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Background: Diagnostic work-up of pulmonary embolism (PE) remains a challenge. Methods: We retrospectively studied all patients referred for computed tomography pulmonary angiography (CTPA) with suspicion of PE during a 12-month period (2018). The diagnostic accuracy of different D-dimer (Dd) cutoff thresholds for ruling out PE was evaluated. Furthermore, the association of Dd and red cell distribution width (RDW) with embolus location, CTPA findings, and patient outcome was recorded. Results: One thousand seventeen (n = 1017) patients were finally analyzed (mean age: 64.6 years (SD = 11.8), males: 549 (54%)). PE incidence was 18.7%. Central and bilateral embolism was present in 44.7% and 59.5%, respectively. Sensitivity and specificity for conventional and age-adjusted Dd cutoff was 98.2%, 7.9%, and 98.2%, 13.1%, respectively. A cutoff threshold (2.1 mg/L) with the best (64.4%) specificity was identified based on Receiver Operating Characteristics analysis. Moreover, a novel proposed Dd cutoff (0.74 mg/L) emerged with increased specificity (20.5%) and equal sensitivity (97%) compared to 0.5 mg/L, characterized by concurrent reduction (17.2%) in the number of performed CTPAs. Consolidation/atelectasis and unilateral pleural effusion were significantly associated with PE (p < 0.05, respectively). Patients with consolidation/atelectasis or intrapulmonary nodule(s)/mass on CTPA exhibited significantly greater median Dd values compared to patients without the aforementioned findings (2.34, (IQR 1.29–4.22) vs. 1.59, (IQR 0.81–2.96), and 2.39, (IQR 1.45–4.45) vs. 1.66, (IQR 0.84–3.12), p < 0.001, respectively). RDW was significantly greater in patients who died during hospitalization (p = 0.012). Conclusions: Age-adjusted Dd increased diagnostic accuracy of Dd testing without significantly decreasing the need for imaging. The proposed Dd value (0.74 mg/L) showed promise towards reducing considerably the need of CTPA. Multiple radiographic findings have been associated with increased Dd values in our study.

Σκοπός:Για τη μελέτη του παθοφυσιολογικού μηχανισμού αντίδρασης του τοιχώματος της νεφρικής αρτηρίας που εκλύεται κατά την αγγειοπλαστική με τοποθέτηση stent πραγματοποιήθηκε ποσοτικός προσδιορισμός έξι διαφορετικών παραγόντων φλεγμονής -μεσολαβητών (κυτοκίνες) στον ορό αίματος ασθενών που υποβλήθηκαν σε αυτήν την μέθοδο. Απώτερος σκοπός της μελέτης, μέσω της αξιολόγησης των διαφορών στις συγκεντρώσεις των μεσολαβητών σε ασθενείς που εμφάνισαν ή όχι επαναστένωση του αγγείου, είναι η αναγνώριση καποιού παράγοντα φλεγμονής που θα αποτελέσει δείκτη πρόβλεψης της επαναστένωσης με στόχο την πρόληψη αυτής.Υλικό - Μέθοδος:Μελετήθηκαν είκοσι δύο ασθενείς (17 άνδρες, μέσος όρος ηλικίας 66 έτη), με στένωση στην έκφυση της νεφρικής αρτηρίας και μή καλώς ρυθμιζόμενη υπέρταση, οι οποίοι υποβλήθησαν σε αγγειοπλαστική νεφρικής αρτηρίας με τοποθέτηση stent. Στους ασθενείς αυτούς πραγματοποιήθηκαν αιμοληψίες σε τρεις διαφορετικούς χρόνους: αμέσως πριν την αγγειοπλαστική (baseline), 24 ώρες και 6 μήνες μετά την αγγειοπλαστική και μετρήθηκαν στον ορό τους οι εξής μεσολαβητές: (1) Παράγοντας Νέκρωσης Όγκου-α (Tumor necrosis factor-α, TNF-α), (2) Ιντερλευκίνη 6 (Interleukin-6, IL-6), (3) Πρωτεΐνη χημειοτακτική για τα μονοκύτταρα τύπου-1 (Monocyte Chemoattractant protein-1, MCP-1), (4) Διακυτταρικό μόριο προσκόλλησης-1 (Intercellular adhesion molecule-1, ICAM-1), (5) Μόριο προσκόλλησης αγγειακών κυττάρων-1 (Vascular cell Adhesion Molecule-1, VCAM-1) και (6) Παράγοντας RANTES (Regulated upon Activation Normal T-cell Expressed presumed Secreted). Στους έξι μήνες μετά την αγγειοπλαστική πραγματοποιήθηκε έχρωμο Doppler υπερηχογράφημα και καταγράφηκε η ανάπτυξη ή όχι επαναστένωσης εντός του stent. Επιπλέον, αξιολογήθηκαν οι διαφορές της συγκέντρωσης αυτών σε ασθενείς που εμφάνισαν επαναστένωση της νεφρικής αρτηρίας στους 6 μήνες μετά την αγειοπλαστική συγκριτικά με αυτούς που δεν εμφάνισαν επαναστένωση.Αποτελέσματα:Η συγκέντρωση της ΙL-6 αυξήθηκε σημαντικά 24 ώρες μετά την αγγειοπλαστική (8.3 pg/mL ± 1.24 vs 2.76 pg/mL ± 1.27 τιμές baseline), ενώ στους 6 μήνες μετά επέστρεψε στις προ την επέμβαση τιμές (2.6 pg/mL ± 1.77) (Ρ

Background Chest computed tomography (CT) is a useful tool for the diagnosis of coronavirus disease-2019 (COVID-19), although its exact value for predicting critical illness remains unclear. This study evaluated the efficacy of chest CT to predict disease progression, pulmonary complications, and viral positivity duration. Methods A single-center cohort study was conducted by consecutively including hospitalized patients with confirmed COVID-19. The chest CT patterns were described and a total severity score was calculated. The predictive accuracy of the severity score was evaluated using the receiver operating characteristic analysis, while a Cox proportional hazards regression model was implemented to identify the radiological features that are linked to prolonged duration of viral positivity. Results Overall, 42 patients were included with 10 of them requiring intensive care unit admission. The most common lesions were ground glass opacities (92.9%), consolidation (66.7%), and crazy-paving patterns (61.9%). The total severity score significantly correlated with inflammatory and respiratory distress markers, as well as with admission CURB-65 and PSI/PORT scores. It was estimated to predict critical illness with a sensitivity and specificity of 75% and 70%, respectively. Time-to-event analysis indicated that patients without ground-glass opacities presented significantly shorter median viral positivity (16 vs. 27 days). Conclusions Chest CT severity score positively correlates with markers of COVID-19 severity and presents promising efficacy in predicting critical illness. It is suggested that ground-glass opacities are linked to prolonged viral positivity. Further studies should confirm the efficacy of the severity score and elucidate the long-term pulmonary effects of COVID-19.

Highlights • The clinical evaluation of a suspected pulmonary infection faces a diagnostic challenge due to the variety of possible viral organisms. • Certain radiographic and computed tomographic patterns may suggest a particular viral pathogen as the cause of the infection. • In most of the cases a definite diagnosis cannot be achieved on the basis of imaging features alone. • Interpretation of the radiological findings should always be made with awareness of epidemiology and clinical presentation., Respiratory viruses are the most common causes of acute respiratory infections. However, identification of the underlying viral pathogen may not always be easy. Clinical presentations of respiratory viral infections usually overlap and may mimic those of diseases caused by bacteria. However, certain imaging morphologic patterns may suggest a particular viral pathogen as the cause of the infection. Although definitive diagnosis cannot be made on the basis of clinical or imaging features alone, the use of a combination of clinical and radiographic findings can substantially improve the accuracy of diagnosis. The purpose of this review is to present the clinical, epidemiological and radiological patterns of lower respiratory tract viral pathogens providing a comprehensive approach for their diagnosis and identification in hospitals and community outbreaks.

Chronic exposure of workers to powder containing crystalline silica (Silicon dioxide; SiO2) can lead to chronic lung diseases (lung cancer, silicosis, etc.). Aim of this study was to evaluate the exposure of Greek construction workers to SiO2 and describe their pulmonary function. The study involved 86 outdoor and underground workers. Medical and professional history was obtained, and breath samples were collected at morning hours through a mask for the determination of SiO2 levels. Pulmonary function tests, radiological examination and evaluation of radiographs were also performed. Pulmonary function examination showed that the majority of the workers were within normal range (61.4%) while the rest were diagnosed with mild (26.5%) and more severe impairment (7.24%). Working conditions (underground-outdoor) were statistically significantly related to the categorization of pulmonary function (P=0.038). During radiological examination, the type of working activity/ conditions (underground-outdoor) were statistically significantly related to the categorization of these findings (P=0.044). Of the 69 employees, 52 did not present findings (75.4%) and 5 were diagnosed with findings specific to occupational diseases (7.23%). Environmental exposure to respirable crystalline silica (RCS) was detected at 0.0125 mg/m3 in the workplace, which is not beyond the legal limits. Underground workers with more than 15 years of exposure to SiO2 are more likely to present chronic silicosis compared to the workers of outdoor activities.

Chronic exposure of workers to powder containing crystalline silica (SiO2) can lead to chronic lung diseases (lung cancer, silicosis, etc.). The aim of the study was to evaluate the exposure of Greek construction workers to SiO2 and describe their pulmonary function. The study involved 86 outdoor and underground workers. Medical and professional history was obtained, and breath samples were collected at morning hours through a mask for the determination of SiO2 levels. Pulmonary function tests, radiological examination and evaluation of radiographs were, also performed. During the examination of the pulmonary function, the majority of the workers were within normal range (61.4%) while the rest were diagnosed with mild (26.5%) and more severe impairment (7.2%). Working conditions (underground-outdoor) were statistically significantly related to the categorization of pulmonary function (p = 0.038). During radiological examination, the type of working conditions (underground-outdoor) were statistically significantly related to the categorization of these findings (p = 0.044). Of the 69 employees, 52 did not present findings (75.4%) and five (5) were diagnosed with findings specific to occupational diseases (7.2%). The environmental exposure to RCS (Respirable crystalline silica) was detected at 0,0125 mg/ m3 in the workplace, which is not beyond the legal limits. Underground workers with more than 15 years of exposure to SiO2 are more likely to present chronic silicosis compared to the workers of outdoor activities.

Introduction and Aim: Percutaneous computed tomography-guided (CT-guided) thermal ablation is a minimally invasive method for the treatment of adrenal metastases, painful bone metastases and liver metastases originating from non-small cell lung cancer (NSCLC). We aimed to further evaluate the safety and efficacy of CT-guided radiofrequency ablation (RFA) and microwave ablation (MWA) in the management of metastases in a real-life cohort of NSCLC patients. Methods: The medical records of 142 patients with metastatic NSCLC (71, 32 and 40 patients with adrenal metastases, painful bone metastases and liver metastases, respectively) treated with CT-guided RFA or MWA were retrospectively studied. The efficacy of thermal ablation was evaluated by post-ablation imaging. For painful bone metastases, palliation was assessed by the Brief Pain Inventory (BPI) score. Results: Technical success of CT-guided thermal ablation was 100%. No major complications occurred. Among patients with adrenal metastases treated with RFA or MWA, local recurrence was observed in 17.1% and 19.4% of cases at 1-year follow up, respectively. In patients with painful bone metastases, significant pain relief was noted after thermal ablation (p Conclusion: CT-guided RF and MW ablation is a safe and effective local treatment for the management of adrenal, bone and liver metastases from NSCLC. For painful bone metastases RF ablation provides significant pain relief.

We report a case of a female admitted to the emergency department with fever and severe type I acute respiratory failure. After detailed examination, all other potential causes were excluded and the patient was diagnosed with nitrofurantoin-induced acute pulmonary toxicity.

Purpose: To retrospectively evaluate the effectiveness and safety of microwave ablation in 42 patients with NSCLC. Materials and Methods: The last three years, 42 patients were submitted for percutaneous microwave ablation sessions. All tumors were larger than 3cm. The procedure was performed under local anesthesia. A thin (14,5G) antenna was placed directly into the tumor. Duration of each session ranged between 3-12 minutes. Follow-up contrast enhanced CT scans were obtained. Results: Follow up CT scans revealed lack of enhancement in 19 patients (45.2%), partial enhancement in 10 (23.8%), who all underwent a second session and four (9.52%) even a third session. ![Figure][1] ![Figure][1] No major complications occurred. No significant worsening in pulmonary function occurred. Post-ablation syndrome was reported in 9 patients (21.42%). Minor complications occurred in a minority of patients; productive cough in 13 patients (25.49%), small pleural effusions in 6 patients (14.28%). Small pneumothorax occurred in 4 patients (9.52%) and was self limited. Conclusion: Microwave ablation is effective and may be safely applied to NSCLC tumors. [1]: pending:yes

Purpose: To evaluate the safety and effectiveness of CT-guided percutaneous drainage of lung abscesses. Methods: In our department between 1/1/2007 and 1/1/2015, eighty patients with lung abscesses, in which antibiotic therapy failed, underwent CT-guided percutaneous drainage. Catheter placement was carried out using the Trocar technique in the majority of the cases ![Figure][1] ![Figure][1] Results: Lung abscess completely resolved in sixty six patients. Fourteen patients had residual cavity and surgery was performed. The success rate was 82.5%(66/80). Ten (12.5%) patients developed pneumothorax. Six developed moderate pneumothorax (7.5%) and chest-tube was inserted and four patients developed mild pneumothorax (5%) which was managed with aspiration. These patients were kept under observation and followed-up by chest X-rays. No other complications and no mortality occurred during the procedure for all eighty patients. Conclusion: CT-guided percutaneous catheter drainage is a useful and safe procedure for the treatment of patients with lung abscesses who do not respond to medical therapy and should be considered as a valuable alternative to open surgery. [1]: pending:yes

Time changes in plasma concentrations of six different cytokines were investigated to evaluate the inflammatory response to renal artery stent placement.A total of 22 patients (17 men; mean age, 66 years +/- 13) with ostial renal artery stenosis and poorly controlled hypertension treated with stent placement were studied. Blood samples were collected at baseline and at 24 hours and 6 months after the intervention. Plasma concentrations of (i) tumor necrosis factor-alpha, (ii) interleukin-6 (IL-6), (iii) monocyte chemoattractant protein-1, (iv) intercellular adhesion molecule-1, (v) vascular cell adhesion molecule-1, and (vi) regulated upon activatin normal T-cell expressed presumed secreted were measured. Restenosis diagnosed with imaging follow-up at 6 months was recorded. Plasma concentrations of the aforementioned cytokines were compared between patients with and without restenosis.IL-6 concentration increased significantly 24 hours after stent placement (8.3 pg/mL +/- 1.24 vs. 2.76 pg/mL +/- 1.27 at baseline) and returned to baseline levels (2.6 pg/mL +/- 1.77) at 6-month follow-up (P.0001). No significant changes occurred in the concentrations of any other cytokines at the three time points. Baseline and 6-month concentrations of IL-6 were significantly higher in patients with restenosis than in those without restenosis (8.13 pg/mL +/- 4 vs 0.75 pg/mL +/- 0.47 [P.005] and 9.55 pg/mL +/- 6.5 vs 0.42 pg/mL +/- 0.35 [P.02], respectively).Renal artery angioplasty with stent placement induces an inflammatory response, as evidenced by increased IL-6 production. Additionally, IL-6 seems to identify patients prone to develop restenosis; therefore, it might be used as an early predictor of restenosis after renal angioplasty with stent placement. However, larger studies are required to confirm IL-6 as a potential predictor of restenosis.