Background Corona Virus Disease 2019 (COVID-19) outbreak was officially announced as a global pandemic by the WHO on March 11th 2020. Thorough understanding of CT imaging features of COVID-19 is essential for effective patient management; rationalizing the need for relevant research. The aim of this study was to analyze the chest CT findings of patients with real-time polymerase chain reaction (RT-PCR) proved COVID-19 admitted to four Egyptian hospitals. The recently published RSNA expert consensus statement on reporting COVID-19 chest CT findings was taken into consideration. Results Normal CT “negative for COVID-19” was reported in 26.1% of our RT-PCR proved COVID-19 cases. In descending order of prevalence, imaging findings of the positive CT studies (73.9%) included GGO (69%), consolidation (49.7%), crazy paving (15.4%), and peri-lobular fibrosis (40.6%). These showed a dominantly bilateral (68.2%), peripheral (72.4%), and patchy (64.7%) distribution. Remarkably, thymic hyperplasia was identified in 14.3% of studies. According to the RSNA consensus, CT findings were classified as typical in 68.9%, indeterminate in 3.6%, and atypical in 1.4% of the evaluated CT studies. Conclusion Although COVID-19 cannot be entirely excluded by chest CT, it can be distinguished in more than two-thirds of cases; making CT a widely available, non-invasive, and rapid diagnostic tool.

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Background There are many causes of pleural disease including variable benign and malignant etiologies. DWI is a non-enhanced functional MRI technique that allows qualitative and quantitative characterization of tissues based on their water molecules diffusivity. The aim of this study was to evaluate the diagnostic value of DWI-MRI in detection and characterization of pleural diseases and its capability in differentiating benign from malignant pleural lesions. Results Conventional MRI was able to discriminate benign from malignant lesions by using morphological features (contour and thickness) with sensitivity 89.29%, specificity 76%, positive predictive value 89%, negative predictive value 76.92%, and accuracy 85.37%. ADC value as a quantitative parameter of DWI found that ADC values of malignant pleural diseases were significantly lower than that of benign lesions (P < 0.001). Hence, we discovered that using ADC mean value of 1.68 × 10-3 mm2/s as a cutoff value can differentiate malignant from benign pleural diseases with sensitivity 89.3%, specificity 100%, positive predictive value 100%, negative predictive value 81.2%, and accuracy 92.68% (P < 0.001). Conclusion Although DWI-MRI is unable to differentiate between malignant and benign pleural effusion, its combined morphological and functional information provide valid non-invasive method to accurately characterize pleural soft tissue diseases differentiating benign from malignant lesions with higher specificity and accuracy than conventional MRI.

Background The extra-pleural space is challenging to view radiologically and is commonly overlooked. Therefore, it is important to have a comprehensive understanding of its anatomy in order to correctly classify lesions as either pleural or extra-pleural so as to choose the most appropriate treatment. CT with multi-planar reformatting allows the assessment of pathological conditions involving the extra-pleural space. The aim of this cross-sectional study was to assess the role of CT in the detection and evaluation of the extra-pleural space lesions and to classify them according to their CT appearance in order to reach a proper diagnosis and successful management plan. Results This study was conducted on 131 patients who underwent CT scan of the chest for different chest complaints, and the detected extra-pleural space abnormalities were classified according to their CT appearance into three major groups which are fatty expansion and soft tissue stranding group that included 59 cases (45%), abnormal attenuation group that included 13 cases (10%), and soft tissue expansion group that included 59 cases (45%). Out of the 59 cases with increased fatty expansion and soft tissue stranding, 73% were of inflammatory cause (either pulmonary or pleural), 17% were of neoplastic cause, and 3 cases were caused by systemic conditions. The abnormal extra-pleural space attenuation group was classified into air-containing and blood-containing groups, and both were mainly caused by trauma. Soft tissue infiltration of extra-pleural space was classified into neoplastic (85%) and non-neoplastic (15%) lesions, while most of the non-neoplastic pathologies were caused by severe inflammatory processes. The axial images were mostly sufficient to detect extra-pleural space lesions. Conclusions CT has a crucial role in the assessment of extra-pleural space and the different lesions involving it. Those lesions can be classified according to their CT appearance in order to reach a proper diagnosis and as a result aid in better management of these pathologies.

Background: Establishing a definite diagnosis in cases of pleural effusion is sometimes challenging. Adding ultrasound-guided tru-cut biopsy at the time of obtaining pleural fluid for analysis may increase the diagnostic yield in such cases. Objective: The aim of the current work was to assess the diagnostic yield and the safety of percutaneous ultrasound guided tru-cut needle biopsy in patients with recurrent undiagnosed pleural effusion. Patients and Methods: A retrospective observational study including 45 patients with recurrent undiagnosed pleural effusion who underwent ultrasound-guided tru-cut needle biopsy in the period between January 2019 and October 2020. Results: By using ultrasound-guided needle biopsy, we were able to reach a final histopathological diagnosis in 40 patients with a diagnostic yield of 88.8%. Only 5 cases remained undiagnosed (11.1%). Mesothelioma was found in 13 cases (28.9%) and bronchogenic carcinoma in 7 cases (15.5%). Post-procedural complications included 1 case of pneumothorax (2.2%) and 1 case of hemothorax (2.2%) all resolving with the small caliber chest drain that was inserted at the conclusion of the procedure. Conclusion:It could be concluded that ultrasound-guided needle biopsy is a safe procedure that can be useful in establishing a diagnosis in patients with recurrent pleural effusion. Its high diagnostic yield, while being simpler and cheaper than CT guided biopsy or thoracoscopy, makes it a suitable option in our clinical settings. More studies are needed to validate our findings.