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Asymptomatic 79-year-old patient. In A, axial CT scan of the left lower lobe, showing areas of bronchial thickening and ectasia. In B, multiplanar reconstruction of a CT scan taken along the bronchial axis, showing bronchial ectasia. Note loss of normal bronchial tapering. In C, the same CT image with minimum intensity projection reconstruction, a technique that highlights the low density areas of the lung parenchyma and allows a better view of the loss of normal bronchial tapering.
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In the elderly (conventionally defined as individuals > 60 years of age), it is often difficult to establish what normality is, because of the numerous anatomical and physiological modifications that occur during the aging process. As a result, the greatest challenge is to differentiate between the normal aging process and the onset of disease. Hea...
Context in source publication
Context 1
... wall compliance decreases with age, which is principally due to musculoskeletal limitations, such as vertebral fractures, spondylosis, and progressive loss of respiratory muscle strength. (31,32) Lung parenchymal compliance normally decreases with age. (33,34) These changes are generally attributed to changes in lung connective tissue. However, biochemical studies have suggested that the total collagen and elastin content of the lung does not change with age. qualitative changes in collagen and in lung compliance. (11,13) The extent of the influence of each of these factors has yet to be determined. The initial pathophysiological consequence of these changes is air trapping due distal airway closure, with a progressive increase in RV. This related phenomenon that has been designated "senile emphysema" (Figure 3). (38) Aging-related parenchymal changes are caused by reduced blood flow from the systemic circulation through the bronchial arteries, as well as by the aforementioned quantitative/ pulmonary hypertension (a clinical manifestation of mild vascular sclerosis) that can redistribute pulmonary flow cranially and be mistaken for early signs of cardiac decompensation. (41)(42)(43) The major determinants of static lung volumes are chest wall compliance and lung parenchymal compliance. Loss of lung parenchymal compliance and, to a lesser degree, decreased respiratory muscle strength result in an increase in RV (air mechanism is analogous to that of pulmonary emphysema, with no signs of inflammation and no significant increase in TLC. At the same time, the ventilation/perfusion ratio changes because of a reduction in the number of alveoli with normal gas exchange; this has two pathophysiological consequences: increased physiological dead space and the shunt effect, both of which lead to a decrease in PaO 2 . (39,41) In addition, there is mild Likewise, correlation with pulmonary function test results (particularly DLCO) can demonstrate how gas exchange is occurring and guide a conservative approach. Another fact that should be taken into consideration in the elderly is life expectancy and the metabolic need for gas exchange, given that patients whose activity is limited by extrathoracic disease have lower physiological needs. This brings us to the well-known Hippocratic principle of primum non nocere (above all, do no harm), which is increasingly true today, given the various choices of procedures and the increase in survival of the population. trapping), which increases by approximately 50% between ages 20 and 70 years. Conversely, VC progressively decreases to approximately 75% of optimal values. Therefore, TLC remains constant throughout life. (44) The closing volume of the small airways (volume at which the small airways begin to close during exhalation) increases with age. This premature closure begins to exceed functional residual capacity at age 44 years and exceeds it at age 65 years, (45) being closely related to the loss of supporting tissues around the airways. This is one of the theories for the aging-related decrease in the ventilation/perfusion ratio. (46)(47)(48)(49) A CT scan of the lung parenchyma shows findings that are quite common in the elderly, and it is speculated that these findings are related to collagen changes. These findings are laminar atelectasis, mostly posterior and basal, located in the dependent regions of the lungs ( Figure 5); subpleural linear thickening ( Figure 6); areas of air trapping ( Figure 7); bronchial thickening and ectasia ( Figure 8); and lung cysts. (41,(50)(51)(52)(53) The differential diagnosis between normal, aging-related imaging findings and imaging findings secondary to disease is quite difficult, and it is often impossible to distinguish between the two types of findings using imaging tests alone. Monitoring these lesions is often necessary, and comparison with previous tests is indispensable. The chest and aging: radiological ...
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Citations
... 24 Currently, the age of ''elderly'' has not been clearly defined, and this study defines elderly as those aged ≥ 60 years. 25 This study demonstrated that the total score of health promotion lifestyle of the elderly in Hebei Province was 100.20 ± 16.21, and the mean score of items was 2.50 ± 0.40, which was in the lower limit of good level, slightly higher than the findings of Dong Yameng, 26 but the excellent rate was only 3.66%, suggesting a large room to be improved in the healthy living level of the elderly in Hebei Province. In terms of dimensions, physical activity, as one of the elements of a healthy lifestyle, had the lowest standard score and excellent rate. ...
Object:
To explore the factors related to health-promoting lifestyles of the elderly based on social-ecosystem theory.
Design:
A cross-sectional survey study was carried out to include 627 elderly people in communities in three cities of Hebei Province (Shijiazhuang, Tangshan, and Zhangjiakou) from October 2021 to January 2022 for questionnaire survey (601 validly returned cases).
Venue:
Three cities of Hebei Province (Shijiazhuang, Tangshan, and Zhangjiakou).
Participants:
627 elderly people.
Interventions:
A cross-sectional survey study.
Main measurements:
The questionnaire survey was conducted by using the general demographic data, health promotion life scale, frailty scale, general self-efficacy scale, health engagement scale, General Self-Efficacy Scale, The family Adaptability, Partnership, Growth, Affection, and Resolve scale, and Perceived Social Support Scale.
Results:
The total health promotion lifestyle score for the elderly was 100.20±16.21, which was at the lower limit of the good level, with the highest mean score for nutrition (2.71±0.51) and the lowest mean score for physical activity (2.25±0.56). Stepwise linear regression showed that exercise frequency (95% confidence interval (CI) 1.304-3.885), smoking status (95% CI -4.190 to -1.556), self-efficacy (95% CI 0.071-0.185), health management (95% CI 0.306-0.590), frailty (95% CI -3.327 to -1.162) in the microsystem, marital status (95% CI 0.677-3.660), children's attention to the elderly health (95% CI 4.866-11.305), family care in the mesosystem (95% CI 1.365-4.968), and pre-retirement occupation (95% CI 2.065-3.894), living area (95% CI 0.813-3.912), whether receive community-based chronic disease prevention and management services (95% CI 2.035-8.149), social support (95% CI 1.667-6.493) in the macrosystem were the main factors affecting health promotion of life in the elderly (P<0.05). Hierarchical regression analysis showed the microsystem accounted for 17.2%, the mesosystem accounted for 7.1%, and the macrosystem accounted for 11.4%.
Conclusion:
The health promotion lifestyle of the elderly in Hebei Province was at the lower limit of good level. Among them, exercise frequency, children's attention to the elderly health, and pre-retirement occupation played a major role in relation to the health-promoting lifestyle of the elderly. Hence, it needs the joint action of individuals, families, and society to promote the elderly to adopt the health promotion lifestyle and realize healthy aging.
... Common agerelated changes seen in asymptomatic elderly patients are discreet, predominantly subpleural, basal reticulations, as well as centrilobular emphysema in upper lung zones and progressive calcification of the airways and ribcage [101,102]. Moreover, many patients show small basal atelectasis due to poor ventilation of lower lung zones, as well as basal effusions [103]. ...
Respiratory infections pose a significant health problem among elderly individuals, particularly during the COVID-19 pandemic. The increased mortality and morbidity rates among individuals over 65 highlight the criticality of these infections. The normal aging process in the lungs increases vulnerability to respiratory infections due to the accumulation of cellular damage and senescence. Consequently, the lung environment undergoes major changes in mechanical function and other systemic factors. This review aims to examine the influence of aging on respiratory infections from a clinical perspective by analyzing clinical studies. Additionally, the review will emphasize potential prevention and diagnostic developments to enhance therapy options available for elderly patients over 65 years of age.
... Despite its simplicity and ease of use, the CXR provides considerable information and is pivotal for the diagnosis and monitoring of cardiovascular and pulmonary diseases such as heart failure, aortic dissection, pneumonia, lung cancer, tuberculosis, sarcoidosis, and lung fibrosis 20 . Because aging 21 and sex difference 22 cause changes in CXR radiological findings, several studies have explored estimating a patient's age from CXR and developing artificial intelligence capable of conducting this task [23][24][25][26][27][28] . However, the estimation accuracy of those models has not been validated with independent external test data 24,[26][27][28] . ...
Background
In recent years, there has been considerable research on the use of artificial intelligence to estimate age and disease status from medical images. However, age estimation from chest X-ray (CXR) images has not been well studied and the clinical significance of estimated age has not been fully determined.
Methods
To address this, we trained a deep neural network (DNN) model using more than 100,000 CXRs to estimate the patients’ age solely from CXRs. We applied our DNN to CXRs of 1562 consecutive hospitalized heart failure patients, and 3586 patients admitted to the intensive care unit with cardiovascular disease.
Results
The DNN’s estimated age (X-ray age) showed a strong significant correlation with chronological age on the hold-out test data and independent test data. Elevated X-ray age is associated with worse clinical outcomes (heart failure readmission and all-cause death) for heart failure. Additionally, elevated X-ray age was associated with a worse prognosis in 3586 patients admitted to the intensive care unit with cardiovascular disease.
Conclusions
Our results suggest that X-ray age can serve as a useful indicator of cardiovascular abnormalities, which will help clinicians to predict, prevent and manage cardiovascular diseases.
... In elderly patients, thorax morphological changes are frequent and need to be known, in order to avoid improper images interpretation. These changes involve the chest wall, thoracic spine, diaphragm, and muscles, with costal cartilage calcification and muscle mass loss representing the most common findings [4]. The chest wall changes in shape and dimension, with an increase of its diameter in the sagittal view and a reduction in the lateral view ( Fig. 2A, B). ...
... Aging determines gradual and inevitable changes of functional and structural features of the musculoskeletal system that leads to a loss of volume, leading to a diffuse decrease in attenuation on the CXR of the elderly patient, consequent to the reduced attenuation of fat tissue against muscles, thus simulating emphysema [4]. In addition, along with the structural musculoskeletal changes, a decrease in contractility and elasticity of muscles occurs. ...
Purpose of Review
The purpose of this review is to describe the main features of the aging chest, studied through different imaging modalities.
Recent Findings
Aging-related changes of the respiratory system are inevitable. Therefore, it is mandatory to be familiar with the para-physiological changes that occurs, in order to avoid inappropriate interpretation of radiological findings that put patients at risk of over or undertreatment.
Summary
The role of the radiologist is fundamental in evaluating aging-related processes affecting the respiratory system and in distinguishing them from frank diseases.
... Minor radiographic changes observed in younger individuals may not impact the perioperative management. [48] These factors along with the evidences were collectively considered and deliberated by the experts during Delphi consensus, prior to arriving at the recommendations. ...
... Patients with COPD develop a "barrel chest" deformity with a stiff chest wall and reduced flexibility. 78 However, no study focused on the changes in the posterior chain muscle groups after diaphragmatic stretching techniques in patients with COPD. The study of Gonzalez et al is a great foundation for an in-depth discussion of the influence of diaphragm stretching technique on the musculoskeletal function of patients with COPD. ...
Purpose:
This review summarizes the characteristics, assessment methods, and targeted rehabilitation therapies of diaphragm dysfunction in patients with chronic obstructive pulmonary disease (COPD).
Methods:
Extensive literature was searched in PubMed, the Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure Database, Wanfang, and SinoMed.
Results:
Under the influence of oxidative stress, inflammation, and other factors, the diaphragm function of patients with COPD changes in mobility, muscle strength, thickness, and thickening. In patients with COPD, diaphragm mobility can be assessed using ultrasound, X-ray fluoroscopy, and magnetic resonance imaging. Diaphragmatic strength can be measured by transdiaphragmatic pressure and maximal inspiratory pressure. Diaphragmatic thickness and thickening can be assessed using ultrasound. Rehabilitation therapies targeting the diaphragm include diaphragmatic breathing, diaphragm-related manual therapy, and phrenic nerve electrical stimulation. Diaphragmatic breathing is safe, simple, and not limited by places. Diaphragmatic manual therapies, which require patient cooperation and one-on-one operation by a professional therapist, are effective. Phrenic nerve electrical stimulation is suitable for patients with severe conditions. These therapies improve the diaphragmatic function, lung function, dyspnea, and exercise capacity of patients with COPD.
Conclusion:
The diaphragmatic function is commonly assessed in terms of mobility, strength, thickness, and thickening. Diaphragmatic targeted rehabilitation therapies have proven to be efficient, which are recommended to be included in the pulmonary rehabilitation strategy for patients with COPD.
... 20 This contributes to hindering rib expansion, increasing lung work, and reducing respiratory function. 56 The authors consider that this type of behavior and excess hours in a sitting position could contribute to a shortening in the thoracoabdominal region and be an important factor in limiting mobility of the diaphragm muscle. ...
Objectives
To analyze the effects at the musculoskeletal level of manual treatment of the diaphragm muscle in adults.
Data Sources
Systematic review using four databases: PubMed, Science Direct, Web of Science and Scopus.
Study selection and data extraction
Two independent reviewers applied the selection criteria and assessed the quality of the studies using the Physiotherapy Evidence Database (PEDro) scale for experimental studies. A third reviewer intervened in cases where a consensus had not been reached. A total of 9 studies were included in the review.
Results
Manual therapy directed to the diaphragm has been shown to be effective in terms of the immediate increase in diaphragmatic mobility and thoracoabdominal expansion. The immediate improvement in the posterior muscle chain flexibility test is another of the most frequently found findings in the evaluated studies. Limited studies show improvements at the lumbar and cervical level in the range of motion and in pain.
Conclusion
Manual diaphragm therapy has shown an immediate significant effect on parameters related to costal, spinal and posterior muscle chain mobility. Further studies are needed, not only to demonstrate the effectiveness of manual diaphragm therapy in the long term and in symptomatic populations, but also to investigate the specific neurophysiological mechanisms involved in this type of therapy.
... El comportamiento sedentario y las alteraciones posturales que conlleva el exceso de horas en posición sentada pudiera suponer un factor importante en la limitación de movilidad del músculo diafragma, encontrándose éste en una posición de acortamiento (158). Esto contribuye a incrementar la rigidez de la pared torácica, obstaculizando la expansión costal, incrementando el trabajo pulmonar, y reduciendo la función respiratoria (377). En este caso, las fibras del diafragma más unidas a la región costal están generalmente dispuestas en posición vertical, y podrían verse orientadas más transversalmente (310), haciendo que la contracción sea menos efectiva, disminuyendo su capacidad para generar presiones (311,312) y por consiguiente, disminuyendo la movilidad del diafragma (158). ...
Effects of diaphragm muscle treatment in shoulder pain and mobility in subjects with rotator cuff injuries.
Introduction: The rotator cuff inflammatory or degenerative pathology is the main cause of shoulder pain. The shoulder and diaphragm muscle have a clear relation through innervation and the connection through myofascial tissue. In the case of nervous system, according to several studies the phrenic nerve has communicating branches to the brachial plexus with connections to shoulder key nerves including the suprascapular, lateral pectoral, musculocutaneous, and axillary nerves, besides, the vagal innervation that receives the diaphragm and their connections with the sympathetic system could make this muscle treatment a remarkable way of pain modulation in patients with rotator cuff pathology. To these should be added a possible common embryological origin in some type of vertebrates. Considering the connection through myofascial system, the improving of chest wall mobility via diaphragm manual therapy could achieve a better function of shoulder girdle muscles with insertion or origin at ribs and those that are influenced by the fascia such as the pectoralis major muscle, latissimus dorsi and subscapularis.
Objectives:
• Main objective:
To compare the immediate effect of diaphragm physical therapy in the symptoms of patients with rotator cuff pathology regarding a manual treatment over shoulder muscles.
• Specific objectives:
1. To evaluate the immediate effectiveness of each of the three groups in shoulder pain using a numerical pain rating scale (NPRS) and compare between them.
27
2. To evaluate the immediate effectiveness of each of the three groups in shoulder range of motion (ROM) using an inclinometer and compare between them. 3. To evaluate the immediate effectiveness of each of the three groups in pressure pain threshold (PPT) using an algometer and compare between them.
Material and method: A prospective, randomized, controlled, single-blind (assessor) trial with a previous pilot study in which a final sample size of 45 subjects was determined to people diagnosed with rotator cuff injuries and with clinical diagnosis of myofascial pain syndrome at shoulder. The sample were divided into 3 groups of treatment (15 subjects per group):
1. A direct treatment over the shoulder by ischemic compression of myofascial trigger points (MTP) (control / rotator cuff group).
2. Diaphragm manual therapy techniques (diaphragm group).
3. Active diaphragm mobilization by hipopressive gymnastic (hipopressive group).
The pain and range of shoulder motion were assessed before and after treatment in all the participants by inclinometry, NPRS of pain in shoulder movements and algometry. The data obtained were analyzed by an independent (blinded) statistician, who compared the effects of each one of the treatments using the Student’s t-test for paired samples or the Wilcoxon signed rank test, and calculated the post -intervention percentage of change in every variable. An analysis of variance (ANOVA) followed by the post-hoc test or a non-parametric Kruskal-Wallis test for non-parametric multiple-groups comparisons were performed to compare pre- to post-intervention outcomes between groups. Effect-size estimates of each intervention and between groups were calculated to allow interpretation of results in a more functional and meaningful way.
Results:
Both the control group and diaphragm group showed a statistically (p< 0.005) and clinically significant improvement, as well as a significant effect size (moderate to strong), on the NPRS in shoulder flexion and abduction movements. Regarding NPRS in shoulder external rotation, only the control group obtained a significant effect size. There was a significant increase in shoulder abduction and external rotation ROM (p<
Efectos del tratamiento del músculo diafragma en el dolor y la movilidad del hombro en sujetos con patología del manguito rotador.
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0.001) with a significant effect size in the control group. The PPT at the xiphoid process of the sternum showed a statistically (p< 0.001) and clinically significant improvement in the diaphragm group. The hipopressive gymnastic treatment was found to be no clinically effective in the shoulder pain and mobility, and showed a less efficacy than the other two groups.
Conclusion:
Both the shoulder non-direct treatment by a protocol of diaphragm manual therapy techniques and the rotator cuff MTP intervention showed been clinically effective in reducing pain (NPRS) immediately in shoulder flexion and abduction movements. The ROM assessment improvements obtained post- intervention by the diaphragm group have not been enough to consider them as clinically significant. The control group has obtained a significant effect size in shoulder abduction and external rotation ROM improvement. Both the control group and the diaphragm group treatments have been more effective in improving shoulder pain and mobility than the hipopressive group. The control group intervention has been the most effective in improving shoulder external rotation pain and mobility. The diaphragm group intervention was more effective in improving PPT at the xiphoid process than the other groups. Neither the effect size nor clinical significance proves the short-term benefit of the hipopressive gymnastic treatment in shoulder pain and mobility. Future studies are necessary to show the effectiveness of the diaphragm manual therapy applied in several sessions to determine its long-term effects in shoulder pain and mobility.
... The rate of incidental findings has increased along with the use of low dose CT, and the importance of non-malignant incidental findings for patient management is well established among clinicians [2]. Therefore, during clinical evaluation it is crucial to carefully examine non-diagnostic CT images in the oncologic PET/CT scans [3]. It is recommended that such additional findings should be taken into account, as they are important for disease management and prognosis [4]. ...
Introduction: Reporting thorax imaging findings on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is important for patient management. Even if some pulmonary findings are benign, they can have serious life-threatening consequences. This study aimed to investigate the frequency of benign or malignant pulmonary findings, which were simultaneously detected in PET/CT scans, of elderly patients with extrapulmonary malignant neoplasms. Methods: Patients aged ≥65 years, applying to nuclear medicine department of a tertiary level health unit between November 2017 and April 2018 were retrospectively evaluated. Demographic and clinical information and PET/CT scans were obtained from their previous hospital records. Data obtained were analyzed using the SPSS version 22. Results: A total of 112 patients (mean age, 72.8 ± 7.0; females, 58.9%) were included in the study. In total, 38.4% of the patients had a smoking history, and 39.2% were exposed to secondhand smoke. The most common indications for PET/CT imaging were post-treatment evaluation (42.9%) and staging (35.7%). Predominantly diagnosed malignancies were cancers of the gastrointestinal system (26.8%), breast (26.8%), and urogenital system (17%). While most patients had benign or malign pulmonary findings in thoracic images, no abnormal pulmonary findings were observed in only 24 patients (21.4%). The most common findings were emphysema (39.3%), metastatic nodules (27.7%), bronchial wall calcifications (14.3%), and air trapping/cysts (9.8%). Discussion and Conclusion: This study revealed that 78.6% of elderly patients with extrapulmonary malignant neoplasms undergoing PET/CT scans had at least one pathologic lung finding. Although most of these findings are benign, reporting of them is important in the management and clinical outcomes of patients with malignancy. Keywords: Elderly patient, PET/CT, malignant neoplasm, incidental pulmoner findings ÖZET Giriş ve Amaç: 18F-fluorodeoksiglukoz (18F-FDG) pozitron emisyon tomografi-bilgisayarlı tomografide (PET/BT) malignite kuşkulu lezyonlara ilaveten, benign karakterdeki bulguların raporlanması da hasta yönetiminde önemlidir. Bazı pulmoner bulgular benign olsa bile hayati tehlike oluşturan ciddi sonuçlara yol açabilir. Bu çalışmanın amacı, ekstrapulmoner malign neoplazm tanısı ile PET/BT çekilmiş olan yaşlı hastalarda benign ya da malign pulmoner bulguların sıklığını araştırmaktır. Yöntem ve Gereçler: Üçüncü basamak sağlık kuruluşu nükleer tıp bölümüne Kasım 2017-Nisan 2018 tarihleri arasında başvuran 65 yaş ve üzeri hastalar retrospektif değerlendirildi. Demografik verileri, klinik bilgileri ve PET/BT görüntüleri hastane kayıtlarından elde edildi. Bulgular SPSS 22 kullanılarak analiz edildi. Bulgular: Toplam 112 hasta (yaş ortalaması 72.8±7.0; %58.9' u kadın olan) çalışmaya dahil edildi. Hastaların %38.4' ü aktif, %39.2' si pasif sigara içicisiydi. En sık PET/BT çekimi endikasyonu, tedavi sonrası yanıt değerlendirme (%42.9) ve evreleme (%35.7) idi. Tanıların çoğunluğunu gastrointestinal www.actaoncologicaturcica.com Copyright©Ankara Onkoloji Hastanesi 88 Acta Oncologica Turcica 2021; 54: xx-xx sistem (%26.8), meme (%26.8) ve ürogenital sistem (%17) maligniteleri oluşturmaktaydı. Hastaların çoğunda toraks kesitlerinde benign yada malign pulmoner bulgulara rastlanırken, sadece 24 hastada (%21.4) hiçbir anormal pulmoner bulgu izlenmedi. En sık saptanan bulgular; amfizem (%39.3), metastatik nodül (%27.7), bronş duvarı kalsifikasyonu (%14.3) ve hava hapsi/kisti (%9.8) idi. Tartışma ve Sonuç: Bu çalışma, ekstrapulmoner malign neoplazm tanısı ile PET/BT çekilen yaşlı hastaların %78.6' sında en az bir anormal pulmoner bulgunun olduğunu gösterdi. Bu bulguların çoğu iyi huylu olmakla birlikte, bunların raporlanması malignitesi olan hastaların yönetimi ve klinik gidişatında önemlidir.
... The rate of incidental findings has increased along with the use of low dose CT, and the importance of non-malignant incidental findings for patient management is well established among clinicians [2]. Therefore, during clinical evaluation it is crucial to carefully examine non-diagnostic CT images in the oncologic PET/CT scans [3]. It is recommended that such additional findings should be taken into account, as they are important for disease management and prognosis [4]. ...
