scholarly journals Phlegmonous Appearance in the Ipsilateral Paracardiac Fat without Paracardiac Lymph Node Enlargement on Chest CT Favors the Diagnosis of Pleural Tuberculosis over Malignant Pleural Effusion

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1041
Author(s):  
Dongjun Lee ◽  
Min Ji Son ◽  
Seung Min Yoo ◽  
Hwa Yeon Lee ◽  
Charles S. White
Keyword(s):  
Lymph Node ◽  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Chest Ct ◽  
Reactive Protein ◽  
Ct Findings ◽  
Pleural Tuberculosis ◽  
Lymph Node Enlargement ◽  
Fluid Collections ◽  
Fat Stranding

This study investigated the potential role of paracardiac fat stranding (FS) interspersed with multiple fluid collections (FC) as a clue to differentiate between pleural tuberculosis (pleural TB) and malignant pleural effusion (MPE). The authors retrospectively analyzed chest computed tomography (CT) findings of 428 patients, 351 with pleural TB and 77 with MPE, focusing on the paracardiac fat, and level of pleural adenosine deaminase (ADA) and blood C-reactive protein (CRP). Two radiologists independently evaluated the chest CT findings regarding the paracardiac fat pad ipsilateral to the effusion, including FS, FC, phlegmonous appearance (a combination of the FS and multiple FC), and the presence of lymph node enlargement (>1 cm in short axis diameter). There were significant differences between patients with pleural TB and those with MPE with respect to the prevalence of phlegmonous appearance in the ipsilateral paracardiac fat (47.6% and 10.4%, p < 0.001, OR = 7.8; 95% CI 3.7–16.8) and paracardiac lymph node enlargement (1.4% and 19.5%, p < 0.001, OR = 0.06; 95% CI 0.02–0.2) on CT. In contrast, there was no difference in the prevalence of isolated FS or multiple FC within the ipsilateral paracardiac fat between the two groups. Median pleural ADA and serum CRP level were higher in patients with pleural TB accompanied by phlegmonous appearance in paracardiac fat compared to those without that appearance (ADA: median 104 IU/L versus 90 IU/L, p < 0.001; CRP: 6.5 mg/dL versus 4.2 mg/dL, p < 0.001). In conclusion, phlegmonous appearance in the ipsilateral paracardiac fat without paracardiac lymph node enlargement on chest CT favors a diagnosis of pleural TB over MPE.

scholarly journals Chest CT Findings and Differential Diagnosis of Mycoplasma pneumoniae Pneumonia and Mycoplasma pneumoniae Combined with Streptococcal Pneumonia in Children

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Jing Wang ◽  
Chen Xia ◽  
Ashutosh Sharma ◽  
Gurjot Singh Gaba ◽  
Mohammad Shabaz
Keyword(s):  
Lymph Node ◽  
Pleural Effusion ◽  
Mycoplasma Pneumoniae ◽  
Ct Images ◽  
Chest Ct ◽  
Transverse Diameter ◽  
Pulmonary Lesions ◽  
Ct Findings ◽  
Lymph Node Enlargement ◽  
Mycoplasma Pneumoniae Pneumonia

Background. In this day and age, 17% of children less than 5 years of age died of pneumonia; it is the common cause of children death. It is one of the main children respiratory infectious diseases, i.e., mycoplasma pneumonia (MP). The imaging examination can be adopted to quickly observe the morphology and scope of the pulmonary lesions and know the effect of disease treatment and subsequent changes in the disease in order to provide a basis for treatment. Therefore, the most commonly applied technology for detecting pneumonia in children is imaging technology, including chest X-ray and CT. Objectives. The main objective of the work is to investigate the chest computed tomography (CT) findings of children patients with Mycoplasma pneumoniae pneumonia (MPP) and MP combined with streptococcal pneumonia (SP). The mixed infection of MP and SP is very common clinically, and the diagnosis of this type of mixed pneumonia is a critical research topic faced by pediatric respiratory physicians. The comparison is done on the incidence of bronchial and pulmonary interstitial lesions, the degree of lymph node enlargement, the volume and depth of pleural effusion, and the location and morphology of the pulmonary lesions in the chest CT images of children patients from the two groups. Methods. There were comparisons on the incidence of bronchial and pulmonary interstitial lesions, the degree of lymph node enlargement, the volume and depth of pleural effusion, and the location and morphology of the pulmonary lesions in the chest CT images of children patients from the two groups. All the experiments are done in the MATLAB. Results. The results showed that the proportions of reticular shadow, ground glass shadow, bronchial inflation phase, tube wall thickening, and vascular bundle thickening on the CT images of children patients from the MPP group were dramatically higher than those of the MP + SP group ( P < 0.05 ). The maximum transverse diameter of enlarged lymph node in children patients from the MPP group was obviously larger than the diameter of the MP + SP group ( P < 0.05 ). The number of children patients with pleural effusion was 22 in the MP + SP group, which was greatly higher than the MPP group ( P < 0.05 ). Conclusion. In conclusion, the chest CT images of children patients from the MPP group were mainly pulmonary interstitial changes. Furthermore, the alveolar inflammation could be observed on the CT images shown when children patients were combined with SP infection. The more obvious manifestations were that the flaky shadows appeared in the lungs, the pleural effusion became thicker, and the transverse diameters of enlarged lymph nodes were bigger.

scholarly journals A simple C-reactive protein measurement for the differentiation between tuberculous and malignant pleural effusion: Comment

Respirology ◽  
2004 ◽  
Vol 9 (4) ◽  
pp. 568-568 ◽  
Author(s):  
Eduardo GARCIA-PACHON ◽  
Isabel PADILLA-NAVAS ◽  
Ismael L. LLORCA ◽  
Conrado SHUM
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Protein Measurement

scholarly journals Viscum pleurodesis is as effective as talc pleurodesis and tends to have less adverse effect

2020 ◽  
Vol 28 (11) ◽  
pp. 5463-5467 ◽  
Author(s):  
YongJin Chang ◽  
DeogGon Cho ◽  
KyuDo Cho ◽  
MinSeop Cho
Keyword(s):  
Pleural Effusion ◽  
Adverse Effects ◽  
Malignant Pleural Effusion ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Chemical Pleurodesis ◽  
Talc Pleurodesis ◽  
Reactive Protein ◽  
Cell Counts ◽  
White Blood Cell Counts

Abstract Purpose Many patients diagnosed with advanced cancer have malignant pleural effusion that does not respond to chemotherapy or radiation therapy. These patients often have respiratory symptoms, especially dyspnea. In order to relieve these symptoms, various procedures including chemical pleurodesis have been performed. Although talc is the most widely used and effective sclerosing agent, there it has various adverse effects. The objective of this study was to determine whether Viscum (ABNOVA Viscum® Fraxini Injection, manufactured by ABNOVA GmbH, Germany) could be used as an agent to replace talc in clinical practice. Methods Data of 56 patients with malignant pleural effusion who received chemical pleurodesis after tube thoracostomy from January 2003 to December 2017 were retrospectively reviewed to analyze clinical course and response after pleurodesis with each agent. Results After pleurodesis, changes in numeric rating scale (NRS) was 1.4 ± 1.6 in the talc group and 0.5 ± 1.5 in the Viscum group (p = 0.108). Changes in white blood cell counts after pleurodesis were 4154.8 ± 6710.7 in the talc group and 3487.3 ± 6067.7 in the Viscum group (p = 0.702). Changes in C-reactive protein (CRP) were 9.03 ± 6.86 in the talc group and 6.3 ± 7.5 in the Viscum group (p = 0.366). The success rate of pleurodesis was 93.3% in the talc group and 96% in the Viscum group (p = 0.225). Conclusion Viscum pleurodesis showed comparable treatment results with talc pleurodesis while its adverse effects such as chest pain and fever tended to be relatively weak.

scholarly journals A case report on expanding horizon of endobronchial ultrasound through esophagus

2020 ◽  
Vol 90 (3) ◽  
Author(s):  
Mario Tamburrini ◽  
Parikshit Thakare ◽  
Francesca Zampieri ◽  
Angelo Scarda ◽  
Alessandra Di Paolo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Pleural Effusion ◽  
Squamous Carcinoma ◽  
Final Diagnosis ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Malignant Cells ◽  
Necrotic Tissue ◽  
Fluid Collections ◽  
Cytology Report

Endobronchial ultrasound has revolutionized the field of bronchoscopy and has become one of the most important tools for the diagnosis of intrathoracic lymphadenopathy and para-bronchial structures. The reach of this technique has not been limited to these structures and pleural lesions have been at times accessible. To our knowledge, pleural fluid collections have not been accessed with endobronchial ultrasound (EBUS) through oesophageal approach and rationale behind using this approach. We report a case of 70 years old man who has been referred from physician for the EBUS in view of hilar mass with mediastinal lymphadenopathy with pleural effusion. The endobronchial ultrasound through oesophagus (EUS-B) was done for thoracocentesis and lymph node cytology evaluation and ultimately endobronchial biopsy of hilar mass was done as rapid on-site (ROSE) analysis of lymph node was suggestive of necrotic tissue. The cytology report of lymph node and pleural effusion was positive for malignant cells. The final diagnosis was metastatic poorly differentiating adeno-squamous carcinoma.

scholarly journals Chest CT Imaging Characteristics of COVID-19 Pneumonia in Surviving and Non-Surviving Hospitalized Patients: A Retrospective Study in a Referral Center in Tehran, Iran

2021 ◽  
Vol 18 (2) ◽  
Author(s):  
Sara Besharat ◽  
Fatemehsadat Rahimi ◽  
Siamak Afaghi ◽  
Farzad Esmaeili Tarki ◽  
Fatemeh Pourmotahari ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Ct Scan ◽  
Chest Ct ◽  
Ct Scans ◽  
Early Management ◽  
Ct Findings ◽  
Imaging Characteristics ◽  
Significant Difference ◽  
Chest Ct Scan ◽  
Lung Lobes

Background: Coronavirus disease 2019 (COVID-19) has several chest computed tomography (CT) characteristics, which are important for the early management of this disease, because viral detection via RT-PCR can be time-consuming, resulting in a delayed pneumonia diagnosis. The Radiological Society of North America (RSNA) proposed a reporting language for CT findings related to COVID-19 and defined four CT categories: typical, indeterminate, atypical, and negative. Objectives: To retrospectively evaluate the chest CT characteristics of patients with COVID-19 pneumonia. Patients and Methods: A total of 115 hospitalized laboratory-verified COVID-19 cases, underdoing chest CT scan, were included in this study from April 30 to May 15, 2020. Of 115 cases, 53 were discharged from the hospital, and 62 expired. The initial clinical features and chest CT scans were assessed for the type, pattern, distribution, and frequency of lesions. Moreover, the findings were compared between ward-hospitalized, ICU-admitted, and non-surviving (expired) patients. Results: Of four CT categories, typical CT findings for COVID-19 were more frequent in the expired group (77.4%), compared to the ward-admitted (44.8%) and ICU-admitted (70.8%) groups (P = 0.017). However, no significant difference was observed in the prevalence of intermediate or atypical CT findings between the groups. Negative CT scans for the diagnosis of COVID-19 were significantly fewer in the expired group (0%) as compared to the ward-admitted (10.3%) and ICU-admitted (8.3%) groups (P = 0.0180). Also, the mean number of involved lung lobes and segments was significantly higher in the expired group compared to the other two groups (P = 0.032 and 0.010, respectively). The right upper lobe involvement, right middle lobe involvement, bilateral involvement, central lesion, air bronchogram, and pleural effusion were among CT scan findings with a significantly higher prevalence in non-surviving cases (P < 0.0001, 0.047, 0.01, 0.036, 0.038, and 0.047, respectively). Conclusion: The increased number of involved lung lobes and segments, bilateral and central distribution patterns, air bronchogram, and severe pleural effusion in the initial chest CT scan can be related to the increased severity and poor prognosis of COVID-19.

scholarly journals Subcutaneous Panniculitic T-Cell Lymphoma in an Adolescent: A Case Report

2020 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Weight Loss ◽  
Case Report ◽  
Lymph Node ◽  
T Cell ◽  
Pleural Effusion ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Cutaneous Manifestations ◽  
Lymph Node Enlargement ◽  
Facial Edema

Rationale and Objectives: Subcutaneous panniculitic T-cell lymphoma (SPTCL) is a rare neoplasm accounting for less than 1% of pediatric Non-Hodgkin Lymphomas. It is most common in young adults with predominance of female cases at 0.5. Symptoms include multiple nodules involving the subcutaneous tissues of the extremities and trunk, neck and face. B symptoms such as fever, chills, night sweats and weight loss, have been reported. Rare extra-cutaneous manifestations include edema, involvement of the bone marrow, lymph nodes, liver, spleen, lungs and viscera. Laboratory abnormalities such as cytopenias and elevated lactate dehydrogenase have been recorded. Hemophagocytic syndrome (HPS) occurs in 33% of cases, which were correlated with fatal outcome. Case Report: We present a rare case of a 17 year-old male diagnosed with subcutaneous pannicultic T-cell lymphoma manifesting with prolonged fever, weight loss, and multiple subcutaneous nodules. He also presented with extra-cutaneous manifestations of facial edema, pleural effusion and ascites, lymph node enlargement, hepatosplenomegaly with jaundice and pancytopenia. Conclusion and Summary: Subcutaneous Panniculitic T-Cell Lymphoma may present with an unusual finding of facial edema, ascites and pleural effusion, lymph node enlargement, hepatosplenomegaly with jaundice and pancytopenia alongside skin manifestations of subcutaneous panniculitis. HPS may complicate the course, treatment decisions and outcome of the disease.

scholarly journals Clinical, Laboratory, and Chest CT Features of Severe Versus Non-Severe Pediatric Patients with COVID‐19 Infection Among Different Age Groups

2020 ◽  
Author(s):  
Meisam Hoseinyazdi ◽  
Saeid Esmaeilian ◽  
Reza Jahankhah ◽  
Arash Teimouri ◽  
Farzaneh ghazi sherbaf ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
Age Groups ◽  
Chest Ct ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Ct Findings ◽  
Abnormal Chest ◽  
Diffuse Distribution

Abstract Background: The aim of this study was to compare the clinical, laboratory, and chest computed tomography (CT) findings between severe and non-severe patients as well as between different age groups of pediatric patients with confirmed COVID-19.Method: This study was performed on 55 pediatric patients with confirmed COVID-19 hospitalized in Namazi and Ali Asghar Hospitals, Shiraz, Iran. Patients were divided into severe (n=27) and non-severe (n=28) groups. Also, they were categorized into three age groups: aged less than two years, 3-12 years and 13-17 years. CT scans, laboratory, and clinical features were taken from all patients at the admission time. Abnormal chest CT in COVID-19 pneumonia was found to show one of the following findings: ground-glass opacities (GGO), bilateral involvement, peripheral and diffuse distribution.Result: Fever (79.2%) and dry cough (75.5%) were the most common clinical symptoms. Severe COVID-19 patients showed lymphocytosis compared to non-severe ones (P = 0.028). C-reactive protein (CRP) was shown to be significantly lower in patients aged less than two years than those aged 3-12 and 13-17 years old (P = 0.009). It was also shown that O2 saturation was significantly increased, as age increased (P = 0.015). Also, severe patients had significantly higher CT abnormalities compared to non-severe ones (48.0% compared to 17.9%, respectively) (P = 0.019).Conclusion: Lymphocytosis and abnormal CT findings are among the factors most associated with COVID-19 severity. It was, moreover, showed that the severity of the COVID-19, O2 saturation, and respiratory distress were improved as the age of confirmed COVID-19 pediatric patients increased.

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