Objective The main objective of our study was to describe the pulmonary distribution of consolidation and ground-glass opacity (GGO) in chest computed tomography (CT) scans of Streptococcus pneumoniae pneumonia. In addition, the percentage of other pulmonary abnormalities was also reported. Methods We retrospectively evaluated chest CT examinations performed between November 2008 and January 2010 in 39 patients with S. pneumoniae pneumonia. Eight patients with Haemophilus influenzae pneumonia were also included for comparison. Patients There were 19 women and 28 men with clinical symptoms of fever and productive cough and laboratory findings of leukocytosis with markedly high C-reactive protein levels. Chest X-ray scores before and after treatment were calculated. The average score before treatment was 4. The average score after treatment was 0. Parenchymal abnormalities were evaluated along with the presence of enlarged lymph nodes and pleural effusions. The distribution of parenchymal disease was also analyzed. Results The chest CT findings in the patients with S. pneumoniae pneumonia consisted primarily of consolidation (56.4%), ground-glass opacity (71.7%), interlobular reticular opacity (69.2%), centrilobular nodules (53.8%), interlobular septal thickening (46.6%), bronchial wall thickening (46.6%), lymph node enlargement (10.2%) and pleural effusion (10.2%). Segmental distribution (65.7%) was seen more frequently than nonsegmental distribution (35.9%). Abnormal findings were noticed bilaterally in 14 patients and unilaterally in 25 patients. On both the right and left sides, predominant zonal distributions were seen in the lower lobes. In contrast, among the eight patients with H. influenzae pneumonia, one patient had both segmental and nonsegmental distributions and the remaining seven patients had only segmental distributions. Conclusion In conclusion, segmental distributions of parenchymal abnormalities are more common than non-segmental distributions on chest CT scans of patients with S. pneumoniae pneumonia.

The traditional surgical pathology assessment requires tissue to be removed from the patient, then processed, sectioned, stained, and interpreted by a pathologist using a light microscope. Today, an array of alternate optical imaging technologies allow tissue to be viewed at high resolution, in real time, without the need for processing, fixation, freezing, or staining. Optical imaging can be done in living patients without tissue removal, termed in vivo microscopy, or also in freshly excised tissue, termed ex vivo microscopy. Both in vivo and ex vivo microscopy have tremendous potential for clinical impact in a wide variety of applications. However, in order for these technologies to enter mainstream clinical care, an expert will be required to assess and interpret the imaging data. The optical images generated from these imaging techniques are often similar to the light microscopic images that pathologists already have expertise in interpreting. Other clinical specialists do not have this same expertise in microscopy, therefore, pathologists are a logical choice to step into the developing role of microscopic imaging expert. Here, we review the emerging technologies of in vivo and ex vivo microscopy in terms of the technical aspects and potential clinical applications. We also discuss why pathologists are essential to the successful clinical adoption of such technologies and the educational resources available to help them step into this emerging role.

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Context.— Histopathology is the current standard to diagnose skin disease. However, biopsy may not always be feasible, such as in patients with multiple nevi, a patient with a lesion on an aesthetically significant site, or in children. Recently, noninvasive techniques, including reflectance confocal microscopy (RCM), optical coherence tomography, and Raman spectroscopy, have enabled dermatologists to manage skin lesions in real time without the need for biopsy. Objective.— To report the updated diagnostic accuracy of RCM for equivocal skin lesions. Design.— In this study, we retrospectively reviewed our data of clinically suspicious lesions from 2010 to 2017 that were evaluated by RCM. Results.— Our results showed an overall sensitivity of 98.2% and specificity of 99.8%. Conclusions.— In conclusion, RCM is a noninvasive real-time tool with the potential to diagnose skin lesions with high accuracy and without biopsy.

As the onset of novel variants of the severe acute respiratory syndrome coronavirus 2 virus pushes policymakers to push widespread vaccination efforts, it is likely that an increased number of severe cutaneous adverse reactions (SCARs) will present. Therefore, it is important to understand the presentation of possible SCARs. However, data are limited regarding which SCARs are most likely to be found following vaccination, and specific presentations in certain demographic groups, such as postmenopausal women, remain widely unknown. Here, we present the case of a 73-year-old female with no medical history or allergies presenting with a unique reaction of systemic bullous pemphigoid following the Moderna mRNA-1273 vaccine. To our knowledge at the time of this writing, based on a thorough review of the literature using PubMed, no such cases exist following the Moderna vaccine in the United States in elderly, postmenopausal women. We present a brief discussion on the presentation and management to hopefully alleviate future morbidity from similar reactions with increased distribution of the vaccine.

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