First experience of lung ultrasound application in patients with acute viral infection caused by SARS-CoV-2

The purpose of the study was the estimation of lung ultrasound examination characteristic in patients with a new COVID-19 virus infection in the infectious Department.Materials and methods. 52 patients (male 29, middle age 51.2 ± 3.4) with an established coronavirus infection caused by the COVID-19 virus were participated in the research. The severity of the patients’ clinical condition was assessed by the NEWS scale. An ultrasound lungs examination was performed on the 1st day an ESAOTE MyLab 70 (Italy) device with S 3–5 MHz Probe. Ultrasound scanning was performed along the main topographic lines (midthoracic, anterior, middle and posterior axillary, scapular lines in the longitudinal and transverse planes).Results. Pathological ultrasound signs of lung tissue damage were determined in COVID–19 patients. Multiple B-lines were detected in all patients (100%): in 34 cases – merging B-lines, in 18 cases – scattered B-lines. Changes of the pleural line structure were visualized in all cases: thickening of more than 2 mm – in 33 cases, and discontinuous contours – in 25 cases. Нydrothorax was determined in 39 cases (75%); marginal zones of lung consolidation – in all patients (100%): homogeneous consolidations were observed in 38 cases (73.0%); heterogeneous consolidations (26%) – in 14 cases.Conclusions. Ultrasound lung scanning is an assistive method viral pneumonia diagnosing caused by the new COVID-19 coronavirus. The method can be applied in clinical situations where there is a mild course of the disease, if it is impossible to perform the research and to monitor patients who are on a ventilator. The advantages of the method include the ability to obtain a dynamic image in online mode, the ability to conduct research in the patient's bed. In addition, ultrasound scanning of lung tissue, in contrast to CT of the lungs, has an advantage in recognizing interstitial lesions and displays the distribution of blood flow in tissues with an assessment of the degree of angiogenesis in inflammatory viral lung lesions.

Predictors for Residual Pulmonary Vascular Obstruction after Unprovoked Pulmonary Embolism: Implications for Clinical Practice—The PADIS-PE Trial

Background We aimed to identify risk factors for residual pulmonary vascular obstruction after a first unprovoked pulmonary embolism (PE). Methods Analyses were based on data from the double-blind randomized “PADIS-PE” trial that included 371 patients with a first unprovoked PE initially treated during 6 uninterrupted months; all patients underwent baseline ventilation–perfusion lung scanning at inclusion (i.e., after 6 months of anticoagulation). Each patient's pulmonary vascular obstruction indexes (PVOIs) at PE diagnosis and at inclusion were centrally assessed. Results Among the 371 included patients, residual PVOI was available in 356 patients, and 150 (42.1%) patients had PVOI ≥ 5%. At multivariable analysis, age > 65 years (odds ratio [OR], 2.81, 95% confidence interval [CI], 1.58–5.00), PVOI ≥ 25% at PE diagnosis (OR, 3.53, 95% CI, 1.94–6.41), elevated factor VIII (OR, 3.89, 95% CI, 1.41–10.8), and chronic respiratory disease (OR, 2.18, 95% CI, 1.11–4.26) were independent predictors for residual PVOI ≥ 5%. Patients with ≥ 1 of these factors represented 94.5% (123 patients) of all patients with residual PVOI ≥ 5%. Conclusion Six months after a first unprovoked PE, age > 65 years, PVOI ≥ 25% at PE diagnosis, elevated factor VIII, or chronic respiratory disease were found to be independent predictors for residual pulmonary vascular obstruction. Clinical Trials Registration URL: http://www.controlled-trials.com. Unique identifier: NCT00740883.

Effectiveness of mobile computerized tomographic (CT) lung scanning unit for early diagnosis of lung cancer in under-served populations.

6567 Background: The National Lung Screening Trial (NLST) demonstrated that screening high-risk patients with low-dose CT (LDCT) of the chest reduces lung cancer mortality compared to screening with chest x-ray. Uninsured and Medicaid patients lack access to this hospital-based screening test due to geographic isolation/socio-economic factors. We hypothesized that a mobile screening unit would improve access and confer benefits demonstrated by the NLST to this under-served group, which is most at risk of lung cancer deaths. Methods: In collaboration with Samsung Inc, we inserted a BodyTom portable 32 slide low-dose CT scanner into a 35-foot coach, reinforced to avoid equipment damage, to function as a mobile lung scanning unit. The unit includes a waiting area, high speed wireless internet connection for rapid image transfer, and electronic tablets to deliver smoking cessation and health education programs and shared decision-making video aids. It has been certified as a lung cancer screening Center of Excellence by Lung Cancer Alliance. We employed the LUNG RADS approach to lesion classification, yielding high sensitivity and specificity in assessment. All films were reviewed by a central panel of oncologists, pulmonologists and radiologists. The protocol was approved by Chesapeake IRB, which oversees all LCI cancer trials. Interim analysis at this time was approved by the Oversight Committee. Results: We screened 470 under-served smokers between 4/2017-1/2019; M:F 1.1:1, mean age 61 years (range 55-64), with average pack year history of 45.7 (30-150) (25% African-American; 3% Hispanic; 65% rural; 100% uninsured, under-insured or Medicaid - NC Medicaid does not cover lung cancer screening). Patients over the age of 64 years were excluded as they are covered by Medicare for lung cancer screening. We found at initial screen 35 subjects with LUNG RADS 4 lesions, 49 subjects with LUNG RADS 3 lesions, 10 lung cancers (2.1%), including 4 at stage I-II. 4 non-lung cancers were identified and treated. Other incidental non-oncologic findings are the subject of another presentation. Conclusions: In this small sample using the first mobile low dose CT lung screening unit in the United States, the initial cancer detection rate is comparable to that reported in the NLST but with marked improvement of screening rates in underserved groups and with better anticipated outcomes at lower cost than if they had first presented with metastatic disease.

Impact of residual pulmonary obstruction on the long-term outcome of patients with pulmonary embolism

The impact of residual pulmonary obstruction on the outcome of patients with pulmonary embolism is uncertain.We recruited 647 consecutive symptomatic patients with a first episode of pulmonary embolism, with or without concomitant deep venous thrombosis. They received conventional anticoagulation, were assessed for residual pulmonary obstruction through perfusion lung scanning after 6 months and then were followed up for up to 3 years. Recurrent venous thromboembolism and chronic thromboembolic pulmonary hypertension were assessed according to widely accepted criteria.Residual pulmonary obstruction was detected in 324 patients (50.1%, 95% CI 46.2–54.0%). Patients with residual pulmonary obstruction were more likely to be older and to have an unprovoked episode. After a 3-year follow-up, recurrent venous thromboembolism and/or chronic thromboembolic pulmonary hypertension developed in 34 out of the 324 patients (10.5%) with residual pulmonary obstruction and in 15 out of the 323 patients (4.6%) without residual pulmonary obstruction, leading to an adjusted hazard ratio of 2.26 (95% CI 1.23–4.16).Residual pulmonary obstruction, as detected with perfusion lung scanning at 6 months after a first episode of pulmonary embolism, is an independent predictor of recurrent venous thromboembolism and/or chronic thromboembolic pulmonary hypertension.

The Diagnosis of Acute Pulmonary Embolism

This paper reviews the most current literature on the diagnosis of pulmonary thromboembolism. The epidemiology and symptomology of this disorder, including common symptoms such as fever, chest pain, dyspnea, edema, and syncope, are reviewed. The utility of basic and easily available testing, such as electrocardiography and chest radiography, is evaluated. The literature on determining the pretest probability of venous thromboembolism with scoring systems, such as the Wells Score, the Geneva Scoring System, and the Pulmonary Embolism Rule Out Criteria, is appraised. As the evaluation of pulmonary embolism has evolved, multiple imaging techniques has been developed and studied. Ultrasonography, computed tomography with angiography, magnetic resonance angiography, ventilation perfusion lung scanning, and SPECT ventilation-perfusion lung imaging are discussed. In conclusion, the diagnosis of pulmonary embolism remains complicated. Clinical suspicion and stratification should guide a diagnostic strategy for the comprehensive evaluation and diagnosis of patients with this disorder.