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Introduction: Coagulation abnormalities are a common occurrence in patients with COVID-19, of particular significance is the relationship between D-dimer levels and clinical outcomes. A higher D-dimer level at admission is found to have a poor clinical outcome with increased severity of the disease and increased mortality. Aim and Objectives: To analyze the coagulation profile and its relation to the outcome of patients admitted with COVID-19 pneumonia in a tertiary care center in South India. Subjects and Methods: We conducted a prospective observational study looking at the admission D-dimer, prothrombin time (PT)/international normalized ratio (INR), and platelet levels in 102 admitted COVID-19 patients from February 2021 to January 2022. The relationship between these parameters on admission and the clinical outcome in the form of oxygen requirement, duration of stay, survival, and need for domiciliary oxygen was studied. Discussion and Results: Higher D-dimer levels at admission were associated with poor survival and longer duration of hospital stay with increased requirement of oxygen support. There was a significant correlation between the mean admission D-dimer level and the need for supplemental oxygen (P < 0.05) with patients having a higher D-dimer level at admission (D-dimer of moderate and severe categories: 0.62 ± 0.88 μg/mL and 2.46 ± 4.22 μg/mL, respectively) requiring a higher concentration of oxygen in the form of noninvasive ventilation/high-flow nasal cannula. Furthermore, PT, INR, and platelet count on admission were not useful in predicting the clinical course, oxygen requirement, and overall survival in the study population. Conclusion: Admission levels of D-Dimer can predict the clinical course and outcome of COVID-19 patients.

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Aim: To assess the role of computed tomography (CT) chest in correlating with the severity and outcome of COVID-19 Patients. Background and Materials and Methods: A prospective study was done on 160 hospitalized patients who were COVID-19 positive by reverse transcription-polymerase chain reaction in Apollo Hospital, Greams Road, Chennai, India. We collected epidemiological data, comorbidities, clinical manifestations, oxygen requirement, and CT chest details of all patients. All images were reviewed by a single consultant radiologist and CT chest severity scoring was done as per the guidelines published in the American Journal of Radiology. CT chest severity score (CTSS) was then compared with clinical severity and various parameters. Results: This study included 160 hospitalized COVID-19 patients with a mean age of 61 ± 13.97 years. Male (74.4%) patients were more when compared to female patients (25.6%). Majority of the patients were belong to mild category (44.38%), followed by severe (28.7%) and moderate (26.8%) categories. Fever (73.8%) was the most common symptom. Diabetes mellitus (57.5%) was the most common comorbidity of COVID-19 patients in our study, followed by hypertension (55%). The average CTSS of mild category was 7.4 ± 4.7; for moderate category, the mean CTSS was 14.6 ± 5.78; and for severe category, it was 18.3 ± 5.28. There was increasing trend of severity score, as clinical severity increases which was statistically significant (P = 0.0001). The mean CTSS of patients who required no oxygen, low flow oxygen, high flow oxygen, noninvasive ventilation, and intubated patients was 8.3 ± 5.71, 14.84 ± 5.39, 18.17 ± 5.7, 18.17 ± 6.04, and 22.18 ± 4.07, respectively, which was statistically significant (P = 0.0001). The mean CTSS of patients discharged without oxygen requirement was 11.09 ± 6.48 and patients discharged with oxygen requirement was 18.09 ± 6.12 (P = 0.001). The mean CTSS of patients who died was 20.27 ± 4.62. Conclusion: There was a significant correlation between CT chest severity score and clinical severity and oxygen requirement. CT chest is one of the best screening tools for rapid identification as well as to predict the clinical severity; thereby, it helps the clinician in managing the COVID-19 patients at crucial points during the progression of disease.

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Background: Diaphragm dysfunction in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) leads to increased morbidity and mortality. Early diagnosis of diaphragm dysfunction and aggressive management to improve the diaphragm function and may improve the outcome in AECOPD. Aims and Objectives: This study aimed to assess diaphragmatic excursion by ultrasound during AECOPD and correlation with the severity of airway obstruction. Materials and Methods: Sixty patients admitted with AECOPD were evaluated. Ultrasonography was done to assess the diaphragm excursion and thickness. Airway obstruction was classified as moderate, severe, and very severe by measuring forced expiratory volume in 1 s (FEV₁). Comparison of excursion and thickness of the diaphragm in the study patients was done with normal values and analyzed using Student's t-test. Values of measured FEV₁ were correlated with the normal values of excursion and thickness of the diaphragm and statistical analysis was done by ANOVA test. Results: Forty-six males and four females were included in the study. Thirty-four percent (17) had moderate COPD, 60% (30) had severe COPD, and 6% (3) had very severe COPD. The mean excursion and thickness of the diaphragm in the study patients were less when compared to the normal values. In moderate COPD, the mean excursion of the diaphragm was 29.94 mm, whereas in those with severe and very severe COPD, the mean excursions were 26.77 mm and 23.33 mm, respectively. Statistical analysis by ANOVA test was done to compare the diaphragm excursion and severity of COPD. The P = 0.039 was considered statistically significant. Patients with moderate COPD (34%) showed a mean diaphragm thickness of 2.82 mm, and those with severe (60%) and very severe (6%) COPD showed a diaphragm thickness of 2.23 mm and 2.00 mm, respectively. Statistical analysis by ANOVA test was done to compare the diaphragm thickness and severity of COPD. The P < 0.001 was considered statistically significant. Conclusions: Patients with AECOPD have reduced excursion and thickness of the diaphragm in comparison with normal subjects. Diaphragm dysfunction increases as the severity of airflow obstruction in COPD increases.

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Leiomyomas are rare benign tumors of the lung. They arise from the smooth muscle cells of the bronchial wall and the interstitium or from the smooth muscles of the arterioles. Symptoms are chiefly based on the degree to which bronchial obstruction occurs. Bronchoscopic intervention or lung sparing surgical resection are the treatments of choice. In leiomyomas that are accessible by bronchoscopy and confined to airway, bronchoscopic resection appears to be safe and effective. This case is being reported because of the rarity of this condition and the need to recognise the role for endobronchial intervention, thereby, avoiding major surgical procedures with the attendant risk of morbidity due to surgery.

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A bulging fissure sign in a chest radiograph is usually associated with right upper lobe lung collapse with horizontal fissural effusion or collection. Etiology and pathophysiology traced to infective and noninfective causes. Commonly bulging fissure sign is described with lung malignancy in old age. Infective etiologies are infective types in children and adults with comorbid conditions. In this case report, we have reported a 54-year-old male presented with cough and hemoptysis with progressive worsening of shortness of breath. Clinically tubular breath sounds in the right infraclavicular region with egophony were heard. Chest X-ray documented right lung consolidation or mass lesion with bulging fissures. Bronchoscopy was done after clinical stabilization and showed endobronchial polypoidal growth in the right mainstem bronchus causing near-complete occlusion of the bronchial lumen. Endobronchial needle aspiration cytology and forceps-guided (forcep biopsy) histopathology suggestive of “squamous cell” type of lung malignancy for bulging fissure sign in our case. A high index of suspicion is must to rule out underlying malignancy and bronchoscopy is “gold-standard” test in cases with bulging fissure sign to confirm a diagnosis.

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In our day-to-day practice, as a pulmonologist, the mediastinal lymphadenopathy is a common finding, the cause of which is difficult to diagnose. Although in endemic countries like India, tuberculosis is the common cause, there are also other causes which are associated with it. Therefore, it is important to get a tissue diagnosis before we arrive at a conclusion.

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A 46-year-old female, with no previous history of respiratory complaints, was found to have a lesion in the left lower zone on chest X-ray during preoperative evaluation for undergoing hysterectomy in view of vaginal prolapse. Computed tomography (CT) of the chest showed a well-defined lobulated pleural-based lesion with smooth margins in the left lower lobe measuring 9.3 cm × 5.3 cm. She underwent CT-guided lung biopsy which showed a mesenchymal neoplasm. Hence, uniportal Video assisted thoracoscopic surgery (VATS) was done and a biopsy Histo-pathological examination (HPE) sent showed pleomorphic spindle cells with little cytoplasm and immunohistochemistry showed vimentin, CD34, STAT 6 positivity, and pan-cytokeratin negativity, consistent with solitary fibrous tumor of the pleura.

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