COVID-19 outbreak in Italy: Clinical-radiological presentation and outcome in three oncologic patients.

We present three patients affected by pulmonary squamous cell carcinoma, metastatic esophageal cancer and advanced non-Hodgkin lymphoma, who incurred in coronavirus 2019 (COVID-19) infection during the early phase of epidemic wave in Italy. All patients presented with fever. Social contact with subject positive for COVID-19 was declared in only one of the three cases. In all cases, laboratory findings showed lymphopenia and elevated C-reactive protein (CRP). Chest x-ray and computed tomography showed bilateral ground-glass opacities, shadowing, interstitial abnormalities, and "crazy paving" pattern which evolved with superimposition of consolidations in one patient. All patients received antiviral therapy based on ritonavir and lopinavir, associated with hydroxychloroquine. Despite treatment, two patients with advanced cancers died after 39 and 17 days of hospitalization, while the patient with lung cancer was dismissed at home, in good conditions.

A Case of Recurrent Secondary Aortoenteric Fistula 4 Months after Surgery Treated by Endovascular Coiling of the Aortic Stump and Bilateral Chimney Stent Grafts to Renal Arteries.

The treatment of recurrent aortoenteric fistula (AEF) previously repaired by surgery is challenging, with a high mortality rate. Open repair is often limited by "hostile abdomen," while endovascular treatment is difficult when the distance between the aortic stump and the origin of the renal arteries is short, with high risk of their occlusion. We describe a recurrent AEF repaired by surgery 4 months earlier, treated by endovascular coiling of the aortic stump after deployment of 2 renal artery stent grafts with the chimney technique.

Extracranial Visceral Artery Aneurysms/Pseudoaneurysms Repaired with Flow Diverter Device Developed for Cerebral Aneurysms: Preliminary Results.

BACKGROUND: Recently, there has been a shift toward elective endovascular repair of visceral artery aneurysms (VAAs). Transcatheter embolization (TE) and covered stenting (CS) represent the 2 most used endovascular techniques; however, TE carries the potential risk of end-organ ischemia, while CS is challenging when the parent arteries are tortuous. Flow diverter devices (FDDs) developed for cerebral aneurysms maintain distal flow and are characterized by high navigability in tortuous arteries. This report describes our initial experience in using FDD developed for cerebral aneurysms to treat extracranial VAAs/pseudoaneurysm (VAP). METHODS: The study was conducted on patients affected by VAP, who underwent endovascular repair using FDD, between January 2015 and April 2017. All patients underwent preinterventional computed tomography angiography (CTA) for diagnosis and procedural planning. VAP features (type, location, size) and the diameter of both the proximal and distal parent arteries were recorded. Since TE or CS was contraindicated or failed in the previous attempt, VAPs were repaired through an elective endovascular procedure with FDD (Surpass; Stryker Neurovascular, Fremont, CA). Follow-up CTAs were performed within 6 months and at 24 months after the endovascular repair, evaluating patency and proper position of the FDD, the maximum diameter of the VAP, any perfusion of the sac, and adequacy of end-organ perfusion. RESULTS: Four VAPs were repaired by FDD in 4 patients (2 females; median age: 72 years, range: 64-80 years). One patient suffered from cervical arterial anastomotic pseudoaneurysm, whereas the remaining VAPs were 2 splenic artery aneurysms and 1 common hepatic aneurysm. VAPs median size was 20 mm (range: 13-26 mm) with median parent artery caliber of 5 mm (range: 3-5 mm). The correct deployment of the device was obtained in all cases; 2/4 VAPs showed endoleak at the end of the procedure. At follow-up CTAs performed after the procedure in a median time of 25 months (range: 4-28 months), all devices were patent and not migrated. All VAPs showed shrinkage of the sac without endoleak or signs of end-organ ischemia. CONCLUSIONS: When high tortuosity and small caliber of the parent arteries prevent CS and the necessity to maintain vessel patency contraindicates TE, FDD could represent an option for the treatment of VAP; however, high costs and the off-label use in extracranial vessels demand an accurate selection of the patients suitable for the VAP treatment with FDD.

Quantitative chest computed tomography is associated with two prediction models of mortality in interstitial lung disease related to systemic sclerosis.

Objective: In this multicentre study, we aimed to evaluate the capacity of a computer-assisted automated QCT method to identify patients with SSc-associated interstitial lung disease (SSc-ILD) with high mortality risk according to validated composite clinical indexes (ILD-Gender, Age, Physiology index and du Bois index). Methods: Chest CT, anamnestic data and pulmonary function tests of 146 patients with SSc were retrospectively collected, and the ILD-Gender, Age, Physiology score and DuBois index were calculated. Each chest CT underwent an operator-independent quantitative assessment performed with a free medical image viewer (Horos). The correlation between clinical prediction models and QCT parameters was tested. A value of P < 0.05 was considered statistically significant. Results: Most QCT parameters had a statistically different distribution in patients with diverging mortality risk according to both clinical prediction models (P < 0.01). The cut-offs of QCT parameters were calculated by receiver operating characteristic curve analysis, and most of them could discriminate patients with different mortality risk according to clinical prediction models. Conclusion: QCT assessment of SSc-ILD can discriminate between well-defined different mortality risk categories, supporting its prognostic value. These findings, together with the operator independence, strengthen the validity and clinical usefulness of QCT for assessment of SSc-ILD.

Operator-independent quantitative chest computed tomography versus standard assessment of interstitial lung disease related to systemic sclerosis: A multi-centric study.

PURPOSE: Interstitial lung disease (ILD) related to systemic sclerosis (SSc) is assessed with pulmonary functional tests (PFTs) and semi-quantitative scores based on extent of ILD detectable on chest computed tomography (CT). CT quantitative indexes (QCTIs) are promising tools to assess extent of ILD. This study's aim is to evaluate the validity of QCTI compared with that of chest CT standard evaluation and PFTs. Moreover, QCTI differences between patients' subgroups according to prognostic stratifications were investigated. METHODS: ILD-SSc of patients from six rheumatological clinics was routinely assessed with chest CT and PFTs. Patients were clustered according to prognosis based on functional and/or radiological examinations. Finally, chest CTs were processed with OsiriX in order to obtain QCTI. RESULTS: Two hundred fifty-seven SSc patients were enrolled. QCTI correlation between extent of ILD and PFTs range from - 0.60 to 0.58 and from - 0.54 to 0.52, respectively. The majority of QCTI have a different distribution in patients' subgroups based on prognosis. Most of QCTI discriminate patients with an ILD severity leading to a poor prognosis. CONCLUSIONS: QCTI assessment of ILD-SSc is comparable to the evaluation based on chest CT and/or PFTs. QCTI values corresponding to severe ILD were identified. QCTIs are excellent candidates for a new and more reliable SSc-ILD assessment.

Advanced gastric cancer with liver and lymph node metastases successfully resected after induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil.

BACKGROUND: At diagnosis, about 35% of patients with gastric cancer present with distant metastases, and most patients with gastric cancer and liver metastases are excluded from curative surgery. CASE: We report a case of human epidermal growth factor receptor-2 (HER2)-negative gastric cancer with metastases to the liver and perigastric lymph nodes. The patient (a 60-year-old man) was considered unresectable at diagnosis and was treated with palliative chemotherapy (docetaxel plus cisplatin and 5-fluorouracil by continuous intravenous infusion over 5 days every 3 weeks). However, after 6 courses of chemotherapy, a computed tomography scan showed a reduction of the liver metastasis and the disappearance of the enlarged perigastric lymph nodes. The patient then underwent a curative gastrectomy, lymphadenectomy and liver resection. After surgery, the patient was treated with 6 courses of FOLFOX-4 regimen as adjuvant chemotherapy. With a follow-up of 26 months after surgery, the patient is alive and disease free. CONCLUSION: In patients with metastatic gastric cancer, the prognosis is poor with a median overall survival of 11 months since curative treatments are excluded; however, this case illustrated that a personalized treatment with chemotherapy and surgery can allow a curative strategy in selected patients with HER2-negative advanced gastric cancer.

Thoracic duct leakage in a patient with Type B-Non-Hodgkin lymphoma treated with transvenous retrograde access embolization: a case report.

Thoracic duct (TD) is the largest lymphatic vessel in the body and drains the lymph at the junction between the left subclavian and jugular veins. Chylothorax (CTX) represents an accumulation of lymphatic fluid in the pleural space. We present a case of a 65 years-old man with an histologically diagnosed mediastinal type B non-Hodgkin Lymphoma, treated with chemo-immunotherapy. CT scan during follow up showed significant left side pleural effusion, amounting to 2.8 litres after drainage. Conservative treatment with low fat parenteral nutrition was started without reduction of drainage output, then lymphangiography (LP) with Lipiodol was performed demonstrating a leak in the distal TD. CTX increased in the following days, and a further LP was performed. Using transvenous retrograde access we catheterized TD at the left subclavian jugular veins using a microcatheter. The leak was treated with multiple conventional and controlled delivery microcroils and cyanoacrylate, obtaining complete embolization without residual leak.