Fire eater's pneumonia: radiographic and CT findings

Acute aspiration of petroleum by fire eaters can cause a distinct type of chemical pneumonitis known as fire eater's pneumonia that manifests on radiologic studies with unilateral or bilateral lung consolidations, well defined nodules, and pneumatoceles. We report three cases of fire eater's pneumonia that manifested with well-defined cavitary nodules (pneumatoceles) on radiographs and CT. One patient developed a bronchopleural fistula and spontaneous pyopneumothorax. CT is valuable for identifying and localizing complications to guide therapy.     

Imaging features of 2019 novel coronavirus pneumonia

European Journal of Nuclear Medicine and Molecular Imaging -     

Chest CT findings of coronavirus disease 2019 (COVID-19): A comprehensive meta-analysis of 9907 confirmed patients

ObjectivesWe performed a systematic review and meta-analysis of the prevalence of chest CT findings in patients with confirmed COVID-19 infection.MethodsSystematic review of the literature was performed using PubMed, Scopus, Embase, and Google Scholar to retrieve original studies on chest CT findings of patients with confirmed COVID-19, available up to 10 May 2020. Data on frequency and distribution of chest CT findings were extracted from eligible studies, pooled and meta-analyzed using random-effects model to calculate the prevalence of chest CT findings.ResultsOverall, 103 studies (pooled population: 9907 confirmed COVID-19 patients) were meta-analyzed. The most common CT findings were ground-glass opacities (GGOs) (77.18%, 95%CI = 72.23–81.47), reticulations (46.24%, 95%CI = 38.51–54.14), and air bronchogram (41.61%, 95%CI = 32.78–51.01). Pleural thickening (33.35%, 95%CI = 21.89–47.18) and bronchial wall thickening (15.48%, 95%CI = 8.54–26.43) were major atypical and airway findings. Lesions were predominantly distributed bilaterally (75.72%, 95%CI = 70.79–80.06) and peripherally (65.64%, 95%CI = 58.21–72.36), while 8.20% (95%CI = 6.30–10.61) of patients had no abnormal findings and pre-existing lung diseases were present in 6.01% (95%CI = 4.37–8.23).ConclusionsThe most common CT findings in COVID-19 are GGOs with/without consolidation, reticulations, and air bronchogram, which often involve both lungs with peripheral distribution. However, COVID-19 might present with atypical manifestations or no abnormal findings in chest CT, which deserve clinicians' notice.     

Adenovirus pneumonia in adults: radiographic and high-resolution CT findings in five patients

OBJECTIVE: The purpose of this study was to describe the radiographic and high-resolution CT (HRCT) findings of adenovirus pneumonia in five patients. CONCLUSION: Adenovirus pneumonia in adults appears as bilateral patchy parenchymal opacities on chest radiographs and as bilateral ground-glass opacities with a random distribution with or without consolidation on HRCT images. These findings, however, are not specific for adenovirus pneumonia.     

Preliminary CT findings of coronavirus disease 2019 (COVID-19)

ObjectivesCoronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This paper aims to examine the CT imaging characteristics of COVID-19.MethodsWe evaluated CT images obtained between 10 January 2019 and 16 February 2020 at Taihe Hospital. Scans were conducted 2–6 times per patient and the re-testing interval was 2–7 days. Ninety-five patients with positive SARS-CoV-2 nucleic acid test results were included in this study and we retrospectively analysed their CT imaging characteristics.ResultsNinety-five patients underwent 2–3 SARS-CoV-2 nucleic acid tests and received a definitive diagnosis of COVID-19. Fifty-three were male and 42 were female, and their mean age was 42 ± 12 years (range: 10 months to 81 years). Sixty-nine patients (72.6%) experienced fever, fatigue, and dry cough, while 15 (15.8%) had poor appetite and fatigue, and 11 (11.6%) had a dry cough and no fever. On CT imaging, early stage patients (n = 53, 55.8%) showed peripheral subpleural ground-glass opacities; these were mainly local patches (22/53, 41.5%), while some lesions were accompanied by interlobular septal thickening. Thirty-four (35.8%) patients were classified in the ‘progression stage’ based on CT imaging; these patients typically showed lesions in multiple lung segments and lobes (21/34,61.8%), and an uneven increase in ground-glass opacity density accompanied by consolidation and grid-like or cord-like shadows(30.5%). Two patients (2.1%) showed a severe presentation on CT. These showed diffuse bilateral lung lesions, mixed ground-glass opacities and consolidation with cord-like interstitial thickening and air bronchograms, entire lung involvement with a “white lung” presentation, and mild pleural effusion. Six patients in remission (6.3%), visible lesion absorption, fibrotic lesions. Based on clinical signs, 71 (74.7%), 22 (23.2%), and 2 (2.1%) patients had mild or moderate, severe, and critical disease, respectively. Within the follow-up period, 93 patients recovered and were discharged, including the 53 early stage patients and 34 progression stage patients. The length of hospitalisation was 7–28 days (mean: 10 ± 3.5 days). On discharge, lesions were significantly reduced in area and had in many cases completely disappeared, while slight pulmonary fibrosis was present in some patients. One severe stage patient was still hospitalised at the end of the follow-up period and the other severe stage patient died. The overall mortality rate was 1.05%.ConclusionsUnderstanding the CT imaging characteristics of COVID-19 is important for early lesion detection, determining the nature of lesions, and assessing disease severity.     

Intrathoracic gossypiboma: radiographic and CT findings

Intrathoracic gossypiboma, a retained surgical sponge in the thoracic cavity, is a rare but serious consequence following surgery. Because of its rare occurrence and non-specific clinical and radiographic presentations, the diagnosis is often missed. Herein we report a patient presenting with a chronic recurrent cough due to a retained surgical sponge in the pleural cavity. The patient has been misdiagnosed with bronchiectasis for 22 years. The characteristic spongiform appearance on CT and a history of previous thoracic surgery led to the diagnosis of a gossypiboma that was confirmed at surgery.     

Thoracic paracoccidioidomycosis: radiographic and CT findings

Paracoccidioidomycosis (PCM) is the most common systemic mycosis in Latin America. Although most cases occur in developing countries, recent immigration patterns and an increase in travel have led to a growing number of PCM cases in the United States and Europe. PCM is caused by the dimorphic fungus Paracoccidioides brasiliensis, and the chronic form may progress to severe pulmonary involvement. Several radiologic patterns have been described for pulmonary PCM, including linear and reticular opacities, variable-sized nodules, patchy ill-defined opacities, airspace consolidation, and cavitary lesions. Fibrosis and paracicatricial emphysema are common associated findings. Chest computed tomography (CT) is the method of choice for evaluating pulmonary PCM, with the most common CT findings being ground-glass attenuation, consolidation, small or large nodules, masses, cavitations, interlobular septal thickening, emphysema, and fibrotic lesions. PCM is also an important cause of the "reversed halo" sign at high-resolution CT and should be considered in the differential diagnosis. Awareness of the multiple radiologic manifestations of PCM as well as its epidemiologic and clinical characteristics may permit early diagnosis and initiation of specific treatment, thereby reducing associated morbidity and mortality.     

Neonatal herpes simplex pneumonia: radiographic findings

The radiologic findings in the lungs of 16 hospitalized neonates with disseminated herpes simplex infection were retrospectively reviewed. A sequential picture was devised of four stages in the evolution of the pneumonitis of this hematogenous infection. The radiologic stages were: Stage I, normal chest; Stage II, prominent perihilar interstitial markings; Stage III, coalescent areas of pulmonary infiltrates; and Stage IV, diffuse alveolar and interstitial disease ("white-out" lungs). In general, the pulmonary abnormalities were widespread and without air trapping. Pleural effusions were noted in one case. All affected neonates died and antemortem clinical and radiological findings were correlated with multiple-organ postmortem histopathologic evidence of viral infection, especially with the associated pneumonia.     

Clinical manifestations and chest radiographic and CT findings of round pneumonia in adults]

Whereas round pneumonia in children is well known, there are few reports of this condition in adults. Chest radiographs, CT findings, clinical manifestations, and peripheral blood results in 14 cases of round pneumonia in 14 adults were evaluated. Round pneumonias ranged in size from 1 to 7 cm. Only round pneumonia was seen in 12 cases, whereas other consolidations besides round pneumonia were present in 2 cases. Eleven of 14 cases of round pneumonia were located in the lower lobes, and 8 of these 11 cases were in the superior segment of the lower lobe. Round pneumonia showed faint density in 9 cases and clear density in 5, while the margin was slightly ill-defined in 10 and well-defined in 4. No characteristic features of round pneumonia were shown on CT scan. CT showed other consolidations besides round pneumonia in 7 of 9 cases in which CT scan was carried out. Most large-sized (more than 2 cm) round pneumonias were associated with fever and elevated WBC and CRP, whereas most small (less than 2 cm) round pneumonias were associated with normal blood results and no fever. Round pneumonia in adults is not uncommon. Most round pneumonias present as slightly dense or ill-defined masses in the posterior subpleural region of the lower lobe. Round pneumonia is suggested by a history of cough, fever, elevated WBC and CRP, and a recent chest radiograph with normal findings.     

Pseudoprominent aorta: radiographic findings and CT correlation

The presence of a persistent left-sided superior vena cava (LSVC) in the absence of a right-sided superior vena cava (RSVC) may be suspected on a posteroanterior (PA) chest radiograph because of a prominent-appearing ascending aorta, which results from the absence of the RSVC. In the absence of an RSVC, the right upper lobe abuts and outlines the course of the ascending aorta, allowing better demonstration of its profile. This report describes a patient with this finding on a PA chest radiograph. Computed tomographic correlation is presented.