Articles in Respiratory (22)

L'embolia polmonare è l'ostruzione dell'albero arterioso polmonare causata da un trombo, solitamente originato da una trombosi venosa profonda. Rappresenta la terza causa di morte cardiovascolare acuta e richiede una stratificazione tempestiva del rischio per indirizzare il paziente verso la terapia anticoagulante o trombolitica appropriata.

The BODE index is a multidimensional prognostic scoring system for chronic obstructive pulmonary disease (COPD) that evaluates body mass index (B), degree of airflow obstruction (O), functional dyspnea (D), and exercise capacity (E) to predict systemic mortality risk. The gold-standard diagnostic evaluation combines post-bronchodilator spirometry (FEV1/FVC < 0.70) with multidimensional clinical grading, while first-line management centers on smoking cessation, long-acting bronchodilator therapy, and structured pulmonary rehabilitation.

The Pneumonia Severity Index (PSI / PORT score) is a validated 20-variable prognostic prediction rule that objectively stratifies adult patients with community-acquired pneumonia into five risk classes to guide safe outpatient versus inpatient site-of-care decisions. Gold-standard evaluation involves chest radiography combined with complete blood counts, arterial blood gas analysis, and renal function panels, while management ranges from supportive outpatient oral antimicrobial therapy to intensive care unit admission depending on risk class.

The Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI) are validated clinical prognostic scoring systems used to stratify 30-day mortality risk in patients diagnosed with acute pulmonary embolism, guiding safe outpatient versus inpatient triage. The gold-standard diagnostic modality is CT pulmonary angiography (CTPA), and first-line management involves prompt anticoagulation with low-molecular-weight heparin or direct oral anticoagulants in low-risk stratified individuals.

The revised Geneva score is a validated clinical prediction rule used to estimate pretest probability for acute pulmonary embolism, dictating the necessity of D-dimer testing and computed tomography pulmonary angiography. The gold-standard diagnostic modality is computed tomography pulmonary angiography demonstrating filling defects in the pulmonary arterial tree, and first-line management involves prompt therapeutic anticoagulation with low-molecular-weight heparin or direct oral anticoagulants.

The Pulmonary Embolism Rule-out Criteria (PERC) rule is a validated clinical decision tool used to safely exclude pulmonary embolism in low-risk patients without requiring diagnostic imaging, relying on eight specific negative clinical variables. The gold-standard diagnostic investigation is Computed Tomography Pulmonary Angiography (CTPA), and the first-line management for confirmed pulmonary embolism involves immediate systemic anticoagulation with low-molecular-weight heparin or direct oral anticoagulants.

The Wells score for pulmonary embolism is an evidence-based clinical prediction rule used to estimate pretest probability and guide diagnostic imaging and D-dimer testing. Computed tomography pulmonary angiography (CTPA) serves as the gold-standard diagnostic imaging modality, while low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) constitute first-line therapy.

Pneumocystis jirovecii pneumonia (PCP) is an opportunistic fungal infection occurring in immunocompromised hosts, diagnosed definitively via bronchoalveolar lavage with Gomori methenamine silver (GMS) staining or PCR, and treated empirically or definitively with high-dose trimethoprim-sulfamethoxazole alongside adjunctive corticosteroids when hypoxic.

Hypersensitivity pneumonitis is an immune-mediated interstitial lung disease triggered by repeated inhalation of diverse environmental antigens, diagnosed definitively via multidisciplinary consensus incorporating high-resolution computed tomography and bronchoalveolar lavage lymphocytosis, and managed primarily through strict antigen avoidance and targeted systemic corticosteroids.

Kartagener syndrome is a rare autosomal recessive genetic disorder characterized by the triad of chronic sinusitis, bronchiectasis, and situs inversus totalis, resulting from defective motile ciliary function. Diagnosis is established via high-resolution computed tomography, nasal nitric oxide testing, and confirmatory transmission electron microscopy or genetic testing, while management centers on aggressive airway clearance and targeted antimicrobial therapy.

Lofgren syndrome is an acute, clinically distinct phenotype of systemic sarcoidosis defined by the classic triad of bilateral hilar lymphadenopathy, erythema nodosum, and acute polyarthritis, typically managed conservatively with non-steroidal anti-inflammatory drugs and possessing a highly favorable prognosis with spontaneous remission.

A Pancoast tumour is a specialized apical non-small cell lung carcinoma invading the superior thoracic sulcus, classically causing shoulder pain and Horner syndrome via sympathetic chain compression; diagnosis is confirmed via contrast-enhanced chest CT and CT-guided needle biopsy or bronchoscopy, with first-line management consisting of preoperative induction chemoradiotherapy followed by en bloc surgical resection.

Primary spontaneous pneumothorax is the accumulation of air in the pleural space without antecedent trauma or underlying clinical pulmonary disease, typically caused by the rupture of visceral pleural blebs or bullae. The gold-standard diagnostic investigation is upright post-inhalation chest radiography demonstrating a visceral pleural line without lung markings, and first-line treatment ranges from conservative observation in small, stable presentations to needle aspiration or tube thoracostomy.

Pemberton sign is a clinical indicator of latent superior vena cava obstruction characterized by facial flushing and neck vein distension when both arms are elevated above the head. The gold-standard diagnostic investigation is contrast-enhanced computed tomography (CT) of the chest and neck, and first-line therapy involves definitive surgical resection or targeted management of the underlying retrosternal goitre or mediastinal mass.

Digital clubbing is a painless, symmetric bulbous enlargement of the distal phalanges of the fingers and toes caused by connective tissue proliferation and increased digital blood flow, evaluated bedside using the Schamroth window test. Gold-standard investigation involves high-resolution chest computed tomography (HRCT) to identify underlying intrathoracic malignancy or suppurative pulmonary disease, while first-line management centers on treating the primary underlying systemic or cardiopulmonary pathology.

The ROX index is a validated bedside scoring tool defined as (SpO2 / FiO2) / respiratory rate, designed to predict the success or failure of high-flow nasal cannula (HFNC) therapy in patients with acute hypoxemic respiratory failure. Gold-standard diagnosis of the underlying etiology involves arterial blood gas analysis and chest computed tomography, while first-line management consists of optimized HFNC support (flow rates >=30-60 L/min, FiO2 titrated to target SpO2 92-96%) combined with targeted etiology-specific therapy.

The GOLD classification of chronic obstructive pulmonary disease (COPD) stratifies airflow limitation severity using post-bronchodilator spirometry (FEV1% predicted) combined with symptom burden and exacerbation history to guide targeted medical therapy. The gold-standard diagnostic test is post-bronchodilator spirometry demonstrating a fixed post-bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) of less than 0.70. First-line management involves smoking cessation, pulmonary rehabilitation, and long-acting bronchodilator therapy tailored to the patient's combined GOLD A-E risk group.

Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to Aspergillus fumigatus colonization in patients with asthma or cystic fibrosis, characterized by persistent airway inflammation, fleeting pulmonary opacities, and central bronchiectasis. The diagnosis is established using serum Aspergillus-specific IgE, elevated total serum IgE, and characteristic imaging findings, while the first-line therapeutic approach relies on systemic glucocorticoids combined with adjunctive oral azoles.

Acute severe asthma is a life-threatening exacerbation of chronic airway inflammation characterized by severe bronchospasm, mucous hypersecretion, and dynamic hyperinflation, requiring immediate emergency intervention with serial peak expiratory flow assessment and aggressive bronchodilator and corticosteroid therapy.

CURB-65 is a validated clinical prediction rule used to assess the severity of community-acquired pneumonia and guide site-of-care decisions, incorporating confusion, urea, respiratory rate, blood pressure, and age. The gold-standard diagnostic approach relies on chest radiography demonstrating new focal consolidation combined with clinical and biochemical stratification, while first-line therapy ranges from outpatient oral amoxicillin for scores of 0–1 to inpatient combination regimens or intensive care assessment for scores of 2 and above.

Tension pneumothorax is a life-threatening, progressive accumulation of air within the pleural space that causes elevated intrathoracic pressure, mediastinal shift, and subsequent obstructive shock. The diagnosis is strictly clinical—requiring immediate emergency decompression before any diagnostic imaging—and is definitively managed via emergent needle thoracostomy or finger thoracostomy followed by tube thoracostomy.

Light criteria for pleural effusion establish the biochemical distinction between transudative and exudative pleural effusions by evaluating pleural fluid-to-serum protein and lactate dehydrogenase (LDH) ratios alongside serum LDH upper limits of normal. The gold-standard diagnostic procedure is ultrasound-guided diagnostic thoracentesis with paired biochemical, cytologic, and microbiologic testing, while first-line treatment addresses the underlying systemic or local etiology.