BACKGROUND:Severe asthma accounts for disproportionate asthma-related morbidity, mortality, and healthcare costs, yet prospective data on its prevalence remain limited, particularly for developing countries. We aimed to determine the prevalence of severe asthma among subjects with difficult-to-treat asthma at a tertiary care center in North India. METHODS:Between January and December 2023, we prospectively enrolled consecutive adults with difficult-to-treat asthma that remained uncontrolled despite treatment with medium- or high-dose inhaled corticosteroids-long-acting beta-agonist (ICS-LABA) or required high-dose ICS-LABA to maintain good control. All subjects underwent systematic evaluation, including diagnosis confirmation, assessment of inhaler technique and adherence, comorbidity screening, and treatment optimization, with reassessment after 3-6 months. We diagnosed severe asthma (uncontrolled despite high-dose ICS-LABA or required high-dose ICS-LABA to maintain good control) after addressing all modifiable factors and assessed type 2 (T2)-targeted biological therapy eligibility. RESULTS:Among 240 subjects (mean age 47.4 ± 14.9 years; 68.8% female), we identified modifiable factors in 218 (90.8%), including suboptimal therapy (74.2%), poor adherence (64.2%), and incorrect technique (58.8%). Following interventions, 154 completed reassessment; 102 (66.2%) no longer met severe asthma criteria. Overall, 67 subjects had severe asthma (27.9%; 95% CI: 22.4-33.9%). Among them, 66.7% had blood eosinophils ≥150 cells/µL, and 68.7% met criteria for T2-targeted biological therapy. CONCLUSION:Approximately one-quarter of subjects with difficult-to-treat asthma have confirmed severe asthma after systematic assessment. A significant proportion improve with targeted interventions, emphasizing the importance of comprehensive evaluation. Most patients with confirmed severe asthma are candidates for T2-targeted biologicals, highlighting the need for structured assessment protocols and improved access to biological therapies.

Background Neoangiogenesis, a key feature of tumor progression, results in increased blood flow (BF), blood volume (BV), and vascular permeability. Dynamic volume perfusion computed tomography (dVPCT) complements conventional morphological assessment by providing valuable insights into tumor vascularity, treatment response, and prognosis. Emerging evidence shows strong correlations between dVPCT parameters, microvessel density, and angiogenic markers, underscoring its potential utility in the comprehensive management of lung cancer. Objectives The aim of this study was to assess the role of dVPCT in the noninvasive evaluation of lung cancer by correlating perfusion parameters with histopathology. Materials and Methods A prospective study was conducted on 40 patients with clinically suspected lung cancer who met the inclusion criteria. All participants underwent dVPCT using a standardized protocol, Adaptive 4D Spiral acquisition followed by postprocessing based on the deconvolution method. Perfusion parameters, including BV, BF, mean transit time (MTT), and flow extraction product (FEP), were analyzed and compared across different histological subtypes. A p-value of less than 0.05 was considered statistically significant. Results Among 40 lung cancer patients, dVPCT revealed significant differences in perfusion parameters across histological subtypes. Adenocarcinoma (AC) demonstrated the highest BV (40.62 +/- 21.42 mL/100 mL) and FEP (21.85 +/- 4.91 mL/100 g/min), both significantly higher than in nonAC groups (p = 0.013 and p = 0.002, respectively). FEP showed the best diagnostic performance with 90% sensitivity and 80% specificity in differentiating AC. BF and MTT did not show statistically significant variation among subtypes. Conclusion dVPCT shows potential as a noninvasive tool for differentiating lung cancer subtypes, with BV and FEP offering significant diagnostic value.

BACKGROUND:Pulmonary mucormycosis (PM) imaging has been characterised primarily in patients with hematologic malignancies. Imaging patterns may differ in diabetes mellitus-associated PM (DAPM), the most common risk factor globally, due to different immunologic profiles and disease progression. The impact of glycemic control on CT findings in DAPM is unknown. METHODS:We retrospectively analysed chest CT scans of patients with PM, compared DAPM with PM in other risk factors (PMOR), and evaluated imaging features across glycated haemoglobin (HbA1c) categories. The secondary objective was to determine associations between imaging features and mortality in DAPM. Imaging patterns recorded by two radiologists were compared between study groups, and multivariable logistic regression analysis of mortality was performed. RESULTS:Among 193 patients (161 DAPM, 32 PMOR), consolidation (97%) and cavitation (84%) were the most frequent. DAPM presented significantly later (median 30 vs. 7 days; P < 0.001) and showed distinct features: smaller nodules (62%, <10 mm) with centrilobular distribution (37.4%), while PMOR had larger nodules (10-30 mm, 55.0%) with random distribution (75.0%). Lymphadenopathy was more common in DAPM (26.0% vs. 9.4%, P = 0.043). Among DAPM, Bird's nest sign increased with HbA1c severity: 7.7% (HbA1c ≤7%), 33.3% (HbA1c 7-9%), and 43.3% (HbA1c>9%), P = 0.030. Overall, 12-week mortality was 47.9%. Although the reversed halo sign and bird's nest sign were associated with mortality on univariable analysis, neither was significant after adjusting for clinical factors. CONCLUSION:DAPM presents later and exhibits distinct imaging features compared to PMOR. Bird's nest sign is more frequent with HbA1c >9%. No imaging features were independently associated with mortality.

This study aims to evaluate the diagnostic accuracy of ultrafast magnetic resonance imaging (UF-MRI)-derived kinetic parameters in differentiating benign from malignant BI-RADS (Breast Imaging-Reporting and Data System) 4 breast masses. It also compares the performance of UF-MRI with standard dynamic contrast-enhanced MRI (DCE-MRI) to determine its impact on clinical decision-making and overall diagnostic accuracy. This cross-sectional observational study included patients with BI-RADS 4 breast masses who underwent UF-MRI from January to December 2024. UF-MRI was acquired continuously over a brief period, capturing kinetic parameters including time to enhancement (TTE), arterial-venous interval (AVI), and maximum slope (MS), in addition to standard DCE-MRI. Two radiologists with more than 10 years of experience in breast radiology independently evaluated the results from standard DCE-MRI and UF-MRI. Statistical analysis assessed the correlation between UF-MRI parameters, standard DCE-MRI, and final histopathology. A total of 31 breast masses from 29 patients (mean age: 45.3 ± 10.9 years) were evaluated, with 16 malignant and 15 benign masses confirmed on histopathology. UF-MRI parameters TTE and AVI demonstrated a strong correlation with malignancy (Cramer's V: 0.81 and 0.87, p < 0.001) while MS (Cramer's V: 0.50) showed moderate association. AVI had the highest specificity (86.7%), followed by TTE (80%) and MS (66.7%) when compared with standard DCE-MRI kinetic curves that showed significantly lower specificity (40%). The combined accuracy of TTE + AVI + MS was 93.5%, with an area under curve of 0.969. UF-MRI showed a high sensitivity and specificity of 100 and 87%, respectively. UF-MRI offers a fast and accurate approach for distinguishing benign from malignant BI-RADS 4 lesions, with TTE and AVI emerging as highly reliable diagnostic markers. It addresses the limitations of standard DCE-MRI by providing early contrast wash-in dynamic data with shorter acquisition times and higher specificity. Integrating UF-MRI kinetic parameters with morphological characteristics such as shape and margins can significantly enhance diagnostic precision, especially in patients with dense breasts and multiple masses, thereby minimizing the need for unnecessary biopsies.

BACKGROUND:Mastitis is an inflammatory condition of the breast which represents an array of underlying etiologies encompassing both infectious and non-infectious causes. Exacerbating factors include endemic infections, lack of awareness and suboptimal breastfeeding practices. Neglected cases lead to prolonged morbidity, recurrent episodes, and complications such as abscess or sinus formation, resulting in permanent breast disfigurement. Its overlapping clinical presentation with breast cancer necessitates an integrated multidisciplinary approach for diagnosis and treatment. OBJECTIVES:The primary aim was to investigate demographic, radiological, and histopathological characteristics of mastitis. Objectives included correlating radiological and histopathological findings, classifying mastitis by etiology, identifying the clinical and imaging patterns across diverse clinical settings to enhance the understanding of mastitis. MATERIAL AND METHOD:This is a retrospective observational study, analysing the clinical, radiological, and histopathological data from 65 patients with mastitis between February 2023 and February 2024. RESULTS:The study included 65 patients, aged 18 to 65 years, with breast pain as the most prevalent clinical presentation. Cases were classified as infectious (47.6%) and non-infectious (52%). Acute puerperal mastitis (26.15%) and granulomatous mastitis (30%) were the most common subtypes. The commonest mammographic finding was focal asymmetry. On ultrasound, infectious mastitis showed oedema with other inflammatory changes, including diffuse skin thickening and collections; while non-infectious mastitis typically presented as solitary or multiple breast masses (p < 0.001). Surprisingly, idiopathic granulomatous mastitis constituted the largest percentage amongst various histopathological causes of mastitis in our study. CONCLUSION:An integrated multidisciplinary approach with understanding of the pathogenesis is imperative for prompt diagnosis and optimizing treatment strategies, thereby improving patient outcome. Radiological imaging is critical for diagnosis, evaluating disease extent, conducting guided interventions, and monitoring treatment response.

BACKGROUND:Mucorales polymerase chain reaction (PCR) is used to diagnose pulmonary mucormycosis (PM) among neutropenic individuals. However, data on the utility of PCR in patients with diabetes mellitus, another major risk factor for PM, are limited. OBJECTIVE:The primary objective was to assess the diagnostic performance of a commercial real-time PCR assay (MucorGenius) in plasma and bronchoalveolar lavage fluid (BALF) for diagnosing PM (proven and probable cases only) in patients with suspected invasive mould disease (IMD). For the secondary objective, we evaluated the performance of the MucorGenius assay in all PM (proven, probable, and possible) cases. METHODS:We prospectively enrolled patients with suspected IMD and assessed the performance of MucorGenius PCR (index test) in plasma and BALF samples. A multidisciplinary team assigned the final diagnosis of IMD (reference standard) based on microscopy, histopathology, cytology, and culture. We report the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% confidence intervals (CI). RESULTS:We enrolled 103 patients, of whom 43 (41.7%) were confirmed to have PM. Plasma PCR showed a sensitivity of 18.6% (95% CI: 8.4-33.4), specificity of 90.7% (95% CI:77.9-97.4), PPV of 66.7%, and NPV of 52.7%. Including possible PM/IMD cases improved the plasma PCR sensitivity to 30.0% (95% CI: 18.9-43.2) and retained specificity at 90.7%. BALF PCR had better sensitivity (47.4%) but poorer specificity (69.6%), with a PPV of 56.3% and NPV of 61.5%. CONCLUSION:Plasma and BALF MucorGenius PCR have poor diagnostic performance for diagnosing PM among individuals with diabetes mellitus. Further multicenter studies are needed to validate these findings.

Although percutaneous renal biopsy is an essential tool for the diagnosis of renal lesions and parenchymal diseases, this procedure is often associated with a number of complications, of which arteriovenous fistula (AVF) is an important one. We report a case of native kidney post-biopsy AVF in a renal transplant recipient that became symptomatic 20 years later and was successfully managed with native kidney nephrectomy. Our case reveals not only an AVF but also an aneurysm that was asymptomatic for over 2 decades.

To describe the spectrum of computed tomography (CT) findings in various chronic pulmonary aspergillosis (CPA) subtypes. This retrospective study analyzed the CT scans of consecutively diagnosed CPA cases. Two radiologists independently evaluated the CT findings (both qualitatively and quantitatively) to characterize the lung cavities, intracavitary contents, pericavitary opacities and fibrosis, mediastinal shift, pleural thickening, and underlying structural lung disease. Patients were then classified into CPA subtypes, and between-group differences were assessed using the sample t test, Wilcoxon test, χ2 test, and Fisher exact test. Among 103 patients with CPA (mean age: 47.26 ± 1.98 y; 69 men), 77.7%, 15.5%, and 6.8% were categorized as chronic cavitary pulmonary aspergillosis, chronic fibrosing pulmonary aspergillosis (CFPA), and single/simple aspergilloma, respectively. The mean symptom duration was 2.7 ± 3.96 years, with cough being the most common symptom (86.4%). Underlying post-tubercular lung abnormalities were observed in 97.1% of the patients. Cavities were observed in all patients (100%), most commonly in the left upper lobe (68.0%). The difference in cavity number among CPA subtypes was statistically significant (P = 0.003), with 87.5% CFPA and 41.5% chronic cavitary pulmonary aspergillosis cases showing multiple cavities. The overall median cavity wall thickness was 6 mm (interquartile range: 2.8), with the highest value in the CFPA. Pericavitary fibrosis was observed in 70.9% of overall cases and in 100% of CFPA cases (P < 0.001). Intracavitary contents were identified in 89.3% of patients. The median pleural thickness was 8 mm (interquartile range: 4), which was significantly different among CPA subtypes (P = 0.001). There was excellent interobserver agreement (k = 0.94) between the two readers. Posterior intercostal lymph nodes were identified in 66%, a novel CPA observation. Comprehensive qualitative and quantitative assessment of CT findings improves the characterization of the CPA subtypes. The number and size of lung cavities, mediastinal shift, and pleural thickness, among other quantitative parameters, vary significantly across CPA subtypes, facilitating more accurate differentiation between them.

LDBio immunochromatographic lateral flow assay, a point-of care test, detects IgM/IgG antibodies against Aspergillus fumigatus (LDBio-ALFA). LDBio-ALFA has been evaluated for diagnosing chronic pulmonary aspergillosis (CPA) in hospital patients, though its efficacy in field settings remains unexamined. Our primary objective was to assess the diagnostic accuracy of LDBio-ALFA in diagnosing CPA in a field and a hospital cohort. The secondary objective was to compare the diagnostic performance of LDBio-ALFA and A. fumigatus-IgG measured by a commercial automated fluorescent enzyme immunoassay (FEIA) using latent class analysis (LCA). We prospectively enrolled adult subjects with post-tuberculosis lung abnormality (PTLA) from a tertiary care hospital (hospital cohort), and designated microscopy centers and a community health center (field cohort). We measured A. fumigatus-IgG using LDBio-ALFA and FEIA in the same serum sample. We enrolled 508 subjects, of which 122 and 386 constituted field and hospital cohorts. CPA was diagnosed in 325/508 (64

PURPOSE:To describe the spectrum of computed tomography (CT) findings in various chronic pulmonary aspergillosis (CPA) subtypes. MATERIAL AND METHODS:This retrospective study analyzed the CT scans of consecutively diagnosed CPA cases. Two radiologists independently evaluated the CT findings (both qualitatively and quantitatively) to characterize the lung cavities, intracavitary contents, pericavitary opacities and fibrosis, mediastinal shift, pleural thickening, and underlying structural lung disease. Patients were then classified into CPA subtypes, and between-group differences were assessed using the sample t test, Wilcoxon test, χ 2 test, and Fisher exact test. RESULTS:Among 103 patients with CPA (mean age: 47.26 ± 1.98 y; 69 men), 77.7%, 15.5%, and 6.8% were categorized as chronic cavitary pulmonary aspergillosis, chronic fibrosing pulmonary aspergillosis (CFPA), and single/simple aspergilloma, respectively. The mean symptom duration was 2.7 ± 3.96 years, with cough being the most common symptom (86.4%). Underlying post-tubercular lung abnormalities were observed in 97.1% of the patients. Cavities were observed in all patients (100%), most commonly in the left upper lobe (68.0%). The difference in cavity number among CPA subtypes was statistically significant ( P = 0.003), with 87.5% CFPA and 41.5% chronic cavitary pulmonary aspergillosis cases showing multiple cavities. The overall median cavity wall thickness was 6 mm (interquartile range: 2.8), with the highest value in the CFPA. Pericavitary fibrosis was observed in 70.9% of overall cases and in 100% of CFPA cases ( P < 0.001). Intracavitary contents were identified in 89.3% of patients. The median pleural thickness was 8 mm (interquartile range: 4), which was significantly different among CPA subtypes ( P = 0.001). There was excellent interobserver agreement (k = 0.94) between the two readers. Posterior intercostal lymph nodes were identified in 66%, a novel CPA observation. CONCLUSION:Comprehensive qualitative and quantitative assessment of CT findings improves the characterization of the CPA subtypes. The number and size of lung cavities, mediastinal shift, and pleural thickness, among other quantitative parameters, vary significantly across CPA subtypes, facilitating more accurate differentiation between them.

INTRODUCTION:Pulmonary Langerhans cell histiocytosis (PLCH) is a rare interstitial lung disease characterized by the accumulation of Langerhans cells within the lung tissue. The diagnosis of PLCH traditionally involves clinical, radiological, and lung biopsy histopathological evaluations. CASE PRESENTATION:We present 2 cases where the diagnosis of PLCH was confirmed through the analysis of bronchoalveolar lavage (BAL) fluid cytology using immunoperoxidase technique, highlighting the significance of this minimally invasive technique in the diagnostic process. Clinical and radiological examination suggested advanced interstitial lung disease characterized by a fibrocystic pattern in both cases. The cytologic analysis of the BAL fluid revealed typical histiocytes with longitudinal grooves and eosinophils, which was better seen on liquid-based cytology (LBC) smears. ICC with CD1a, Langerin, and S-100 confirmed the diagnosis of PLCH. CONCLUSION:Detecting PLCH through the examination of BAL cytology poses challenges, yet it is achievable, particularly with the assistance of LBC and ICC.

Background: Hemoptysis is defined as coughing out of blood. Pulmonary tuberculosis is the most common cause of hemoptysis in tuberculosis-endemic countries like India. Rasmussen aneurysm is a pseudoaneurysm arising from the pulmonary artery adjacent to or within a tuberculous cavity. Chest radiographs, chest computed tomography angiography (CTA), and digital subtraction angiography (DSA) are the imaging tools for evaluating a case of hemoptysis.Case: A 32-year-old man with a history of pulmonary tuberculosis presented with complaints of recurrent hemoptysis. On imaging evaluation, multiple pulmonary artery pseudoaneurysms were seen in the left lung. The patient was shifted to the DSA lab and the pseudoaneurysms were subsequently treated by endovascular coil embolization. Hemoptysis resolved following the procedure and the patient was again started on anti-tubercular therapy.Conclusion: Endovascular coiling is minimally invasive, safe, and effective management of multiple Rasmussen aneurysms for preventing possible torrential blood loss and unfortunate death.

Background: Many survivors of severe COVID-19 pneumonia experience lingering respiratory issues. There is limited research on follow-up chest imaging findings in patients with COVID-19 ARDS, particularly in relation to their mMRC dyspnea scores and pulmonary function tests (PFTs). This study addresses this gap by investigating the clinical characteristics, mMRC dyspnea scores, PFTs, and chest CT findings of COVID-19 ARDS patients at the 6 months post-recovery. By analyzing these variables together, we aim to gain a better understanding of the long-term health consequences of COVID-19 ARDS.Methods: This prospective observational study included 56 subjects with COVID-19 ARDS with dyspnea at the six-month follow-up visits. These patients were evaluated by chest CT, mMRC dyspnea scale, and PFT. The CT severity score was calculated individually for each of the four major imaging findings - ground glass opacities (GGOs), parenchymal/atelectatic bands, reticulations/septal thickening, and consolidation - using a modified CT severity scoring system. Statistics were carried out to find any association between individual CT chest findings and the mMRC dyspnea scale and forced vital capacity (FVC). p values < 0.05 were considered statistically significant.Results: Our study population had a mean age of 55.86 ± 9.60 years, with 44 (78.6%) being men. Grades 1, 2, 3, and 4 on the mMRC dyspnea scale were seen in 57.1%, 30.4%, 10.7%, and 1.8% of patients respectively. Common CT findings observed were GGOs (94.6%), reticulations/septal thickening (96.4%), parenchymal/atelectatic bands (92.8%), and consolidation (14.3%). The mean modified CT severity scores for GGOs, reticulations/septal thickening, parenchymal/atelectatic bands, and consolidation were 10.32 ± 5.51 (range: 0–21), 7.66 ± 4.33 (range: 0–19), 4.77 ± 3.03 (range: 0–14) and 0.29 ± 0.91 (range 0–5) respectively. Reticulations/septal thickening (p = 0.0129) and parenchymal/atelectatic bands (p = 0.0453) were associated with an increased mMRC dyspnea scale. Parenchymal/atelectatic bands were also associated with abnormal FVC (<80%) (p = 0.0233).Conclusion: Six-month follow-up chest CTs of COVID-19 ARDS survivors with persistent respiratory problems showed a statistically significant relationship between increased mMRC dyspnea score and imaging patterns of reticulations/septal thickening and parenchymal/atelectatic bands; while parenchymal/atelectatic bands also showed a statistically significant correlation with reduced FVC.

Dear Editor, We read the interesting case report on airway mucormycosis by Kaliya et al.[1] and the accompanying literature review. Isolated tracheal or airway mucormycosis is indeed an uncommon entity. However, several cases,[2] including a recent systematic review on the topic, have been missed.[3] Thus, the search strategy employed by the authors is unclear. While the authors discuss surgery and anti-fungal therapy in managing isolated tracheobronchial mucormycosis (ITBM), bronchoscopic management was not highlighted. Notably, nearly 30% of subjects with ITBM may require therapeutic bronchoscopy.[3] We illustrate the role of bronchoscopy by describing a case of critical central airway obstruction due to ITBM requiring airway stenting. A 49-year-old man presented with fever, productive cough, and noisy breathing developing over 10 days. He denied haemoptysis, facial swelling, or trauma. There was no recent hospitalization or endotracheal intubation. He had no history of smoking or substance abuse. The physical examination was unremarkable except for stridor at rest. There was a history of poorly controlled diabetes, with glycated haemoglobin of 10.9% at admission. Complete blood count, renal, and liver function tests were normal. Computed tomography of the thorax [Figure 1] showed a polypoidal enhancing soft tissue lesion arising from the lateral tracheal wall along with an endoluminal component. The patient's stridor worsened, and he required endotracheal intubation. Bronchoscopy showed fleshy yellowish-grey material arising from the lower end of trachea, extending 1 cm above the carina [Figure 2a]. The distal tracheobronchial tree was normal. We performed a rigid bronchoscopy under general anaesthesia, and the fleshy, unhealthy material was removed with difficulty using rigid bronchoscopic forceps [Supplemental Video 1] and an electrocautery snare. Once the blackish necrotic content was cleared from the trachea, the underlying trachea appeared unhealthy, and we deployed a covered self-expanding metallic Y-stent [Figure 2b]. The histopathology of the necrotic material and biopsy specimens revealed invasive mucormycosis [Figure 3]. Culture grew Rhizopus arrhizus. He had symptomatic relief after the procedure and was successfully liberated from the ventilator in 24 hours. After initial management with intravenous liposomal amphotericin B (5 mg/kg/day for 12 days), maintenance therapy with posaconazole was continued for 2 months. The metallic stent was removed, and the patient is doing well after 1 year of follow-up.Figure 1: Contrast-enhanced computed tomography images showing polypoidal enhancing soft tissue lesion (mediastinal window, a) arising from the right wall of the trachea with the endoluminal and exophytic components. Air focus interspersed in the tissue and narrowing of the tracheal lumen are also noted. Lung window sections (b) show the same finding (white arrows) with a small subpleural nodule in the right upper lobe (black arrow)Figure 2: Bronchoscopy showing: a. fleshy yellowish-grey material arising from the lower end of trachea and the arrowhead demonstrates underlying unhealthy lateral tracheal wall, and b shows the lower trachea, carina, and bilateral main bronchi after deployment of the covered self-expanding metallic Y-stentFigure 3: a. Photomicrograph of the endobronchial biopsy showing bland tissue necrosis with fungal hyphae; b. High power showing broad aseptate right angle branching fungal hyphae conforming to morphology of mucor {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_j166g66q"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Critical airway narrowing due to ITBM is relatively uncommon and challenging to diagnose, requiring a high index of suspicion. In the index case, a tracheal tumour was suspected after the initial presentation and radiology; however, bronchoscopy did not show a tumour. Instead, a fleshy necrotic material from the lateral tracheal wall was seen, suggesting a possible non-malignant aetiology for the central airway obstruction.[4] In immuno-compromised subjects, invasive aspergillosis and mucormycosis can have a similar clinical presentation. Surgery for pulmonary mucormycosis is associated with improved survival.[5,6] However, surgery is not possible in patients with critical central airway narrowing and requires initial rigid bronchoscopy, as in the index case. Therapeutic bronchoscopy, including rigid bronchoscopic mechanical debulking, cryotherapy, argon plasma coagulation, Nd: YAG LASER, snaring, and extraction of mucus plugs, has been performed to relieve luminal obstruction and improve outcomes.[7-14] In ITBM with no respiratory compromise, adjunctive therapies like inhaled or bronchoscopic instillation of amphotericin B can be considered.[15] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

BackgroundFrequent chest CTs within a short period during follow-up of long COVID patients may increase the risk of radiation-related health effects in the exposed individuals. We aimed to assess the image quality and diagnostic accuracy of ultra-low-dose CT (ULDCT) chest compared to standard-dose CT (SDCT) in detecting lung abnormalities associated with long COVID.MethodsIn this prospective study, 100 long COVID patients with respiratory dysfunction underwent SDCT and ULDCT chest that were compared in terms of objective (signal-to-noise ratio, SNR) and subjective image quality (image graininess, sharpness, artifacts, and diagnostic accuracy along with the European guidelines on image quality criteria for CT chest), detection of imaging patterns of long COVID, CT severity score, and effective radiation dose. Additionally, the diagnostic performance of ULDCT was compared among obese (BMI≥30 kg/m2) and non-obese (BMI<30 kg/m2) subjects.ResultsThe mean age of study participants was 53 ± 12.9 years, and 68% were male. The mean SNR was 31.4 ± 5.5 and 11.3 ± 4.6 for SDCT and ULDCT respectively (p< 0.0001). Common findings seen on SDCT included ground-glass opacities (GGOs, 77%), septal thickening/reticulations (67%), atelectatic/parenchymal bands (63%) and nodules (26%). ULDCT provided sharp images, with no/minimal graininess, and high diagnostic confidence in 81%, 82% and 80% of the cases respectively. The sensitivity of ULDCT for various patterns of long COVID was 72.7% (GGOs), 71.6% (interlobular septal thickening/reticulations), 100% (consolidation), 81% (atelectatic/parenchymal bands) and 76.9% (nodules). ULDCT scans in non-obese subjects exhibited a significantly higher sensitivity (88% vs. 60.3%, p < 0.0001) and diagnostic accuracy (97.7% vs. 84.9%, p < 0.0001) compared to obese subjects. ULDCT showed very strong correlation with SDCT in terms of CT severity score (r = 0.996, p < 0.0001). The mean effective radiation dose with ULDCT was 0.25 ± 0.02 mSv with net radiation dose reduction of 94.8% ± 1.7% (p < 0.0001) when compared to SDCT (5.5 ± 1.96 mSv).ConclusionULDCT scans achieved comparable diagnostic accuracy to SDCT for detecting long COVID lung abnormalities in non-obese patients, while significantly reducing radiation exposure.

A BSTRACT Isolated renal mucormycosis (IRM) in an apparently healthy immunocompetent adult is a rare entity with most cases reported from India and China. Fever not responding to antibiotics, sterile pyuria, and characteristic imaging findings are strong pointers toward renal mucormycosis. We report a rare case of IRM due to Apophysomyces elegans in an apparently healthy young adult who underwent bilateral nephrectomy and ultimately succumbed to sepsis. Clinical indicators such as fever not responding to antibiotics, severe flank tenderness, sterile pyuria, and characteristic computed tomography findings (diffuse or patchy areas of absent contrast enhancement, perinephric fat stranding, and thickened Gerota’s fascia) are strong pointers toward renal mucormycosis. Aggressive surgical debridement and timely antifungal is imperative for favorable patient outcome in this aggressive infection.