Tuberkuloz ve toraks最新文献

Introduction: Diffuse pulmonary ossification (DPO) refers to the unusual formation of mature bone tissue within the lung parenchyma. It has been shown to be associated with a number of cardiac and chronic lung diseases. The relation between DPO and idiopathic pulmonary fibrosis (IPF) has been shown in the literature. We examined DPO, which is the supporting computed tomography (CT) finding of IPF. In this way, it was aimed to distinguish cases with an IPF-like pattern non-invasively.

Materials and methods: A retrospective analysis included 89 cases exhibiting a CT pattern typical of usual interstitial pneumonia (UIP). The cases were divided into two groups: One with an IPF diagnosis and the other with a nonIPF diagnosis. The presence of DPO was then assessed in each case according to the criteria outlined in the literature. Finally, the occurrence of DPO was compared between the IPF group and the non-IPF group.

Result: Forty-seven of 89 cases had a diagnosis of IPF (52.8%). DPO was observed in 31 patients (34.8%). Presence of DPO was detected in 28 (59.6%) patients in the IPF group. The presence of DPO was detected in 3 (7.1%) cases in the non-IPF UIP patient group. A moderate correlation was found between IPF and DPO, and a moderate correlation was found between IPF and the male sex (r= 0.549; r= 0.311, respectively).

Conclusions: DPO is an important finding to support the diagnosis of IPF.

Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction observed in asthma as well as cystic fibrosis (CF) patients due to the colonization of the airways by Aspergillus fumigatus. While ABPA is most commonly observed in CF patients (2-9%), it is seen at a rate of 1-2% in patients diagnosed with asthma. ABPA is mostly seen in steroid dependent adult asthma patients and has rarely been reported in pediatric asthma patients. The aim of our study was to provide the clinical, laboratory, and radiological characteristics of two patients under our follow-up care who were also diagnosed with ABPA. In the pediatric population, ABPA is often seen in patients with cystic fibrosis and rarely as a complication of childhood asthma. However, it is not clear whether this is because ABPA is really rare or because there is low level of suspicion for this disease. Furthermore, diagnostic criteria and staging systems are created by taking adults into consideration and not having different diagnostic criteria or staging systems for pediatric patients makes the diagnosis even more difficult.

Introduction: Sedation is often required during flexible fiberoptic bronchoscopy (FFB) to ensure patient comfort and the success of the procedure. The choice of sedative agents may differ between anesthesiologists and pulmonologists. This pilot study aimed to investigate the current pre-procedure preparation, monitoring, premedication and sedation practices for FFB in Türkiye, focusing on the preferences and practices of pulmonologists.

Materials and methods: A structured survey consisting of 30 questions was distributed to pulmonologists at various hospitals in Türkiye via Google Forms. A total of 97 responses were received, of which 80 were analyzed. Participants were divided into two groups based on their FFB experience: Group 1 with ≥10 years of experience and Group 2 with <10 years of experience.

Result: The majority of pulmonologists ordered complete blood count, biochemistry, and coagulation tests before the procedure. The most preferred oral ingestion duration was 6-8 hours. Additionally, 98% of the physicians reported using at least one agent for premedication purposes. Routine topical local anesthetic use was high in both groups (88.3% and 85%, respectively). In addition, 40% of the physicians stated that they always applied sedation during FOB, and 48% stated that they applied sedation in certain situations, and that patient request was the most effective factor. Without the assistance of an anesthesiologist, pulmonologists preferred mono midazolam or a combination of midazolam and fentanyl for sedation. In Group I, two physicians reported using dexmedetomidine for combination sedation. It was also determined that propofol was not used in cases where an anesthesiologist was not available. Additionally, 47% of the physicians reported that they found current sedation practices completely adequate.

Conclusions: Findings highlight the variability in sedation practices for FFB in Türkiye and underscore the need for standardized guidelines to optimize patient care and procedural outcomes. This study can be considered as a fundamental step towards more comprehensive studies by pulmonologists.

Tracheal schwannomas are exceedingly rare, accounting for a minute fraction of primary tracheal tumors. They are classified into intraluminal and mixed types, with treatment strategies varying significantly between these subtypes. While thorax tomography is usually sufficient to distinguish intraluminal and mixed type, endobronchial ultrasonography (EBUS) can also be used in cases where the distinction cannot be made clearly with tomography. This case highlights the use of bronchoscopic procedures in the diagnosis and treatment of tracheal schwannomas and the role of radial EBUS in guiding clinical management in distinguishing between intraluminal and mixed type tracheal schwannomas.

Introduction: This study aimed to evaluate the imaging findings of the chest flat panel detector computed tomography (FDCT) among coronavirus disease-2019 (COVID-19) positive patients during urgent/emergent interventional neuroradiologic procedures.

Materials and methods: Chest FDCT examinations were performed using a C-arm mounted FDCT within the interventional radiology (IR) suite if the reverse transcription polymerase chain reaction (RT-PCR) results were pending in patients with clinical findings suggestive of COVID-19. In those who already had positive RT-PCR results, FDCT was performed for acute evaluation only if an acute unexpected cardiopulmonary event occurred during the procedure. FDCT images were evaluated retrospectively by a thoracic radiologist based on Radiological Society of North America classification.

Result: Eleven patients (four males, four females, one boy and two girls) with positive RT-PCR test results were included. Six presented for acute ischemic stroke treatment, three children had retinoblastomas, and two patients had hemorrhagic strokes. One (9.1%) patient had typical CT findings of COVID19, whereas 4 (36.4%) patients had indeterminate findings. Six (54.5%) patients had no findings suggestive of COVID-19. The most common parenchymal finding was atelectasis (eight patients), followed by consolidation (five patients), pleural effusion (two patient) and pulmonary mass lesion (one patient).

Conclusions: This study is the first in the literature utilizing C-arm FDCT for dedicated thoracic imaging at the IR suite. Ability to perform on-site chest CT without a need to transfer the patient to a regular CT scan may be helpful in both the management of acute pulmonary complications that occur during interventional procedures and pre-interventional assessment for pulmonary conditions like COVID-19 in the IR suite in emergent interventions.

Introduction: Telemedicine is a health service that provides diagnosis, treatment evaluation, preventive medicine by using information and communication technologies between distant locations and aims to improve the health of the individuals and society. Social restrictions were applied during the pandemic process caused by coronavirus disease-2019 due to the virus called severe acute respiratory syndrome coronavirus-2 which emerged in late 2019. Through remote communication and information technologies in the followup of asthma patients, there is a need for studies on the effectiveness of using telemedicine methods was seen.

Materials and methods: Our study included 328 patients aged 18 to 65 who were diagnosed with asthma and followed up by our team. The clinical evaluations and scale results of these patients were conducted at least three times by a single physician using telemedicine applications. In our study, the control group consisted of routine control results from asthma patients, who were reachable via hospital records before the pandemic, covering a one-year period. This file review includes data from October 1, 2019, to October 1, 2020.

Result: Three hundred and twenty-eight patients with asthma were included in the study. When the current data of the participants were compared with face-to-face data before follow-up with telemedicine, no statistically significant difference was found (p> 0.05). Although there was a slight decrease in asthma control test scores during the follow-up, it was not statistically significant (p> 0.05). A statistically significant difference was found in severe persistent asthma as a result of the comparison of the asthma control test results of the participants in follow-up according to disease severity (p<0.05). In this study, when the effect of the presence of comorbidity on asthma control test results in follow-up was examined, statistically significant results were obtained (p<0.05).

Conclusions: It is predicted that telemedicine will have an important place in disease control since asthma is a disease that requires close monitoring. Disease follow-up with telemedicine was predicted to be a good alternative to traditional face-to-face follow-ups in selected patient groups. This study also supported the effectiveness of telemedicine.

Introduction: Pneumonia is a common symptom of coronavirus disease-2019 (COVID-19), and this study aimed to determine how analyzing initial thoracic computerized-tomography (CT) scans using semi-quantitative methods could be used to predict the outcomes for hospitalized patients.

Materials and methods: This study looked at previously collected data from adult patients who were hospitalized with a positive test for severe acute respiratory syndrome coronavirus-2 and had CT scans of their thorax at the time of presentation. The CT scans were evaluated for the extent of lung involvement using a semi-quantitative scoring system ranging from 0 to 72. The researchers then analyzed whether CT score could be used to predict outcomes.

Result: The study included 124 patients, 55 being females, with a mean age of 46.13 years and an average duration of hospitalization of 11.69 days. Twelve patients (9.6%) died within an average of 17.2 days. The non-surviving patients were significantly older, had more underlying health conditions, and higher CT scores than the surviving patients. After taking age and comorbidities into account, each increase in CT score was associated with a 1.048 increase in the risk of mortality. CT score had a good ability to predict mortality, with an area under the curve of 0.857 and a sensitivity of 75% and specificity of 85.7% at a cut-off point of 25.5.

Conclusions: Radiologic severity index, which is calculated using a semi-quantitative CT scoring system, can be used to predict the mortality of COVID-19 patients at the time of their initial hospitalization.

Lung cancers associated with cystic airspaces (LCCAs) are a rare and relatively novel concept analyzed in various case reports and retrospective studies. In this review, it was our aim to investigate the morphologic, imaging, and clinicopathologic characteristics of this entity, as well as its natural course in light of the current literature. Literature search including the years 2000-2022 was conducted in PubMed. We analyzed the definition, morphological classification, pathogenesis and histopathology, imaging and clinical features, differential diagnosis and natural course and prognosis of LCCAs. LCCAs are increasingly being identified as missed or delayed diagnoses in lung cancer screening programs. Early recognition and intervention of this entity when cyst wall thickening or solid components appear can potentially improve outcomes. Nevertheless, the prognosis and survival of these patients are still poorly understood due to limited data, and further research is needed to better understand the behavior of these lesions and propose management guidelines.

Introduction: In solid-organ transplant (SOT) recipients, while survival rates have improved with immunosuppressive therapies, the risk of opportunistic infections has also increased. This study aimed to evaluate the frequency of pneumonia, identify microbiological factors, investigate diagnostic methods, and analyse prognosis.

Materials and methods: A retrospective study was conducted to identify adult SOT recipients referred to the pulmonary diseases department with a preliminary pneumonia diagnosis between 2011 and 2019. Data on demographics, clinical and transplantation characteristics, pneumonia frequency, microbiological sampling methods, pathogens, radiological findings, and prognosis were collected. Confirmed pneumonia was defined as symptoms consistent with pneumonia alongside microbiological confirmation.

Result: We conducted 426 pulmonary consultations involving 168 patients (86 kidney; 82 liver transplant recipients) with a preliminary pneumonia diagnosis. Pneumonia was diagnosed in 87% of the cases, with common findings including multiple symptoms, glucocorticoid use, focal or multilobar infiltrations, and diffuse ground-glass nodules. Pneumonia frequency was higher during the first, sixth, and twelfth months for liver transplants and after twelve months for kidney transplants. Diagnostic sampling was conducted for 128 patients, with a success rate of 63.3%. Of 476 respiratory samples, 32.6% yielded diagnoses, with bacterial growth detected in 42.9%, predominantly Pseudomonas aeruginosa. Microbiological agents were isolated by 18.4% using non-invasive methods, 15.5% using invasive methods. Non-invasive methods primarily isolated gram-positive and gram-negative bacteria, Acinetobacter spp., Klebsiella spp., Haemophilus spp., whereas invasive methods were more effective for Candida spp. Acinetobacter spp. was more prevalent in liver transplant patients and fungal species in kidney transplant patients. Intensive care unit admission occurred in 36.3% of the patients, 19% died.

Conclusions: : While pneumonia was common among SOT recipients, the associated mortality rate was relatively low. Over half the patients were diagnosed through microbiological sampling. Invasive sampling is valuable for non-bacterial agents. Due to high gramnegative bacteria frequency and early post-transplant pneumonia, increased attention is needed for hospital-acquired agents.