Congenital Lobar Emphysema in a 17-Day-Old Male Neonate: The Plain Radiographic Features and a Case Report

Congenital lobar emphysema (CLE) is a rare respiratory disorder which allows air to enter the lungs but can’t escape causing over-inflation of the lobes of the lung. This condition (CLE) is commonly detected in the newborn or young infants but some cases are diagnosed in adulthood. Congenital lobar emphysema is a rare congenital malformation with a prevalence of 1 in 20,000 to 1 in 30, 000, and more prevalent in males, with a male to female ratio of about 3:1. This is a 17 day old male neonate that presented with respiratory difficulty and .had a supine chest radiograph that showed an overinflated left lung field more on the upper and middle zones with flattening of the left hemi diaphragm, marked shift of the heart and mediastinum to the right with some degree of loss of volume involving the right lung. We report the radiographic findings of this case due the rare nature of congenital lobar emphysema.

An efficient and fast multi-band focused bioimpedance solution with EIT-based reconstruction for pulmonary embolism assessment: a simulation study from massive to segmental blockage

Objective: Pulmonary embolism (PE) is an acute condition that blocks the perfusion to the lungs and is a common complication of Covid-19. However, PE is often not diagnosed in time, especially in the pandemic time due to complicated diagnosis protocol. In this study, a non-invasive, fast and efficient bioimpedance method with the EIT-based reconstruction approach is proposed to assess the lung perfusion reliably. Approach: Some proposals are presented to improve the sensitivity and accuracy for the bioimpedance method: (1) a new electrode configuration and focused pattern to help study deep changes caused by PE within each lung field separately, (2) a measurement strategy to compensate the effect of different boundary shapes and varied respiratory conditions on the perfusion signals and (3) an estimator to predict the lung perfusion capacity, from which the severity of PE can be assessed. The proposals were tested on the first-time simulation of PE events at different locations and degrees from segmental blockages to massive blockages. Different object boundary shapes and varied respiratory conditions were included in the simulation to represent for different populations in real measurements. Results: The correlation between the estimator and the perfusion was very promising (R = 0.91, errors < 6%). The measurement strategy with the proposed configuration and pattern has helped stabilize the estimator to non-perfusion factors such as the boundary shapes and varied respiration conditions (3-5% errors). Significance: This promising preliminary result has demonstrated the proposed bioimpedance method’s capability and feasibility, and might start a new direction for this application.

Pulmonary fungal ball due to Trichophyton successfully managed with oral itraconazole: a case report

Pulmonary fungal balls are caused by long-term fungal infection of the lung. They are sometimes a complication of previous cavitary pulmonary tuberculosis. Pulmonary fungal balls caused by Trichophyton are extremely rare. A 65-year-old man who worked in a leather recycling factory was admitted because of a productive cough and shortness of breath. He had a history of tuberculosis with lung destruction. A chest radiograph showed an opacity surrounding an air lucency over the left lung field, and chest computed tomography showed a mass within a cavity, producing a ball-in-hole appearance, over the left upper lung lobe. Bronchoalveolar lavage was performed, and fungal culture of the lavage fluid yielded Trichophyton. After 6 months of treatment with oral itraconazole, the patient’s general condition improved. This case emphasizes the importance of awareness of fungal infection within cavitary lesions of the lung and shows that Trichophyton may be the etiologic organism in such cases. Itraconazole is a recommended treatment of pulmonary fungal balls.

Radiomic Phenotyping of the Lung Parenchyma: Feasibility Study in a Screening Cohort

Rationale: High-throughput extraction of radiomic features from low-dose CT scans can characterize the heterogeneity of the lung parenchyma and potentially aid in identifying subpopulations that may have higher risk of lung diseases, such as COPD, and lung cancer due to inflammation or obstruction of the airways. We aim to determine the feasibility a lung radiomics phenotyping approach in a lung cancer screening cohort, while quantifying the effect of different CT reconstruction algorithms on phenotype robustness. Methods: We identified low-dose CT scans (n = 308) acquired with Siemens Healthineers scanners from patients who completed low-dose CT within our lung cancer screening program between 2015-2018 and had two different sets of image reconstructions kernel available (i.e., medium (I30f), sharp (I50f)) for the same acquisition. Following segmentation of the lung field, a total of 26 radiomic features were extracted from the entire 3D lung-field using a previously validated fully-automated lattice-based software pipeline, adapted for low-dose CT scans. The features extracted included gray-level histogram, co-occurrence, and run-length descriptors. Each feature was averaged for each scan within a range of lattice window sizes (W) ranging from 4-20mm. The extracted imaging features from both datasets were harmonized to correct for differences in image acquisition parameters. Subsequently, unsupervised hierarchal clustering was applied on the extracted features to identify distinct phenotypic patterns of the lung parenchyma, where consensus clustering was used to identify the optimal number of clusters (K = 2). Differences between? phenotypes for demographic and clinical covariates including sex, age, BMI, pack-years of smoking, Lung-RADS and cancer diagnosis were assessed for each phenotype cluster, and then compared across clusters for the two different CT reconstruction algorithms using the cluster entanglement metric, where a lower entanglement coefficient corresponds to good cluster alignment. Furthermore, an independent set of low-dose CT scans (n = 88) from patients with available pulmonary function data on lung obstruction were analyzed using the identified optimal clusters to assess associations to lung obstruction and validate the lung phenotyping paradigm. Results: Heatmaps generated by radiomic features identified two distinct lung parenchymal phenotype patterns across different feature extraction window sizes, for both reconstruction algorithms (P < 0.05 with K = 2). Associations of radiomic-based clusters with clinical covariates showed significant difference for BMI and pack-years of smoking (P < 0.05) for both reconstruction kernels. Radiomic phenotype patterns where similar across the two reconstructed kernels, specifically when smaller window sizes (W=4 and 8mm) were used for radiomic feature extraction, as deemed by their entanglement coefficient. Validation of clustering approaches using cluster mapping for the independent sample with lung obstruction also showed two statistically significant phenotypes (P < 0.05) with significant difference for BMI and smoking pack-years.ConclusionsRadiomic analysis can be used to characterize lung parenchymal phenotypes from low-dose CT scans, which appear reproducible for different reconstruction kernels. Further work should seek to evaluate the effect of additional CT acquisition parameters and validate these phenotypes in characterizing lung cancer screening populations, to potentially better stratify disease patterns and cancer risk.

Eosinophilic pneumonia induced by lettuce: A case report

Background: Lettuce (Lactuca sativa) belongs to the Composite family and is a vegetable widely consumed globally. Although lettuce is extensively cultivated and consumed, lettuce-associated occupational allergy is rarely reported. Herein, we are reporting a case of eosinophilic pneumonia induced by lettuce for the first time.Case presentation: A 56-year-old female lettuce farmer was admitted to the hospital with a low-grade fever, worsening cough, and dyspnoea. A blood test revealed eosinophilia and a high serum IgE concentration. A chest X-ray taken on admission showed an infiltrative shadow in the upper lung field. Chest CT revealed patchy ground glass opacity on the upper lung field and thickening of the bronchial wall. The bronchoalveolar lavage fluid contained 8% eosinophils. The IgG-binding proteins that reacted with the patient’s sera were identified by immunoblot analysis. She was diagnosed as lettuce induced eosinophilic pneumonia and was treated with prednisolone, and her symptoms and radiological findings improved. Wearing a mask and reducing the amount of the crop improved her symptoms the following year.Conclusions: This is the first case report about lettuce-induced eosinophilic pneumonia which occurred in a lettuce farmer. The avoidance from antigen is quite useful in this patient.

Spontaneous pulmonary emphysema in mice lacking all three nitric oxide synthase isoforms

The roles of endogenous nitric oxide (NO) derived from the entire NO synthases (NOSs) system have yet to be fully elucidated. We addressed this issue in mice in which all three NOS isoforms were deleted. Under basal conditions, the triple n/i/eNOSs−/− mice displayed significantly longer mean alveolar linear intercept length, increased alveolar destructive index, reduced lung elastic fiber content, lower lung field computed tomographic value, and greater end-expiratory lung volume as compared with wild-type (WT) mice. None of single NOS−/− or double NOSs−/− genotypes showed such features. These findings were observed in the triple n/i/eNOSs−/− mice as early as 4 weeks after birth. Cyclopaedic and quantitative comparisons of mRNA expression levels between the lungs of WT and triple n/i/eNOSs−/− mice by cap analysis of gene expression (CAGE) revealed that mRNA expression levels of three Wnt ligands and ten Wnt/β-catenin signaling components were significantly reduced in the lungs of triple n/i/eNOSs−/− mice. These results provide the first direct evidence that complete disruption of all three NOS genes results in spontaneous pulmonary emphysema in juvenile mice in vivo possibly through down-regulation of the Wnt/β-catenin signaling pathway, demonstrating a novel preventive role of the endogenous NO/NOS system in the occurrence of pulmonary emphysema.

Prognostic Predictors For COVID-19 in Daily Clinical Practice in Japan: a Propensity Score-Matched Case-Control Study

Introduction: Blood tests and computed tomography (CT) findings at diagnosis are widely used in daily clinical practice and can offer useful prognostic factors for coronavirus disease 2019.Methods: We retrospectively evaluated 66 patients who underwent a blood test and CT between January 1 and May 31, 2020, and performed a propensity score-matched case-control study. Cases and controls were a severe respiratory failure group (non-rebreather mask, nasal high-flow, positive-pressure ventilation) and a non-severe respiratory failure group, matched at a ratio of 1:3 by propensity scores constructed by age, sex, and medical history. We compared groups for maximum body temperature up to diagnosis, laboratory findings, and CT findings in the matched cohort. Two-tailed P-values <0.05 were considered statistically significant.Results: Nine cases and 27 controls were included in the matched cohort. Significant differences were seen in maximum body temperature up to diagnosis (p=0.0043), the number of shaded lobes (p=0.0434), amount of ground-glass opacity (GGO) in the total lung field (p=0.0071), amounts of GGO (p=0.0001), and consolidation (p=0.0036) in the upper lung field, and pleural effusion (p=0.0117).Conclusions: Fever and CT findings (such as GGO and consolidation) may be prognostic indicators that can be easily measured at diagnosis.

Poland Syndrome Associated with Lung Cancer: A Case Report and Literature Review

Background: Poland syndrome is a rare congenital disease consisting a spectrum of defects occupied by unilateral chest wall hypoplasia and ipsilateral hand abnormalities. It is also closely associated with some malignant diseases and some benign diseases, such as breast cancer, lymphoma, recurrent spontaneous pneumothorax, perforating dermatosis, hemangioma, gastric cancer and lung cancer. The low incidence of Poland syndrome has hindered investigators’ attempts to develop randomized prospective trials, so the disease is poorly understood. Now We find out a case of Poland’s syndrome associated with adenocarcinoma of right lung, in which before this article there was only article depicting a case of lung squamous cancer with poland syndrome, this is an interesting topic. To the best of our knowledge, this is the second case of poland syndrome closely related to lung cancer.Case presentation: A 61-year-old man came to the hospital accompanied by intermittent dry cough and hemoptysis that lasted for 2 months. Chest CT revealed showed a large lobulated mass about 5.5cm × 4.0 cm × 3.0 cm in the right lower lung field and the normal right pectoralis major muscle and pectoralis minor were both absent. we diagnosed the patient with stage IIIa lung adenocarcinoma. After two cycles of preoperative platinum-doublet chemotherapy, we have performed a regular right lower lobectomy and lymph node dissection. Until now, after 2.5 years of follow up, he did not relapse.Conclusions: In addition to some other reported types of malignancies, there is increasing evidence that an association between these two clinical entities. Although we do not understand the underlying mechanisms, we assume there exists some common gene pathways that regulate these two clinical entities. Because these patients who got Poland syndrome are susceptibility to different kinds of malignancies, longitudinal epidemiological studies may be needed.

Re-expansion pulmonary edema following a pneumothorax drainage in a patient with COVID-19

Background Re-expansion pulmonary edema is an uncommon complication following drainage of a pneumothorax or pleural effusion. While pneumothorax is noted to complicate COVID-19 patients, no case of COVID-19 developing re-expansion pulmonary edema has been reported. Case representation A man in his early 40 s without a smoking history and underlying pulmonary diseases suddenly complained of left chest pain with dyspnea 1 day after being diagnosed with COVID-19. Chest X-ray revealed pneumothorax in the left lung field, and a chest tube was inserted into the intrathoracic space without negative pressure 9 h after the onset of chest pain, resulting in the disappearance of respiratory symptoms; however, 2 h thereafter, dyspnea recurred with lower oxygenation status. Chest X-ray revealed improvement of collapse but extensive infiltration in the expanded lung. Therefore, the patient was diagnosed with re-expansion pulmonary edema, and his dyspnea and oxygenation status gradually improved without any intervention, such as steroid administration. Abnormal lung images also gradually improved within several days. Conclusions This case highlights the rare presentation of re-expansion pulmonary edema following pneumothorax drainage in a patient with COVID-19, which recovered without requiring treatment for viral pneumonia. Differentiating re-expansion pulmonary edema from viral pneumonia is crucial to prevent unnecessary medication for COVID-19 pneumonia and pneumothorax.