Is diagnostic accuracy for detecting pulmonary nodules in chest CT reduced after a long day of reading?

Background: Application of chest radiography for all patients with chest diseases is associated with a significant increase in total costs, exposure to radiation, and overcrowding of the emergency department in case of emergency. Ultrasound has been introduced as an alternative diagnostic tool in this regard. The aim of the work is to determine sensitivity, specificity and diagnostic accuracy of chest ultrasonography as an easy and fast form of imagery for different thoracic conditions. Results: This prospective study was carried out on sixty patients. The majority of patients presented with lung masses (20%) and pleural effusion (16.7%). Chest US findings showed great concordance or agreement with the chest CT findings. The only lower concordance is noted in the diagnosis of pulmonary nodules or mass, where chest US reported pulmonary nodules or mass in 33.3% of patients compared to 46.7%% by chest CT. US showed a highly comparable diagnostic performance in chest-related pathological entities, compared to chest CT. Chest US had 100% sensitivity in detecting all pathological chest entities except for lung collapse (83.3%) and pulmonary nodules (71.4%). However, chest US was more specific than sensitive. It had 100% specificity in all pathological entities except for lung collapse consolidation. Chest US had 100% diagnostic accuracy in all chest-related pathological entities except for lung collapse consolidation and pulmonary nodules or masses. However, when presenting these findings among male and female patients, Chest US had better overall diagnostic accuracy among female patients than male patients. Conclusion: US examination of the chest is a noninvasive and promising bedside tool for the examination of respiratory problems patients. Consequently, chest ultrasonography can be adjoined in the up-to-date work-up of the outpatients as an ancillary tool aiding in disease diagnosis.

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Clinical and chest CT presentations from 27 patients with COVID-19 pneumonia in Mogadishu, Somalia: a descriptive study

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00302-2 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Yahye Garad Mohamed ◽

Mohamed Farah Yusuf Mohamud ◽

M. Sabri Medişoğlu ◽

Ihsan Yavuz Atamaca ◽

Ibrahim Hussein Ali

Keyword(s):

Sore Throat ◽

Pulmonary Nodules ◽

Ground Glass Opacity ◽

Chest Ct ◽

First Case ◽

Abnormal Chest ◽

Lower Lung ◽

History Of ◽

Normal Chest ◽

Bilateral Lung

Abstract Background Coronavirus disease 2019 (COVID-19) is an acute viral pneumonia that had recently been found in humans. The first case was discovered in Wuhan, Hubei province, China, in December 2019. In this article, we aimed to demonstrate the clinical and radiological characteristics of COVID-19 patients in Somalia from 20 March 2020 to 20 April 2020. Results Twenty-seven patients that had a positive RT-PCR test between 20 March 2020 and 20 April 2020 were retrospectively observed. This study included 19 (70.4%) males and 8 (29.6%) females, and the mean age and range were 43 years (SD ± 14.0) and 27–70 years, respectively. The majority (59.3%) of COVID-19-infected patients had no obvious history of exposure to infected patients. The participants of our study mostly presented with dry cough 24 (88.9%) patients, fever 19 (70.4%), myalgia 18 (66.6%), and sore throat 16 (59.3%). Twenty-five of 27 patients had abnormal chest CT, while 2 (7.4%) patients had normal chest CT. The most common patterns of abnormality seen on chest CT in patients with COVID-19 were ground-glass opacity (GGO) 74.1%, crazy paving pattern 18.5%, consolidation 14.8%, and mixed GCO 11.1%. Also, the most common predominant lesion distributions were bilateral lung involvement (88.9%), peripheral distribution (77.8%), and lower lung predominance (63%). Particularly, lung cavitation, discrete pulmonary nodules, pleural effusion, and underlying pulmonary fibrosis or emphysema had not been observed. Conclusion Dry cough, fever, myalgia, and sore throat were the most clinical presentations. GGO, crazy paving pattern, patchy consolidation, and mixed GCO were the typical chest CT manifestations.

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Diagnostic performance of chest CT in differentiating COVID-19 from other causes of ground-glass opacities

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00398-6 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Ali H. Elmokadem ◽

Dalia Bayoumi ◽

Sherif A. Abo-Hedibah ◽

Ahmed El-Morsy

Keyword(s):

Diagnostic Performance ◽

Pulmonary Nodules ◽

Ground Glass Opacity ◽

Chest Ct ◽

Ground Glass ◽

Rt Pcr ◽

Laboratory Findings ◽

Halo Sign ◽

Traction Bronchiectasis ◽

Chest Ct Scan

Abstract Background To evaluate the diagnostic performance of chest CT in differentiating coronavirus disease 2019 (COVID-19) and non-COVID-19 causes of ground-glass opacities (GGO). Results A total of 80 patients (49 males and 31 females, 46.48 ± 16.09 years) confirmed with COVID-19 by RT-PCR and who underwent chest CT scan within 2 weeks of symptoms, and 100 patients (55 males and 45 females, 48.94 ± 18.97 years) presented with GGO on chest CT were enrolled in the study. Three radiologists reviewed all CT chest exams after removal of all identifying data from the images. They expressed the result as positive or negative for COVID-19 and recorded the other pulmonary CT features with mention of laterality, lobar affection, and distribution pattern. The clinical data and laboratory findings were recorded. Chest CT offered diagnostic accuracy ranging from 59 to 77.2% in differentiating COVID-19- from non-COVID-19-associated GGO with sensitivity from 76.25 to 90% and specificity from 45 to 67%. The specificity was lower when differentiating COVID-19 from non-COVID-19 viral pneumonias (30.5–61.1%) and higher (53.1–70.3%) after exclusion of viral pneumonia from the non-COVID-19 group. Patients with COVID-19 were more likely to have lesions in lower lobes (p = 0.005), peripheral distribution (p < 0.001), isolated ground-glass opacity (p = 0.043), subpleural bands (p = 0.048), reverse halo sign (p = 0.005), and vascular thickening (p = 0.013) but less likely to have pulmonary nodules (p < 0.001), traction bronchiectasis (p = 0.005), pleural effusion (p < 0.001), and lymphadenopathy (p < 0.001). Conclusions Chest CT offered reasonable sensitivity when differentiating COVID-19- from non-COVID-19-associated GGO with low specificity when differentiating COVID-19 from other viral pneumonias and moderate specificity when differentiating COVID-19 from other causes of GGO.

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A Case of Fusobacterium necrophorum without Lemierre’s Syndrome Mimicking Acute Leptospirosis

Case Reports in Infectious Diseases ◽

10.1155/2019/4380429 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Ryo Yasuhara ◽

Shunichi Shibazaki ◽

Takayoshi Yamanouchi

Keyword(s):

Anaerobic Bacteria ◽

Kidney Injury ◽

Pulmonary Nodules ◽

Fusobacterium Necrophorum ◽

Chest Ct ◽

Blood Cultures ◽

Conjunctival Hyperemia ◽

Potential Risks ◽

Pcr Assays ◽

Chest Ct Scan

Jaundice, conjunctival hyperemia, and acute kidney injury (AKI) are the characteristics of leptospirosis. However, it is not well known that Fusobacterium necrophorum infection can have a clinical picture similar to that of leptospirosis. A 38-year-old man was admitted with jaundice, conjunctival hyperemia, and AKI for 7 days. Chest CT scan showed multiple pulmonary nodules, atypical for leptospirosis. We started treatment with IV piperacillin-tazobactam and minocycline. He became anuric and was urgently started on hemodialysis on the second hospital day. Later on, blood cultures grew Fusobacterium necrophorum and other anaerobic bacteria. Antibody and PCR assays for Leptospira were negative. We narrowed the antibiotics to IV ceftriaxone and metronidazole. He responded well to the treatment and was discharged on the 18th hospital day. F. necrophorum infection is known to cause mixed infection with other anaerobic bacteria. The resistance of many anaerobic bacteria continues to progress, and F. necrophorum itself sometimes produces β-lactamase. This case highlights the potential risks of using penicillin before diagnosis of leptospirosis.

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Diagnostic accuracy and complication rate of image-guided percutaneous transthoracic needle lung biopsy for subsolid pulmonary nodules: a systematic review and meta-analysis

British Journal of Radiology ◽

10.1259/bjr.20210065 ◽

2021 ◽

Author(s):

Junghoon Kim ◽

Choong Guen Chee ◽

Jungheum Cho ◽

Youngjune Kim ◽

Min A Yoon

Keyword(s):

Diagnostic Accuracy ◽

Complication Rate ◽

Needle Biopsy ◽

Meta Analysis ◽

Pulmonary Nodules ◽

Major Complication ◽

Needle Aspiration ◽

Fine Needle ◽

Major Complication Rate ◽

Higher Sensitivity

Objectives: To determine the diagnostic accuracy and complication rate of percutaneous transthoracic needle biopsy (PTNB) for subsolid pulmonary nodules and sources of heterogeneity among reported results. Methods: We searched PubMed, EMBASE, and Cochrane libraries (until November 7, 2020) for studies measuring the diagnostic accuracy of PTNB for subsolid pulmonary nodules. Pooled sensitivity and specificity of PTNB were calculated using a bivariate random-effects model. Bivariate meta-regression analyses were performed to identify sources of heterogeneity. Pooled overall and major complication rates were calculated. Results: We included 744 biopsies from 685 patients (12 studies). The pooled sensitivity and specificity of PTNB for subsolid nodules were 90% (95% confidence interval [CI]: 85–94%) and 99% (95% CI: 92–100%), respectively. Mean age above 65 years was the only covariate significantly associated with higher sensitivity (93% vs 85%, p = 0.04). Core needle biopsy showed marginally higher sensitivity than fine-needle aspiration (93% vs 83%, p = 0.07). Pooled overall and major complication rate of PTNB were 43% (95% CI: 25–62%) and 0.1% (95% CI: 0–0.4%), respectively. Major complication rate was not different between fine-needle aspiration and core needle biopsy groups (p = 0.25). Conclusion: PTNB had acceptable performance and a low major complication rate in diagnosing subsolid pulmonary nodules. The only significant source of heterogeneity in reported sensitivities was a mean age above 65 years. Advances in knowledge: This is the first meta-analysis attempting to systemically determine the cause of heterogeneity in the diagnostic accuracy and complication rate of PTNB for subsolid pulmonary nodules.

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