Comparison of chest X-ray lesion characteristics of multidrug-resistant tuberculosis and non-tuberculous mycobacterial infection

Purpose: This research aimed to compared chest radiographic characteristics of multidrug-resistant tuberculosis (MDR-TB) and non-tuberculous mycobacteria (NTM) infection, which can be used in early diagnostic screening. Material and methods: The method of this study was cross-sectional to obtain the relationship between radiographic findings. Results: Among 538 subjects who were positive for TB during screening, 11 (2.04%) had MDR-TB, 147 (27.32%) had drug-sensitive TB, and 380 (70.63%) had NTM infection. The radiographic findings that correlated with MDR-TB were infiltrates (p = 0.010), cavities (p = 0.021), nodules (p = 0.001), and fibrosis (p = 0.010), with the best predictor of MDR-TB lesions being the presence of a nodule. The lesion locations related to MDR-TB were the upper right and left lung (p = 0.00). There were no specific lesions present in NTM infection (p < 0.05) because almost all had a meaningful correlation (p < 0.05), except the presence of a mass. The lesion location related to NTM infection was the medial aspect of the left lung (p = 0.01), and the lesion extent was also correlated (p < 0.05). Conclusions: Chest X-ray lesion characteristics of MDR-TB show significant correlation among cavities, nodules, and fibrosis. There were no specific lesions that could differentiate NTM infection from MDR-TB; however, the most common lesion location in NTM infection was the medial aspect of the left lung

The role of Chest HRCT in diagnosis active tuberculosis & lung destruction

Tuberculosis is a public health problem caused by Mycobacterium tuberculosis. In 2021 there will be 10.6 million cases in the world, and Indonesia ranks 2nd with 700,000 cases. In 2022, there will be 17,303 cases in North Sumatra Province and 2,430 cases in Medan City. In current practice, evaluation and diagnosis of active tuberculosis relies on bacteriological examination and Chest Radiographs. However, Chest Radiographs have limited specificity and high intraobserver and interobserver variability. HRCT is also not widely used as a routine option for patients suspected of suffering from tuberculosis, even though HRCT has high accuracy in detecting tuberculosis. We present a case of a patient with active pulmonary tuberculosis and lung destruction e.c. advanced pulmonary tuberculosis (MDR-Tuberculosis) (declared cured in 2018 after 2 years of treatment). This patient was evaluated with chest radiograph and chest HRCT. In this case, the initial findings on the Chest Radiograph, showed the impression of inactive tuberculosis but on further examination with chest HRCT, there was a tree in bud image which indicated active tuberculosis. This shows that there are limitations in diagnosing tuberculosis activity using Chest Radiographs. Due to the significant role of HRCT in the diagnosis of tuberculosis activity, it is necessary to consider the use of HRCT in the evaluation of patients with tuberculosis

The Diagnostic Accuracy of Chest CT in the Detection of Tumor and Nodal Status in Non Small Cell Lung Carcinoma

At this time there is an increasing demand for an accurate pre operative staging in non small cell lung cancer. Chest&nbsp;Computed Tomography (CT) is one of the imaging modality of choice used for this purpose. This study evaluated the&nbsp;accuracy of the chest CT to determine the status of the tumor and nodules in non small cell lung cancer. During the&nbsp;years 1998 and 1999, a descriptive prospective study of 32 patients undergoing a contrast enhanced chest CT&nbsp;examination for non small cell lung cancer, stage I-IIIA, was conducted. Lobectomy, lymph nodes dissection and&nbsp;postoperative histo-pathological examination were done. CT findings were as follows: a sensitivity of 100%, a&nbsp;specificity of 25% and an accuracy of 60% in the detection of the nodule stage were found. In 17 patients with adenocarcinoma,&nbsp;the sensitivity, the specificity and the accuracy were 86.6%, 100% and 88.2% respectively. The diagnosis of&nbsp;all patients was confirmed histo-pathologically. Six patients with T2 and 26 patients with T3 were detected by chest CT;&nbsp;the accuracy of the tumor status was 93.7%, confirmed by surgical and histo-pathological examinations. It was&nbsp;concluded that the CT played an important role in determining the clinical stage of non small cell lung cancer. The&nbsp;specificity and accuracy were higher in adeno-carcinoma as compared with squamous cell carcinoma in detecting the&nbsp;nodal status

Radiology Appearance of Malignant Peripheral Nerve Sheath Tumor: a Case Report

Malignant peripheral nerve sheath tumor (MPNST) merupakan sarkoma jaringan lunak yang jarang. Tumor ini meliputi MPNST sampai 10% dari 1-2 per 100.000 populasi/tahun kasus sarkoma jaringan lunak. Makalah ini memaparkan kasus MPNST yang ditemukan di permukaan tubuh, yaitu kepala bagian frontal, temporal, parietal kanan, leher, lengan kiri, torso, dan di organ-organ dalam yaitu otak, paru-paru, hepar, ginjal kanan, intraabdomen kiri, dan tanpa terkait dengan neurofibromatosis tipe 1 (NF1) serta tanpa riwayat terapi radiasi. Pasien hanya mengeluh sakit pada benjolan di punggung. Gambaran computed tomography (CT) otak ditemukan massa jaringan lunak di subkutis frontal dan parietal, serta lesi hipodens di serebri frontal yang menyangat di perifer setelah pemberian kontras dicurigai ke arah keganasan. Pada foto toraks dan CT paru ditemukan nodul multipel. Tampak pula massa pada ginjal kanan dan massa intrabdomen kiri. Massa heterogen pada hepar lobus kiri ditemukan pada ultrasonografi abdomen. Pemeriksaan histologi memastikan diagnosis MPNST. Pasien ini direncanakan untuk perawatan paliatif

Gambaran CT Scan Toraks Sesuai dengan Jenis Sitologi/Histologi pada Pasien Kanker Paru yang Merokok

Kanker paru merupakan&nbsp; penyebab kematian paling banyak akibat keganasan. Kanker paru memberikan gambaran CT scan yang berbeda sesuai dengan jenis sitologi/histologinya. Pemeriksaan CT scan&nbsp; toraksdengan teknik high resolution computed tomography (HRCT) dapat memperlihatkan kelainan kanker parusecara rinci. Penelitian dilakukan di Instalasi Radiologi RSU Persahabatan, Jakarta bekerja sama denganDepartemen Pulmonologi dan Respirasi RSU Persahabatan terhadap 100 sampel yang diperoleh pada bulanNovember 2014 hingga Maret 2015. Berdasarkan jenis sitologi/histologi kanker paru (adenokarsinoma dankarsinoma sel skuamosa/KSS) tidak ditemukan&nbsp; variabel yang bermakna secara statistik&nbsp; (bentuk, letak, tepispikulasi, tepi lobulasi, nodul satelit). Variabel yang paling banyak ditemukan pada adenokarsinoma maupunKSS adalah bentuk massa, lokasi di sentral dan paru sebelah kanan. Gambaran kanker paru adenokarsinomadan KSS pada pasien merokok paling banyak berupa massa, lokasi di sentral dan lobus kanan paru

Pleural plaques and pleural changes among lung cancer patients exposed to asbestos

Background Indonesia is one of the world's largest asbestos importing countries. While asbestos is the main contributor to work-related lung cancer, studies or reports regarding the CT findings of asbestos-related lung cancer have been limited in the country. The objective of this study was to compare CT findings of the size of the tumor and pleural and lung parenchymal changes between lung cancer patients exposed to asbestosis and those not exposed. Methods This cross-sectional study involved 96 lung cancer patients consisting of 48 subjects who had been exposed to asbestos and 48 who had not been exposed. They underwent thoracic CT scans at the Radiology Department of Persahabatan Hospital. Asbestos exposure was determined using interviews that followed a protocol similar to that of a previous study about asbestos-related lung cancer. Senior radiologists investigated the existence of pleural and parenchymal changes. An independent T- test and chi-square test to compare CT scan features between the two groups. Results The mean age was 57.75 ± 8.56 years in the asbestos-exposed group and 58.56 ± 7.99 years in the unexposed group. The proportion of tumor sizes of more than five cm, pleural plaques, and subpleural dot-like or branching opacities were significantly higher among asbestos-exposed subjects compared to the non-exposed group (p = 0.044;p=0.37;p=0.041, respectively). Conclusions Asbestos exposure is significantly related to the size of the tumor and the existence of pleural plaques and asbestosis. These findings may help further management of lung cancer patients and the policy of asbestos use in Indonesia

Kasus Teratoma Mediastinal Imatur Dengan Komponen Khoriokarsinoma Disertai Sindrom Vena Kava Superior

Tumor sel germinal (TSG) merupakan suatu kelompok neoplasma jinak dan ganas yang berasal dari sel germinal primitif pada awal embriogenesis. TSG sering terjadi di gonad, namun dapat juga di ekstragonad (5-10%). TSG ekstragonad tersering adalah di mediastinum anterosuperior. Salah satu jenis tumor sel germinal teratoma mediastinal imatur primer jarang ditemukan, hanya 1% dari semua teratoma mediastinal. Dilaporkan kasus seorang anak laki-laki yang menderita teratoma mediastinal imatur dengan komponen choriocarcinoma disertai sindrom vena kava superior. Data epidemiologi pasien, pemeriksaan CT scan toraks, dan tumor marker serum menunjukkan tumor mediastinum nonseminoma. Hasil pemeriksaan sitologi dari transthoracal needle aspiration biopsy dengan tuntunan CT scan menunjukkan bahwa tumor sel germinal campuran cenderung seminoma. Kemudian dilakukan radiasi untuk mengatasi sindrom vena kava superior. Namun, pasien makin sesak. Dari pemeriksaan foto toraks pascaradiasi, tampak konsolidasi di hemitoraks bertambah luas. Kemudian dilakukan operasi reseksi dan sekitar 90% massa tumor diangkat. Hasil pemeriksaan histopatologi menunjukkan teratoma imatur dengan unsur ganas dan unsur choriocarcinoma. Terapi pada pasien ini dilanjutkan dengan kemoterapi kombinasi sisplatin, etoposid, dan bleomisin. CT scan merupakan modalitas radiologi utama dalam menentukan diagnosis dan evaluasi terapi TSG mediastinal. Terapi yang dianjurkan pada TSG mediastinal Maligna adalah terapi multimodaliti, yakni kemoterapi, radiasi, dan operasi, mengingat variasi sel tumor yang memiliki kepekaan yang berbeda terhadap berbagai macam terapi

Asbestos-Related Lung Cancer: A Hospital-Based Case-Control Study in Indonesia

Indonesia has limited data on asbestos-related diseases despite abundant use. This study investigated the risk of occupational asbestos exposure for lung cancer development, utilizing a hospital-based case-control study. Subjects were patients who received a thoracic CT scan at Persahabatan Hospital, Jakarta. The cases had primary lung cancer confirmed by histology, the controls were negative for lung cancer. The cumulative occupational asbestos exposure was calculated by multiplying the exposure intensity by the years of exposure. The exposure intensity was obtained by adopting the weighted arithmetic mean value of asbestos exposure from a job-exposure matrix developed in Korea. The primary data analysis was based on logistic regression. The study included 696 subjects, with 336 cases and 360 controls. The chance of lung cancer for subjects exposed to asbestos was doubled (OR = 2.04, 95% CI = 1.21–3.42) compared with unexposed, and subjects with a cumulative asbestos exposure of 10 fiber-years or more even showed an OR of 3.08 (95% CI = 1.01–9.46). The OR of the combined effect between smoking and asbestos was 8.7 (95% CI = 1.71–44.39); the interaction was consistent with an additive and multiplicative risk model. Asbestos exposure is associated with a higher chance of lung cancer. Improved policies are needed to protect the population from asbestos hazards

Effect of intra-arterial heparin flushing (IAHF) to prestin and vascular endothelial growth factor (VEGF) level in hearing loss patients

Background: According to the World Health Organization (WHO), hearing loss is the fourth largest disability globally, affecting an estimated 466 million people in 2018. In Indonesia, the prevalence of hearing loss was estimated at 16.8% in 2016. Intra-Arterial Heparin Flushing (IAHF) is an endovascular technique that uses heparin to promote reperfusion and increases Vascular Endothelial Growth Factor (VEGF) expression. VEGF is a polypeptide angiogenesis factor present in the nervous system, which functions as a neurotrophic and neuroprotective. Meanwhile, prestin is a protein of outer ear hair cells that shows early signs of hearing loss through increased levels in cases of ear hair cell damage. Objective: This study aims to evaluate the effect of IAHF on prestin and VEGF levels in hearing-impaired patients. Methods: The design is experimental with Pre-Post Test One-Group Only. A total of 22 patients with hearing loss were measured for prestin and VEGF before and 4 hours after the IAHF procedure. Results: The results of the Wilcoxon test showed no significant differences in prestin level (p=0.658) and VEGF level (p=0.291) before and after the IAHF procedure. The mean showed an insignificant decrease in prestin level before and after the IAHF procedure with values of 1,185+1,229 pg/mL and 1,096+1,183 pg/mL, respectively. However, the VEGF level insignificantly increased before and after the procedure with values of 484.83+274.6 pg/mL and 498.79+257.7 pg/mL, respectively. Conclusion: There were no significant differences in prestin and VEGF levels before and after the IAHF procedure. However, there was a decrease in the prestin level and an increase in the VEGF level

AKURASI SISTIM SKORING CT SCAN TORAKS TANPA KONTRAS POTONGAN TERBATAS UNTUK MENEGAKKAN DIAGNOSIS TUBERKOLOSIS PARU DEWASA

Background: Tuberculosis (TB) is still a malo- CCl'JSeof morbidity and mortality in Indonesia. Thus we need a fast and accurate method in diagnosing pulmonary TB especially in adult smear negative TB cases. The limited slice non-enhanced thoracic CT and a standardized method of expertise, such as a scoring system, could be a fast, effective and relatively easy alternative to provide a greater accuracy in diagnosing adult pulmonary TB. Objective: This study was performed to determine the accuracy of a scoring system using the limited slice non-enhanced thoracic CT in diagnosing adult pulmonary TB. Methods: This cross sectional study was conducted in Department of Radiology, Persahabatan hospital, Jakarta, Indonesia and starting from September 2012 to June 2013. The subjects comprised of 130 patients suspected of having smear negative pulmonary TB. A limited slice nonenhanced thoracic CT was performed to assess the diagnostic value based on a scoring system. Pulmonary TB was diagnosed in 84 subjects compare to reference standard. The scoring system was calculated using bivariate and multivariate cox regression analysis. The variables included in the analysis were the patient's age, history of previous contact with pulmonary TB patients, history of smoking and 9 characteristic chest CT patterns of TB. The ROC analysis was done to found the cutoff point score prediction pulmonary TB value. Results: Based on limited slice non enhanced thoracic CT and done by scoring system, a total score of equal or more than 29 could diagnose pulmonary TB with the accuracy 96.1% (95%Cls 91.3-98.3), sensitivity 96,5% (95%Cls 90.1-98,8), specificity 95.6% (95%Cls 90.1-98.8), PPV 97.6% (95%Cls 91.7-99.3%), NPV of 93.5% ( (95%Cls 82.5- 97.8), LRP 21.7 (95%Cls 8.1-57.9) and LRN 0.04 (95%Cls 0.02- 0.07)compared to reference standard. Limited slice non-enhanced thoracic CT could also provide information regarding pulmonary abnormalities other than TB Conclusion: Scoring system performed in limited slice non-enhanced thoracic CT has a highly comparable accuracy with the reference standard for the diagnosis of adult pulmonary TB Keyword: Limited slice non enhanced thoracic CT, Scoring system, Adult pulmonary TB