The role of computed tomography in the diagnosis of lung cancer - a case report

Introduction Lung cancer has been the main oncological problem in the world for years. It is extremely important to use appropriate diagnostic methods that enable its detection and implementation of appropriate treatment. Aim The presented case shows the advantage of computed tomography over chest X-ray (X-ray) in visualizing neoplastic changes in the lungs. Case Study The paper presents a description of a patient diagnosed with centrally located advanced lung adenocarcinoma with a strong expression of PD-L1 qualified for treatment with pembrolizumab. Results and Discussion Presented case confirms that X-ray is less sensitive, especially in the case of centrally located tumors. Therefore, the emergence of a new cough in a smoker or ex-smoker should raise concerns related to lung cancer despite a normal X-ray image. The central location of the tumor may cause dramatic course of the symptoms. In the presented case, a sudden significant deterioration of the condition was observed due to atelectasis of the entire lung. Haemoptysis observed during hospitalization was another symptom of centraly located tumor mass. Conclusions In conclusion, the history of cigarette smoking, presence of typical symptoms should provide an in-depth diagnosis of lung cancer, despite normal X-ray. Diagnostic procedures include computed tomography in the first place. The course of centrally localized disease may change rapidly during on first cycle of treatment. Due to the possibility of serious complications of the ongoing neoplastic disease, the patient should be under constant medical supervision.

A Unique Case of Multicentric Infantile Myofibromatosis with Radiologic-Pathologic Correlation

Infantile myofibromatosis (IM) is a rare condition with a variable clinical presentation that characteristically affects young children. Most frequently it presents as one or more benign nodules of the skin, bones, soft tissues, or, rarely, visceral organs. According to the location and number of lesions, there are three different forms: solitary, multicentric without visceral involvement, and multicentric with visceral involvement (generalised), with the latter having the least favourable prognosis. We present a unique case of severe congenital generalised IM in a new-born male who required intubation and mechanical ventilation immediately after the birth due to respiratory distress. A chest radiograph showed numerous tumours involving the entire lung, resembling a metastatic lung disease. Additionally, the neonate had multiple, bluish, papular skin nodules and a biopsy of a skin nodule ultimately led to the diagnosis of IM. Diffuse lung involvement prevented adequate ventilation which resulted in multiorgan failure and death before targeted treatment could have been initiated. The presented case is unique, as such atypical extensive involvement of the lung and leptomeninges in IM has not been reported before. In this brief report, we present the findings of radiographic and ultrasonographic examinations in correlation with autopsy and histopathology.

Chest CT Usage in Covid-19 Pneumonia: Multicenter Study on Radiation Doses and Diagnostic Quality in Brazil

We assessed variations in chest CT usage, radiation dose and image quality in COVID-19 pneumonia. Our study included all chest CT exams performed in 533 patients from 6 healthcare sites from Brazil. We recorded patients’ age, gender and body weight and the information number of CT exams per patient, scan parameters and radiation doses (volume CT dose index—CTDIvol and dose length product—DLP). Six radiologists assessed all chest CT exams for the type of pulmonary findings and classified CT appearance of COVID-19 pneumonia as typical, indeterminate, atypical or negative. In addition, each CT was assessed for diagnostic quality (optimal or suboptimal) and presence of artefacts. Artefacts were frequent (367/841), often related to respiratory motion (344/367 chest CT exams with artefacts) and resulted in suboptimal evaluation in mid-to-lower lungs (176/344) or the entire lung (31/344). There were substantial differences in CT usage, patient weight, CTDIvol and DLP across the participating sites.

Reduced risk of recurrent pneumothorax for sirolimus therapy after surgical pleural covering of entire lung in lymphangioleiomyomatosis

Background Patients with lymphangioleiomyomatosis (LAM) frequently experience pneumothorax. Although sirolimus is the standard therapy for LAM, its effect on pneumothorax is controversial. Recently, total pleural covering (TPC) and modified TPC (mTPC) were introduced as surgical treatment options for pneumothorax for patients with LAM. However, the effect of sirolimus on the recurrence of pneumothorax in patients who underwent the treatments is still uncertain. We hypothesized that some clinical factors including sirolimus treatment could predict postoperative recurrence of pneumothorax. In order to clarify this hypothesis, we retrospectively analyzed the clinical data from 18 consecutive patients with LAM who underwent 24 surgical pleural covering of entire lung (SPC) as 17 TPC and 7 mTPC against pneumothoraces from surgical database between January 2005 and January 2019, and we determined the predictors of postoperative recurrence. Results Of the 24 surgeries of SPC, 14 surgeries (58.3%) had a history of two or more ipsilateral pneumothoraces, and 11 surgeries (45.8%) had a history of ipsilateral pleural procedures before SPC. Sixteen surgeries (66.6%) in 12 patients received treatment of sirolimus after SPC (sirolimus group). With a median follow-up time of 69.0 months after SPC, four surgeries (16.6%) in three patients had a postoperative recurrence, and the 5-year recurrence-free survival (RFS) after SPC was 82.9%. In patients with postoperative recurrence, serum level of vascular endothelial growth factors D was significantly higher than that in those with non-recurrence (3260.5 vs. 892.7 pg/mL, p = 0.02), and the rate of sirolimus treatment in the recurrence group was significantly lower than that in the no-recurrence group (0 vs. 80%, p = 0.006). The log-rank test showed that the RFS of the sirolimus group (sirolimus use after SPC) was significantly better than that of the non-sirolimus group (p = 0.001), and no significant difference was observed for other factors. Conclusion We first reported sirolimus might effectively suppress the recurrence of pneumothoraces in LAM patients who received SPC. Sirolimus induction after SPC (TPC or mTPC) might be a feasible option for frequent pneumothorax in LAM.

CT-Based Radiomics Helps to Predict Residual Lung Lesions in COVID-19 Patients at Three Months after Discharge

Background: In this study, our focus was on pulmonary sequelae of coronavirus disease 2019 (COVID-19). We aimed to develop and validate CT-based radiomic models for predicting the presence of residual lung lesions in COVID-19 survivors at three months after discharge. Methods: We retrospectively enrolled 162 COVID-19 confirmed patients in our hospital (84 patients with residual lung lesions and 78 patients without residual lung lesions, at three months after discharge). The patients were all randomly allocated to a training set (n = 114) or a test set (n = 48). Radiomic features were extracted from chest CT images in different regions (entire lung or lesion) and at different time points (at hospital admission or at discharge) to build different models, sequentially, or in combination, as follows: (1) Lesion_A model (based on the lesion region at admission CT); (2) Lesion_D model (based on the lesion region at discharge CT); (3) Δlesion model (based on the lesion region at admission CT and discharge CT); (4) Lung_A model (based on the lung region at admission CT); (5) Lung_D model (based on the lung region at discharge CT); (6) Δlung model (based on the lung region at admission CT and discharge CT). The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were used to evaluate the predictive performances of the radiomic models. Results: Among the six models, the Lesion_D and the Δlesion models achieved better predictive efficacy, with AUCs of 0.907 and 0.927, sensitivity of 0.898 and 0.763, and specificity of 0.855 and 0.964 in the training set, and AUCs of 0.875 and 0.837, sensitivity of 0.920 and 0.680, and specificity of 0.826 and 0.913 in the test set, respectively. Conclusions: The CT-based radiomic models showed good predictive effects on the presence of residual lung lesions in COVID-19 survivors at three months after discharge, which may help doctors to plan follow-up work and to reduce the psychological burden of COVID-19 survivors.

Lung disease manifestations in Down Syndrome

Down Syndrome (DS) is one of the most prevalent chromosomal abnormalities world-wide, affecting 1 in 700 live births. Although multiple organ systems are affected by the chromosomal defects, respiratory failure and lung disease are the leading causes of morbidity and mortality observed in DS. Manifestations of DS in the respiratory system encompass the entire lung starting from the nasopharynx, trachea/upper airways to the lower airways and alveolar spaces, as well as vascular and lymphatic defects. Most of our knowledge on respiratory illness in persons with DS arises from pediatric studies, however many of these disorders present early in infancy supporting developmental mechanisms. In this review we will focus on the different lung phenotypes in DS, as well as the genetic and molecular pathways that may be contributing to these complications during development.

Automated Digital Quantification of Pulmonary Fibrosis in Human Histopathology Specimens

Pulmonary fibrosis is characterized by abnormal interstitial extracellular matrix and cellular accumulations. Methods quantifying fibrosis severity in lung histopathology samples are semi-quantitative, subjective, and analyze only portions of sections. We sought to determine whether automated computerized imaging analysis shown to continuously measure fibrosis in mice could also be applied in human samples. A pilot study was conducted to analyze a small number of specimens from patients with Hermansky-Pudlak syndrome pulmonary fibrosis (HPSPF) or idiopathic pulmonary fibrosis (IPF). Digital images of entire lung histological serial sections stained with picrosirius red and alcian blue or anti-CD68 antibody were analyzed using dedicated software to automatically quantify fibrosis, collagen, and macrophage content. Automated fibrosis quantification based on parenchymal tissue density and fibrosis score measurements was compared to pulmonary function values or Ashcroft score. Automated fibrosis quantification of HPSPF lung explants was significantly higher than that of IPF lung explants or biopsies and was also significantly higher in IPF lung explants than in IPF biopsies. A high correlation coefficient was found between some automated quantification measurements and lung function values for the three sample groups. Automated quantification of collagen content in lung sections used for digital image analyses was similar in the three groups. CD68 immunolabeled cell measurements were significantly higher in HPSPF explants than in IPF biopsies. In conclusion, computerized image analysis provides access to accurate, reader-independent pulmonary fibrosis quantification in human histopathology samples. Fibrosis, collagen content, and immunostained cells can be automatically and individually quantified from serial sections. Robust automated digital image analysis of human lung samples enhances the available tools to quantify and study fibrotic lung disease.

Demarcation of arteriopulmonary segments: a novel and effective method for the identification of pulmonary segments

Objective Each pulmonary segment is an anatomical and functional unit. However, it is fundamentally difficult to precisely distinguish every pulmonary segment using the conventional pulmonary intersegmental planes from computed tomography images. Building arteriopulmonary segments is likely to be an effective way to identify pulmonary segments. Methods The thoracic computed tomography images of 40 patients were collected. The anatomic structures of interest were extracted in the transverse, sagittal, and coronal planes using the semi-automated segmentation tools provided by Amira software. The intrapulmonary vessels were subsequently segmented and reconstructed. The distributions of the pulmonary arteries, veins, and bronchi were observed. In patients with pulmonary masses, the mass was also reconstructed. Results The three-dimensional reconstructed images showed the branches of the pulmonary artery ramified up to their eighth order covering the entire lung as well as evident intersegmental gaps without pulmonary arteries. The segmental artery was closely accompanied by the segmental bronchi in 486 pulmonary segments (90% of total number of segments). The size and spatial location of the pulmonary mass within a pulmonary segment were also clearly visible. Conclusions Demarcation of arteriopulmonary segments can be used to precisely distinguish every pulmonary segment and provide its detailed anatomical structure before pulmonary segmentectomy.

Video-assisted pulmonary metastectomy is equivalent to thoracotomy regarding resection status and survival

Background Surgical resection of pulmonary metastases leads to prolonged survival if strictly indicated. Usually, thoracotomy with manual palpation of the entire lung with lymph node dissection or sampling is performed. The aim of this study was to evaluate the role of video-assisted thoracoscopic surgery (VATS) in pulmonary metastectomy with curative intent. Methods In this study, all patients with suspected pulmonary metastasis (n = 483) who visited the Center for Thoracic Surgery in Regensburg, between January 2009 and December 2017 were analysed retrospectively. Results A total of 251 patients underwent metastectomy with curative intent. VATS was performed in 63 (25.1%) patients, 54 (85.7%) of whom had a solitary metastasis. Wedge resection was the most performed procedure in patients treated with VATS (82.5%, n = 52) and thoracotomy (72.3%, n = 136). Postoperative revisions were necessary in nine patients (4.8%), and one patient died of pulmonary embolism after thoracotomy (0.5%). Patients were discharged significantly faster after VATS than after thoracotomy (p < 0.001). Complete (R0) resection was achieved in 89% of patients. The median recurrence-free survival was 11 months (95% confidence interval 7.9–14.1). During follow-up, eight (12.7%) patients in the VATS group and 42 (22.3%) patients in the thoracotomy group experienced recurrence (p = 0.98). The median overall survival was 61 months (95% confidence interval 46.1–75.9), and there was no significant difference with regard to the surgical method used (p = 0.34). Conclusions VATS metastasectomy can be considered in patients with a solitary lung metastasis. An open surgical approach with palpation of the lung showed no advantage in terms of surgical outcome or survival.

Drug Regimen for Patients after a Pneumonectomy

Pneumonectomy is an entire lung removal and is indicated for both malignant and benign diseases. Due to its invasiveness and postoperative complications, pneumonectomy is still associated with high mortality and morbidity. Appropriate postoperative management is crucial in pneumonectomy patients to improve quality of life and overall survival rates. Diverse drug regimens are under development to be used in adjuvant chemotherapy or to improve respiratory health after a pneumonectomy. The most common causes for a pneumonectomy are non-small cell lung cancer, malignant pleural mesothelioma, and tuberculosis; thus, an appropriate drug regimen is necessary. The uncommon incidence of pneumonectomy cases remains the major obstacle in studies of postoperative drug regimens. As the majority of current studies include post-lobectomy and post-segmentectomy patients, it is highly recommended that further research of postoperative drug regimens be focused on post-pneumonectomy patients.