Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after percutaneous tracheostomy -A case report-

We report a rare case of a 72-year-old female who developed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum after a percutaneous dilatational tracheostomy. The patient's T-cannula was accidentally connected to the oxygen line with a non-perforated connector. The patient rapidly developed respiratory insufficiency and subcutaneous emphysema in the neck and both shoulders. The bilateral pneumothoraces were managed using a chest tube. CT scans of the chest, abdomen, and pelvis revealed an extensive distribution of air throughout the chest and abdomen. The patient was treated successfully with supportive care. This case illustrates the rare occurrence of air passing into multiple body compartments, highlighting the potentially serious complications of a tracheostomy and the importance of intensive care during the recovery period

Can the ADO Index Be Used as a Predictor of Mortality from COVID-19 in Patients with COPD?

Esra Ertan Yazar,1 Gulsah Gunluoglu,2 Burcu Arpinar Yigitbas,1 Mukadder Calikoglu,3 Gazi Gulbas,4 Nilgün Y&inodot;lmaz Demirci,5 Nurhan Sarioglu,6 Fulsen Bozkus,7 Nevin Taci Hoca,5 Nalan Ogan,8 Seda Tural Onur,2 Muzaffer Onur Turan,9 Filiz Kosar,2 Evrim Eylem Akpinar,8 Burak Mete,10 Can Ozturk5 1Department of Chest Diseases, Istanbul Medeniyet University, Medical Faculty, Istanbul, Turkey; 2Department of Chest Diseases, Yedikule Chest Disease and Chest Surgery Research and Training Hospital, Istanbul, Turkey; 3Department of Chest Diseases, Mersin University, Medical Faculty, Mersin, Turkey; 4Department of Chest Diseases, Inonu University, Medical Faculty, Malatya, Turkey; 5Department of Chest Diseases, Gazi University, Medical Faculty, Ankara, Turkey; 6Department of Chest Diseases, Balikesir University, Medical Faculty, Balikesir, Turkey; 7Department of Chest Diseases, Kahramanmaras Sutcu Imam University, Medical Faculty, Kahramanmaras, Turkey; 8Department of Chest Diseases, Ufuk University, Medical Faculty, Ankara, Turkey; 9Department of Chest Diseases, Prof Dr, Izmir Katip Celebi University, Atatürk Research and Training Hospital, Izmir, Turkey; 10Department of Public Health Çukurova University, Medical Faculty, Adana, TurkeyCorrespondence: Esra Ertan Yazar, Istanbul Medeniyet University, Medical Faculty, Department of Chest Diseases, Istanbul, Turkey, Email [email protected]: Several studies have shown that the risk of mortality due to COVID-19 is high in patients with COPD. However, evidence on factors predicting mortality is limited.Research Question: Are there any useful markers to predict mortality in COVID-19 patients with COPD?.Study Design and Methods: A total of 689 patients were included in this study from the COPET study, a national multicenter observational study investigating COPD phenotypes consisting of patients who were followed up with a spirometry-confirmed COPD diagnosis. Patients were also retrospectively examined in terms of COVID-19 and their outcomes.Results: Among the study patients, 105 were diagnosed with PCR-positive COVID-19, and 19 of them died. Body mass index (p= 0.01) and ADO (age, dyspnoea, airflow obstruction) index (p= 0.01) were higher, whereas predicted FEV1 (p< 0.001) and eosinophil count (p= 0.003) were lower in patients who died of COVID-19. Each 0.755 unit increase in the ADO index increased the risk of death by 2.12 times, and each 0.007 unit increase in the eosinophil count decreased the risk of death by 1.007 times. The optimum cut-off ADO score of 3.5 was diagnostic with 94% sensitivity and 40% specificity in predicting mortality.Interpretation: Our study suggested that the ADO index recorded in the stable period in patients with COPD makes a modest contribution to the prediction of mortality due to COVID-19. Further studies are needed to validate the use of the ADO index in estimating mortality in both COVID-19 and other viral respiratory infections in patients with COPD.Keywords: body mass index, COVID-19, eosinophils, FEV1, mortality, pneumonia, pulmonary disease, chronic obstructiv

Value of real-time endobronchial ultrasound-guided transbronchial needle aspiration

<b>Aim :</b> The diagnostic value of real-time convex-probe endobronchial ultrasound (CP-EBUS)-guided transbronchial needle aspiration (TBNA) in mediastinal pathologies, and the factors influencing it are not clearly known. This study has been designed to examine factors affecting the efficacy and diagnostic value of CP-EBUS-TBNA. <b>Methods :</b> Patients (<i>n</i> = 321) with mediastinal mass or enlarged lymph node in the mediastinum, participated in this study, conducted between April 2007 and May 2009. Samples were obtained from the lesions using the TBNA method, with the guidance of CP-EBUS. Histopathologic (in all samples) and microbiologic (in 151 patients&#x2032; samples) evaluations were carried out. Biopsy using an appropriate surgical method was taken when the result of the TBNA procedure was nondiagnostic. Thirty-four patients were excluded from the analysis due to several reasons. The diagnostic efficacy of the procedure was analyzed in the remaining 287 patients. <b>Results :</b> The diagnostic rate was 92&#x0025; (89.7&#x0025; for the benign diseases and 92.6&#x0025; for the malignant diseases (<i>P</i> = 0.59)). In granulomatous diseases, the rate was 96&#x0025; for sarcoidosis and 79&#x0025; for tuberculosis (<i>P</i> = 0.002). Patients in whom only one lymph node was sampled and in whom two or more lymph nodes were sampled had a diagnostic rate of 85&#x0025; and 95&#x0025;, respectively (<i>P</i> = 0.03). When left hilar nodes were sampled, a higher diagnostic rate was achieved (<i>P</i> = 0.01). <b>Conclusions :</b> CP-EBUS-guided TBNA has a high diagnostic rate. Sampling of at least two separate lymph nodes and the discovery of left hilar station in these lymph nodes increase the rate of diagnosis

Ultrasonographic Applications in the Thorax

Abstract: Rapid developments and increasing technological knowledge have changed perspectives on ultrasonography. Previously, ultrasonography was used to evaluate chest wall pathologies, to distinguish between pleural effusion and consolidation, to evacuate pleural effusion, or to evaluate diaphragm movement. Today, it is also used in a wide range of pleural and parenchymal diseases. Ultrasonography is not just used in the emergency department and the intensive care units, it is also utilized in many clinical branches dealing with the respiratory system-due to its ease of use, fast access, price advantage, non-radiation exposure, higher diagnostic sensitivity, and specificity in many clinical situations-and has become a part of the examination. In this review, we have assessed not just transthoracic ultrasonography but also more focal and targeted sonographic applications, such as the endobronchial ultrasound and esophageal ultrasound. </jats:sec