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The objective of this review was to summarize the most pertinent CT imaging findings in patients with coronavirus disease 2019 (COVID-19). A literature search retrieved eligible studies in PubMed, EMBASE, Cochrane Library and Web of Science up to June 1, 2020. A comprehensive review of publications of the Chinese Medical Association about COVID-19 was also performed. A total of 84 articles with more than 5340 participants were included and reviewed. Chest CT comprised 92.61% of abnormal CT findings overall. Compared with real-time polymerase chain reaction result, CT findings has a sensitivity of 96.14% but a low specificity of 40.48% in diagnosing COVID-19. Ground glass opacity (GGO), pure (57.31%) or mixed with consolidation (41.51%) were the most common CT features with a majority of bilateral (80.32%) and peripheral (66.21%) lung involvement. The opacity might associate with other imaging features, including air bronchogram (41.07%), vascular enlargement (54.33%), bronchial wall thickening (19.12%), crazy-paving pattern (27.55%), interlobular septal thickening (42.48%), halo sign (25.48%), reverse halo sign (12.29%), bronchiectasis (32.44%), and pulmonary fibrosis (26.22%). Other accompanying signs including pleural effusion, lymphadenopathy and pericardial effusion were rare, but pleural thickening was common. The younger or early stage patients tended to have more GGOs, while extensive/multilobar involvement with consolidation was prevalent in the older or severe population. Children with COVID-19 showed significantly lower incidences of some ancillary findings than those of adults and showed a better performance on CT during follow up. Follow-up CT showed GGO lesions gradually decreased, and the consolidation lesions first increased and then remained relatively stable at 6-13 days, and then absorbed and fibrosis increased after 14 days. Chest CT imaging is an important component in the diagnosis, staging, disease progression and follow-up of patients with COVID-19.

Introduction Sublobar resection has been widely accepted for treating pure ground-glass opacities (GGOs). As GGOs have good prognosis, preserving postoperative pulmonary function is the major concern in surgery. No studies have yet compared the success rates of pulmonary function reservation between segmentectomy and wedge resection. Method The three-dimensional rebuild of computed tomography (CT) images was performed, the segmentectomy and wedge resection of the GGO in the target segment were simulated, and the area of cut surface was measured, which was important data for successful postoperative pulmonary recruitment maneuvers. Result With equal volumes of tissue removed, segmentectomy and wedge resection showed similar surface area loss for RS4 and RS5, followed by LS7 + 8, LS6 and LS1 + 2 segments. Compared with other segments, wedge resection performed in RS10, LS3, LS10, RS9 and RS7 may lead to a loss of lot more surface area than segmentectomy. Conclusion Wedge resection is suggested for segments RS4, RS5, LS1 + 2 and LS7 + 8, whereas segmentectomy is advised for segments RS1, LS4 + 5 and RS2. Meanwhile, deep wedge resection should be avoided for segments RS8, RS7, RS10, LS3, LS10. RS9 and LS9, in order to preserve a larger lung surface area.

Background : The COVID-19 pandemic has created an unprecedented health care crisis with, disruptions in both routine and emergency health care delivery and immense strain on health care resources . The clinical spectrum of disease with coronavirus disease (COVID-19) infection is variable and ranges from an asymptomatic infection or mild upper respiratory tract illness to severe viral pneumonia with respiratory failure and occasionally death. In a resourceconstrained environment with a high community burden of the disease and rapid point-of-care testing either unavailable or showing negative results, CT has been used to rapidly triage patients into non COVID-19, possible COVID-19, or most likely COVID-19 . As per the Fleischner Society consensus statement, CT is appropriate in certain scenarios, including for patients who are at risk for and/or develop clinical worsening .The common chest CT findings of COVID-19 are multiple ground glass opacity(most common), consolidation and interlobular septal thickening in both lungs, which are mostly distributed under the pleura. The ground-glass opacities are usually peripherally located with the lower lobes being commonly involved. Imaging differentiation is important for management and isolation purposes and for appropriate disposition of patients . (1,7) The purpose of this article is to discuss the common presentations of emergency department with ground glass opacities and to review the differential diagnosis of typical imaging findings of COVID-19. Ground glass opacities appear in a variety of disease processes of emergenc Conclusion : y department presentations . Not all presentations with GGO” s have SARS COV2 or Covid -19 viral pneumonia .

s Background Pneumocystis pneumonia (PCP) is a common opportunistic infection with high mortality in individuals with decreased immunity. Pulmonary coinfections with PCP are associated with poor prognosis. The study aims to identify radiological predictors for pulmonary coinfections in patients with PCP and risk factors for mortality. Methods This is a retrospective, five-year study was conducted in a medical center, enrolling patients diagnosed with PCP, who received a chest computed tomography (CT) scan. The radiological findings and medical records of all participants were reviewed carefully by 2 independent doctors. Univariable and multivariable analysis was performed to identify radiological predictors for pulmonary coinfection and clinical risk factors for poor prognosis. Results A total of 101 participants were included, of which 39 were HIV-infected and 62 were non-HIV-infected. In multivariable analysis, radiologic predictors on chest CT for coinfection with bacteria pneumonia included lack of ground glass opacity (adjusted odds ratio [aOR], 6.33; 95% confidence interval [CI], 2.03-19.77; p = 0.001) and presence of pleural effusion (aOR, 3.74; 95% CI, 1.27-10.99; p = 0.017). Predictors for fungal pneumonia included diffuse consolidation (adjusted OR, 6.27; 95% CI, 1.72-22.86; p = 0.005) and presence of pleural effusion (adjusted OR, 5.26; 95% CI, 1.44-19.17; p = 0.012). A significantly higher in-hospital mortality was associated with older age, recent corticosteroid exposure, cytomegalovirus coinfection, and acute respiratory failure. Conclusion Early identification of pulmonary coinfections in PCP using radiological features on the CT scans, will enable appropriate treatment which is crucial to improve the prognosis.

Wenliang Song,1,&ast; Junhua Li,2,&ast; Ning Zou,1 Wenhe Guan,1 Jiali Pan,1 Wei Xu1 1Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, People’s Republic of China; 2Department of Pediatrics, Central Hospital of XiangYang City, Xiangyang City, Hubei Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Wei XuDepartment of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, People’s Republic of ChinaEmail tomxu.123@163.comObjective: The number of children presenting with coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 infection is increasing, and we aimed to assess the clinical characteristics of pediatric patients with a definite epidemiological history during the early COVID-19 epidemic.Methods: Retrospective analysis was performed on the clinical data of children admitted to the fever ward of Xiangyang Central Hospital in Hubei province between January 1, 2020 and March 17, 2020. According to definite epidemiological history, patients with SARS-CoV-2 nucleic acid test (NAT) positive detection were grouped as confirmed cases, and patients with two consecutive negative NATs were grouped as suspected cases. We compared the clinical characteristics of the two groups.Results: A total of 47 (47/127, 37%) cases had a definite epidemiological history, of which 32 (68.1%) were suspected, with a median age of 5.5 years (interquartile range [IQR]: 0.7– 10.3), and 15 (31.9%) were confirmed, with a median age of 9 years (IQR: 4– 14). Statistically significant differences in age, family cluster of infection, and numbers of patients with clinical symptoms and fever (P< 0.05) were found between the two groups, but no statistically significant differences in leucocyte and lymphocyte counts were observed (P> 0.05). Significant differences were found in the computed tomography (CT) manifestation of ground glass opacity (GGO) between the two groups (P< 0.05).Conclusion: Children of older age and from family clusters of infection were more easily diagnosed as having COVID-19. GGO changes on chest CT was more likely in confirmed cases. Although obvious clinical manifestations increase our awareness of COVID-19, children without manifestations of fever or cough should not be ignored as they may be asymptomatic carriers.Keywords: novel coronavirus disease, COVID-19, SARS-CoV-2, children, clinical manifestation

Anti-melanoma differentiation-associated gene 5-positive dermatomyositis-associated interstitial lung disease (MDA5+ DM-ILD) is a life-threatening disease. This study aimed to develop a novel pulmonary CT visual scoring method for assessing the prognosis of the disease, and an artificial intelligence (AI) algorithm-based analysis and an idiopathic pulmonary fibrosis (IPF)-based scoring were conducted as comparators. A retrospective cohort of hospitalized patients with MDA5+ DM-ILD was analyzed. Since most fatalities occur within the first half year of the disease course, the primary outcome was the six-month all-cause mortality since the time of admission. A ground glass opacity (GGO) and consolidation-weighted CT visual scoring model for MDA5+ DM-ILD, namely ‘MDA5 score’, was then developed with C-index values of 0.80 (95%CI 0.75–0.86) in the derivation dataset (n = 116) and 0.84 (95%CI 0.71–0.97) in the validation dataset (n = 57), respectively. While, the AI algorithm-based analysis, namely ‘AI score’, yielded C-index 0.78 (95%CI 0.72–0.84) for the derivation dataset and 0.77 (95%CI 0.64–0.90) for the validation dataset. These findings suggest that the newly derived ‘MDA5 score’ may serve as an applicable prognostic predictor for MDA5+ DM-ILD and facilitate further clinical trial design. The AI based CT quantitative analysis provided a promising solution for ILD evaluation.

The COVID-19 pandemic has had devastating medical and economic consequences globally. The severity of COVID-19 is related, in a large measure, to the extent of pulmonary involvement. The role of chest CT imaging in the management of patients with COVID-19 has evolved since the onset of the pandemic. Specifically, the description of CT scan findings, use of chest CT imaging in various acute and subacute settings, and its usefulness in predicting chronic disease have been defined better. We performed a review of published data on CT scans in patients with COVID-19. A summary of the range of imaging findings, from typical to less common abnormalities, is provided. Familiarity with these findings may facilitate the diagnosis and management of this disease. A comparison of sensitivity and specificity of chest CT imaging with reverse-transcriptase polymerase chain reaction testing highlights the potential role of CT imaging in difficult-to-diagnose cases of COVID-19. The usefulness of CT imaging to assess prognosis, to guide management, and to identify acute pulmonary complications associated with SARS-CoV-2 infection is highlighted. Beyond the acute stage, it is important for clinicians to recognize pulmonary parenchymal abnormalities, progressive fibrotic lung disease, and vascular changes that may be responsible for persistent respiratory symptoms. A large collection of multi-institutional images were included to elucidate the CT scan findings described.

Identification of pulmonary ground-glass opacity (GGO) lesions during bronchoscopic procedures remains challenging, as GGOs cannot be directly visualized under 2-dimensional (2D) fluoroscopy and are often difficult to detect by radial endobronchial ultrasound. Recently, a mobile 2D/3D C-arm fluoroscopy system was developed that provides both 2D fluoroscopy and mobile 3D imaging to assess and confirm the location of the lesions and ancillary bronchoscopic tools. However, previous studies focused mainly on experience of utilizing mobile 3D C-arm system for transbronchial biopsy of solid pulmonary nodules. Here, we evaluated the feasibility of mobile 3D imaging assisted transbronchial biopsy with and without ablation of two patients with GGO nodules. The first patient underwent biopsy only, and the second patient underwent biopsy in the right upper lobe lung nodule and ablation of a left upper lobe lung nodule in one session. Procedures in both patients were successfully performed, and no significant complications have been observed intra- or post-procedurally. Our case study highlights the potential value of the mobile 3D imaging system in accurate identification of the target lung lesion, confirmation of bronchoscopic tools within the lesion, and assessment of the target lesion and surrounding tissue following bronchoscopic ablation procedure. Furthermore, a “one-stop shop” bronchoscopy workflow combining both biopsy and ablation for one or more lung lesions in one session could be made possible by utilizing a hybrid mobile 2D/3D C-arm system in the bronchoscopy suite.

Background There is no consensus on the imaging modality to be used in the diagnosis and management of Coronavirus disease 2019 (COVID-19) pneumonia. The purpose of this study was to make a comparison between computed tomography (CT) and chest X-ray (CXR) through a scoring system that can be beneficial to the clinicians in making the triage of patients diagnosed with COVID-19 pneumonia at their initial presentation to the hospital. Results Patients with a negative CXR (30.1%) had significantly lower computed tomography score (CTS) (p < 0.001). Among the lung zones where the only infiltration pattern was ground glass opacity (GGO) on CT images, the ratio of abnormality seen on CXRs was 21.6%. The cut-off value of X-ray score (XRS) to distinguish the patients who needed intensive care at follow-up (n = 12) was 6 (AUC = 0.933, 95% CI = 0.886–0.979, 100% sensitivity, 81% specificity). Conclusions Computed tomography is more effective in the diagnosis of COVID-19 pneumonia at the initial presentation due to the ease detection of GGOs. However, a baseline CXR taken after admission to the hospital can be valuable in predicting patients to be monitored in the intensive care units.

BACKGROUND: Thoracoscopic localization of small peripheral pulmonary nodules is a concern. Failure can lead to larger parenchymal resection or conversion to thoracotomy. This study evaluates our experience in preoperative electromagnetic navigation bronchoscopy-guided localization of small peripheral lung lesions. METHODS: From January 2017 to March 2020 clinical, radiographic, surgical, and pathological data of patients who underwent electromagnetic navigation bronchoscopy (ENB)-guided methylene blue pleural marking of highly suspected pulmonary lesions before a full thoracoscopic resection were evaluated. Localization was performed for solid or mixed subpleural nodules measuring

Wenfei Xue1 1, Xiaopeng Zhang2 2, Zhancong Niu3 3, Zhifei Xin2 2, Hua Zhang2 2, Qingtao Zhao1 12 2, Jie He2 2, Zhonghui Hu2 2, Guochen Duan1 1 1Study Office of Thoracic Surgery, Hebei Medical University, Shijiazhuang, 050017, People’s Republic of China; 2Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, 050000, People’s Republic of China; 3Department of Infectious Diseases, Hebei General Hospital, Shijiazhuang, 050000, People’s Republic of ChinaCorrespondence: Guochen DuanStudy Office of Thoracic Surgery, Hebei Medical University, No. 361, Zhongshan East Road, Changan District, Shijiazhuang, 050017, People’s Republic of ChinaTel +86 13513380703Email duanguoc@126.comBackground: The object of the study was to elucidate the relationship between the neutrophil–lymphocyte ratio (NLR) and the growth of pulmonary ground-glass opacity (GGO) in stage IA lung adenocarcinoma.Methods: All patients with GGO following surgical procedures were enrolled, with the time of follow-up and the variation tendency of GGO recorded. Meanwhile, laboratory parameters, age, gender, smoking history, histology, tumor size, and stage were recorded. Logistic regression was used to evaluate the value of NLR and the cutoff value was calculated by SPSS 22.0.Results: In the whole cohort, 30 cases of growing GGO and 43 cases of stable GGO undergoing surgical procedures were diagnosed as lung adenocarcinoma. There was significant statistical difference between the two groups. Multivariable analysis showed that NLR could predict the GGOs with growth (odds ratio 5.198, 95% confidence interval (95%CI: 1.583– 14.581, P=0.002). Receiver operating characteristics analysis for NLR showed the optimal cutoff value of 2.38, with a sensitivity of 60.0% and specificity of 81.4%.Conclusion: Our study demonstrated that the NLR appeared to have value as a promising clinical predictor of GGOs with growth. Further studies are needed to confirm this conclusion.Keywords: neutrophil–lymphocyte ratio, ground-glass opacity, early lung adenocarcinoma

Aim: To compare the high resolution computed tomography features in Covid and other viral pneumonia presented in recent literature. Methodology: For this study, total 25 studies were included which follow the Preferred Reporting Items guideline for conducting this systematic review analysis (PRISMA). Electronic articles of Covid from January 2020 to April 2020 were searched on PUB Med, online Willey library, and Science Direct site by using keywords related to CT imaging and Corona virus. For pneumonia related studies articles from year 2010 to year 2017 were included for better comparison. Results: After pooling data, it was observed that bilateral involvement was found in 76.8% of studies, 68.4% GGO, and 62.2% ratio was occupied by peripheral distribution in different studies. Total 48.7% of studies were concerned about the ground glass opacity (GGO) consolidation, 33.2% observed consolidation, 27.7% look for crazy paving pattern, and 25% of studies observed mixed central and peripheral distribution. Conclusion: Study concludes that the chest CT finding results of selected studies for Covid and pneumonia cases were overlapping. Only high prevalence related to upper and lower lobe involvement and peripheral distribution was relatively high in Covid studies. Keywords: Computed tomography, pneumonia viral disease, Sars Covid-19

Objective We aim to investigate high-resolution CT features of COVID-19 infection in Abu Dhabi, UAE, and to compare the diagnostic performance of CT scan with RT-PCR test. Methods Data of consecutive patients who were suspected to have COVID-19 infection and presented to our hospital were collected from March 2, 2020, until April 12, 2020. All patients underwent RT-PCR test; out of which 53.8% had chest CT scan done. Using RT-PCR as a standard reference, the sensitivity and specificity of the CT scan were calculated. We also analyzed the most common imaging findings in patients with positive RT-PCR results. Results The typical HRCT findings were seen in 50 scans (65.8%) out of total positive ones; 44 (77.2%) with positive RT-PCR results and 6 (31.6%) with negative results. The peripheral disease distribution was seen in 86%, multilobe involvement in 70%, bilateral in 82%, and posterior in 82% of the 50 scans. The ground glass opacities were seen in 50/74 (89.3%) of the positive RT-PCR group. The recognized GGO patterns in these scans were: rounded 50%, linear 38%, and crazy-paving 24%. Using RT-PCR as a standard of reference, chest HRCT scan revealed a sensitivity of 68.8% and specificity of 70%. Conclusion The commonest HRCT findings in patients with COVID-19 pneumonia were peripheral, posterior, bilateral, multilobe rounded ground-glass opacities. The performance of HRCT scan can vary depending on multiple factors.

This study aimed to discuss whether a diameter of 3 cm is a threshold for diagnosing lung adenocarcinomas presenting with radiological pure ground-glass mass (PGGM, pure ground-glass opacity > 3 cm) as adenocarcinomas in situ or minimally invasive adenocarcinomas (AIS-MIAs). Another aim was to identify CT features and patient prognosis that differentiate AIS-MIAs from invasive adenocarcinomas (IACs) in patients with PGGMs. From June 2007 to October 2015, 69 resected PGGMs with HRCT and followed up for ≥ 5 years were included in this study and divided into AIS-MIA (n = 13) and IAC (n = 56) groups. Firth’s logistic regression model was performed to determine CT characteristics that helped distinguish IACs from AIS-MIAs. The discriminatory power of the significant predictors was tested with the area under the receiver operating characteristics curve (AUC). Disease recurrence was also evaluated. Univariable and multivariable analyses identified that the mean CT attenuation (odds ratio: 1.054, p = 0.0087) was the sole significant predictor for preoperatively discriminating IACs from AIS-MIAs in patients with PGGMs. The CT attenuation had an excellent differentiating accuracy (AUC: 0.981), with the optimal cut-off value at −600 HU (sensitivity: 87.5%; specificity: 100%). Additionally, no recurrence was observed in patients manifesting with PGGMs > 3 cm, and the 5-year recurrence-free survival and overall survival rates were both 100%, even in cases of IAC. This study demonstrated that PGGMs > 3 cm could still be AIS-MIAs. When PGGMs are encountered in clinical practice, the CT value may be the only valuable parameter to preoperatively distinguish IACs from AIS-MIAs. • Patients with pure ground-glass opacity > 3 cm in diameter are rare but can be diagnosed as adenocarcinomas in situ or minimally invasive adenocarcinomas. • The mean CT attenuation is the sole significant CT parameter that differentiates invasive adenocarcinoma from adenocarcinoma in situ or minimally invasive adenocarcinoma in patients with pure ground-glass opacity > 3 cm. • Lung adenocarcinoma with pure ground-glass opacity > 3 cm has an excellent prognosis, even in cases of invasive adenocarcinoma.

Background We aimed to investigate the association of initial chest CT scan findings with status and adverse outcomes of COVID-19 (including ICU admission, mortality, and disease severity). This retrospective cohort study was performed in three hospitals in Babol, northern Iran, between February and March 2020. Cases were confirmed by real-time polymerase chain reaction (RT-PCR). Clinical and paraclinical data of the patients were collected from their medical records. CT severity score (CSS) was calculated by a senior radiologist. Disease severity was determined based on the World Health Organization criteria. Results In total, 742 patients were included, of whom 451 (60.8%) were males and 291 (39.2%) were females. The mean age was 56.59 ± 14.88 years old. Also, 523 (70.5%) were RT-PCR-positive. Ground glass opacity was directly associated with RT-PCR positivity (odds ratio [OR] = 2.07). Also, RT-PCR-positive cases had significantly a higher CSS than RT-PCR-negative cases (p = 0.037). In patients confirmed with COVID-19, peribronchovascular distribution of lesions, number of zones involved, and CSS were associated with increased risk of ICU admission (OR = 2.93, OR = 2.10, and OR = 1.14, respectively), mortality (OR = 2.30, OR = 1.35, and OR=1.08, respectively), severe disease (OR = 2.06, OR = 1.68, and OR = 1.10, respectively), and critical disease (OR = 4.62, OR = 3.21, and OR = 1.23, respectively). Also, patients who had consolidation were at a higher risk of severe disease compared with those who did not (OR = 4.94). Conclusion Initial chest CT scan can predict COVID-19 positivity, ICU admission, mortality, and disease severity, specifically through CSS.

Aim: To assess the results of chest x ray radiographs of patients positive for Covid-19, presented at the tertiary care hospital according to the classification by the British Society of Thoracic Imaging (BSTI. Place and Duration: In COVID-19 Ward (Department of Medicine) Sheikh Zayed Hospital, Lahore for three months duration from January 2021 to March 2021. Methods: A total of 96 patients were selected. In this observational study, positive COVID-19 patient determined by the reverse transcriptase polymerase chain reaction (RT-PCR) were enrolled for this study above the age of 14 years. CXR results were classified conferring to BSTI documentation and classification in terms of percentage and frequency. Results: Chest rays of 96 patients who tested positive for Covid-19 by RT-PCR over the age of 14 years were examined. Chest X-rays are classified according to the BSTI Covid-19 X-ray classification. Out of 96 patients, 10 patients (10.41%) had normal chest x-rays, 19 (19.80%) patients had classic bilateral, peripheral and basal consolidation / ground glass opacity (GMO), 60 (62.5%) had unspecified group,7(7.29%) patients have poor quality X-ray film. The unilateral involvement was noticed in 15 and bilateral in 49 patients, 12 of the patients had diffuse involvement on chest radiograph and peripheral involvement in 39 patients. According to regional dominance, 41 of the unspecified (42.70%) had middle and lower lung involvement, 7 (7.29%) had only the middle zone, and 8 (8.33%) had involvement of lower zone. Conclusions: In this study, Covid-19 chest X-rays are usually presented as ground glass opacity, mixed consolidation with GGOs in the middle and lower peripheral areas of the bilateral lung. Chest X-ray BSTI classification is used to classify Covid-19 severity in our patients, thus differentiating in the classic Covid-19 of the middle zone versus low zone involvement. Keywords: Consolidation, Covid, Ground Glass Opacity, Chest Image.

Various radiological tools can predict the prognosis of non-small cell lung cancer (NSCLC). In this study, we evaluated the prognostic effect of different radiological tools such as whole tumor size (WTS), consolidation size (CS), consolidation tumor ratio (CTR), tumor disappearance ratio (TDR), mediastinal diameter (MD), and ground glass opacity (GGO) using high-resolution computed tomography (HRCT). We reviewed recent retrospective studies on the predictive effect of these radiological tools on disease-free survival (DFS) and overall survival (OS) in patients with T1N0-staged NSCLC. We searched PubMed and the British Library databases for the English literature published from January 2010 to December 2020 and generated a total of 32 publications (NSCLC, n=16; adenocarcinoma, n=16). The TNM classification version 7 was used in 18 studies, and version 8 in 14 studies. The evaluated radiological parameters were WTS, CS including T category, CTR, TDR, MD, presence of GGO, GGO ratio, and pure GGO. This review suggested that CS, MD, and the presence of GGO are optimal prognostic radiological tools for cT1N0-Staged NSCLC. CTR or TDR for part solid nodules (PSNs) is not a well-accepted prognostic factor. Further investigations are required to differentiate between benign scars and malignant components on HRCT and evaluate the prognosis of PSNs (1< CS ≤2 cm) with large WTS in the future.

Background An outbreak of coronavirus disease 2019 (COVID-19) infection caused by a novel coronavirus began in December 2019 in Wuhan in central China that affect the children and adult and causes respiratory disease. This study aimed to highlight the CT features of pediatric patients with COVID-19 with upper respiratory symptoms. Results The mean age of the 53 patients who enrolled in this study were 14.06 ± 4.12 years (range 1-18 years). Majority (75.5%) of them were adolescent. Running nose and fever were the most common symptoms. Forty-four (83%) patients had normal CT with no ground glass opacity (GGO) or consolidation, only 9 patients showed lung opacities; 5 cases showed consolidation, 2 cases with GGO, while consolidation with GGO was noted in another 2 patients. Among these 9 patient, six (66.7%) of them show unilateral lung opacities with peripheral distribution of these opacities in eight (88.9%) patients. The most frequently affected lobes were right and left lower lung lobes that were noted in 6 out of 9 patients with lung opacities (66.7%) in each lobe. Bronchitis was predominant in 23 (43.4%) cases. Conclusions RT-PCR is a gold slandered test in the diagnosis of COVID-19 in children with upper respiratory tract symptoms as Chest CT cannot standalone as a diagnostic tool owing to high prevalence of normal chest CT in these patients. However, in case of lung affection, the presence of unilateral, peripheral consolidation with lower lobe predominance, in addition to bronchial wall thickening should be considered as a hallmark of chest CT in diagnosis of pediatric patients with COVID-19 with upper respiratory symptoms.

Thoracic imaging is fundamental in the diagnostic route of Coronavirus disease 2019 (COVID-19) especially in patients admitted to hospitals. In particular, chest computed tomography (CT) has a key role in identifying the typical features of the infection. Ground-glass opacities (GGO) are one of the main CT findings, but their presence is not specific for this viral pneumonia. In fact, GGO is a radiological sign of different pathologies with both acute and subacute/chronic clinical manifestations. In the evaluation of a subject with focal or diffuse GGO, the radiologist has to know the patient’s medical history to obtain a valid diagnostic hypothesis. The authors describe the various CT appearance of GGO, related to the onset of symptoms, focusing also on the ancillary signs that can help radiologist to obtain a correct and prompt diagnosis.

To evaluate the safety and technical efficacy of a customized blunt-tip microwave ablation (MWA) electrode for CT-guided ablation of pulmonary ground-glass opacity nodules (GGOs). This was a retrospective before-after study. All consented patients with GGOs who underwent MWA treatment using conventional sharp-tip electrodes (group A) between January 2018 and December 2018 or new blunt-tip electrodes (group B) between January 2019 and December 2019 in our institution were included. The individual features of each patient and lesion, as well as technical and clinical information, were collected and analyzed. Sixteen (7 males, 9 females; mean age, 64.9 ± 12.3 years) and twenty-six (11 males, 15 females; mean age, 66.5 ± 10.7 years) patients were enrolled in groups A and B, respectively. The technique was successfully performed in all patients and a follow-up CT scan at 24 h after MWA showed that the technical efficacy rate was 100% in both groups. Twelve (75.0%) grade I complications were noted in group A, whereas 11 (42.3%) were noted in group B (p = 0.039, chi-square test). No bleeding occurred within the lesions in group B. The blunt-tip MWA electrode is a safe and technically effective tool for ablating GGO lesions. • A new blunt-tip MWA electrode was used for CT-guided ablation of GGO lesions. • The blunt-tip MWA electrode could improve the safety of GGO ablation. • The technical efficacy of ablation was maintained by using the blunt-tip MWA electrode.

Objective Delineation of the intersegmental plane during pulmonary segmentectomy by systemic injection of indocyanine green (ICG) has been rapidly emerging. We evaluated the feasibility of the use of ICG in a large-scale cohort according to the type of segmentectomy and the presence of obstructive lung disorder and compared the demarcation status with air injection. Methods We collected the data of 209 patients who underwent segmentectomy using ICG at National Cancer Center Hospital, Tokyo, Japan. Data of the operation including the demarcation status of the intersegmental plane were analyzed retrospectively. Results The median operation duration and blood loss were 105 minutes (interquartile range, 94-118 minutes) and 12 mL (interquartile range, 5-24 mL), respectively. Good demarcation of the intersegmental plane by ICG was observed in 184 (88.0%) cases, with no correlation to the type of resected segments or the presence of obstructive lung disorder. Postoperative complications of Clavien–Dindo classification grade 3 or more were observed in 5 cases (2.4%), and no ICG-related adverse event was noted. High-frequency jet ventilation was also used in 160 cases (76.6%) to delineate the intersegmental inflation–deflation plane. The air injected by high-frequency jet ventilation tended to spread further beyond the intersegmental plane that was depicted by ICG. Conclusions The use of ICG might demarcate the intersegmental plane more restricted to the target segment compared with air injection. Delineation of the intersegmental plane by ICG is feasible regardless of the type of segmentectomy or the presence of obstructive lung disorder, and it can be commonly applicable in pulmonary segmentectomy., Graphical abstract

Introduction Ground glass opacity (GGO) nodules were found incidentally by computed tomography (CT) scan in some teenagers, which turned out to be lung cancer. The purpose of this study is to summarize the characteristics of teenage patients with GGO featured lung adenocarcinoma. Methods Patients aging from 13 to 20 who were incidentally diagnosed with lung cancer were reviewed between February 2015 to December 2020. The clinical, radiological and pathological characteristics were analyzed. Results Totally 12 patients were included. All of them were diagnosed as GGO featured lung cancer through CT scan, with no presenting symptom. The median surveillance before surgery was 5.5 months, and none of these GGO lesions enlarged or altered in the property during the surveillance. The mean tumor diameter was 0.93 ± 0.25 cm. Ten patients underwent wedge resection by video-assisted thoracoscopic surgery (VATS), 9 of which were minimally invasive adenocarcinoma (MIA) and 1 of which were invasive adenocarcinoma (IAC) in the pathological analysis. One patient underwent VATS left-upper sublobectomy, pathologically diagnosed as MIA and 1 patient underwent VATS left-upper lobectomy with systematic mediastinal lymphadenectomy, pathologically diagnosed as IAC. The median postoperative hospital stay was 3 days. All patients survived without recurrence during a median follow-up of 12.5 months. Conclusions GGO nodules could be a sign of early-stage teenage lung adenocarcinoma. We proposed a screening strategy with long intervals based on a baseline CT scan for the teenage population, and a treatment strategy for diagnosed teenage patients.

We read with great interest the article “Needle-based confocal laser endomicroscopy [CLE] for real-time diagnosing and staging of lung cancer” by Wijmans et al. [1], recently published in the European Respiratory Journal, demonstrating the feasibility and safety of realtime lung cancer detection by endosonography-guided CLE. The authors elegantly describe three CLE characteristics for lung cancer: dark, enlarged pleomorphic cells; dark clumps; and directional streaming. The accuracy of CLE for detecting malignancy was 90% in tumours and 89% in metastatic lymph nodes., Confocal laser endomicroscopy imaging of lepidic adenocarcinomas is feasible. This technique should be further evaluated as a realtime guiding tool during virtual electromagnetic navigation bronchoscopy for ground-glass opacities https://bit.ly/3uzTcMU

Tuberculosis is a serious public health challenge facing mankind and one of the top ten causes of death. Diagnostic imaging plays an important role, particularly for the diagnosis and treatment planning of tuberculosis patients with negative microbiology results. This article illustrates a number of atypical computed tomography (CT) appearances of pulmonary tuberculosis (PTB), including (I) clustered micronodules (CMNs) sign; (II) reversed halo sign (RHS); (III) tuberculous pneumatocele; (IV) hematogenously disseminated PTB with predominantly diffuse ground glass opacity manifestation; (V) hematogenously disseminated PTB with randomly distributed non-miliary nodules; (VI) PTB changes occur on the background of emphysema or honeycomb changes of interstitial pneumonia; and (VII) PTB manifesting as organizing pneumonia. While the overall incidence of PTB is decreasing globally, the incidence of atypical manifestations of tuberculosis is increasing. A good understanding of the atypical CT imaging changes of active PTB shall help the diagnosis and differential diagnosis of PTB in clinical practice.

BACKGROUND: Evidence of honeycombing in high-resolution computed tomography (HRCT) is a recognized risk factor for shortened survival in patients with idiopathic pulmonary fibrosis (IPF), but few studies have evaluated the feasibility of exploiting other specific patterns for predicting survival. The aim of this study was to examine the extent of specific HRCT patterns in IPF and determine whether they correlate with clinical features, pulmonary function tests (PFT), and survival. METHODS: Both the presence and extent of specific HRCT patterns, such as traction bronchiectasis, honeycombing, architectural distortion, reticulation, emphysema, and ground glass opacity, in 129 HRCT examinations were scored semi-quantitatively in three zones of each lung. HRCT examinations were also re-classified according to the 2011 and 2018 international statements. Correlations were calculated between the scores of specific HRCT patterns, clinical features, PFT, and patient survival. RESULTS: The extent of traction bronchiectasis was found to be an independent risk factor of shortened survival (HR 1.227, P=0.001). Patients with a possible usual interstitial pneumonia (UIP) pattern had a better median survival than the patients with a definite UIP pattern (61 vs. 37 months, P=0.026). The extents of traction bronchiectasis, honeycombing, and architectural distortion displayed an inverse correlation with all PFT values at the time of diagnosis. There were few differences between the radiological classifications of the 2011 and 2018 international statements. CONCLUSIONS: We conclude that several specific HRCT patterns displayed a correlation with shortened survival in IPF; these may help in evaluating the risk of death in IPF patients.

Aim of the work To investigate the frequency and types of pulmonary involvement using high resolution computed tomography (HRCT) and pulmonary function tests (PFTs) and to identify different disease parameters as predictors of lung involvement. Patients and Methods One hundred RA patients were recruited from El-Maadi Armed Forces Rheumatology clinic. Spirometry, plain X-ray chest, and HRCT were performed. Disease activity score (DAS28) and Larsen score were assessed. Results They were 77 females and 23 males with a mean age of 55.7 ± 11.4 years and disease duration of 14.9 ± 6.8 years. Extra-articular manifestations included pleura-pulmonary involvement (33%), eye dryness (30%) and skin nodules (13%). PFTs showed abnormalities in 38%. X-ray chest abnormalities were found in 12 patients as follows: pleural effusion (3%), atelectasis in (6%), pulmonary nodules (2%) and hyperinflated chest (3%). Abnormal HRCT findings were found in 68% of the patients: ground glass opacity (GGO) in 36 (52.9%), air trapping in 26 (38.2%), thickened septal/non-septal lines in 21 (30.9%), nodules in 17 (25%), Caplan’s syndrome in 8 (11.8%) and bronchial wall thickening in 8 (11.8%) while 3 (4.4%) showed honey combing and bronchiectasis. Passive smoking, chronic cough, Larsen score and anti-cyclic citrullinated peptide (anti-CCP) titre were significant predictors of lung involvement as detected by HRCT. Conclusion HRCT of the chest was found to be a more sensitive measure than spirometry to diagnose pulmonary abnormalities. Passive smoking, chronic cough, disease severity and high anti-CCP titre were significant independent predictors of lung involvement as detected by PFT and HRCT among rheumatoid patients.

Research goal. Comparative characteristics of the dynamics of CT semiotics and biochemical parameters of two groups of patients: with positive RT-PCR and with triple negative RT-PCR. Reflection of the results by comparing them with the data already available in the literature.The aim of the study is to compare the dynamics of CT semiotics and biochemical parameters of blood tests in two groups of patients: with positive RT-PCR and with triple negative RT-PCR. We also reflect the results by comparing them with the data already available in the literature.Materials and methods. We have performed a retrospective analysis of CT images of 66 patients: group I (n1 = 33) consists of patients who had three- time negative RT-PCR (nasopharyngeal swab for SARS-CoV-2 RNA) during hospitalization, and group II (n2 = 33) includes patients with triple positive RT-PCR. An important selection criterion is the presence of three CT examinations (primary, 1st CT and two dynamic examinations – 2nd CT and 3rd CT) and at least two results of biochemistry (C-reactive protein (CRP), fibrinogen, prothrombin time, procalcitonin) performed in a single time interval of ± 5 days from 1st CT, upon admission, and ± 5 days from 3st CT. A total of 198 CT examinations of the lungs were analyzed (3 examinations per patient).Results. The average age of patients in the first group was 58 ± 14.4 years, in the second – 64.9 ± 15.7 years. The number of days from the moment of illness to the primary CT scan 6.21 ± 3.74 in group I, 7.0 (5.0–8.0) in group II, until the 2nd CT scan – 12.5 ± 4, 87 and 12.0 (10.0–15.0), before the 3rd CT scan – 22.0 (19.0–26.0) and 22.0 (16.0–26.0), respectively.In both groups, all 66 patients (100%), the primary study identified the double-sided ground-glass opacity symptom and 36 of 66 (55%) patients showed consolidation of the lung tissue. Later on, a first follow-up CT defined GGO not in all the cases: it was presented in 22 of 33 (67%) patients with negative RT-PCR (group I) and in 28 of 33 (85%) patients with the positive one (group II). The percentage of studies showing consolidation increased significantly: up to 30 of 33 (91%) patients in group I, and up to 32 of 33 (97%) patients in group II. For the first time, radiological symptoms of “involutional changes” appeared: in 17 (52%) patients of the first group and in 5 (15%) patients of the second one. On second follow-up CT, GGO and consolidations were detected less often than on previous CT: in 1 and 27 patients of group I (3% and 82%, respectively) and in 6 and 30 patients of group II (18% and 91%, respectively), although the consolidation symptom still prevailed significantly . The peak of “involutional changes” occurred on last CT: 31 (94%) and 25 (76%) patients of groups I and II, respectively.So, in the groups studied, the dynamics of changes in lung CT were almost equal.After analyzing the biochemistry parameters, we found out that CRP significantly decreased in 93% of patients (p < 0.001) in group I; in group II, there was a statistically significant decrease in the values of C-reactive protein in 81% of patients (p = 0.005). With an increase in CT severity of coronavirus infection by one degree, an increase in CRP by 41.8 mg/ml should be expected. In group I, a statistically significant (p = 0.001) decrease in fibrinogen was recorded in 77% of patients; and a similar dynamic of this indicator was observed in group II: fibrinogen values decreased in 66% of patients (p = 0.002).Such parameters as procalcitonin and prothrombin time did not significantly change during inpatient treatment of the patients of the studied groups (p = 0.879 and p = 0.135), which may indicate that it is inappropriate to use these parameters in assessing dynamics of patients with a similar course of the disease. When comparing the outcomes of the studied groups, there was a statistically significant higher mortality in group II – 30.3%, in group I – 21.2% (p = 0.043).Conclusion. According to our data, a course of the disease does not significantly differ in the groups of patients with positive RT-PCR and three-time negative RT-PCR. A negative RT-PCR analysis may be associated with an individual peculiarity of a patient such as a low viral load of SARS-CoV-2 in the upper respiratory tract. Therefore, with repeated negative results on the RNA of the virus in the oro- and nasopharynx, one should take into account the clinic, the X-ray picture and biochemical indicators in dynamics and not be afraid to make a diagnosis of COVID-19.

To investigate the prognostic implications and pathological features of clinical stage I lung adenocarcinoma with ground-glass opacity (GGO) on computed tomography (CT). The subjects of this retrospective study were 1228 patients with lung adenocarcinoma classified as clinical stage I, who underwent complete resection by lobectomy. The patients were divided into four groups based on the presence and proportion of GGO according to the consolidation-to-tumor ratio (CTR); A, CTR ≤ 0.5; B, 0.5

Background Radiological and pathological studies in severe COVID‐19 pneumonia (SARS‐CoV‐2) have demonstrated extensive pulmonary immunovascular thrombosis and infarction. This study investigated whether these focal changes may present with chest pain mimicking pulmonary emoblism (PE) in ambulant patients. Methods CTPAs from outpatients presenting with chest pain to Leeds Teaching Hospital NHS Trust 1st March to 31 May 2020 (n = 146) and 2019 (n = 85) were compared. Regions of focal ground glass opacity (GGO), consolidation and/or atelectasis (parenchymal changes) were determined, and all scans were scored using British Society for Thoracic Imaging (BSTI) criteria for COVID‐19, and the 2020 cohort was offered SARS‐CoV‐2 antibody testing. Results Baseline demographic and clinical data were similar between groups with absence of fever, normal lymphocytes and marginally elevated CRP and D‐Dimer values. Evidence of COVID‐19 or parenchymal changes was observed in 32.9% (48/146) of cases in 2020 compared to 16.5% (14/85) in 2019 (P = 0.007). 11/146 (7.5%) patients met BSTI criteria for COVID‐19 in 2020 compared with 0/14 in 2019 (P = 0.008). 3/39 patients tested had detectable COVID‐19 antibodies (2 with parenchymal changes and 1 with normal parenchyma) however 0/6 patients whose CTPA met BSTI criteria “likely/suspicious for COVID‐19” and attended antibody testing were SARS‐CoV‐2 antibody positive. Conclusions 32.8% ambulatory patients with suspected PE in 2020 had parenchymal changes with 7.5% diagnosed as COVID‐19 infection by imaging criteria, despite the absence of other COVID‐19 symptoms. These findings suggest that localized COVID‐19 pneumonitis with immunothrombosis occurs distal to the bronchiolar arteriolar circulation, causing pleural irritation and chest pain without viraemia, accounting for the lack of fever and systemic symptoms.

A better understanding of temporal relationships between chest CT and labs may provide a reference for disease severity over the disease course. Generalized curves of lung opacity volume and density over time can be used as standardized references from well before symptoms develop to over a month after recovery, when residual lung opacities remain. 739 patients with COVID-19 underwent CT and RT-PCR in an outbreak setting between January 21st and April 12th, 2020. 29 of 739 patients had serial exams (121 CTs and 279 laboratory measurements) over 50 ± 16 days, with an average of 4.2 sequential CTs each. Sequential volumes of total lung, overall opacity and opacity subtypes (ground glass opacity [GGO] and consolidation) were extracted using deep learning and manual segmentation. Generalized temporal curves of CT and laboratory measurements were correlated. Lung opacities appeared 3.4 ± 2.2 days prior to symptom onset. Opacity peaked 1 day after symptom onset. GGO onset was earlier and resolved later than consolidation. Lactate dehydrogenase, and C-reactive protein peaked earlier than procalcitonin and leukopenia. The temporal relationships of quantitative CT features and clinical labs have distinctive patterns and peaks in relation to symptom onset, which may inform early clinical course in patients with mild COVID-19 pneumonia, or may shed light upon chronic lung effects or mechanisms of medical countermeasures in clinical trials.

Background The coronavirus disease 2019 (COVID-19) causes a wide spectrum of lung manifestations ranging from mild asymptomatic disease to severe respiratory failure. We aimed to clarify the characteristics of radiological and functional lung sequelae of COVID-19 patients described in follow-up period. Method PubMed and EMBASE were searched on January 20th, 2021 to investigate characteristics of lung sequelae in COVID-19 patients. Chest computed tomography (CT) and pulmonary function test (PFT) data were collected and analyzed using one-group meta-analysis. Results Our search identified 15 eligible studies with follow-up period in a range of 1–6 months. A total of 3066 discharged patients were included in these studies. Among them, 1232 and 1359 patients were evaluated by chest CT and PFT, respectively. The approximate follow-up timing on average was 90 days after either symptom onset or hospital discharge. The frequency of residual CT abnormalities after hospital discharge was 55.7% (95% confidential interval (CI) 41.2–70.1, I2 = 96.2%). The most frequent chest CT abnormality was ground glass opacity in 44.1% (95% CI 30.5–57.8, I2 = 96.2%), followed by parenchymal band or fibrous stripe in 33.9% (95% CI 18.4–49.4, I2 = 95.0%). The frequency of abnormal pulmonary function test was 44.3% (95% CI 32.2–56.4, I2 = 82.1%), and impaired diffusion capacity was the most frequently observed finding in 34.8% (95% CI 25.8–43.8, I2 = 91.5%). Restrictive and obstructive patterns were observed in 16.4% (95% CI 8.9–23.9, I2 = 89.8%) and 7.7% (95% CI 4.2–11.2, I2 = 62.0%), respectively. Conclusions This systematic review suggested that about half of the patients with COVID-19 still had residual abnormalities on chest CT and PFT at about 3 months. Further studies with longer follow-up term are warranted.

Objective This study aims to evaluate the demographic, epidemiological, and clinical features of novel coronavirus disease 2019 (COVID-19) cases aged between 0 and 18 years.Methods The demographic characteristics of the patients, admission symptoms, contact and travel histories, clinical onset duration, symptoms, treatments, laboratory findings, radiological images, and polymerase chain reaction (PCR) negation times were evaluated in a retrospective manner. Thirty-eight children (19 boys and 19 girls) were included in the study.Results The mean age of the patients was 10.36 ± 5.59 years. The average admission times of the patients after the onset of the symptoms was determined as 1.84 ± 2.02 days. Thirteen (34.2%) patients were observed as asymptomatic. The most common identified symptoms were fever, cough, and fatigue (55.2, 34.2, and 13.2%, respectively). Febrile convulsions, myalgia, dizziness, and diarrhea were the least common symptoms. Also, 25-hydroxyvitamin D3 (vitamin D3) levels were low and aspartate aminotransferase (AST) values were higher in the moderate group than the mild group and the relationships were statistically significant (p = 0.044and 0.027). Ferritin levels of the patients with ground glass opacity (GGO) were found statistically and significantly higher than the patients without GGO (p = 0,031). There was more than one lobe and segment involvement in five patients, the average number of affected lobes and segments was 3.8 and 8.8, respectively. High-resolution computed tomography of the 24 patients showed that; GGO in five (20.8%), consolidation + GGO (mixed) in three (12.5%), consolidation (alone) in one, subpleural linear opacities in three (12.5%), and pavement stone opacities in one (4.2%) patient. COVID-19, which is seen less frequently in children, may pose a risk in infants and young children.Conclusion Especially high ferritin levels may present with lung involvement and low vitamin D levels may worsen the aggravation of the lung involvement. There is a great need for further research on this subject.

There are increasing numbers of synchronous multiple primary lung cancer (SMPLC) patients in clinical practice, with most lesions presenting as ground-glass opacity (GGO). For SMPLC patients, surgical resection should be a prior option for all lesions suspected of being malignant, if medically and technically feasible. However, it is frequently a dilemma for the management of residual GGO lesions that were unresected simultaneously with the main tumor in SMPLC patients. We report a case of SMPLC, in which the patient underwent surgical resection of the major lesion with EGFR mutation and then received compelling EGFR-TKI treatment for one enlarging residual GGO lesion after 12 months since operation. Furthermore, a comprehensive literature review about the risk for the progress of GGOs unresected simultaneously with the main lesion and the management of these residual GGOs was also summarized. With the treatment of EGFR-TKI gefitinib for 3 months, the biggest residual GGO lesion (more than 10mm) achieved a complete response (CR), three lesions reduced in size, and the other three lesions remained stable in this case. Surgical resection for major lesion and EGFR-TKI treatment on unresected GGOs might bring favorable outcome for patients with EGFR-mutated multifocal lung cancer. This strategy is safe and effective, which could be a promising therapeutic approach for unresectable GGO lesions in EGFR-mutated SMPLC patients after primary surgery. Notably, folate receptor-positive circulating tumor cell (FR+-CTC) for therapeutic monitoring was more sensitive for GGO-featured lung adenocarcinoma than serum markers.

Bo Cheng,* Hongsheng Deng,* Yi Zhao,* Feng Zhu, Hengrui Liang, Caichen Li, Ran Zhong, Jianfu Li, Shan Xiong, Zhuxing Chen, Wenhua Liang, Jianxing He Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wenhua Liang; Jianxing HeDepartment of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, 151, Yanjiang Road, Guangzhou, 510120, People’s Republic of ChinaTel +86-20-83337792Fax +86-20-83350363Email liangwh1987@163.com; drjianxing.he@gmail.comAbstract: There are increasing numbers of synchronous multiple primary lung cancer (SMPLC) patients in clinical practice, with most lesions presenting as ground-glass opacity (GGO). For SMPLC patients, surgical resection should be a prior option for all lesions suspected of being malignant, if medically and technically feasible. However, it is frequently a dilemma for the management of residual GGO lesions that were unresected simultaneously with the main tumor in SMPLC patients. We report a case of SMPLC, in which the patient underwent surgical resection of the major lesion with EGFR mutation and then received compelling EGFR-TKI treatment for one enlarging residual GGO lesion after 12 months since operation. Furthermore, a comprehensive literature review about the risk for the progress of GGOs unresected simultaneously with the main lesion and the management of these residual GGOs was also summarized. With the treatment of EGFR-TKI gefitinib for 3 months, the biggest residual GGO lesion (more than 10mm) achieved a complete response (CR), three lesions reduced in size, and the other three lesions remained stable in this case. Surgical resection for major lesion and EGFR-TKI treatment on unresected GGOs might bring favorable outcome for patients with EGFR-mutated multifocal lung cancer. This strategy is safe and effective, which could be a promising therapeutic approach for unresectable GGO lesions in EGFR-mutated SMPLC patients after primary surgery. Notably, folate receptor-positive circulating tumor cell (FR+-CTC) for therapeutic monitoring was more sensitive for GGO-featured lung adenocarcinoma than serum markers.Keywords: multiple primary lung cancer, ground-glass opacity, epidermal growth factor receptor-tyrosine kinases inhibitor, folate receptor-positive circulating tumor cell, literature review

Background The data on medium-term follow-up of coronavirus disease-19 (COVID-19) pneumonia survivors is scarce. Medium-term follow-up will generate knowledge and help in devising a structured follow-up plan and to facilitate enrolment in clinical trials assessing the role of antifibrotic drugs in modifying the course of disease in order to avert long-term pulmonary sequelae of disease. The study was aimed to evaluate the lung findings on a medium-term follow-up (3 months or more) chest computed tomography (CT) in COVID-19 pneumonia survivors, assess the rate of resolution or persistence of lung abnormalities and to identify the initial demographic, clinical, and imaging characteristics that could potentially predict the persistence of lung abnormalities on follow-up. Results Out of the total study cohort of 81 patients, 46 (56.8%) demonstrated complete resolution of lung findings and the remaining 35 (43.2%) had residual lung opacities on follow-up CT. The most common type of residual abnormality was ground glass opacity (GGO) (16/35; 45.7%), followed by parenchymal bands (9/35; 25.7%), mixed pattern of GGO and parenchymal bands (6/35; 17.2%), bronchiectasis (6/35; 17.2%), and interlobular septal thickening (4/35; 11.4%). Patients with residual abnormalities were older, had higher BMI, more comorbidities, lower SpO2, longer hospital stay, higher rate of intensive care unit (ICU) admission, higher WBC count, a higher CT severity score, and lower rate of steroid administration with all p values < 0.05. Conclusion Nearly half of post-COVID-19 survivors had residual lung abnormalities after ≥ 3 months of follow-up. Certain clinico-radiological characteristics have the potential to identify the individuals at risk of having residual lung abnormalities on medium-term follow-up.

The paper describes a clinical case of hypersensitivity pneumonitis in a young patient during the COVID-19 pandemic when the patient having complaints of dyspnea and interstitial lung changes as ground glass opacity was initially unambiguously diagnosed with viral COVID-related bilateral pneumonia. The chief computed tomography manifestations in the lung were infiltrative inflammatory changes as numerous areas of predominantly interstitial infiltration by the type of ground glass, with consolidation areas and reticular changes, varying in extent, peripheral localization, mainly in the lower lobes and with the 25–50% involvement of the right and left lung parenchyma. The diagnosis of hypersensitivity pneumonitis was confirmed by cytological and histological examinations of the biopsy material obtained during bronchoscopy using a set of biopsies and endobronchial cryobiopsy.This clinical case demonstrates that the chest computed tomography detection of pulmonary ground glasstype changes is a reason for further patient examinations and requires morphological verification of the diagnosis, since the cost of a diagnostic error is the life of a patient.

BACKGROUND and AIM: COVID-19 shares similarities with lung diseases and causie difficulties in the management. The aim of this study is to describe demographic, clinical, laboratory, and radiological characteristics of patients who admitted to the emergency department (ED) of a chest diseases hospital and how we managed these patients. MATERIALS AND METHODS: ED admissions from March 11, 2020, to May 11, 2020 were retrospectively evaluated. Patients were divided into two groups as probable COVID-19 (P-COVID-19) and non-COVID-19. The data were analyzed and compared. RESULTS: A total of 223 patients, of which 31.8% were P-COVID-19 and 68.2% were non-COVID-19, were included. The mean age was 49.14 ± 18.05 years in P-COVID-19 group and 59.17 ± 17.32 years in non-COVID-19 group (P < 0.001). The most common symptoms in all patients were dyspnea (26.5%) and cough (21.1%). In P-COVID-19 group, cough, dyspnea, and fever were the most common symptoms, and the presence of fever was statistically significantly higher (P = 0.03). Increased C-reactive protein, sedimentation, and D-dimer levels were observed in 61.5%, 70.9%, and 52.6% of patients, respectively. Laboratory findings showed no significant differences between two groups. All patients underwent chest X-ray examination and 42.6% of them had pathological findings. 56.3% of P-COVID-19 patients had normal chest X-rays. Bilateral involvement on HRCT was more frequent in P-COVID-19 group than non-COVID-19 group (47.8% vs. 36.7%, P < 0.001). The presence of ground-glass opacity (GGO) was statistically significantly higher in P-COVID-19 group (P < 0.001). CONCLUSIONS: The presence of fever and GGO with bilateral involvement on HRCT could be used for the early detection and triage of suspected patients in ED.

Objectives: Comparative analysis of laboratory data in moderate-to-severe COVID-19 patients presenting with or without ground-glass opacities (GGOs). Methods: This retrospective study examined 61 patients with moderate-to-severe COVID-19, as defined by the report of the WHO-China Joint Mission on COVID-19. All patients were admitted to the Department of Infectious Diseases, Wuhan Union Hospital from Dec 28, 2019 to Feb 22, 2020 and classified into a GGO group or a non-GGO group based on CT results. The clinical characteristics and laboratory data of the two groups were compared. Data were analyzed using univariate and multivariate analysis, and using receiver operating characteristic (ROC) analysis. Results: Forty-five patients were in the GGO group (73.8%, 21 females, 24 males, mean age 54.8±17.8 years) and 16 were in the non-GGO group (26.2%, 11 females, 5 males, mean age 53±14.9 years). The levels of IL-2, IL-4, and IFN-γ were greater in the GGO group (all P

Background: Due to the relative early lockdown in India, relative greater availability of reverse transcription polymerase chain reaction (RT-PCR) testing, and mandate to admit all positive corona virus disease 2019 (COVID-19) patients, the protocol in our hospital is to perform a baseline chest X-ray (CXR) at the time of admission and for follow up. There are currently limited publications demonstrating the radiographic findings and the role of CXR of COVID-19 patients at presentation. Aims: Evaluatethe radiographic findings on CXR in COVID-19 patients at presentation. Recommend a guideline for its judicious use. Settings and Design: Retroprospective study performed on RT-PCR confirmed COVID-19 patients admitted in our hospital between March 31,2020 to May 25, 2020. The study included symptomatic and asymptomatic patients. CXR was performed for218 patients. Materials and Methods: Portable bedside CXR was performed. The CXRs were evaluated by three radiologists to record the findings and grade the disease. All variables were expressed as mean, ranges, counts, and percentages. Results: 157 patients (72%) were symptomatic and 61 (28%) were asymptomatic. 104 CXRs (48%) were abnormal (97 in symptomatic (62%) and fourin asymptomatic (6%)). 74 patients (47%) in the symptomatic group had known comorbidities and of these, 62 (84%) had abnormal CXR. 97 CXRs (93%) had bilateral findings and 87 CXRs (84%) had peripherally predominant abnormalities. The lower zone was the most common area of involvement (73%). Ground glass opacity (GGO) was the most common finding (94%–98 CXRs). Mild disease was seen in 56 (54%). Conclusion: CXR can be used to assess symptomatic COVID-19 patients at presentation and to grade the severity of disease. It may be avoided in asymptomatic patients.

Objective The aim of this study was to assess long-term outcomes after lobectomy in patients with clinical T1 N0 lung cancer based on thin-section computed tomography. Methods We collected the data of patients with pathological adenocarcinoma who had undergone lobectomy. The patients were categorized into 4 groups according to a consolidation tumor ratio and tumor size. Groups A and B included tumors with consolidation tumor ratio ≤0.5 and size ≤3 cm. Group A consisted of tumors ≤2 cm. Group B consisted of the remaining tumors. Groups C and D consisted of tumors with consolidation tumor ratio >0.5. Group C consisted of those with tumors ≤2 cm and Group D consisted of tumors of size 2 to 3 cm. The 10-year overall survival and recurrence-free survival rates were examined. Results Among the 543 patients, the 10-year overall survival was 80.4% and the 10-year recurrence-free survival rate was 77.1%. The 10-year overall survival for group A was 94.0%, 92.7% for group B, 84.1% for group C, and 68.8% for group D, and the 10-year recurrence-free survival rate for each group was 94.0%, 89.0%, 79.7%, and 66.1%, respectively. Group A + B showed better overall survival than group C + D (hazard ratio, 2.78; 95% confidence interval, 1.45-5.06) and better 10-year recurrence-free survival (hazard ratio, 2.74; 95% confidence interval, 1.55-4.88). No patient in group A had recurrence. Conclusions Those patients with total tumor size ≤3 cm and consolidation tumor ratio ≤0.5 showed excellent prognosis and might be suitable candidates for sublobar resection. If noninferior survival of segmentectomy compared with lobectomy is confirmed in an ongoing Japan Clinical Oncology Group trial, segmentectomy will be included in the standard of care.

Introduction Radiological evaluation of suspected COVID-19 patients is required for early detection of thoracic involvement, particularly in emergency units, while waiting for definitive diagnosis by real-time reverse transcription polymerase chain reaction (RT-PCR). Here, we report a case series of CXR findings in Indonesian patients with COVID-19 in our institution. Presentation of cases We included 7 patients with COVID-19 confirmed by RT-PCR, including 4 females and 3 males, with ages ranging from 36 to 71 years. All patients showed abnormal findings on CXR when admitted to the hospital, except one, composed of ground glass opacity (GGO) (n = 1), consolidation (n = 3), and both (n = 2). Both and one side of the lung were affected in three and three (left side = 2; right side = 1) patients, respectively. Pneumonia degrees of mild, moderate and severe were observed in three, one, and two patients, respectively. All patients eventually recovered. Discussion CXR is the most common radiological examination for patients with respiratory disorders, including COVID-19, and it is readily available in almost all health care facilities. The imaging manifestation of COVID-19 is similar to viral pneumonia but also has its own characteristics, including GGO, consolidation, multiple plaque shadows, and interstitial changes that are mostly seen in peripherals and subpleural areas, as well as shadow infiltration in both lungs. Conclusion CXR showed various abnormality findings in patients with COVID-19, including the type, location, and degree of pneumonia. Moreover, CXR is considered more effective and useful for initial screening and follow-up of the progress of patients with COVID-19., Highlights • CXR is the most common radiological examination for patients with respiratory disorders, including COVID-19. • CXR is considered more effective and useful for initial screening and follow-up of the progress of patients with COVID-19. • CXR shows various abnormality findings in patients with COVID-19, including the type, location, and degree of pneumonia.