Post-COVID-19 interstitial lung disease: Insights from a machine learning radiographic model

IntroductionPost-acute sequelae of COVID-19 seem to be an emerging global crisis. Machine learning radiographic models have great potential for meticulous evaluation of post-COVID-19 interstitial lung disease (ILD).MethodsIn this multicenter, retrospective study, we included consecutive patients that had been evaluated 3 months following severe acute respiratory syndrome coronavirus 2 infection between 01/02/2021 and 12/5/2022. High-resolution computed tomography was evaluated through Imbio Lung Texture Analysis 2.1.ResultsTwo hundred thirty-two (n = 232) patients were analyzed. FVC% predicted was ≥80, between 60 and 79 and <60 in 74.2% (n = 172), 21.1% (n = 49), and 4.7% (n = 11) of the cohort, respectively. DLCO% predicted was ≥80, between 60 and 79 and <60 in 69.4% (n = 161), 15.5% (n = 36), and 15.1% (n = 35), respectively. Extent of ground glass opacities was ≥30% in 4.3% of patients (n = 10), between 5 and 29% in 48.7% of patients (n = 113) and <5% in 47.0% of patients (n = 109). The extent of reticulation was ≥30%, 5–29% and <5% in 1.3% (n = 3), 24.1% (n = 56), and 74.6% (n = 173) of the cohort, respectively. Patients (n = 13, 5.6%) with fibrotic lung disease and persistent functional impairment at the 6-month follow-up received antifibrotics and presented with an absolute change of +10.3 (p = 0.01) and +14.6 (p = 0.01) in FVC% predicted at 3 and 6 months after the initiation of antifibrotic.ConclusionPost-COVID-19-ILD represents an emerging entity. A substantial minority of patients presents with fibrotic lung disease and might experience benefit from antifibrotic initiation at the time point that fibrotic-like changes are “immature.” Machine learning radiographic models could be of major significance for accurate radiographic evaluation and subsequently for the guidance of therapeutic approaches

An Unusual Presentation of Diffuse Large B-Cell Lymphoma

Hyperlactemia is a rare and potentially fatal complication of hematologic malignancies, as well as an oncological emergency, which requires a fast diagnosis and early therapeutic management, as these interventions may alter disease prognosis. Herein, we present a case of secondary liver-biopsy-confirmed diffuse large B-cell lymphoma (DLBCL), presented with elevated liver enzymes and lactic acidosis, without depicted hepatic lesions, hepatosplenomegaly, or enlarged lymph nodes on computed tomography. This case confirms the poor prognosis of cases with delayed diagnostic intervention and highlights the importance of early clinical suspicion, liver biopsy, and prompt treatment initiation

A Challenging Cutaneous Lesion in a Patient With Chronic Idiopathic Neutropenia

Ecthyma gangrenosum (EG) is an uncommon necrotizing vasculitis that affects mainly immunocompromised and burn patients, and it is frequently associated with Pseudomonas aeruginosa bacteremia. However, cases of EG with other related pathogens and cases of EG affecting immunocompetent hosts have also been described in the literature. Besides, less common cases of EG without bacteremia have been reported. Herein, we describe a rare case of EG due to Pseudomonas aeruginosa without bacteremia in a patient with chronic idiopathic neutropenia (CIN). Considering the high mortality rate associated with EG, early diagnosis and appropriate effective treatment are crucial

Multilocular Thymic Cyst in a Young, Otherwise Healthy Woman: A Case Report

Thymic cysts are rare lesions, accounting approximately for 1% of all mediastinal masses. We report a case of a 36-year old woman who presented preoperatively with a calcified mass shadow found on a routine chest radiograph X-ray. After further investigation with chest computed tomography (CT), magnetic resonance imaging (MRI), and tests for Myasthenia gravis, a benign mediastinal cyst was diagnosed and the patient underwent median sternotomy and complete surgical excision of the lesion. The histological examination described a multilocular thymic cyst. Thymic cysts are usually associated with thymic epithelial tumors, such as thymomas, or multisystemic morbid conditions such as human immunodeficiency virus (HIV) infection, rheumatologic disease, and Myasthenia gravis. At all follow-up examinations to date, the patient remains healthy

Simultaneous Pleural and Pericardial Effusion as First Clinical Manifestations of Giant Cell Arteritis: A Case Report

Giant cell arteritis (GCA) is a chronic granulomatous vasculitis of unknown aetiology occurring in the older patients and affecting mostly the cranial branches of the arteries originating from the aortic arch. GCA is associated with polymyalgia rheumatica (PMR). Clinical features of the disorder include headache, scalp tenderness, jaw claudication, temporal artery abnormalities on physical examination, vision changes, and symptoms associated to PMR. Systemic manifestations include fever, anorexia and weight loss while less rare manifestations are related to the nervous system, the respiratory system, the pericardium and extra-cranial large vessels. Here we report a rare case of simultaneous pleural and pericardial effusion as the first manifestations of GCA. The diagnosis was made with a temporal artery biopsy. Such a diagnosis should, therefore, be considered in older patients presenting with pleuropericardial manifestations, even in the absence of typical clinical features

Recurrent Exacerbations of Chronic Obstructive Pulmonary Disease Reveal Swyer-James-MacLeod Syndrome in a 63-year-old Patient

Swyer-James-Macleod syndrome is an infrequent clinical condition characterized by unilateral hyperlucent lung as a complication following infectious bronchiolitis obliterans, typically diagnosed during childhood. However, in some patients, the diagnosis may be confirmed in adulthood. The syndrome can be misdiagnosed with other lung disorders such as asthma, pulmonary embolism, and pneumothorax, leading to inappropriate management and worse outcome. We present a case of Swyer-James-MacLeod syndrome, diagnosed in a 63-year-old man, with frequent hospitalisations due to chronic obstructive pulmonary disease (COPD) exacerbations without a history of significant lung infection in childhood. Complications of Swyer-James-MacLeod syndrome include recurrent infections, lung abscess, pneumothorax, and pulmonary hypertension. The syndrome should always be considered in adults with recurrent respiratory infections or pulmonary hyperlucency on chest imaging to prevent a delay in correct diagnosis and improper treatment

Triple Renal Arteries in a Cadaveric Kidney Donor: A Case Report

Variation in the number of renal arteries is rare and is the most frequent and clinically important variation in the renal vascular system. Typically, this variant represents an immature form of complicated development of the renal arteries resulting from the persistence of more than one mesonephric artery during the transition period from metanephros to metanephros in embryogenesis. The knowledge of Ibis anatomical variation will allow the best healthcare to be provided for patients undergoing kidney surgical procedures and may reduce or eliminate avoidable postoperative complications. Although a double renal artery consists of a common anatomical variation, three or more arteries in a single kidney is less common. Herein, we report a case of a 42-year-old healthy cadaveric donor whose left kidney was found to have three renal arteries