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Highlights of this retrospective study of adults with repaired truncus arteriosus (rTA) and contemporary cardiovascular magnetic resonance imaging studies (CMR) include:•CMR measures are stratified according to anatomic subtype in rTA•Right ventricular mass is increased in rTA as compared with normal•Right ventricular function and aortic size in rTA are associated with outcomes The cardiovascular magnetic resonance imaging (CMR) features of adults with repaired truncus arteriosus (rTA) are largely undefined. We sought to explore CMR characteristics in rTA and to identify associations between imaging findings and cardiovascular outcomes. Adults with rTA and CMR were identified and anatomic subtypes (1-4) were assigned (Collett and Edwards classification). CMR characteristics, clinical data at last follow-up and adverse cardiovascular outcome were recorded. Twenty-seven adults (19% male) were studied (median age at cardiovascular magnetic resonance 26 years [interquartile range 18 to 40]) over 5.2-year duration [interquartile range 2.5 to 7.5]. With the exception of mildly increased RV mass (30 ± 12 g/m2), cardiac chamber measurements were within the normal range. In CMR measurements, only pulmonary artery peak velocity differed in subtypes (highest in subtype 3, 318 ± 26 cm/s, p = 0.029). Number of cardiovascular interventions in adulthood was moderately correlated with left ventricular end-diastolic volume (r = 0.463, p = 0.015), left ventricular ejection fraction (r = 0.425, p = 0.027) and neoaortic root size (r = 0.398, p = 0.039). Cardiovascular events (nonmutually exclusive) in 5 of 27 patients (19%) included death (n = 1), heart failure (n = 1), ventricular tachycardia (n = 1), and atrial tachycardia (n = 3). Increased cardiovascular risk was associated with decreased right ventricular ejection fraction (odds ratio 1.153, confidence interval 1.003 to 1.326, p = 0.046) and smaller ascending aorta diameter (odds ratio 1.758, confidence interval 1.037 to 2.976, p = 0.036). In conclusion, decreased right ventricular ejection fraction and smaller ascending aorta on cardiovascular magnetic resonance were associated with adverse events in rTA.

ObjectiveMelioidosis being an important cause of community-acquired sepsis, caused by Burkholderia pseudomallei in the tropical and subtropical countries, is often underreported or misinterpreted on imaging investigations. We aim to describe the spectrum of imaging manifestations of melioidosis and to evaluate its role in prognosticating clinical outcome, and look for association of specific organ involvement with risk factors.MethodsFrom January 2011 to October 2017, retrospective analysis of imaging investigations of 189 consecutive patients with culture-proven melioidosis was performed. Clinical and demographic records were collected from the hospital medical records.ResultsOut of 67% with a localised disease musculoskeletal involvement was most common, whereas the common organs involved in disseminated infections were the lungs, spleen, liver and genitourinary tract in descending order. Twenty percent suffered unfavourable outcome with a mortality rate of 8.5%. The lung involvement was associated with unfavourable outcome (OR 3.2 [95%CI 1.54–6.63] p = 0.002). The lymph node involvement (OR 0.22 [95% CI 0.05–0.95] p = 0.04) predicted a favourable outcome. Those with diabetes were at a higher risk of splenic (OR 3.05 [95% CI 1.62–5.77]; p = 0.001) and musculoskeletal involvement (OR 2.14 [95% CI 1.09–4.17] p = 0.03) of melioidosis.ConclusionsIn this study, we have described the spectrum of imaging manifestation of melioidosis and evaluated its association with clinical outcome. Respiratory system involvement in melioidosis showed significant association with unfavourable outcome. Diabetes mellitus, a common risk factor for melioidosis, is more prone for infection of the spleen and musculoskeletal system. Thus awareness of imaging manifestations of melioidosis can complement microbiological diagnostic tests for accurate early diagnosis and management.

Tuberculosis (TB) diagnosis remains a challenge, particularly in low-resource settings. Point-of-care ultrasound (POCUS) has shown promise, but most studies focus on HIV-infected populations. In the case of TB, data on lung ultrasound (LUS) are sparse. Therefore, this study evaluates the diagnostic accuracy of lung and abdominal ultrasound for TB diagnosis in an Indian tertiary care hospital. We prospectively enrolled adults with presumed TB and performed comprehensive ultrasound assessments. Accuracy of individual and combined sonographic findings was evaluated against a robust reference standard (mycobacterial culture and PCR). Comparators were C-reactive protein at a cut-off of 5mg/l and chest x-ray (CXR). A multivariable model incorporating clinical and ultrasound findings was explored using generalized mixed models and a random forest approach. (Trial registry DRKS00026636). Among 541 participants, 102 (19%) were diagnosed with TB and 1% were HIV-positive. The \"Focused Assessment with Sonography for HIV-associated TB\" (FASH) demonstrated moderate sensitivity (51%) and specificity (70%). Consolidations <1 cm on LUS showed high sensitivity (93%) but low specificity (16%) and were also seen in non-TB lung infections and other conditions like bronchial asthma and COPD. Accuracy of larger (≥1 cm) consolidations (72% sensitive, 55% specific) on LUS was comparable with CXR suggesting possible TB (81% sensitive, 58% specific). Predictive modeling suggests moderate diagnostic performance (AUC = 0.79). In our study, POCUS did not meet WHO targets for a stand-alone facility-based screening test. Nevertheless, diagnostic accuracy for some findings is comparable to CXR and could be integrated into diagnostic algorithms to improve TB screening where CXR cannot reach. Future research should explore artificial intelligence to enhance TB-POCUS accuracy and accessibility, as was previously reported for CXR. Prior to this study, lung ultrasound (LUS) for TB had been assessed in only a few studies, limited by uncertain sonographic characterization of TB-related findings, lack of consistent terminology, and small numbers of participants with confirmed non-TB diagnoses to determine specificity for TB. Studies evaluating Focused assessment with sonography for HIV-associated tuberculosis (FASH) almost exclusively included HIV-infected individuals and demonstrated moderate sensitivity and specificity. However, varying study designs and reference standards limit broader generalization of their findings. Our prospective study from a TB-endemic setting (India) recruited 541 predominantly HIV-negative participants with presumed TB. This is the largest cohort to date assessing LUS, FASH, and additional ultrasound findings for TB diagnosis. Our study demonstrates that no single ultrasound finding alone, or even in combination, reaches the accuracy targets of the target product profile for a facility-based screening test (triage) proposed by WHO. FASH accuracy in our study aligned with previously reported data in HIV-negative participants but was less specific in HIV-positive participants. The accuracy of additional ultrasound items of LUS and FASH was comparable to chest x-ray (CXR). In summary, this study demonstrates accuracy of ultrasound for TB diagnosis, backed by a robust study design and using a comprehensive reference standard and CXR comparator for LUS. Modelling suggests that an algorithmic approach combining ultrasound and clinical findings may be of highest value to inform risk of TB and guide further testing to confirm the diagnosis of TB. Other use cases of POCUS, which may aid clinical decision making in the assessment of disease severity, sampling strategy, and monitoring, should be evaluated by future studies. These should also focus on the accuracy of POCUS in people living with HIV and children, as well as evaluate POCUS more broadly as part of a diagnostic algorithm and by using artificial intelligence to improve the yield of TB-POCUS.

A male patient in his 70s, who had previously worked as a bricklayer, presented with worsening shortness of breath on exertion and cough for 6 months. He had lost weight, and a respiratory examination suggested a right pleural effusion. Routine evaluation was unremarkable. Sputum examination for tuberculosis was negative; hence, a contrast-enhanced CT of the thorax was performed, which revealed features of silicosis with pleural effusion. Pleural fluid analysis was inconclusive; hence, a medical thoracoscopy was performed, which showed black nodules over the parietal pleura, which were biopsied and showed anthracotic pigmentation with collagenous nodules suggestive of silicosis. A chest drain was inserted, and no further silica exposure was ensured, following which he showed clinicoradiological improvement. In this report, we describe the first case of silicosis presenting with pleural effusion in which the diagnosis was confirmed with medical thoracoscopic pleural biopsy.

In this period following the COVID-19 pandemic, there is increasing evidence to indicate the presence of long-term sequelae in individuals who were infected with COVID-19. This study was performed to assess the proportion of CT abnormalities in patients who underwent CT imaging of the thorax at least 4 weeks after the date of RT-PCR confirmation of COVID-19 infection and to assess the severity of lung involvement using a semiquantitative CT scoring system in the above population. Institutional Review Board approval was obtained for this study. We conducted a retrospective study to assess the post-COVID-19 findings on CT imaging of thorax. The cases for analysis were obtained from the radiology department database of our Institution by performing a RIS-PACS search. The CT images were analyzed both in a qualitative manner and by using a semiquantitative score, which was correlated with spirometry. A total of 192 CT imaging studies of various patients were reviewed as part of this study. The mean age of the study population was 50. The predominant CT abnormalities included ground glass opacities (87%), reticulations (77%), consolidations (52%), subpleural bands (65%), tractional bronchiectasis (59%), and air trapping (19%). The mean semiquantitative score obtained was 35.08 (range 0-80). There was a significantly higher score among diabetics and those with multiple comorbidities. There was a significant correlation between spirometric variables (FVC, FEV1) and the semiquantitative score. We qualitatively assessed the spectrum of post-COVID-19 sequelae in the lungs. The common findings included ground glass opacities, reticulations, and consolidations. The severity of post-COVID-19 sequelae quantified by the semiquantitative score showed a weak to moderate correlation with spirometry.

A male patient in his 20s presented with a cough and a small volume of haemoptysis that lasted a year. He had no other constitutional symptoms and a respiratory examination was suggestive of a consolidation. A chronic infection, such as tuberculosis, was suspected. The routine evaluation showed peripheral eosinophilia with raised serum total IgE. Sputum examination for tuberculosis was negative; hence, a high-resolution CT of the thorax was performed, which revealed bilateral bronchiectasis with high-attenuation mucus plugging. The imaging and blood profiles were in favour of allergic bronchopulmonary aspergillosis, but there was no history suggestive of asthma, and the pulmonary function test was normal. The patient underwent a skin prick test and an allergen-specific IgE test for Aspergillus fumigatus , and both were positive. His bronchoalveolar lavage cultures also grew A. fumigatus , and he responded well to antifungal therapy. This case illustrates the presentation of a rare entity—allergic bronchopulmonary aspergillosis sans asthma.

Bronchial Dieulafoy's disease (BDD), remains poorly understood, with only 88 cases reported globally. Herein, we present the largest case series ( n  = 7) from a single centre, between 2017 and 2023, retrospectively reviewed, detailing clinical presentations, diagnoses, management and up to 4‐year follow‐up outcomes. Diagnosis relied on characteristic lesions detected through white light bronchoscopy with or without endobronchial ultrasound (EBUS) or narrow band imaging (NBI), along with computed tomography (CT) scans or bronchial angiography. Identification of aberrant vessels beneath lesions and bronchoscopy details were documented. Treatment modalities and follow‐up outcomes until December 2023 were noted. All patients were non‐smokers. Review of imaging findings by an experienced radiologist was crucial in suspected cases due to risk of bleeding and often unconclusive results from biopsy. Management of BDD varied, with six patients undergoing bronchial artery embolization (BAE) and one requiring lobectomy; four patients received additional endobronchial therapy, one died due to malignancy, none experienced recurrence of haemoptysis. Identifying patients with large volume haemoptysis disproportionate to parenchymal disease in CT scans is important. A bronchoscopic surveillance is crucial to avoid biopsy; it can be confirmed using EBUS of NBI. While no established guidelines exist, BAE and endobronchial therapy emerge as valuable interventions, with surgical resection reserved for recurrent cases.

Interstitial lung disease (ILD) is seen in 17% of patients with Rhupus syndrome. Organising pneumonia (OP), a subtype of connective tissue disease-associated ILD, is rare but associated with good outcomes. Here, we present a patient with Rhupus who developed OP.

Background Thoracic air leak syndrome (TALS) is a rare complication associated with chronic lung graft-versus-host disease (GVHD) and bronchiolitis obliterans syndrome (BOS). In the present case, TALS was the sole pulmonary manifestation of GVHD. Case presentation A 30-year-old woman presented with dyspnea on exertion and swelling of the neck and face after allogeneic stem cell transplantation for acute myeloid leukemia. She was found to have subcutaneous emphysema, and chest imaging suggested pneumomediastinum, with normal lung parenchyma. Her clinical and radiological findings indicated TALS. There were no other features suggestive of lung GVHD. Her condition improved with conservative management and increased immunosuppression. However, she subsequently had two relapses, developed severe infection and pneumothorax, and died. Conclusions The present case report illustrates a unique presentation of TALS, a rare complication of GVHD, in a post-stem cell transplant patient. It highlights the challenges in the diagnosis and management of this condition.

Congenital mitral stenosis (MS) is a spectrum of anomalies that result in functional and anatomic obstruction of inflow into the left ventricle. Mitral arcade is one of the varieties of congenital MS where there is an abnormal development of chordae tendineae, resulting in stenosis, regurgitation, or both. Here, we describe the case of a mitral arcade in a child, which was diagnosed on echocardiography and confirmed with other imaging modalities.