BACKGROUND:The most common complication preventing outpatient management after percutaneous CT-guided lung biopsy (PTLB) is the occurrence of pneumothorax requiring drainage. We previously developed a pragmatic score to predict the risk of clinically relevant pneumothorax after PTLB (hereafter called the CAPAD score), to guide patient management. OBJECTIVES:To externally validate the CAPAD score in an independent cohort, with a specific focus on its ability to rule out pneumothorax requiring drainage after PTLB. METHOD:We retrospectively analysed a pre-existing institutional database of consecutive adult patients undergoing CT-guided PTLB at Bichat-Claude-Bernard University Hospital (Paris, France) between 1 January 2015 and 31 December 2017. The CAPAD score combines five variables: COPD, Anterior PTLB approach, more than one Pleural crossing, pneumothorax ≥10 mm on the end-of-procedure CT (post-procedural immediate pneumothorax), and skin-pleura Distance ≤30 mm, with a pre-specified cut-off of 73 points. The primary endpoint was the diagnostic performance of the score for post-PTLB pneumothorax on the 4-6 h control CXR and secondary endpoint was its performance for pneumothorax requiring drainage. RESULTS:The CAPAD score was computable in 313 of 474 patients. Pneumothorax occurred in 95 patients (30.4%), and 23 patients (7.3%) required drainage. At the pre-specified cut-off of 73, the score had a C-index of 0.77, a sensitivity of 75%, a specificity of 56%, a negative predictive value (NPV) of 84% and a positive predictive value of 43% for any post-PTLB pneumothorax. For pneumothorax requiring drainage, a score < 73 was associated with a 2.0% risk (3/147), corresponding to a NPV of 98%. CONCLUSION:Our pragmatic CAPAD score demonstrated a good prognostic performance for predicting the risk of post-procedural pneumothorax, achieve a NPV of 98% for pneumothorax requiring drainage.

OBJECTIVES:Lung transplantation (LTx) is the solid organ transplantation with the comparatively worst prognosis. Therefore, improving candidate selection and risk stratification for these patients has become a high-priority research focus. Incorporating objective markers of frailty such as sarcopenia in the pretransplant evaluation may help achieve this goal. We evaluated the association between CT-measured psoas muscle sarcopenia and early LTx outcomes. METHODS:We performed a retrospective study including patients who underwent LTx from 2014 to 2018 at our institution with available chest and abdominal CT scans in the year prior to LTx. The psoas cross-sectional area was measured, and previously established sex-specific cutoffs were used to define sarcopenia. We compared sarcopenic and non-sarcopenic LTx recipients regarding 1-year mortality and perioperative outcomes. RESULTS:A total of 140 patients were included, who received LTx primarily for interstitial lung disease (ILD) (n = 75, 53%) or chronic obstructive pulmonary disease (n = 54, 39%). Forty-six (33%) were sarcopenic. We found no association between psoas sarcopenia and 1-year all-cause mortality (multivariable P = .13) nor perioperative complications or FEV1 at 1 year post-LTx. Exploratory subgroup analysis revealed an association between psoas sarcopenia and 1-year all-cause mortality in patients with ILD (multivariable P = .042). CONCLUSIONS:Pre-established sex-specific cutoffs for psoas sarcopenia did not reach statistical significance for 1-year mortality or perioperative outcomes in the overall cohort; given the limited statistical power, a clinically meaningful association cannot be excluded. An exploratory signal in ILD patients warrants further investigation. Future studies may benefit from disease-specific threshold validation and the integration of muscle strength and physical performance alongside muscle mass assessment.

Diagnosing pulmonary diseases caused by non-fumigatus Aspergillus species remains challenging. We conducted a single-center, retrospective observational study in a French Respiratory Medicine Department. Patients with at least one respiratory sample positive for a non-fumigatus Aspergillus species, without concurrent A. fumigatus isolation over a 12-month period, were included. The primary objective was to determine the prevalence of pulmonary events (colonization or pulmonary diseases) associated with non-fumigatus Aspergillus species. Secondary objectives included species characterization and assessment of positive results for available diagnostic tests, including direct examination and fungal culture from respiratory samples, galactomannan in bronchoalveolar lavage, and serum A. fumigatus-specific IgG. Between April 2017 and January 2022, 497 patients (39.6%) had cultures positive for non-fumigatus Aspergillus species. Among them, 52 (10.5%) experienced pulmonary events: 36 were colonized, and 16 had a documented pulmonary disease. Aspergillus niger was the most frequently isolated species (41%), followed by Aspergillus flavus (27%) and Aspergillus nidulans (10%). Positive results were observed in 10/437 (2.3%) samples for direct examination, 75/808 (9.3%) for fungal culture, 7/94 (7.4%) for galactomannan in bronchoalveolar lavage, and 12/49 (24.5%) for serum Aspergillus fumigatus-specific IgG. Among patients with non-fumigatus Aspergillus positive respiratory samples, most were colonized, while nearly one-third had clinically significant pulmonary diseases, underscoring the clinical relevance of these species. Low positivity rates across diagnostic tests underscore the need for repeated respiratory sampling and fungal culture and suggest that assays primarily designed for A. fumigatus may under-detect these pulmonary events. IMPORTANCE:Non-fumigatus Aspergillus species are recognized as pulmonary pathogens, but their diagnosis is poorly documented. In this 5-year, single-center study, 497 of 1,256 patients had at least one positive respiratory culture for a non-fumigatus species, with 36 considered colonized and 16 with documented lung disease. A. niger, A. flavus, and A. nidulans accounted for almost four-fifths of the isolates. Routine tests produced poor results, with positivity rates of 2.3% for microscopy, 9.3% for repeat culture, 7.4% for bronchoalveolar galactomannan, and 24.5% for Aspergillus fumigatus serum IgG. Overall, the study shows that non-fumigatus species can cause treatable chronic lung disease, but that current diagnostics miss most cases. Until more sensitive tests are available, clinicians must rely on repeated respiratory sampling and culture to identify these infections.

Background Incidental lung cancer, in the field of lung transplantation (LTx), is more often related to malignancies diagnosed in explants or transplanted organs. Little is known about cancer diagnosed during the medical evaluation of potential LTx candidates. What are the clinical, and prognostic differences between lung cancers diagnosed before or after transplantation in LTx candidates? Methods We performed a retrospective, observational, single-center study to describe the characteristics of lung malignancies first discovered during the pre-transplant assessment and then identified in lung explants, over the same period. Results From 1630 consecutive patients referred to Paris-Bichat Lung Transplant Program from 2006 to 2022, 288 were deemed not suitable for transplantation. The reason was lung malignancy in 20 patients (15 non-small cell lung cancer (NSCLC) proved). The one-year survival rate was 55%. Seven died from their respiratory insufficiency, and six died from lung cancer progression. Over the same period, 611 patients received LTx. NSCLC were identified in six explants (1%). One-year survival was 66.7% in these transplanted patients. Conclusions Lung cancer diagnosed during the medical evaluation of potential LTx candidates is rare. However, this represents a critical issue because it contraindicates LTx and leads to a non-optimal management of both lung cancer and of end-stage lung disease. We report an encouraging one-year survival rate in transplanted patients with a pathological lung malignancy diagnosis in lung explant, compared to their counterpart in whom lung cancer discovery contraindicated LTx. A multicenter observational study is mandatory in order to confirm such observation, as it might change current standard to deny LTx in patients with incidental localized NSCLC.

Background Central nervous system (CNS) infections carry a severe prognosis and often require intensive care unit (ICU) admission. This study evaluated the prognostic value of neuroimaging in patients with all-type CNS infections. Methods Using a predefined strategy, we first conducted a systematic search of PubMed/MEDLINE, PubMed Central, Embase, Cochrane and Google Scholar. Eligible studies published between January 1st, 2000, and June 1st, 2023, were included. We considered randomized controlled trials, non-randomized trials, cohort studies, excluding abstracts, cost-effectiveness analyses, letters, conference proceedings, systematic reviews, and meta-analyses. Two authors independently screened publications and extracted data. The meta-analysis was performed using a random-effects model. The main outcomes were (1) unfavorable outcome, defined as severe functional disability or death, and (2) mortality. Pooled odds ratios (OR) and 95% confidence intervals (95%CI) were calculated for each neuroimaging feature. We performed prespecified subgroup analyses depending on type of CNS infection (bacterial meningitis, CNS tuberculosis, CNS cryptococcosis, viral encephalitis, and brain abscess), country income, and ICU admission status. Results Of 7,864 studies identified, 83 met the inclusion criteria, with 48 studies (6,434 patients) included in the meta-analysis. Abnormal MRI (OR: 3.55; 95%CI: 1.81–6.96; I²=0%), brain ischemia (OR: 4.65; 95%CI: 3.14–6.88; I²=28.5%), and hydrocephalus (OR: 4.56; 95%CI: 2.49–8.36; I²=61.5%) were significantly associated with unfavorable outcome. Hydrocephalus (OR, 3.99; 95%CI 1.83–8.70; I²=61%) and brain ischemia (OR, 3.51; 95%CI, 2.22–5.54; I²=16.4%) were associated with mortality. These associations remained consistent in patients with bacterial meningitis and in patients with CNS tuberculosis, but not in other CNS infections. Subgroup analyses depending on country income and ICU admission status revealed similar findings. Conclusion Neuroimaging provides essential prognostic information in patients with CNS infections. Abnormal MRI findings, cerebral ischemia, and hydrocephalus are associated with unfavorable outcome, particularly in bacterial meningitis and CNS tuberculosis. These neuroimaging features should be considered when discussing prognosis in affected patients.

Introduction: Eastern Cooperative Oncology Group performance status 2 to 3 is associated with poor survival and chemotherapy-related adverse events (AEs). The impact of poor PS on the safety and efficacy of immune checkpoint inhibitors has not been elucidated. This study aimed to assess first-line durvalumab in patients with PS 2 to 3 with advanced NSCLC and high programmed cell death-ligand 1 (PD-L1) expression. Methods: In this single-arm, prospective, multicenter, phase II trial, patients with PS 2 to 3 aged 18 to 75 years with metastatic NSCLC and PD-L1 tumor proportion score more than or equal to 25% received durvalumab until progression or toxicity. Primary end point was safety, that is incidence of grade more than or equal to 3 TRAEs during the first 8 weeks. Secondary end points included blinded independent central review overall response rate, progression-free survival, duration of response, overall survival (OS), and PS improvement at 8 weeks and health-related quality of life. Results: A total of 50 patients were enrolled. Median follow-up was 26.2 (19.9–35.2) months. Prevalence of grade more than or equal to 3 TRAEs during the first 8 weeks was 10.0% (five of 50, 95% confidence interval [CI] 1.7–18.3), and no grade 5 occurred. Overall response rate at 8 weeks was 26% (95% CI 13.8–38.2). Median duration of response, progression-free survival, and OS were 11.8 months (95% CI, 7.2-not reached), 2.3 months (95% CI 1.7–5.6), and 7.1 months (95% CI 3.9–14.5), respectively. The 12-month OS rate was 40% (95% CI 26.5–53.1). Median OS in patients with PS 2 and PS 3 was 11.4 (95% CI 4.4–32.8) and 3.0 (95% CI 0.2–5.6) months, respectively. Of 27 patients, 12 (44.4%) still receiving durvalumab at 8 weeks had improved PS (p = 0.0096). Mean global QLQ-C30 score significantly increased at 8 weeks. Conclusions: In patients with a PS of 2 to 3 with advanced NSCLC and high PD-L1 expression, first-line durvalumab was safe with 40% 1-year OS.

BACKGROUND:Susac syndrome (SuS) is a rare immune-mediated microangiopathy with potential disabling evolution. We aimed to analyze brain microstructural damage through diffusion tensor imaging (DTI) in SuS and determine its association with poor outcomes. METHOD:CarESS study is a prospective multicenter national cohort study of patients with SuS. Patients included at the principal investigator's center with at least two available brain magnetic resonance imaging (MRI) with DTI were analyzed. Mean diffusivity (MD) and fractional anisotropy (FA) were measured in fibers crossing three regions of interest (ROIs): the corpus callosum as a whole, the genu of the corpus callosum, and the splenium of the corpus callosum. The primary outcome was work resumption. RESULTS:Twenty-two patients (36 (25;42) years, 16 (73%) females) were studied. The triad (i.e., brain, eye, and ear involvement) was complete in 21 (95%) patients. All but one patients received steroids alone or in combination with immunosuppressive drugs (n = 11) and/or IVIg (n = 7). Over a median follow-up of 6 (5;8) years, 15 (68%) patients went back to work. FA and MD were longitudinally measured in 123 DTI MRI accounting for a median of 5.6 [4.2; 7] MRI per patient. Microstructural damages in the corpus callosum as a whole, the genu of the corpus callosum, and the splenium of the corpus callosum increased during follow-up and were significantly associated with the inability to return to work. CONCLUSION:Brain DTI identified microstructural damage in fibers crossing the corpus callosum that are associated with long-term disability in SuS. TRIAL REGISTRATION:ClinicalTrials.gov portal identifier: NCT01481662 (https://clinicaltrials.gov/ct2/show/NCT01481662?term=caress&draw=2&rank=5).

To describe initial and follow-up CT features of chronic interstitial lung disease (cILD) associated with systemic lupus erythematosus (SLE), focusing on variant signs of lung fibrosis. This multicentric retrospective study included 76 patients (72 females, 95

Background: To determine the prevalence, the clinical and radiological features, associated factors, treatment, and outcome of splenic artery aneurysms (SAAs) in infective endocarditis (IE). Methods: We retrospectively reviewed 474 consecutive patients admitted to our institution with definite IE (2005-2020). Results: Six patients had SAAs (1.3%; 3 women; mean age: 50 years). In all cases, the diagnosis was obtained by abdominal computed tomography angiography (CTA). SAAs-IE were solitary and saccular with a mean diameter of 30 mm (range: 10-90 mm). SAAs-IE were intrasplenic (n = 4) or hilar (n = 2). Streptococcus spp. were the predominant organisms (n = 4). In all cases, a left-sided native valve was involved (aortic, n = 3; mitral, n = 2; mitral-aortic, n = 1). SAAs were silent in half patients and were revealed by abdominal pain (n = 2) and by the resurgence of fever after cardiac surgery (n = 1). All patients underwent emergent valve replacement. One patient died within 24 hr from multiorgan failure. For the others, uneventful coil embolization was performed in 4 patients after valve replacement (3 diagnosed early and 1 at 8 weeks). In the remaining patient, SAA-IE diagnosed at abdominal CTA at day 16, with complete resolution under appropriate antibiotherapy alone. Conclusions: SAAs-IE are a rare occurrence that may be clinically silent. SAAs-IE can be intrasplenic or hilar in location. Endovascular treatment in this context was safe. According to current guidelines, radiologic screening by abdominal CTA allowed the detection of silent SAAs which could be managed by endovascular treatment to prevent rupture. The delayed formation of these SAAs could justify a CTA control at the end of antibiotherapy.

Background: Size matching between donors and recipients is a major issue in lung transplantation (LTx), especially in patients with restrictive lung disease (RLD). This study aims to evaluate computed tomography (CT) as an additional method for defining the total lung capacity (TLC) in patients with end-stage interstitial disease awaiting LTx. Methods: Clinical data and CT scans from patients who underwent a first LTx from January 2014 to July 2018 in Bichat Hospital, Paris, were prospectively included in a database. CT TLC (ctTLC) was retrospectively calculated after semi-automatic contouring of the parenchyma and compared with measured TLC (mTLC) and predicted TLC (pTLC) values. Results: The study group included 89 patients (male:female =68:21; mean age, 59.5 +/- 10.0 years). The time between pulmonary function tests (PFTs) and CT scan was 162 +/- 270 days [median, 67 days; interquartile range (IQR), 0-233 days]. ctTLC was inferior to mTLC and pTLC (respectively 2,979 +/- 1,001 mL, 3,530 +/- 1,077 and 6,381 +/- 955 mL, P<0.001). The relative difference between CT lung volume (ctLV) and measured lung volume (mLV) was higher on the left than on the right side (25.4% vs . 16.3%, respectively, P=0.11). After exclusion of two outliers, we found a significant correlation between ctTLC and mTLC (r=0.762, P<0.001). Conclusions: CT volume is a feasible method to assess TLC in patients with end-stage interstitial disease awaiting LTx. This study highlights potential size-mismatch for graft selection before LTx and opens the perspective of a prospective trial evaluating impact of size-matching by donor-recipient (D-R) ctTLC ratio on postoperative outcomes.

Background: Respiratory syncytial virus (RSV) is widely recognized as a cause of acute respiratory failure in infants and immunocompromised patients. However, RSV can also contribute to acute respiratory failure in adults, particularly among the elderly population. The objective of this study was to analyze the clinical characteristics and outcomes of immunocompetent adults hospitalized for RSV infection. Methods: This retrospective study included all immunocompetent adult patients consecutively admitted to a tertiary care hospital with RSV-related acute respiratory failure over a seven-year period (2016-2023). Diagnosis of RSV infection was made through nasal swabs or pulmonary samples, with multiplex reverse transcription polymerase chain reaction (RT-PCR). Patients were eligible for inclusion if they required supplemental oxygen therapy for at least 48 h. Results: One hundred and four patients met the inclusion criteria. Median age [IQR] was 77 years [67-85]. Ninety-seven patients had at least one comorbidity (97/104, 93%). At the time of RSV diagnosis, 67 patients (67/104, 64%) experienced acute decompensation of a pre-existing chronic comorbidity. Antibiotics were started in 80% (77/104) of patients; however, only 16 patients had a confirmed diagnosis of bacterial superinfection. Twenty-six patients needed ventilatory support (26/104, 25%) and 21 were admitted to the intensive care unit (21/104, 20%). The median duration of oxygen therapy [IQR] was 6 days [3-9], while the median hospital length of stay [IQR] was 11 days [6-15]. The overall mortality rate within 1 month of hospital admission was 13% (14/104). The sole variables associated with one -month mortality were age and maximum oxygen flow during hospitalization. Conclusion: RSV -associated acute respiratory failure affected elderly individuals with multiple comorbidities and was associated with prolonged hospitalization and a high mortality rate.

Objectives: To characterise chest CT abnormalities one year following severe-to-critical COVID-19 pneumonia, assess their functional significance and analyse the time-course of CT signs. Methods: Retrospective observational monocentric study. Chest CT analysis of residual pulmonary opacities in patients having one year follow-up CT (between February 2021 and February 2022) after severe-to-critical COVID-19 pneumonia. Opacities were categorized into fibrotic-like and predominant ground-glass opacities and compared to pulmonary function tests. Sequential analysis of decreasing, stable or increasing signs at 3, 6, 12 and up to 24 months. Results: One-year pulmonary opacities were present in 46 out of the 66 included patients, and were more frequent in patients admitted as compared to those not admitted to the intensive care unit (38/48, 79% versus 8/18, 44%, p=0.006), with an extent correlated to the length of ICU stay. Pulmonary function tests abnormalities were present in 24/29 patients (82.8%) having fibrotic-like residual opacities versus 6/13 patients (46.1%) having predominant ground-glass opacities (p=0.015). Bronchial distortions decreased in 29% of patients between 6 and 12 months, but CT abnormalities remained mostly stable thereafter in the 16 patients having follow-up CT up to 2 years. Conclusion: One-year pulmonary opacities are more frequent in patients admitted to ICU as compared to non-ICU patients following severe-to-critical COVID-19 and seem related to the length of ICU stay. Fibrotic-like residual opacities are frequently associated to functional impairment.

Introduction: Immunotherapy and targeted therapy have extended life expectancy in non-small cell lung cancer (NSCLC) patients, shifting it into a chronic condition with comorbidities, including osteoporosis. This study aims to evaluate the prevalence and incidence of osteoporotic vertebral fracture (OPVF) during NSCLC follow-up, identify risk factors of OPVF, and determine the impact on overall survival (OS). Methods: We performed a longitudinal single-center retrospective cohort study involving patients with histologically proven NSCLC of any stage. Chest-abdomen-pelvis computed tomography (CAP CT) at diagnosis and during follow-up were double-blind reviewed to determine OPVF site, count, type, time to incident OPVF, and trabecular volumetric bone density (TVBD). An institutional expert committee adjudicated discrepancies. Binary logistic regression was used to predict the occurrence of incident OPVF. OS was calculated using the Kaplan-Meier method. Results: We included 289 patients with a median follow-up of 29.7 months. OPVF prevalence was 10.7% at inclusion and 23.2% at the end of follow-up. Cumulative incidence was 12.5%, with an incidence rate of 4 per 100 patient-years. Median time to incident OPVF was 13 months (IQR: 6.7-21.2). Seven of the 36 patients with incident OPVF received denosumab or bisphosphonates. In multivariable analysis, independent risk factors for incident OPVF were BMI < 19 kg/m(2) (OR: 5.62, 95%CI 1.84-17.20, p = 0.002), lower TVBD (OR: 0.982 per HU, 95%CI 0.97-0.99, p = 0.001) and corticosteroid use (OR: 4.77, 95%CI: 1.76-12.89, p = 0.001). OPVF was not significantly associated with OS. Conclusions: Osteoporosis should be screened for in NSCLC patients. Thoracic oncologists must broaden the use of steroid-induced osteoporosis recommendations.