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Raad RA, Garrana S, Moreira AL, Moore WH, Ko JP. Imaging and Management of Subsolid Lung Nodules. Radiol Clin North Am 2025; 63:517-535. [PMID: 40409933 DOI: 10.1016/j.rcl.2024.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2025]
Abstract
Subsolid nodules (SSNs) are increasingly encountered in chest computed tomography (CT) imaging and clinical practice, as awareness of their significance and CT utilization grows. Either part-solid or solely ground-glass in attenuation, SSNs are shown to correlate with lung adenocarcinomas and their precursors, although a differential diagnosis is to be considered that includes additional neoplastic and inflammatory etiologies. This review discusses the differential diagnosis for SSNs, imaging and clinical features, and pathology that are helpful when making management decisions that may include PET/CT, biopsy, or surgery. Potential pitfalls in nodule characterization and management will be highlighted, to aid in managing SSNs appropriately.
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Affiliation(s)
- Roy A Raad
- Department of Radiology, NYU Langone Health, 660 First Avenue, 3rd Floor, New York, NY 10016, USA.
| | - Sherief Garrana
- Department of Radiology, NYU Langone Health, 660 First Avenue, 3rd Floor, New York, NY 10016, USA
| | - Andre L Moreira
- Department of Pathology, NYU Langone Health, 560 First Avenue, TH4 15J, New York, NY 10016, USA
| | - William H Moore
- Department of Radiology, NYU Langone Health, 660 First Avenue, 3rd Floor, New York, NY 10016, USA
| | - Jane P Ko
- Department of Radiology, NYU Langone Health, 660 First Avenue, 3rd Floor, New York, NY 10016, USA
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Zhang S, Fu Y, Fang L, Xu Q, Gu S, Zhou H, Zhou J. Psittacosis pneumonia with the reversed halo sign: a case report and literature review. BMC Infect Dis 2025; 25:717. [PMID: 40382544 PMCID: PMC12085835 DOI: 10.1186/s12879-025-11081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/05/2025] [Indexed: 05/20/2025] Open
Abstract
BACKGROUND Chlamydia psittaci is a rare pathogen that causes community-acquired pneumonia. The reversed halo sign (RHS) is a computed tomography (CT) finding that is commonly observed in diseases such as cryptogenic organizing pneumonia, invasive fungal infections, tuberculosis, sarcoidosis, and pulmonary thromboembolism, but has seldom been described in association with psittacosis pneumonia. CASE PRESENTATION We report a case in which a 26-year-old man with a history of close contact with pigeons and chicken manure presented with fever and cough for 6 days. A CT examination revealed the RHS in the right lower lobe of the lung. Psittacosis pneumonia was diagnosed by metagenomic next-generation sequencing of the patient's bronchoalveolar lavage fluid. Treatment with omadacycline abolished his symptoms. We also discuss six other cases of psittacosis pneumonia with the RHS identified by literature search. CONCLUSIONS When clinicians encounter patients with atypical pneumonia with the RHS and a history of contact with poultry, psittacosis should be considered.
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Affiliation(s)
- Shumeng Zhang
- Department of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiqi Fu
- Department of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liangjie Fang
- Department of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiaomai Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Silan Gu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hua Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Jianying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Yanagawa M, Han J, Wada N, Song JW, Hwang J, Lee HY, Hata A, Franquet T, Chung MP, Tomiyama N, Hatabu H, Lee KS. Advances in Concept and Imaging of Interstitial Lung Disease. Radiology 2025; 315:e241252. [PMID: 40358445 DOI: 10.1148/radiol.241252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2025]
Abstract
Although idiopathic pulmonary fibrosis (IPF) is a type of idiopathic interstitial pneumonia (IIP), it is different from other IIPs. IPF also differs from interstitial lung disease (ILD) with known causes, including connective tissue disease, exposure, cysts and/or airspace filling disease, and sarcoidosis. More than 90% of IPFs demonstrate progressive disease. Non-IPF ILD has been classified as progressive pulmonary fibrosis on the basis of disease behavior (progressive disease that gets worse over time) as opposed to classification based on cause and/or morphologic characteristics. Progressive fibrosis predictors in ILD include demographic characteristics, underlying connective tissue disease, more extensive disease at CT, honeycombing and usual interstitial pneumonia (UIP) pattern at CT, and greater impairment of lung function. Hypersensitivity pneumonitis (HP), a type of ILD, is separated into fibrotic and nonfibrotic types. Extensive peribronchiolar metaplasia supports the diagnosis of fibrotic HP over UIP, as does predominantly peribronchiolar disease with relative subpleural sparing at CT. Interstitial lung abnormality (ILA) is incidentally identified at CT; thus, ILA is under radiologist purview. Subpleural fibrotic ILA is a prognostic imaging biomarker, predictive of worse prognosis. Photon-counting CT can provide high spatial resolutions of up to 125 μm (in-plane) and 200 μm (through-plane) for improved evaluation of abnormalities.
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Affiliation(s)
- Masahiro Yanagawa
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (M.Y., A.H., N.T.); Department of Pathology (J. Han), Department of Radiology (H.Y.L., K.S.L.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (N.W., H.H.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.W.S.); Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (J. Hwang); and Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Joungho Han
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (M.Y., A.H., N.T.); Department of Pathology (J. Han), Department of Radiology (H.Y.L., K.S.L.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (N.W., H.H.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.W.S.); Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (J. Hwang); and Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Noriaki Wada
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (M.Y., A.H., N.T.); Department of Pathology (J. Han), Department of Radiology (H.Y.L., K.S.L.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (N.W., H.H.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.W.S.); Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (J. Hwang); and Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Jin Woo Song
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (M.Y., A.H., N.T.); Department of Pathology (J. Han), Department of Radiology (H.Y.L., K.S.L.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (N.W., H.H.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.W.S.); Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (J. Hwang); and Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Jiwon Hwang
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (M.Y., A.H., N.T.); Department of Pathology (J. Han), Department of Radiology (H.Y.L., K.S.L.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (N.W., H.H.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.W.S.); Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (J. Hwang); and Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Ho Yun Lee
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (M.Y., A.H., N.T.); Department of Pathology (J. Han), Department of Radiology (H.Y.L., K.S.L.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (N.W., H.H.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.W.S.); Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (J. Hwang); and Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Akinori Hata
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (M.Y., A.H., N.T.); Department of Pathology (J. Han), Department of Radiology (H.Y.L., K.S.L.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (N.W., H.H.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.W.S.); Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (J. Hwang); and Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Tomás Franquet
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (M.Y., A.H., N.T.); Department of Pathology (J. Han), Department of Radiology (H.Y.L., K.S.L.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (N.W., H.H.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.W.S.); Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (J. Hwang); and Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Man Pyo Chung
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (M.Y., A.H., N.T.); Department of Pathology (J. Han), Department of Radiology (H.Y.L., K.S.L.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (N.W., H.H.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.W.S.); Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (J. Hwang); and Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Noriyuki Tomiyama
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (M.Y., A.H., N.T.); Department of Pathology (J. Han), Department of Radiology (H.Y.L., K.S.L.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (N.W., H.H.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.W.S.); Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (J. Hwang); and Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Hiroto Hatabu
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (M.Y., A.H., N.T.); Department of Pathology (J. Han), Department of Radiology (H.Y.L., K.S.L.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (N.W., H.H.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.W.S.); Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (J. Hwang); and Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Kyung Soo Lee
- From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (M.Y., A.H., N.T.); Department of Pathology (J. Han), Department of Radiology (H.Y.L., K.S.L.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.P.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (N.W., H.H.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.W.S.); Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (J. Hwang); and Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
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Wang Y, Wang S, Zhao H, Wang C. Bronchial stenosis requires vigilance against tracheal mucormycosis: a case report. Front Med (Lausanne) 2025; 12:1510292. [PMID: 40196349 PMCID: PMC11973059 DOI: 10.3389/fmed.2025.1510292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Accepted: 02/27/2025] [Indexed: 04/09/2025] Open
Abstract
This report highlights the importance of differentiating the etiology of dyspnea and tracheal stenosis. While acknowledging that tracheal stenosis can significantly cause respiratory distress, we emphasize the need to consider tracheal mucormycosis in the differential diagnosis, particularly in patients with risk factors such as uncontrolled diabetes and trauma. Early recognition and timely antifungal therapy remain crucial in managing this potentially fatal infection. Prioritizing early identification and treatment of mucormycosis before it progresses to the lungs can significantly improve patient outcomes and impact clinical practice.
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Affiliation(s)
- Ye Wang
- Beijing University of Chinese Medicine, Chaoyang, Beijing, China
| | - Shiyao Wang
- National Respiratory Medical Center, China-Japan Friendship Hospital, Beijing, China
| | - Hongmei Zhao
- National Respiratory Medical Center, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- National Respiratory Medical Center, China-Japan Friendship Hospital, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Liao D, Zhang J, Yan T, Chen Y, Fu Y, Xie N, Long M. A Systematic Review of Mechanisms, Incidence, and Management of Trastuzumab Deruxtecan Induced ILD/Pneumonitis in Solid Tumors. Drug Des Devel Ther 2025; 19:1655-1668. [PMID: 40083848 PMCID: PMC11904318 DOI: 10.2147/dddt.s508773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 02/28/2025] [Indexed: 03/16/2025] Open
Abstract
Trastuzumab deruxtecan (T-DXd) has been approved to treat various tumors. While most adverse events (AEs) associated with T-DXd are manageable, interstitial lung disease (ILD)/pneumonitis is a notable AE of special concern. This review describes the incidence, severity, and management of T-DXd-induced ILD/pneumonitis across different tumors. We conducted a systematic search of PubMed, Embase, Cochrane Library, and Web of Science for literature published up to 13 September 2024, regarding the use of T-DXd in the treatment of HER2-positive tumors. Studies included were clinical trials involving HER2-positive tumors with reported ILD/pneumonitis cases.The main data extracted from the full-text articles included the incidence and severity of T-DXd-induced ILD. 18 studies involving 3380 patients with various advanced solid malignancies were included in our review. The overall incidence of adjudicated drug-related ILD/pneumonitis was 12.40%. Although most ILD/pneumonitis cases were low-grade, the risk of ILD/pneumonitis-related death should not be overlooked. Given the prolonged exposure to the drug, careful monitoring and management of T-DXd-induced ILD/pneumonitis are critical. Management strategies include dose reduction, treatment interruption, discontinuation, corticosteroids, and supportive care. Further research is needed to clarify the risk factors and mechanisms underlying T-DXd-induced ILD/pneumonitis. This review highlights critical gaps in understanding the risk factors and mechanisms of T-DXd-induced ILD, underscoring the need for further research.
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Affiliation(s)
- Dehua Liao
- Department of Pharmacy, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China
| | - Jiwen Zhang
- Department of Pharmacy, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China
- School of Pharmacy, University of South China, Hengyang, People’s Republic of China
| | - Ting Yan
- Department of Pharmacy, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China
| | - Yun Chen
- Department of Pharmacy, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China
| | - Yilan Fu
- Department of Pharmacy, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China
| | - Ning Xie
- Medical Department of Breast Cancer, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China
| | - Minghui Long
- Department of Pharmacy, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China
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Qian Y, Li X, Li X, Zhang X, Yuan Q, Wang Z, Zhang M, Huang M, Ji N. TOM5 regulates the mitochondrial membrane potential of alveolar epithelial cells in organizing pneumonia. Redox Rep 2024; 29:2354625. [PMID: 38794801 PMCID: PMC11134018 DOI: 10.1080/13510002.2024.2354625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024] Open
Abstract
Deficiency of TOM5, a mitochondrial protein, causes organizing pneumonia (OP) in mice. The clinical significance and mechanisms of TOM5 in the pathogenesis of OP remain elusive. We demonstrated that TOM5 was significantly increased in the lung tissues of OP patients, which was positively correlated with the collagen deposition. In a bleomycin-induced murine model of chronic OP, increased TOM5 was in line with lung fibrosis. In vitro, TOM5 regulated the mitochondrial membrane potential in alveolar epithelial cells. TOM5 reduced the proportion of early apoptotic cells and promoted cell proliferation. Our study shed light on the roles of TOM5 in OP.
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Affiliation(s)
- Yan Qian
- Department of Respiratory and Critical Care Medicine, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China
| | - Xiao Li
- Department of Pathology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China
| | - Xinyu Li
- NHC Key Laboratory of Antibody Technique, Department of Immunology, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Xijie Zhang
- Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China
| | - Qi Yuan
- Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China
| | - Zhengxia Wang
- Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China
| | - Minghun Zhang
- NHC Key Laboratory of Antibody Technique, Department of Immunology, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Mao Huang
- Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China
| | - Ningfei Ji
- Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China
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Kallianos K. Imaging of Pulmonary Manifestations of Connective Tissue Disease. Rheum Dis Clin North Am 2024; 50:409-422. [PMID: 38942577 DOI: 10.1016/j.rdc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
The majority of connective tissue diseases (CTDs) are multisystem disorders that are often heterogeneous in their presentation and do not have a single laboratory, histologic, or radiologic feature that is defined as the gold standard to support a specific diagnosis. Given this challenging situation, the diagnosis of CTD is a process that requires the synthesis of multidisciplinary data which may include patient clinical symptoms, serologic evaluation, laboratory testing, and imaging. Pulmonary manifestations of connective tissue disease include interstitial lung disease as well as multicompartmental manifestations. These CT imaging patterns and features of specific diseases will be discussed in this article.
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Affiliation(s)
- Kimberly Kallianos
- Department of Radiology and Biomedical Imaging, UCSF, 505 Parnassus Avenue, M391, San Francisco, CA 94143, USA.
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Hasegawa T, Ryu K, Fukuda T, Mizobuchi Y, Yoshimatsu L, Sato R, Takatsuka M, Shinfuku K, Yamada M, Yamanaka Y, Hosaka Y, Seki A, Takasaka N, Ishikawa T, Araya J. Ultrasonic humidifier lung with a reversed halo sign: A case report. Radiol Case Rep 2024; 19:2520-2524. [PMID: 38585406 PMCID: PMC10997810 DOI: 10.1016/j.radcr.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
The reversed halo sign was initially reported as a representative computed tomography scan finding of cryptogenic organizing pneumonia. Since then, however, it has been reported in various diseases and is now considered a nonspecific finding. However, there are no cases of humidifier lung with the reversed halo sign. An 82-year-old Japanese male patient presented with moving difficulties 48 days after starting darolutamide treatment for prostate cancer. He was admitted to the hospital due to acute pneumonia, which presented as bilateral extensive nonsegmental ground-glass opacities in the peripheral regions and extensive areas of ground-glass opacity with a circumferential halo of consolidation, with the reversed halo sign on computed tomography scan. After darolutamide discontinuation with the concomitant administration of antibiotics, the patient's pneumonia improved, and he was discharged from the hospital. However, within a few days, he was again admitted to the hospital due to pneumonia. He was found to have been using an ultrasonic humidifier at home and was then diagnosed with humidifier lung based on the bronchoscopy and provocative testing findings. Hence, ultrasonic humidifier lung should be considered as a differential diagnosis in patients presenting with the reversed halo sign, and a detailed medical history must be taken.
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Affiliation(s)
- Tsukasa Hasegawa
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Kai Ryu
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Taiki Fukuda
- Department of Radiology, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Yuko Mizobuchi
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Lynn Yoshimatsu
- Department of Radiology, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Ryo Sato
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Makiko Takatsuka
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Kyota Shinfuku
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Masami Yamada
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Yumie Yamanaka
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Yusuke Hosaka
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Aya Seki
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Naoki Takasaka
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Takeo Ishikawa
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan
| | - Jun Araya
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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9
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Schapiro AH, Morin CE, Wikenheiser-Brokamp KA, Tanimoto AA. Connective tissue disease-associated lung disease in children. Pediatr Radiol 2024; 54:1059-1074. [PMID: 38850285 PMCID: PMC11182853 DOI: 10.1007/s00247-024-05962-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/10/2024]
Abstract
Connective tissue diseases are a heterogeneous group of autoimmune diseases that can affect a variety of organ systems. Lung parenchymal involvement is an important contributor to morbidity and mortality in children with connective tissue disease. Connective tissue disease-associated lung disease in children often manifests as one of several radiologic-pathologic patterns of disease, with certain patterns having a propensity to occur in association with certain connective tissue diseases. In this article, key clinical, histopathologic, and computed tomography (CT) features of typical patterns of connective tissue disease-associated lung disease in children are reviewed, with an emphasis on radiologic-pathologic correlation, to improve recognition of these patterns of lung disease at CT and to empower the pediatric radiologist to more fully contribute to the care of pediatric patients with these conditions.
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Affiliation(s)
- Andrew H Schapiro
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kathryn A Wikenheiser-Brokamp
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pathology & Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- The Perinatal Institute Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aki A Tanimoto
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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10
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Tokuyasu H, Sato Y, Sueda Y, Sakai H, Esumi C, Yamasaki A. Concentrically expanded reversed halo sign caused by nivolumab-related pneumonia. Respirol Case Rep 2024; 12:e01352. [PMID: 38736507 PMCID: PMC11082530 DOI: 10.1002/rcr2.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/04/2024] [Indexed: 05/14/2024] Open
Abstract
Among immune-related adverse events, pneumonitis is relatively uncommon, and nivolumab-related pneumonitis may present with a reversed halo sign.
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Affiliation(s)
- Hirokazu Tokuyasu
- Department of Respiratory MedicineMatsue Red Cross HospitalMatsueJapan
| | | | - Yuriko Sueda
- Department of Respiratory MedicineMatsue Red Cross HospitalMatsueJapan
| | - Hiromitsu Sakai
- Department of Respiratory MedicineMatsue Red Cross HospitalMatsueJapan
| | - Chika Esumi
- Department of PathologyMatsue Red Cross HospitalMatsueJapan
| | - Akira Yamasaki
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of MedicineTottori UniversityYonagoJapan
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11
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Enomoto N. Relationship between idiopathic interstitial pneumonias (IIPs) and connective tissue disease-related interstitial lung disease (CTD-ILD): A narrative review. Respir Investig 2024; 62:465-480. [PMID: 38564878 DOI: 10.1016/j.resinv.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/17/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
While idiopathic interstitial pneumonia (IIP) centering on idiopathic pulmonary fibrosis (IPF) is the most prevalent interstitial lung disease (ILD), especially in the older adult population, connective tissue disease (CTD)-related ILD is the second most prevalent ILD. The pathogenesis of IPF is primarily fibrosis, whereas that of other ILDs, particularly CTD-ILD, is mainly inflammation. Therefore, a precise diagnosis is crucial for selecting appropriate treatments, such as antifibrotic or immunosuppressive agents. In addition, some patients with IIP have CTD-related features, such as arthritis and skin eruption, but do not meet the criteria for any CTD, this is referred to as interstitial pneumonia with autoimmune features (IPAF). IPAF is closely associated with idiopathic nonspecific interstitial pneumonia (iNSIP) and cryptogenic organizing pneumonia (COP). Furthermore, patients with iNSIP or those with NSIP with OP overlap frequently develop polymyositis/dermatomyositis after the diagnosis of IIP. Acute exacerbation of ILD, the most common cause of death, occurs more frequently in patients with IPF than in those with other ILDs. Although acute exacerbation of CTD-ILD occurs at a low rate of incidence, patients with rheumatoid arthritis, microscopic polyangiitis, or systemic sclerosis experience more acute exacerbation of CTD-ILD than those with other CTD. In this review, the features of each IIP, focusing on CTD-related signatures, are summarized, and the pathogenesis and appropriate treatments to improve the prognoses of patients with various ILDs are discussed.
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Affiliation(s)
- Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan; Health Administration Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
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12
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Aitnasser K, Nakkabi I, Amrani HN. Diffuse reversed halo sign in an immunocompetent patient. Radiol Case Rep 2024; 19:1055-1059. [PMID: 38226052 PMCID: PMC10788371 DOI: 10.1016/j.radcr.2023.09.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 01/17/2024] Open
Abstract
The reversed halo sign (RHS) is a specific radiological image observed mostly on computed tomography (CT) scans as a focal round area of ground-glass attenuation surrounded by a crescent or ring of consolidation. It is common to many entities of respiratory diseases and can be found in both infectious, noninfectious inflammatory pathologies and some malignant tumors, including invasive pulmonary fungal infection, tuberculosis (TB), community-acquired pneumonia, granulomatosis, sarcoidosis. It is also seen in pulmonary neoplasms and infarction, and following radiation and radiofrequency. We report the case of an immunocompetent 54-year-old North African male patient, initially hospitalized for chronic cough associated with dysphonia and general symptoms such as weight loss, fever, and night sweats. Radiological exploration surprisingly confirmed the presence of RHS, tuberculosis was confirmed by a postbronchoscopy positive sputum Xpert MTB/RIF essay tuberculosis after we started antibacillary treatment, and the evolution was spectacular with regression of the lesions. The objective of this report is to increase knowledge about RHS and its pathological correlation with TB. Since it is not specific to any disorder, it is important to explore its finding in a clinical and epidemiological manner, especially in endemic countries where the prevalence of tuberculosis is still high.
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Affiliation(s)
- K. Aitnasser
- Pneumo-Phthisiology Department, Souss Massa University Hospital Center, Agadir, Morocco
- Medical and Pharmacological Faculty, Ibn Zohr University, Agadir, Morocco
| | - I. Nakkabi
- Medical and Pharmacological Faculty, Ibn Zohr University, Agadir, Morocco
- ENT and Cervico-Facial Surgery Department, Oued Eddahab Military Hospital, Agadir, Morocco
| | - H. Naji Amrani
- Pneumo-Phthisiology Department, Oued Eddahab Military Hospital, Agadir, Morocco
- Medical and Pharmacological Faculty, Sidi Mohammed Benabdellah University, Fes, Morocco
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13
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Bhalla S. Emojis and Radiology: The Power of Shared Language. Radiology 2024; 310:e233089. [PMID: 38411511 DOI: 10.1148/radiol.233089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
- Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
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14
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Bailey GL, Wells AU, Desai SR. Imaging of Pulmonary Sarcoidosis-A Review. J Clin Med 2024; 13:822. [PMID: 38337517 PMCID: PMC10856519 DOI: 10.3390/jcm13030822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
Sarcoidosis is the classic multisystem granulomatous disease. First reported as a disorder of the skin, it is now clear that, in the overwhelming majority of patients with sarcoidosis, the lungs will bear the brunt of the disease. This review explores some of the key concepts in the imaging of pulmonary sarcoidosis: the wide array of typical (and some of the less common) findings on high-resolution computed tomography (HRCT) are reviewed and, with this, the concept of morphologic/HRCT phenotypes is discussed. The pathophysiologic insights provided by HRCT through studies where morphologic abnormalities and pulmonary function tests are compared are evaluated. Finally, this review outlines the important contribution of HRCT to disease monitoring and prognostication.
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Affiliation(s)
- Georgina L. Bailey
- Department of Radiology, Royal Brompton Hospital, London SW3 6NP, UK (S.R.D.)
| | - Athol U. Wells
- The Interstitial Lung Disease Unit, Royal Brompton Hospital, London SW3 6NP, UK
- The National Heart & Lung Institute, Imperial College London, London W12 7RQ, UK
- The Margaret Turner-Warwick Centre for Fibrosing Lung Diseases, Imperial College London, London W12 7RQ, UK
| | - Sujal R. Desai
- Department of Radiology, Royal Brompton Hospital, London SW3 6NP, UK (S.R.D.)
- The National Heart & Lung Institute, Imperial College London, London W12 7RQ, UK
- The Margaret Turner-Warwick Centre for Fibrosing Lung Diseases, Imperial College London, London W12 7RQ, UK
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15
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Mochizuka Y, Enomoto N, Daisuke A, Inoue Y, Yasui H, Hozumi H, Suzuki Y, Karayama M, Furuhashi K, Katsumata M, Hashimoto D, Imokawa S, Fujisawa T, Inui N, Nakamura Y, Tabata K, Johkoh T, Suda T. "Bull's-eye" Sign and Its Longitudinal Change on High-Resolution Computed Tomography in Pulmonary Sarcoidosis. Am J Respir Crit Care Med 2024; 209:e1-e3. [PMID: 37788379 DOI: 10.1164/rccm.202307-1226im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/03/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine
- Health Administration Centre, and
| | | | - Yusuke Inoue
- Second Division, Department of Internal Medicine
| | - Hideki Yasui
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Yuzo Suzuki
- Second Division, Department of Internal Medicine
| | | | | | - Mineo Katsumata
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Dai Hashimoto
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shiro Imokawa
- Department of Respiratory Medicine, Iwata City Hospital, Iwata, Japan
| | | | - Naoki Inui
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaro Nakamura
- Respiratory and Allergy Medicine, National Hospital Organization Tenryu Hospital, Hamamatsu, Japan
| | - Kazuhiro Tabata
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; and
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan
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16
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Batra K, Adams TN. Imaging Features of Idiopathic Interstitial Lung Diseases. J Thorac Imaging 2023; 38:S19-S29. [PMID: 37505195 DOI: 10.1097/rti.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Idiopathic interstitial pneumonias (IIPs) are a group of diffuse parenchymal lung diseases of unclear etiology and are distinguished from diffuse parenchymal lung diseases of known cause, such as connective tissue disease-related interstitial lung diseases or hypersensitivity pneumonitis by history, physical exam, imaging, serologic testing, and, when necessary, histopathology. The 2013 American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines are the most widely accepted classification of IIPs and include the following diagnoses: idiopathic pulmonary fibrosis, idiopathic nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, idiopathic lymphocytic interstitial pneumonia, idiopathic pleuro-parenchymal fibroelastosis, respiratory bronchiolitis-interstitial lung disease, and desquamative interstitial pneumonia. The gold standard for diagnosis of IIP involves multidisciplinary discussion among pulmonologists, radiologists, and pathologists. The focus of this review will be to discuss the imaging features of the most common IIPs and the role of multidisciplinary discussion as the gold standard for diagnosis.
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Affiliation(s)
| | - Traci N Adams
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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17
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Suo H, Shi YJ, Huang ZD, Xu K, Huang H. Pulmonary reversed halo cycles and consolidations after immunotherapy: A case report. World J Clin Cases 2023; 11:6938-6942. [PMID: 37901007 PMCID: PMC10600855 DOI: 10.12998/wjcc.v11.i28.6938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitor-associated interstitial lung disease (ICI-ILD) and opportunistic pneumonias are the main pulmonary complications during immunotherapy for malignancies. The organizing pneumonia (OP) pattern is one of the common radiological manifestations of ICI-ILD, and OP is the most common cause of reversed halo cycles and consolidations. However, opportunistic pneumonias should be excluded. CASE SUMMARY In this report, we described a case of a 44-year-old man with esophageal cancer who showed multiple reversed-halo cycles and consolidations on chest computed tomography (CT) after he had a cold during immunotherapy. He was diagnosed with esophageal squamous-cell cancer (T2NIM0) after surgery. Then, he was successfully treated with 6 cycles of chemotherapy plus tislelizumab, one cycle of radiotherapy and 9 cycles of tislelizumab. Two months later, he complained of low-grade fever and cough with nonpurulent sputum after he had a cold. Community-acquired pneumonia was considered, but moxifloxacin was ineffective. Chest CT showed multiple reversed-halo cycles and consolidations. Mycobacterium tuberculosis was identified with next-generation sequence analysis of bronchoalveolar lavage fluid (BALF). Two months later, he improved with standard anti-tuberculosis medications. Both the cycles and consolidations disappeared in the repeat CT after 6 mo of medications. CONCLUSION When chest CT shows reversed-halo cycles and consolidations in patients during anticancer immunotherapy, both ICI-ILD and infectious pneumonia should be considered. BALF microbiological analysis was helpful to differentiate them.
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Affiliation(s)
- Hong Suo
- Department of Pulmonary and Critical Care Medicine, The Affiliate Hospital of Inner Mongolia Medical University, Hohhot 010050, Inner Mongolia Autonomous Region, China
| | - Yu-Jie Shi
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Zhao-Di Huang
- Department of Internal Medicine, Inner Mongolia Medical University, Hohhot 010011, Inner Mongolia Autonomous Region, China
| | - Kai Xu
- Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Hui Huang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China
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18
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Marquis KM, Hammer MM, Steinbrecher K, Henry TS, Lin CY, Shifren A, Raptis CA. CT Approach to Lung Injury. Radiographics 2023; 43:e220176. [PMID: 37289644 DOI: 10.1148/rg.220176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Diffuse alveolar damage (DAD), which represents the pathologic changes seen after acute lung injury, is caused by damage to all three layers of the alveolar wall and can ultimately result in alveolar collapse with loss of the normal pulmonary architecture. DAD has an acute phase that predominantly manifests as airspace disease at CT owing to filling of the alveoli with cells, plasma fluids, and hyaline membranes. DAD then evolves into a heterogeneous organizing phase, with mixed airspace and interstitial disease characterized by volume loss, architectural distortion, fibrosis, and parenchymal loss. Patients with DAD have a severe clinical course and typically require prolonged mechanical ventilation, which may result in ventilator-induced lung injury. In those patients who survive DAD, the lungs will remodel over time, but most will have residual findings at chest CT. Organizing pneumonia (OP) is a descriptive term for a histologic pattern characterized by intra-alveolar fibroblast plugs. The significance and pathogenesis of OP are controversial. Some authors regard it as part of a spectrum of acute lung injury, while others consider it a marker of acute or subacute lung injury. At CT, OP manifests with various forms of airspace disease that are most commonly bilateral and relatively homogeneous in appearance at individual time points. Patients with OP most often have a mild clinical course, although some may have residual findings at CT. In patients with DAD and OP, imaging findings can be combined with clinical information to suggest the diagnosis in many cases, with biopsy reserved for difficult cases with atypical findings or clinical manifestations. To best participate in the multidisciplinary approach to patients with lung injury, radiologists must not only recognize these entities but also describe them with consistent and meaningful terminology, examples of which are emphasized in the article. © RSNA, 2023 See the invited commentary by Kligerman et al in this issue. Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Kaitlin M Marquis
- From the Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., K.S., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Department of Radiology, Duke University, Durham, NC (T.S.H.); and Department of Pathology & Immunology (C.Y.L.) and Department of Pulmonology (A.S.), Washington University, St Louis, Mo
| | - Mark M Hammer
- From the Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., K.S., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Department of Radiology, Duke University, Durham, NC (T.S.H.); and Department of Pathology & Immunology (C.Y.L.) and Department of Pulmonology (A.S.), Washington University, St Louis, Mo
| | - Kacie Steinbrecher
- From the Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., K.S., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Department of Radiology, Duke University, Durham, NC (T.S.H.); and Department of Pathology & Immunology (C.Y.L.) and Department of Pulmonology (A.S.), Washington University, St Louis, Mo
| | - Travis S Henry
- From the Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., K.S., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Department of Radiology, Duke University, Durham, NC (T.S.H.); and Department of Pathology & Immunology (C.Y.L.) and Department of Pulmonology (A.S.), Washington University, St Louis, Mo
| | - Chieh-Yu Lin
- From the Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., K.S., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Department of Radiology, Duke University, Durham, NC (T.S.H.); and Department of Pathology & Immunology (C.Y.L.) and Department of Pulmonology (A.S.), Washington University, St Louis, Mo
| | - Adrian Shifren
- From the Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., K.S., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Department of Radiology, Duke University, Durham, NC (T.S.H.); and Department of Pathology & Immunology (C.Y.L.) and Department of Pulmonology (A.S.), Washington University, St Louis, Mo
| | - Constantine A Raptis
- From the Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., K.S., C.A.R.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Department of Radiology, Duke University, Durham, NC (T.S.H.); and Department of Pathology & Immunology (C.Y.L.) and Department of Pulmonology (A.S.), Washington University, St Louis, Mo
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19
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Williams JM, Hurst P, Rajiah PS. I saw the "atoll sign" - and now I need a tropical vacation. Clin Imaging 2023; 101:156-160. [PMID: 37369143 DOI: 10.1016/j.clinimag.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
The atoll sign describes ring-shaped opacities surrounding central ground glass attenuation seen on chest CT and was first associated with organizing pneumonia. The name is derived from the Maldives' language, denoting a ring or crescentic-shaped coral reef island surrounding a central lagoon. Although biopsy is usually required for diagnosis, understanding some of the more common pathologies associated with the atoll sign may help narrow a differential and guide management.
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Affiliation(s)
| | - Philip Hurst
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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20
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Gozzi L, Cozzi D, Cavigli E, Moroni C, Giannessi C, Zantonelli G, Smorchkova O, Ruzga R, Danti G, Bertelli E, Luzzi V, Pasini V, Miele V. Primary Lymphoproliferative Lung Diseases: Imaging and Multidisciplinary Approach. Diagnostics (Basel) 2023; 13:diagnostics13071360. [PMID: 37046580 PMCID: PMC10093093 DOI: 10.3390/diagnostics13071360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
Lymphoproliferative lung diseases are a heterogeneous group of disorders characterized by primary or secondary involvement of the lung. Primary pulmonary lymphomas are the most common type, representing 0.5–1% of all primary malignancies of the lung. The radiological presentation is often heterogeneous and non-specific: consolidations, masses, and nodules are the most common findings, followed by ground-glass opacities and interstitial involvement, more common in secondary lung lymphomas. These findings usually show a prevalent perilymphatic spread along bronchovascular bundles, without a prevalence in the upper or lower lung lobes. An ancillary sign, such as a “halo sign”, “reverse halo sign”, air bronchogram, or CT angiogram sign, may be present and can help rule out a differential diagnosis. Since a wide spectrum of pulmonary parenchymal diseases may mimic lymphoma, a correct clinical evaluation and a multidisciplinary approach are mandatory. In this sense, despite High-Resolution Computer Tomography (HRCT) representing the gold standard, a tissue sample is needed for a certain and definitive diagnosis. Cryobiopsy is a relatively new technique that permits the obtaining of a larger amount of tissue without significant artifacts, and is less invasive and more precise than surgical biopsy.
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Affiliation(s)
- Luca Gozzi
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Diletta Cozzi
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Edoardo Cavigli
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Chiara Moroni
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | | | - Giulia Zantonelli
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Olga Smorchkova
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Ron Ruzga
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Ginevra Danti
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Elena Bertelli
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Valentina Luzzi
- Interventional Pneumology, Careggi University Hospital, 50134 Florence, Italy
| | - Valeria Pasini
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, 50133 Florence, Italy
| | - Vittorio Miele
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
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21
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Bazdyrev E, Panova M, Zherebtsova V, Burdenkova A, Grishagin I, Novikov F, Nebolsin V. The Hidden Pandemic of COVID-19-Induced Organizing Pneumonia. Pharmaceuticals (Basel) 2022; 15:1574. [PMID: 36559025 PMCID: PMC9780828 DOI: 10.3390/ph15121574] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Since the beginning of the COVID-19 pandemic, clinical, radiological, and histopathological studies have provided evidence that organizing pneumonia is a possible consequence of the SARS-CoV2 infection. This post-COVID-19 organizing pneumonia (PCOP) causes persisting dyspnea, impaired pulmonary function, and produces radiological abnormalities for at least 5 weeks after onset of symptoms. While most patients with PCOP recover within a year after acute COVID-19, 5-25% of cases need specialized treatment. However, despite substantial resources allocated worldwide to finding a solution to this problem, there are no approved treatments for PCOP. Oral corticosteroids produce a therapeutic response in a majority of such PCOP patients, but their application is limited by the anticipated high-relapse frequency and the risk of severe adverse effects. Herein, we conduct a systematic comparison of the epidemiology, pathogenesis, and clinical presentation of the organizing pneumonias caused by COVID-19 as well as other viral infections. We also use the clinical efficacy of corticosteroids in other postinfection OPs (PIOPs) to predict the therapeutic response in the treatment of PCOP. Finally, we discuss the potential application of a candidate anti-inflammatory and antifibrotic therapy for the treatment of PCOP based on the analysis of the latest clinical trials data.
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Affiliation(s)
- Evgeny Bazdyrev
- Research Institute for Complex Issues of Cardiovascular Diseases, 6, Sosnoviy Blvd., 650002 Kemerovo, Russia
| | - Maria Panova
- Pharmenterprises LLC, Skolkovo Innovation Center, Bolshoi Blvd., 42(1), 143026 Moscow, Russia
- Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, 47 Leninsky Avenue, 119991 Moscow, Russia
| | - Valeria Zherebtsova
- Pharmenterprises LLC, Skolkovo Innovation Center, Bolshoi Blvd., 42(1), 143026 Moscow, Russia
- Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, 47 Leninsky Avenue, 119991 Moscow, Russia
- Dmitry Mendeleev University of Chemical Technology of Russia, Miusskaya sq. 9, 125047 Moscow, Russia
| | - Alexandra Burdenkova
- Pharmenterprises LLC, Skolkovo Innovation Center, Bolshoi Blvd., 42(1), 143026 Moscow, Russia
- Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, 47 Leninsky Avenue, 119991 Moscow, Russia
| | - Ivan Grishagin
- Rancho BioSciences, 16955 Via Del Campo Suite 200, San Diego, CA 92127, USA
| | - Fedor Novikov
- Pharmenterprises LLC, Skolkovo Innovation Center, Bolshoi Blvd., 42(1), 143026 Moscow, Russia
- Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, 47 Leninsky Avenue, 119991 Moscow, Russia
| | - Vladimir Nebolsin
- Pharmenterprises LLC, Skolkovo Innovation Center, Bolshoi Blvd., 42(1), 143026 Moscow, Russia
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22
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Arenas-Jiménez JJ, García-Garrigós E, Ureña Vacas A, Sirera Matilla M, Feliu Rey E. Organizing pneumonia. RADIOLOGIA 2022; 64 Suppl 3:240-249. [PMID: 36737163 DOI: 10.1016/j.rxeng.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/01/2022] [Indexed: 02/05/2023]
Abstract
Organizing pneumonia is a nonspecific pathologic pattern of response to lung damage. It can be idiopathic, or it can occur secondary to various medical processes, most commonly infections, connective tissue disease, and pharmacological toxicity. Although there is no strict definition of the pattern of organising pneumonia as in other idiopathic interstitial pneumonias, the characteristic pattern of this disease could be considered to include patchy consolidations and ground-glass opacities in the peribronchial and subpleural areas of both lungs. Moreover, studies of the course of the disease show that these lesions respond to treatment with corticoids, migrate with or without treatment, and tend to recur when treatment is decreased or withdrawn. Other manifestations of organising pneumonia include nodules of different sizes and shapes, solitary masses, nodules with the reverse halo sign, a perilobular pattern, and parenchymal bands.
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Affiliation(s)
- J J Arenas-Jiménez
- Departamento de Patología y Cirugía, Hospital General Universitario Dr. Balmis, Departamento de Patología y Cirugía, Universidad Miguel Hernández, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - E García-Garrigós
- Servicio de Radiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - A Ureña Vacas
- Servicio de Radiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - M Sirera Matilla
- Servicio de Radiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - E Feliu Rey
- Servicio de Radiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
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23
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McNally E, Moloney E, Nicholson S, Young V. Relapse of idiopathic acute fibrinous and organising pneumonia 12 years after successful treatment with corticosteroids. BMJ Case Rep 2022; 15:e250424. [PMID: 36423943 PMCID: PMC9693665 DOI: 10.1136/bcr-2022-250424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/25/2022] Open
Abstract
Acute fibrinous and organising pneumonia (AFOP) is a rare form of interstitial lung disease. It is a pathological diagnosis sharing similarities to organising pneumonia, diffuse alveolar damage and eosinophilic pneumonia, however, is histologically distinct, characterised by intra-alveolar fibrin deposition ('fibrin balls') and associated organising pneumonia. AFOP was first described in 2002, only 150 cases have been reported since. While it has been described in association with infection, autoimmune disorders, connective tissue diseases, drugs, environmental exposures and organ transplant, it can also be idiopathic in nature. AFOP follows an acute course with potential rapid fulminant respiratory failure, or a subacute trajectory with a more favourable prognosis. Corticosteroids are commonly prescribed to induce remission. While cases of relapse of AFOP during weaning or cessation of steroids have been described, there are no published cases of remote relapse of AFOP. We describe a case of idiopathic AFOP, which recurred after 12 years of good health.
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Affiliation(s)
- Emma McNally
- Department of Respiratory Medicine, Tallaght University Hospital, Dublin, Ireland
| | - Eddie Moloney
- Department of Respiratory Medicine, Tallaght University Hospital, Dublin, Ireland
| | | | - Vincent Young
- Department of Cardiothoracic Surgery, St James Hospital, Dublin, Ireland
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24
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Kallianos K. Imaging of Pulmonary Manifestations of Connective Tissue Disease. Radiol Clin North Am 2022; 60:915-924. [DOI: 10.1016/j.rcl.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Neumonía organizada. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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26
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Pathogenesis, Imaging, and Evolution of Acute Lung Injury. Radiol Clin North Am 2022; 60:925-939. [DOI: 10.1016/j.rcl.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Cherian SV, Patel D, Machnicki S, Naidich D, Stover D, Travis WD, Brown KK, Naidich JJ, Mahajan A, Esposito M, Mina B, Lakticova V, Cohen SL, Muller NL, Schulner J, Shah R, Raoof S. Algorithmic Approach to the Diagnosis of Organizing Pneumonia: A Correlation of Clinical, Radiologic, and Pathologic Features. Chest 2022; 162:156-178. [PMID: 35038455 PMCID: PMC9899643 DOI: 10.1016/j.chest.2021.12.659] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/23/2021] [Accepted: 12/27/2021] [Indexed: 01/19/2023] Open
Abstract
Organizing pneumonia (OP), characterized histopathologically by patchy filling of alveoli and bronchioles by loose plugs of connective tissue, may be seen in a variety of conditions. These include but are not limited to after an infection, drug reactions, radiation therapy, and collagen vascular diseases. When a specific cause is responsible for this entity, it is referred to as "secondary OP." When an extensive search fails to reveal a cause, it is referred to as "cryptogenic OP" (previously called "bronchiolitis obliterans with OP"), which is a clinical, radiologic, and pathologic entity classified as an interstitial lung disease. The clinical presentation of OP often mimics that of other disorders, such as infection and cancer, which can result in a delay in diagnosis and inappropriate management of the underlying disease. The radiographic presentation of OP is polymorphous but often has subpleural consolidations with air bronchograms or solitary or multiple nodules, which can wax and wane. Diagnosis of OP sometimes requires histopathologic confirmation and exclusion of other possible causes. Treatment usually requires a prolonged steroid course, and disease relapse is common. The aim of this article is to summarize the clinical, radiographic, and histologic presentations of this disease and to provide a practical diagnostic algorithmic approach incorporating clinical history and characteristic imaging patterns.
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Affiliation(s)
- Sujith V Cherian
- Divisions of Critical Care, Pulmonary and Sleep Medicine, Dept. Of Internal Medicine, University of Texas Health-McGovern Medical School, Houston, TX
| | - Dhara Patel
- Pulmonary Medicine, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Hempstead, NY
| | - Stephen Machnicki
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Hempstead, NY
| | - David Naidich
- Department of Radiology, Center for Biologic Imaging, NYU-Langone Medical Center, New York, NY
| | - Diane Stover
- Pulmonary, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - William D Travis
- Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO
| | - Jason J Naidich
- Departments of Radiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Pathology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Northwell Health Lung Institute, and Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Akhilesh Mahajan
- Division of Pulmonary and Critical Care Medicine, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Hempstead, NY
| | - Michael Esposito
- Pathology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Bushra Mina
- Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Hempstead, NY
| | - Viera Lakticova
- Division of Pulmonary and Critical Care Medicine, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Hempstead, NY
| | - Stuart L Cohen
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Nestor L Muller
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Jenna Schulner
- Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, New York, NY
| | - Rakesh Shah
- Departments of Radiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Suhail Raoof
- Northwell Health Lung Institute, and Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
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28
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Conte P, Ascierto PA, Patelli G, Danesi R, Vanzulli A, Sandomenico F, Tarsia P, Cattelan A, Comes A, De Laurentiis M, Falcone A, Regge D, Richeldi L, Siena S. Drug-induced interstitial lung disease during cancer therapies: expert opinion on diagnosis and treatment. ESMO Open 2022; 7:100404. [PMID: 35219244 PMCID: PMC8881716 DOI: 10.1016/j.esmoop.2022.100404] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Drug-induced interstitial lung disease (DIILD) is a form of interstitial lung disease resulting from exposure to drugs causing inflammation and possibly interstitial fibrosis. Antineoplastic drugs are the primary cause of DIILD, accounting for 23%-51% of cases, with bleomycin, everolimus, erlotinib, trastuzumab-deruxtecan and immune checkpoint inhibitors being the most common causative agents. DIILD can be difficult to identify and manage, and there are currently no specific guidelines on the diagnosis and treatment of DIILD caused by anticancer drugs. OBJECTIVE To develop recommendations for the diagnosis and management of DIILD in cancer patients. METHODS Based on the published literature and their clinical expertise, a multidisciplinary group of experts in Italy developed recommendations stratified by DIILD severity, based on the Common Terminology Criteria for Adverse Events. RESULTS The recommendations highlight the importance of multidisciplinary interaction in the diagnosis and management of DIILD. Important components of the diagnostic process are physical examination and careful patient history-taking, measurement of vital signs (particularly respiratory rate and arterial oxygen saturation), relevant laboratory tests, respiratory function testing with spirometry and diffusing capacity of the lung for carbon monoxide and computed tomography/imaging. Because the clinical and radiological signs of DIILD are often similar to those of pneumonias or interstitial lung diseases, differential diagnosis is important, including microbial and serological testing to exclude or confirm infectious causes. In most cases, management of DIILD requires the discontinuation of the antineoplastic agent and the administration of short-term steroids. Steroid tapering must be undertaken slowly to prevent reactivation of DIILD. Patients with severe and very severe (grade 3 and 4) DIILD will require hospitalisation and often need oxygen and non-invasive ventilation. Decisions about invasive ventilation should take into account the patient's cancer prognosis. CONCLUSIONS These recommendations provide a structured step-by-step diagnostic and therapeutic approach for each grade of suspected cancer-related DIILD.
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Affiliation(s)
- P Conte
- DiSCOG, University of Padova and Medical Oncology 2, IOV-Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - P A Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - G Patelli
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - R Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Vanzulli
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Radiology Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - F Sandomenico
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy
| | - P Tarsia
- Pneumology Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - A Cattelan
- Tropical and Infectious Diseases Unit, Padua University Hospital, Padua, Italy
| | - A Comes
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M De Laurentiis
- Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - A Falcone
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - D Regge
- Department of Radiology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy
| | - L Richeldi
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Siena
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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29
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Affiliation(s)
- Talmadge E King
- From the University of California, San Francisco (T.E.K.); and the University of Colorado Anschutz Medical Campus, Aurora (J.S.L.)
| | - Joyce S Lee
- From the University of California, San Francisco (T.E.K.); and the University of Colorado Anschutz Medical Campus, Aurora (J.S.L.)
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30
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Keskin Z, Yesildag M. The evaluation of the association between the prevalence and patterns of computed tomography findings of cryptogenic organizing pneumonia, and neutrophil/lymphocyte and platelet/lymphocyte ratios. CHINESE JOURNAL OF ACADEMIC RADIOLOGY 2022; 5:61-68. [PMID: 35224446 PMCID: PMC8857733 DOI: 10.1007/s42058-022-00090-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/16/2022] [Accepted: 02/05/2022] [Indexed: 10/25/2022]
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31
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Li H, Zou J, Li J. Organizing Pneumonia with Solitary Focal Nodule and Subsequent Multiple Pulmonary Shadows. Am J Med Sci 2022; 364:e4-e5. [DOI: 10.1016/j.amjms.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/21/2021] [Accepted: 01/20/2022] [Indexed: 11/01/2022]
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32
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Stański M, Gąsiorowski Ł, Wykrętowicz M, Majewska NK, Katulska K. COVID-19 pandemic in flu season. Chest computed tomography - what we know so far. Pol J Radiol 2021; 86:e692-e699. [PMID: 35059062 PMCID: PMC8757012 DOI: 10.5114/pjr.2021.112377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
Chest computed tomography (CT) is proven to have high sensitivity in COVID-19 diagnosis. It is available in most emergency wards, and in contrast to polymerase chain reaction (PCR) it can be obtained in several minutes. However, its imaging features change during the course of the disease and overlap with other viral pneumonias, including influenza pneumonia. In this brief analysis we review the recent literature about chest CT features, useful radiological scales, and COVID-19 differentiation with other viral infections.
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Affiliation(s)
- Marcin Stański
- Correspondence address: Marcin Stański, Department of General Radiology and Neuroradiology, Poznan University of Medical Sciences, Poznan, Poland, e-mail:
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33
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Lang JA, Bhalla S, Ganeshan D, Felder GJ, Itani M. Side Effects of Oncologic Treatment in the Chest: Manifestations at FDG PET/CT. Radiographics 2021; 41:2071-2089. [PMID: 34723703 DOI: 10.1148/rg.2021210130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fluorodeoxyglucose (FDG) PET/CT is a vital imaging technique used for staging, assessing treatment response, and restaging following completion of therapy in patients who are undergoing or have completed oncologic treatment. A variety of adverse effects from chemotherapy, targeted therapy, immunotherapy, and radiation therapy are commonly encountered in oncologic patients. It is important to be aware of the manifestations of these adverse effects seen on FDG PET/CT images to avoid misinterpreting these findings as disease progression. Furthermore, early identification of these complications is important, as it may significantly affect patient management and even lead to a change in treatment strategy. The authors focus on the FDG PET/CT manifestations of a broad spectrum of oncologic therapy-related adverse effects in the thorax, as well as some treatment-related changes that may potentially mimic malignancy. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Jordan A Lang
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Dhakshinamoorthy Ganeshan
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Gabriel J Felder
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
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34
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Chong WH, Saha BK, Chopra A. Does COVID-19 pneumonia signify secondary organizing pneumonia?: A narrative review comparing the similarities between these two distinct entities. Heart Lung 2021; 50:667-674. [PMID: 34098237 PMCID: PMC8164344 DOI: 10.1016/j.hrtlng.2021.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022]
Abstract
Multiple observational studies have described the similarities between COVID-19 pneumonia and organizing pneumonia (OP). These two entities clinically manifest with mild and subacute respiratory symptoms, often with a delayed diagnosis due to the atypical ARDS and silent hypoxemia presentation. Radiological features are often indistinguishable between the two. With the increase in antemortem lung biopsies and autopsies being performed, more histopathological findings of OP and its variant, acute fibrinous and organizing pneumonia (AFOP), are being diagnosed. These entities are known complications of viral infections as a delayed immunological process, explaining the favorable response to corticosteroids. Clinicians should be vigilant to diagnose this under-recognized entity of secondary OP in people with COVID-19 when clinical deterioration occurs, especially with compatible radiologic findings and recent cessation of corticosteroids. Despite the proven benefits of corticosteroids in treating COVID-19, treatment approaches can be more effective as OP often requires higher doses and a more prolonged therapy duration for remission and preventing relapses. The purpose of our narrative review is to compare the similarities between COVID-19 pneumonia and OP, emphasizing the clinical, radiological, and histopathological features based on the evidence available in the literature.
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Affiliation(s)
- Woon H Chong
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany 12208, New York, USA.
| | - Biplab K Saha
- Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, Missouri, USA
| | - Amit Chopra
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany 12208, New York, USA
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35
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Guarnera A, Santini E, Podda P. Idiopathic Interstitial Pneumonias and COVID-19 Pneumonia: Review of the Main Radiological Features and Differential Diagnosis. Tomography 2021; 7:397-411. [PMID: 34564297 PMCID: PMC8482091 DOI: 10.3390/tomography7030035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/28/2021] [Accepted: 08/16/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 pneumonia represents a challenging health emergency, due to the disproportion between the high transmissibility, morbidity, and mortality of the virus and healthcare systems possibilities. Literature has mainly focused on COVID-19 pneumonia clinical-radiological diagnosis and therapy, and on the most common differential diagnoses, while few papers investigated rare COVID-19 pneumonia differential diagnoses or the overlapping of COVID-19 pneumonia on pre-existing lung pathologies. This article presents the main radiological characteristics of COVID-19 pneumonia and Idiopathic Interstitial Pneumonias (IIPs) to identify key radiological features for a differential diagnosis among IIPs, and between IIPs and COVID-19 pneumonia. COVID-19 pneumonia differential diagnosis with IIPs is challenging, since these entities may share common radiological findings as ground glass opacities, crazy paving patterns, and consolidations. Multidisciplinary discussion is crucial to reach a final and correct diagnosis. Radiologists have a pivotal role in identifying COVID-19 pneumonia patterns, reporting possible overlapping with long-lasting lung diseases, and suggesting potential differential diagnoses. An optimal evaluation of HRTC may help in containing the disease, in promoting better treatment for patients, and in providing an efficient allocation of human and economic resources.
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Affiliation(s)
- Alessia Guarnera
- Radiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy; (E.S.); (P.P.)
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy
- Correspondence:
| | - Elena Santini
- Radiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy; (E.S.); (P.P.)
| | - Pierfrancesco Podda
- Radiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy; (E.S.); (P.P.)
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36
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Radiologic Review With Pathology Correlation of E-Cigarette or Vaping Product Use-associated Lung Injury. J Thorac Imaging 2021; 35:277-284. [PMID: 32384414 DOI: 10.1097/rti.0000000000000526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
More than 2000 cases of vaping-associated lung injury have been reported in a recent outbreak, including >40 deaths. Although chest imaging is integral in the evaluation of these patients and is often abnormal, the spectrum of findings and the role of imaging in the diagnosis are not widely appreciated. The aim of this review is to highlight the imaging findings of vaping-associated lung injury. Basilar-predominant ground-glass opacities and/or consolidations, often with areas of subpleural or lobular sparing, are the most common pattern, and many other patterns are known to occur. Radiologists are encouraged to become familiar with the different imaging patterns of vaping-associated lung injury. The diagnosis should be considered in patients who have vaped within 90 days of onset of symptoms and present with bilateral lung opacities.
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Makimoto G, Kawakado K, Nakanishi M, Tamura T, Noda M, Makimoto S, Sato Y, Kuyama S. Heerfordt's Syndrome Associated with Trigeminal Nerve Palsy and Reversed Halo Sign. Intern Med 2021; 60:1747-1752. [PMID: 33390492 PMCID: PMC8222113 DOI: 10.2169/internalmedicine.6176-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Heerfordt's syndrome is a rare subtype of sarcoidosis and features a combination of facial palsy, parotid swelling, and uveitis, associated with a low-grade fever. Cases with two of three symptoms are called "incomplete Heerfordt's syndrome." Heerfordt's syndrome involving other cranial nerve symptoms is relatively rare. We herein report a case of incomplete Heerfordt's syndrome presenting with trigeminal nerve palsy and a reversed halo sign, a rare manifestation of pulmonary sarcoidosis. The histological diagnosis following a biopsy of the parotid gland and endobronchial ultrasound-guided trans-bronchial needle aspiration of the mediastinal lymph nodes was sarcoidosis. The symptoms and lung lesions improved after corticosteroid therapy.
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Affiliation(s)
- Go Makimoto
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, Japan
| | - Keita Kawakado
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, Japan
| | - Masamoto Nakanishi
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, Japan
| | - Tomoki Tamura
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, Japan
| | - Minori Noda
- Department of Otorhinolaryngology, National Hospital Organization Iwakuni Clinical Center, Japan
| | - Satoko Makimoto
- Department of Radiology, National Hospital Organization Iwakuni Clinical Center, Japan
| | - Yumiko Sato
- Department of Pathology, National Hospital Organization Iwakuni Clinical Center, Japan
| | - Shoichi Kuyama
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, Japan
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Tzilas V, Poletti V, Bouros D. Reversed halo sign in radiation induced organizing pneumonia: natural course of the underlying pathophysiology. Pulmonology 2021; 27:460-464. [PMID: 33853753 DOI: 10.1016/j.pulmoe.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- V Tzilas
- Interstital Lung Disease Unit, Athens Medical Center, Athens, Greece
| | - V Poletti
- Department of Diseases of the Thorax, Azienda USL Romagna, GB Morgagni Hospital, Forlì, Italy; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - D Bouros
- Interstital Lung Disease Unit, Athens Medical Center, Athens, Greece; First Academic Department of Pneumonology, Hospital for Diseases of the Chest, "Sotiria", Medical School, National and Kapodistrian University of Athens, Greece.
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Zeng Y, Zhai XL, Wáng YXJ, Gao WW, Hu CM, Lin FS, Chai WS, Wang JY, Shi YL, Zhou XH, Yu HS, Lu XW. Illustration of a number of atypical computed tomography manifestations of active pulmonary tuberculosis. Quant Imaging Med Surg 2021; 11:1651-1667. [PMID: 33816198 DOI: 10.21037/qims-20-1323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Tuberculosis is a serious public health challenge facing mankind and one of the top ten causes of death. Diagnostic imaging plays an important role, particularly for the diagnosis and treatment planning of tuberculosis patients with negative microbiology results. This article illustrates a number of atypical computed tomography (CT) appearances of pulmonary tuberculosis (PTB), including (I) clustered micronodules (CMNs) sign; (II) reversed halo sign (RHS); (III) tuberculous pneumatocele; (IV) hematogenously disseminated PTB with predominantly diffuse ground glass opacity manifestation; (V) hematogenously disseminated PTB with randomly distributed non-miliary nodules; (VI) PTB changes occur on the background of emphysema or honeycomb changes of interstitial pneumonia; and (VII) PTB manifesting as organizing pneumonia. While the overall incidence of PTB is decreasing globally, the incidence of atypical manifestations of tuberculosis is increasing. A good understanding of the atypical CT imaging changes of active PTB shall help the diagnosis and differential diagnosis of PTB in clinical practice.
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Affiliation(s)
- Yi Zeng
- Department of Tuberculosis, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Xiao-Li Zhai
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei-Wei Gao
- Department of Tuberculosis, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Chun-Mei Hu
- Department of Tuberculosis, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Fei-Shen Lin
- Department of Tuberculosis, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Wen-Shu Chai
- Department of Respiratory Medicine, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Jian-Yun Wang
- Department of Radiology, Lanzhou Lung Hospital, Lanzhou, China
| | - Yan-Ling Shi
- Department of Radiology, Second Hospital of Daqing City, Daqing, China
| | - Xin-Hua Zhou
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Hui-Shan Yu
- Department of Radiology, Wuhan Pulmonary Hospital, Wuhan, China
| | - Xi-Wei Lu
- Department of Tuberculosis, Dalian Tuberculosis Hospital, Dalian, China
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Clinical features of acute fibrinous and organizing pneumonia: An early histologic pattern of various acute inflammatory lung diseases. PLoS One 2021; 16:e0249300. [PMID: 33793625 PMCID: PMC8016294 DOI: 10.1371/journal.pone.0249300] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/16/2021] [Indexed: 12/29/2022] Open
Abstract
Background Acute fibrinous and organizing pneumonia (AFOP) is a rare histologic pattern of acute lung involvement with intra-alveolar fibrin deposition. However, the clinical significance of the pathological findings of AFOP remains unclear. This study aimed to explore the clinical significance of AFOP through a comprehensive clinical examination. Methods The medical records of patients with lung diseases accompanied by the pathological finding of intra-alveolar organization between January 2010 and December 2019 were retrospectively reviewed. The clinical and radiological findings were compared between the groups with and without the histologic pattern of AFOP. Results We identified 34 patients with AFOP (AFOP group) and 143 without AFOP (non-AFOP group). The underlying diseases of the AFOP group were as follows: 19 patients had cryptogenic organizing pneumonia (OP), 5 had connective tissue diseases, 3 had radiation pneumonitis, 3 had chronic eosinophilic pneumonia, 2 had myelodysplastic syndromes, and 2 had drug-induced pneumonia. Fever was more common, the time from symptom onset to biopsy was shorter, and the serum C-reactive protein level was higher in the AFOP group than in the non-AFOP group. On high-resolution computed tomography, 85% of patients had OP pattern, and halo sign was more common in the AFOP group. Corticosteroids were effective in 94% of the patients in the AFOP group; however, recurrences were more frequent, and a higher corticosteroid dose was needed during recurrence. Conclusions AFOP might be an early phase of a histologic pattern associated with known etiologies. In addition, it could be a marker indicating intense inflammatory diseases with a tendency of recurrence.
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Jain A, Knoll B, Lim S, Kleinman G, Epelbaum O. For Whom the Atoll Tolls: Targeting the Reversed Halo Sign. Am J Med 2021; 134:e150-e152. [PMID: 33353726 DOI: 10.1016/j.amjmed.2020.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023]
Affiliation(s)
| | | | | | | | - Oleg Epelbaum
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Westchester Medical Center, Valhalla, NY
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Krupar R, Kümpers C, Haenel A, Perner S, Stellmacher F. [Cryptogenic organizing pneumonia versus secondary organizing pneumonia]. DER PATHOLOGE 2021; 42:55-63. [PMID: 33462627 PMCID: PMC7812985 DOI: 10.1007/s00292-020-00903-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/22/2022]
Abstract
Die organisierende Pneumonie (OP) beschreibt ein histologisches Muster des akuten bzw. subakuten Lungenschadens. Klinisch fallen die Patienten mit Husten, Fieber und Dyspnoe auf. Es wird zwischen der idiopathischen bzw. kryptogen organisierenden (COP) und der sekundären organisierenden Pneumonie (OP) unterschieden. Bei der COP kann weder klinisch/radiologisch noch histologisch eine Ursache bestimmt werden. Sie wird zu den interstitiellen idiopathischen Pneumonien (IIP) gezählt nach Kriterien der American Thoracic Society (ATS) und der European Respiratory Society (ERS). Bei der sekundären organisierenden Pneumonie liegt ein bekannter auslösender Mechanismus vor, wie z. B. infektiöse Erreger, bestimmte Medikamente oder auch Begleiterscheinungen anderer primär pulmonaler Erkrankungen und Erkrankungen anderer Organsysteme. Beiden Formen gemeinsam ist das histologische Bild der intraalveolären Mesenchymknospen. Diese sind Myofibroblastenproliferate, welche sich zopfartig entlang der Alveolarräume verzweigen. Sie werden in der Regel von einem bis mäßigen interstitiellen und alveolären, chronischen und makrophagenreichen Entzündungszellinfiltrat begleitet. Wichtigste Differenzialdiagnose ist die gewöhnliche interstitielle Pneumonie (UIP). Diese zeigt ebenfalls Fibroblastenproliferate, welche allerdings interstitiell liegen. Die korrekte Zuordnung einer IIP als COP mittels klinischer, radiologischer und histologischer Befunderhebung ist essenziell, da die COP im Gegensatz zur UIP sehr gut auf Kortikosteroide anspricht und somit gegenüber der UIP eine exzellente Prognose hat. Der Verlauf sekundärer organisierender Pneumonien hängt von der jeweiligen Grunderkrankung ab. Hier ist es wichtig, dass der Pathologe histologische Begleitcharakteristika einer OP korrekt identifiziert, um Hinweise auf eine mögliche Ursache geben zu können.
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Affiliation(s)
- Rosemarie Krupar
- Pathologie, Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 3A, 23845, Borstel, Deutschland. .,Institut für Pathologie, Universität zu Lübeck und Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.
| | - Christiane Kümpers
- Institut für Pathologie, Universität zu Lübeck und Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Alexander Haenel
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Sven Perner
- Pathologie, Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 3A, 23845, Borstel, Deutschland.,Institut für Pathologie, Universität zu Lübeck und Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.,Airway Research Center North, Deutsches Zentrum für Lungenforschung, Großhansdorf, Deutschland
| | - Florian Stellmacher
- Pathologie, Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 3A, 23845, Borstel, Deutschland
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Marwah V, Peter DK, Sharma N, Bhattacharjee S, Hegde A, Shelly D, Malik V, Bhati G, Singh S. Clinico-etiological characteristics of organizing pneumonia: A retrospective study. Lung India 2021; 38:144-148. [PMID: 33687008 PMCID: PMC8098885 DOI: 10.4103/lungindia.lungindia_105_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction: Organizing pneumonia (OP) is an idiopathic interstitial pneumonia characterized radiologically by the patchy peripheral areas of ground-glass opacities and consolidation. It is commonly associated with a variety of conditions such as connective tissue diseases (CTD), drugs, infections, malignancy, radiation exposure, post-transplant, and other interstitial pneumonia. There are no specific clinical manifestations unless there is an underlying etiology. We present a series of such cases. Aims and Objectives: The aim of the study was to identify the clinical characteristics and etiological spectrum of patients manifesting radiologically with OP pattern. Materials and Methods: This was a retrospective analysis of clinico-radiological profile and etiological diagnosis of 23 patients, who had a radiological diagnosis of OP during the period of January 2017–September 2019. Results: Our patients presented with nonspecific symptoms of cough, fever, breathlessness, and occasionally with hemoptysis. The various etiologies identified were CTD (n = 4), infection (n = 2), drugs (n = 4), radiation (n = 1), chronic aspiration syndrome (n = 1), malignancy (n = 2), hypersensitivity pneumonitis (n = 1), and chronic heart failure (n = 2), and in majority (n = 7), no underlying etiology was evident and were labeled as cryptogenic organizing pneumonia. Conclusion: OP is an underdiagnosed entity and is associated with numerous diseases varying from pulmonary tuberculosis to malignancy. Identification of the underlying disease process is of paramount importance as it enables the treating physician to implement necessary therapeutic interventions.
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Affiliation(s)
- Vikas Marwah
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardio Thoracic Sciences (AI CTS), Pune, Maharashtra, India
| | - Deepu K Peter
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardio Thoracic Sciences (AI CTS), Pune, Maharashtra, India
| | - Neeraj Sharma
- Medical Division, Command Hospital (EC), Kolkata, West Bengal, India
| | - Saikat Bhattacharjee
- Department of Radiology, Army Institute of CardioThoracic Sciences (AI CTS), Pune, Maharashtra, India
| | - Arun Hegde
- Department of Medicine, Command Hospital (SC), Pune, Maharashtra, India
| | - Divya Shelly
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Virender Malik
- Department of Radiology, Army Institute of CardioThoracic Sciences (AI CTS), Pune, Maharashtra, India
| | - Gaurav Bhati
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardio Thoracic Sciences (AI CTS), Pune, Maharashtra, India
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Hanfi SH, Lalani TK, Saghir A, McIntosh LJ, Lo HS, Kotecha HM. COVID-19 and its Mimics: What the Radiologist Needs to Know. J Thorac Imaging 2021; 36:W1-W10. [PMID: 32852419 DOI: 10.1097/rti.0000000000000554] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the current outbreak of Coronavirus disease 2019 (COVID-19). Although imaging should not be used for first-line screening or diagnosis, radiologists need to be aware of its imaging features, and those of common conditions that may mimic COVID-19 pneumonia. In this Pictorial Essay, we review frequently encountered conditions with imaging features that overlap with those that are typical of COVID-19 (including other viral pneumonias, chronic eosinophilic pneumonia, and organizing pneumonia), and those with features that are indeterminate for COVID-19 (including hypersensitivity pneumonitis, pneumocystis pneumonia, diffuse alveolar hemorrhage, pulmonary edema, and pulmonary alveolar proteinosis).
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Affiliation(s)
- Sameer H Hanfi
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
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Duzgun SA, Durhan G, Demirkazik FB, Akpinar MG, Ariyurek OM. COVID-19 pneumonia: the great radiological mimicker. Insights Imaging 2020; 11:118. [PMID: 33226521 PMCID: PMC7681181 DOI: 10.1186/s13244-020-00933-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/27/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since December 2019. Although the reference diagnostic test is a real-time reverse transcription-polymerase chain reaction (RT-PCR), chest-computed tomography (CT) has been frequently used in diagnosis because of the low sensitivity rates of RT-PCR. CT findings of COVID-19 are well described in the literature and include predominantly peripheral, bilateral ground-glass opacities (GGOs), combination of GGOs with consolidations, and/or septal thickening creating a "crazy-paving" pattern. Longitudinal changes of typical CT findings and less reported findings (air bronchograms, CT halo sign, and reverse halo sign) may mimic a wide range of lung pathologies radiologically. Moreover, accompanying and underlying lung abnormalities may interfere with the CT findings of COVID-19 pneumonia. The diseases that COVID-19 pneumonia may mimic can be broadly classified as infectious or non-infectious diseases (pulmonary edema, hemorrhage, neoplasms, organizing pneumonia, pulmonary alveolar proteinosis, sarcoidosis, pulmonary infarction, interstitial lung diseases, and aspiration pneumonia). We summarize the imaging findings of COVID-19 and the aforementioned lung pathologies that COVID-19 pneumonia may mimic. We also discuss the features that may aid in the differential diagnosis, as the disease continues to spread and will be one of our main differential diagnoses some time more.
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Affiliation(s)
- Selin Ardali Duzgun
- Department of Radiology, School of Medicine, Tıp Fakültesi Hastanesi, Hacettepe University, 06100, Sıhhiye, Ankara, Turkey.
| | - Gamze Durhan
- Department of Radiology, School of Medicine, Tıp Fakültesi Hastanesi, Hacettepe University, 06100, Sıhhiye, Ankara, Turkey
| | - Figen Basaran Demirkazik
- Department of Radiology, School of Medicine, Tıp Fakültesi Hastanesi, Hacettepe University, 06100, Sıhhiye, Ankara, Turkey
| | - Meltem Gulsun Akpinar
- Department of Radiology, School of Medicine, Tıp Fakültesi Hastanesi, Hacettepe University, 06100, Sıhhiye, Ankara, Turkey
| | - Orhan Macit Ariyurek
- Department of Radiology, School of Medicine, Tıp Fakültesi Hastanesi, Hacettepe University, 06100, Sıhhiye, Ankara, Turkey
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Contribution of CT Features in the Diagnosis of COVID-19. Can Respir J 2020; 2020:1237418. [PMID: 33224361 PMCID: PMC7670585 DOI: 10.1155/2020/1237418] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/19/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
The outbreak of novel coronavirus disease 2019 (COVID-19) first occurred in Wuhan, Hubei Province, China, and spread across the country and worldwide quickly. It has been defined as a major global health emergency by the World Health Organization (WHO). As this is a novel virus, its diagnosis is crucial to clinical treatment and management. To date, real-time reverse transcription-polymerase chain reaction (RT-PCR) has been recognized as the diagnostic criterion for COVID-19. However, the results of RT-PCR can be complemented by the features obtained in chest computed tomography (CT). In this review, we aim to discuss the diagnosis and main CT features of patients with COVID-19 based on the results of the published literature, in order to enhance the understanding of COVID-19 and provide more detailed information regarding treatment.
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Affiliation(s)
- Amita Sharma
- From the Departments of Radiology (A.S., J.-A.O.S., B.P.L.) and Medicine (J.E.E.), Massachusetts General Hospital, and the Departments of Radiology (A.S., J.-A.O.S., B.P.L.) and Medicine (J.E.E.), Harvard Medical School - both in Boston; and the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York (A.B.)
| | - Jonathan E Eisen
- From the Departments of Radiology (A.S., J.-A.O.S., B.P.L.) and Medicine (J.E.E.), Massachusetts General Hospital, and the Departments of Radiology (A.S., J.-A.O.S., B.P.L.) and Medicine (J.E.E.), Harvard Medical School - both in Boston; and the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York (A.B.)
| | - Jo-Anne O Shepard
- From the Departments of Radiology (A.S., J.-A.O.S., B.P.L.) and Medicine (J.E.E.), Massachusetts General Hospital, and the Departments of Radiology (A.S., J.-A.O.S., B.P.L.) and Medicine (J.E.E.), Harvard Medical School - both in Boston; and the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York (A.B.)
| | - Adam Bernheim
- From the Departments of Radiology (A.S., J.-A.O.S., B.P.L.) and Medicine (J.E.E.), Massachusetts General Hospital, and the Departments of Radiology (A.S., J.-A.O.S., B.P.L.) and Medicine (J.E.E.), Harvard Medical School - both in Boston; and the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York (A.B.)
| | - Brent P Little
- From the Departments of Radiology (A.S., J.-A.O.S., B.P.L.) and Medicine (J.E.E.), Massachusetts General Hospital, and the Departments of Radiology (A.S., J.-A.O.S., B.P.L.) and Medicine (J.E.E.), Harvard Medical School - both in Boston; and the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York (A.B.)
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Dogan E, Tapan U, Tapan OO, Togan T, Çelik ÖI. Idiopathic focal organizing pneumonia mimicking malignancy. Pan Afr Med J 2020; 36:256. [PMID: 33014252 PMCID: PMC7519795 DOI: 10.11604/pamj.2020.36.256.23129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/03/2020] [Indexed: 01/15/2023] Open
Abstract
Idiopathic FOP is a rare type of COP. What we know on this subject is made up of a few clinical cases published in recent years. Our patient was admitted to the hospital with an intermittent coughing complaint that worsens over time. Due to a suspicion of malignancy, a radiological evaluation was requested including a PET-CT and a transbronchial biopsy was performed. Until the last part of our algorithm, the patient profile was clinically and radiologically in favor of the diagnosis of malignancy but, in the end, the diagnosis of FOP was fixed with a follow-up decision. In conclusion, FOP is a relatively new entity that should be kept in mind in the differential diagnosis of malignancy.
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Affiliation(s)
- Emrah Dogan
- Mugla Sitki Kocman University, Faculty of Medicine, Department of Radiology, Mugla, Turkey
| | - Utku Tapan
- Mugla Sitki Kocman University, Faculty of Medicine, Pulmonology, Mugla, Turkey
| | - Ozge Oral Tapan
- Mugla Sitki Kocman University, Faculty of Medicine, Pulmonology, Mugla, Turkey
| | - Turhan Togan
- Mugla Sitki Kocman University, Infectious Diseases, Mugla, Turkey
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Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol 2020; 30:4381-4389. [PMID: 32193638 PMCID: PMC7088323 DOI: 10.1007/s00330-020-06801-0] [Citation(s) in RCA: 785] [Impact Index Per Article: 157.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) outbreak, first reported in Wuhan, China, has rapidly swept around the world just within a month, causing global public health emergency. In diagnosis, chest computed tomography (CT) manifestations can supplement parts of limitations of real-time reverse transcription polymerase chain reaction (RT-PCR) assay. Based on a comprehensive literature review and the experience in the frontline, we aim to review the typical and relatively atypical CT manifestations with representative COVID-19 cases at our hospital, and hope to strengthen the recognition of these features with radiologists and help them make a quick and accurate diagnosis.Key Points• Ground glass opacities, consolidation, reticular pattern, and crazy paving pattern are typical CT manifestations of COVID-19.• Emerging atypical CT manifestations, including airway changes, pleural changes, fibrosis, nodules, etc., were demonstrated in COVID-19 patients.• CT manifestations may associate with the progression and prognosis of COVID-19.
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Affiliation(s)
- Zheng Ye
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, China
| | - Yun Zhang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, China
| | - Yi Wang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, China
| | - Zixiang Huang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, China.
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Güneyli S, Atçeken Z, Doğan H, Altınmakas E, Atasoy KÇ. Radiological approach to COVID-19 pneumonia with an emphasis on chest CT. Diagn Interv Radiol 2020; 26:323-332. [PMID: 32352917 PMCID: PMC7360081 DOI: 10.5152/dir.2020.20260] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has recently become a worldwide outbreak with several millions of people infected and more than 160.000 deaths. A fast and accurate diagnosis in this outbreak is critical to isolate and treat patients. Radiology plays an important role in the diagnosis and management of the patients. Among various imaging modalities, chest CT has received attention with its higher sensitivity and specificity rates. Shortcomings of the real-time reverse transcriptase-polymerase chain reaction test, including inappropriate sample collection and analysis methods, initial false negative results, and limited availability has led to widespread use of chest CT in the diagnostic algorithm. This review summarizes the role of radiology in COVID-19 pneumonia, diagnostic accuracy of imaging, and chest CT findings of the disease.
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Affiliation(s)
- Serkan Güneyli
- From the Department of Radiology (S.G. ), Koc University School of Medicine, Istanbul, Turkey
| | - Zeynep Atçeken
- From the Department of Radiology (S.G. ), Koc University School of Medicine, Istanbul, Turkey
| | - Hakan Doğan
- From the Department of Radiology (S.G. ), Koc University School of Medicine, Istanbul, Turkey
| | - Emre Altınmakas
- From the Department of Radiology (S.G. ), Koc University School of Medicine, Istanbul, Turkey
| | - Kayhan Çetin Atasoy
- From the Department of Radiology (S.G. ), Koc University School of Medicine, Istanbul, Turkey
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