A Case Report of Osteopoikilosis in the ribs, pelvic region and spine

Osteopoikilosisis a rare inherited benign bone dysplasia incidentally found on radiological exams. It ischaracterized by a specific radiological pattern which consists in diffuse, round or oval, symmetrically shaped sclerotic bone areas distributed throughout the skeleton. It is important to do a correct diagnosis because these lesions could be easily confused with bone metastasis. We reported a case of an osteopoikilosis patient presenting to our clinic with transient loss of consciousness and without any numbness, tingling and weakness in the legs or other parts of the body. The CT scan showed multiple small sclerotic foci bone islands, scattered throughout the thoracic and lumbar spine, ribs, pelvic bone, sacrum and bilateral proximal femur. No significant increase in the activity was detected in Technetium-99m (Tc-99m) whole body bone scintigraphy. The patient was diagnosed with characteristic radiological findings of osteopoikilosis and was followed up.

“A STUDY OF CORRELATION BETWEEN CLINICAL FEATURES, RADIOLOGICAL FINDINGS AND SPIROMETRY PARAMETERS IN PATIENTS OF BRONCHIECTASIS”

INTRODUCTION: Bronchiectasis is dened as an irreversible dilation and destruction of one or more bronchi with a reduction in clearance of secretions and in the expiratory airow. Etiologies include prior lung infection, systemic inammatory disorders, and genetic disorders of host defense. METHODOLOGY: This is an Observational study of 160 patients patient who were diagnosed with Bronchiectasis in tertiary health care centre over a period of 15 months. Data was collected and analyzed for correlation between clinical features, radiological ndings and spirometry parameters. RESULT: Mean age of presentation was 21-30 years. Most important etiology was post-infections, pulmonary tuberculosis followed by pneumonia. The cardinal symptoms of bronchiectasis were productive cough followed by dyspnoea on exertion. The most common bacteria isolated from sputum culture was Haemophilus Inuenzae. The commonest radiological pattern of bronchiectasis was cylindrical followed by cystic and varicose. Most of the patients had obstructive pattern in spirometry tests. CONCLUSION: Radiological ndings and spirometry test are more valuable for early and accurate diagnosis of bronchiectasis which help in early and prompt management. Cases of bronchiectasis have repeated history of admissions in the hospital thus all options of treatment including surgical intervention must be taken into consideration for good quality life and healthy.

COVID-19 Pneumonia: The Great Ultrasonography Mimicker

The pandemic spread of the new severe acute respiratory syndrome coronavirus 2 has raised the necessity to identify an appropriate imaging method for early diagnosis of coronavirus disease 2019 (COVID-19). Chest computed tomography (CT) has been regarded as the mainstay of imaging evaluation for pulmonary involvement in the early phase of the pandemic. However, due to the poor specificity of the radiological pattern and the disruption of radiology centers' functionality linked to an excessive demand for exams, the American College of Radiology has advised against CT use for screening purposes. Lung ultrasound (LUS) is a point-of-care imaging tool that is quickly available and easy to disinfect. These advantages have determined a “pandemic” increase of its use for early detection of COVID-19 pneumonia in emergency departments. However, LUS findings in COVID-19 patients are even less specific than those detectable on CT scans. The scope of this perspective article is to discuss the great number of diseases and pathologic conditions that may mimic COVID-19 pneumonia on LUS examination.

Comparing the first and the second waves of COVID-19 in Italy: differences in epidemiological features and CT findings using a semi-quantitative score

Purpose CT findings of hospitalized COVID-19 patients were analyzed during both the first and the second waves of the pandemic, in order to detect any significant differences between the two groups. Methods In this observational, retrospective, monocentric study, all hospitalized patients who underwent CT for suspected COVID-19 pneumonia from February 27 to March 27, 2020 (first wave) and from October 26 to November 24, 2020 (second wave) were enrolled. Epidemiological data, radiological pattern according to the RSNA consensus statement and visual score extension using a semi-quantitative score were compared. Results Two hundred and eleven patients (mean age, 64.52 years ± 15.14, 144 males) were evaluated during the first wave while 455 patients (mean age, 68.26 years ± 16.34, 283 males) were studied during the second wave. The same prevalence of patterns was documented in both the first and the second waves (p = 0.916), with non-typical patterns always more frequently observed in elderly patients, especially the “indeterminate” pattern. Compared to those infected during the first wave, the patients of the second wave were older (64.52 vs.68.26, p = 0.005) and presented a slightly higher mean semi-quantitative score (9.0 ± 2.88 vs. 8.4 ± 3.06, p = 0.042). Age and semi-quantitative score showed a positive correlation (r = 0.15, p = 0.001). Conclusions There was no difference regarding CT pattern prevalence between the first and the second waves, confirming both the validity of the RSNA consensus and the most frequent radiological COVID-19 features. Non-typical COVID-19 features were more frequently observed in older patients, thus should not be underestimated in the elderly population.

CHEST RADIOGRAPHS OF COVID-19 PATIENTS AFFECTED IN FIRST AND SECOND COVID WAVE IN INDIA: A COMPARATIVE STUDY

INTRODUCTION: The COVID-19 pandemic in India is part of the global coronavirus disease pandemic of 2019 (COVID-19), which is caused by the coronavirus that causes severe acute respiratory syndrome (SARS-CoV-2). India was the rst country to report over 400,000 new cases in a 24-hour period on April 30, 2021. The problems with the second wave were increasing manifolds as the symptoms of COVID-19 infections were strange and not common to the rst wave. The majority of those infected in the rst wave were the elderly with various comorbidities, but as the second wave began, the trend shifted, with younger people becoming infected. This study was conducted to evaluate the difference between chest X rays of the subjects affected in the rst and the second wave of COVID19 in India MATERIAL AND METHODS: This was a retrospective study in which chest X ray PA view of 40 COVID positive patients from rst wave of pandemic and 40 such patients from second wave of pandemic were selected. The age and gender of the patient were also noted. Chest X rays were evaluated and classied according to BSTI(11) and Brixia scoring system(12). RESULTS AND DISCUSSION: Out of total 40 patients in the rst wave 14 (35%) were female and 26 (65%) male, whereas in second wave subjects 22 (55%) were male and 18 (45%) female. BSTI classication revealed that classical features of COVID19 pneumonia were more common in the rst wave. Chest X-rays were also classied according to Brixia scoring. The average Brixia score in wave 1 and wave 2 subjects was 6.925 and 8.825 respectively. CONCLUSION: Mutations occurring within the coronavirus and vaccination against it may play a possible role in the difference of radiological pattern and extent of the disease in the consecutive waves.

Idiopathic Pulmonary Fibrosis in the Practice of a Therapist

Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic progressive fibrosing interstitial pneumonia of unknown etiology that affects only the lungs and is associated with the histological and / or radiological pattern of common interstitial pneumonia. The clinical substrate for IPF is progressive dyspnea and dry cough. The characteristic auscultatory sign of IPF is inspiratory crepitus. Fibrosis is an important morphological component of IPF. The leading CT sign of IPF is a “honeycomb” lung (local air cysts located subpleurally and having similar sizes from 2–3 to 10 mm with clearly delineated walls). Mostly people over 60 years old are ill, often smokers, or with a history of smoking. In 60% of patients, the course of IPF is progressive, death within 5 years in 40% of cases. In 30–50% of cases, IPF requires the exclusion of other forms of interstitial lung disease. To date, it has been established that the basic drugs in the treatment of IPF with proven efficacy are nintedanib and pirfenidone. This article presents a clinical case of idiopathic pulmonary fibrosis in a 63-year-old patient who was hospitalized in the pulmonology department. The given example justifies the need for increased vigilance among pulmonologists and general practitioners when interpreting the clinical manifestations of the disease.

AB0047 CLINICAL AND RADIOLOGICAL CHARACTERISTICS AND TREATMENTS OF A COHORT OF PATIENTS WITH RHEUMATOID ARTHRITIS AND DIFFUSE INTERSTICIAL PULMONARY DISEASE FOLLOWED AT THE VIRGEN MACARENA UNIVERSITY HOSPITAL

Background:Diffuse interstitial lung disease (ILD) is an extra-articular manifestation of rheumatoid arthritis (RA)1,2. The most common pattern is the usual interstitial pneumonia (UIP), conditioning a worse prognosis3.Objectives:To describe epidemiological, clinical, and radiological characteristics and treatment used in a cohort of patients diagnosed with RA and ILD.Methods:Retrospective descriptive study, including patients with a diagnosis of RA and ILD, reviewed in the Rheumatology and Pneumology consultations of the Virgen Macarena University Hospital, from 2010 to 2019. Data obtained from medical records are analyzed. SPSS statistical software is used.Results:26 patients were included, 18 women (69.2%). Median age at diagnosis of ILD was 62 years (53-73). Twelve patients (46.6%) used to smoke. The mean time from RA diagnosis to ILD diagnosis was 79 months (8-264). The RF was positive in 91.3% cases (21) and 87% of them (20) were ACPA positive. Fourteen patients (53.8%) had erosions and 3 (11.5%) had an associated Sjögren’s Syndrome. When ILD was diagnosed, the RA activity by DAS28PCR was moderate (3.28; 2.34-3.28) and 13 patients (54.1%) suffered from dyspnea. The mean value of FVC and DLCO in the first assessment was 84% (63-108) and 71.7% (64-86), respectively. The most frequent radiological pattern of ILD was NINE in 15 patients (57.7%), 6 of them (23.1%) had UIP and 5 (19.3%) presented other patterns. Prior to ILD diagnosis, 24 (92.3%) patients received oral glucocorticoids, 18 (69.2%) cases started treatment with c-DMARD and 11 (42.3%) of them with b-DMARD; the most widely used were methotrexate (MTX) in 17 patients (65.4%) and anti-TNFα in 10 (38.5%). After diagnosis, treatment was changed to 12 patients (46.6%); the most used DMARD was leflunomide, in 11 (42.3%), MTX was maintained in 7 patients (26.9%); the number of anti-TNFα used decreased to 4 cases (15.4%), using instead drugs such as rituximab 5 (19.2%), abatacept 3 (11.5%), baricitinib 2 (7.7%) and anti-IL6 2 (7, 7%). During follow-up, 11 cases (57.9%) remained radiologically stable. A slight deterioration in DLCO was observed (66%; 51-80) and there was one death due to lung disease (UIP).Conclusion:In this study, the most frequent radiological pattern was NINE. Half of the patients used to smoke. At the diagnosis of ILD (at ILD diagnosis), dyspnea was the most relevant clinical symptom, with a slight deterioration in the? respiratory function tests. This represented a change in the therapeutic strategy.References:[1]Olson AL, Swigris JJ, Sprunger DB, et al. Rheumatoid arthritis-interstitial lung disease-associated mortality. Am J Respir Crit Care Med. 2011;183:372-78.[2]Fragoulis GE, Nikiphorou E, Larsen J, Korsten P and Conway R. Methotrexate-Associated Pneumonitis and Rheumatoid Arthritis-Interstitial Lung Disease: Current Concepts for the Diagnosis and Treatment. Front. Med. 2019;6:238.[3]Tanaka N, Kim JS, Newell JD, et al. Rheumatoid arthritis-related lung diseases: CT findings. Radiology. 2004;232:81-91.Disclosure of Interests:None declared

A “Galactic” Chest X-ray

Clinical manifestations accompanying respiratory failure with insidious and rapidly progressive onset are often non-specific. Symptoms such as a cough, dyspnea, and fever are common to a large number of inflammatory, infectious, or neoplastic diseases. During the COVID-19 pandemic it is essential to limit the use of hospital services and inappropriate diagnostic techniques. A particular radiological pattern can orient the clinical and laboratory scenario and guide the diagnostic workup. A 58-year-old woman was admitted to our COVID-19 unit for suspected coronavirus infection. She was complaining of worsening dyspnea, tachycardia, and low grade fever. A chest X-ray showed diffuse, alveolar, and interstitial lung involvement with micronodules tending to coalescence. This radiographic pattern known as “galaxy sign”, consistent with diffuse, coalescing nodular miliary pulmonary involvement, simulating a non-specific alveolar opacification of the lungs is typical of a few pneumological differential diagnoses, represented by sarcoidosis, tuberculosis, pneumoconiosis, and metastatic lesions, and virtually excludes an interstitial viral pneumonitis. The use of endoscopic techniques can, in such cases, confirm the clinical suspicion for initiating appropriate targeted therapies.

Tuberculosis miliar, hallazgo clínico-radiológico. Sobre un caso

Tuberculosis is a granulomatous disease with a variable clinical spectrum. The objective is to present a case with miliar tuberculosis, one of the least frequent clinical forms of the disease, and the use of the clinical method provided an accurate diagnosis. We present a 54-year-old male, non-smoker, alcoholic who attended in the Ameijeiras Brothers Surgical Clinical Hospital for referring to a history of unproductive cough, headache, fever, loss of appetite, and weight two months of evolution. Chest X-ray and CT showed a miliar pattern and direct bacilloscopy confirmed the presence of Mycobacterium tuberculosis. Miliar TB is very rare but can be suspected by a miliar radiological pattern and confirmed by microbiological analysis.