Background. Pulmonary tuberculoma can mimic lung malignancy and thereby pose a diagnostic dilemma to clinicians. The purpose of this study was to establish an accurate, convenient, and clinically practical model for distinguishing small-sized, noncalcified, solitary pulmonary tuberculoma from solid lung adenocarcinoma. Methods. Thirty-one patients with noncalcified, solitary tuberculoma and 30 patients with solid adenocarcinoma were enrolled. Clinical characteristics and CT morphological features of lesions were compared between the two groups. Multivariate logistic regression analyses were applied to identify independent predictors of pulmonary tuberculoma and lung adenocarcinoma. Receiver operating characteristic (ROC) analysis was performed to investigate the discriminating efficacy. Results. The mean age of patients with tuberculoma and adenocarcinoma was 46.8 ± 12.3 years (range, 28–64) and 61.1 ± 9.9 years (range, 41–77), respectively. No significant differences were observed concerning smoking history and smoking index, underlying disease, or tumor markers between the two groups. Univariate and multivariate analyses showed age and lobulation combined with pleural indentation demonstrated excellent discrimination. The sensitivity, specificity, accuracy, and the area under the ROC curve were 87.1%, 93.3%, 90.2%, and 0.956 (95% confidence interval (CI), 0.901–1.000), respectively. Conclusion. The combination of clinical characteristics and CT morphological features can be used to distinguish noncalcified, solitary tuberculoma from solid adenocarcinoma with high diagnostic performance and has a clinical application value.

Acute exacerbation of idiopathic inflammatory myopathies-associated interstitial lung disease (AE-IIM-ILD) is a significant event associated with increased morbidity and mortality. However, few studies investigated the potential prognostic factors contributing to mortality in patients who experience AE-IIM-ILD. The purpose of our study was to comprehensively investigate whether high-resolution computed tomography (HRCT) findings predict the 1-year mortality in patients who experience AE-IIM-ILD. A cohort of 69 patients with AE-IIM-ILD was retrospectively created. The cohort was 79.7 % female, with a mean age of 50.7. Several HRCT features, including total interstitial lung disease extent (TIDE), distribution patterns, and radiologic ILD patterns, were assessed. A directed acyclic graph (DAG) was used to evaluate the statistical relationship between variables. The Cox regression method was performed to identify potential prognostic factors associated with mortality. The HRCT findings significantly associated with AE-IIM-ILD mortality include TIDE (HR per 10%-increase, 1.64; 95%CI, 1.29-2.1, p < 0.001; model 1: C-index, 0.785), diffuse distribution pattern (HR, 3.75, 95%CI, 1.5-9.38, p = 0.005; model 2: C-index, 0.737), and radiologic diffuse alveolar damage (DAD) pattern (HR, 6.37, 95 % CI, 0.81-50.21, p = 0.079; model 3: C-index, 0.735). TIDE greater than 58.33 %, diffuse distribution pattern, and radiologic DAD pattern correlate with poor prognosis. The 90-day, 180-day, and 1-year survival rates of patients who experience AE-IIM-ILD were 75.3 %, 66.3 %, and 63.3 %, respectively. HRCT findings, including TIDE, distribution pattern, and radiological pattern, are predictive of 1-year mortality in patients who experience AE-IIM-ILD.

Background: Acute exacerbation (AE) of idiopathic inflammatory myopathy-associated interstitial lung disease (IIM-ILD) is fatal. Infection is one of the most important triggers of the AE of IIM-ILD. We evaluated the clinical features and prognosis of idiopathic (I-AE) and infection-triggered (iT-AE) acute exacerbation in IIM-ILD patients. Methods: We retrospectively reviewed 278 consecutive patients with IIM admitted to our hospital between January 2014 and December 2020. Among them, 69 patients experienced AE of IIM-ILD, including 34 with I-AE and 35 with iT-AE. Clinical features and short- and long-term outcomes were analyzed in this preliminary study. Results: Compared with I-AE, patients with iT-AE presented with lower hemoglobin and PaO₂/FiO₂ ratios but higher pulse, body temperature, white blood cell count, neutrophil percentage (NEU), C-reactive protein, erythrocyte sedimentation rates, lactate dehydrogenase, and hydroxybutyrate dehydrogenase levels. They also had more extensive ground-glass opacities (GGOs) on high-resolution computed tomography (all p < 0.05). Mortality was significantly higher in iT-AE than that in I-AE at 30 days (28.6% vs. 5.9%), 90 days (34.3% vs. 14.9%), and 1 year (54.3% vs. 17.6%; log-rank test, p = 0.002). Multivariate logistic regression showed that the combination of NEU and GGO extent could help discriminate iT-AE from I-AE (area under the receiver operating characteristic curve: 0.812; 95% confidence interval: 0.711–0.913; sensitivity: 71.4%, specificity: 73.5%, accuracy: 72.5%). Conclusion: This study found that iT-AE patients exhibited more severe hyperinflammation and markedly worse survival than I-AE patients. Combining NEU and GGO extent may assist in differentiating AE subtypes. Larger prospective studies are required to validate these findings.