Retrospective Analysis of Lymphangitis Carcinomatosa Regarding Primer Tumor Spectrum and Computer Tomography Features

INTRODUCTION: Lymphangitis carcinomatosis (LC) is used to describe the metastatic involvement of pulmonary lymphatic canals and perilymphatic connective tissue by primary tumor cells and commonly occurs secondary to primary tumors, mostly adenocarcinomas, originated from breast, lung, gastrointestinal system cancers. Common findings in lung computed tomography (CT) are interlobular septal thickening and increased reticular/reticulonodular density. In this study, we aim to present the primary tumor spectrum and most frequent computed tomography findings of patients with LC. METHODS: In this double-centered study 63 patients, who had lung CT examination due to prediagnosis of LC, were retrospectively investigated. 41 patients with final diagnosis of LC due to findings upon Positron emission tomography/Computed tomography (PET/CT), ultrasonography, CT scan, endoscopic, bronchoscopic and cytopathologic investigations and/or clinical manifestations are ultimately included RESULTS: In 41 patients with LC, lung in 11 cases, esophagus in 7 cases, colon in 6 cases, stomach in 4 cases, pancreas in 3 cases, breast in 2 cases, bladder in 2 cases, thyroid in 2 cases and singly larynx, kidney, prostate and bone marrow in 4 cases were respectively revealed as primary tumor origins. Most frequent lung CT findings were increased reticular/reticulonodular and nodular densities, thickenings of interlobular septa, mediastinal and hilar lymphadenopathies, pleural and/or pericardial effusions, atelectasis, ground-glass opacities. Extrapulmonary involvement was detected in 14 patients DISCUSSION AND CONCLUSION: LC occurs with metastatic involvement of pulmonary lymphatics in patients with primary malignancy, especially adenocarcinomas. In CT, the reticular, reticulonodular, and noduler pattern (most common pulmonary parenchymal changes) and mediastinal lymphadenopathies (LAP) are the most common findgs. Pulmonary CT examination is accepted as the most important radiological modality in diagnosis and follow up of LC

Orta lob sendromlu olgularda bilgisayarlı tomografi bulguları

Amaç: Orta lob sendromu OLS , sağ akciğer orta lobunun kronik veya tekrarlayan atelektazileri ile karakterize bir tablodur. Spesifik bir klinik bulgusu yoktur. OLS tanısında Bilgisayarlı Tomografi BT en sık kullanılan modalitedir. Kliniğimizde son iki yılda OLS tanısı almış hastaların BT bulgularını literatür eşliğinde sunmayı amaçladık.Gereç ve Yöntem: Mayıs 2015- Mayıs 2017 tarihleri arasında hastanemiz radyoloji kliniğine başvuran ve OLS tanısı alan 29 hastanın, BT ve klinik bulguları retrospektif olarak iki radyolog ve bir göğüs hastalıkları uzmanı tarafından incelendi. Bulgular: OLS tanısı alan 29 hastanın 17’si %58,6 kadın, 12’si %41,4 erkek hastaydı. Kadın/erkek oranı 1.42 idi. Bu olguların yaş ortalaması ise 59,4±17,01 8-84 yaş olarak hesaplandı. Klinik değerlendirmede en sık semptom öksürük, nefes darlığı ve balgam olarak saptandı. Radyolojik görüntülemede tüm hastaların BT tetkiklerinde sağ akciğer orta lobda atelektazi mevcuttu. Atelektazi ile birlikte diğer en sık eşlik eden bulgular ise 11 hastada mediastinal ve/veya hiler patolojik görünümde lenfadenopati, 6 hastada bronşektazi, 4 hastada enfeksiyon ile uyumlu parankimal bulgular, 3 hastada parankimal nodüller, 3 hastada peribronşial kalınlaşma, 2 hastada operasyon sonrası değişiklikler, 2 hastada diafragmaevantrasyonu, 2 hastada mukus tıkacı, 1 hastada squamöz hücreli kanser, 1 hastada da pulmoneremboli idi. Dört hastada herhangi bir ek akciğer patolojisi saptanmadı. Sonuç: OLS, sağ akciğer orta lobun total atelektazisi olup spesifik klinik bulguları olmaması nedeniyle kronik ve tekrarlayan akciğer şikayetleri olan her hastada özellikle sağ akciğerde yerleşim gösteren lezyonlarda ayırıcı tanılar arasında göz önünde bulundurulmalıdır. BT’nin rutine girmesi ile de radyolojik olarak görülme sıklığı artmıştır. BT, OLS tanısında etkin ve noninvaziv bir görüntüleme yöntemidi

Mortality Risk Factors among Critically Ill Children with Acute COVID-19 in PICUs: A Multicenter Study from Turkish Pediatric Critical COVID-19 and MIS-C Study Group

© 2022 Lippincott Williams and Wilkins. All rights reserved.Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality

Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study

Background: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. Results: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. Conclusions: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. Impact: MIS-C is a life-threatening condition.Patients need to be followed up in the intensive care unit.Early detection of factors associated with mortality can improve outcomes.Determining the factors associated with mortality and length of stay will help clinicians in patient management.High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients.We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality