scholarly journals High prevalence of peribronchial focal lesions of airway invasive aspergillosis in hematological cancer patients with prolonged neutropenia

2020 ◽  
Vol 93 (1113) ◽  
pp. 20190693
Author(s):  
Alessio Casutt ◽  
Jade Couchepin ◽  
Anne-Sophie Brunel ◽  
Alban Lovis ◽  
Pierre-Yves Bochud ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Ct Scan ◽  
Cancer Patients ◽  
Invasive Pulmonary Aspergillosis ◽  
Chest Ct ◽  
Common Finding ◽  
Clinical Report ◽  
Focal Lesions ◽  
Hematological Cancer ◽  
Chest Ct Scan

Objective: The aim of this study is to characterize chest CT findings of neutropenic patients with proven/probable invasive pulmonary aspergillosis (IPA). Methods: Hematological cancer patients admitted to our institution (2007–2017) were retrospectively enrolled if the diagnostic criteria of proven/probable IPA during the neutropenia were met (EORTC/MSG). Galactomannan (GM) was routinely measured in serum and chest CT-scan was routinely performed in case of recurrent/persistent fever. Bronchoscopy was performed in case of chest CT-scan abnormalities. Chest CT-scan and GM dosage were analyzed at the time of IPA suspicion. Chest lesions were classified using a clinical report form by two expert radiologists. Results: 35 patients were identified. Peribronchial focal lesions were observed in 29 IPA (82.9%) by the first radiologist and in 31 (88.5%) by the second (k = 0.768). 12 weeks mortality was 20%. Conclusion: Peribronchial focal lesions are a common finding in early-IPA whatever the GM value during neutropenia and our findings reinforce the efficiency of a preemptive approach. Advances in knowledge; Peribronchial focal lesions, which are classically described in airway invasive aspergillosis, are a common finding in early-IPA in hematological cancer patients with prolonged neutropenia regardless of the GM value, and such peribronchial lesions should reinforce the possibility of IPA.

scholarly journals Coronary Artery Calsification on Chest CT Scan as Coronary Heart Disease Predictor in Lung Cancer Patients

2021 ◽  
Vol 41 (2) ◽  
pp. 94-101
Author(s):  
Luths Maharina ◽  
Yusup Subagio Sutanto ◽  
Widiastuti Widiastuti ◽  
Sulistyani Kusumaningrum ◽  
Adam Prabata ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ct Scan ◽  
Cancer Patients ◽  
Chest Ct ◽  
Lung Cancer Patients ◽  
Chest Ct Scan

scholarly journals Invasive pulmonary aspergillosis in COVID-19 patients

2021 ◽  
Vol 13 (1) ◽  
pp. 38-49
Author(s):  
V. G. Gusarov ◽  
M. N. Zamyatin ◽  
D. A. Kamyshova ◽  
V. S. Fomina ◽  
Yu. A. Abovich ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Distress Syndrome ◽  
Scientific Literature ◽  
Invasive Pulmonary Aspergillosis ◽  
Tracheal Aspirate ◽  
Medical Data ◽  
Chest Ct ◽  
Laboratory Examination ◽  
Pulmonary Aspergillosis ◽  
Chest Ct Scan

A retrospective analysis of the medical data of 12 patients with COVID-19 was performed. For the diagnosis of invasive aspergillosis the international criteria ECMM/ISHAM 2020 were used. We analyzed the scientific literature data on the diagnosis and treatment of invasive aspergillosis in patients with COVID-19.Results. Among the 12 examined patients with a severe course of COVID-19, invasive aspergillosis was diagnosed in 5 patients. Four patients (80%) were treated in the ICU. Steroids or interleukin-6 inhibitors were used in 80% patients. Severe lymphocytopenia was in 80% patients, neutropenia 20%. A fever refractory to antibiotic therapy was noted in 80% patients, an increase in respiratory failure – 60%, acute respiratory distress syndrome – 60%. All patients showed negative dynamics of changes in the chest CT scan. Invasive aspergillosis was confirmed with a positive test for galactomannan in bronchoalveolar lavage and / or serum in 100% of cases. All patients received antifungal therapy with voriconazole and/or caspofungin. The overall 12-week survival rate was 80%.Conclusion. In ICU patients with severe COVID-19 and progressive pulmonary symptoms invasive aspergillosis should be excluded. Examination of substrates from the lower respiratory tract (BAL, tracheal aspirate, or nonbronchoscopic lavage) is necessary. Laboratory examination should include microscopy, culture and test for galactomannan. Voriconazole and isavuconazole are drugs of choice for the treatment of invasive aspergillosis in patients with COVID-19.

scholarly journals Chest X-Ray Findings and Temporal Lung Changes in Patients with COVID-19 Pneumonia

2020 ◽  
Author(s):  
Liqa A Rousan ◽  
Eyhab Elobeid ◽  
Musaab Karrar ◽  
Yousef Khader
Keyword(s):  
Ct Scan ◽  
Chest Ct ◽  
Common Finding ◽  
X Rays ◽  
Radiographic Findings ◽  
X Ray ◽  
Abnormal Chest ◽  
Chest X Ray ◽  
Chest Ct Scan

Abstract Background: Chest CT scan and chest x-rays show characteristic radiographic findings in patients with COVID-19 pneumonia. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia. The study aims at describing the chest x-ray findings and temporal radiographic changes in COVID-19 patients.Methods: From March 15 to April 20, 2020 patients with positive reverse transcription polymerase chain reaction (RT-PCR) for COVID-19 were retrospectively studied. Patients’ demographics, clinical characteristics, and chest x-ray findings were reported. Radiographic findings were correlated with the course of the illness and patients’ symptoms.Results: A total of 88 patients (50 (56.8%) females and 38 (43.2%) males) were admitted to the hospital with confirmed COVID-19 pneumonia. Their age ranged from 3-80 years (35.2 ±18.2 years). 48/88 (45%) were symptomatic, only 13/88 (45.5%) showed abnormal chest x-ray findings. A total of 190 chest x-rays were obtained for the 88 patients with a total of 59/190 (31%) abnormal chest x-rays. The most common finding on chest x-rays was peripheral ground glass opacities (GGO) affecting the lower lobes. In the course of illness, the GGO progressed into consolidations peaking around 6-11 days (GGO 70%, consolidations 30%). The consolidations regressed into GGO towards the later phase of the illness at 12-17 days (GGO 80%, consolidations 10%). There was increase in the frequency of normal chest x-rays from 9% at days 6- 11 up to 33% after 18 days indicating a healing phase. The majority (12/13, 92.3%) of patients with abnormal chest x-rays were symptomatic (P=0.005).Conclusion: The chest x-ray findings were similar to those reported on chest CT scan in patients with COVID-19, Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia.

scholarly journals Lung Nodules in Cancer Patients: Chest CT Scan Misses Up to 66% of Malignant Nodules

2017 ◽  
Vol 65 (S 01) ◽  
pp. S1-S110
Author(s):  
S. Macherey ◽  
F. Doerr ◽  
A. Gassa ◽  
J.Y. Seo ◽  
M. Heldwein ◽  
...  
Keyword(s):  
Ct Scan ◽  
Cancer Patients ◽  
Chest Ct ◽  
Lung Nodules ◽  
Chest Ct Scan

scholarly journals COVID-19 and Cancer: A Comparative Case Series

2020 ◽  
Author(s):  
seied Asadollah Mousavi ◽  
Tahereh Rostami ◽  
Azadeh kiumarsi ◽  
soroush Rad ◽  
mohammadreza Rostami ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Ct Scan ◽  
Cancer Patients ◽  
Case Series ◽  
Cytotoxic Chemotherapy ◽  
Chest Ct ◽  
P Value ◽  
Solid Cancer ◽  
Rt Pcr ◽  
Chest Ct Scan

Abstract BackgroundCancer patients, with an incidence of more than 18 million new cases per year, may constitute a significant portion of the COVID-19 infected population. In the pandemic situation, these patients are considered highly vulnerable to infectious complications due to their immunocompromised state.Material & MethodsIn this retrospective case series, the documents of solid cancer patients infected by SARS-CoV-2, hospitalized in Shariati hospital (a tertiary care referral center designated for COVID-19 patients, affiliated by Tehran University of Medical Sciences) between 20 February and 20 April 2020, were evaluated. The diagnosis of COVID-19 was based on a positive real-time fluorescence reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 nucleic acids from nasal and/or pharyngeal specimens and/or features of chest CT scan highly suggestive for SARS-CoV-2.ResultsAmong 33 patients with solid cancer, 11 patients had a positive RT-PCR for SARS-CoV-2 and 22 patients had highly suggestive chest CT scan findings in favor of SARS-CoV-2 but negative RT-PCR . The mean age of the patients was 63.9 years, and 54.5% of the patients were males. Age and sex of the patients did not correlate with mortality. There was no difference in COVID-19 symptoms, lymphocytopenia, thrombocytopenia between survived and un-survived cancer patients. However, LDH level was significantly higher (7170±2077 vs. 932.3±324.7, P-value=0.016) and also serum albumin was significantly lower in un-survived group (3.6±0.5 vs. 2.9±0.6 p-value=0.03). Among 16 patients with stage IV cancer, thirteen patients died, which was significantly higher compared to stage I-III cancer patients (81.3% vs. 18.8% P-value= <0.001). In terms of developing complications, sepsis, invasive ventilation and mortality was significantly higher in patients who received cytotoxic chemotherapy within the last 14 days. There was no significant difference between the two groups of positive and negative SARS-CoV-2 RT-PCR regarding their sex, age, cancer type, mean Hemoglobin concentration, Platelet count, lymphocyte count, serum albumin level, ESR and CRP titer or other laboratory findings and also in terms of clinical symptoms and coexisting.ConclusionIn this study, we showed that the mortality rate among cancer patients affected by COVID-19 was higher than general population and this rate has a significant correlation with factors such as the stage of the disease, the type of cancer, the activity of cancer and finally receiving cytotoxic chemotherapy within 14 days before diagnosis of COVID-19. We also showed that the outcome of cancer patients with positive RT-PCR for COVID-19 similar to those with negative RT-PCR with highly suggestive chest CT scan findings.

scholarly journals Invasive pulmonary aspergillosis after heart transplantation

2021 ◽  
Vol 23 (2) ◽  
pp. 30-35
Author(s):  
M. A. Simonenko ◽  
M. Yu. Sitnikova ◽  
P. A. Fedotov ◽  
Yu. V. Sazonova ◽  
M. A. Bortsova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Ct Scan ◽  
Immunosuppressive Therapy ◽  
Invasive Pulmonary Aspergillosis ◽  
Chest Ct ◽  
First Year ◽  
Pulmonary Aspergillosis ◽  
Chest Ct Scan

Objective: to assess the incidence, determine the peculiarities of the course of invasive pulmonary aspergillosis (IPA) and identify risk factors for IPA in heart transplant recipients.Materials and methods. From January 2010 to December 2019, 137 heart transplantations (HT) were performed: mean age 46 ± 14 years; male 102 (74%) and female 35 (26%). All patients received a three-component immunosuppressive therapy: calcineurin inhibitors, mycophenolate mofetil (MMF) and Glucocorticoid (GCs). Induction therapy consisted of Basiliximab (81%, n = 111) and antithymocyte immunoglobulin (15%, n = 20). A retrospective analysis of patients with identified post-HT invasive IPA was performed; risk factors for IPA were assessed. In patients with early IPA, the length of stay in the intensive care unit (ICU), the duration of mechanical ventilation, and the initial severity of the condition were studied. All patients with suspected pneumonia underwent bronchoscopy with examination of bronchoalveolar lavage (BAL) and chest computed tomography (chest CT scan).Results. During the follow-up, there were 58 episodes of pneumonia, of which 16 (28%) were IPA (age 33 to 64 years). All patients had a target level of immunosuppressive drugs concentration in blood; basiliximab was used as induction therapy in 15 of 16 patients. Half of the recipients developed IPA in the early post-HT period (less than 3 months after HT), in the rest (n = 8) – at a later date (3 months to 1 year after HT). The diagnosis was verified: 14 out of 16 patients showed an increase in the Aspergillus antigen positivity in the BAL to 7.2 (2.8 ± 1.6); chest CT scan revealed specific changes. In two patients, there were no diagnostic criteria for IPA, but the diagnosis was made based on the results of histological examination after resection of the left lower lobe of the lung. All patients received voriconazole therapy for 2 to 6 months, their immunosuppressive therapy was adjusted (tacrolimus and MMF dose adjustment) and their white blood cell count was monitored. Complete cure of the disease was achieved in 13 (81%) patients. Two patients died within 30 days after HT in the intensive care unit, one died from urogenital diseases caused by bacterial flora and leading to urosepsis, 4 months after IPA treatment was initiated. All patients had risk factors for IPA: taking immunosuppression, including GCs (n = 16), prolonged ICU stay (n = 14), inotropic support exceeding 2 days in the early post-transplant period (n = 10), cachexia during HT (n = 6), leukopenia (n = 9) and neutropenia (n = 14).Conclusion. In heart transplantat recipients, the incidence of IPA among respiratory tract infections is 28%. The risk of developing IPA was highest during the first year following HT. In the majority of recipients, the disease was detected at the early stages; diagnosis required surgical intervention in 12% of cases. A decrease in the risk of developing IPA was associated with correction of the following risk factors for this disease in all patients: volume of immunosuppressive therapy during the first year after transplantation and prevention of the development of neutropenia as a marker of infectious complications or immunosuppression overdose. Early diagnosis of IPA allowed for initiation of timely specific therapy in most recipients and achievement of a positive effect in 80% of them.

Cancer surgery during the COVID‐19 pandemic: The experience of a comprehensive cancer center performing preoperative screening by RT‐PCR and chest CT scan

2021 ◽  
Vol 123 (4) ◽  
pp. 815-822
Author(s):  
Joanne Guerlain ◽  
Fabienne Haroun ◽  
Alexandra Voicu ◽  
Charles Honoré ◽  
Franck Griscelli ◽  
...  
Keyword(s):  
Ct Scan ◽  
Chest Ct ◽  
Cancer Surgery ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Preoperative Screening ◽  
Rt Pcr ◽  
Chest Ct Scan

scholarly journals A meta-analysis of accuracy and sensitivity of chest CT and RT-PCR in COVID-19 diagnosis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Fatemeh Khatami ◽  
Mohammad Saatchi ◽  
Seyed Saeed Tamehri Zadeh ◽  
Zahra Sadat Aghamir ◽  
Alireza Namazi Shabestari ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Reverse Transcriptase ◽  
Ct Scan ◽  
Predictive Value ◽  
Meta Analysis ◽  
Chest Ct ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
Chest Ct Scan

AbstractNowadays there is an ongoing acute respiratory outbreak caused by the novel highly contagious coronavirus (COVID-19). The diagnostic protocol is based on quantitative reverse-transcription polymerase chain reaction (RT-PCR) and chests CT scan, with uncertain accuracy. This meta-analysis study determines the diagnostic value of an initial chest CT scan in patients with COVID-19 infection in comparison with RT-PCR. Three main databases; PubMed (MEDLINE), Scopus, and EMBASE were systematically searched for all published literature from January 1st, 2019, to the 21st May 2020 with the keywords "COVID19 virus", "2019 novel coronavirus", "Wuhan coronavirus", "2019-nCoV", "X-Ray Computed Tomography", "Polymerase Chain Reaction", "Reverse Transcriptase PCR", and "PCR Reverse Transcriptase". All relevant case-series, cross-sectional, and cohort studies were selected. Data extraction and analysis were performed using STATA v.14.0SE (College Station, TX, USA) and RevMan 5. Among 1022 articles, 60 studies were eligible for totalizing 5744 patients. The overall sensitivity, specificity, positive predictive value, and negative predictive value of chest CT scan compared to RT-PCR were 87% (95% CI 85–90%), 46% (95% CI 29–63%), 69% (95% CI 56–72%), and 89% (95% CI 82–96%), respectively. It is important to rely on the repeated RT-PCR three times to give 99% accuracy, especially in negative samples. Regarding the overall diagnostic sensitivity of 87% for chest CT, the RT-PCR testing is essential and should be repeated to escape misdiagnosis.

scholarly journals The role of CT imaging for management of COVID-19 in epidemic area: early experience from a University Hospital

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Vikram rao Bollineni ◽  
Koenraad Hans Nieboer ◽  
Seema Döring ◽  
Nico Buls ◽  
Johan de Mey
Keyword(s):  
Ct Scan ◽  
Predictive Value ◽  
Ct Imaging ◽  
Chest Ct ◽  
University Hospital ◽  
Rt Pcr ◽  
Ct Findings ◽  
Epidemic Area ◽  
Chest Ct Scan ◽  
Pcr Test

Abstract Background To evaluate the clinical value of the chest CT scan compared to the reference standard real-time polymerase chain reaction (RT-PCR) in COVID-19 patients. Methods From March 29th to April 15th of 2020, a total of 240 patients with respiratory distress underwent both a low-dose chest CT scan and RT-PCR tests. The performance of chest CT in diagnosing COVID-19 was assessed with reference to the RT-PCR result. Two board-certified radiologists (mean 24 years of experience chest CT), blinded for the RT-PCR result, reviewed all scans and decided positive or negative chest CT findings by consensus. Results Out of 240 patients, 60% (144/240) had positive RT-PCR results and 89% (213/240) had a positive chest CT scans. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of chest CT in suggesting COVID-19 were 100% (95% CI: 97–100%, 144/240), 28% (95% CI: 19–38%, 27/240), 68% (95% CI: 65–70%) and 100%, respectively. The diagnostic accuracy of the chest CT suggesting COVID-19 was 71% (95% CI: 65–77%). Thirty-three patients with positive chest CT scan and negative RT-PCR test at baseline underwent repeat RT-PCR assay. In this subgroup, 21.2% (7/33) cases became RT-PCR positive. Conclusion Chest CT imaging has high sensitivity and high NPV for diagnosing COVID-19 and can be considered as an alternative primary screening tool for COVID-19 in epidemic areas. In addition, a negative RT-PCR test, but positive CT findings can still be suggestive of COVID-19 infection.

A 71-Year-Old Man With Fever, Productive Cough, and Tree-in-Bud Pattern on Chest CT Scan

CHEST Journal ◽  
2013 ◽  
Vol 144 (2) ◽  
pp. 700-703 ◽  
Author(s):  
Sarah Bastawrous ◽  
Jan V. Hirschmann
Keyword(s):  
Ct Scan ◽  
Chest Ct ◽  
Productive Cough ◽  
Chest Ct Scan
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