scholarly journals Lung Ultrasound as a First-Line Test in the Evaluation of Post-COVID-19 Pulmonary Sequelae

2022 ◽  
Vol 8 ◽  
Author(s):  
David Clofent ◽  
Eva Polverino ◽  
Almudena Felipe ◽  
Galo Granados ◽  
Marta Arjona-Peris ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Pulmonary Function Tests ◽  
Inverse Correlation ◽  
Strongly Correlated ◽  
First Line ◽  
Roc Curve Analysis ◽  
High Resolution Computed Tomography ◽  
Line Test ◽  
Moderate Inverse Correlation

Background: Interstitial lung sequelae are increasingly being reported in survivors of COVID-19 pneumonia. An early detection of these lesions may help prevent the development of irreversible lung fibrosis. Lung ultrasound (LUS) has shown high diagnostic accuracy in interstitial lung disease (ILD) and could likely be used as a first-line test for post-COVID-19 lung sequelae.Methods: Single-center observational prospective study. Follow-up assessments of consecutive patients hospitalized for COVID-19 pneumonia were conducted 2–5 months after the hospitalization. All patients underwent pulmonary function tests (PFTs), high-resolution computed tomography (HRCT), and LUS. Radiological alterations in HRCT were quantified using the Warrick score. The LUS score was obtained by evaluating the presence of pathological B-lines in 12 thoracic areas (range, 0–12). The correlation between the LUS and Warrick scores was analyzed.Results: Three hundred and fifty-two patients who recovered from COVID-19 pneumonia were recruited between July and September 2020. At follow-up, dyspnea was the most frequent symptom (69.3%). FVC and DLCO alterations were present in 79 (22.4%) and 234 (66.5%) patients, respectively. HRCT showed relevant interstitial lung sequelae (RILS) in 154 (43.8%) patients (Warrick score ≥ 7). The LUS score was strongly correlated with the HRCT Warrick score (r = 0.77) and showed a moderate inverse correlation with DLCO (r = −0.55). The ROC curve analysis revealed that a LUS score ≥ 3 indicated an excellent ability to discriminate patients with RILS (sensitivity, 94.2%; specificity, 81.8%; negative predictive value, 94.7%).Conclusions: LUS could be implemented as a first-line procedure in the evaluation of Post-COVID-19 interstitial lung sequelae. A normal LUS examination rules out the presence of these sequelae in COVID-19 survivors, avoiding the need for additional diagnostic tests such as HRCT.

scholarly journals Serum IGFBP-2 in systemic sclerosis as a prognostic factor of lung dysfunction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Julien Guiot ◽  
Makon-Sébastien Njock ◽  
Béatrice André ◽  
Fanny Gester ◽  
Monique Henket ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Prognostic Factor ◽  
Pulmonary Function ◽  
Lung Disease ◽  
Pulmonary Function Tests ◽  
Serum Levels ◽  
Roc Curve Analysis ◽  
Significant Deterioration ◽  
Lung Dysfunction

AbstractSystemic sclerosis (SSc) is a rare connective tissue disease associated with rapid evolving interstitial lung disease (ILD), driving its mortality. Specific biomarkers associated with the progression of this lung disease are highly needed. We aimed to identify specific biomarkers of SSc-ILD to predict the evolution of the disease. For this, we compared prospectively serum levels of several biomarkers associated with lung fibrosis in SSc patients (n = 102), among which SSc-no ILD (n = 63) and SSc-ILD (n = 39), compared to healthy subjects (HS) (n = 39). We also performed a longitudinal study in a subgroup of 28 patients analyzing biomarkers variations and pulmonary function tests over a period of 2 years. Serum level of IGFBP-2 was significantly increased in SSc patients compared to HS, and negatively correlated with pulmonary function (assessed by carbon monoxide transfer coefficient (KCO)) (r = − 0.29, p < 0.01). Two-year longitudinal analysis in a subgroup of 28 SSc patients determined that IGFBP-2 variation was positively correlated with KCO at 2-year follow-up (r = 0.6, p < 0.001). SSc patients with a lower variation of IGFBP-2 (less than 22%) presented significant deterioration of pulmonary function at 2-year follow-up (p < 0.01). ROC curve analysis enabled us to identify that baseline IGFBP-2 > 105 ng/ml was associated with a poor outcome (KCO < 70% predicted) at 2-year follow-up (AUC = 0.75, p < 0.05). We showed for the first time that serum levels of IGFBP-2 might be a prognostic factor of the development of SSc-ILD.

scholarly journals Update on Lung Cancer

2015 ◽  
Vol 10 (2) ◽  
Author(s):  
Nicole Bouchard MD, FRCPC ◽  
Jason Scott Agulnik MD, CM, BSc
Keyword(s):  
Lung Cancer ◽  
Tnm Classification ◽  
Cancer Staging ◽  
Small Cell Lung ◽  
First Line ◽  
Node Metastasis ◽  
Molecular Tests ◽  
Line Test ◽  
Tumour Node

Investigation and treatment of lung cancer has changed dramatically since the last articles in this journal in 2008. These changes include a new study on lung cancer staging, a new tumour, node, metastasis (TNM) classification, linear endoscopic ultrasound as a first-line test formediastinal staging, investigation and follow-up of ground glass and mixed-lung nodules, radiosurgery for inoperable patients with localized lung tumours, and molecular tests and targeted therapies for advanced non-small cell lung cancer.

scholarly journals Morphological Patterns of Sarcoidosis and Clinical Outcome: Retrospective Analysis through a Multidisciplinary Approach

Diagnostics ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 212 ◽  
Author(s):  
Giulio Distefano ◽  
Ada Vancheri ◽  
Monica Palermo ◽  
Francesco Tiralongo ◽  
Pietro Valerio Foti ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Pulmonary Function Tests ◽  
Inverse Correlation ◽  
Clinical History ◽  
Interstitial Lung Diseases ◽  
University Hospital ◽  
High Resolution Computed Tomography ◽  
Atypical Manifestations ◽  
Hrct Patterns ◽  
Morphological Patterns

The aim of this work was to verify the correlations between different pulmonary morphological patterns and functional outcomes in sarcoidosis patients, using a validated score for the comparison between the high-resolution computed tomography (HRCT) of patients belonging to different imaging patterns. From the electronic database of the reference center for interstitial lung diseases of our University Hospital, we retrospectively selected 55 patients with a diagnosis of sarcoidosis according to the American Thoracic Society (ATS) criteria; we evaluated the initial HRCT examination and pulmonary function tests collected at baseline and after a year. Patients were divided into typical (48% of patients) and atypical (52%) HRCT patterns, and a computer tomography activity score (CTAS) was associated with each HRCT appearance detected; clinical history, impact of therapy, and extra-thoracic locations were also considered. We found that worsening of diffusing capacity for carbon monoxide (DLCO) is related to the CTAS (r = −0.20, p = 0.01), and there was an inverse correlation between the variation of forced vital capacity (FVC) and the value of the CTAS (r = −0.30, p = 0.23) in the subgroup of patients with atypical patterns. CTAS were higher in patients with extra-pulmonary localizations (p = 0.05) and the subgroup of patients with extra-thoracic locations and atypical manifestations had a greater worsening in terms of variation of FVC (p = 0.03) and DLCO% (p = 0.04). No difference between treated and untreated patients was found.

Cyclosporine in Anti-Jo1-positive Patients with Corticosteroid-refractory Interstitial Lung Disease

2013 ◽  
Vol 40 (4) ◽  
pp. 484-492 ◽  
Author(s):  
Lorenzo Cavagna ◽  
Roberto Caporali ◽  
Lul Abdì-Alì ◽  
Roberto Dore ◽  
Federica Meloni ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Vital Capacity ◽  
Low Dose ◽  
Pulmonary Function Tests ◽  
Line Treatment ◽  
Antisynthetase Syndrome ◽  
First Line ◽  
High Resolution Computed Tomography ◽  
First Line Treatment

Objective.To describe the longterm effectiveness and safety of cyclosporine (CYC) in patients with anti-Jo1-positive antisynthetase syndrome with corticosteroid-refractory interstitial lung disease (ILD).Methods.All patients with anti-Jo1 antisynthetase syndrome referred to our division between June 1991 and February 2010 were retrospectively evaluated for ILD. ILD was assessed using pulmonary function tests (PFT) and/or high-resolution computed tomography (HRCT). Kazerooni score was used to evaluate the HRCT extent of ILD. Prednisone was the first-line treatment in all cases (1 mg/kg/day orally, then tapering). Patients with corticosteroid-refractory or relapsing ILD were then included in this retrospective study. All patients started CYC (3 mg/kg/day) without increasing prednisone dosage. Both PFT and chest HRCT were regularly reassessed during followup.Results.Over the period of study we evaluated 18 patients with antisynthetase syndrome; 17 had ILD (13 women; median age at ILD onset 57 yrs); all patients failed prednisone within 12 months of ILD onset and subsequently started CYC. The median followup on CYC was 96 months [interquartile range (IQR) 57–120 mo]. Upon starting CYC, median forced vital capacity (FVC) was 60% (IQR 56%–70%), median DLCO 60% (IQR 50%–62.75%), and median Kazerooni score 16 (IQR 7–18). After 1 year of CYC, FVC (p = 0.0006), DLCO (p = 0.0010), and total Kazerooni score (p = 0.0002) improved and prednisone was tapered (median reduced from 25 mg/day to 2.5 mg/day; p < 0.0001). The results were substantially maintained including at last available followup. CYC side effects were hypertension (5 patients) and creatinine increase (6 patients). CYC was reduced in 3 cases and withdrawn in 4. Three out of 4 patients who interrupted CYC experienced ILD relapse; 2 patients recommenced low-dose CYC with subsequent ILD control. One patient refused re-treatment and subsequently died.Conclusion.CYC is effective and substantially safe in patients with anti-Jo1 antisynthetase syndrome with corticosteroid-refractory ILD. CYC withdrawal may be associated with ILD relapse, and low-dose CYC was effective in ILD control.

scholarly journals The role of high-resolution computed tomography in the follow-up of diffuse lung disease

2017 ◽  
Vol 26 (144) ◽  
pp. 170008 ◽  
Author(s):  
Brett M. Elicker ◽  
Kimberly G. Kallianos ◽  
Travis S. Henry
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Lung Disease ◽  
Pulmonary Function Tests ◽  
Clinical History ◽  
High Resolution Computed Tomography ◽  
Diffuse Lung Disease ◽  
Diffuse Lung

High-resolution computed tomography (HRCT) of the lung is a key component of the multidisciplinary approach to diagnosis in diffuse lung disease (DLD). HRCT also plays an important role in the follow-up of patients with established DLD. In this respect, serial HRCT examinations may provide valuable information that cannot be determined from clinical history and other diagnostic tests, such as pulmonary function tests. Important roles of HRCT in this context include assisting in determining prognosis, monitoring for the efficacy of treatment, detecting progression of disease or complications, and evaluating patients with worsening or acute symptoms. Both clinicians and radiologists should be aware of the expected evolution of HRCT changes in a variety of DLDs. The goals of this paper are to discuss: 1) the expected evolution of HRCT findings over time in common DLDs; 2) the role of serial HRCT examinations in formulating an initial diagnosis; and 3) the role of HRCT in the follow-up of patients with known DLD.

Evaluation of a new strategy for detection of thyroid dysfunction in the routine laboratory.

1988 ◽  
Vol 34 (6) ◽  
pp. 1110-1114
Author(s):  
R John ◽  
R Henley ◽  
G Lloyd ◽  
G H Elder
Keyword(s):  
Thyroid Dysfunction ◽  
Thyroid Disorders ◽  
Routine Laboratory ◽  
Sensitive Assay ◽  
First Line ◽  
Replacement Treatment ◽  
Free Thyroid Hormone ◽  
New Strategy ◽  
Line Test

Abstract We assessed the use of a new strategy for detecting thyroid disorders, utilizing a sensitive assay for concentrations of thyrotropin (TSH) and free thyroid hormone in serum as follow-up tests. Of 1279 patients who were not on thyroxin (T4) replacement treatment, 82% could be classified as euthyroid and would require no further tests. In patients who were on T4 replacement, 41% fell into the euthyroid category and would require no further tests. Using this strategy to replace our existing strategy of free thyroxin as a "first-line" test would reduce the proportion of patients who would require one or more follow-up tests from 49% to 24%.

scholarly journals Does Technetium-99m Diethylenetriaminepentaacetate Clearance Predict the Clinical Course of Idiopathic Pulmonary Fibrosis?

2004 ◽  
Vol 11 (7) ◽  
pp. 477-479 ◽  
Author(s):  
Marco Mura ◽  
Gelorma Belmonte ◽  
Stefano Fanti ◽  
Angela Maria Pacilli ◽  
Luca Fasano ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Vital Capacity ◽  
Clinical Course ◽  
Pulmonary Function Tests ◽  
Functional Tests ◽  
High Resolution Computed Tomography ◽  
Technetium 99M ◽  
Potential Indicator

Clearance of inhaled technetium-99m diethylenetriaminepentaacetate (99mTc-DTPA) is a potential indicator of disease activity and progression in idiopathic pulmonary fibrosis (IPF). The objective of the present study was to evaluate the prognostic value of99mTc-DTPA scans in IPF. A total of 22 patients (18 males), aged 33 to 80 years with IPF were followed for six to 20 months (mean 13 months). At diagnosis, high resolution computed tomography (HRCT) scans showed a honeycomb pattern with bibasilar reticular opacities in all cases. At T0 (diagnosis) and T1 (follow-up), each patient had pulmonary function tests (forced vital capacity, diffusing capacity of the lung for carbon monoxide and partial arterial O2pressure), extension of fibrosis evaluated by HRCT visual score and99mTc-DTPA lung clearance. Results at T0 and T1 were compared, taking into account the whole population and patients with relatively fast and slow99mTc-DTPA wash-out.99mTc-DTPA clearance did not show any significant correlation with functional tests or HRCT score. These findings indicate that clearance of inhaled99mTc-DTPA is not of value in following the progress of IPF.

Esophageal Dilation and Other Clinical Factors Associated with Pulmonary Function Decline in Patients with Systemic Sclerosis

2021 ◽  
pp. jrheum.210533
Author(s):  
Kimberly Showalter ◽  
Aileen Hoffmann ◽  
Carrie Richardson ◽  
David Aaby ◽  
Jungwha Lee ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
Esophageal Dilation ◽  
Clinical Factors ◽  
High Resolution Computed Tomography ◽  
Mixed Effect ◽  
Mixed Effect Models ◽  
Clinically Significant

Objective To identify clinical factors, including esophageal dilation on chest high-resolution computed tomography (HRCT), that are associated with pulmonary function decline in patients with systemic sclerosis (SSc). Methods Patients fulfilled 2013 SSc criteria and had ≥1 HRCT and ≥2 pulmonary function tests (PFTs). According to published methods, widest esophageal diameter (WED) and radiographic interstitial lung disease (ILD) were assessed, and WED was dichotomized as dilated (≥19mm) vs. not dilated (<19mm). Clinically meaningful PFT decline was defined as %-predicted change in forced vital capacity (FVC) ≥5 and/or diffusion capacity for carbon monoxide (DLCO) ≥15. Linear mixed effect models were used to model PFT change over time. Results 138 SSc patients met study criteria: 100 (72%) had radiographic ILD; 49 (35%) demonstrated FVC decline (median follow-up 2.9y). Patients with Scl-70 autoantibodies had 5- year %-predicted FVC decline (-6.3; 95% CI -9.9, -2.8), while patients without Scl-70 autoantibodies demonstrated 5-year FVC stability (+1.78; 95% CI -0.6, 4.15). Esophageal diameter did not distinguish between those with vs. without FVC decline. Patients with esophageal dilation had statistically significant 5-year %-predicted DLCO decline (-5.6; 95% CI - 10.0, -1.2), but this decline was unlikely clinically significant. Similar results were observed in sub-analysis of patients with radiographic ILD. Conclusion In patients with SSc, Scl-70 positivity is a risk factor for %-predicted FVC decline at five years. Esophageal dilation on HRCT was associated with a minimal, non-clinically significant decline in DLCO and no change in FVC during 5-year follow-up. These results have prognostic implications for SSc-ILD patients with esophageal dilation.

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