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Brogna B, Bignardi E, Megliola A, Laporta A, La Rocca A, Volpe M, Musto LA. A Pictorial Essay Describing the CT Imaging Features of COVID-19 Cases throughout the Pandemic with a Special Focus on Lung Manifestations and Extrapulmonary Vascular Abdominal Complications. Biomedicines 2023; 11:2113. [PMID: 37626610 PMCID: PMC10452395 DOI: 10.3390/biomedicines11082113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
With the Omicron wave, SARS-CoV-2 infections improved, with less lung involvement and few cases of severe manifestations. In this pictorial review, there is a summary of the pathogenesis with particular focus on the interaction of the immune system and gut and lung axis in both pulmonary and extrapulmonary manifestations of COVID-19 and the computed tomography (CT) imaging features of COVID-19 pneumonia from the beginning of the pandemic, describing the typical features of COVID-19 pneumonia following the Delta variant and the atypical features appearing during the Omicron wave. There is also an outline of the typical features of COVID-19 pneumonia in cases of breakthrough infection, including secondary lung complications such as acute respiratory distress disease (ARDS), pneumomediastinum, pneumothorax, and lung pulmonary thromboembolism, which were more frequent during the first waves of the pandemic. Finally, there is a description of vascular extrapulmonary complications, including both ischemic and hemorrhagic abdominal complications.
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Affiliation(s)
- Barbara Brogna
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (A.L.); (A.L.R.); (L.A.M.)
| | - Elio Bignardi
- Department of Radiology, Francesco Ferrari Hospital, ASL Lecce, 73042 Casarano, Italy;
| | - Antonia Megliola
- Radiology Unit, “Frangipane” Hospital, ASL Avellino, 83031 Ariano Irpino, Italy; (A.M.); (M.V.)
| | - Antonietta Laporta
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (A.L.); (A.L.R.); (L.A.M.)
| | - Andrea La Rocca
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (A.L.); (A.L.R.); (L.A.M.)
| | - Mena Volpe
- Radiology Unit, “Frangipane” Hospital, ASL Avellino, 83031 Ariano Irpino, Italy; (A.M.); (M.V.)
| | - Lanfranco Aquilino Musto
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (A.L.); (A.L.R.); (L.A.M.)
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Ershadi R, Rafieian S, Salehi M, Kazemizadeh H, Amini H, Sohrabi M, Samimiat A, Sharafi Y, Dashtkoohi M, Vahedi M. COVID-19 and spontaneous pneumothorax: a survival analysis. J Cardiothorac Surg 2023; 18:211. [PMID: 37403072 DOI: 10.1186/s13019-023-02331-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION COVID-19 Patients may be at risk for involving with spontaneous pneumothorax. However, clinical data are lacking in this regard. In this study, we aimed to investigate the demographic, clinical, and radiological characteristics and survival predictors in COVID-19 patients with pneumothorax. METHODS This is a retrospectivestudy conducted on COVID-19 patients with pneumothorax that had been hospitalized at hospital. l from December 2021 to March 2022. The chest computed tomography (CT) scan of all patients was reviewed by an experienced pulmonologist in search of pulmonary pneumothorax. Survival analysis was conducted to identify the predictors of survival in patients with COVID-19 and pneumothorax. RESULTS A total of 67 patients with COVID-19 and pneumothorax were identified. Of these, 40.7% were located in the left lung, 40.7% were in the right lung, and 18.6% were found bilaterally. The most common symptoms in the patient with pneumothorax were dyspnea (65.7%), increased cough severity (53.7%), chest pain (25.4%), and hemoptysis (16.4%). The frequency of pulmonary left and right bullae, pleural effusion, andfungus ball were 22.4%, 22.4%, 22.4%, and 7.5%, respectively. Pneumothorax was managed with chest drain (80.6%), chest drain and surgery (6%), and conservatively (13.4%). The 50-day mortality rate was 52.2% (35 patients). The average survival time for deceased patients was 10.06 (2.17) days. CONCLUSIONS Our results demonstrated that those with pleural effusion or pulmonary bullae have a lower survival rate. Further studies are required to investigate the incidence and causality relation between COVID-19 and pneumothorax.
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Affiliation(s)
- Reza Ershadi
- Department of thoracic surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahab Rafieian
- Department of thoracic surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Research center of Antibiotic stewardship & Anti-microbial resistance, Infectious diseases department, Imam Khomeini hospital complex, Tehran University of medical sciences, Tehran, Iran
| | - Hossein Kazemizadeh
- Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hesam Amini
- Department of thoracic surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Sohrabi
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Samimiat
- Department of surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Sharafi
- Department of surgery, Sina Hospital, Tehran University pf Medical Sciences, Tehran, Iran
| | | | - Matin Vahedi
- Department of surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Jain P, Agarwal N, Saxena V, Srivastav S, Solanki H. Mortality in patients with Coronavirus disease 2019 (COVID- 19) and its clinicoradiological and laboratory correlates: A retrospective study. J Family Med Prim Care 2022; 11:6197-6203. [PMID: 36618193 PMCID: PMC9810907 DOI: 10.4103/jfmpc.jfmpc_364_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022] Open
Abstract
Aim To delineate and analyze the mortality from COVID -19 in our institute during the devastating second wave of pandemic. Settings and Design A retrospective cohort analysis. Methods and Materials A comprehensive mortality analysis of 142 laboratory-confirmed severe acute respiratory syndrome coronavirus 2-infected deceased patients from our hospital's medical records was done. These patients presented with severe disease at the time of admission and were managed in intensive care units. Statistical Analysis Used Statistical Package for Social Sciences software, IBM manufacturer, Chicago, USA, version 21.0 was used. Results The number of deceased males (82, 62.6%) was higher than females (53, 37.3%). Median age of deceased patient was 57 (44.25-69.75) years. Most frequent comorbidities were diabetes mellitus (42, 29.6%) and hypertension (41, 28.9%). Most common symptoms being shortness of breath (137, 96.5%), fever (94, 66.2%) and cough (73, 51.4%). Median peripheral capillary oxygen saturation (SpO2) at time of admission was 86% (77.25-90). Median time interval from symptom onset to admission in hospital was 3 (2.25-5) days. Neutrophil lymphocyte ratio was more than 5 in 117 (90.7%) patients. Complications seen were acute respiratory distress syndrome in 82.3%, acute liver injury in 58.4%, acute kidney injury in 26.7%, sepsis in 13.3% and acute cardiac injury in 12% patients. The median high-resolution computed tomography score was 20 (17-22). Conclusions Male and elderly patients with underlying comorbidities had poorer outcome and involvement of multiple organ systems was common. A short time interval between symptom onset and admission/mortality, particularly encountered was worrisome.
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Affiliation(s)
- Payal Jain
- Department of Internal Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India,Address for correspondence: Dr. Payal Jain, Associate Professor, Department of Internal Medicine, Government Institute of Medical Sciences, Greater Noida – 201 310, Uttar Pradesh, India. E-mail:
| | - Neema Agarwal
- Department of Radio Diagnosis, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Vikas Saxena
- Department of Orthopedics, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Saurabh Srivastav
- Department of Internal Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Hariom Solanki
- Department of Community Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
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Ilieva E, Boyapati A, Chervenkov L, Gulinac M, Borisov J, Genova K, Velikova T. Imaging related to underlying immunological and pathological processes in COVID-19. World J Clin Infect Dis 2022; 12:1-19. [DOI: 10.5495/wjcid.v12.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/09/2021] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
The introduction of coronavirus disease-2019 (COVID-19) as a global pandemic has contributed to overall morbidity and mortality. With a focus on understanding the immunology and pathophysiology of the disease, these features can be linked with the respective findings of imaging studies. Thus, the constellation between clinical presentation, histological, laboratory, immunological, and imaging results is crucial for the proper management of patients. The purpose of this article is to examine the role of imaging during the particular stages of severe acute respiratory syndrome coronavirus 2 infection – asymptomatic stage, typical and atypical COVID-19 pneumonia, acute respiratory distress syndrome, multiorgan failure, and thrombosis. The use of imaging methods to assess the severity and duration of changes is crucial in patients with COVID-19. Radiography and computed tomography are among the methods that allow accurate characterization of changes.
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Affiliation(s)
- Elena Ilieva
- Department of Diagnostic Imaging, University Emergency Hospital (UMHATEM) "N. I. Pirogov”, Sofia 1606, Bulgaria
| | - Alexandra Boyapati
- Department of Diagnostic Imaging, University Emergency Hospital (UMHATEM) "N. I. Pirogov”, Sofia 1606, Bulgaria
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University, Plovdiv, University Hospital "St George", Plovdiv 4000, Bulgaria
| | - Milena Gulinac
- Department of General and Clinical Pathology, Medical University, Plovdiv, University Hospital "St George", Plovdiv 4000, Bulgaria
| | - Jordan Borisov
- Department of Diagnostic Imaging, MBAL-Dobrich” AD, Dobrich 9300, Bulgaria
| | - Kamelia Genova
- Department of Diagnostic Imaging, University Emergency Hospital (UMHATEM) "N. I. Pirogov”, Sofia 1606, Bulgaria
| | - Tsvetelina Velikova
- Department of Clinical Immunology, University Hospital “Lozenetz”, Sofia 1407, Bulgaria
- Medical Faculty, Sofia University “St. Kliment Ohridski”, Sofia 1407, Bulgaria
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Laghi A, Tamburi V, Polici M, Anibaldi P, Marcolongo A, Caruso D. Management decisions of an Academic Radiology Department during COVID-19 pandemic: the important support of a business analytics software. Eur Radiol 2022; 32:7048-7055. [PMID: 35380224 PMCID: PMC8981182 DOI: 10.1007/s00330-022-08709-3] [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: 01/21/2022] [Revised: 01/21/2022] [Accepted: 02/28/2022] [Indexed: 12/05/2022]
Abstract
Objectives To analyze the response in the management of both radiological emergencies and continuity of care in oncologic/fragile patients of a radiology department of Sant’Andrea Academic Hospital in Rome supported by a dedicated business analytics software during the COVID-19 pandemic. Methods Imaging volumes and workflows for 2019 and 2020 were analyzed. Information was collected from the hospital data warehouse and evaluated using a business analytics software, aggregated both per week and per quarter, stratified by patient service location (emergency department, inpatients, outpatients) and imaging modality. For emergency radiology subunit, radiologist workload, machine workload, and turnaround times (TATs) were also analyzed. Results Total imaging volume in 2020 decreased by 21.5% compared to that in 2019 (p < .001); CT in outpatients increased by 11.7% (p < .005). Median global TAT and median code-blue global TAT were not statistically significantly different between 2019 and 2020 and between the first and the second pandemic waves in 2020 (all p > .09). Radiologist workload decreased by 24.7% (p < .001) during the first pandemic wave in 2020 compared with the same weeks of 2019 and showed no statistically significant difference during the second pandemic wave, compared with the same weeks of 2019 (p = 0.19). Conclusions Despite the reduction of total imaging volume due to the COVID-19 pandemic in 2020 compared to 2019, management decisions supported by a dedicated business analytics software allowed to increase the number of CT in fragile/oncologic outpatients without significantly affecting emergency radiology TATs, and emergency radiologist workload. Key Points • During the COVID-19 pandemic, management decisions supported by business analytics software guaranteed efficiency of emergency and preservation of fragile/oncologic patient continuity of care. • Real-time data monitoring using business analytics software is essential for appropriate management decisions in a department of radiology. • Business analytics should be gradually introduced in all healthcare institutions to identify strong and weak points in workflow taking correct decisions. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08709-3.
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Affiliation(s)
- Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
| | - Virginia Tamburi
- Department of Radiology, Federico II University Hospital, Naples, Italy
| | - Michela Polici
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Paolo Anibaldi
- Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Adriano Marcolongo
- Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
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Gabelloni M, Faggioni L, Cioni D, Mendola V, Falaschi Z, Coppola S, Corradi F, Isirdi A, Brandi N, Coppola F, Granata V, Golfieri R, Grassi R, Neri E. Extracorporeal membrane oxygenation (ECMO) in COVID-19 patients: a pocket guide for radiologists. Radiol Med 2022; 127:369-382. [PMID: 35279765 PMCID: PMC8918086 DOI: 10.1007/s11547-022-01473-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/23/2022] [Indexed: 01/08/2023]
Abstract
During the coronavirus disease 19 (COVID-19) pandemic, extracorporeal membrane oxygenation (ECMO) has been proposed as a possible therapy for COVID-19 patients with acute respiratory distress syndrome. This pictorial review is intended to provide radiologists with up-to-date information regarding different types of ECMO devices, correct placement of ECMO cannulae, and imaging features of potential complications and disease evolution in COVID-19 patients treated with ECMO, which is essential for a correct interpretation of diagnostic imaging, so as to guide proper patient management.
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Affiliation(s)
- Michela Gabelloni
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Lorenzo Faggioni
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
| | - Dania Cioni
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, Via della Signora 2, 20122, Milano, Italy
| | - Vincenzo Mendola
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Zeno Falaschi
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Sara Coppola
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Isirdi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria Di Bologna, 40138, Bologna, Italy
| | - Francesca Coppola
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, Via della Signora 2, 20122, Milano, Italy
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria Di Bologna, 40138, Bologna, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS Di Napoli, 80131, Naples, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria Di Bologna, 40138, Bologna, Italy
| | - Roberto Grassi
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, Via della Signora 2, 20122, Milano, Italy
- Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, 80127, Naples, Italy
| | - Emanuele Neri
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, Via della Signora 2, 20122, Milano, Italy
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Caruso D, Zerunian M, Polici M, Pucciarelli F, Guido G, Polidori T, Rucci C, Bracci B, Tremamunno G, Laghi A. Diagnostic performance of CT lung severity score and quantitative chest CT for stratification of COVID-19 patients. Radiol Med 2022; 127:309-317. [PMID: 35157241 PMCID: PMC8852873 DOI: 10.1007/s11547-022-01458-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/21/2022] [Indexed: 12/23/2022]
Abstract
Purpose Lung severity score (LSS) and quantitative chest CT (QCCT) analysis could have a relevant impact to stratify patients affected by COVID-19 pneumonia at the hospital admission. The study aims to assess LSS and QCCT performances in severity stratification of COVID-19 patients. Materials and methods From April 19, 2020, until May 3, 2020, patients with chest CT suggestive for interstitial pneumonia and tested positive for COVID-19 were retrospectively enrolled and stratified for hospital admission as Group 1, 2 and 3 (home isolation, low intensive care and intensive care, respectively). For LSS, lungs were divided in 20 regions and visually assessed by two radiologists who scored for each region from non-lung involvement as 0, < 50% assigned as 1 and > 50% as 2. QCCT was performed with a dedicated software that extracts pulmonary involvement expressed in liters and percentage. LSS and QCCT were analyzed with ROC curve analysis to predict the performance of both methods. P values < 0.05 were considered statistically significant. Results Final population enrolled included 136 patients (87 males, mean age 66 ± 16), 19 patients in Group 1, 86 in Group 2 and 31 in Group 3. Significant differences for LSS were observed in almost all comparisons, especially in Group 1 vs 3 (AUC 0.850, P < 0,0001) and Group 1 + 2 vs 3 (AUC 0.783, P < 0,0001). QCCT showed significant results in almost all comparisons, especially between Group 1 vs 3 (AUC 0.869, P < 0,0001). LSS and QCCT comparison between Group 1 and Group 2 did not show significant differences. Conclusions LSS and QCCT could represent promising tools to stratify COVID-19 patient severity at the admission.
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Affiliation(s)
- Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Marta Zerunian
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Michela Polici
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Francesco Pucciarelli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Gisella Guido
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Tiziano Polidori
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Carlotta Rucci
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Benedetta Bracci
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Giuseppe Tremamunno
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
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Abdelhadi A, Kassem A. Candida Pneumonia with Lung Abscess as a Complication of Severe COVID-19 Pneumonia. Int Med Case Rep J 2022; 14:853-861. [PMID: 34992473 PMCID: PMC8711636 DOI: 10.2147/imcrj.s342054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
A South Asian male patient in his mid-forties presented with symptoms of severe 2019-nCoV (COVID-19) and recent brain infarction. Subsequently, he was found to have evidence of sepsis, underlying undetected diabetes mellitus (DM) and oral candida mucositis, possibly leading to the rare occurrence of direct spread to the lung, manifesting as a necrotizing candida lung abscess. We describe the diagnosis, clinical course, and management of the unique complication in this case that occurred during his admission, hospitalization, and eventual successful discharge from the hospital. This case highlights the importance of early identification and treatment of suspected COVID-19 infection based on clinical and radiological assessments before the confirmation of COVID-19 by real-time polymerase chain reaction (rtPCR) test result, especially in patients with hyperglycemia. It also indicates the complications that can occur due to COVID-19 such as arteriovenous manifestations and the rare occurrence of pulmonary candida lung abscess. Early detection and prompt management by interdisciplinary teams in the emergency room, followed by close monitoring of complications in the intensive care unit (ICU), can lead to successful outcomes in severe/critical COVID-19 infection.
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Affiliation(s)
- Adel Abdelhadi
- Department of Critical Care Medicine, Saqr Hospital, MOH, Ras Al-Khaimah, Ras Al-Khaimah, United Arab Emirates
| | - Abeer Kassem
- Department of Pulmonary Medicine, IBHOA Hospital, MOH, Ras Al-Khaimah, Ras Al-Khaimah, United Arab Emirates
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Tawfeeq D, Najim R, Abdulwahab A. Significance of chest computed tomography scan findings at time of diagnosis in patients with COVID-19 pneumonia. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2022. [DOI: 10.4103/injms.injms_101_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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COVID-19 associated with disseminated histoplasmosis in a kidney transplant patient. Rev Argent Microbiol 2021; 54:209-214. [PMID: 35012808 PMCID: PMC8683274 DOI: 10.1016/j.ram.2021.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/15/2021] [Accepted: 10/31/2021] [Indexed: 11/23/2022] Open
Abstract
We report a case of disseminated histoplasmosis and COVID-19 infection in a renal transplant recipient in Argentina. The patient exhibited respiratory symptoms, and a chest computed tomography scan (CT) showed multiple bilateral centrilobular opacities with a tree-in-bud pattern in both lobes. The patient was initially treated as having bacterial community-acquired pneumonia, and then tuberculosis. A month later, histoplasmosis was diagnosed, and Histoplasma capsulatum LAmB clade was isolated from sputum, skin and oral lesions. The patient was hospitalized and treatment was started with intravenous liposomal amphotericin B. During the course of the antifungal therapy the respiratory symptoms worsened, a new chest CT showed a unilateral lesion with a ground glass appearance and SARS-CoV-2 was detected in a new nasopharyngeal sample. In addition, plasma therapy was administered, and the immunosuppressive regimen was adjusted (everolimus was interrupted, mycophenolate mofetil reduced, and meprednisone increased). Finally, the patient's progress was favorable and was discharged after five days on oral itraconazole treatment for histoplasmosis.
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Douedi S, Kauffman S, AlAzzawi M, Patel SV, Abu A. COVID-19-Induced Cavitary Lesion: A Rare Presentation. Cureus 2021; 13:e18723. [PMID: 34790478 PMCID: PMC8585239 DOI: 10.7759/cureus.18723] [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] [Accepted: 10/12/2021] [Indexed: 11/05/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in widespread infection with significant morbidity and mortality. Primarily involving the respiratory system, COVID-19 has also been known to cause systemic findings. Cavitary lesions in the setting of COVID-19 have been rarely reported in literature and the treatment and management of these lesions are poorly understood and defined. We present a case of a patient with a history of COVID-19 infection found to have cavitary lesions, eventually improving with supportive care. While our patient showed marked improvement with observation, more extensive studies and patient populations are needed to guide clinicians and cavitary lesion management in the setting of COVID-19.
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Affiliation(s)
- Steven Douedi
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Sydney Kauffman
- Internal Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Mohammed AlAzzawi
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Swapnil V Patel
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Ahmad Abu
- Pulmonary and Critical Care Medicine, Jersey Shore University Medical Center, Neptune, USA
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Korkmaz İ, Keleş F. COVID-19-Related Lung Involvement at Different Time Intervals: Evaluation of Computed Tomography Images With Semiquantitative Scoring System and COVID-19 Reporting and Data System Scoring. Cureus 2021; 13:e18554. [PMID: 34765340 PMCID: PMC8575326 DOI: 10.7759/cureus.18554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION This study aimed to evaluate the frequency of typical and atypical thoracic CT findings in patient groups diagnosed during different periods of the pandemic, examine disease severity using radiological scoring methods, and determine the relationship between atypical CT findings and disease severity. MATERIALS AND METHODS One hundred fifty-one patients with positive reverse transcription polymerase chain reaction (RT-PCR) test and thoracic CT scan were included in the study. The patients were divided into two groups as group 1 (March to August 2020) diagnosed in the first six months of the pandemic and group 2 (September 2020 to February 2021) diagnosed in the second six months. CT images of the patients were analyzed for the frequency of typical and atypical findings. Evaluation was made in terms of disease suspicion and severity by scoring methods, and the relationship between atypical findings and disease severity was examined. RESULTS There was no statistically significant difference between the frequency and distribution patterns of typical CT findings observed in both groups. The most common atypical finding in both groups was nodular lesions. Central distribution, one of the atypical findings, was not seen in group 1, whereas it was present in nine patients in group 2 (p=0.001). The mean CT severity score was higher in group 2, and there was a statistically significant difference between the mean CT scores of both groups (p<0.001). In addition, six (7.2%) patients in group 1 and 34 (50%) patients in group 2 had CT scores above the cut-off value (p<0.001). There was no statistically significant relationship between atypical findings and severity score. CONCLUSION Other diseases and atypical findings that may accompany COVID-19 pneumonia may increase the rate of misdiagnosis. In the diagnosis of the disease, clinical signs and symptoms and radiological findings should be evaluated together, and it should be kept in mind that lung findings in thorax CT change over time.
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Affiliation(s)
- İnan Korkmaz
- Department of Radiology, Hatay Mustafa Kemal University, Faculty of Medicine, Antakya, TUR
| | - Fatma Keleş
- Department of Radiology, Hatay Mustafa Kemal University, Faculty of Medicine, Antakya, TUR
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13
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Muñoz-Palacio BJ, Syro D, Pinzón MA, Ramirez B, Betancur JF. Pulmonary Cystic Disease Associated With COVID 19 Pneumonia: An Emerging Atypical Manifestation. Cureus 2021; 13:e19352. [PMID: 34909313 PMCID: PMC8653961 DOI: 10.7759/cureus.19352] [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] [Accepted: 11/08/2021] [Indexed: 11/15/2022] Open
Abstract
Chest tomography has played an essential role during the coronavirus disease 2019 (COVID-19) pandemic since it has allowed to suspect and diagnose the disease early and to assess the severity of lung involvement, predict the disease's course, and detect the complications associated with it. Certain chest CT findings have been reported in more than 70% of reverse transcription polymerase chain reaction (RT-PCR) test-proven COVID-19 cases, including ground-glass opacities, vascular enlargement, bilateral abnormalities, lower lobe involvement, and posterior predilection. In COVID-19-endemic regions, observing these chest CT findings should raise the suspicion of a possible COVID-19 diagnosis. Rare reported CT findings in RT-PCR test-proven COVID-19 cases include pleural effusion, lymphadenopathy, tree-in-bud sign, central lesion distribution, pericardial effusion, and cavitating lung lesions. The observation of one or more of these findings suggests an alternative diagnosis, although COVID-19 cannot be excluded from the differential diagnosis. Here, we report an interesting case of a patient with no relevant history presenting a COVID-19 infection which, as a complication, presented cystic lesions; we discuss its etiology briefly.
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Affiliation(s)
| | - Daniel Syro
- Anesthesiology and Reanimation, CES University, Medellín, COL
| | - Miguel A Pinzón
- Infectious Disease, Clínica Medellín/Grupo QuirónSalud, Medellín, COL
| | - Beatriz Ramirez
- Epidemiology, Clínica Medellín/Grupo QuirónSalud, Medellin, COL
| | - Juan F Betancur
- Internal Medicine, Clínica Medellín/Grupo QuirónSalud, Medellín, COL
- Internal Medicine, Sura, Medellín, COL
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14
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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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15
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Caruso D, Zerunian M, Pucciarelli F, Lucertini E, Bracci B, Polidori T, Guido G, Polici M, Rucci C, Iannicelli E, Laghi A. Imaging of abdominal complications of COVID-19 infection. BJR Open 2021; 2:20200052. [PMID: 34381937 PMCID: PMC8320136 DOI: 10.1259/bjro.20200052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/30/2020] [Accepted: 01/29/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a respiratory syndrome caused by severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) first described in Wuhan, Hubei
Province, China in the last months of 2019 and then declared as a pandemic. Typical
symptoms are represented by fever, cough, dyspnea and fatigue, but SARS-CoV-2
infection can also cause gastrointestinal symptoms (vomiting, diarrhoea, abdominal
pain, loss of appetite) or be totally asymptomatic. As reported in literature, many
patients with COVID-19 pneumonia had a secondary abdominal involvement (bowel,
pancreas, gallbladder, spleen, liver, kidneys), confirmed by laboratory tests and
also by radiological features. Usually the diagnosis of COVID-19 is suspected and
then confirmed by real-time reverse-transcription-polymerase chain reaction (RT-PCR),
after the examination of the lung bases of patients, admitted to the emergency
department with abdominal symptoms and signs, who underwent abdominal-CT. The aim of
this review is to describe the typical and atypical abdominal imaging findings in
patients with SARS-CoV-2 infection reported since now in literature.
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Affiliation(s)
- Damiano Caruso
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Marta Zerunian
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Pucciarelli
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Elena Lucertini
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Benedetta Bracci
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Tiziano Polidori
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Gisella Guido
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Michela Polici
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Carlotta Rucci
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Elsa Iannicelli
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Andrea Laghi
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
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16
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Caruso D, Pucciarelli F, Zerunian M, Ganeshan B, De Santis D, Polici M, Rucci C, Polidori T, Guido G, Bracci B, Benvenga A, Barbato L, Laghi A. Chest CT texture-based radiomics analysis in differentiating COVID-19 from other interstitial pneumonia. Radiol Med 2021; 126:1415-1424. [PMID: 34347270 PMCID: PMC8335460 DOI: 10.1007/s11547-021-01402-3] [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: 04/21/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the potential role of texture-based radiomics analysis in differentiating Coronavirus Disease-19 (COVID-19) pneumonia from pneumonia of other etiology on Chest CT. MATERIALS AND METHODS One hundred and twenty consecutive patients admitted to Emergency Department, from March 8, 2020, to April 25, 2020, with suspicious of COVID-19 that underwent Chest CT, were retrospectively analyzed. All patients presented CT findings indicative for interstitial pneumonia. Sixty patients with positive COVID-19 real-time reverse transcription polymerase chain reaction (RT-PCR) and 60 patients with negative COVID-19 RT-PCR were enrolled. CT texture analysis (CTTA) was manually performed using dedicated software by two radiologists in consensus and textural features on filtered and unfiltered images were extracted as follows: mean intensity, standard deviation (SD), entropy, mean of positive pixels (MPP), skewness, and kurtosis. Nonparametric Mann-Whitney test assessed CTTA ability to differentiate positive from negative COVID-19 patients. Diagnostic criteria were obtained from receiver operating characteristic (ROC) curves. RESULTS Unfiltered CTTA showed lower values of mean intensity, MPP, and kurtosis in COVID-19 positive patients compared to negative patients (p = 0.041, 0.004, and 0.002, respectively). On filtered images, fine and medium texture scales were significant differentiators; fine texture scale being most significant where COVID-19 positive patients had lower SD (p = 0.004) and MPP (p = 0.004) compared to COVID-19 negative patients. A combination of the significant texture features could identify the patients with positive COVID-19 from negative COVID-19 with a sensitivity of 60% and specificity of 80% (p = 0.001). CONCLUSIONS Preliminary evaluation suggests potential role of CTTA in distinguishing COVID-19 pneumonia from other interstitial pneumonia on Chest CT.
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Affiliation(s)
- Damiano Caruso
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Francesco Pucciarelli
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Marta Zerunian
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, London, UK
| | - Domenico De Santis
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Michela Polici
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Carlotta Rucci
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Tiziano Polidori
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Gisella Guido
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Benedetta Bracci
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Antonella Benvenga
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Luca Barbato
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Andrea Laghi
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
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17
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Caruso D, Guido G, Zerunian M, Polidori T, Lucertini E, Pucciarelli F, Polici M, Rucci C, Bracci B, Nicolai M, Cremona A, De Dominicis C, Laghi A. Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up. Radiology 2021; 301:E396-E405. [PMID: 34313468 PMCID: PMC8335814 DOI: 10.1148/radiol.2021210834] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The long-term post acute pulmonary sequelae of COVID-19 remain
unknown. Purpose To evaluate lung injury in patients affected by COVID-19 pneumonia at
six-month follow-up compared to baseline chest CT. Methods From March 19th,2020 to May 24th,2020, patients with moderate to severe
COVID-19 pneumonia and baseline Chest CT were prospectively enrolled at
six-months follow-up. CT qualitative findings, semi-quantitative Lungs
Severity Score (LSS) and well-aerated lung quantitative Chest CT (QCCT)
were analyzed. Baseline LSS and QCCT performances in predicting
fibrotic-like changes (reticular pattern and/or honeycombing) at
six-month follow-up Chest CT were tested with receiver operating
characteristic curves. Univariable and multivariable logistic regression
analysis were used to test clinical and radiological features predictive
of fibrotic-like changes. The multivariable analysis was performed with
clinical parameters alone (clinical model), radiological parameters
alone (radiological model) and the combination of clinical and
radiological parameters (combined model). Results One-hundred-eighteen patients, with both baseline and six-month follow-up
Chest CT, were included in the study (62 female, mean age 65±12
years). At follow-up Chest CT, 85/118 (72%) patients showed
fibrotic-like changes and 49/118 (42%) showed GGOs. Baseline LSS
(>14), QCCT (≤3.75L and ≤80%) showed an
excellent performance in predicting fibrotic-like changes at Chest CT
follow-up. In the multivariable analysis, AUC was .89 (95%CI
.77-.96) for the clinical model, .81 (95%CI .68-.9) for the
radiological model and .92 (95%CI .81-.98)for the combined
model. Conclusion At six-month follow-up Chest CT, 72% of patients showed late
sequelae, in particular fibrotic-like changes. Baseline LSS and QCCT of
well-aerated lung showed an excellent performance in predicting
fibrotic-like changes at six-month Chest CT (AUC>.88). Male sex,
cough, lymphocytosis and QCCT well-aerated lung were significant
predictors of fibrotic-like changes at six-month with an inverse
correlation (AUC .92). See also the editorial by Wells and Devaraj.
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Affiliation(s)
- Damiano Caruso
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Gisella Guido
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Marta Zerunian
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Tiziano Polidori
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Elena Lucertini
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Francesco Pucciarelli
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Michela Polici
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Carlotta Rucci
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Benedetta Bracci
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Matteo Nicolai
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Antonio Cremona
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Chiara De Dominicis
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Andrea Laghi
- Institution: Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
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Egoryan G, Hyser E, Mushtaq AH, Yanez-Bello MA, Trelles-Garcia DP, Friedman HJ, Rodriguez-Nava G. Development of cavitary lung disease as a long-term complication of coronavirus disease 2019 in a young previously healthy patient: a case report. J Med Case Rep 2021; 15:377. [PMID: 34256831 PMCID: PMC8276840 DOI: 10.1186/s13256-021-02961-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cavities are frequent manifestations of a wide variety of pathological processes involving the lung. There has been a growing body of evidence of coronavirus disease 2019 leading to a cavitary pulmonary disease. CASE PRESENTATION A healthy 29-year-old Filipino male presented to the hospital a couple of months after convalescence from coronavirus disease 2019 with severe pleuritic chest pain, fever, chills, and shortness of breath, and was found to have a cavitary lung lesion on chest computed tomography. While conservative management alone failed to improve the patient's condition, he ultimately underwent left lung video-assisted thoracoscopic surgery decortication. Even though the surgical pathology revealed only necrosis with dense acute inflammation and granulation tissue with no microorganisms, he gradually improved with medical therapy adjunct with surgical therapy. CONCLUSION Documented cases of cavitary lung disease secondary to coronavirus disease 2019 have been mostly reported in the acute or subacute phase of the infection. However, clinicians should recognize this entity as a late complication of coronavirus disease 2019, even in previously healthy individuals.
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Affiliation(s)
- Goar Egoryan
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA.
| | - Elise Hyser
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA
| | - Ammar H Mushtaq
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA
| | - Maria Adriana Yanez-Bello
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA
| | | | - Harvey J Friedman
- Critical Care Units, AMITA Health Saint Francis Hospital, Evanston, IL, USA.,Clinical Associate Professor of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Guillermo Rodriguez-Nava
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA
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19
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Ghodsi A, Bijari M, Alamdaran SA, Saberi A, Mahmoudabadi E, Balali MR, Ghahremani S. Chest computed tomography findings of COVID-19 in children younger than 1 year: a systematic review. World J Pediatr 2021; 17:234-241. [PMID: 33963512 PMCID: PMC8104919 DOI: 10.1007/s12519-021-00424-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of this systematic review is to evaluate the chest computed tomography (CT) findings in infants with confirmed COVID-19 infection by providing a comprehensive review of the existing literature. DATA SOURCES A systematic search was conducted on PubMed and Embase from the onset of the COVID-19 outbreak to October 20, 2020, for studies that discussed the chest CT findings in infants younger than 1 year with COVID-19 infection. RESULTS A total of 35 studies comprising 70 COVID-19 (58.5% boys) confirmed infants were included. The mean age of the included patients was 4.1 months with a range of 1 day to 12 months. Chest CT scans showed bilateral abnormalities in 34 patients, and unilateral lung involvement in 25 patients. Ground-glass opacities (GGO) (71.43%) were found to be the most prevalent chest CT manifestation, followed by peribronchial thickening (60%), linear or band-shaped opacities (32.8%), consolidation (28.57%), nodule (18.57%), effusion (7.14%) and focal lucency (7.14%). CONCLUSIONS GGO and peribronchial thickening were the most prevalent findings in the infants' chest CT scans. Linear or band-shaped opacities, consolidation, and pulmonary nodules are more common in infants than in adults. These findings suggest that the disease is more likely to be presented as an atypical pneumonia (peribronchial thickening and linear or band-shaped opacities) in this age group. Other chest CT scan manifestations can be classified as typical COVID-19 infection (peripheral GGO), lobar pneumonia (consolidation) and opportunistic infections (pulmonary nodules).
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Affiliation(s)
- Alireza Ghodsi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Moniba Bijari
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ali Alamdaran
- Radiology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Saberi
- Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Sq, Mashhad, Iran
| | - Elnaz Mahmoudabadi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Sara Ghahremani
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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20
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Bianco A, Valente T, Perrotta F, Stellato E, Brunese L, Wood BJ, Carrafiello G, Parrella R. Remarkable vessel enlargement within lung consolidation in COVID-19 compared to AH1N1 pneumonia: A retrospective study in Italy. Heliyon 2021; 7:e07112. [PMID: 34036187 PMCID: PMC8135228 DOI: 10.1016/j.heliyon.2021.e07112] [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: 07/21/2020] [Revised: 12/12/2020] [Accepted: 05/17/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose To investigate the early CT findings in COVID-19 pneumonia as compared to influenza A virus H1N1 (AH1N1), with focus on vascular enlargement within consolidation or ground glass opacity (GGO) areas. Methods 50 patients with COVID-19 pneumonia were retrospectively compared to 50 patients with AH1N1 pneumonia diagnosed during the 2009 pandemic. Two radiologists reviewed chest CT scans independently and blindly, with discordance resolved by consensus. Dilated or tortuous vessels within hyperdense lesions were recorded. Results COVID-19 pneumonia presented with bilateral (96%), peripheral areas of GGO (22%), consolidation (4%) or combined GGO-consolidation (74%). The vascular enlargement sign in COVID-19 pneumonia was much more commonly present in COVID-19 (45/50, 90%) versus AH1N1 pneumonia (12/50, 24%) (p < 0.001). Vascular enlargement was more often present in lower lobes with a peripheral distribution. Conclusions Vascular enlargement in consolidative/GGO areas may represent a reasonably common early CT marker in COVID-19 patients and is of uncertain etiology. Although speculative, theoretical mechanisms could potentially reflect acute inflammatory changes, pulmonary endothelial activation, or acute stasis. Further studies are necessary to verify specificity and to study if prognostic for clinical outcomes.
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Affiliation(s)
- Andrea Bianco
- Department of Translational Medical and Surgical Science, University of Campania Luigi Vanvitelli, Naples, Italy.,COViD Unit PNL Vanvitelli, Hospital Monaldi, A.O. R.N. dei Colli, Naples, Il Italy
| | - Tullio Valente
- Department of Radiology, Monaldi Hospital, A.O.R.N. dei Colli, Naples, Italy
| | - Fabio Perrotta
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Elvira Stellato
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Milan, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Brad J Wood
- Center for Interventional Oncology, Radiology and Imaging Science, National Institutes of Health, Bethesda, USA
| | - Gianpaolo Carrafiello
- Radiology Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Roberto Parrella
- Department of Infectious Diseases, COVID Unit D. Cotugno Hospital, A.O.R.N. dei Colli, Naples, Italy
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21
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Wang CS, Gao Y, Kang K, Fei DS, Meng XL, Liu HT, Luo YP, Yang W, Dai QQ, Gao Y, Zhao MY, Yu KJ. Standardization of critical care management of non-critically ill patients with COVID-19. World J Clin Cases 2021; 9:2696-2702. [PMID: 33969052 PMCID: PMC8058685 DOI: 10.12998/wjcc.v9.i12.2696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/12/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
The large global outbreak of coronavirus disease 2019 (COVID-19) has seriously endangered the health care system in China and globally. The sudden surge of patients with severe acute respiratory syndrome coronavirus 2 infection has revealed the shortage of critical care medicine resources and intensivists. Currently, the management of non-critically ill patients with COVID-19 is performed mostly by non-intensive care unit (ICU) physicians, who lack the required professional knowledge, training, and practice in critical care medicine, especially in terms of continuous monitoring of the respiratory function, intervention, and feedback on treatment effects. This clinical problem needs an urgent solution. Therefore, here, we propose a series of clinical strategies for non-ICU physicians aimed at the standardization of the management of non-critically ill patients with COVID-19 from the perspective of critical care medicine. Isolation management is performed to facilitate the implementation of hierarchical monitoring and intervention to ensure the reasonable distribution of scarce critical care medical resources and intensivists, highlight the key patients, timely detection of disease progression, and early and appropriate intervention and organ function support, and thus improve the prognosis. Different management objectives are also set based on the high-risk factors and the severity of patients with COVID-19. The approaches suggested herein will facilitate the timely detection of disease progression, and thus ensure the provision of early and appropriate intervention and organ function support, which will eventually improve the prognosis.
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Affiliation(s)
- Chang-Song Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Yang Gao
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Kai Kang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Dong-Sheng Fei
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Xiang-Lin Meng
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Hai-Tao Liu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Yun-Peng Luo
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Wei Yang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Qing-Qing Dai
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Yan Gao
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Ming-Yan Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Kai-Jiang Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
- Institute of Critical Care Medicine, The Sino Russian Medical Research Center of Harbin Medical University, Harbin 150081, Heilongjiang Province, China
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22
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Li H, Luo S, Zhang Y, Xiao X, Liu H. Longitudinal Chest CT Features in Severe/Critical COVID-19 Cases and the Predictive Value of the Initial CT for Mortality. J Inflamm Res 2021; 14:1111-1124. [PMID: 33790623 PMCID: PMC8007600 DOI: 10.2147/jir.s303773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/04/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose To evaluate longitudinal computed tomography (CT) features and the predictive value of the initial CT and clinical characteristics for mortality in patients with severe/critical coronavirus disease 2019 (COVID-19) pneumonia. Methods A retrospective analysis was performed on patients with COVID-19 pneumonia confirmed by laboratory. By excluding mild and common patients, 155 severe/critical patients with definite outcome were finally enrolled. A total of 516 CTs of 147 patients were divided into four stages according to the time after onset (stage 1, 1–7 days; stage 2, 8–14 days; stage 3, 15–21 days, and stage 4, >21 days). The evolving imaging features between the survival and non-survival groups were compared by using Chi-square, Fisher’s exact test, student’s t-test or Mann–Whitney U-test, as appropriate. The predictive value of clinical and CT features at admission for mortality was analysed through logistic regression analysis. To avoid overfitting caused by CT scores, CT scores were divided into two parts, which were combined with clinical variables, respectively, to construct the models. Results Ground-glass opacities (GGO) patterns were predominant for stages 1 and 2 for both groups (both P>0.05). The numbers of consolidation lesions increased in stage 3 in both groups (P=0.857), whereas the linear opacity increased in the survival group but decreased in the non-survival group (P=0.0049). In stage 4, the survival group predominantly presented linear opacity patterns, whereas the non-survival group mainly showed consolidation patterns (P=0.007). Clinical and imaging characteristics correlated with mortality; multivariate analyses revealed age >71 years, neutrophil count >6.38 × 109/L, aspartate aminotransferase (AST) >58 IU/L, and CT score (total lesions score >17 in model 1, GGO score >14 and consolidation score >2 in model 2) as independent risk factors (all P<0.05). The areas under the curve of the six independent risk factors alone ranged from 0.65 to 0.75 and were 0.87 for model 2, 0.89 for model 1, and 0.92 for the six variables combined. Statistical differences were observed between Kaplan Meier curves of groups separated by cut-off values of these six variables (all P<0.01). Conclusion Longitudinal imaging features demonstrated differences between the two groups, which may help determine the patient’s prognosis. The initial CT score combined with age, AST, and neutrophil count is an excellent predictor for mortality in COVID-19 patients.
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Affiliation(s)
- Hailan Li
- Department of Radiology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410000, Hunan Province, People's Republic of China
| | - Shiyong Luo
- Department of Radiology, Wuhan Third Hospital (Tongren Hospital of Wuhan University), Wuhan, 430060, Hubei Province, People's Republic of China
| | - Youming Zhang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, People's Republic of China
| | - Xiaoyi Xiao
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan Province, People's Republic of China
| | - Huaping Liu
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan Province, People's Republic of China
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23
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Pulmonary Artery Filling Defects in COVID-19 Patients Revealed Using CT Pulmonary Angiography: A Predictable Complication? BIOMED RESEARCH INTERNATIONAL 2021; 2021:8851736. [PMID: 33778084 PMCID: PMC7958141 DOI: 10.1155/2021/8851736] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/27/2021] [Accepted: 02/22/2021] [Indexed: 02/05/2023]
Abstract
Purpose This study is aimed at assessing the prevalence of pulmonary artery filling defects (PAFDs) consistent with pulmonary artery embolism (PAE) in patients with SARS-CoV-2 infection and at investigating possible radiological or clinical predictors. Materials and Methods Computed Tomography Pulmonary Angiographies (CTPAs) from 43 consecutive patients with a confirmed COVID-19 infection were retrospectively reviewed, taking into consideration the revised Geneva score and the D-dimer value for each patient. Filling defects within the pulmonary arteries were recorded along with pleural and parenchymal findings such as ground glass opacities, consolidation, crazy paving, linear consolidation, and pleural effusion. All these variables were compared between patients with and without PAFD. The predictive performance of statistically different parameters was investigated using the receiver operating characteristics (ROC). Results Pulmonary embolism was diagnosed in 15/43 patients (35%), whereas CTPA and parenchymal changes related to pulmonary COVID-19 disease were evident in 39/43 patients (91%). The revised Geneva score and the mean D-dimer value obtained using two consecutive measurements were significantly higher in patients with PAFD. The ROC analysis demonstrated that a mean D-dimer value is the parameter with the higher predictivity (AUC 0.831) that is a cut‐off value > 1800 μg/l which predicts the probability of PAFD with a sensitivity and specificity of 70% and 78%, respectively. Conclusions This single centre retrospective report shows a high prevalence of pulmonary artery filling defects revealed using CTPA in COVID-19 patients and demonstrates that the mean value of multiple D-dimer measurements may represent a predicting factor of this complication.
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Zaffino P, Marzullo A, Moccia S, Calimeri F, De Momi E, Bertucci B, Arcuri PP, Spadea MF. An Open-Source COVID-19 CT Dataset with Automatic Lung Tissue Classification for Radiomics. Bioengineering (Basel) 2021; 8:26. [PMID: 33669235 PMCID: PMC7919807 DOI: 10.3390/bioengineering8020026] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/22/2021] [Accepted: 02/12/2021] [Indexed: 11/28/2022] Open
Abstract
The coronavirus disease 19 (COVID-19) pandemic is having a dramatic impact on society and healthcare systems. In this complex scenario, lung computerized tomography (CT) may play an important prognostic role. However, datasets released so far present limitations that hamper the development of tools for quantitative analysis. In this paper, we present an open-source lung CT dataset comprising information on 50 COVID-19-positive patients. The CT volumes are provided along with (i) an automatic threshold-based annotation obtained with a Gaussian mixture model (GMM) and (ii) a scoring provided by an expert radiologist. This score was found to significantly correlate with the presence of ground glass opacities and the consolidation found with GMM. The dataset is freely available in an ITK-based file format under the CC BY-NC 4.0 license. The code for GMM fitting is publicly available, as well. We believe that our dataset will provide a unique opportunity for researchers working in the field of medical image analysis, and hope that its release will lay the foundations for the successfully implementation of algorithms to support clinicians in facing the COVID-19 pandemic.
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Affiliation(s)
- Paolo Zaffino
- Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Aldo Marzullo
- Department of Mathematics and Computer Science, University of Calabria, 87036 Rende, Italy; (A.M.); (F.C.)
| | - Sara Moccia
- Department of Information Engineering, Università Politecnica delle Marche, 60131 Ancona, Italy;
- Department of Advanced Robotics, Istituito Italiano di Tecnologia, 16163 Genova, Italy
| | - Francesco Calimeri
- Department of Mathematics and Computer Science, University of Calabria, 87036 Rende, Italy; (A.M.); (F.C.)
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, 20133 Milano, Italy;
| | - Bernardo Bertucci
- Department of Radiology, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy; (B.B.); (P.P.A.)
| | - Pier Paolo Arcuri
- Department of Radiology, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy; (B.B.); (P.P.A.)
| | - Maria Francesca Spadea
- Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
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25
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A Descriptive Study on Causes of Death in Hospitalized Patients in an Acute General Hospital of Southern Italy during the Lockdown due to Covid-19 Outbreak. Healthcare (Basel) 2021; 9:healthcare9020119. [PMID: 33503857 PMCID: PMC7911594 DOI: 10.3390/healthcare9020119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 12/16/2022] Open
Abstract
(1) Background: All deaths that occurred in a hospital of Southern Italy (“San Giuseppe Moscati” Hospital of Avellino) with medium jurisdiction (up to 425,000 citizens approximately) in the period from 9 March to 4 May 2020 were analyzed. The primary endpoint of the study was to analyze the causes of death in the period study. Secondary endpoints included: (1) the assessment of overall mortality in the emergency period compared with the same period of the past years (2018–2019) in the jurisdiction area; (2) the assessment of the amounts of deaths with positive and negative reverse transcription-polymerase chain reaction (RT-PCR) of nasopharyngeal and oropharyngeal swabs; (3) the frequency of clinical and radiological features consistent with Covid-19 infection in negative RT-PCR cases. (2) Methods: Patients’ information and laboratory data were collected through the computerized medical record system (My Hospital, Italy) used for the clinical management of all referring patients. Epidemiological, clinical, and radiological data were reviewed along with the results of nasopharyngeal and oropharyngeal swabs. (3) Results: From 9 March to 4 May 2020, 140 deaths (87 males, 53 females) from all causes occurred in total at “San Giuseppe Moscati” Hospital, of which 32 deaths were Covid-19 related. (4) Conclusions: The excess of mortality could be higher than the one reported in the official epidemiological surveys. False negative cases can have a distorting effect on the assessment of the real mortality rate and the excess mortality. Furthermore, many who died from Covid-19 were likely never tested or they had false negative RT-PCR results. Other victims probably died from causes indirectly related to Covid-19.
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26
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Wu Z, Liu X, Liu J, Zhu F, Liu Y, Liu Y, Peng H. Correlation between ground-glass opacity on pulmonary CT and the levels of inflammatory cytokines in patients with moderate-to-severe COVID-19 pneumonia. Int J Med Sci 2021; 18:2394-2400. [PMID: 33967617 PMCID: PMC8100652 DOI: 10.7150/ijms.56683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/31/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives: Comparative analysis of laboratory data in moderate-to-severe COVID-19 patients presenting with or without ground-glass opacities (GGOs). Methods: This retrospective study examined 61 patients with moderate-to-severe COVID-19, as defined by the report of the WHO-China Joint Mission on COVID-19. All patients were admitted to the Department of Infectious Diseases, Wuhan Union Hospital from Dec 28, 2019 to Feb 22, 2020 and classified into a GGO group or a non-GGO group based on CT results. The clinical characteristics and laboratory data of the two groups were compared. Data were analyzed using univariate and multivariate analysis, and using receiver operating characteristic (ROC) analysis. Results: Forty-five patients were in the GGO group (73.8%, 21 females, 24 males, mean age 54.8±17.8 years) and 16 were in the non-GGO group (26.2%, 11 females, 5 males, mean age 53±14.9 years). The levels of IL-2, IL-4, and IFN-γ were greater in the GGO group (all P<0.05). ROC analysis indicated that an elevated level of IL-2 was a good predictor of GGO (area under the curve: 0.716, optimal cutoff: 3.205 pg/mL, 53.8% sensitivity, 87.5% specificity, p<0.05). Multivariate analysis showed that IL-2 level was a significant and independent risk factor for lung GGO (OR: 8.167; 95% CI: 1.63, 40.8; P<0.05). Conclusions: There were correlations between GGO in the lungs of patients with moderate-to-severe COVID-19 and the levels of IL-2, IL-4, and INF-γ. IL-2 was a significant and independent risk factor for GGO. These findings provide a basis for studying the mechanism of pulmonary lesions in COVID-19 patients.
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Affiliation(s)
- Zubo Wu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, P.R. China
| | - Xiaoping Liu
- Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, 518102, P.R.China
| | - Jie Liu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, P.R. China
| | - Feng Zhu
- Clinical Center of Human Gene Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, P.R. China.,Department of Cardiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, P.R. China
| | - Yali Liu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, P.R. China
| | - Yalan Liu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, P.R. China
| | - Hua Peng
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, P.R. China
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27
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Saburi A, Schoepf UJ, Ulversoy KA, Jafari R, Eghbal F, Ghanei M. From Radiological Manifestations to Pulmonary Pathogenesis of COVID-19: A Bench to Bedside Review. Radiol Res Pract 2020; 2020:8825761. [PMID: 33294226 PMCID: PMC7716750 DOI: 10.1155/2020/8825761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/16/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
In this review, we aim to assess previous radiologic studies in COVID-19 and suggest a pulmonary pathogenesis based on radiologic findings. Although radiologic features are not specific and there is heterogeneity in symptoms and radiologic and clinical manifestation, we suggest that the dominant pattern of computed tomography is consistent with limited pneumonia, followed by interstitial pneumonitis and organizing pneumonia.
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Affiliation(s)
- Amin Saburi
- Chemical Injuries Research Center, Systems Biology & Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - U. Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Kyle A. Ulversoy
- Augusta University/University of Georgia Medical Partnership, Athens, GA, USA
| | - Ramezan Jafari
- Chemical Injuries Research Center, Systems Biology & Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology & Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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28
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Abstract
COVID-19 is a global healthcare pandemic that is now growing through nations across the world. The role of radiology is crucial, and a variety of guidelines have been published regarding the role of imaging. These aim to protect healthcare workers (HCWs) and the general public from exposure, while preserving critical radiology operations and conserving personal protective equipment (PPE) and other critical care resources during the COVID-19 pandemic. Fleischner Society published guidelines on indications of imaging various settings. These guidelines take into account resource availability, pre-test probability, degree of symptoms and risk factors, which is crucial for decision-making regarding need and indications of imaging. Mitigating steps and alternative approaches should be considered to provide the best care for patients while protecting all HCWs. Owing to overlap of COVID-19 imaging findings with other pathologies, standardized reporting acquires importance for risk assessment and effective communication of suspicious findings. RSNA followed by Dutch Radiological Society (NVvR) have published guidelines on standardized CT reporting for COVID-19, which show excellent inter-observer variability. Standardized reporting can provide guidance and confidence to radiologists as well as increased clarity to physicians through reduced reporting variability. The article discusses the published recommendations and aims to make radiologists aware of the protocols and guidelines that need to be followed in this ongoing public health crisis for effective patient care while protecting HCWs and conserving resources.
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