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260


Current Imaging of Idiopathic Pulmonary Fibrosis

Gruden, James F; Green, Daniel B; Girvin, Francis G; Naidich, David P
The major role of imaging (CT) in usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) is in the initial diagnosis. We propose several modifications to existing guidelines to help improve the accuracy of this diagnosis and to enhance interobserver agreement. CT detects the common complications and associations that occur with UIP/IPF including acute exacerbation, lung cancer, and dendriform pulmonary ossification and is useful in informing prognosis based on baseline fibrosis severity. Serial CT imaging is a topic of great interest; it may identify disease progression before FVC decline or clinical change.
PMID: 36202475
ISSN: 1557-8275
CID: 5360732

Algorithmic approach to the diagnosis of organizing pneumonia: a correlation of clinical, radiological and pathological features

Cherian, Sujith V; Patel, Dhara; Machnicki, Stephen; Naidich, David; Stover, Diane; Travis, William D; Brown, Kevin K; Naidich, Jason J; Mahajan, Akhilesh; Esposito, Michael; Mina, Bushra; Lakticova, Viera; Cohen, Stuart L; Muller, Nestor L; Schulner, Jenna; Shah, Rakesh; Raoof, Suhail
Organizing pneumonia (OP), characterized histopathologically by patchy filling of alveoli and bronchioles by loose plugs of connective tissue may be seen in a variety of conditions. These include but are not limited to post-infection, drug reactions, radiation therapy and collagen vascular diseases. When a specific etiology is found to be responsible to cause this entity, it is referred to as secondary organizing pneumonia. When an extensive search fails to reveal a cause, it is referred to as cryptogenic organizing pneumonia (previously called bronchiolitis obliterans with organizing pneumonia), which is a clinical, radiologic and pathologic entity that is classified as an interstitial lung disease. The clinical presentation of organizing pneumonia often mimics other disorders such as infection and cancer which can result in delay in diagnosis and inappropriate management of the underlying disease. The radiographic presentation of OP is polymorphous but often presents with subpleural consolidations with air bronchograms or solitary/ multiple nodules, which can wax and wane. Diagnosis of OP sometimes requires histopathologic confirmation and exclusion of other possible causes. Treatment usually requires a prolonged steroid course and disease relapse is common. The aim of this paper is to summarize the clinical, radiographic and histologic presentations of this disease and to provide a practical diagnostic algorithmic approach incorporating clinical history and characteristic imaging patterns.
PMID: 35038455
ISSN: 1931-3543
CID: 5131392

Managing Incidental Findings on Thoracic CT: Lung Findings. A White Paper of the ACR Incidental Findings Committee

Munden, Reginald F; Black, William C; Hartman, Thomas E; MacMahon, Heber; Ko, Jane P; Dyer, Debra S; Naidich, David; Rossi, Santiago E; McAdams, H Page; Goodman, Eric M; Brown, Kathleen; Kent, Michael; Carter, Brett W; Chiles, Caroline; Leung, Ann N; Boiselle, Phillip M; Kazerooni, Ella A; Berland, Lincoln L; Pandharipande, Pari V
The ACR Incidental Findings Committee presents recommendations for managing incidentally detected lung findings on thoracic CT. The Chest Subcommittee is composed of thoracic radiologists who endorsed and developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address commonly encountered incidental findings in the lungs and are not intended to be a comprehensive review of all pulmonary incidental findings. The goal is to improve the quality of care by providing guidance on management of incidentally detected thoracic findings.
PMID: 34246574
ISSN: 1558-349x
CID: 5039232

The Usefulness of Chest CT Imaging in Patients With Suspected or Diagnosed COVID-19: A Review of Literature

Machnicki, Stephen; Patel, Dhara; Singh, Anup; Talwar, Arunabh; Mina, Bushra; Oks, Margarita; Makkar, Priyanka; Naidich, David; Mehta, Atul; Hill, Nicholas; Brown, Kevin; Raoof, Suhail
The COVID-19 pandemic has had devastating medical and economic consequences globally. The severity of COVID-19 is related, in a large measure, to the extent of pulmonary involvement. The role of chest CT imaging in the management of patients with COVID-19 has evolved since the onset of the pandemic. Specifically, the description of CT scan findings, use of chest CT imaging in various acute and subacute settings, and its usefulness in predicting chronic disease have been defined better. We performed a review of published data on CT scans in patients with COVID-19. A summary of the range of imaging findings, from typical to less common abnormalities, is provided. Familiarity with these findings may facilitate the diagnosis and management of this disease. A comparison of sensitivity and specificity of chest CT imaging with reverse-transcriptase polymerase chain reaction testing highlights the potential role of CT imaging in difficult-to-diagnose cases of COVID-19. The usefulness of CT imaging to assess prognosis, to guide management, and to identify acute pulmonary complications associated with SARS-CoV-2 infection is highlighted. Beyond the acute stage, it is important for clinicians to recognize pulmonary parenchymal abnormalities, progressive fibrotic lung disease, and vascular changes that may be responsible for persistent respiratory symptoms. A large collection of multi-institutional images were included to elucidate the CT scan findings described.
PMCID:8056836
PMID: 33861993
ISSN: 1931-3543
CID: 4871522

Shades of Gray: Subsolid Nodule Considerations and Management

Azour, Lea; Ko, Jane P; Naidich, David P; Moore, William H
Subsolid nodules are common on chest CT and may be either benign or malignant. Their varied features, and broad differential diagnoses present management challenges. While subsolid nodules often represent lung adenocarcinomas, other possibilities are common, and influence management. Practice guidelines exist for subsolid nodule management for both incidentally and screening-detected nodules, incorporating patient and nodule characteristics. This review will highlight similarities and differences amongst these algorithms, with the intent of providing a resource for comparison, and aid in choosing management options.
PMCID:7534873
PMID: 33031828
ISSN: 1931-3543
CID: 4627172

CT features of electronic-cigarette or vaping-associated lung injury (EVALI); our experience during the recent outbreak [Case Report]

Girvin, Francis; Naidich, David
As an emerging clinical syndrome, our knowledge of the clinical, pathologic and radiologic features of electronic-cigarette or vaping-associated lung injury is evolving. CT appearances are described in six cases imaged at our institution (NYU Langone Health, New York) in the cluster of 2019.
PMCID:7465747
PMID: 32922848
ISSN: 2055-7159
CID: 4629822

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report

Mazzone, Peter J; Gould, Michael K; Arenberg, Douglas A; Chen, Alexander C; Choi, Humberto K; Detterbeck, Frank C; Farjah, Farhood; Fong, Kwun M; Iaccarino, Jonathan M; Janes, Samuel M; Kanne, Jeffrey P; Kazerooni, Ella A; MacMahon, Heber; Naidich, David P; Powell, Charles A; Raoof, Suhail; Rivera, M Patricia; Tanner, Nichole T; Tanoue, Lynn K; Tremblay, Alain; Vachani, Anil; White, Charles S; Wiener, Renda Soylemez; Silvestri, Gerard A
BACKGROUND:The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. METHODS:An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. RESULTS:Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer. CONCLUSIONS:There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.
PMCID:7177099
PMID: 32485147
ISSN: 1558-349x
CID: 4498732

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report

Mazzone, Peter J; Gould, Michael K; Arenberg, Douglas A; Chen, Alexander C; Choi, Humberto K; Detterbeck, Frank C; Farjah, Farhood; Fong, Kwun M; Iaccarino, Jonathan M; Janes, Samuel M; Kanne, Jeffrey P; Kazerooni, Ella A; MacMahon, Heber; Naidich, David P; Powell, Charles A; Raoof, Suhail; Rivera, M Patricia; Tanner, Nichole T; Tanoue, Lynn K; Tremblay, Alain; Vachani, Anil; White, Charles S; Wiener, Renda Soylemez; Silvestri, Gerard A
BACKGROUND:The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. METHODS:An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. RESULTS:Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer. CONCLUSIONS:There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.
PMCID:7177089
PMID: 32335067
ISSN: 1931-3543
CID: 4526752

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report

Mazzone, Peter J; Gould, Michael K; Arenberg, Douglas A; Chen, Alexander C; Choi, Humberto K; Detterbeck, Frank C; Farjah, Farhood; Fong, Kwun M; Iaccarino, Jonathan M; Janes, Samuel M; Kanne, Jeffrey P; Kazerooni, Ella A; MacMahon, Heber; Naidich, David P; Powell, Charles A; Raoof, Suhail; Rivera, M Patricia; Tanner, Nichole T; Tanoue, Lynn K; Tremblay, Alain; Vachani, Anil; White, Charles S; Wiener, Renda Soylemez; Silvestri, Gerard A
Background:The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. Materials and Methods:An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. Results:Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer. Conclusion:There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.© 2020 RSNA; The American College of Chest Physicians, published by Elsevier Inc; and The American College of Radiology, published by Elsevier Inc.
PMCID:7233408
PMID: 33778716
ISSN: 2638-616x
CID: 4882362

Managing Stable Subsolid Lung Nodules: A Possible Approach [Comment]

Naidich, David P; Azour, Lea
PMID: 32186460
ISSN: 1527-1315
CID: 4352702