Diffuse Pulmonary Nodules
SarcoidosisSarcoidosis is a systemic inflammatory disease that predominantly involves the lungs but also may affect the joints, eyes, kidneys, and skin. The disease most commonly develops between the ages of 25 and 40 years. Although the exact cause of sarcoidosis is unknown, it may reflect a disproportional immunologic reaction against a bacterial or environmental antigen. The diagnosis of sarcoidosis is often made when characteristic findings are detected incidentally on a chest radiograph obtained for unrelated symptoms. Patients may have persistent cough or such systemic manifestations as erythema nodosum, uveitis, arthralgia, arthritis, and hypercalcemia. The most common complication of sarcoidosis is respiratory failure due to pulmonary fibrosis. Cardiac involvement can result in myocardial infarction, arrhythmias, or even sudden death.
To describe the chest CT features reported in children with confirmed COVID-19 infection, published in English literature. A systematic review was completed on PubMed, Embase and Scopus databases on the 1st of June 2020 using the PICO strategy. The NIH Quality Assessment Tool was used to assess the quality of the selected articles. The systematic review was evaluated by Case Series Studies and the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA). The extracted data were assessed and compared with those reported in the adult population. Seventy-two articles were retrieved from the database search and screened by the title, abstract and keywords. Eleven articles were deemed eligible for full-text assessment. Nine articles were included for the data extraction and in the final analysis. Chest CT features in children with COVID-19 differ from those in adults. 'Groundgrass opacities' (GGOs) are the most commonly described abnormalities, but closely followed by a combination of GGO and consolidation, not usual in adults. Children tend to have a more variable involvement than the subpleural and posterior and basal topography described in adults. Interlobular thickening and air bronchogram found in adults with COVID-19 are not frequent in children. Pulmonary embolism reported in up to 30% of adults has not been yet reported in children. Original articles describing chest CT features in children with COVID-19 in the English literature are limited to small populations of Chinese children. Chest CT imaging features are very diverse across the selected studies and globally different from those reported in adults. Data from children of different countries would provide a more comprehensive description of chest CT features in children with COVID-19.
The intra-articular injection of the knee under fluoroscopic guidance with the patient in lateral position is an easy technique for operators in training with a low rate of extravasation. Lateral position does not require a supplementary irradiation and does not increase the procedural pain. Personal operator's skill is an independent factor in determining the success of the training.
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