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Scleroderma
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
Cardiopulmonary disease, such as interstitial lung disease (ILD), cardiac disease, or pulmonary hypertension, is one of the leading causes of SSc-associated death (21). Interstitial lung disease (ILD) is one of the most common complications of SSc. Depending on the definition used to characterize ILD, the prevalence can vary widely. For example, in early autopsy studies, it was noted that 100% of histopathologic specimens of the lung demonstrated nonspecific interstitial fibrosis (22). Furthermore, it has also been reported that up to 90% of patients will have interstitial abnormalities on high-resolution computed tomography (HRCT) and 40–75% will have decline in the pulmonary function tests (PFTs) (23–25). The most common form of ILD is nonspecific interstitial pneumonia (NSIP) in SSc-associated ILD that can be seen either radiographically or histopathology. Other reported lung involvement include usual interstitial pneumonia (UIP), diffuse alveolar hemorrhage, organizing pneumonia, and/or lymphocytic interstitial pneumonia (26, 27).
Temporal Bone Tumours
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Multi-modality cross-sectional imaging: Physical examination alone is insufficient to characterise the extent of a patient's disease, particularly in malignant conditions. High-resolution computed tomography (CT) (axial and coronal) and gadolinium-enhanced magnetic resonance imaging (MRI) are complementary studies, allowing assessment of the disease burden. Additionally, in malignant conditions, staging of the neck and chest is often appropriate to assess for metastatic disease.
Lysinuric protein intolerance
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Imaging of the lungs revealed thickened intrabobular septa and tissues, as well as cysts and ground glass opacity. High-resolution computed tomography has been recommended for the detection of these abnormalities [33].
A retrospective study on immune-related pneumonitis in patients with non-small-cell lung cancer undergoing treatment with PD-1/PD-L1 inhibitors
Published in European Clinical Respiratory Journal, 2023
Dorthe Yakymenko, Kristin Skougaard
Severity of ir-pneumonitis is graded based on the symptomatology using Common Terminology Criteria for Adverse Events (CTCAE) [10]. In a Danish setting, management is based on the guidelines from the European Society of Medical Oncology (ESMO) [11]. In case of severe or persistent symptoms, it is recommended to perform a high-resolution computed tomography (HRCT). Ir-pneumonitis can present various radiological patterns such as organizing pneumonia (OP), hypersensitivity pneumonia (HP), nonspecific interstitial pneumonia (NSIP) and bronchiolitis [12]. Bronchoalveolar lavage (BAL) is recommended in case of persistent symptoms, mainly to rule out alternative diagnoses. However, caution should be made towards the possible complications to this procedure. First choice of treatment is corticosteroids, slowly tapered in 4–6 weeks depending on the CTCAE grade; higher grades usually entailing longer taper. In case of no improvement after 48 hours, intensification of treatment is recommended according to ESMO guidelines [11]. In case of CTCAE grade 3–4 this includes an additional immunosuppressive strategy. The preferred drug is the choice of the clinician, and might include infliximab, mycophenolate mofetil, cyclophosphamide or tocilizumab [6,11]. However, very limited evidence supports the effect, nor indicates an optimal strategy.
A Case of Idiopathic Retinitis Vasculitis Aneurysms and Neuroretinitis (IRVAN) Treated with Adalimumab
Published in Ocular Immunology and Inflammation, 2023
Sanjana B. Singh, Anuradha V. Kanakath, V. Saravanan, Jayakumar K.S., Narendran V.
A 13-year-old female presented to us with complaints of central scotoma both eyes for past 10 months. She had no history of systemic illness. She had received multiple courses of oral steroids with poor response. When she presented to us her BVCA was 20/80 in both eyes . Anterior segment examination was normal . Posterior segment evaluation showed vitreous cells 1+, bilateral disc edema with aneurysms, hard exudates in macula, retinal vasculitis, and aneurysmal dilation of retinal arterioles. Optical Coherence Tomography (OCT) revealed macular edema with subfoveal hard exudates in both eyes. Fundus Fluorescein angiography (FFA) showed aneurysmal dilatation of the arteries on the disc and along the arterial arcade and features of active vasculitis with no evidence of peripheral capillary nonperfusion (CNP) areas. Serum Rheumatoid factor (RA Factor), QuantiFERON TB, Perinuclear AntiNeutrophil Cytoplasmic Antibodies (P-ANCA), Cytoplasmic AntiNeutrophil Cytoplasmic Antibodies (C-ANCA), Anti Double stranded DNA Antibodies (anti-ds–DNA), and serum Angiotensin converting enzyme (ACE) were negative. High Resolution Computed Tomography (HRCT) was normal. Serum Anti Neutrophil Antibodies (ANA) was positive. She was evaluated by a rheumatologist who ruled out systemic collagen vascular disorders.
Laboratory biomarkers in the diagnosis and follow-up of treatment of allergic bronchopulmonary aspergillosis in cystic fibrosis
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Sophie Steels, Marijke Proesmans, Xavier Bossuyt, Lieven Dupont, Glynis Frans
In a classic case of ABPA, radiological investigations show the presence of new or increased bronchiectasis and mucus impaction (not specific to ABPA). Other common features are the “finger-in-glove,” tramline shadows, and tooth paste shadows [5,41]. High-resolution computed tomography of the chest is preferable to chest radiograph because of better visualization of bronchiectasis distribution [5,41]. Central bronchiectasis, an arbitrary classification in which bronchiectasis is confined to the medial two-thirds or medial half of the lung, is believed to be characteristic of ABPA. This should be considered a complication of ABPA rather than a diagnostic criterion as the presence of central bronchiectasis has a sensitivity of only 37% in diagnosing ABPA [5,42]. In addition, central bronchiectasis extended to the periphery in almost one-third of the cases described in the literature [5,43]. High-attenuation mucus, however, is a pathognomonic finding and helps to distinguish ABPA from other causes of bronchiectasis [5,44]. Nevertheless, the benefits of performing repeated high-resolution computed tomography scans should be judged against the risks of cumulative radiation exposure, especially in children. Magnetic resonance imaging offers a non-invasive imaging alternative for diagnosing ABPA without using contrast fluids or radiation. It describes mucoid impactions with T1 hyper-intensity and T2 hypo-intensity, also called inverted mucoid impaction signal sign. This sign was specific [100%, confidence interval (CI): 96–100%, n = 18] for the diagnosis of CF-ABPA [45].