scholarly journals Amiodarone-Induced Pulmonary Toxicity – A Frequently Missed Complication

2016 ◽  
Vol 9 ◽  
pp. CCRep.S39809 ◽  
Author(s):  
Alexander J. Sweidan ◽  
Navneet K. Singh ◽  
Natasha Dang ◽  
Vinh Lam ◽  
Jyoti Datta
Keyword(s):  
Coronary Artery ◽  
Lung Disease ◽  
Interstitial Pneumonitis ◽  
Pulmonary Toxicity ◽  
Pulmonary Nodules ◽  
Ground Glass ◽  
X Rays ◽  
X Ray ◽  
Chest X Ray ◽  
New Onset

Introduction Amiodarone is often used in the suppression of tachyarrhythmias. One of the more serious adverse effects includes amiodarone pulmonary toxicity (APT). Several pulmonary diseases can manifest including interstitial pneumonitis, organizing pneumonia, acute respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary nodules or masses, and pleural effusion. Incidence of APT varies from 5–15% and is correlated to dosage, age of the patient, and preexisting lung disease. Description A 56-year-old male with a past medical history of coronary artery disease and chronic obstructive pulmonary disease was admitted for a coronary artery bypass graft. Post-operatively, the patient was admitted to the ICU for ventilator management and continued to receive his home dose of amiodarone 400 mg orally twice daily, which he had been taking for the past 3 months. The patient was found to be hypoxemic with a PaO2 52 mmHg and bilateral infiltrates on chest x-ray. Patient also complained of new onset dyspnea. Physical exam found bilateral rhonchi with bibasilar crackles and subcutaneous emphysema along the left anterior chest wall. Daily chest x-rays showed worsening of bilateral interstitial infiltrates and pleural effusions. A chest high-resolution computed tomography on post-operative day 3 showed extensive and severe bilateral ground glass opacities. APT was suspected and amiodarone was discontinued. A course of oral prednisone without antibiotics was initiated, and after one week of treatment the chest film cleared, the PaO2 value normalized and dyspnea resolved. Discussion APT occurs via cytotoxic T cells and indirectly by immunological reaction. Typically the lungs manifest a diffuse interstitial pneumonitis with varying degrees of fibrosis. Infiltrates with a ‘ground-glass’ appearance appreciated on HRCT are more definitive than chest x-ray. Pulmonary nodules can be seen, frequently in the upper lobes. These are postulated to be accumulations of amiodarone in areas of previous inflammation. Those undergoing major cardiothoracic surgery are known to be predisposed to APT. Some elements require consideration: a baseline pulmonary function test (PFT) did not exist prior. APT would manifest a restrictive pattern of PFTs. In APT diffusing capacity (DLCO) is generally >20 percent from baseline. A DLCO was not done in this patient. Therefore, not every type of interstitial lung disease could be ruled out. Key features support a clinical diagnosis: (1) new dyspnea, (2) exclusion of lung infection, (3) exclusion of heart failure, (4) new radiographic features, (5) improvement with withdrawal of amiodarone. Our case illustrates consideration of APT in patients who have extensive use of amiodarone and new onset dyspnea.

scholarly journals Chest X-ray findings in COVID-19 patients: a descriptive study

2021 ◽  
Author(s):  
Asraf Hussain ◽  
Jeetendra Mishra ◽  
Achutanand Lal Karn ◽  
Alok Kumar Singh ◽  
Parwez Ansari ◽  
...  
Keyword(s):  
Descriptive Study ◽  
British Society ◽  
Ground Glass ◽  
X Rays ◽  
Lower Zone ◽  
Thoracic Imaging ◽  
X Ray ◽  
Peripheral Lung ◽  
Normal Chest ◽  
Chest X Ray

Background: Early suspicion and diagnosis remains the cornerstone for the better outcome of patients and to decrease cross infection in cases of COVID-19 pneumonia. In a country like Nepal X-ray facilities are readily available radiological tool in most of the centers and can be important screening tool.  There is a lack of studies detailing the chest XR (C-XR) findings in these patients when compared to that dedicated to the CT features. Study aims to describe the patterns of the lung opacities in CXR in these patients.Methods: This is retrospective descriptive study conducted at NMCTH in COVID-19 patients from 12 September to 17 October 2020. Demographic characteristics, symptoms, co-morbidities and C-XR findings were studied. CXR findings were categorized according to BSTI classification.Results: Among 111 COVID-19 RT-PCR positive cases admitted 102 (91.9%) belonged to age group 18-65 years, 89 (80.2%) were males. Cough and fever were the commonest symptoms present in 109 (98.2%) patients. Ischemic heart disease and hypertension in 32 (28.8%) patients were the commonest co morbidities. According to British society of thoracic imaging (BSTI) COVID-19 CXR classification, six patients (5.4%) had normal chest X-rays. Classic/probable COVID-19 picture was present in 79 (71.17%) patients while (7.2%) had intermediate for COVID-19 X-ray findings. Among 79 patients with classic/probable COVID-19 CXR findings 71 (89.8%) had bilateral consolidation/ground glass haze, 72 (91.1%) had peripheral lung involvement while 66 (83.5%) had middle and lower zone involvement.Conclusions: Ground glass opacities/consolidations with bilateral location, peripheral distribution and middle- lower zone predominance were the commonest X-ray findings in our study.

Chest X-Rays Findings in Patients Positive for COVID 19 at Sheikh Zayed Hospital Lahore

2021 ◽  
Vol 15 (5) ◽  
pp. 1196-1199
Author(s):  
A. Z. Sheikh ◽  
Z. Tariq ◽  
S. Noor ◽  
A. Ambreen ◽  
S. Awan ◽  
...  
Keyword(s):  
Ground Glass Opacity ◽  
British Society ◽  
Ground Glass ◽  
Care Hospital ◽  
X Rays ◽  
Middle Zone ◽  
Rt Pcr ◽  
Thoracic Imaging ◽  
X Ray ◽  
Chest X Ray

Aim: To assess the results of chest x ray radiographs of patients positive for Covid-19, presented at the tertiary care hospital according to the classification by the British Society of Thoracic Imaging (BSTI. Place and Duration: In COVID-19 Ward (Department of Medicine) Sheikh Zayed Hospital, Lahore for three months duration from January 2021 to March 2021. Methods: A total of 96 patients were selected. In this observational study, positive COVID-19 patient determined by the reverse transcriptase polymerase chain reaction (RT-PCR) were enrolled for this study above the age of 14 years. CXR results were classified conferring to BSTI documentation and classification in terms of percentage and frequency. Results: Chest rays of 96 patients who tested positive for Covid-19 by RT-PCR over the age of 14 years were examined. Chest X-rays are classified according to the BSTI Covid-19 X-ray classification. Out of 96 patients, 10 patients (10.41%) had normal chest x-rays, 19 (19.80%) patients had classic bilateral, peripheral and basal consolidation / ground glass opacity (GMO), 60 (62.5%) had unspecified group,7(7.29%) patients have poor quality X-ray film. The unilateral involvement was noticed in 15 and bilateral in 49 patients, 12 of the patients had diffuse involvement on chest radiograph and peripheral involvement in 39 patients. According to regional dominance, 41 of the unspecified (42.70%) had middle and lower lung involvement, 7 (7.29%) had only the middle zone, and 8 (8.33%) had involvement of lower zone. Conclusions: In this study, Covid-19 chest X-rays are usually presented as ground glass opacity, mixed consolidation with GGOs in the middle and lower peripheral areas of the bilateral lung. Chest X-ray BSTI classification is used to classify Covid-19 severity in our patients, thus differentiating in the classic Covid-19 of the middle zone versus low zone involvement. Keywords: Consolidation, Covid, Ground Glass Opacity, Chest Image.

scholarly journals Chest X-ray findings in COVID-19: A Pictorial Review

2020 ◽  
Vol 24 (Supp-1) ◽  
pp. 44-49
Author(s):  
Nasir Khan ◽  
Muhammad Umar ◽  
Maria Khaliq ◽  
Hina Hanif ◽  
Misbah Durrani ◽  
...  
Keyword(s):  
British Society ◽  
Ground Glass ◽  
X Rays ◽  
Rt Pcr ◽  
Radiological Investigation ◽  
Thoracic Imaging ◽  
X Ray ◽  
Pictorial Review ◽  
Clinical Scenarios ◽  
Chest X Ray

Introduction: Chest X-ray and Computed tomography(CT) of chest play an important role in the diagnosis and management of the Coronavirus disease (COVID-19). As chest CT may not be readily available in most clinical setups X-ray Chest plays a pivotal role in such clinical scenarios and an irreplaceable initial radiological investigation of these patients. Objective: The objective of this article is to identify and elaborate the commonest appearances and patterns of lung changes on Chest X rays in COVID-19 positive patients confirmed on RT-PCR COVID testing. Materials and Methods: Cross-sectional descriptive-analytical study of Chest X-ray findings of 294  RT-PCR confirmed COVID-19 patients admitted across 3 hospitals (Rawalpindi institute of urology (RIU), Benazir Bhutto Hospital (BBH) and Holy Family Hospital (HFH)) from March 30th, 2020 till April 30th, 2020. CXR was analyzed for consolidation patches, ground-glass opacification (GGO), multi-lobe involvement, bilateral distribution, and pleural fluid. The chest X-ray with positive findings was graded into mild, moderate, and severe grades using BSTI (British Society of Thoracic imaging) guidelines. Results: Mean age of study patients was 45.5 years. Among the study population 230 (78.2 %) were male and 64 (21.8%) female. On baseline chest X rays, consolidations were the commonest finding (n=84, 28.5%), followed by ground-glass opacity (n=17, 5.7 %). The more common locations were peripheral and lower zones, and the majority had bilateral lung involvement (Table 1). Pleural effusions were found in only 5 of the study patients.  Among these patients, 187 (63.6%) had an initial normal chest X-ray. Moreover, 35, 34, and 38patients had mild, moderate, and severe diseases respectively. Conclusion: Chest X-ray is an important initial radiological investigation for COVID 19 patients and plays an important role in the management during the course of the disease.

Spontaneous Pneumomediastinum: Uncommon Cause of Air Leak in Late Preterm Neonate

2021 ◽  
Vol 35 (2) ◽  
pp. 93-94
Author(s):  
Jyotsna Bhushan ◽  
Shagufta Iqbal ◽  
Abhishek Chopra
Keyword(s):  
Respiratory Distress ◽  
Conservative Management ◽  
Preterm Neonate ◽  
Late Preterm ◽  
Intravenous Fluids ◽  
X Rays ◽  
Blood Gas ◽  
X Ray ◽  
Spontaneous Pneumomediastinum ◽  
Chest X Ray

A clinical case report of spontaneous pneumomediastinum in a late-preterm neonate, chest x-ray showing classical “spinnaker sail sign,” which was managed conservatively and had excellent prognosis on conservative management. Respiratory distress in a preterm neonate is a common clinical finding. Common causes include respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, and pneumothorax. Pneumomediastinum is not very common cause of respiratory distress and more so spontaneous pneumomediastinum. We report here a preterm neonate with spontaneous pneumomediastinum who had excellent clinical recovery with conservative management. A male baby was delivered to G3P1A1 mother at 34 + 6 weeks through caesarean section done due to abruptio placenta. Apgar scores were 8 and 9. Maternal antenatal history was uneventful and there were no risk factors for early onset sepsis. Baby had respiratory distress soon after birth with Silverman score being 2/10. Baby was started on oxygen (O2) by nasal prongs through blender 0.5 l/min, FiO2 25%, and intravenous fluids. Blood gas done was normal. Possibility of transient tachypnea of newborn or mild hyaline membrane disease was kept. Respiratory distress increased at 20 h of life (Silverman score: 5), urgent chest x-ray done revealed “spinnaker sign” suggestive of pneumomediastinum, so baby was shifted to O2 by hood with FiO2 being 70%. Blood gas repeated was normal. Baby was managed conservatively on intravenous fluids and O2 by hood. Baby was gradually weaned off from O2 over next 5 days. As respiratory distress decreased, baby was started on orogastric feed, which baby tolerated well and then was switched to oral feeds. Serial x-rays showed resolution of pneumomediastinum. Baby was discharged on day 7 of life in stable condition on breast feeds and room air.

scholarly journals Accessory pathway analysis using a multimodal deep learning model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Makoto Nishimori ◽  
Kunihiko Kiuchi ◽  
Kunihiro Nishimura ◽  
Kengo Kusano ◽  
Akihiro Yoshida ◽  
...  
Keyword(s):  
Deep Learning ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Learning Model ◽  
X Rays ◽  
X Ray ◽  
Wpw Syndrome ◽  
Chest X Ray ◽  
Deep Learning Model ◽  
Ecg Data

AbstractCardiac accessory pathways (APs) in Wolff–Parkinson–White (WPW) syndrome are conventionally diagnosed with decision tree algorithms; however, there are problems with clinical usage. We assessed the efficacy of the artificial intelligence model using electrocardiography (ECG) and chest X-rays to identify the location of APs. We retrospectively used ECG and chest X-rays to analyse 206 patients with WPW syndrome. Each AP location was defined by an electrophysiological study and divided into four classifications. We developed a deep learning model to classify AP locations and compared the accuracy with that of conventional algorithms. Moreover, 1519 chest X-ray samples from other datasets were used for prior learning, and the combined chest X-ray image and ECG data were put into the previous model to evaluate whether the accuracy improved. The convolutional neural network (CNN) model using ECG data was significantly more accurate than the conventional tree algorithm. In the multimodal model, which implemented input from the combined ECG and chest X-ray data, the accuracy was significantly improved. Deep learning with a combination of ECG and chest X-ray data could effectively identify the AP location, which may be a novel deep learning model for a multimodal model.

scholarly journals Smart access development for classifying lung disease with chest x-ray images using deep learning

2021 ◽  
Author(s):  
Tarunika kumaraguru ◽  
P. Abirami ◽  
K.M. Darshan ◽  
S.P. Angeline Kirubha ◽  
S. Latha ◽  
...  
Keyword(s):  
Deep Learning ◽  
Lung Disease ◽  
X Ray ◽  
Chest X Ray

AB0796 THE EVALUATION OF LUNG DIAGNOSTIC PROCEDURE AT THE ONSET OF INFLAMMATORY RHEUMATIC DISEASES WITH INTERSTITIAL LUNG DISEASE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1422.3-1423
Author(s):  
T. Hoffmann ◽  
P. Oelzner ◽  
F. Marcus ◽  
M. Förster ◽  
J. Böttcher ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Interstitial Lung Disease ◽  
Lung Function ◽  
Lung Disease ◽  
Sensitivity And Specificity ◽  
Lung Function Test ◽  
Inflammatory Rheumatic Diseases ◽  
X Ray ◽  
Function Test ◽  
Chest X Ray

Background:Interstitial lung disease (ILD) in inflammatory rheumatic diseases (IRD) is associated with increased mortality. Moreover, the lung is one of the most effected organs on IRD. Consequently, screening methods were required to the detect ILD in IRD.Objectives:The objective of the following study is to evaluate the diagnostic value of lung function test, chest x-ray and HR-CT of the lung in the detection of ILD at the onset of IRD.Methods:The study is designed as a case-control study and includes 126 patients with a newly diagnosed IRD. It was matched by gender, age and the performance of lung function test and chest x-ray. The sensitivity and specificity were verified by crosstabs and receiver operating characteristic (ROC) curve analysis. The study cohort was divided in two groups (ILD group: n = 63 and control group: n = 63). If possible, all patients received a lung function test and optional a chest x-ray. Patients with pathological findings in the screening tests (chest x-ray or reduced diffusing capacity for carbon monoxide (DLCO) < 80 %) maintained a high-resolution computer tomography (HR-CT) of the lung. Additionally, an immunological bronchioalveolar lavage was performed in the ILD group as gold standard for the detection of ILD.Results:The DLCO (< 80 %) revealed a sensitivity of 83.6 % and specificity of 45.8 % for the detection of ILD. Other examined parameter of lung function test showed no sufficient sensitivity as screening test (FVC = Forced Vital Capacity, FEV1 = Forced Expiratory Volume in 1 second, TLC = Total Lung Capacity, TLCO = Transfer factor of the Lung for carbon monoxide). Also, a combination of different parameter did not increase the sensitivity. The sensitivity and specificity of chest x-ray for the verification of ILD was 64.2 % versus 73.6 %. The combination of DLCO (< 80 %) and chest x-ray showed a sensitivity with 95.2 % and specificity with 38.7 %. The highest sensitivity (95.2 %) and specificity (77.4 %) was observed for the combination of DLCO (< 80 %) and HR-CT of the lung.Conclusion:The study highlighted that a reduced DLCO in lung function test is associated with a lung involvement in IRD. DLCO represented a potential screening parameter for lung manifestation in IRD. Especially patients with suspected vasculitis should receive an additional chest x-ray. Based on the high sensitivity of DLCO in combination with chest x-ray or HR-CT for the detection of ILD in IRD, all patients with a reduced DLCO (< 80%) should obtained an imaging of the lung.Disclosure of Interests:None declared

scholarly journals 3D Imaging in Unilateral Primary Pulmonary Hypoplasia in an Adult: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-6
Author(s):  
Aristida Georgescu ◽  
Crinu Nuta ◽  
Simona Bondari
Keyword(s):  
3D Imaging ◽  
Pulmonary Hypoplasia ◽  
Left Lung ◽  
Left Lobe ◽  
X Rays ◽  
X Ray ◽  
Female Smoker ◽  
Multidetector Computer Tomography ◽  
Biological Tests ◽  
Chest X Ray

Unilateral primary pulmonary hypoplasia is rare in adulthood (UPHA); it is characterized by a decreased number of bronchial segmentation and decreased/absent alveolar air space. Classical chest X-ray may be confusing, and the biological tests are unspecific. We present a case of UPHA in a 60-year-old female, smoker, with 3 term normal deliveries, who presented with late recurrent pneumonias and bronchiectasis-type symptomathology, arterial hypertension, and obesity. Chest X-rays revealed opacity in the left lower pulmonary zone, an apparent hypoaerated upper left lobe and left deviation of the mediastinum. Preoperatory multidetector computer tomography (MDCT) presented a small retrocardiac left lung with 5-6 bronchial segmentation range and cystic appearance. After pneumonectomy the gross specimen showed a small lung with multiple bronchiectasis and small cysts, lined by hyperplasic epithelium, surrounded by stromal fibrosclerosis. We concluded that this UPHA occurred in the 4–7 embryonic weeks, and the 3D MDCT reconstructions offered the best noninvasive diagnosis.

Amiodarone – induced pulmonary nodules mimiking metastatic lung disease – investigation by somatostatin radio peptide scaning

2005 ◽  
Vol 4 (2) ◽  
pp. 63-65
Author(s):  
Veronica Varney ◽  
◽  
Mary Warren ◽  
M Palmer ◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Nodules ◽  
Alcoholic Cardiomyopathy ◽  
X Ray ◽  
The Past ◽  
Previous Diagnosis ◽  
Metastatic Lung ◽  
Chest X Ray ◽  
200Mg Daily

A 61 year old former paramedic presented to A&E complaining of palpitations. He was found to be in atrial fibrillation, which reverted spontaneously to sinus rhythm. A chest x-ray taken at that time showed multiple pulmonary nodules consistent with metastatic malignancy (Figure 1). In the past he had been treated with amiodarone 200mg daily for 6 years following a previous diagnosis of atrial fibrillation, which had been attributed to alcoholic cardiomyopathy. He had discontinued the drug 8 months earlier, after selfdiagnosing hypotension and bradycardia. A previous chest X-ray, taken before starting amiodarone, was normal.

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