Spontaneous alveolo-pleural fistula in a case of COVID-19 pneumonia-challenges and solutions: case report

Abstract BackgroundChest diseases are serious health problems that threaten the lives of people. The early and accurate diagnosis of such diseases is very crucial in the success of their treatment and cure. Pneumonia is one of the most widely occurred chest diseases responsible for a high percentage of deaths especially among children. So, detection and classification of pneumonia using the non-invasive chest x-ray imaging would have a great advantage of reducing the mortality rates.ResultsThe results showed that the best input image size in this framework was 64 64 based on comparison between different sizes. Using CNN as a deep features extractor and utilizing the 10-fold methodology the propose artificial intelligence framework achieved an accuracy of 94% for SVM and 93.9% for KNN, a sensitivity of 93.33% for SVM and 93.19% for KNN and a specificity of 96.68% for SVM and 96.60% for KNN.ConclusionsIn this study, an artificial intelligence framework has been proposed for the detection and classification of pneumonia based on chest x-ray imaging with different sizes of input images. The proposed methodology used CNN for features extraction that were fed to two different types of classifiers, namely, SVM and KNN; in addition to the SoftMax classifier which is the default CNN classifier. The proposed CNN has been trained, validated, and tested using a large dataset of chest x-ray images contains in total 5852 images.

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Comparison of Chest CT Scan Versus Chest X-ray in Evaluating Radiologic Improvement After Treatment With Intrapleural Tissue Plasminogen Activator (TPA) and Deoxiribonuclease (DNase) for Chest Tube Refractory Complex Pleural Effusions

CHEST Journal ◽

10.1378/chest.2278052 ◽

2015 ◽

Vol 148 (4) ◽

pp. 329A

Author(s):

Aishatu Aloma ◽

Erik Folch ◽

Matt Del Guzzo ◽

Sebastian Ochoa ◽

George Cheng ◽

...

Keyword(s):

Ct Scan ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Chest Tube ◽

Chest Ct ◽

Pleural Effusions ◽

X Ray ◽

Tissue Plasminogen ◽

Chest X Ray ◽

Chest Ct Scan

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Comparison of Baseline, Bone-Subtracted, and Enhanced Chest Radiographs for Detection of Pneumothorax

Canadian Association of Radiologists Journal ◽

10.1177/0846537120908852 ◽

2020 ◽

pp. 084653712090885

Author(s):

Fatemeh Homayounieh ◽

Subba R. Digumarthy ◽

Jennifer A. Febbo ◽

Sherief Garrana ◽

Chayanin Nitiwarangkul ◽

...

Keyword(s):

False Negative ◽

Tension Pneumothorax ◽

Area Under The Curve ◽

Ground Truth ◽

Chest Radiographs ◽

Detection Rates ◽

X Ray ◽

Institutional Review ◽

Type Area ◽

Chest X Ray

Purpose: To assess and compare detectability of pneumothorax on unprocessed baseline, single-energy, bone-subtracted, and enhanced frontal chest radiographs (chest X-ray, CXR). Method and Materials: Our retrospective institutional review board–approved study included 202 patients (mean age 53 ± 24 years; 132 men, 70 women) who underwent frontal CXR and had trace, moderate, large, or tension pneumothorax. All patients (except those with tension pneumothorax) had concurrent chest computed tomography (CT). Two radiologists reviewed the CXR and chest CT for pneumothorax on baseline CXR (ground truth). All baseline CXR were processed to generate bone-subtracted and enhanced images (ClearRead X-ray). Four radiologists (R1-R4) assessed the baseline, bone-subtracted, and enhanced images and recorded the presence of pneumothorax (side, size, and confidence for detection) for each image type. Area under the curve (AUC) was calculated with receiver operating characteristic analyses to determine the accuracy of pneumothorax detection. Results: Bone-subtracted images (AUC: 0.89-0.97) had the lowest accuracy for detection of pneumothorax compared to the baseline (AUC: 0.94-0.97) and enhanced (AUC: 0.96-0.99) radiographs ( P < .01). Most false-positive and false-negative pneumothoraces were detected on the bone-subtracted images and the least numbers on the enhanced radiographs. Highest detection rates and confidence were noted for the enhanced images (empiric AUC for R1-R4 0.96-0.99). Conclusion: Enhanced CXRs are superior to bone-subtracted and unprocessed radiographs for detection of pneumothorax. Clinical Relevance/Application: Enhanced CXRs improve detection of pneumothorax over unprocessed images; bone-subtracted images must be cautiously reviewed to avoid false negatives.

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Factors Associated with Chest Tube Placement in Blunt Trauma Patients with an Occult Pneumothorax

Critical Care Research and Practice ◽

10.1155/2019/9274697 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Michael Paplawski ◽

Swapna Munnangi ◽

Jody C. Digiacomo ◽

Edwin Gonzalez ◽

Ashley Modica ◽

...

Keyword(s):

Blunt Trauma ◽

Chest Tube ◽

Rib Fractures ◽

Tube Placement ◽

Chest Tubes ◽

Chest Tube Placement ◽

X Ray ◽

Factors Associated ◽

Occult Pneumothorax ◽

Chest X Ray

Background. An occult pneumothorax is identified by computed tomography but not visualized by a plain film chest X-ray. The optimal management remains unclear. Methods. A retrospective review of an urban level I trauma center’s trauma registry was conducted to identify patients with occult pneumothorax over a 2-year period. Factors predictive of chest tube placement were identified using univariate and multivariate logistic regression analysis. Results. A total of 131 patients were identified, of whom 100 were managed expectantly with an initial period of observation. Ultimately, 42 (32.0%) patients received chest tubes and 89 did not. The patients who received chest tubes had larger pneumothoraces at initial assessment, a higher incidence of rib fractures, and an increased average number of rib fractures, of which significantly more were displaced. Conclusions. Displaced rib fractures and moderate-sized pneumothoraces are significant factors associated with chest tube placement in a victim of blunt trauma with occult pneumothorax. The optimal timing for the first follow-up chest X-ray remains unclear.

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Intrapleural Alteplase in a Patient with Complicated Pleural Effusion

Annals of Pharmacotherapy ◽

10.1345/aph.1c248 ◽

2003 ◽

Vol 37 (3) ◽

pp. 376-379 ◽

Cited By ~ 22

Author(s):

Charlotte A Walker ◽

Mary Beth Shirk ◽

Marva M Tschampel ◽

James A Visconti

Keyword(s):

Pleural Effusion ◽

Chest Tube ◽

Pleural Cavity ◽

Surgical Intervention ◽

Chest Tube Drainage ◽

Tube Drainage ◽

X Ray ◽

Case Summary ◽

Chest X Ray ◽

Intrapleural Administration

OBJECTIVE: To report the intrapleural use of alteplase in a patient diagnosed with complicated pleural effusion (CPE). CASE SUMMARY: A 62-year-old white woman admitted with respiratory distress and hypotension developed a right-sided multi-loculated pleural effusion. Thoracentesis and chest tube drainage were not successful in resolving the effusion. In an attempt to increase the drainage of the pleural effusion, alteplase 16 mg was administered into the pleural cavity via the chest tube on 6 consecutive days. As a result, the volume drained from the patient's chest tube increased, there was improvement on the chest X-ray, and she did not require surgical intervention. DISCUSSION: While streptokinase and urokinase have been shown to be useful adjuncts to chest tube drainage in the treatment of complicated pleural effusion and empyema, there have been no reports on the use of intrapleural alteplase. This report demonstrates that intrapleural administration of alteplase is a useful adjunct to tube drainage in resolving CPE. CONCLUSIONS: This patient's CPE resolved when intrapleural alteplase was used as an adjunct to chest tube drainage and antibiotics. Controlled trials need to be conducted to investigate fully the efficacy, dosing, and safety of intrapleural alteplase in the treatment of patients with CPE and empyema.

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Artificial Intelligence Framework for Efficient Detection and Classification of Pneumonia Using Chest Radiography Images

10.21203/rs.3.rs-66836/v1 ◽

2020 ◽

Author(s):

Ali Mohammad Alqudah ◽

Shoroq Qazan ◽

Ihssan S. Masad

Keyword(s):

Artificial Intelligence ◽

Input Image ◽

Image Size ◽

X Ray ◽

Softmax Classifier ◽

Non Invasive ◽

Efficient Detection ◽

X Ray Imaging ◽

Chest X Ray

Abstract BackgroundChest diseases are serious health problems that threaten the lives of people. The early and accurate diagnosis of such diseases is very crucial in the success of their treatment and cure. Pneumonia is one of the most widely occurred chest diseases responsible for a high percentage of deaths especially among children. So, detection and classification of pneumonia using the non-invasive chest x-ray imaging would have a great advantage of reducing the mortality rates.ResultsThe results showed that the best input image size in this framework was 64 64 based on comparison between different sizes. Using CNN as a deep features extractor and utilizing the 10-fold methodology the propose artificial intelligence framework achieved an accuracy of 94% for SVM and 93.9% for KNN, a sensitivity of 93.33% for SVM and 93.19% for KNN and a specificity of 96.68% for SVM and 96.60% for KNN.ConclusionsIn this study, an artificial intelligence framework has been proposed for the detection and classification of pneumonia based on chest x-ray imaging with different sizes of input images. The proposed methodology used CNN for features extraction that were fed to two different types of classifiers, namely, SVM and KNN; in addition to the SoftMax classifier which is the default CNN classifier. The proposed CNN has been trained, validated, and tested using a large dataset of chest x-ray images contains in total 5852 images.

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Acupuncture-Induced Tension Pneumothorax Presenting as Acute Heart Failure

Case Reports in Cardiology ◽

10.1155/2021/9986300 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Alia Arif Hussain ◽

Jeppe Nygaard ◽

Kasper Kofod Pedersen ◽

Celi Anne Schoenike ◽

Erik Kovacs ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular Function ◽

Ventricular Function ◽

Acute Heart Failure ◽

Chest Tube ◽

Clinical Condition ◽

Tension Pneumothorax ◽

Left Ventricular ◽

X Ray ◽

Patient Reported

Takotsubo syndrome (TSS) is a reversible, acute cardiomyopathy with transient heart failure, often secondary to other disorders. A 64-year-old woman, with no history of ischemic heart disease, was admitted to the emergency department after developing sudden-onset dyspnea after a planned acupuncture treatment for back pain. Acute echocardiography showed decreased left ventricular function with basal hypercontraction and apical akinesia and was interpreted, and treated, as acute heart failure. When the attending cardiologist arrived, the patient still had dyspnea with a declining blood pressure (97/65 mmHg) and tachycardia (111/minute). The cardiologist suspected a tension pneumothorax induced by the penetration of an acupuncture needle to the apex of the lung, as well as secondary TSS cardiomyopathy. An acute chest X-ray was performed, which showed a large left-sided rim pneumothorax. The attending surgeon placed a chest tube in the left 6th intercostal space in the midaxillary line, and the patient reported immediate pain relief and improvement in her dyspnea. The patient’s clinical condition improved, and a control X-ray showed that the lung was fully expanded. The chest tube was removed, but after a few minutes, the patient developed a massive subcutaneous emphysema in the upper chest and in the face and her clinical condition deteriorated rapidly. A new chest tube was inserted, and the patient’s tachycardia diminished, with her clinical condition improving immediately. The patient remained hospitalized for the next seven days. After three continuous days without any escaped air in the chest tube, the tube was removed, and the patient was observed for another 48 hours. This time, the removal was without any complications and within two days, the patient was ready for discharge. The follow-up echocardiography showed complete recovery of left ventricular function.

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Non-invasive imaging

10.1093/med/9780198759959.003.0003 ◽

2017 ◽

Author(s):

Sara Thorne ◽

Sarah Bowater

Keyword(s):

Computed Tomography ◽

Congenital Heart Disease ◽

Congenital Heart ◽

X Ray ◽

Non Invasive ◽

Invaluable Tool ◽

Assessment And Monitoring ◽

Chest X Ray ◽

Invasive Techniques ◽

Cmr Imaging

Non-invasive imaging is used extensively in patients with congenital heart disease. It is an invaluable tool in both in the initial diagnosis and also with the serial assessment and monitoring of patients. As the technology and our knowledge continues to develop in this field, it has largely replaced the use of invasive techniques, such as cardiac catheterization, for diagnosis and assessment in many conditions. This chapter discusses chest X-ray (CXR), transthoracic echocardiography (TTE), transoesophageal echo (TOE), cardiovascular magnetic resonance (CMR) imaging, and computed tomography (CT).

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