 02/2017. All cases were confirmed by microbiologic direct analysis of bronchial lavage. On chest-CT-scans, the presence of imaging features like ground-glass opacity(GGO), crazy-paving, air-space consolidation, reticulation, bronchial wall thickening and centrilobular nodules were described. A representative large area was chosen in both lungs and used for CTTA-parameters (included heterogeneity, intensity, average, deviation, skewness). RESULTS: Discriminatory CTTA-features were found between alveolar hemorrhage and PJP consisting of differences in mean heterogeneity(p < 0.015) and uniformity of skewness(p < 0.006). There was no difference between CT-textural features of diffuse alveolar hemorrhage and viral pneumonia or PJP and viral pneumonia. Visual HRCT-assessment yielded great overlap of imaging findings with predominance of GGO for PJP and airspace consolidation for pneumonia/alveolar hemorrhage. Significant correlations between HRCT-based imaging findings and CT-textural features were found for all three disease groups. CONCLUSION: CT-textural features showed significant differences in mean heterogeneity and uniformity of skewness. HRCT-based imaging findings correlated with certain CT-textural features showing that the latter have the potential to characterize structural properties of lung parenchyma and related abnormalities.


Assuntos
Hemorragia/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii/isolamento & purificação , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
18.
Intern Med ; 58(17): 2443-2449, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31118378

RESUMO

Objective Although rare, pulmonary tuberculosis occasionally develops in patients with interstitial pneumonia (IP). In this study, we aimed to evaluate the clinicoradiological features of pulmonary tuberculosis associated with IP. Methods In this retrospective, observational, single-center study, the medical charts, high-resolution computed tomography (HRCT) findings, and bacteriological test results of patients with IP who also tested positive for Mycobacterium tuberculosis were reviewed. Patients The study included 20 patients with IP out of 329 who tested positive for M. tuberculosis in sputum or bronchoalveolar lavage fluid cultures at Toranomon Hospital between January 2006 and December 2017. Results The HRCT patterns were usual interstitial pneumonia (UIP) in 11 patients and non-UIP in 9 patients. Consolidations (80%) were the most frequent HRCT findings, followed by cavities (60%) and nodules (45%), which are generally characteristic of pulmonary tuberculosis. Consolidations often developed in relation to fibrotic or emphysematous lesions. Tuberculosis lesions could not be identified in one patient. All patients were treated with anti-tuberculosis drugs according to WHO guidelines, and 13 patients achieved a WHO category of "Treatment success." No patient died of tuberculosis, and the median survival time for the 20 patients was 1,196 days. Conclusion Although the HRCT findings for pulmonary tuberculosis associated with IP are atypical, appropriate tuberculosis treatments can lead to favorable outcomes.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/epidemiologia , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Líquido da Lavagem Broncoalveolar , Feminino , Humanos , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Estudos Retrospectivos , Escarro/microbiologia , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/patologia
19.
Medicine (Baltimore) ; 98(21): e15779, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124970

RESUMO

To assess characteristics and outcomes of patients hospitalized with interstitial lung diseases (ILD) and to analyze patient's comorbidities, procedures, and in-hospital outcomes.We identified patients hospitalized with idiopathic pulmonary fibrosis and others ILD such as hypersensitivity pneumonitis, cryptogenic organizing pneumonia, lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, and sarcoidosis in Spain during 2014 and 2015.We identified 14,565 discharges among patients admitted for ILD in Spain during the study period: idiopathic pulmonary fibrosis (IPF) in 42.32% (n = 6164), sarcoidosis in 37.65% (n = 5484), hypersensitivity pneumonitis in 10.55% (n = 1538), cryptogenic organizing pneumonia in 7.06% (n = 1028), pulmonary Langerhans cell histiocytosis in 1.48% (n = 215), and lymphangioleiomyomatosis in 0.94% (n = 136). The most common associated comorbidities according to those included in the Charlson Comorbidity Index (CCI) were COPD, diabetes, and congestive heart disease. The presence of pulmonary hypertension increased the probability of dying in patients with idiopathic pulmonary fibrosis (OR 1.36; 95%CI 1.06-1.73). Patients with cryptogenic organizing pneumonia had the longest length of hospital stay and the highest percentage of hospital readmissions (23.64%). The highest IHM corresponded to the idiopathic pulmonary fibrosis (14.94%). Computed tomography of the chest was the procedure more used during admissions for ILD.IPF was responsible for larger percentage of hospital admission among ILD in our study. In addition, the IHM were higher in IPF patients in comparison with those with other ILD. The most common associated comorbidity in ILD according to those included in the CCI was COPD. Computed tomography of the chest was the procedure more frequently used.


Assuntos
Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Doenças Pulmonares Intersticiais/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alveolite Alérgica Extrínseca/diagnóstico por imagem , Alveolite Alérgica Extrínseca/epidemiologia , Criança , Comorbidade , Pneumonia em Organização Criptogênica/diagnóstico por imagem , Pneumonia em Organização Criptogênica/epidemiologia , Feminino , Histiocitose de Células de Langerhans/diagnóstico por imagem , Histiocitose de Células de Langerhans/epidemiologia , Mortalidade Hospitalar , Humanos , Fibrose Pulmonar Idiopática/diagnóstico por imagem , Fibrose Pulmonar Idiopática/epidemiologia , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoidose/diagnóstico por imagem , Sarcoidose/epidemiologia , Espanha/epidemiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto Jovem
20.
Medicine (Baltimore) ; 98(22): e15936, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145365

RESUMO

The aim of this study was to assess the effects of reconstruction on the image quality and quantitative analysis for interstitial lung disease (ILD) using filtered back projection (FBP) and model-based iterative reconstruction (MBIR) with the lung setting and the conventional setting on ultra-low-dose computed tomography (CT).Fifty-two patients with known ILD were prospectively enrolled and underwent CT at an ultra-low dose (0.18 ±â€Š0.02 mSv) and a standard dose (7.01 ±â€Š2.66 mSv). Ultra-low-dose CT was reconstructed using FBP (uFBP) and MBIR with the lung setting (uMBIR-Lung) and the conventional setting (uMBIR-Stnd). Standard-dose CT was reconstructed using FBP (sFBP). Three radiologists subjectively evaluated the images on a 3-point scale (1 = worst, 3 = best). For objective image quality analysis, regions of interest were placed in the lung parenchyma and the axillary fat, and standard deviation (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were evaluated. For 32 patients with clinically diagnosed idiopathic interstitial pneumonia, quantitative measurements including total lung volume (TLV) and the percentage of ILD volume (%ILDV) were obtained. The medians of 3 radiologists' scores were analyzed using the Wilcoxon signed-rank test and the objective noise was analyzed using the paired t test. The Bonferroni correction was used for multiple comparisons. The quantitative measurements were analyzed using the Bland-Altman method.uMBIR-Lung scored better than uMBIR-Stnd and worse than sFBP (P < .001), except for noise and streak artifact in subjective analysis. The SD decreased significantly in the order of uMBIR-Stnd, uMBIR-Lung, sFBP, and uFBP (P < .001). The SNR and CNR increased significantly in the order of uMBIR-Stnd, uMBIR-Lung, sFBP, and uFBP (P < .001). For TLV, there was no significant bias between ultra-low-dose MBIRs and sFBP (P > .3). For %ILDV, there was no significant bias between uMBIR-Lung and sFBP (p = 0.8), but uMBIR-Stnd showed significantly lower %ILDV than sFBP (P = .013).uMBIR-Lung provided more appropriate image quality than uMBIR-Stnd. Although inferior to standard-dose CT for image quality, uMBIR-Lung showed equivalent CT quantitative measurements to standard-dose CT.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Artefatos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Razão Sinal-Ruído
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