scholarly journals Carcinoembryonic antigen (CEA) as a candidate prognostic marker of nonmucinous pneumonic adenocarcinoma (P-ADC) of the lung.

2019 ◽  
Vol 5 (suppl) ◽  
pp. 28-28
Author(s):  
Satoru Nakamura ◽  
Minoru Fukuda
Keyword(s):  
Serum Level ◽  
Prognostic Marker ◽  
First Generation ◽  
Initial Diagnosis ◽  
Smoking History ◽  
Normal Range ◽  
X Ray ◽  
Chest X Ray ◽  
Serum Cea ◽  
Egfr Tki

28 Background: Serum level of CEA as a prognostic marker in NSCLC is well known. In patients with non-mucinous P-ADC, there were some paradoxical cases with high CEA, in spite of improved symptom and chest X-ray after chemotherapy including first-generation EGFR-TKI. Methods: We retrospectively comfirmed serum level of CEA of five patients, including four patients with non-mucinous P-ADC and one patient with mucinous P-ADC, between 2001-2007, all Japanese female without smoking history, 66-78 years old (mean 73.6 y.o.). All of them revealed abnormal pneumonic shadow on chest X-ray, and were diagnosed by TBLB or cytology. These cases were all stage IIIB or IV, and were applied to chemotherapy including first-generation EGFR-TKI. We had measured serum CEA as possible from initial diagnosis and pre or post chemotherapy including first-generation EGFR-TKI to death. OS were between 25~66 months with four patients of non-mucinous P-ADC, and 9 month with one patient of mucinous P-ADC. Other tumor marker such as CYFRA and Pro GRP were all almost normal range. Results: CEA of three patients with non-mucinous P-ADC was elevated according to worsened symptom and X-ray, and were all highly maintained or increased in spite of improved symptom and X-ray after chemotherapy including first-generation EGFR-TKI. CEA of one patient with non-mucinous P-ADC was normal range in initial diagnosis, and no more measured. She has got symptom free and improved chest X-ray after chemotherapy. In one patient with mucinous P-ADC, serum CEA was normal range, so no longer measured. This patient was no effective for chemotherapy, and was dead 9 month after the initial diagnosis. Number of cases was quite few, so further examination is favorable. Furthermore, All cases were exaggerated finally, they might be resistant to first-generation EGFR-TKI. Conclusions: In three patients with non-mucinous P-ADC of the lung, serum CEA was paradoxically highly maintained or elevated in spite of improved symptom and chest X-ray after chemotherapy including first-generation EGFR-TKI. Therefore, serum CEA is a candidate for useful prognostic marker of non-mucimous P-ADC of the lung.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kosaku Komiya ◽  
Ryosuke Hamanaka ◽  
Hisayuki Shuto ◽  
Hiroki Yoshikawa ◽  
Atsushi Yokoyama ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pulmonary Edema ◽  
Left Lung ◽  
Viral Pneumonia ◽  
Smoking History ◽  
Lung Field ◽  
Rare Presentation ◽  
X Ray ◽  
Chest X Ray ◽  
Oxygenation Status

Abstract 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.

scholarly journals Lung Ultrasound for Initial Diagnosis and Subsequent Monitoring of Aspiration Pneumonia in Elderly in Home Medical Care Setting

2019 ◽  
Vol 5 ◽  
pp. 233372141985844
Author(s):  
Hirofumi Namiki ◽  
Tadashi Kobayashi
Keyword(s):  
Aspiration Pneumonia ◽  
Care Setting ◽  
Lung Ultrasound ◽  
Initial Diagnosis ◽  
Resource Limited Settings ◽  
X Ray ◽  
Resource Limited ◽  
X Ray Imaging ◽  
Chest X Ray ◽  
B Lines

The number of aspiration pneumonia cases has increased in recent times. A definitive diagnosis of aspiration pneumonia is difficult in resource-limited settings where radiological equipment is unavailable. We report the initial diagnosis and subsequent monitoring of aspiration pneumonia in a home medical care setting. An 88-year-old Japanese male presented an acute onset of dyspnea, fever, and productive cough. At home, lung ultrasound displayed pleural effusion along with B-lines and subpleural consolidations. Upon admission, tests revealed increased total leucocyte counts with left-shifted neutrophils, elevated C-reactive protein levels, and positive sputum Gram stain. Chest X-ray imaging and computed tomography (CT) showed bibasilar infiltrates and wall thickening in the left S10 bronchi. The patient was diagnosed with aspiration pneumonia and treated with an antibiotic. After a 10-day hospitalization, lung ultrasound showed some remaining B-lines and disappearance of pleural effusion and subpleural consolidation. Chest X-ray image was normal, and CT revealed pleural abnormality and disappearance of bibasilar infiltrates, consistent with the ultrasound findings. Aspiration pneumonia develops with various clinical signs. However, diagnosis using chest X-ray imaging or CT in resource-limited settings is difficult. Ultrasound might allow physicians to make more accurate judgments, particularly while monitoring aspiration pneumonia following initial diagnosis in resource-limited settings.

Screening for Small-Cell Lung Cancer: A Follow-Up Study of Patients With Lambert-Eaton Myasthenic Syndrome

2008 ◽  
Vol 26 (26) ◽  
pp. 4276-4281 ◽  
Author(s):  
Maarten J. Titulaer ◽  
Paul W. Wirtz ◽  
Luuk N.A. Willems ◽  
Klaas W. van Kralingen ◽  
Peter A.E. Sillevis Smitt ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Lung Tumor ◽  
Small Cell ◽  
Smoking History ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma ◽  
X Ray ◽  
Myasthenic Syndrome ◽  
Chest X Ray

Purpose A small-cell lung carcinoma (SCLC) is found in 50% of patients with Lambert-Eaton myasthenic syndrome (LEMS). We evaluated screening to optimize screening strategy for SCLC. It is important to detect these tumors early in newly diagnosed patients with LEMS to offer optimal patient treatment. Patients and Methods A large nationwide cohort study of consecutive patients in the Netherlands, seen between 1990 and 2007, were screened for the presence of a tumor using chest x-ray, computed tomography of the thorax (CT-thorax), [18F]fluorodeoxyglucose positron emission tomography (FDG-PET), bronchoscopy, and/or mediastinoscopy. Results SCLC was found in 54 patients, and in 46 patients, no tumor was found during a median follow-up of 8 years (range, 3 to 26 years). All patients with SCLC had a positive smoking history and 86% were still smoking at diagnosis. SCLC was found in 92% of these patients within 3 months and in 96% within a year. At first screening, CT-thorax detected an SCLC in 45 patients (83%), whereas chest x-ray found the tumor in only 23 patients (51%). An SCLC was found during secondary screening in another nine patients (median, 3 months; range, 1 to 41 months). In six patients, a lung tumor was found by CT-thorax or FDG-PET, and in three patients, extrapulmonary metastases were found, initially without identifiable tumor mass on CT-thorax. Conclusion In almost all patients (96%), the SCLC was found within 1 year of diagnosis. CT-thorax scans detected most of the tumors (93%) and was far more sensitive than chest x-ray (51%). FDG-PET may have additive value in selected cases. We propose a screening protocol based on CT-thorax and FDG-PET.

scholarly journals COPD in Germany: Use of Diagnostic Measures Including Blood Eosinophil Counts in Daily Practice

Pneumologie ◽  
2020 ◽  
Author(s):  
T. Greulich ◽  
V. Töpfer ◽  
M. Hennig ◽  
C. C. Orehounig ◽  
K. Ams ◽  
...  
Keyword(s):  
Medical Records ◽  
Eosinophil Count ◽  
Initial Diagnosis ◽  
Blood Eosinophil ◽  
Body Plethysmography ◽  
Blood Eosinophil Count ◽  
X Ray ◽  
Diagnostic Measures ◽  
Chest X Ray ◽  
Eosinophil Counts

Abstract Background Accumulating evidence on the role of blood eosinophils as a biomarker prompted the Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee to refine the existing treatment algorithm by incorporating eosinophil counts into treatment recommendations. However, there is a lack of data on when, why and how frequently such blood tests and other measures are being performed by German private respiratory specialists. Methods A questionnaire evaluating doctors’ opinions on the use of diagnostic measures at initial diagnosis and during follow-up, including blood eosinophil count in patients with COPD, was completed by 27 respiratory specialists. Medical records from the past 12 months of 251 patients treated by the same physicians were reviewed retrospectively to investigate the use of these measures. Results Body plethysmography (100 % of doctors) and chest X-ray (96.3 %) were the most commonly used measures according to the doctor’s questionnaire; other measures were COPD assessment test (CAT; 85.2 %) and blood eosinophil count (81.5 %). The evaluation of patients’ medical records revealed that body plethysmography was performed in 72.7 %, the CAT in 61.8 % and chest X-ray in 40.6 % of patients. Blood eosinophil count was measured in 7.2 %. Conclusions In line with the GOLD recommendations, these results confirm that lung function, imaging and patient-reported outcome questionnaires play a crucial role in managing COPD. Our analyses reveal that measurement of the blood eosinophil count gained importance due to physicians’ increased awareness of these cells as a useful biomarker. However, this test seems to be performed mainly for initial diagnosis and not on a regular basis.

scholarly journals Focused Ultrasound In The Emergency Department For Patients With Acute Heart Failure

2015 ◽  
Vol 1 (2) ◽  
pp. 83 ◽  
Author(s):  
Frances M Russell ◽  
Matt Rutz ◽  
Peter S Pang ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Efficient Method ◽  
Focused Ultrasound ◽  
Initial Diagnosis ◽  
X Ray ◽  
Diagnosis And Management ◽  
Novel Biomarkers ◽  
Chest X Ray

The emergency department (ED) plays a key role in the initial diagnosis and management of acute heart failure (AHF). Despite the advent of novel biomarkers and traditional methods of assessment, such as history, examination, and chest X-ray, diagnosis of the dyspnoeic ED patient is, at times, very challenging. Focused cardiac and pulmonary ultrasound has emerged as a valid, facile and efficient method to aid in the initial diagnosis and management of AHF.

scholarly journals Elevation of Serum Pro-Brain Natriuretic Peptide in G-CSF Stimulated Hematopoietic Progenitor Cell Donors

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2185-2185
Author(s):  
Montemayor Celina ◽  
Kamille A West ◽  
Anne Eder ◽  
Cathy Cantilena ◽  
Harvey G. Klein
Keyword(s):  
Side Effects ◽  
Progenitor Cell ◽  
Clinical Evidence ◽  
Hematopoietic Progenitor Cell ◽  
Normal Range ◽  
X Ray ◽  
Healthy Donors ◽  
Chest X Ray ◽  
Preliminary Study

Abstract Introduction: Healthy donors who are treated with GCSF before peripheral blood hematopoietic progenitor cell (HPC) collection may develop side effects and aberrant laboratory values that have been described with the mobilization regimen. Alternatively, unexpected abnormal laboratory results could reflect occult complications or underlying disease. While many serum chemistry test results are affected by G-CSF, there have been no published reports describing an effect on BNP (pro-brain natriuretic peptide), a serum marker of heart failure. We encountered a donor who developed an elevated BNP after GCSF-stimulated HPC collection, and investigated its possible association with GCSF administration in healthy donors. Case Report: A 41-year old woman was evaluated for matched allogeneic peripheral HPC donation. History and physical exam were unremarkable, and standard laboratory values, EKG and chest X-ray revealed no abnormalities. The donor was mobilized with 10mcg/kg GCSF daily for 5 days. Her only complaint was of headache starting on day 4 that was relieved partially with acetaminophen. No other side effects were recorded. Her pre-apheresis peripheral CD34+ count was 87/mcL. At the start of apheresis HPC collection, the donor reported headache 7/10 in intensity and intolerance to light, unrelieved by acetaminophen but partially relieved with oxycodone. She complained of nausea during collection, but the procedure was otherwise successful and uneventful (15L of whole blood processed). Her headache persisted at the time of discharge, and the donor was counseled and prescribed one additional dose of oxycodone. Five hours after discharge the donor reported “the worst headache of her life”, nausea and difficulty breathing. She was evaluated at the ER, where she had stable vital signs and normal oxygen saturation. Her physical exam was unremarkable. Head CT was negative for intracranial hemorrhage or mass effect. A panel of laboratory analyses revealed leukocytosis, decreased platelets, and increased alkaline phosphatase and liver enzymes, which are documented findings associated with GCSF stimulation and large-volume apheresis. Given the donor's complaint of dyspnea, serum BNP was measured and found increased to 483pg/mL (normal <124pg/mL). The donor had a normal pulmonary examination and no clinical evidence of cardiac insufficiency; a chest X-ray and an echocardiogram were also within normal limits. Her symptoms resolved with IV hydromorphone and she was discharged in stable condition. A follow-up serum BNP 4 weeks after donation was within normal range (105pg/mL). Investigation: A preliminary study evaluated 11 additional HPC donors who were stimulated with 10mcg/kg GSCF for 5 days (Table 1). Nine of twelve (75%) donors were male, and seven were Caucasian. Ten of the total 12 donors demonstrated an increase in BNP levels compared to pre-stimulation results. Follow-up of four total donors 9-17 days after donation demonstrated return of BNP levels to baseline. None of the donors had clinical evidence of heart failure during stimulation, donation, or follow-up. The average increase in BNP was 4.2 fold, and in a total of 3 donors it exceeded the normal range for the laboratory. The presence or degree of BNP elevation did not correlate with age, gender, severity of GCSF side effects, liver panel results, or pre-apheresis peripheral CD34+ count. Conclusion: This case and preliminary study indicate that an increase in BNP levels can be observed in approximately 80% of HPC donors stimulated with 5 days of 10mcg/kg GCSF. The increase in BNP in these donors is not associated with ventricular dysfunction or symptoms of cardiac congestion, and it returns to baseline levels in 2-4 weeks. Two possible molecular mechanisms for this BNP increase include 1) activation of gp130 by increased circulating cytokines associated with GCSF; or 2) direct transcriptional activation of the BNP gene by cardiomyocyte GCSF receptor activation of the JAK-STAT pathway. Disclosures No relevant conflicts of interest to declare.

scholarly journals GAMBARAN FOTO TORAKS EMFISEMATOUS LUNG DI BAGIAN RADIOLOGI FK UNSRAT/SMF RADIOLOGI RSUP PROF. Dr. R. D. KANDOU MANADO PERIODE NOVEMBER 2014 – OKTOBER 2015

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Elshadday V. Tendean ◽  
Vonny N. Tubagus ◽  
Elvie Loho
Keyword(s):  
Radiological Diagnosis ◽  
Smoking History ◽  
Cross Sectional ◽  
X Ray ◽  
X Ray Imaging ◽  
Record Data ◽  
Emphysematous Lung ◽  
Chest X Ray ◽  
Cross Sectional Design ◽  
Age Over 60

Abstract: Emphysema is an uplift condition of air space in lung. This disease is needed to be concerned particularly among patients with smoking history. Emphysematous lung diagnosis can be found in chest x-ray imaging. This study aimed to obtain emphysematous lung in chest x-ray imaging. This was a descriptive retrospective study with a cross sectional design. Population was all medical record data of chest x-ray at Prof. Dr. R. D. Kandou Hospital Manado. Samples were medical records of emphysematous lungs according to radiological diagnosis. The results showed that there were 28 patients with radiological diagnosis as emphysematous lung. The most common characteristic feature was hyperaeration. There were also normal and abnormal heart imaging, and flattened diaphragm. Males were more often suffering from emphysematous lung than females, and age over 60 were more susceptible to suffer this emphysematous lung. Keywords: emphysematous, radiology, chest x-ray. Abstrak: Emfisema merupakan kondisi peningkatan ruang udara di dalam paru. Penyakit ini perlu diperhatikan khususnya pada pasien emfisema dengan riwayat merokok. Diagnosis paru emfisematous lung dapat diketahui melalui salah satu pemeriksaan penunjang radiologi yaitu foto toraks. Penelitian ini bertujuan untuk mendapatkan gambaran paru emfisematous pada pemeriksaan foto toraks. Penelitian ini menggunakan metode deskriptif retrospektif dengan rancangan potong lintang. Populasi yaitu semua data rekam medis pemeriksaan foto toraks di bagian Radiologi RSUP Prof. Dr. R. D. Kandou Manado. Sampel yaitu rekam medik yang sudah didiagnosis radiologik paru emfisematous. Hasil penelitian memperlihatkan dari semua pasien yang melakukan pemeriksaan foto toraks dan telah didiagnosis radiologik paru emfisematous berjumlah 28 penderita. Temuan yang paling khas pada gambaran foto toraks paru emfisematous yaitu hiperaerasi; juga terdapat gambaran jantung normal maupun abnormal serta diafragma mendatar. Laki-laki lebih sering terkena paru emfisematous dari pada perempuan dan usia ≥60 tahun lebih rentan terkena paru emfisematous.Kata kunci: emfisematous, radiologi, foto toraks.

scholarly journals An Unusual Case of Metastatic Follicular Thyroid Cancer 40 Years after Initial Diagnosis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Lakshmi Pakath Menon ◽  
Spyridoula Maraka
Keyword(s):  
Thyroid Cancer ◽  
Cancer Recurrence ◽  
Initial Diagnosis ◽  
Response To Therapy ◽  
Follicular Thyroid Cancer ◽  
X Ray ◽  
Excellent Response ◽  
Chest X Ray ◽  
Thyroid Cancer Recurrence

Thyroid cancer recurrence can occur decades after initial diagnosis despite excellent response to therapy. Thyroid cancer recurrence is evaluated using serum thyroglobulin (Tg) and imaging studies including I-131 WBS and neck ultrasound. Limitations in Tg measurement and WBS may result in failure to detect recurrence. We report the case of a 63-year-old man who was noted to have rhonchi during a routine visit. He had a past history of follicular thyroid cancer that was diagnosed 40 years ago and treated with total thyroidectomy and radioactive iodine. He had excellent response to therapy with undetectable Tg levels, normal neck ultrasounds, and multiple negative whole body scans (WBS) due to which he was discharged from endocrinology clinic after 37 years of follow-up. Chest X-ray revealed a left lung mass with biopsy positive for thyroid cancer. Tg remained undetectable with negative anti-Tg antibody. Left pneumonectomy was done which revealed a mix of 70% differentiated thyroid cancer and 30% poorly differentiated/anaplastic thyroid cancer. He received two cycles of Doxorubicin and Paclitaxel. At 4 months follow-up after surgery, he had 3 subcentimeter nodules in his right lung. This case highlights that physical exam remains an essential tool to evaluate for recurrence. Since the lungs are the most common site of metastasis in follicular thyroid cancer, a chest X-ray may help detect metastasis that is missed on other modalities.

scholarly journals Risk Factors For COVID-19 Positivity in Hospitalized Patients in A Low Prevalence Setting

2020 ◽  
Author(s):  
Iris Zohar ◽  
Orna Schwartz ◽  
Debby Ben David ◽  
Margarita Mashavi ◽  
Mohamad Aboulil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Neutrophil Count ◽  
Respiratory Illness ◽  
Hospitalized Patients ◽  
Multivariate Regression Model ◽  
Normal Range ◽  
X Ray ◽  
Chest X Ray ◽  
Low Probability ◽  
Low Prevalence

Abstract Background: Identifying hospitalized patients with Coronavirus disease 2019 (COVID-19) in a low prevalence setting is challenging. We aimed to identify differences between COVID-19 positive and negative patients. Methods: Hospitalized patients with respiratory illness, or fever, were isolated in the emergency room and tested for COVID-19. Patients with a negative PCR and low probability for COVID-19 were taken out of isolation. Patients with a higher probability for COVID-19 remained in isolation during hospitalization and were retested after 48 hours. Risk factors for COVID-19 were assessed using logistic regression. Results: 254 patients were included, 37 COVID-19-positive (14.6%) and 217 COVID-19-negative (85.4%). Median age was 76 years, 52% were males. In a multivariate regression model, variables significantly associated with COVID-19 positivity were exposure to a confirmed COVID-19 case, length of symptoms before testing, bilateral and peripheral infiltrates in chest X-ray, neutrophil count within the normal range, and elevated LDH. In an analysis including only patients with pneumonia (N=78, 18 positive for COVID-19), only bilateral and peripheral infiltrates, normal neutrophil count and elevated LDH were associated with COVID-19 positivity. Conclusions: The clinical presentation of COVID-19 positive and negative patients is similar, but radiographic and laboratory features may help to identify COVID-19 positive patients and to initiate quick decisions regarding isolation.

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