The clinical respiratory journal
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Comparative Study
Usefulness of admission red blood cell distribution width as a predictor of severity of acute pulmonary embolism.
Previous researches have represented a considerable relation between acute pulmonary embolism (PE) and red blood cell distribution width (RDW). To the authors' knowledge no research has been informed in subjects with PE severity. Pulmonary arterial obstruction index (PAOI) is associated with the severity of acute PE. ⋯ PAOI was correlated with PE severity, D-dimer level, sPAP and clinical probability scores. PAOI was correlated with RDW levels. RDW levels, an inexpensive and easily measurable laboratory factor, were considerable associated with the severity and presence of PE.
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Comparative Study
Utility of endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing non-specific inflammatory intrathorcacic lymphadenitis.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive technique for diagnosing intrathoracic malignancies and some benignancies; however, there are no data available on the utility of EBUS-TBNA for the diagnosis of non-specific inflammatory intrathoracic lymphadenitis. ⋯ EBUS-TBNA can provide pathological and microbiological evidences for diagnosing non-specific inflammatory intrathoracic lymphadenopathy, and it is a safe and effective first-line investigation for ruling out malignancies and other benign diseases.
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In patients with pulmonary embolism (PE), a pulmonary radiograph may reveal oligemic fields (the Westermark sign) associated with sites of occlusion of the pulmonary arteries, interruption or loss of the artery line (the knuckle sign), and even unilateral hyperlucency attributable to reduced overall lung vascularity. In Swyer-James-Macleod syndrome (SJMS), which develops as a result of bronchiolitis obliterans, unilateral hyperlucency is evident because of emphysema and hypoplasia of the pulmonary artery and its branches. Therefore, SJMS cases with clinical and laboratory data compatible with PE may in fact be confused with PE. The cases of six adult patients who were initially presumed to have PE but on further investigation were diagnosed with SJMS are presented in this report, which thus can serve as a guide for diagnosis of similar cases in future. ⋯ Unilateral hyperlucency may be a feature of both PE and SJMS. Although these conditions are very different, both present similarly in radiographic terms and may be easily confused when the clinical data and the anamnesis raise a suspicion of PE, causing unnecessary testing and treatment.
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Reliable differentiation of benign from malignant mediastinal lymphadenopathy is important, especially in countries with a high tuberculosis burden. We hypothesized that specific sonographic features on endobronchial ultrasonography (EBUS) may differentiate benign from malignant nodes. In this study, the sonographic features of non-malignant and malignant nodes were compared. ⋯ Sonographic features of well-defined margins, presence of central hilar structure, and presence of nodal conglomeration in the lymph nodes on EBUS are predictive of benign disease.
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The important role of radiological examinations of invasive pulmonary aspergillosis (IPA) in patients with neutropenia has been well studied; however, little is known about IPA in critically ill chronic obstructive pulmonary disease (COPD) patients. ⋯ Multiple nodules that were distributed along with broncho-vascular bundles were relatively common and specific in critically ill COPD patients with IBPA. Deteriorated CXR combined with specific laboratory examinations, even when appropriate antibiotics were used, could indicate a diagnosis of IBPA. Large consolidations might be considered as poor prognostic indicators.