In recent years, the incidence of pulmonary cryptococcosis (PC) has risen among patients without human immunodeficiency virus (HIV) infection, including individuals with preserved immune function. The clinical manifestations of PC are largely non-specific, frequently presenting with fever, cough, chest tightness, or chest pain. In some cases, PC remains asymptomatic, which increases the likelihood of misdiagnosis or delayed recognition. The present study reports the diagnostic evaluation and therapeutic course of a child with PC and normal immune function, accompanied by a literature review, with the objective of enhancing clinical awareness and reducing disease-related mortality. A 14-year-old girl was admitted to the hospital on April 28, 2025, with cough accompanied by intermittent fever. During the illness, chest tightness and chest pain were reported. Her past medical history was unremarkable. Physical examination demonstrated stable breathing, with scattered rales auscultated bilaterally. Chest computed tomography (CT) revealed extensive inflammatory consolidation with cavitary change in the right upper lobe. Cryptococcus neoformans capsular antigen (CrAg Lateral Flow Assay) was positive in both blood and bronchoalveolar lavage fluid (BALF), whereas cerebrospinal fluid (CSF) testing was negative. Targeted next-generation sequencing (tNGS) of BALF detected Cryptococcus neoformans (7,193 sequence reads), establishing the diagnosis of pulmonary cryptococcosis. Oral fluconazole at 6 mg/kg/day was administered as antifungal therapy. After 6 days of inpatient management, body temperature normalized and clinical symptoms markedly improved. The patient was discharged on day 9 in stable condition. Following discharge, she remained afebrile and free of cough, chest tightness, chest pain, or other complaints. Follow-up chest radiography at 16 weeks demonstrated near-complete resolution of the lesion, and repeat chest CT at 6 months showed absorption of the cavity with clear improvement compared with baseline; fluconazole was subsequently discontinued. PC may develop in children with preserved immune function. In pediatric patients presenting with pulmonary cavitation, non-specific respiratory manifestations, inadequate response to conventional anti-infective therapy, and suspected pulmonary tuberculosis or malignancy, cryptococcus-related etiologic investigations should be performed promptly. Treatment strategies should be individualized according to immune status and disease severity.
To assess the budget impact of incidental pulmonary nodule (IPN) detection using an artificial intelligence-software for chest X-ray (CXR) interpretation - qXR - for early lung cancer (LC) detection in Vietnam, Colombia, Thailand, Costa Rica, and Mexico. Country-specific hybrid decision-tree and budget impact models were developed from the public payer perspective over a 5-year time horizon. Each compared current symptomatic LC detection with a scenario adding AI-enabled Chest X-Ray for IPN detection and referral to low-dose computed tomography. Costs included diagnostics, set-up, treatment, healthcare resource use, and end-of-life care, expressed in 2024 USD. One-way sensitivity and scenario analyses tested parameter and structural uncertainty. Over the 5-year time horizon, the implementation of AI-enabled CXR for IPN detection is estimated to avert 24,763 premature deaths across the five countries, improving survival and lowering long-term expenditures. Following the introduction of qXR, more costs were incurred due to additional patients being diagnosed and treated. This resulted in fewer late-stage patients and cost savings. The breakeven point was reached in year 3 for Vietnam, Thailand, Colombia, and Mexico and in year 4 for Costa Rica. Cost savings were primarily driven by the stage shift towards earlier detection, where treatment costs are lower and survival outcomes are better. Integrating AI-enabled CXR for IPN detection into national hospital workflows may enable earlier LC detection and achieve cost neutrality within 5 years in low- and middle-income countries. These findings support the economic feasibility and scalability of AI-assisted imaging as part of national lung cancer control strategies.
Anti-granulocyte macrophage colony stimulating factor (anti-GM-CSF) antibodies, classically associated with pulmonary alveolar proteinosis (PAP), are increasingly recognised as a cause of adult-onset immunodeficiency predisposing to opportunistic infections. Coinfections with multiple opportunistic pathogens in this context are uncommon. We describe a rare case of disseminated Nocardia paucivorans, pulmonary Cryptococcus gattii, pulmonary Mycobacterium chelonae, and subsequent PAP in a patient with high-level anti-GM-CSF antibodies. A 64-year-old man presented with subacute bilateral shoulder pain and was diagnosed with acromioclavicular septic arthritis. N. paucivorans was isolated, and subsequent evaluation demonstrated disseminated infection with numerous brain abscesses, left eye endophthalmitis and pulmonary involvement. Interval computed tomography of the chest revealed new right lower lobe consolidation, a biopsy of which identified C. gattii and M. chelonae. Immunological testing confirmed high-level anti-GM-CSF antibodies. The patient received prolonged combination antimicrobial therapy, including meropenem, ceftriaxone, linezolid, trimethoprim-sulfamethoxazole, moxifloxacin, fluconazole, tigecycline and clofazimine, with clinical and radiological improvement of infectious lesions. Despite microbiological clearance, progressive bilateral ground-glass opacities developed on serial chest imaging consistent with PAP, with no pathogens identified on bronchoscopic sampling. Given minimal respiratory symptoms, PAP-directed therapy was deferred. The patient remains clinically stable on trimethoprim-sulfamethoxazole prophylaxis with ongoing clinical and radiological surveillance. This case illustrates the expanding clinical spectrum of anti-GM-CSF antibody-associated disease and underscores the importance of considering this diagnosis in patients presenting with opportunistic infections, in particular, disseminated nocardiosis or C. gattii infection. It also highlights the need for vigilance in evaluating for coinfections, recognition of PAP as a noninfectious codiagnosis, and the importance of long-term follow-up in affected patients.
Radiologic findings associated with SARS-CoV-2 infection have been well described since its emergence. However, long-term clinical and radiologic complications of pediatric SARS-CoV-2 infection are less defined, including radiologic findings in children following recovery. This study compares chest radiographic (CXR) and low-dose chest computed tomography (CT) findings in pediatric participants; a longitudinal cohort of children who have recovered from SARS-CoV-2 infection and uninfected controls. Eight hundred forty-six children (700 laboratory confirmed SARS-CoV-2-infected children and 146 uninfected controls) completed a radiologic exam at the baseline visit, which occurred 9.8 months (mean) post-infection. CXR (n=485) and CT (n=362) images were evaluated by three radiologists for known radiologic manifestations of COVID-19 including various patterns of opacities (ground glass, reticular, consolidation), nodules, perihilar thickening, effusions, and/or cystic changes. Comparisons were made using generalized estimating equations with cohort (infected vs. uninfected) as the predictor. Overall, the incidence of radiologic abnormalities detected at baseline was 32.1% in the infected cohort and 24.0% in the uninfected cohorts. Infected participants were more likely to have CXR abnormalities than uninfected (21.2% vs. 12.4%; OR 2.44; 95% CI 1.19-5.02; P=0.016). This was primarily due to an increased incidence of perihilar peribronchial thickening (17.4% in infected vs. 10.1% in noninfected). There were no statistically significant differences between cohorts for CT abnormalities (46.2% vs. 42.1%; OR 1.24; 95% CI 0.71-2.16; P=0.46). Radiologic abnormalities were not statistically significantly associated with presence of pulmonary symptoms after recovery. At the baseline visit, infected participants were more likely than uninfected controls to have chest radiographic abnormalities, limited to perihilar peribronchial thickening. There was no significant difference in CT abnormalities between the two cohorts. There was no increased frequency of radiographic findings in children with underlying asthma, nor in children who experienced pulmonary symptoms following recovery at the baseline visit.
Primary pulmonary inflammatory myofibroblastic tumor (IMT) associated with paraneoplastic pemphigus (PNP) is extremely rare. IMT is an intermediate (rarely metastasizing) mesenchymal neoplasm rather than a conventional sarcoma. We report a case of a 68-year-old female patient who initially presented with generalized skin rash, oral mucosal ulceration, and fever. Chest CT revealed a thoracic mass (initially difficult to determine whether mediastinal or pulmonary in origin). Subsequent thoracotomy and surgical resection with pathological examination confirmed an ALK-rearranged inflammatory myofibroblastic tumor (SQSTM1: ALK fusion) of pulmonary origin. Oral mucosal pathology, combined with clinical findings, supported a diagnosis of PNP. This case aims to provide reference for the diagnosis and treatment of patients with primary pulmonary IMT complicated by PNP. However, the follow-up period was short and systemic immunosuppressive therapy was not administered; this should be regarded as a cautionary note rather than a therapeutic recommendation.
In patients with congenital lung malformations (CLM), prenatal imaging is used to risk stratify patients and delineate algorithms for delivery planning and neonatal care. Most algorithms include a chest x-ray immediately after birth in all patients. This study sought to evaluate whether chest x-ray impacts clinical decision-making, ability to predict symptoms, and the decision to manage patients in the Neonatal Intensive Care Unit (NICU). A single center, retrospective cohort study was performed of patients diagnosed prenatally with a CLM (2015 - 2025). Maternal demographics, pre- and postnatal imaging, surgical details and outcomes were collected. Patients with symptoms at birth were compared to the asymptomatic cohort. 124 patients were included, with a median peak Congenital Pulmonary Airway Malformation Volume Ratio (CVR) of 0.79 (IQR 0.38-1.17). Only 15.3% received supplemental oxygen after birth (4% required mechanical ventilation). 72.3% were admitted to the NICU. 47.2% (50/106) had an abnormal x-ray, including 62% with a potential CLM and 38% with a clearly visible CLM. Of those with a clear CLM on x-ray, 84.2% (16/19) didn't have symptoms. The abnormal x-ray did not trigger further imaging or management changes. 13/19 patients with a clear CLM on x-ray were monitored in the NICU. X-ray sensitivity to detect symptomatic patients was 56.3% and specificity was 54.4%. Comparing the symptomatic and asymptomatic cohorts revealed no significant differences in the probability of an abnormal x-ray. Chest x-rays have poor sensitivity and specificity in the initial evaluation of asymptomatic CLM patients and did not change clinical decision-making including whether the patient required NICU-level care.
Purpose: Acute ischemic stroke (AIS) is the most prevalent stroke subtype. Given the brain-heart interaction, this study investigated the association between cardiac parameters on admission routine preoperative chest CT and recanalization following thrombectomy in AIS patients. Method: We retrospectively analyzed 215 AIS patients (August 2018-June 2022) who underwent admission of none contrast chest computed tomography (NCCT) and thrombectomy within 24 h. Successful recanalization was defined as modified Treatment in Cerebral Ischemia (mTICI) score 2b-3. Multivariable logistic regression identified independent predictors. A nomogram was developed and validated using ROC, calibration, and decision curve analyses. Result: The cohort had a median age of 72 years; 63.7% were male. Hypertension (65.1%), atrial fibrillation (25.1%), and pleural effusion (56.3%) were prevalent. Successful recanalization occurred in 172 patients (80%). Independent predictors included mean arterial pressure (OR: 1.022, CI: 1.003-1.041, p = 0.025), left pulmonary artery diameter (OR: 0.838, CI: 0.733-0.958, p = 0.010), RV/A ratio (standardized) (OR:1.908, CI: 1.293-2.817, p = 0.001), septal angle (OR: 1.055, CI: 1.018-1.094, p = 0.004), and intraventricular septal angle (OR: 0.973, CI: 0.952-0.995, p = 0.015). The model achieved an AUC of 0.774 (p < 0.001) with strong calibration and net benefit. Conclusions: Cardiac parameters on routine preoperative chest CT correlate with recanalization following thrombectomy in AIS patients. The developed nomogram offers a reliable tool for clinical risk stratification.
Timely and accurate Computed Tomography (CT) screening is crucial for the early clinical treatment of lung cancer and preventing the progression of malignant pulmonary nodules. However, owing to the large scale variations and blurred boundaries of lesions, existing deep learning models struggle to strike an optimal balance between computational costs, receptive field size, and the precise reconstruction of fine details. To address these challenges, this paper integrates three complementary components-A2C2f_DFFN, SPPF_LSKA, and DySample-into the YOLOv12n framework to construct PD-YOLO, a high-precision fine-grained lung cancer detection model. The main contribution lies in the synergistic optimization of these modules for CT‑based pulmonary lesion detection, rather than the theoretical novelty of any single component. Specifically, we introduce the A2C2f_DFFN module, which utilizes a Dynamic Feed-Forward Network to significantly enhance the non-linear feature representation of low-contrast early lesions. Furthermore, the SPPF_LSKA module is designed by combining Spatial Pyramid Pooling with Large Separable Kernel Attention, which expands the effective receptive field with extremely low computational overhead to handle large-scale massive tumor consolidations typical of advanced lung cancer. Additionally, an ultra-lightweight dynamic upsampling module (DySample) is employed to adaptively reconstruct high-resolution features, effectively mitigating the loss of edge textures and minor infiltrates during feature propagation. Extensive experiments on a chest CT dataset containing 4200 images demonstrate that PD-YOLO achieves a mean Average Precision (mAP @0.5) of 97.3%, outperforming state-of-the-art detectors including YOLOv12s and YOLOv12n. The proposed model successfully optimizes the trade-off between missed detections and false alarms, exhibiting highly robust overall object detection capabilities for complex clinical applications, particularly in the automated screening and localization of malignant pulmonary lesions.
Systemic inflammation is closely associated with acute exacerbations of chronic obstructive pulmonary disease and may reflect the risk of future exacerbations. Blood-based inflammatory biomarkers represent simple and practical tools for identifying patients at increased risk. The aim of this study was to evaluate the association between systemic inflammatory biomarkers measured during stable chronic obstructive pulmonary disease and overall exacerbation burden across Global Initiative for Chronic Obstructive Lung Disease stages. This retrospective cohort study included 132 patients with chronic obstructive pulmonary disease followed for at least 2 years. Clinical, functional, and laboratory data obtained during clinically stable periods were analyzed. Systemic inflammatory indices (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, aggregate index of systemic inflammation, and modified Glasgow prognostic score) were calculated. Exacerbation frequency was defined as the annualized number of moderate-to-severe exacerbations. Patients were classified according to Global Initiative for Chronic Obstructive Lung Disease groups A, B, and E, and associations between inflammatory biomarkers and clinical outcomes were evaluated using appropriate statistical methods, including receiver operating characteristic curve analyses. Elevated levels of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, aggregate index of systemic inflammation, modified Glasgow prognostic score, and C-reactive protein were significantly associated with increased exacerbation frequency and hospitalization rates in the overall cohort (all p<0.05), whereas systemic inflammation response index showed no significant association. Receiver operating characteristic analyses demonstrated moderate discriminative ability of C-reactive protein and inflammatory indices for predicting frequent exacerbations. Systemic inflammatory biomarkers were associated with adverse clinical outcomes in patients with chronic obstructive pulmonary disease and were significantly related to exacerbation frequency and severity. These findings suggest that systemic inflammatory markers may be useful for overall clinical assessment and identifying patients at increased risk of exacerbations, rather than for stage-specific risk stratification.
Sarcopenia, assessed via computed tomography (CT), is an emerging prognostic tool in critically ill, pulmonary, and geriatric patients. Laboratory inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and neutrophil-to-lymphocyte ratio (NLR) are routinely obtained in these populations. Whether CT-assessed sarcopenia combined with laboratory markers offers superior prognostic accuracy over either measure alone remains unclear. To systematically evaluate the prognostic value of CT-assessed sarcopenia, alone or combined with laboratory inflammatory/nutritional markers, for predicting mortality, mechanical ventilation duration, and ICU length of stay in critically ill, pulmonary, and geriatric patients. MEDLINE/PubMed, Scopus, Embase, and Cochrane Library were searched from inception to December 2024. Observational studies (prospective or retrospective cohorts, case-control) that reported CT-based sarcopenia assessment alongside at least one laboratory inflammatory marker and at least one clinical outcome were included. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale (NOS). Random-effects meta-analysis was performed; heterogeneity was assessed using the I² statistic. Twenty-five studies encompassing 12,347 patients were identified. The pooled odds ratio for mortality in sarcopenic versus non-sarcopenic patients was 2.28 (95% CI: 1.83-2.83; I² = 22.1%) across critically ill ICU cohorts. In COVID-19 pulmonary populations, pooled OR for in-hospital mortality with low skeletal muscle mass was 5.84 (95% CI: 1.07-31.83). CT-derived muscle measurements correlated inversely with CRP (r = -0.315), fibrinogen (r = -0.392), D-dimers (r = -0.363), and WBC count (r = -0.287). Combined CT-sarcopenia and inflammatory marker models outperformed conventional scoring systems (APACHE II, SOFA, CURB-65, PSI). CT-assessed sarcopenia, when integrated with laboratory inflammatory markers, provides a robust, mechanistically grounded, and clinically accessible multimodal prognostic framework across critically ill, pulmonary, and geriatric populations.
Long-term pulmonary sequelae following hospitalization for COVID-19 remain incompletely characterized, and few studies have reported radiological outcomes beyond 2 years. This study investigated the persistence of chest CT abnormalities up to 4.5 years after hospitalization for COVID-19 and their association with current dyspnea and fatigue. This longitudinal cohort study included patients hospitalized for COVID-19 in 2020. Chest CT was performed 3 months after hospital admission, with follow-up imaging after 12 months and 4.5 years in patients with persisting abnormalities. CT images were evaluated using a CT severity score (CSS) on a 0-12 scale, which was subsequently recoded to an abbreviated CSS (aCSS) on a 0-3 scale. Trends in CT abnormalities and their determinants were analyzed using multivariable mixed effects ordinal regression. In total, 187 patients underwent chest CT at 3 months. Among patients with persistent abnormalities, 99 completed follow-up CT at 12 months and 54 at 4.5 years. Dyspnea (33%) and fatigue (61%) remained common at 4.5 years; however, correlations between current symptoms and aCSS were weak. Greater severity of the initial disease and older age were strong predictors of CT abnormalities. Regression analysis showed a gradual reduction in ground glass opacities (GGO) severity over time, whereas parenchymal bands increased and were associated with initial severity as assessed by the WHO 8-point ordinal scale for clinical improvement. Mosaic attenuation decreased during follow-up, but remained associated with the severity of the initial COVID-19 episode. From 3 months to 4.5 years after hospitalization, GGO and mosaic attenuation decreased, whereas parenchymal bands increased, with minimal change beyond 12 months. CT abnormalities were associated with initial disease severity and age but showed little association with dyspnea or fatigue.
The diagnostic evaluation of pulmonary embolism (PE) in pregnancy is challenging, as the physiologic changes of pregnancy can mimic several PE symptoms. Acute respiratory infections introduce additional diagnostic complexity by producing systemic inflammation, altering vital signs, and, in some cases, elevating D-dimer levels. As a case in point, we examined how SARS-CoV-2 infection affected presentation, pretest probability, and diagnostic testing in pregnant patients with possible PE. We performed a retrospective cohort study across 21 community medical centers from October 1, 2021, to March 30, 2023. We included pregnant outpatients ≥ 18 years evaluated for suspected PE with D-dimer testing, compression ultrasonography, computed tomography pulmonary angiography (CTPA), or lung scintigraphy. We compared patients with and without COVID-19 using bivariate analysis. Among 860 patients, the median age was 30.0 years; 39.1% were in the third trimester. COVID-19 was present in 147 (17.1%). Compared with non-COVID-19 patients, those with COVID-19 more often had fever (36.1% vs. 4.2%), tachycardia ≥ 110 bpm (66.0% vs. 34.2%), and oxygen saturation < 95% (12.2% vs. 4.8%), but less often reported chest pain (49.7% vs. 65.5%; all p  < 0.001). Nearly all patients had low-to-intermediate pretest probability, but intermediate classification was more common with COVID-19 patients (63.3% vs. 39.0%; p  < 0.001). COVID-19 patients more often had elevated D-dimer > 1.0 mg/L (49.1% vs. 36.4%; p  < 0.001) and more commonly underwent chest radiography (61.9% vs. 50.1%; p  = 0.009). Among patients who underwent advanced imaging ( n  = 393), CTPA predominated in both cohorts. Overall, PE was rare ( n  = 6; 0.7%), and mortality was low ( n  = 3; 0.3%). COVID-19 in pregnancy was associated with worse vital signs, higher pretest probability, higher D-dimer values, and increased diagnostic testing. These findings illustrate how acute respiratory infections may recalibrate PE risk assessment in pregnancy and highlight the need to refine diagnostic strategies when infection-related physiologic changes are present.
Amiodarone is a widely used antiarrhythmic agent. Pulmonary toxicity is its most feared non-cardiac complication and is classically associated with high doses and prolonged duration of therapy. We report a case of early-onset amiodarone pulmonary toxicity (APT) developing after approximately one month of standard-dose amiodarone therapy (400 mg/day) in the setting of concurrent decompensated heart failure with preserved ejection fraction (HFpEF), which substantially complicated the diagnostic evaluation. A 71-year-old male with paroxysmal atrial fibrillation, nonischemic cardiomyopathy, and multiple comorbidities was initiated on amiodarone 400 mg/day in April. Within one month, he developed progressive dyspnea on exertion and productive cough. He presented to the emergency department in September with acute hypoxic respiratory failure (SpO₂ 86% on room air), weight gain, and bilateral lower extremity edema approximately five months after symptom onset. CT of the chest demonstrated bilateral ground-glass and consolidative opacities with upper lobe predominance and interlobular septal thickening. The initial working diagnosis of decompensated HFpEF was supported by elevated BNP and peripheral edema; intravenous furosemide led to the resolution of edema but no improvement in oxygenation. APT was subsequently suspected, and intravenous methylprednisolone was initiated, resulting in marked clinical improvement. The patient was discharged on room air on a prolonged prednisone taper. At the three-month follow-up, he demonstrated complete symptomatic resolution, marked radiological improvement, and normalization of BNP. This case adds to the existing evidence that clinically significant APT may occur at standard maintenance doses and within a shorter timeframe than traditionally recognized. Coexistent HFpEF poses a major diagnostic challenge given the substantial overlap in clinical and radiological features. The possibility of concurrent rather than competing pathology should always be considered. Clinicians should maintain a high index of suspicion for APT in any patient on amiodarone with progressive respiratory symptoms, irrespective of dose or duration of exposure.
Kounis syndrome is an allergic acute coronary syndrome triggered by hypersensitivity reactions. Its association with allergic bronchopulmonary aspergillosis (ABPA) is rarely reported. We describe a 77-year-old woman with asthma, chronic obstructive pulmonary disease, and established ABPA who developed acute chest tightness and dyspnea during an ABPA relapse. Laboratory testing showed marked eosinophilia, elevated total IgE, and evidence of myocardial injury, with increased cardiac troponin I and B-type natriuretic peptide. Electrocardiography revealed ischemic changes, and coronary angiography demonstrated nonobstructive coronary arteries. Based on the clinical and immunologic findings, Kounis syndrome, possibly triggered by ABPA, was diagnosed. The patient improved with antifungal therapy, systemic corticosteroids, coronary vasodilators, and supportive care. This case highlights ABPA relapse as a potential trigger of Kounis syndrome and emphasizes the need for cardiovascular vigilance in patients with severe allergic airway disease.
Pulmonary hypertension (PH) refers to a disease condition with elevated mean pulmonary arterial pressure of more than 20 mm Hg. This may arise secondary to an underlying pathology involving the lungs, heart, or major vessels of the chest. Patients with PH can present with nonspecific cardiac or respiratory complaints. Although right heart catheterization is the gold standard for diagnosing PH, it is not always done or required and often, PH is diagnosed based on clinical suspicion and noninvasive tests such as echocardiography. Computed tomography (CT) scans play a vital role in diagnosing PH, detecting the severity of the disease, and discerning the etiological factors. A stepwise approach to review CT imaging of the thorax to aid in the diagnosis of PH and to look for the etiology and prognostic factors is described in this article.
Unilateral upper-lung field pulmonary fibrosis (upper-PF) can occur on the operative side after lung cancer surgery. It is reportedly associated with pleural effusion at 6 months post-surgery (PE-6mo), but the perioperative risk factors for PE-6mo and the cumulative incidence of upper-PF remain unclear. We retrospectively reviewed all patients with lung cancer who underwent radical surgical resection between 2008 and 2016. Perioperative characteristics were compared based on the presence of PE-6mo. The cumulative incidence of upper-PF in patients with PE-6mo was estimated using a competing risk analysis. Of the 587 patients, 160 (27.2%) had PE-6mo. Multivariate analysis identified age > 70 years, body mass index < 22, thoracotomy, lobectomy, pulmonary apical cap, and adjuvant chemotherapy as independent risk factors for PE-6mo. Among 115 patients evaluable by chest CT for 2 years, 25 (21.7%) subsequently developed upper-PF (upper-PF group), while 90 did not (non-upper-PF group). The 3-, 5-, and 10-year cumulative incidences of upper-PF were 11.5%, 16.4%, and 24.6%. The upper-PF group more commonly had prolonged pleural effusion at 2 years than the non-upper-PF group (21/25 vs. 51/90, p = 0.018). Furthermore, pleural thickening was already evident at 6 months in the upper-PF group (15/25 vs. 18/90, P < 0.001) and thereafter. For patients with pleural thickening at 6 months, the 3-, 5-, and 10-year cumulative incidences of upper-PF were 24.2%, 35.0%, and 51.8%. Prolonged pleural effusion with pleural thickening was a common phenomenon in patients who later developed upper-PF after surgery and may therefore be a strong postoperative indicator of upper-PF development.
Congenital pulmonary airway malformation (CPAM), previously termed congenital cystic adenomatoid malformation (CCAM), is a rare developmental anomaly of the lower respiratory tract that is most commonly diagnosed prenatally or during early infancy. Presentation in adolescence is uncommon, particularly when associated with bilateral lesions and pneumothorax. We report the case of a 14-year-old female with no relevant past medical history who presented with sudden-onset progressive dyspnea and was found to have an approximately 50% right-sided pneumothorax. Contrast-enhanced chest computed tomography demonstrated bilateral apical cystic lesions initially interpreted as pneumatoceles, measuring 25 × 10 mm in the right lung apex and 10 × 18 mm in the left lung apex. After initial pleural drainage, the patient underwent right apical wedge resection, followed one week later by left-sided wedge resection. Histopathological examination of both specimens revealed pulmonary tissue with congested vessels, focal alveolar collapse, and multiple cystic spaces of variable size with thin fibrous walls and focal simple cuboidal epithelial lining. CD31 immunostaining was negative in the cyst lining, and Ziehl-Neelsen staining was negative. The overall findings were consistent with Stocker type 2 CPAM. This case highlights an unusual adolescent presentation of bilateral apical CPAM complicated by pneumothorax and underscores the importance of histopathologic confirmation when imaging findings are atypical or inconclusive.
Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly with exceptional survival into adulthood. We present a 66-year-old woman with chest and back pain in whom ALCAPA was diagnosed using coronary computed tomography angiography (CCTA) with curved planar reformation and cinematic volume rendering technique (cVRT). Photorealistic three-dimensional reconstruction provided complementary three-dimensional visualization that may facilitate anatomic understanding and communication of the anomalous origin. Conservative management was adopted given the patient's age and well-developed collateral circulation. This case underscores the value of advanced CCTA visualization in diagnosing rare coronary anomalies in elderly patients.
COVID-19 pandemic has significantly impacted global health, particularly evident in the detection of lung lesions via chest computed tomography scans. This study investigates the role of biomarkers in lung injury among COVID-19 patients and patients with idiopathic pulmonary fibrosis (IPF). This single-center prospective study included 154 hospitalized and 10 outpatient COVID-19 patients, 62 IPF patients, and 40 healthy volunteers, and evaluated biomarkers of alveolar epithelial cell dysfunction, extracellular matrix (ECM) and fibroblast dysfunction, and macrophage/monocyte activation (Galectin-3, CXCL13). Findings were further validated in an independant confirmation cohort (DisCoVeRy trial). COVID-19 patients had higher levels of biomarkers compared to healthy controls, except for SP-D. Compared to IPF patients, COVID-19 patients had significantly higher plasma levels of OPN, Galectin-3 and CXCL13 at admission. Elevated CXCL13 and Galectin-3 levels in COVID-19 were associated with greater lung injury. Multivariate logistic regression and Kaplan Meier analysis confirmed the role of CXCL13 in predicting severe lung injury (odd ratio 3.17, 95% CI 1.03-9.76) and in-hospital mortality (p = 0.04), with consistent results observed in the confirmation cohort. COVID-19 is characterized by increased ECM and macrophage activation biomarkers compared with IPF. CXCL13 may serve as a relevant biomarker for assessing lung injury and improving risk stratification at hospital admission.
This analysis evaluates respiratory outcomes and the occurrence of respiratory complications during the first 24 hours after hospital admission, according to the ventilatory strategy used during out-of-hospital cardiopulmonary resuscitation, including a group with a ventilatory mode synchronized with chest compressions. Pragmatic quasi-experimental study including all patients with out of hospital cardiac arrest with persistence of cardiac arrest 3 minutes after early intubation who were transferred to a hospital. Duration: 3.5 years. Patients were grouped according to ventilation strategy: Chest Compression Synchronized Ventilation (CCSV), Intermittent Positive Pressure Ventilation (IPPV), or bag-valve ventilation. Radiological findings (pneumothorax, signs of barotrauma, and pulmonary infiltrates according to the Modified Chest X-ray Scoring System) and arterial blood gas parameters within the first 24 hours after hospital admission were analyzed. A total of 278 patients transferred to a hospital were included, and 68 were excluded because no radiological study was performed due to immediate certification of death (22.7% women, mean age 61.9 (SD, 16.5) years, 44.3% with shockable rhythm): 41 in the CCSV group, 65 in the IPPV group, and 104 with bag-valve ventilation. PaO2/FiO2 values were, respectively, 247 (SD, 162), 200 (SD, 117), and 202 (SD, 118) mmHg (P < .05 between CCSV and the other groups). Pneumothorax or subcutaneous emphysema was found in 2.4% of patients ventilated with CCSV, 10.8% with IPPV, and 6.7% with bag-valve ventilation (P = .26). The Modified Chest X-ray Score was, respectively, 4.6 (SD, 3.1), 5.7 (SD, 3.3), and 5.1 (SD, 3.1) (P = .23). CCSV is associated with better PaO2/FiO2 at 24 hours vs other ventilation strategies. There was no higher incidence rate of pneumothorax with CCSV, and no significant differences were found in the development of radiological infiltrates. Se analiza la evolución y aparición de complicaciones respiratorias en las primeras 24 horas de ingreso de los pacientes que fueron trasladados a un hospital, en función de la estrategia ventilatoria empleada durante la reanimación cardiopulmonar extrahospitalaria, incluyendo un grupo con un modo ventilatorio sincronizado con las compresiones. Estudio cuasiexperimental pragmático que incluye todos los pacientes en parada cardiaca extrahospitalaria no traumática con persistencia de la parada cardiaca 3 minutos después de intubación precoz que fueron trasladados a un hospital. Durante un periodo de 3,5 años. Los pacientes se agruparon según la estrategia ventilatoria: ventilación sincronizada con la compresión torácica (CCSV), ventilación con presión positiva intermitente (IPPV) o balón de resucitación. Se analizan datos radiológicos (neumotórax, signos de barotrauma e infiltrados pulmonares según la escala Modified Chest X-ray Scoring System) y parámetros gasométricos arteriales de las primeras 24 horas de ingreso hospitalario. Se incluyeron 278 pacientes trasladados a un hospital y se excluyeron 68 sin estudio radiológico por certificación inmediata de fallecimiento (22,7% mujeres, edad media 61,9 (DE 16,5) años, 44,3% con ritmo desfibrilable): 41 en CCSV, 65 en IPPV y 104 con balón. La PaO2/FiO2 fue, respectivamente, 247 (DE 162), 200 (DE 117) y 202 (DE 118) mmHg (p < 0,05 entre CCSV y los otros grupos). Se encontró neumotórax o enfisema subcutáneo el 2,4% de los ventilados en CCSV, 10,8% en IPPV y 6,7% con balón (p = 0,26). El Modified Chest X-ray Score fue, respectivamente, 4,6 (DE 3,1), 5,7 (DE 3,3) y 5,1 (DE 3,1) (p = 0,23). CCSV se asocia a mejor PaO2/FiO2 a las 24 horas que las otras estrategias. No existe una mayor incidencia de neumotórax con CCSV ni se encuentran diferencias significativas en la aparición de infiltrados radiológicos.