Background: It is unclear how far the superior efficacy of omalizumab, established in randomized controlled clinical trials of patients with severe allergic asthma (SAA), translates into routine practice and when compared to matched controls. Methods: New-onset omalizumab-treated (OT) patients with SAA (n = 53) were compared to a matched control group of usual-care (UC) patients (n = 53). Treatment and procedures were naturalistic. Subsequent to a baseline assessment, patients were followed up over at least 6 months with at least two follow-up assessments. Primary clinical outcomes were the number of asthma attacks, persistence of asthma symptoms and degree of control [asthma control test (ACT), Global Initiative for Asthma]. Secondary outcome criteria were quality of life (Euro-Qol 5D) and number of medications. For each outcome we compared within-group effects from baseline to 6-month follow-up as well as between-group effects. Results: OT patients showed significant improvements in number [effect size (ES) = 0.03] and frequency (ES = 0.04) of asthma attacks as well as asthma control (ES = 0.09), whereas controls revealed no significant improvements in these measures. Further improvements in the OT group were found for ‘perceived control always’ (ACT, p = 0.006), no impairment (ACT, p = 0.02), reduction of sickness days (p = 0.002) and number of medications needed (p = 0.001). Conclusions: Substantial beneficial effects of omalizumab, similar to those observed in controlled trials and after marketing studies, were confirmed, particularly with regard to the reduction of asthma attacks, persistence of symptoms, asthma control and reduction of concomitant asthma medications. This study provides a tougher test and generalizable evidence for the effectiveness of omalizumab in routine care.

Rhabdomyosarcomas (RMS) are the most common type of soft tissue neoplasm in children. They typically arise from primitive skeletal muscle and are usually observed in either the head and neck or the genitourinary region. We report a rare case of an embryonal rhabdomyosarcoma lung malignancy and a formulated histopathological process to differentiate these lesions from its main differentials. We aim to bring attention to this case in an effort to assist physicians in making the correct diagnosis, should they be presented with a similar case. Here we present a case of a 56-year-old female with a past medical history of COPD and a 30-pack-year smoking history who was referred to a Regional Cancer Center clinic due to newly diagnosed lung cancer. The patient presented with anorexia, weight loss, cough, dyspnea for two months, and a 30-pound weight loss over the last month. CTA of the chest on 7/26/2021 revealed a 14 cm confluent mass extending throughout the mediastinum and the left hilum with associated narrowing of the left-sided pulmonary arteries and bronchi consistent with neoplasia. Several cavitary nodules in the left lung are present, consistent with metastatic disease. CT-guided biopsy on 8/2/2021 revealed a high-grade neoplasm with neuroendocrine features, and frequent mitotic figures, and tumor necrosis. Immunohistochemical staining was positive for synaptophysin, and CD56. Negative stains include cytokeratin TTF-1, AE1/AE3, CAM 5.2, CK 34 beta E12, CK5/6, CK7, CK20, p40, mart 1, SOX10 and CD45. The patient was then diagnosed with pulmonary embryonal rhabdomyosarcoma. In this case report the patient was diagnosed with pulmonary embryonal rhabdomyosarcoma, which characteristically has cells that show variable degrees of skeletal muscle differentiation with spindled morphology and differentiated rhabdomyoblasts. Desmin, myoD1, and myogenin are the key immunohistochemical stains that should be utilized to confirm the suspected diagnosis of a RMS. The staining pattern varies between different RMS subtypes, as the pulmonary subtype staining pattern is more focal compared to the others which tend to stain diffusely. CD56 staining can also be used to identify an alveolar RMS, however, is nonspecific. In this patient's case, CD56 was positive but the FISH analysis confirmed embryonal RMS as the final diagnosis. Previous studies have indicated that RMS can metastasize to the lung, thus this strain can prove to be a useful tool in rare cases such as this one, where the etiology of the cancer is unclear but has progressed to the lung. This unique case report highlights the diagnostic approach and aims to provide a differential diagnosis for a pulmonary embryonal rhabdomyosarcoma as well as an effective workup. Future research into the origin of the pulmonary embryonal rhabdomyosarcoma is indicated to provide comprehensive treatment for the patient and further understand the pathophysiology of the disease discussed.

Background: The etiology of pulmonary disease is complex and influenced by various factors, resulting in a significant public health issue, with 16 million Americans living with chronic obstructive pulmonary disease (COPD) and 24 million with asthma, and cases are on the rise. The purpose of this study was to explore demographic, health status, and lifestyle behaviors with pulmonary disease so patterns of risk can be understood and inform interventions. Methods: This cross-sectional study utilized the National Inpatient Sample Data from 2019 (NIS 2019). The predictor variables consisted of: demographics (age (18+), sex, race), health status (obesity, depression, diabetes), lifestyle behaviors (smoking, alcohol use, and aspirin use), and the outcome variable was pulmonary disease. To ensure accuracy, the data was weighted by the variable discharge weight (DISCWT), and chi-square analyses and ANOVA tests were conducted to determine the independence of categorical and numerical predictor variables. Descriptive statistics were conducted for all variables, simple and multiple logistic regression analyses were performed to identify factors that contribute to the likelihood of having pulmonary disease. Results: The sample of the NIS 2019 data included 6,043,654 cases of which, 22.65% of inpatients had pulmonary disease. The collective sample demographic characteristics were: mean age of 58.4 years, and more than half of inpatients were females (57.05% compared to 42.95% males). In terms of health, 17.75% of the sample were obese, 28.8% had diabetes, and 14.25% were depressed. Within the collective sample, 16.8% of inpatients reported smoking, 9.09% drank alcohol, and 14.51% consumed aspirin (long-term (current) use of aspirin). Results of the multivariate statistical analyses reveal that individuals who were obese were 68.3% more likely to have pulmonary disease compared to non-obese patients (aOR = 1.683, CI 1.679-1.686, pConclusion: Results of our study provide important insights between pulmonary disease and associated risk patterns. As pulmonary symptoms have risen in the wake of the COVID-19 pandemic, there is an urgent public health need to explore disruption of risk pathways to avoid overwhelming fragile global healthcare systems.

Com o objetivo de se avaliar a importância do \"clearance\" do dietilenotriamino-pentacetato marcado com Tecnécio 99m (DTPA-Tecnécio-99m) em portadores de pneumopatia por amiodarona foram estudados 40 indivíduos, em quatro grupos. Grupo I: 10 voluntários normais, assintomáticos e não fumantes (8 homens e 2 mulheres), com média de idade de 56,80 anos. Grupo II: 10 voluntários normais, assintomáticos e fumantes (6 homens e 4 mulheres ), com média de idade de 27,50 anos. Grupo III: 10 pacientes não fumantes ( 4 homens e 5 mulheres ), com média de idade de 52,90 anos. Todos faziam uso crônico de amiodarona por via oral. Grupo IV: 10 pacientes portadores de pneumopatia por amiodarona, quatro ex-fumantes, dois fumantes e quatro não fumantes ( 8 homens e 2 mulheres) com média de idade de 52,90 anos. Todos faziam uso de amiodarona por via oral e nenhum fumou nas 4 semanas que precederam o estudo. Após espirometria que constou do registro da curva volume-tempo, todos inalaram 4 ml de solução salina contendo 740 MBq de DTPA Tecnécio-99m, durante cinco minutos. Através de uma c~mara de cintilação computadorizada foram obtidas imagens pulmonares, definindo-se 9 áreas de interesse. Para cada região escolhida foi determinada uma curva de \"clearance\" extraindo-se o valor de meia-vida biológica em minu- tos ( T 1/2 ) e a taxa percentual de \" clearance\" alvéolo capilar do radioaerossol por minuto (K%/min). Observamos que, das variáveis espirométricas consideradas, a capacidade vital forçada (CVF) e o volume expiratório forçado no 1 segundo (VEF1) mostraram diferenças significantes entre os grupos I e IV. A contagem total de radioatividade de ambos os pulmões não mostrou relação com a CVF e o VEF1. O \" clearance \" pulmonar do DTPA Tecnécio-99m foi maior nos grupos 11 e IV, porém não permitindo sua diferenciação. Estes resultados permitem concluir: Os pacientes portadores de pneumonite por amiodaro- na apresentam\" clearance \" alvéolo-capilar de DTPA Tecnécio-99m significativamente maior que os indivíduos do grupo de normais não fumantes. Este fato também se verificou em relação aos pacientes em uso crônico de amiodarona mas sem evidências de pneumopatia. Não é possível diferenciar os fumantes dos portadores de pneumonite por amiodarona através da análise da integridade da barreira alvéolo-epitelial com DTPA Tecnécio-99m. Comparativamente, o estudo da integridade alvéolo-epitelial pelo \"clearance\" pulmonar de DTPA Tecnécio-99m é mais sensível que a espirometria na avaliação da pneumonite por amiodarona, permitindo diferenciar estes pacientes dos que fazem uso crônico da droga / In order to evaluate the role of the clearance of 99m Technetium chelated to diethylenetriamine-penta-acetate ( 99mTc-DTPA) in amiodarone induced pulmonary disease, 40 individuaIs were studied in four groups. Group I: 10 normal non smoking volunteers (8 men and 2 women ), whose mean age was 56.80 years. Group lI: 10 normal smoking volunteers ( 6 men and 4 women ), aging 27.50 years in average. Group III: 10 non smoking patients ( 4 men and women ), aging 52.90 years in average, who were chronically taking oral amiodarone. Group IV: 10 patients with amiodarone induced pul- monary disease (8 men and 2 women), four non-smokers, two smokers and four previous smokers. Their mean age was 62.90 years. AIl of them were taking oral amiodarone and none has smoked in the 4 weeks previous to the study. After spirometry, where a volume-time curve was registered, alI individuaIs inhaled 740 MBq of 99mTc-DTPA diluted in 4 ml of saline, for five minutes. Pulmonary images were obtained in a computadorized scintillation camera and 9 regions of interest were selected. A clearance curve of each region was determined, from which the effective half-life in minutes (T 1/2 ) and the alveolar-capilar clearance rate per minute ( k%/min ) of the radiolabeled aerosol were mea- sured. The spirometric analys disclosed a statistically lower value of the forced vital capacity ( FVC ) and forced expiratory volume in the first second ( FEV1 ) in the patients of group IV when compared to group I. The total radioactivity count for both lungs were not influenced by FVC and FEV1. The 99mTc-DTPA clearance rate was higher in groups 11 and IV, but these two groups could not be statistically differentiated. Based on these results it 1s concluded: patients with amiodarone induced pulmonary pneumonitis have higher clearance rates of 99m Tc-DTPA than normal non smoking controls and than patients taking amiodarone but with no lung toxicity. It is not possible to separate patients with amiodarone induced disease from normal smokers by determining 99m Tc-DTPA clearance rates. The determination of the alveolar-epithelial barrier integrity by 99m Tc-DTPA clearance rate is a more sensitive test than spirometry in the evaluation of amiodarone induced pneumonitis making it possible to differentiate these patients from those who take the drug and have no lung toxicity

Com o objetivo de se avaliar a importância do \"clearance\" do dietilenotriamino-pentacetato marcado com Tecnécio 99m (DTPA-Tecnécio-99m) em portadores de pneumopatia por amiodarona foram estudados 40 indivíduos, em quatro grupos. Grupo I: 10 voluntários normais, assintomáticos e não fumantes (8 homens e 2 mulheres), com média de idade de 56,80 anos. Grupo II: 10 voluntários normais, assintomáticos e fumantes (6 homens e 4 mulheres ), com média de idade de 27,50 anos. Grupo III: 10 pacientes não fumantes ( 4 homens e 5 mulheres ), com média de idade de 52,90 anos. Todos faziam uso crônico de amiodarona por via oral. Grupo IV: 10 pacientes portadores de pneumopatia por amiodarona, quatro ex-fumantes, dois fumantes e quatro não fumantes ( 8 homens e 2 mulheres) com média de idade de 52,90 anos. Todos faziam uso de amiodarona por via oral e nenhum fumou nas 4 semanas que precederam o estudo. Após espirometria que constou do registro da curva volume-tempo, todos inalaram 4 ml de solução salina contendo 740 MBq de DTPA Tecnécio-99m, durante cinco minutos. Através de uma c~mara de cintilação computadorizada foram obtidas imagens pulmonares, definindo-se 9 áreas de interesse. Para cada região escolhida foi determinada uma curva de \"clearance\" extraindo-se o valor de meia-vida biológica em minu- tos ( T 1/2 ) e a taxa percentual de \" clearance\" alvéolo capilar do radioaerossol por minuto (K%/min). Observamos que, das variáveis espirométricas consideradas, a capacidade vital forçada (CVF) e o volume expiratório forçado no 1 segundo (VEF1) mostraram diferenças significantes entre os grupos I e IV. A contagem total de radioatividade de ambos os pulmões não mostrou relação com a CVF e o VEF1. O \" clearance \" pulmonar do DTPA Tecnécio-99m foi maior nos grupos 11 e IV, porém não permitindo sua diferenciação. Estes resultados permitem concluir: Os pacientes portadores de pneumonite por amiodaro- na apresentam\" clearance \" alvéolo-capilar de DTPA Tecnécio-99m significativamente maior que os indivíduos do grupo de normais não fumantes. Este fato também se verificou em relação aos pacientes em uso crônico de amiodarona mas sem evidências de pneumopatia. Não é possível diferenciar os fumantes dos portadores de pneumonite por amiodarona através da análise da integridade da barreira alvéolo-epitelial com DTPA Tecnécio-99m. Comparativamente, o estudo da integridade alvéolo-epitelial pelo \"clearance\" pulmonar de DTPA Tecnécio-99m é mais sensível que a espirometria na avaliação da pneumonite por amiodarona, permitindo diferenciar estes pacientes dos que fazem uso crônico da droga / In order to evaluate the role of the clearance of 99m Technetium chelated to diethylenetriamine-penta-acetate ( 99mTc-DTPA) in amiodarone induced pulmonary disease, 40 individuaIs were studied in four groups. Group I: 10 normal non smoking volunteers (8 men and 2 women ), whose mean age was 56.80 years. Group lI: 10 normal smoking volunteers ( 6 men and 4 women ), aging 27.50 years in average. Group III: 10 non smoking patients ( 4 men and women ), aging 52.90 years in average, who were chronically taking oral amiodarone. Group IV: 10 patients with amiodarone induced pul- monary disease (8 men and 2 women), four non-smokers, two smokers and four previous smokers. Their mean age was 62.90 years. AIl of them were taking oral amiodarone and none has smoked in the 4 weeks previous to the study. After spirometry, where a volume-time curve was registered, alI individuaIs inhaled 740 MBq of 99mTc-DTPA diluted in 4 ml of saline, for five minutes. Pulmonary images were obtained in a computadorized scintillation camera and 9 regions of interest were selected. A clearance curve of each region was determined, from which the effective half-life in minutes (T 1/2 ) and the alveolar-capilar clearance rate per minute ( k%/min ) of the radiolabeled aerosol were mea- sured. The spirometric analys disclosed a statistically lower value of the forced vital capacity ( FVC ) and forced expiratory volume in the first second ( FEV1 ) in the patients of group IV when compared to group I. The total radioactivity count for both lungs were not influenced by FVC and FEV1. The 99mTc-DTPA clearance rate was higher in groups 11 and IV, but these two groups could not be statistically differentiated. Based on these results it 1s concluded: patients with amiodarone induced pulmonary pneumonitis have higher clearance rates of 99m Tc-DTPA than normal non smoking controls and than patients taking amiodarone but with no lung toxicity. It is not possible to separate patients with amiodarone induced disease from normal smokers by determining 99m Tc-DTPA clearance rates. The determination of the alveolar-epithelial barrier integrity by 99m Tc-DTPA clearance rate is a more sensitive test than spirometry in the evaluation of amiodarone induced pneumonitis making it possible to differentiate these patients from those who take the drug and have no lung toxicity

Ventricular assist devices are used in patients with heart failure refractory to standard management. Though left ventricular assist devices are more often used, patients with severe right ventricular dysfunction may also be treated with mechanical support. This case presents a patient with mixed cardiogenic and septic shock requiring placement of a percutaneous right ventricular assist device. A 38-year-old obese male with a medical history of alcoholism presented to the hospital with a complaint of dyspnea. He was found to have volume overload and was given intravenous diuretics. However, he had progressive renal insufficiency, hypotension requiring vasopressor support, and worsening respiratory status requiring mechanical ventilation. An echocardiogram showed a severely enlarged right ventricle, reduced RV function, normal RV wall thickness, moderate to severe tricuspid regurgitation, a severely dilated right atrium, ventricular septal flattening, and mild pulmonary hypertension. Left ventricular ejection fraction was 65-70%, LV diastolic function was normal, and there were no other significant valvular abnormalities. Troponin levels, ECG, and CT pulmonary angiography were unrevealing. Right heart catheterization showed a right atrial pressure of 29 mmHg (2 – 6 mmHg), right ventricular pressures of 50/24 mmHg (15-25/0-8 mmHg), pulmonary artery pressures of 56/35/43 mmHg (15-25/8-15/10-20 mmHg), a pulmonary capillary wedge pressure of 22 mmHg (6-12 mmHg), and a Prognostic Impact of Pulmonary Artery Pulsatility Index (PAPi) score of 0.3 to 0.6 (>1). Cardiac chamber oxygen saturations did not demonstrate intracardiac shunting. A right-sided mechanical circulatory support device was placed. The hospital course was complicated by sepsis due to pneumonia and presumed central line-associated bloodstream infection requiring antibiotic therapy, anemia secondary to device-related hemolysis requiring blood transfusions, renal failure requiring renal replacement therapy, and candidemia requiring antifungal therapy. Due to concern for device-associated infection, his central lines were replaced. The mechanical circulatory support device was able to be removed after ten days. Subsequent cardiac imaging did not reveal any other structural abnormalities, and a definitive cause for the right heart failure was not determined. Etiologies of right-sided heart failure include left-sided heart failure, pulmonary hypertension, chronic pulmonary disease, myocardial infarction, pulmonary embolism, myocarditis, valvular dysfunction, and congenital anomalies. Mechanical circulatory support may be used to support cardiac function, to allow the ventricular function to improve. Potential complications of mechanical circulatory support include infection, hemolysis, bleeding, device migration, and malfunction. RVAD therapy should be considered for patients with isolated right ventricular failure refractory to less invasive therapy.

As doenças pulmonares intersticiais difusas caracterizam-se pela presença de um distúrbio ventilatório restritivo cuja intensidade está associada ao grau de extensão do comprometimento intersticial e consequentemente ao estágio da doença. As provas de função pulmonar em conjunto com o grau de comprometimento intersticial na TCAR são os principais métodos de avaliação utilizados para determinar o estágio da doença, bem como para acompanhar sua progressão e a resposta terapêutica. A densitovolumetria pulmonar realizada através da TC Helicoidal consiste em uma técnica objetiva e mais precisa que permite calcular a proporção de volume de pulmão com densidade aumentada pelo acometimento por fibrose sobre o volume de pulmão com densidade normal, ou seja, sem acometimento significativo dos interstícios. Na literatura, sugere-se –870 UH como o limiar de separação ideal para quantificação de fibrose pulmonar por tomografia computadorizada, acima do qual o pulmão seria considerado como apresentando aumento de densidade pela presença de fibrose ou de atenuação em vidro-fosco. O presente estudo comparou o limiar fixo em –870UH com a utilização de um limiar subjetivo ou variável selecionado com o auxílio de máscara de densidades em 30 pacientes com comprovação histológica FPI em relação as provas de função pulmonar. A correlação dos resultados da densitovolumetria pulmonar utilizando o limiar fixo (-870 HU) com as provas de função pulmonar foram de r= 0,265 com o VEF1, r=-0,450 com a CVF, r=-0,705 com a CPT e r= -0,305 com a DCO. Em comparação, as correlações entre os resultados da densitovolumetria pulmonar estabelecidos com base na seleção subjetiva de um limiar subjetivo foram: r= –0,347 com o VEF1, r= - 0,534 com a CVF, r= -0,734 com a CPT e r= –0,413 com a DCO. Tanto as medidas objetivas como subjetivas da extensão da fibrose realizadas pela densitovolumetria apresentaram boa correlação com as medidas funcionais que expressam restrição. As correlações foram fracas, quando correlacionadas com medidas funcionais que não expressam a extensão da fibrose pulmonar. A densitovolumetria pode proporcionar uma técnica mais precisa que a simples análise subjetiva das imagens de tomografia computadorizada de alta resolução em pacientes com FPI, sendo assim mais efetiva na avaliação evolutiva de cada paciente. / Diffuse interstitial pulmonary diseases are characterized by restrictive lung disorders whose intensity is associated with the extent of interstitial involvement and, consequently, the stage of the disease. Pulmonary function tests and HRCT assessment of the degree of interstitial involvement are the primary methods to establish the stage of the disease, to follow up its progression, and to evaluate therapeutic response. Pulmonary densitovolumetry using helical CT is an objective and accurate technique to calculate the proportion of volume of lung with increased density due to fibrosis with relation to volume of lung with normal density, that is, without significant interstitial involvement. Studies in the literature suggest - 870 UH as the ideal segmentation threshold to assess pulmonary fibrosis using CT; above this value, increased density due to fibrosis or ground-glass opacity should be considered. In this study, the use of a -870 HU fixed threshold was compared with the use of a subjective or variable threshold selected with the aid of a density mask in 30 patients with a histologic diagnosis of IPF, and results were correlated with pulmonary function test results. Correlations between pulmonary densitovolumetry using the fixed threshold (-870 HU) and pulmonary function tests were r= 0.265 for FEV1, r=-0.450 for FVC, r=-0.705 for TLC and r= -0.305 for DLCO. When pulmonary densitovolumetry with selection of a subjective threshold was used, results were: r= –0.347 for FEV1, r= -0.534 for FVC, r= -0.734 for TLC and r= –0.413 for DLCO. Both objective and subjective measurements of the extent of fibrosis using densitovolumetry had a good correlation with results of functional tests that indicate restriction. Correlations were weak with functional measurements that do not indicate the extent of pulmonary fibrosis. Densitovolumetry may be a more accurate technique than the simple subjective analysis of high-resolution CT images in patients with IPF, and may be, therefore, more effective in the evaluation of disease progression.

As doenças pulmonares intersticiais difusas caracterizam-se pela presença de um distúrbio ventilatório restritivo cuja intensidade está associada ao grau de extensão do comprometimento intersticial e consequentemente ao estágio da doença. As provas de função pulmonar em conjunto com o grau de comprometimento intersticial na TCAR são os principais métodos de avaliação utilizados para determinar o estágio da doença, bem como para acompanhar sua progressão e a resposta terapêutica. A densitovolumetria pulmonar realizada através da TC Helicoidal consiste em uma técnica objetiva e mais precisa que permite calcular a proporção de volume de pulmão com densidade aumentada pelo acometimento por fibrose sobre o volume de pulmão com densidade normal, ou seja, sem acometimento significativo dos interstícios. Na literatura, sugere-se –870 UH como o limiar de separação ideal para quantificação de fibrose pulmonar por tomografia computadorizada, acima do qual o pulmão seria considerado como apresentando aumento de densidade pela presença de fibrose ou de atenuação em vidro-fosco. O presente estudo comparou o limiar fixo em –870UH com a utilização de um limiar subjetivo ou variável selecionado com o auxílio de máscara de densidades em 30 pacientes com comprovação histológica FPI em relação as provas de função pulmonar. A correlação dos resultados da densitovolumetria pulmonar utilizando o limiar fixo (-870 HU) com as provas de função pulmonar foram de r= 0,265 com o VEF1, r=-0,450 com a CVF, r=-0,705 com a CPT e r= -0,305 com a DCO. Em comparação, as correlações entre os resultados da densitovolumetria pulmonar estabelecidos com base na seleção subjetiva de um limiar subjetivo foram: r= –0,347 com o VEF1, r= - 0,534 com a CVF, r= -0,734 com a CPT e r= –0,413 com a DCO. Tanto as medidas objetivas como subjetivas da extensão da fibrose realizadas pela densitovolumetria apresentaram boa correlação com as medidas funcionais que expressam restrição. As correlações foram fracas, quando correlacionadas com medidas funcionais que não expressam a extensão da fibrose pulmonar. A densitovolumetria pode proporcionar uma técnica mais precisa que a simples análise subjetiva das imagens de tomografia computadorizada de alta resolução em pacientes com FPI, sendo assim mais efetiva na avaliação evolutiva de cada paciente. / Diffuse interstitial pulmonary diseases are characterized by restrictive lung disorders whose intensity is associated with the extent of interstitial involvement and, consequently, the stage of the disease. Pulmonary function tests and HRCT assessment of the degree of interstitial involvement are the primary methods to establish the stage of the disease, to follow up its progression, and to evaluate therapeutic response. Pulmonary densitovolumetry using helical CT is an objective and accurate technique to calculate the proportion of volume of lung with increased density due to fibrosis with relation to volume of lung with normal density, that is, without significant interstitial involvement. Studies in the literature suggest - 870 UH as the ideal segmentation threshold to assess pulmonary fibrosis using CT; above this value, increased density due to fibrosis or ground-glass opacity should be considered. In this study, the use of a -870 HU fixed threshold was compared with the use of a subjective or variable threshold selected with the aid of a density mask in 30 patients with a histologic diagnosis of IPF, and results were correlated with pulmonary function test results. Correlations between pulmonary densitovolumetry using the fixed threshold (-870 HU) and pulmonary function tests were r= 0.265 for FEV1, r=-0.450 for FVC, r=-0.705 for TLC and r= -0.305 for DLCO. When pulmonary densitovolumetry with selection of a subjective threshold was used, results were: r= –0.347 for FEV1, r= -0.534 for FVC, r= -0.734 for TLC and r= –0.413 for DLCO. Both objective and subjective measurements of the extent of fibrosis using densitovolumetry had a good correlation with results of functional tests that indicate restriction. Correlations were weak with functional measurements that do not indicate the extent of pulmonary fibrosis. Densitovolumetry may be a more accurate technique than the simple subjective analysis of high-resolution CT images in patients with IPF, and may be, therefore, more effective in the evaluation of disease progression.

As doenças pulmonares intersticiais difusas caracterizam-se pela presença de um distúrbio ventilatório restritivo cuja intensidade está associada ao grau de extensão do comprometimento intersticial e consequentemente ao estágio da doença. As provas de função pulmonar em conjunto com o grau de comprometimento intersticial na TCAR são os principais métodos de avaliação utilizados para determinar o estágio da doença, bem como para acompanhar sua progressão e a resposta terapêutica. A densitovolumetria pulmonar realizada através da TC Helicoidal consiste em uma técnica objetiva e mais precisa que permite calcular a proporção de volume de pulmão com densidade aumentada pelo acometimento por fibrose sobre o volume de pulmão com densidade normal, ou seja, sem acometimento significativo dos interstícios. Na literatura, sugere-se –870 UH como o limiar de separação ideal para quantificação de fibrose pulmonar por tomografia computadorizada, acima do qual o pulmão seria considerado como apresentando aumento de densidade pela presença de fibrose ou de atenuação em vidro-fosco. O presente estudo comparou o limiar fixo em –870UH com a utilização de um limiar subjetivo ou variável selecionado com o auxílio de máscara de densidades em 30 pacientes com comprovação histológica FPI em relação as provas de função pulmonar. A correlação dos resultados da densitovolumetria pulmonar utilizando o limiar fixo (-870 HU) com as provas de função pulmonar foram de r= 0,265 com o VEF1, r=-0,450 com a CVF, r=-0,705 com a CPT e r= -0,305 com a DCO. Em comparação, as correlações entre os resultados da densitovolumetria pulmonar estabelecidos com base na seleção subjetiva de um limiar subjetivo foram: r= –0,347 com o VEF1, r= - 0,534 com a CVF, r= -0,734 com a CPT e r= –0,413 com a DCO. Tanto as medidas objetivas como subjetivas da extensão da fibrose realizadas pela densitovolumetria apresentaram boa correlação com as medidas funcionais que expressam restrição. As correlações foram fracas, quando correlacionadas com medidas funcionais que não expressam a extensão da fibrose pulmonar. A densitovolumetria pode proporcionar uma técnica mais precisa que a simples análise subjetiva das imagens de tomografia computadorizada de alta resolução em pacientes com FPI, sendo assim mais efetiva na avaliação evolutiva de cada paciente. / Diffuse interstitial pulmonary diseases are characterized by restrictive lung disorders whose intensity is associated with the extent of interstitial involvement and, consequently, the stage of the disease. Pulmonary function tests and HRCT assessment of the degree of interstitial involvement are the primary methods to establish the stage of the disease, to follow up its progression, and to evaluate therapeutic response. Pulmonary densitovolumetry using helical CT is an objective and accurate technique to calculate the proportion of volume of lung with increased density due to fibrosis with relation to volume of lung with normal density, that is, without significant interstitial involvement. Studies in the literature suggest - 870 UH as the ideal segmentation threshold to assess pulmonary fibrosis using CT; above this value, increased density due to fibrosis or ground-glass opacity should be considered. In this study, the use of a -870 HU fixed threshold was compared with the use of a subjective or variable threshold selected with the aid of a density mask in 30 patients with a histologic diagnosis of IPF, and results were correlated with pulmonary function test results. Correlations between pulmonary densitovolumetry using the fixed threshold (-870 HU) and pulmonary function tests were r= 0.265 for FEV1, r=-0.450 for FVC, r=-0.705 for TLC and r= -0.305 for DLCO. When pulmonary densitovolumetry with selection of a subjective threshold was used, results were: r= –0.347 for FEV1, r= -0.534 for FVC, r= -0.734 for TLC and r= –0.413 for DLCO. Both objective and subjective measurements of the extent of fibrosis using densitovolumetry had a good correlation with results of functional tests that indicate restriction. Correlations were weak with functional measurements that do not indicate the extent of pulmonary fibrosis. Densitovolumetry may be a more accurate technique than the simple subjective analysis of high-resolution CT images in patients with IPF, and may be, therefore, more effective in the evaluation of disease progression.

Pulmonary function testing is an important part when it comes to evaluating patients with or at risk for lung diseases. Measurement of the diffusing capacity with carbon monoxide (DLCO) of the lung is a very important parameter and reflects how well the gas exchange work. Traditionally the DLCO have been measured by the single breath (SB) method which requires a forcefully inhalation and a 10 second breath-hold. Not all patients are able to perform the method due to illness or related problems therefore it would be favourable if the ward could change to an easier method called intrabreath (IB). The IB method is not depending on a breath-holding manoeuvre, which should make it easier to perform. Eleven volunteers participated in the study. They all performed both DLCO techniques, starting with the SB followed by IB. The DLCO, when determined with the IB technique, had an excellent correlation to the SB technique. However, the IB systematically showed a lower value for DLCO, and can therefore not use the same references as SB. Before the ward can change from the SB- to the IB- method there are needs for further studies. New studies should include more volunteers so more trustworthy reference values can be made, they should also include sick patients as a check-up for the new reference values. For the moment the ward have to stay with the SB method.