El diámetro del tronco pulmonar y su relación con diferentes grados de neumonía

El tronco de la arteria pulmonar (AP) ha tomado relevancia en el diagnóstico de la hipertensión pulmonar y su asociación con complicaciones en patologías pulmonares, procedimientos quirúrgicos y disfunción ventricular derecha. La tomografía computarizada (TC) de tórax ha tenido gran valor diagnóstico y pronóstico en el caso de patologías respiratorias y cardiovasculares, por lo que es de utilidad en la medición de la AP en este tipo de población. En diversos estudios se ha observado una correlación entre el diámetro de la AP y la severidad de la neumonía, por lo que es importante determinar un marco de referencia en población mexicana respecto al diámetro de la AP para apoyar en la toma de decisiones terapéuticas y en la definición del pronóstico de los pacientes. El objetivo del presente estudio es definir el diámetro normal del tronco de la arteria pulmonar en población mexicana sana, así como en pacientes con diferentes grados de neumonía y la asociación entre este tipo de poblaciones

Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study

Objectives: To identify the diagnostic accuracy of common imaging modalities, chest X-ray (CXR) and CT, for diagnosis of COVID-19 in the general emergency population in the UK and to find the association between imaging features and outcomes in these patients. Design: Retrospective analysis of electronic patient records. Setting Tertiary: academic health science centre and designated centre for high consequence infectious diseases in London, UK. Participants 1198 patients who attended the emergency department with paired reverse transcriptase PCR (RT-PCR) swabs for SARS-CoV-2 and CXR between 16 March and 16 April 2020. Main outcome measures: Sensitivity and specificity of CXR and CT for diagnosis of COVID-19 using the British Society of Thoracic Imaging reporting templates. Reference standard was any RT-PCR positive naso-oropharyngeal swab within 30 days of attendance. ORs of CXR in association with vital signs, laboratory values and 30-day outcomes were calculated. Results: Sensitivity and specificity of CXR for COVID-19 diagnosis were 0.56 (95% CI 0.51 to 0.60) and 0.60 (95% CI 0.54 to 0.65), respectively. For CT scans, these were 0.85 (95% CI 0.79 to 0.90) and 0.50 (95% CI 0.41 to 0.60), respectively. This gave a statistically significant mean increase in sensitivity with CT of 29% (95% CI 19% to 38%, p<0.0001) compared with CXR. Specificity was not significantly different between the two modalities. CXR findings: were not statistically significantly or clinically meaningfully associated with vital signs, laboratory parameters or 30-day outcomes. Conclusions: Computed tomography has substantially improved diagnostic performance over CXR in COVID-19. CT should be considered in the initial assessment for suspected COVID-19 instead of CXR if capacity allows and balanced against radiation exposure risk