High Resolution Computed Tomography (HRCT)

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Diagnosing fibrotic lung disease: When is high resolution computed tomography sufficient to make a diagnosis of idiopathic pulmonary fibrosis?

Diagnosing fibrotic lung disease: When is high resolution computed tomography sufficient to make a diagnosis of idiopathic pulmonary fibrosis?

Idiopathic pulmonary fibrosis (IPF), a progressive and fatal diffuse parenchymal lung disease, is defined pathologically by the pattern of usual interstitial pneu- monia (UIP). Unfortunately, a surgical lung biopsy cannot be performed in all patients due to comorbidi- ties that may significantly increase the morbidity and mortality of the procedure. High-resolution computed tomography (HRCT) has been put forth as a surrogate to recognize pathological UIP. The quality of the HRCT impacts the ability to make a diagnosis of UIP and varies based on the centre performing the study and patient factors. The evaluation of the HRCT includes assessing the distribution and predominance of key radiographical findings, such as honeycomb, septal thickening, traction bronchiectasis and ground glass attenuation lesions. The combination of the pattern and distribution is what leads to a diagnosis and asso- ciated confidence level. HRCT features of definite UIP (subpleural, basal predominant honeycomb with septal thickening, traction bronchiectasis and ground glass attenuation lesions) have a high specificity for the UIP pathological pattern. In such cases, surgical lung biopsy can be avoided. There are caveats to using the HRCT to diagnose IPF in isolation as a variety of chronic pulmonary interstitial diseases may progress to a UIP pattern. Referral centres with experience in diffuse parenchymal lung disease that have multidisci- plinary teams encompassing clinicians, radiologists and pathologists have the highest level of agreement in diagnosing IPF.
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The value of high-resolution computed tomography (HRCT) to determine exercise ventilatory inefficiency and dynamic hyperinflation in adult patients with cystic fibrosis

The value of high-resolution computed tomography (HRCT) to determine exercise ventilatory inefficiency and dynamic hyperinflation in adult patients with cystic fibrosis

High-resolution computed tomography (HRCT) of the lung is able to demonstrate a broad range of pulmonary abnormalities in CF patients with mild-to-moderate lung disease [7], identifying lower airway inflammation and early lung impairments [8]. The Brody score [7] is a composite HRCT score including different radiological features of lung disease (Bronchiectasis-B, Airways Wall Thickening-AWT, Mucous plugging-MP, Parenchyma-P and Air Trapping-AT) and demonstrating a high inter-observer reproducibility [9]. In CF patients, higher Brody scores indicate more severe disease [7]; they are also strongly associated with lung disease progression [10], predicting the rate of pulmonary exacerbations up to 10-year follow-up [11].
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Idiopathic Interstitial Pneumonias (IIPs): Review of Clinical, Radiographic and High Resolution Computed Tomography (HRCT)

Idiopathic Interstitial Pneumonias (IIPs): Review of Clinical, Radiographic and High Resolution Computed Tomography (HRCT)

Reference [35] coined the term desquamative interstitial pneumonia. DIP is considered as a form of interstitial pneumonia in which the alveolar spaces shows the presence of diffuse exudation of pigmented macrophages [4]. Reference [31] by comprehensive evaluation of HRCT findings, various degrees of severity of a reaction of small airways and lung parenchyma to cigarette smoke should be well advised in DIP and RB-ILD. Drug reac- tions and connective tissue diseases such as scleroderma, lupus and rheumatoid arthritis interrelate with DIP [36]-[38]. Reference [39] studies shows less than 3% of interstitial lung disease comes under DIP; patients in their third to fifth decade are usually affected, with value of males twice to that of females. Definite histological patterns to differentiate DIP from RB-IDL are given according to the guidelines [4], however making it difficult in histopathological diagnosis of DIP from RB-IDL. Lesions affecting in DIP are in uniform manner while RB-IDL shows bronchiolocentric distribution [31].
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Search | Preprints

Search | Preprints

World is now experiencing a major health calamity due to the coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus clade 2 (SARS-CoV- 2). The foremost challenge facing the scientific community is to explore the growth and transmission capability of the virus. Use of artificial intelligence (AI), such as, deep learning, in (i) rapid disease detection from x-ray/computerized tomography (CT)/ high-resolution computed tomography (HRCT) images, (ii) accurate prediction of the epidemic patterns and their saturation throughout the globe, (iii) identification of the epicenter in each country/state and forecasting the disease from social networking data, (iv) prediction of drug-protein interactions for repurposing the drugs, and (v) socio-economic impact and prediction of future relapses, has attracted much attention. In the present manuscript, we describe the role of various AI-based technologies for rapid and efficient detection from CT images complementing quantitative real time polymerase chain reaction (qRT-PCR) and immunodiagnostic assays. AI-based technologies to anticipate the current pandemic pattern, possibility of future relapses and socio-economic impact are also discussed. We inspect how the virus transmits depending on different factors, such as, population density and mobility among others. We depict how AI-based mobile app for contact tracing and surveys can prevent the transmission. A modified deep learning technique can assess affinity of the most probable drugs to treat COVID-19.
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Correlation of 30 consecutive idiopathic pulmonary fibrosis patients intertiary care center

Correlation of 30 consecutive idiopathic pulmonary fibrosis patients intertiary care center

Background: Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause, primarily occurring in older adults, limited to the lungs, and associated with histological and/ or radiologic pattern of usual interstitial pneumonia. The objective of the study is to correlate severity of IPF and duration of symptoms with spirometry test/ forced vital capacity (FVC), high resolution computed tomography (HRCT) findings, smoking history, age and sex of 30 consecutive IPF patients in a tertiary care centre.
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Fiberoptic bronchoscopy for the rapid diagnosis of smear negative pulmonary tuberculosis

Fiberoptic bronchoscopy for the rapid diagnosis of smear negative pulmonary tuberculosis

Chest high-resolution computed tomography (HRCT) provides information about the extent and distribution of PTB and can be a great help in identifying its activity. In sputum smear-negative cases, HRCT is superior to chest x-ray in the diagnosis of PTB and in the determin- ation of its extent and distribution. Further, it confirms the presumptive diagnosis of active PTB and allows anti- tuberculosis treatment to commence more quickly. Des- pite some disadvantages such as high cost and radiation exposure, HRCT is widely used when traditional meth- ods have failed to diagnose PTB in sputum smear- negative patients. Typical radiological patterns of PTB reactivation such as upper lobe involvement or cavity formation are rarely observed in sputum smear-negative cases due to the smaller burden of mycobacterium [5]; therefore, HRCT alone is limited in diagnosing PTB in sputum smear-negative patients.
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Successful resumption of tocilizumab for rheumatoid arthritis after resection of a pulmonary Mycobacterium avium complex lesion: a case report

Successful resumption of tocilizumab for rheumatoid arthritis after resection of a pulmonary Mycobacterium avium complex lesion: a case report

In September 2013, a 63-year-old woman was referred to our outpatient clinic due to hemoptysis and a pul- monary lesion on high-resolution computed tomography (HRCT). Her height was 165.0 cm and body weight was 46.0 kg. The patient never smoked but had a medical history of Crohn’s disease, which remained in remission, and RA that was diagnosed in 2010 according to the criteria of the American College of Rheumatology. She had been treated with prednisolone (PSL) (5 mg/day) and methotrexate (12 mg/week). Because the disease activity was not properly controlled with these medica- tions, methotrexate was stopped and 360 mg of TCZ was administered intravenously once every 4 weeks from October 2011. At this time, the visual analogue scale (VAS) was 37 mm and the disease activity score (DAS) 28–C-reactive protein (CRP) was 3.81. When TCZ was introduced, her chest radiograph was normal (Fig. 1a), but HRCT showed a small nodular shadow in the right upper lobe of the lung (Fig. 1b). Although the patient had no respiratory symptoms with no pathogenic bacteria isolated from the sputum, she was prescribed 400 mg/day clarithromycin (CAM) as a monotherapy before her referral to our department. Two years after
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The reliability of lung ultrasound in assessment of idiopathic pulmonary fibrosis

The reliability of lung ultrasound in assessment of idiopathic pulmonary fibrosis

Notes: (A, B) Axial HRCT imaging in the lung window at the level of middle and lower lobes with subpleural reticulation with a basal predominance; honeycombing (black arrows) and traction bronchiectasis (red arrow) associated in .50%. (C, D) LUS at the level of both sixth Pv lines: .3 B-lines are seen per IS (white thin arrows) with a median distance between one another of 5.6 mm; irregular, thickened, blurred pleural line confirmed the fibrotic interstitial syndrome. The yellow arrow shows the pleural line. Abbreviations: HRCT, high-resolution computed tomography; LUS, lung ultrasound; NSIP, nonspecific interstitial pattern; IPF, idiopathic pulmonary fibrosis; UIP, usual interstitial pneumonia; PV, paravertebral; IS, intercostal space.
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Highlights of HRCT imaging in IPF

Highlights of HRCT imaging in IPF

High-resolution computed tomography (HRCT) imaging has a central role in the diagnosis of interstitial lung diseases, particularly in the evaluation of patients with suspected idiopathic pulmonary fibrosis (IPF). In approximately half of cases, HRCT scans are sufficient to allow a confident IPF diagnosis. Advances in HRCT scanning and interpretation have facilitated improved accuracy for use in diagnosing IPF, eliminating the need for a surgical biopsy in many patients. HRCT may also have a role to play in predicting the prognosis of the disease;. The role of routine follow-up with HRCT to monitor patients with IPF remains unclear due to lack of sufficient evidence, although, sometimes follow-up HRCT might be necessary to rule out progressive disease in patients with undetermined diagnosis. Advances in the field of HRCT imaging are discussed, along with insights into the clinical utility of this procedure in the diagnosis and management of IPF.
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Sclerosing Variant of the Bronchioloalveolar Carcinoma:  Imaging Findings in an Atypical Case

Sclerosing Variant of the Bronchioloalveolar Carcinoma: Imaging Findings in an Atypical Case

A chest radiograph revealed bilateral nonhomogeneous opacities, predominantly in the middle third of the right lung (Figure 1). The high-resolution computed tomography (HRCT) demonstrated confluent airspace nodules, form- ing areas of consolidation in both lungs, with signs of architectural distortion (Figure 2). Bronchoscopy showed no abnormalities. Microscopical examination and cultures of sputum and bronchoalveolar lavage were negative for

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Role of Quantitative CT in COPD and Its Correlation with Pulmonary Function Test Values

Role of Quantitative CT in COPD and Its Correlation with Pulmonary Function Test Values

ABBREVIATIONS COPD : Chronic Obstructive Pulmonary Disease GOLD : Global Initiative for Chronic Obstructive Lung Disease HRCT : High-resolution computed tomography QCT : Quantitative CT [r]

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Characterizing idiopathic pulmonary fibrosis patients using US Medicare-advantage health plan claims data

Characterizing idiopathic pulmonary fibrosis patients using US Medicare-advantage health plan claims data

The cohort entry date (index date) was set as the date of the first medical claim with a diagnosis of IPF within the study period. Only incident cases, defined as IPF patients without IPF claims in the baseline period were eligible for this study. Patients with other known causes of ILD such as connective tissue disease, hypersensitivity pneumonitis and others during baseline were excluded (Additional file 1, [3]). Patients with claims for IPF diag- nostic testing (high-resolution computed tomography (HRCT) of the thorax or surgical lung biopsy (SLB) during baseline) were identified for a subgroup analysis (referred to as the IPF diagnostic testing subgroup). This was a stricter case definition done to identify a subgroup who would more definitively be considered to have IPF, to assess how the case definition may influence the results. The number of patients with IPF diagnostic testing in the first 30 days after diagnosis was also evaluated.
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Diagnostic accuracy of a velcro sound detector (VECTOR) for interstitial lung disease in rheumatoid arthritis patients: the InSPIRAtE validation study (INterStitial pneumonia in rheumatoid ArThritis with an electronic device)

Diagnostic accuracy of a velcro sound detector (VECTOR) for interstitial lung disease in rheumatoid arthritis patients: the InSPIRAtE validation study (INterStitial pneumonia in rheumatoid ArThritis with an electronic device)

Background: Interstitial lung disease (ILD) is a severe systemic manifestation of rheumatoid arthritis (RA). High- resolution computed tomography (HRCT) represents the gold standard for the diagnosis of ILD, but its routine use for screening programs is not advisable because of both high cost and X-ray exposure. Velcro crackles at lung auscultation occur very early in the course of interstitial pneumonia, and their detection is an indication for HRCT. Recently, we developed an algorithm (VECTOR) to detect the presence of Velcro crackles in pulmonary sounds and showed good results in a small sample of RA patients.
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A long-term study assessing the factors influencing survival and morbidity in the surgical management of bronchiectasis

A long-term study assessing the factors influencing survival and morbidity in the surgical management of bronchiectasis

A retrospective chart review was conducted of 129 patients who underwent surgical resection for bronch- iectasis between April 2002 and April 2010. The patients demographic features, the symptoms, etiologies and resection types, morbidity, mortality and outcomes after surgical management were analyzed. Patients were cho- sen as candidates for surgical treatment according to the following criteria: localized bronchiectasis documented by high-resolution computed tomography (HRCT), ade- quate cardiopulmonary reserve, symptoms such as chronic productive cough, repeated or significant hemoptysis, lung abscess, empyema, and recurrent pul- monary infections, and failure of medical treatment. Medical therapy constituted judicious use of systemic antibiotics based on current sputum or bronchoscopic lavage cultures, mucolytic agents, expectorants, postural drainage, humidification, anti-inflammatory agents, and bronchodilators. Fiberoptic bronchoscopy or rijit bronchoscopy was performed in all patients to rule out any intraluminal pathology. Failure of medical treatment was defined as frequent exacerbations interfering with normal professional and social life or requiring multiple hospitalizations. The focus of hemorrhage was identified bronchoscopically in patients with repeated or signifi- cant hemoptysis, and, after the lungs were assessed by HRCT, surgery was planned in patients who did not respond adequate to conservative treatment.
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Newly formed cystic lesions for the development of pneumomediastinum in Pneumocystis jirovecii pneumonia

Newly formed cystic lesions for the development of pneumomediastinum in Pneumocystis jirovecii pneumonia

a WBC count of 1,760/uL, Hb 10.9 g/dL, and platelet count of 297,000/uL. Arterial blood gas analysis while breathing room air revealed PaO 2 of 48.0 mmHg, PaCO 2 of 32.7 mmHg, and saturation of 88.5%, and the calcu- lated (A-a)DO 2 was 53.7. CD4 count and HIV viral load were 4/uL and 130,000 IU/mL, respectively. Diffuse bilat- eral infiltrates of both lung fields were noted, and no cystic lesions were observed on the chest X-ray and high resolution computed tomography (HRCT) taken on admission. Bronchoscopic alveolar lavage for diagnosis of P. jirovecii was carried out, and microscopic examination of the bronchoalveolar lavage fluid obtained showed P. jirovecii; no other microorganisms were detected by cul- ture. Treatment with trimethoprim/sulfamethoxazole, fluconazole and corticosteroids at standard dosages was started. The patient had never been on HAART therapy prior to admission. HAART therapy was added to the treatment on the 8 th hospital day. During the treatment
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Managing diagnostic procedures in idiopathic pulmonary fibrosis

Managing diagnostic procedures in idiopathic pulmonary fibrosis

ABSTRACT: Idiopathic pulmonary fibrosis (IPF), the most prevalent of the idiopathic interstitial pneumonias, is associated with a poor prognosis. An accurate diagnosis of IPF is essential for its optimal management. The 2011 American Thoracic Society (ATS)/European Respiratory Society (ERS)/Japanese Respiratory Society (JRS)/Latin American Thoracic Association (ALAT) recommendations on the diagnosis and management of IPF were developed from a systematic review of the published literature. High-resolution computed tomography (HRCT) scanning has a central role in the IPF diagnostic pathway, with formal designation of criteria for an HRCT pattern of usual interstitial pneumonia. In the correct clinical context, a usual interstitial pneumonia pattern on HRCT is indicative of a definite diagnosis of IPF and negates the need for a surgical lung biopsy. However, although the 2011 ATS/ERS/JRS/ALAT statement is a major advance, the application of the guideline recommendations by clinicians has identified limitations that should be addressed in future statements. Key problems include: 1) HRCT misdiagnosis, particularly by less experienced radiologists; 2) lack of management recommendations for the highly prevalent clinical scenarios of ‘‘probable’’ or ‘‘possible’’ IPF; 3) ongoing confusion concerning the diagnostic role of bronchoalveolar lavage; and 4) the lack of integration of clinical data in the designation of the diagnostic likelihood of IPF, including the treated course of disease. These issues become evident as the recommendations are applied and highlight the need for continued guideline adjustments.
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How I manage pulmonary Langerhans cell histiocytosis

How I manage pulmonary Langerhans cell histiocytosis

A 24-year-old man was referred for a nodulocystic pattern on lung high-resolution computed tomography (HRCT) that suggested PLCH (figure 1a). He had been smoking 10 cigarettes·day −1 since he was 17 years of age and had started complaining of a disabling dry cough 3 months before being referred. The physical examination was normal. Plethysmography showed normal total lung capacity (TLC) (89% predicted), a mild decrease in vital capacity (VC) (74% predicted), air trapping (residual volume (RV)/TLC 152% predicted) and no airflow obstruction. Diffusing capacity of the lung for carbon monoxide (D LCO ) was decreased to 65% predicted. Bronchoalveolar lavage (BAL) recovered 240 000 cells·mL −1 with 90% macrophages, 6% lymphocytes, 2% neutrophils, 2% eosinophils and no pathogens. A presumptive diagnosis of isolated PLCH was made and the patient was strongly encouraged to quit smoking, which he managed to do. He was regularly seen at 3, 6 and 12 months during follow-up while he weaned himself off tobacco. He rapidly improved and became asymptomatic at 3 months of follow-up, and his chest radiograph and lung function improved. At his 1-year evaluation, plethysmography showed normal lung volume (TLC 91% predicted, VC 97% predicted and RV/TLC 88% predicted) and significant improvement of D LCO (76% predicted). Lung HRCT confirmed that there was virtually a complete resolution of pulmonary lesions (figure 1b).
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KCNA5 gene is not confirmed as a systemic sclerosis related pulmonary arterial hypertension genetic susceptibility factor

KCNA5 gene is not confirmed as a systemic sclerosis related pulmonary arterial hypertension genetic susceptibility factor

residents with ancestry from northern and western Europe; dcSSc: diffuse cutaneous systemic sclerosis; hRCT: High-resolution computed tomography; HWE: Hardy-Weinberg equilibrium; K: potassium; KCNA5: potassium voltage- gated channel shaker-related subfamily member 5; Kv channels: potassium voltage-gated channels; lcSSc: limited cutaneous systemic sclerosis; MAF: minor allele frequency; NOTCH4: Notch (Drosophila) homologue 4; OR: odds ratio; PAH: pulmonary arterial hypertension; PASMC: pulmonary artery smooth muscle cell; PCR: polymerase chain reaction; SNP: single-nucleotide polymorphism; SOX5: SRY (sex-determining region Y)-box 5; SSc: systemic sclerosis.
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Real-time and nested polymerase chain reaction in the diagnosis of multifocal serpiginoid choroiditis caused by Mycobacterium tuberculosis - a case report

Real-time and nested polymerase chain reaction in the diagnosis of multifocal serpiginoid choroiditis caused by Mycobacterium tuberculosis - a case report

ATT: antitubercular therapy; CRA: chorioretinal atrophic; DOV: diminution of vision; HRCT: high-resolution computed tomography; LE: left eye; MSC: multifocal serpiginoid choroiditis; MTb: Mycobacterium tuberculosis ; N-PCR: nested PCR; PCR: polymerase chain reaction; RE: right eye; RT-PCR: real-time PCR; SC: serpiginous choroiditis; TB: tuberculosis.

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Genetic testing in diffuse parenchymal lung disease

Genetic testing in diffuse parenchymal lung disease

Idiopathic pulmonary fibrosis (IPF; ORPHA2032) is the most common of the idiopathic interstitial pneumonias. The histopathologic hallmark is a heterogeneous appear- ance in which areas of fibrosis with scarring and honey- comb change alternate with areas of less affected or normal parenchyma (so called usual interstitial pneumo- nia - UIP - pattern). According to the prevailing hypoth- esis, IPF develops as a result of excessive, sequential lung injury and aberrant wound healing. Patients usually present with progressive dyspnoea, chronic dry cough, reticular infiltrates on chest X-ray or chest high- resolution computed tomography (HRCT) and a restric- tive ventilatory defect with decreased diffusion capacity for carbon monoxide. Clinical trials of some therapeutic agents suggest a possible benefit, although to date there is insufficient evidence to support the use of any specific pharmacologic therapy for patients with IPF [5].
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