Differential diagnoses of acute ground-glass opacity in chest computed tomography: pictorial essay

Matos, Marina Justi Rosa de; Rosa, Marcela Emer Egypto; Brito, Vanessa Mizubuti; Amaral, Lucas Tadashi Wada; Beraldo, Gabriel Laverdi; Fonseca, Eduardo Kaiser Ururahy Nunes; Chate, Rodrigo Caruso; Passos, Rodrigo Bastos Duarte; Silva, Murilo Marques Almeida; Yokoo, Patrícia; Neto, Roberto Sasdelli; Teles, Gustavo Borges da Silva; Silva, Marina Carolina Bueno da; Szarf, Gilberto

doi:10.31744/einstein_journal/2021rw5772

Cited by 7 publications

(6 citation statements)

References 20 publications

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“…Most of the patients readmitted showed chest CT typical for SARS‐CoV‐2 infection, with bilateral pulmonary involvement and ground‐glass opacities. This clinical aspect is very characteristic of the disease and has been reported in a specific report of the World Health Organization 11 . Approximately half of readmitted patients required ICU treatment, with pulmonary involvement (≥50%), LOS, days between discharge/first readmission, and use of oxygen therapy significantly higher than patients who did not need the ICU.…”

Section: Discussionmentioning

confidence: 52%

“…This clinical aspect is very characteristic of the disease and has been reported in a specific report of the World Health Organization. 11 Approximately half of readmitted patients required ICU treatment, with pulmonary involvement (≥50%), LOS, days between discharge/first readmission, and use of oxygen therapy significantly higher than patients who did not need the ICU. In multivariate analysis, longer LOS, longer days between discharge/first readmission, and pulmonary involvement (≥50%) were independently associated with ICU admission.…”

Section: Discussionmentioning

confidence: 95%

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Longer length of stay, days between discharge/first readmission, and pulmonary involvement ≥50% increase prevalence of admissions in ICU in unplanned readmissions after COVID‐19 hospitalizations

Peixoto

Wolf

Glaeser

et al. 2022

Journal of Medical Virology

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Hospital readmissions due to COVID-19 are one of the main concerns for the health system due to risks to the patient's life and increased use of health resources.Studies focusing on this issue are important to understand the risk factors and create strategies to avoid readmissions. We evaluated the readmission of patients with confirmed COVID-19 in a private hospital in southern Brazil, between March 2020 and 2021. Also, the characteristics and clinical outcomes of patients admitted to the intensive care unit (ICU) and nonadmitted were compared. Poisson regression models with prevalence ratio (PR) with 95% confidence intervals (95% CIs) were applied to confirm the association between variables and ICU admission. Of the 2084 hospitalized patients with COVID-19, 1806 were discharged alive. Among them, 106 were readmitted for unplanned reasons during one year. Early hospital readmission (≤30 days) occurred in 52.8% of the cases. The main reasons were respiratory, gastroenterological, kidney, and cardiac disease. The median age was 73.0 years old and women correspond to 52.8%. The presence of at least one comorbidity was detected in 87.7% of patients. Hypertension, diabetes, cardiac, and lung disease were more frequent. The ICU admitted patients (n = 43; 40.5%) mostly had 4-5 comorbidities, pulmonary involvement ≥50%, length of stay (LOS), and days between discharge and first readmission. Longer LOS (PR: 3.46; 95% CI: 1.24-5.67), days between discharge/first readmission (PR: 2.21; 95% CI: 1.15-5.88), and pulmonary involvement (≥50%; PR: 1.59; 95% CI: 1.11-3.54) were independently associated with ICU admission. Longer LOS, longer days between discharge/first readmission, and pulmonary involvement (≥50%) were associated with ICU admission in readmitted patients. Readmissions evaluation is pivotal and may help in ensuring safe care transition and postdischarge follow-up.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 95%

Longer length of stay, days between discharge/first readmission, and pulmonary involvement ≥50% increase prevalence of admissions in ICU in unplanned readmissions after COVID‐19 hospitalizations

Peixoto

Wolf

Glaeser

et al. 2022

Journal of Medical Virology

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“…Pulmonary GGO is a very frequent and nonspeci c nding in chest computed tomography [4] . Clinically, the common causes of GGO include infections (atypical bacterial and viral infections), intrapulmonary hemorrhage, diffuse alveolar damage, pulmonary embolism, bronchioloalveolar carcinoma, atypical adenomatoid hyperplasia, and active PTB [5][6][7][8][9][10] . Though the main CT signs of active PTB include bronchial spread (central lobular nodules, tree bud signs, micronodules), consolidation, voids, patch shadows with blurred edges, ground glass density shadows, and bronchial wall thickening [10] , GGO can also be seen in active tuberculosis patients, and it is mainly manifested as reversed hato sign (RHS).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary tuberculosis complicated by extensive and multiple ground-glass opacity diagnosed by metagenomic next-generation sequencing in a patient with normal immune function: A case report

Mao

Qian

et al. 2023

Preprint

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A 53-year-old immune-competent female presented with atypical pulmonary tuberculosis (PTB) imaging complicated by extensive and multiple clear boundary ground-glass opacity (GGO) in both lungs. Conventional diagnostic methods for infectious or non-infectious causes failed to identify the etiology. To further detect the accurate pathogen, bronchoalveolar lavage fluid (BALF) was collected for metagenomic next-generation sequencing (mNGS). Mycobacterium tuberculosis was identified by mNGS, thus the patient was diagnosed with PTB. The GGO lesions were healed after the patient received anti-tuberculosis treatment. In a follow-up after 3 months, the patient’s GGO lesion vanished. Based on these results, we for the first time reported a case of PTB in an immune-competent patient complicated by extensive and multiple GGO. And we found that mNGS was a useful complement to conventional pathogenic diagnostic methods and can be used to diagnose infections of unknown cause.

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“…Non-infectious causes were also considered. Two-dimensional echocardiogram and CT pulmonary angiogram excluded cardiogenic pulmonary edema and pulmonary infarct ( 13 - 15 ). The chest imaging and acuity of symptoms were also inconsistent with aspiration pneumonia and childhood interstitial lung disease ( 16 ).…”

Section: Case Presentationmentioning

confidence: 99%

Trimethoprim-sulfamethoxazole-induced lung injury: a case report

Huang,

Kam,

Tan

et al. 2023

Transl Pediatr

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Background Trimethoprim-sulfamethoxazole (TMP-SMX) is a commonly used antibiotic. While cutaneous adverse drug reactions associated with TMP-SMX are commonly recognized, lung toxicity induced by TMP-SMX is an unusual condition, with scattered reports of hypersensitivity pneumonitis, acute fibrinous organizing pneumonia, interstitial lung disease and acute respiratory distress syndrome. Reports of TMP-SMX-associated drug-induced lung injury (DLI) are rare in the pediatric population and its pathogenesis is not well understood. Diagnosis of DLI remains a challenge, given the wide range of clinical presentations that overlap with other conditions and the lack of diagnostic tests. In this report, we describe a case of TMP-SMX-induced lung injury in an eight-year-old child. Case Description An eight-year-old girl presented in respiratory failure with acute symptoms of shortness of breath, fever, maculopapular rash and vomiting. This was associated with pneumonitis, pneumothorax, pneumomediastinum and subcutaneous emphysema on imaging. She had been on 25 days of TMP-SMX for treatment of Group D Salmonella bacteremia and osteomyelitis that was diagnosed prior to this current presentation. TMP-SMX was discontinued on admission due to concerns of possible drug reaction. Extensive infective, autoimmune and immunologic workup did not reveal the cause of the respiratory failure. Considering the absence of an alternative explanation for her clinical presentation and similarities in clinical courses to other reported cases, she was eventually diagnosed with TMP-SMX-associated DLI. She received a course of corticosteroids with subsequent clinical improvement and was weaned off home oxygen therapy a few months after her discharge from the hospital. Conclusions Diagnosis of DLI can be challenging. The early identification of DLI and discontinuation of culprit drug is essential in its management. Further understanding of the underlying pathophysiology and risk factors for TMP-SMX-associated DLI is required.

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Differential diagnoses of acute ground-glass opacity in chest computed tomography: pictorial essay

Cited by 7 publications

References 20 publications

Longer length of stay, days between discharge/first readmission, and pulmonary involvement ≥50% increase prevalence of admissions in ICU in unplanned readmissions after COVID‐19 hospitalizations

Longer length of stay, days between discharge/first readmission, and pulmonary involvement ≥50% increase prevalence of admissions in ICU in unplanned readmissions after COVID‐19 hospitalizations

Pulmonary tuberculosis complicated by extensive and multiple ground-glass opacity diagnosed by metagenomic next-generation sequencing in a patient with normal immune function: A case report

Trimethoprim-sulfamethoxazole-induced lung injury: a case report

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