Transthoracic Ultrasound in Infectious Organizing Pneumonia: A Useful Guide for Percutaneous Needle Biopsy

In patients presenting with classical features of CAP (i.e., new peripheral pulmonary consolidations and symptoms including fever, cough, and dyspnea), a clinical response to the appropriate therapy occurs in few days. When clinical improvement has not occurred and chest imaging findings are unchanged or worse, a more aggressive approach is needed in order to exclude other non-infective lesions (including neoplasms). International guidelines do not currently recommend the use of transthoracic ultrasound (TUS) as an alternative to chest X-ray (CXR) or chest computed tomography (CT) scan for the diagnosis of CAP. However, a fundamental role for TUS has been established as a guide for percutaneous needle biopsy (US-PNB) in pleural and subpleural lesions. In this retrospective study, we included 36 consecutive patients whose final diagnosis, made by a US-guided percutaneous needle biopsy (US-PTNB), was infectious organizing pneumonia (OP). Infective etiology was confirmed by additional information from microbiological and cultural studies or with a clinical follow-up of 6–12 months after a second-line antibiotic therapy plus corticosteroids. All patients have been subjected to a chest CT and a systematic TUS examination before biopsy. This gave us the opportunity to explore TUS performance in assessing CT findings of infective OP. TUS sensitivity and specificity in detecting air bronchogram and necrotic areas were far lower than those of CT scan. Conversely, TUS showed superiority in the detection of pleural effusion. Although ultrasound findings did not allow the characterization of chronic subpleural lesions, TUS confirmed to be a valid diagnostic aid for guiding percutaneous needle biopsy of subpleural consolidations.

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Effectiveness and Safety of Transthoracic Ultrasound in Guiding Percutaneous Needle Biopsy in the Lung and Comparison vs. CT Scan in Assessing Morphology of Subpleural Consolidations

Diagnostics ◽

10.3390/diagnostics11091641 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1641

Author(s):

Marco Sperandeo ◽

Evaristo Maiello ◽

Paolo Graziano ◽

Annalisa Simeone ◽

Salvatore De Cosmo ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Ct Scan ◽

Needle Biopsy ◽

Diagnostic Yield ◽

Chest Ct ◽

Percutaneous Needle Biopsy ◽

Benign Lesions ◽

Lung Lesions ◽

Peripheral Lung ◽

Transthoracic Ultrasound

(1) Background: The aim of this study was to conduct a prospective analysis on the diagnostic accuracy of transthoracic ultrasound-guided percutaneous needle biopsy (TUS-PNB) for the histological assessment of peripheral lung lesions and to assess the performance of transthoracic ultrasound (TUS) examination vs. chest CT (gold standard) in the differentiation between malignant and benign peripheral lung lesions. (2) Methods: A total of 961 consecutive patients with subpleural pulmonary lesions were enrolled. All the patients received a CT scan with contrast; 762 patients underwent TUS-PTNB for suspicion of malignancy, and the remaining 199 enrolled patients underwent only TUS examination as a part of routine follow-up for known non-malignant subpleural consolidations. (3) Results: Among the 762 TUS-guided biopsies, there were 627 (82.28%) malignant lesions, 82 (10.76%) benign lesions, and 53 (6.96%) indeterminate lesions. The overall diagnostic accuracy was 93.04%. The rates of pneumothorax not requiring chest-tube insertion and self-limited hemoptysis were 0.79 and 0.26%, respectively. Patients were divided into two groups based on the benign or malignant nature of the subpleural consolidations. On TUS, both malignant and benign lesions showed mostly irregular margins and a hypoechoic pattern, but no differences were assessed in terms of sonographic margins and pattern between the two groups. There was poor agreement between TUS and chest CT in assessing air bronchograms and necrotic areas. The only finding in the detection of which TUS showed superiority compared to chest-CT was pleural effusion. (4) Conclusions: TUS-PNB was confirmed to be an effective and safe diagnostic method for peripheral pulmonary consolidation, but their sonographic pattern did not allow to rule out a malignant nature. A pre-operative evaluation on CT images, combined with the possibility of performing additional immunohistochemical and cytological investigations and the experience of the medical staff, may improve the diagnostic yield of TUS-guided biopsies.

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Percutaneous Needle Biopsy for Small Lung Nodules Beneath the Rib Under CT Scan Fluoroscopic Guidance With Gantry Tilt

CHEST Journal ◽

10.1378/chest.126.3.744 ◽

2004 ◽

Vol 126 (3) ◽

pp. 744-747 ◽

Cited By ~ 20

Author(s):

Takuji Yamagami ◽

Takeharu Kato ◽

Shigeharu Iida ◽

Tatsuya Hirota ◽

Tsunehiko Nishimura

Keyword(s):

Ct Scan ◽

Needle Biopsy ◽

Lung Nodules ◽

Fluoroscopic Guidance ◽

Percutaneous Needle Biopsy

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Virtual Bronchoscopy Planner and Radial-EBUS Guided Biopsy for Organizing Pneumonia Diagnosis

Journal of Clinical Medicine ◽

10.3390/jcm11010104 ◽

2021 ◽

Vol 11 (1) ◽

pp. 104

Author(s):

Samy Lachkar ◽

Mathieu Salaün ◽

Loic Perrot ◽

Diane Gervereau ◽

Marielle De Marchi ◽

...

Keyword(s):

Ct Scan ◽

Diagnostic Yield ◽

Ultrasound Image ◽

Pulmonary Nodules ◽

Final Diagnosis ◽

University Hospital ◽

Endobronchial Ultrasound ◽

Virtual Bronchoscopy ◽

Histopathological Diagnosis ◽

Organizing Pneumonia

Background: The diagnosis of organizing pneumonia (OP) often requires histological confirmation. The aim of this retrospective study was to evaluate the diagnostic yield and complication rate of radial endobronchial ultrasound (r-EBUS) for OP. Methods: All patients who had r-EBUS as a first diagnostic procedure for a peripheral pulmonary lesion at Rouen University Hospital, France, between April 2008 and December 2020 were included. Cases without a final diagnosis of OP or follow-up were excluded. Patients, lesions, and r-EBUS characteristics were retrospectively analyzed. Results: 2735 r-EBUS procedures were performed, and 33 cases with final OP could be analyzed. Procedures were performed under local anesthesia in 28/33 cases (85%). Among the 33 final OP cases, 17 were considered cryptogenic, and 16 secondary. The lesions were patchy alveolar opacities in 23 cases (70%), masses or pulmonary nodules in 8 cases (24%), and diffuse infiltrative opacities in 2 cases (6%). A bronchus sign on CT scan was found in all cases. In 22 cases (67%), a histopathological diagnosis was obtained from the r-EBUS samples. In 4 cases (12%), histopathological diagnosis was made by surgery, and in 7 cases (21%) the diagnosis was made based on clinical, radiological, and evolution features. An ultrasound image was found in 100% (22/22) of cases in the r-EBUS positive (r-EBUS+) group vs. 60% (6/10) in the r-EBUS negative (r-EBUS-) group, respectively (p < 0.002). The diagnostic yield of r-EBUS for OP was 67% and increased to 79% (22/28) when an ultrasound image was obtained. The median time between CT scan and r-EBUS procedure was 14 days (3–94): 11.5 days in the r-EBUS+ group and 22 days in the r-EBUS- group (p < 0.0001). No severe complications were reported. Conclusion: r-EBUS, when performed shortly after a CT scan showing a bronchus sign, is an efficient and safe technique for OP diagnosis.

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Percutaneous needle biopsy of the lung in evaluation of pulmonary disorders

JAMA ◽

10.1001/jama.198.11.1198 ◽

1966 ◽

Vol 198 (11) ◽

pp. 1198-1202 ◽

Cited By ~ 1

Author(s):

F. Manfredi

Keyword(s):

Needle Biopsy ◽

Percutaneous Needle Biopsy

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A Survey on Deep Convolutional Generative Adversarial Neural Network (DCGAN) for Detection of Covid-19 using Chest X-ray/CT-Scan

2020 3rd International Conference on Intelligent Sustainable Systems (ICISS) ◽

10.1109/iciss49785.2020.9316125 ◽

2020 ◽

Author(s):

S. Nikkath Bushra ◽

G. Shobana

Keyword(s):

Neural Network ◽

Ct Scan ◽

X Ray ◽

Chest X Ray

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A Hybrid Method of Covid-19 Patient Detection From Modified CT-Scan/Chest-X-Ray Images Combining Deep Convolutional Neural Network And Two- Dimensional Empirical Mode Decomposition

Computer Methods and Programs in Biomedicine Update ◽

10.1016/j.cmpbup.2021.100022 ◽

2021 ◽

pp. 100022

Author(s):

Nahian Ibn Hasan

Keyword(s):

Neural Network ◽

Convolutional Neural Network ◽

Ct Scan ◽

Empirical Mode Decomposition ◽

Hybrid Method ◽

Deep Convolutional Neural Network ◽

Two Dimensional ◽

X Ray ◽

Mode Decomposition ◽

Chest X Ray

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Deep learning-based meta-classifier approach for COVID-19 classification using CT scan and chest X-ray images

Multimedia Systems ◽

10.1007/s00530-021-00826-1 ◽

2021 ◽

Author(s):

Vinayakumar Ravi ◽

Harini Narasimhan ◽

Chinmay Chakraborty ◽

Tuan D. Pham

Keyword(s):

Deep Learning ◽

Ct Scan ◽

X Ray ◽

Chest X Ray

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Pulmonary aspergilloma on transthoracic ultrasound

Infection ◽

10.1007/s15010-021-01589-7 ◽

2021 ◽

Author(s):

Lisa C. Ruby ◽

Rajagopal Kadavigere ◽

Shubha Sheshadri ◽

Kavitha Saravu ◽

Sabine Bélard

Keyword(s):

Pulmonary Tuberculosis ◽

Point Of Care ◽

Computed Tomography Imaging ◽

Imaging Tool ◽

Irregular Border ◽

History Of ◽

Chest X Ray ◽

Previously Treated ◽

Pulmonary Aspergilloma ◽

Transthoracic Ultrasound

Abstract Purpose Pulmonary aspergilloma affects immunocompromised patients but is also a recurrent condition in patients previously treated for pulmonary tuberculosis. Methods and Results We report the case of a 45-year-old patient with a history of cured pulmonary tuberculosis 15 years earlier in whom we visualized pulmonary aspergilloma by transthoracic lung sonography. Sonography of pulmonary aspergilloma demonstrated an oval cavity with hypoechoic contents and an irregular border, measuring a diameter of 4.7 cm; inside the lesion, a roundish structure with an anechoic rim was discernable. Conclusions The sonographic findings corresponded to chest X-ray and computed tomography imaging in this patient and to previously reported sonographic characteristics of mycotic abscesses in other organs. Lung ultrasound may be a tool to identify pulmonary aspergilloma, especially as a point-of-care imaging tool and where other imaging modalities are inaccessible.

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