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Valenzuela C, de la Fuente L, Hernández S, Olivera MJ, Molina C, Montes N, Benavides C, Caballero P. Persistent pulmonary abnormalities after 18 months of SARS-CoV-2 pneumonia. RADIOLOGIA 2024; 66 Suppl 1:S47-S56. [PMID: 38642961 DOI: 10.1016/j.rxeng.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/19/2023] [Indexed: 04/22/2024]
Abstract
OBJECTIVE To describe persistent pulmonary abnormalities detected on HRCT after 18 months of SARS-CoV-2 pneumonia, and to determine their extension and correlation with pulmonary function. PATIENTS AND METHODS A prospective cross-sectional study with an initial cohort of 90 patients in follow-up due to persisting lung abnormalities on imaging, functional respiratory impairment and/or respiratory symptoms. Of these, 31 (34%) were selected for analysis due to the persistence of their lung abnormalities on HRCT at 18 months after infection. A double reading was performed for each HRCT (62 observations). RESULTS Of the 31 patients included: 20 (65%) were men; mean age was 67 years; 17 (55%) were smokers/ex-smokers. The mean hospitalisation time was 38 days. Eighteen (58%) patients were admitted to intensive care units. Five patients (16%) suffered an acute pulmonary thromboembolism and three (9.7%) had a pneumothorax. The mean time between the onset of pneumonia and the follow-up HRCT was 20.34 months. Nineteen percent of patients suffered from total lung function abnormalities; and ground-glass opacities and reticulation were present in 12% and 4.5% respectively. The findings of the 62 readings were: ground-glass opacities (100%), reticulation (83%), subpleural curvilinear lines (62%), parenchymal bands (34%), traction bronchiectasis (69%), displacement of vessels/fissures (46%) and honeycombing (4.9%). Pulmonary function 18 months after the acute episode revealed a mean FVC of 92% of predicted value, with an FVC < 80% of predicted value in 11 patients (35.4%). Mean DLCO was 71% of predicted value, with a DLCO < 80% in 22 patients (70%). We observed a statistically significant relationship between total lung function abnormalities on HRCT and FVC (P < 0.05), and a trend towards statistical significance with DLCO (P = 0.051); there was a statistically significant relationship between the presence of ground-glass opacities and FEV1/FVC (P < 0.01). The relationships between reticulation and FVC, FVC%, FEV1, FEV1% and DLCO% were also considered statistically significant (P < 0.05). CONCLUSION Persistent interstitial lung abnormalities are seen on HRCT for a subset of patients infected with SARS-CoV-2 pneumonia. Seventy percent of these patients suffered a slight decrease in DLCO.
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Affiliation(s)
- C Valenzuela
- Servicio de Neumología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - L de la Fuente
- Servicio de Radiología, Hospital Universitario La Princesa. Universidad Autónoma de Madrid, Madrid, Spain
| | - S Hernández
- Servicio de Radiología, Hospital Universitario La Princesa. Universidad Autónoma de Madrid, Madrid, Spain
| | - M J Olivera
- Servicio de Radiología, Hospital Universitario La Princesa. Universidad Autónoma de Madrid, Madrid, Spain
| | - C Molina
- Servicio de Radiología, Hospital Universitario La Princesa. Universidad Autónoma de Madrid, Madrid, Spain
| | - N Montes
- Unidad de Apoyo Metodológico, Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain
| | - C Benavides
- Servicio de Radiología, Hospital Universitario La Princesa. Universidad Autónoma de Madrid, Madrid, Spain
| | - P Caballero
- Servicio de Radiología, Hospital Universitario La Princesa. Universidad Autónoma de Madrid, Madrid, Spain.
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Plasencia Martínez JM. Schematic approach to the diagnosis of multifocal lung opacities in the emergency department. RADIOLOGIA 2023; 65 Suppl 1:S63-S72. [PMID: 37024232 DOI: 10.1016/j.rxeng.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/21/2022] [Indexed: 04/08/2023]
Abstract
Radiologists in the emergency department must be prepared to deal with any type of disease in any organ at any time. Many entities involving the chest can result in patients' presenting at the emergency department. This chapter deals with entities that manifest with multifocal lung opacities and that can be mistaken for pneumonia. To facilitate their identification, this chapter approaches these entities by considering their most characteristic distribution on chest X-rays, the main diagnostic modality used for thoracic problems in the emergency department. Our schematic approach includes the key findings in patients' personal histories, clinical examination, laboratory tests, and imaging studies that can be available during the initial workup.
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3
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Abordaje esquemático del diagnóstico de las opacidades pulmonares multifocales en la urgencia. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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4
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Association between lung opacities and visceral fat in COVID-19 patients. Pol J Radiol 2023; 88:e119-e123. [PMID: 36910886 PMCID: PMC9995241 DOI: 10.5114/pjr.2023.125407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/21/2022] [Indexed: 03/06/2023] Open
Abstract
Purpose To assess the relationship between the amount of the epigastric visceral fat area and the severity of pneumonia in the course of COVID-19 using chest computed tomography (CT) examinations. Material and methods 177 patients (54 female), with COVID-19 infection were included. A routine chest CT was performed to assess the severity of pneumonia. The affected lung tissue as well as semi-quantitative scales such as the Chest CT Score and Total Opacity Score were calculated using SyngoVia VB30A CT Pneumonia Analysis software. The epigastric region area of visceral fat (L1) was also determined. Results The mean value of the visceral adipose tissue area was 196.23 ± 101.36 cm2. The area of adipose tissue significantly correlated with the percentage of the affected lung tissue (r = 0.1476; p = 0.050), the Chest CT Score (r = 0.2086; p = 0.005), and the Total Opacity Score (r = 0.1744; p = 0.200). The mean area of adipose tissue in the age group ≥ 65 years was 216.13 ± 105.19 cm2, while in the group < 65 years, it was 169.18 ± 89.69 cm2. This difference was statistically significant (p = 0.002). Conclusions The study showed a relationship between the area of visceral adipose tissue and the degree of lung inflammation in COVID-19 disease in patients under 65 years of age.
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del Valle R, Ballesteros Á, Calvo C, Sainz T, Mendez A, Grasa C, Molina PR, Mellado MJ, Sanz‐Santaeufemia FJ, Herrero B, Calleja L, Soriano‐Arandes A, Melendo S, Rincón‐López E, Hernánz A, Epalza C, García‐Baeza C, Rupérez‐García E, Berzosa A, Ocaña A, Villarroya‐Villalba A, Barrios A, Otheo E, Galán JC, Rodríguez MJ, Mesa JM, Domínguez‐Rodríguez S, Moraleda C, Tagarro A. Comparison of pneumonia features in children caused by SARS-CoV-2 and other viral respiratory pathogens. Pediatr Pulmonol 2022; 57:2374-2382. [PMID: 35754093 PMCID: PMC9349806 DOI: 10.1002/ppul.26042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/01/2022] [Accepted: 06/23/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pneumonia is a frequent manifestation of coronavirus disease 2019 (COVID-19) in hospitalized children. METHODS The study involved 80 hospitals in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spanish Pediatric National Cohort. Participants were children <18 years, hospitalized with SARS-CoV-2 community-acquired pneumonia (CAP). We compared the clinical and radiological characteristics of SARS-CoV-2-associated CAP with CAP due to other viral etiologies from ValsDance (retrospective) cohort. RESULTS In total, 151 children with SARS-CoV-2-associated CAP and 138 with other viral CAP were included. Main clinical features of SARS-CoV-2-associated CAP were cough, fever, or dyspnea. Lymphopenia was found in 43% patients and 15% required admission to the pediatric intensive care unit (PICU). Chest X-ray revealed condensation (42%) and other infiltrates (58%). Compared with CAP from other viral pathogens, COVID-19 patients were older, with lower C-reactive protein (CRP) levels, less wheezing, and greater need of mechanical ventilation (MV). There were no differences in the use of continuous positive airway pressure (CPAP) or HVF, or PICU admission between groups. CONCLUSION SARS-CoV-2-associated CAP in children presents differently to other virus-associated CAP: children are older and rarely have wheezing or high CRP levels; they need less oxygen but more CPAP or MV. However, several features overlap and differentiating the etiology may be difficult. The overall prognosis is good.
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Affiliation(s)
- Rut del Valle
- Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
| | - Álvaro Ballesteros
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Cristina Calvo
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Talía Sainz
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
- Research Center, Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC)Instituto de Salud Carlos III, Madrid, SpainMadridSpain
| | - Ana Mendez
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Carlos Grasa
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Paula R. Molina
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - María J. Mellado
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | | | - Blanca Herrero
- Pediatrics DepartmentHospital Universitario Niño JesúsMadridSpain
| | - Lourdes Calleja
- Pediatrics DepartmentHospital Universitario Niño JesúsMadridSpain
| | - Antoni Soriano‐Arandes
- Infectious Diseases and Pediatric Immunology Unit, Department of PediatricsHospital Universitario Vall d'HebronBarcelonaSpain
| | - Susana Melendo
- Infectious Diseases and Pediatric Immunology Unit, Department of PediatricsHospital Universitario Vall d'HebronBarcelonaSpain
| | - Elena Rincón‐López
- Pediatric Infectious Diseases Unit, Department of PediatricsHospital Universitario Gregorio MarañónMadridSpain
| | - Alicia Hernánz
- Pediatric Infectious Diseases Unit, Department of PediatricsHospital Universitario Gregorio MarañónMadridSpain
- Research CenterGregorio Marañón Research Institute (IiSGM)MadridSpain
| | - Cristina Epalza
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
- Pediatric Infectious Diseases Unit, Department of PediatricsHospital Universitario 12 de OctubreMadridSpain
| | - Carmen García‐Baeza
- Pediatric Infectious Diseases Unit, Department of PediatricsHospital Universitario 12 de OctubreMadridSpain
| | | | - Arantxa Berzosa
- Pediatrics DepartmentHospital Universitario Clínico San CarlosMadridSpain
| | - Angustias Ocaña
- Pediatric Intensive Care Unit DepartmentHospital La MoralejaMadridSpain
| | - Alvaro Villarroya‐Villalba
- Pediatric Infectious Diseases Unit, Pediatrics DepartmentHospital Universitari i Politècnic La FeValenciaSpain
| | - Ana Barrios
- Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
| | - Enrique Otheo
- Pediatrics Department, Hospital Universitario Ramón y CajalUniversidad de Alcalá MadridMadridSpain
| | - Juan C. Galán
- Microbiology Department, Hospital Universitario Ramón y CajalInstituto Ramón y Cajal para la Investigación Sanitaria (IRYCIS)MadridSpain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - Mario José Rodríguez
- Microbiology Department, Hospital Universitario Ramón y CajalInstituto Ramón y Cajal para la Investigación Sanitaria (IRYCIS)MadridSpain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - Juan M. Mesa
- Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
| | - Sara Domínguez‐Rodríguez
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Cinta Moraleda
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Alfredo Tagarro
- Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
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Amini S, Rezabakhsh A, Hashemi J, Saghafi F, Azizi H, Sureda A, Habtemariam S, Khayat Kashani HR, Hesari Z, Sahebnasagh A. Pharmacotherapy consideration of thrombolytic medications in COVID-19-associated ARDS. J Intensive Care 2022; 10:38. [PMID: 35908022 PMCID: PMC9338522 DOI: 10.1186/s40560-022-00625-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is responsible for coronavirus disease (COVID-19), was identified as the new pathogen to lead pneumonia in Wuhan, China, which has spread all over the world and developed into a pandemic. Despite the over 1 year of pandemic, due to the lack of an effective treatment plan, the morbidity and mortality of COVID-19 remains high. Efforts are underway to find the optimal management for this viral disease. MAIN BODY SARS-CoV-2 could simultaneously affect multiple organs with variable degrees of severity, from mild to critical disease. Overproduction of pro-inflammatory mediators, exacerbated cellular and humoral immune responses, and coagulopathy such as Pulmonary Intravascular Coagulopathy (PIC) contributes to cell injuries. Considering the pathophysiology of the disease and multiple microthrombi developments in COVID-19, thrombolytic medications seem to play a role in the management of the disease. Beyond the anticoagulation, the exact role of thrombolytic medications in the management of patients with COVID-19-associated acute respiratory distress syndrome (ARDS) is not explicit. This review focuses on current progress in underlying mechanisms of COVID-19-associated pulmonary intravascular coagulopathy, the historical use of thrombolytic drugs in the management of ARDS, and pharmacotherapy considerations of thrombolytic therapy, their possible benefits, and pitfalls in COVID-19-associated ARDS. CONCLUSIONS Inhaled or intravenous administration of thrombolytics appears to be a salvage therapy for severe ARDS associated with COVID-19 by prompt attenuation of lung injury. Considering the pathogenesis of COVID-19-related ARDS and mechanism of action of thrombolytic agents, thrombolytics appear attractive options in stable patients without contraindications.
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Affiliation(s)
- Shahideh Amini
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Aysa Rezabakhsh
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Hashemi
- Department of Pathobiology and Laboratory Sciences, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Fatemeh Saghafi
- Department of Clinical Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Azizi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Antoni Sureda
- Research Group On Community Nutrition and Oxidative Stress, University of the Balearic Islands, Palma, Spain
- CIBEROBN (Physiopathology of Obesity and Nutrition CB12/03/30038), Instituto de Salud Carlos III, Madrid, Spain
| | - Solomon Habtemariam
- Pharmacognosy Research Laboratories and Herbal Analysis Services, University of Greenwich, Central Avenue, Chatham-Maritime, Kent, ME4 4TB UK
| | | | - Zahra Hesari
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Adeleh Sahebnasagh
- Clinical Research Center, Department of Internal Medicine, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Prognostic significance of peripheral consolidations at chest x-ray in severe COVID-19 pneumonia. Radiol Med 2022; 127:602-608. [PMID: 35416574 PMCID: PMC9005617 DOI: 10.1007/s11547-022-01487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022]
Abstract
To evaluate the possible prognostic significance of the development of peripheral consolidations at chest x-ray in COVID-19 pneumonia, we retrospectively studied 92 patients with severe respiratory failure (PaO2/FiO2 ratio < 200 mmHg) that underwent at least two chest x-ray examinations (baseline and within 10 days of admission). Patients were divided in two groups based on the evolution of chest x-ray toward the appearance of peripheral consolidations or toward a greater extension of the lung abnormalities but without peripheral consolidations. Patients who developed lung abnormalities without peripheral consolidations as well as patients who developed peripheral consolidations showed, at follow-up, a significant worsening of the PaO2/FiO2 ratio but a significantly lower mortality and intubation rate was observed in patients with peripheral consolidations at chest x-ray. The progression of chest x-ray toward peripheral consolidations is an independent prognostic factor associated with lower intubation rate and mortality.
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Torres-Vargas C, Legorreta-Soberanis J, Sánchez-Gervacio BM, Fernández-López PA, Flores-Moreno M, Alvarado-Castro VM, Paredes-Solís S, Andersson N, Cockcroft A. Utility of a Pulmonary Oedema Score for Predicting the Need for Mechanical Ventilation in COVID-19 Patients in a General Hospital. Arch Med Res 2022; 53:399-406. [PMID: 35370011 PMCID: PMC8938260 DOI: 10.1016/j.arcmed.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/14/2022] [Accepted: 03/16/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Criseida Torres-Vargas
- Hospital General Regional No. 1 Vicente Guerrero, Instituto Mexicano del Seguro Social, Acapulco, Guerrero, México
| | - José Legorreta-Soberanis
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | | | | | - Miguel Flores-Moreno
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | | | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México.
| | - Neil Andersson
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México; Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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Spontaneous tension hemothorax in a severe COVID-19 patient receiving ECMO therapy: The other side of COVID-19-associated coagulopathy. Respir Med Case Rep 2022; 37:101663. [PMID: 35559365 PMCID: PMC9072841 DOI: 10.1016/j.rmcr.2022.101663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/26/2022] Open
Abstract
As opposed to widely recognized Coronavirus Disease 2019 (COVID-19)-associated thrombotic events, the unusual but serious bleeding complications in COVID-19 patients are worth-mentioned. Here, we describe a 44-year-old man afflicted by COVID-19 pneumonia with acute respiratory distress syndrome (ARDS) and submassive pulmonary embolism. The patient's condition initially improved with the prescription of ECMO, tocilizumab, and hemoadsorption, however, he later developed spontaneous tension hemothorax, which is considered rare but devastating in the setting of COVID-19. While the exact pathogenesis of COVID-19-associated bleeding events remains poorly understood, we aim to highlight the other aspect of coagulation dysfunction potentially caused by COVID-19.
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10
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Belletti A, Palumbo D, Zangrillo A, Fominskiy EV, Franchini S, Dell'Acqua A, Marinosci A, Monti G, Vitali G, Colombo S, Guazzarotti G, Lembo R, Maimeri N, Faustini C, Pennella R, Mushtaq J, Landoni G, Scandroglio AM, Dagna L, De Cobelli F. Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients. J Cardiothorac Vasc Anesth 2021; 35:3642-3651. [PMID: 33678544 PMCID: PMC8054543 DOI: 10.1053/j.jvca.2021.02.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). DESIGN Observational study. SETTING Tertiary-care university hospital. PARTICIPANTS One hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS. INTERVENTIONS The authors collected demographic, mechanical ventilation, imaging, laboratory, and outcome data. Primary outcome was the incidence of PNX/PMD. Multiple logistic regression analyses were performed to identify predictors of PNX/PMD. MEASUREMENTS AND MAIN RESULTS PNX/PMD occurred in a total of 28 patients (24.1%), with 22 patients developing PNX (19.0%) and 13 developing PMD (11.2%). Mean time to development of PNX/PMD was 14 ± 11 days from intubation. The authors found no significant difference in mechanical ventilation parameters between patients who developed PNX/PMD and those who did not. Mechanical ventilation parameters were within recommended limits for protective ventilation in both groups. Ninety-five percent of patients with PNX/PMD had the Macklin effect (linear collections of air contiguous to the bronchovascular sheaths) on a baseline computed tomography scan, and tended to have a higher lung involvement at intensive care unit (ICU) admission (Radiographic Assessment of Lung Edema score 32.2 ± 13.4 v 18.7 ± 9.8 in patients without PNX/PMD, p = 0.08). Time from symptom onset to intubation and time from total bilirubin on day two after ICU admission were the only independent predictors of PNX/PMD. Mortality was 60.7% in patients who developed PNX/PMD versus 38.6% in those who did not (p = 0.04). CONCLUSION PNX/PMD occurs frequently in COVID-19 patients with ARDS requiring mechanical ventilation, and is associated with increased mortality. Development of PNX/PMD seems to occur despite use of protective mechanical ventilation and has a radiologic predictor sign.
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Affiliation(s)
- Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Evgeny V Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Franchini
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Dell'Acqua
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Marinosci
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Monti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giordano Vitali
- Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sergio Colombo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Guazzarotti
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Maimeri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carolina Faustini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Renato Pennella
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Junaid Mushtaq
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Morelli C, Francavilla M, Stabile Ianora AA, Cozzolino M, Gualano A, Stellacci G, Sacco A, Lorusso F, Pedote P, De Ceglie M, Scardapane A. The Multifaceted COVID-19: CT Aspects of Its Atypical Pulmonary and Abdominal Manifestations and Complications in Adults and Children. A Pictorial Review. Microorganisms 2021; 9:microorganisms9102037. [PMID: 34683358 PMCID: PMC8541408 DOI: 10.3390/microorganisms9102037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/12/2022] Open
Abstract
Our daily experience in a COVID hospital has allowed us to learn about this disease in many of its changing and unusual aspects. Some of these uncommon manifestations, however, appeared more frequently than others, giving shape to a multifaceted COVID-19 disease. This pictorial review has the aim to describe the radiological aspects of atypical presentations and of some complications of COVID-19 disease in adults and children and provide a simple guide for radiologists to become familiar with the multiform aspects of this disease.
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Affiliation(s)
- Chiara Morelli
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
- Correspondence:
| | | | - Amato Antonio Stabile Ianora
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Monica Cozzolino
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Alessandra Gualano
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | | | - Antonello Sacco
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Filomenamila Lorusso
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Pasquale Pedote
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Michele De Ceglie
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
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Cabrera Gaytán DA, Pérez Andrade Y, Espíritu Valenzo Y. Pneumothorax due to COVID-19: Analysis of case reports. Respir Med Case Rep 2021; 34:101490. [PMID: 34336592 PMCID: PMC8312092 DOI: 10.1016/j.rmcr.2021.101490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 02/07/2023] Open
Abstract
Cases of pneumothorax/pneumomediastinum have been reported in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, the time to onset and hospital stay have rarely been studied. Coronavirus disease 2019 (COVID-19) patients with these complications are described to determine the time to onset, associated comorbidities, and location and duration of pneumothorax. A search in PubMed yielded simple frequencies and a bivariate analysis of deaths. There were 113 confirmed cases in 67 articles. The median time from the date of hospital admission to the presence of pneumothorax was 8 days. Right hemithorax was the most frequent form of pneumothorax. Almost half of the patients required intubation for invasive mechanical ventilation. Although the frequency of this phenomenon was not high among hospitalized patients with confirmed SARS-CoV-2, it was high among those who developed acute respiratory distress syndrome (ARDS). This study contributes to the literature because it presents a large number of patients who developed pneumothorax after admission, which was characterized by clinical deterioration (dyspnea, tachypnea, pleuritic chest pain, and subcutaneous emphysema) and low oxygen saturation levels. Pneumothorax/pneumomediastinum is recommended as a differential diagnosis, even without considering the presence of chronic pulmonary comorbidities or invasive mechanical ventilation.
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Affiliation(s)
- David Alejandro Cabrera Gaytán
- Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc # 330 Block “B” 4° Floor, Annex to the Unidad de Congresos del Centro Médico Nacional Siglo XXI, Neighborhood Doctores, Alcaldía Cuauhtmoc, CP. 06720, Mexico City, Mexico
| | - Yadira Pérez Andrade
- Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mier y Pesado No. 120, Neighborhood Del Valle Benito Juárez, CP. 03100, Mexico City, Mexico
| | - Yuridia Espíritu Valenzo
- Hospital General Regional No. 72, Instituto Mexicano del Seguro Social, Av. Gustavo Baz Prada S/N, Neighborhood Centro Industrial Tlalnepantla, CP 54000, Tlalnepantla de Baz, Estado de México, Mexico
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Extrathoracic manifestations of COVID-19 in adults and presentation of the disease in children. RADIOLOGIA 2021; 63:370-383. [PMID: 34246427 PMCID: PMC8133527 DOI: 10.1016/j.rxeng.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/17/2021] [Indexed: 12/21/2022]
Abstract
In March 2020, the World Health Organization declared a global pandemic of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); epidemic conditions continue in nearly all countries today. Although the symptoms and imaging manifestations of COVID-19 predominantly involve the respiratory system, it is fundamental to know the manifestations of the disease and its possible complications in other organs to help in diagnosis and orient the prognosis. To improve the diagnostic process without increasing the risk of contagion unnecessarily, it is crucial to know when extrathoracic imaging tests are indicated and which tests are best in each situation. This paper aims to provide answers to these questions. To this end, we describe and illustrate the extrathoracic imaging manifestations of COVID-19 in adults as well as the entire spectrum of imaging findings in children.
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