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Tuberculosis is a major health threat in many regions of the world. Opportunistic infections in immunocompromised HIV/AIDS patients and multi-drug-resistant bacterial strains have exacerbated the problem, while diagnosing tuberculosis still remains a challenge. When left undiagnosed and thus untreated, mortality rates of patients with tuberculosis are high. Standard diagnostics still rely on methods developed in the last century. They are slow and often unreliable. In an effort to reduce the burden of the disease, this paper presents our automated approach for detecting tuberculosis in conventional posteroanterior chest radiographs. We first extract the lung region using a graph cut segmentation method. For this lung region, we compute a set of texture and shape features, which enable the X-rays to be classified as normal or abnormal using a binary classifier. We measure the performance of our system on two datasets: a set collected by the tuberculosis control program of our local county's health department in the United States, and a set collected by Shenzhen Hospital, China. The proposed computer-aided diagnostic system for TB screening, which is ready for field deployment, achieves a performance that approaches the performance of human experts. We achieve an area under the ROC curve (AUC) of 87% (78.3% accuracy) for the first set, and an AUC of 90% (84% accuracy) for the second set. For the first set, we compare our system performance with the performance of radiologists. When trying not to miss any positive cases, radiologists achieve an accuracy of about 82% on this set, and their false positive rate is about half of our system's rate. [ABSTRACT FROM AUTHOR]

The p110δ subunit of phosphatidylinositol-3-OH kinase (PI(3)K) is selectively expressed in leukocytes and is critical for lymphocyte biology. Here we report fourteen patients from seven families who were heterozygous for three different germline, gain-of-function mutations in PIK3CD (which encodes p110δ). These patients presented with sinopulmonary infections, lymphadenopathy, nodular lymphoid hyperplasia and viremia due to cytomegalovirus (CMV) and/or Epstein-Barr virus (EBV). Strikingly, they had a substantial deficiency in naive T cells but an over-representation of senescent effector T cells. In vitro, T cells from patients exhibited increased phosphorylation of the kinase Akt and hyperactivation of the metabolic checkpoint kinase mTOR, enhanced glucose uptake and terminal effector differentiation. Notably, treatment with rapamycin to inhibit mTOR activity in vivo partially restored the abundance of naive T cells, largely 'rescued' the in vitro T cell defects and improved the clinical course. [ABSTRACT FROM AUTHOR]

The article discuses the study of UpRight radiographic marker that displays upright angles when portable abdominal and chest x-rays (CXRs) are taken. Due to more precision reflected by the UpRight device in the angle of inclination of cassette as compared to positional markers, radiologists are able to compare serial CXRs more effectively leading to a proper prognosis of a certain diagnostic. It is also suggested the using this device will be economical & reduce unnecessary radiation.

Deep learning (DL) has drawn tremendous attention for object localization and recognition in both natural and medical images. U-Net segmentation models have demonstrated superior performance compared to conventional hand-crafted feature-based methods. Medical image modality-specific DL models are better at transferring domain knowledge to a relevant target task than those pretrained on stock photography images. This character helps improve model adaptation, generalization, and class-specific region of interest (ROI) localization. In this study, we train chest X-ray (CXR) modality-specific U-Nets and other state-of-the-art U-Net models for semantic segmentation of tuberculosis (TB)-consistent findings. Automated segmentation of such manifestations could help radiologists reduce errors and supplement decision-making while improving patient care and productivity. Our approach uses the publicly available TBX11K CXR dataset with weak TB annotations, typically provided as bounding boxes, to train a set of U-Net models. Next, we improve the results by augmenting the training data with weak localization, postprocessed into an ROI mask, from a DL classifier trained to classify CXRs as showing normal lungs or suspected TB manifestations. Test data are individually derived from the TBX11K CXR training distribution and other cross-institutional collections, including the Shenzhen TB and Montgomery TB CXR datasets. We observe that our augmented training strategy helped the CXR modality-specific U-Net models achieve superior performance with test data derived from the TBX11K CXR training distribution and cross-institutional collections (p < 0.05). We believe that this is the first study to i) use CXR modality-specific U-Nets for semantic segmentation of TB-consistent ROIs and ii) evaluate the segmentation performance while augmenting the training data with weak TB-consistent localizations. [ABSTRACT FROM AUTHOR]

We present a severe case of progressive autoimmune pneumonitis requiring surgical intervention in a patient with the monogenic syndrome, autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED). APECED is caused by loss-of-function mutations in the autoimmune regulator (AIRE) gene, which lead to impaired central immune tolerance and autoimmune organ destruction including pneumonitis, an underrecognized, life-threatening complication. When clinicians evaluate patients with pneumonitis, recurrent mucosal candidiasis, and autoimmunity, APECED should be considered in the differential. Additionally, in patients with established APECED, a chest computed tomography is preferred to identify pneumonitis early on and to promptly initiate lymphocyte-directed immunomodulatory treatment, which can prevent irreversible lung destruction. [ABSTRACT FROM AUTHOR]

Background: GATA2 deficiency is a genetic disorder of hematopoiesis, lymphatics, and immunity caused by autosomal dominant or sporadic mutations in GATA2. The disease has a broad phenotype encompassing immunodeficiency, myelodysplasia, leukemia, and vascular or lymphatic dysfunction as well as prominent pulmonary manifestations.Research Question: What are the pulmonary manifestations of GATA2 deficiency?Study Design and Methods: A retrospective review was conducted of clinical medical records, diagnostic imaging, pulmonary pathologic specimens, and tests of pulmonary function.Results: Of 124 patients (95 probands and 29 ascertained), the lung was affected in 56%. In addition to chronic infections, pulmonary alveolar proteinosis (11 probands) and pulmonary arterial hypertension (nine probands) were present. Thoracic CT imaging found small nodules in 54% (54 probands and 12 relatives), reticular infiltrates in 40% (45 probands and four relatives), paraseptal emphysema in 25% (30 probands and one relative), ground-glass opacities in 35% (41 probands and two relatives), consolidation in 21% (23 probands and two relatives), and a typical crazy-paving pattern in 7% (eight probands and no relatives). Nontuberculous mycobacteria were the most frequent organisms associated with chronic infection. Allogeneic hematopoietic stem cell transplantation successfully reversed myelodysplasia and immune deficiency and also improved pulmonary hypertension and pulmonary alveolar proteinosis in most patients.Interpretation: GATA2 deficiency has prominent pulmonary manifestations. These clinical observations confirm the essential role of hematopoietic cells in many aspects of pulmonary function, including infections, alveolar proteinosis, and pulmonary hypertension, many of which precede the formal diagnosis, and many of which respond to stem cell transplantation. [ABSTRACT FROM AUTHOR]

AIRE deficiency causes a characteristic pattern of pulmonary immunopathology that is responsive to T and B lymphocyte–directed immunomodulation. A breath of fresh AIRE: Mutations in the AIRE gene lead to APECED, which presents with a variety of autoimmune symptoms. Ferré et al. prospectively studied a large cohort of patients with APECED and discovered that a substantial proportion of them suffered from pneumonitis, which had gone largely undiagnosed. The airways and lung tissue were characterized by infiltration of activated neutrophils and lymphocytes. This infiltration was also observed in Aire−/− mice, and pneumonitis was ablated by T or B cell deficiency. Accordingly, patients treated with drugs to modulate T or B lymphocytes resolved pneumonitis symptoms and improved respiratory function. This study reveals a serious and previously unappreciated manifestation of AIRE deficiency and paves the way for interventions. Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), a monogenic disorder caused by AIRE mutations, presents with several autoimmune diseases. Among these, endocrine organ failure is widely recognized, but the prevalence, immunopathogenesis, and treatment of non-endocrine manifestations such as pneumonitis remain poorly characterized. We enrolled 50 patients with APECED in a prospective observational study and comprehensively examined their clinical and radiographic findings, performed pulmonary function tests, and analyzed immunological characteristics in blood, bronchoalveolar lavage fluid, and endobronchial and lung biopsies. Pneumonitis was found in >40% of our patients, presented early in life, was misdiagnosed despite chronic respiratory symptoms and accompanying radiographic and pulmonary function abnormalities, and caused hypoxemic respiratory failure and death. Autoantibodies against BPIFB1 and KCNRG and the homozygous c.967_979del13 AIRE mutation are associated with pneumonitis development. APECED pneumonitis features compartmentalized immunopathology, with accumulation of activated neutrophils in the airways and lymphocytic infiltration in intraepithelial, submucosal, peribronchiolar, and interstitial areas. Beyond APECED, we extend these observations to lung disease seen in other conditions with secondary AIRE deficiency (thymoma and RAG deficiency). Aire-deficient mice had similar compartmentalized cellular immune responses in the airways and lung tissue, which was ameliorated by deficiency of T and B lymphocytes. Accordingly, T and B lymphocyte–directed immunomodulation controlled symptoms and radiographic abnormalities and improved pulmonary function in patients with APECED pneumonitis. Collectively, our findings unveil lung autoimmunity as a common, early, and unrecognized manifestation of APECED and provide insights into the immunopathogenesis and treatment of pulmonary autoimmunity associated with impaired central immune tolerance. [ABSTRACT FROM AUTHOR]

The article describes the cases of two patients who developed a Solitary Pulmonary Nodule (SPN). The first patient experienced a cough as a symptom of her SPN. A chest radiography showed a nodule in the upper left lobe of the patient. The nodule has a higher likelihood of malignancy. The second patient developed large cell carcinoma. A biopsy revealed the condition of the patient.

The article discusses the case of a 34-year-old soldier who presented with gunshot wound (GSW) to his left thorax. It was stated that the presence of tracheal deviation in the patient indicates a left lung pneumothorax, as shown by the scout computed tomography (CT). It cites several approaches taken by medical professionals that led to the prompt diagnosis of hemothorax in the patient including thoracic CT, resultant MultiPlanar Reformation (MPR) and trajectory analysis.

The article focuses on the diagnosis, prevalence and etiology of bilateral patellar tendon rupture among U.S. soldiers. It notes that the risk factors associated with tendon rupture are war fog, wearing of heavy body armor and adrenaline. About 12 of the 52 soldiers who had tendon ruptures at Fort Bragg in North Carolina were patellar tendon rupture. It advises the use of ultrasound and magnetic resonance imaging (MRI) to determine changes in the patella tendon fibers and the extent of patella alta.

The article discusses a case of a 13 year old girl with a history of intractable partial seizures that occurred when she was five months of age and mental deficiency and benign tumors on her heart. The diagnosis made to the patient was tuberous sclerosis (TS) also called as Bourneville's disease which is characterized by growth of benign tumor in vital organs. It cites the imaging systems used in the analysis of epilepsy in patients with TS including diffusion tensor magnetic resonance imaging (MRI) and positron emission tomography/MRI.

The article offers information on the medical case of a 45-year-old soldier patient with severe epistaxis from an intracranial vascular bleed from grenade injury. The patient sustained his injury while conducting operations in Iraq when a hand grenade exploded on the ground to his left. Diagnosis results show that the epistaxis was caused by a small amount of active extravasation into the sphenoid sinus. It adds that para-axial and para-sagittal reformations suggest that the left maxillary sinus served as an entry point.

The following case demonstrates the importance of emergent imaging in victims of gunshot wound to the chest. The AP chest in our case highlights findings that correlate well with support of follow up CT Angiogram of the chest. This case also exemplifies description of complex planes now available with modern CT imaging capabilities described here as para-axial, para-coronal and para-sagittal reconstructions. [ABSTRACT FROM AUTHOR]

The article presents a radiology case of a 31 year old active duty male deployed soldier suffering a gunshot wound (GSW) to the left chest. The patient was diagnosed with lung laceration with loculated blood in resultant cavity, active bleeding, contusion and hemothorax, based on the chest x-ray (CXR). Also provided is a summary of the findings. It notes that a tool commonly used to find out the trajectory or wound path a bullet took through tissues is computed tomography (CT).

The article discusses the chest x-ray findings in a patient with cystic fibrosis and another with bilateral atelectasis after sternotomy. It says that in the first patient, there are multiple nodular opacities which depict the mucus plugs and tram-tracking is visible in all lung fields. Meanwhile, it says that there is a complete air-bronchogram in the left lower lung field of the other patient extending from the chillum to the periphery and a partial air-bronchogram in the right lower lung field that extends inferiorly from the hilum.

The article presents a case report involving a deployed 28-year-old active soldier who had a painful mass on his right leg. It mentions that the soldier had prior focal pain on the same region in his right leg that radiated to his knee joint during prolonged walking or short distant running. Accordingly, the author states that stress fractures on the posterior medial side of the tibia often have the best prognosis while poorer prognosis usually occur in stress fractures on the distal tibia.

The article discusses the findings and diagnosis of the case of a 46-year-old male who was initially evaluated for severe right flank and right lower quadrant pain. Findings of multiple axial abdominal CT scans show a right heterogenous lesion coming off the posterior mid-kidney representing a large angiomyolipoma. The patient was diagnosed with ruptured renal angiomyolipoma. Nephrectomy or partial nephrectomy and selective embolization to preserve kidney function were among the treatment options.

The article presents the medical case of a 21-year-old man who twisted his knee while playing softball and presented with pain and swelling of the knee. The patient was diagnosed with internal derangement of the knee, a common sports related injury. It cites several minor osseous abnormalities of the knee that are associated with more serious but radiographically occult soft tissue injuries.

The article presents questions and answers related to radiology. It mentions that the third most diagnosed malignant neoplasm and the second leading cause of cancer related mortality in the U.S. is colon cancer. The diagnosis for an asymptomatic man who has been ordered to undergo contrast-enhanced thoracic computed tomography scan is asked.