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Cîrjaliu RE, Gurrala SV, Nallapati B, Krishna V, Oancea C, Tudorache E, Marc M, Bratosin F, Bogdan I, Rosca O, Barata PI, Hangan LT, Chirilă SI, Fildan AP. Prognostic Implications of Initial Radiological Findings of Pulmonary Fibrosis in Patients with Acute SARS-CoV-2 Infection: A Prospective Multicentric Study. Diseases 2024; 12:285. [PMID: 39589960 PMCID: PMC11592577 DOI: 10.3390/diseases12110285] [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: 08/26/2024] [Revised: 10/02/2024] [Accepted: 11/04/2024] [Indexed: 11/28/2024] Open
Abstract
Pulmonary fibrosis detected during the acute phase of SARS-CoV-2 infection may significantly influence patient prognosis. This study aimed to evaluate the prognostic value of initial high-resolution computed tomography (HRCT) findings of pulmonary fibrosis in hospitalized COVID-19 patients and to examine how these findings relate to disease severity and clinical outcomes, with a particular focus on the development and validation of predictive scoring systems. In this multicentric prospective cohort study from January 2023 to January 2024, 120 adult patients with confirmed SARS-CoV-2 infection requiring hospitalization were enrolled from two Romanian university hospitals. Patients were categorized based on the presence (n = 60) or absence (n = 60) of pulmonary fibrosis signs on admission HRCT scans, identified by reticular opacities, traction bronchiectasis, honeycombing, and architectural distortion. Biochemical analyses, severity scores (SOFA, APACHE II, NEWS 2), and novel compound scores combining clinical and radiological data were assessed. Patients with HRCT evidence of pulmonary fibrosis had significantly higher severity scores and worse clinical outcomes. The HRCT score alone was a strong predictor of severe COVID-19 (area under the ROC curve [AUC] = 0.885), with a best cutoff value of 9.72, yielding 85.7% sensitivity and 79.8% specificity. Compound Score 1, integrating SOFA, APACHE II, and HRCT scores, demonstrated excellent predictive performance with an AUC of 0.947, sensitivity of 92.5%, and specificity of 88.9%. Compound Score 2, combining systemic inflammation markers (SIRI, SII) and NEWS 2, also showed a strong predictive capability (AUC = 0.913), with 89.2% sensitivity and 85.7% specificity at the optimal cutoff. Regression analysis revealed that Compound Score 1 had the highest hazard ratio for severe COVID-19 outcomes (HR = 4.89; 95% CI: 3.40-7.05), indicating its superior prognostic value over individual markers and traditional severity scores. Initial HRCT findings of pulmonary fibrosis are significantly associated with increased disease severity in hospitalized COVID-19 patients. The HRCT score is a valuable prognostic tool, and, when combined with clinical severity scores into Compound Score 1, it enhances the prediction of severe COVID-19 outcomes with high sensitivity and specificity. These compound scores facilitate the early identification of high-risk patients, guiding clinical decision-making and optimizing patient management to improve outcomes.
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Affiliation(s)
- Roxana-Elena Cîrjaliu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (R.-E.C.); (L.T.H.); (S.I.C.); (A.-P.F.)
| | - Sri Vidhya Gurrala
- NRI Academy of Medical Sciences, NTR Health University, Mangalagiri Road, Chinakakani, Guntur, Andhra Pradesh 522503, India;
| | - Balaji Nallapati
- Department of General Medicine, Katuri Medical College and Hospital, Katuri City 522019, India;
| | - Vamsi Krishna
- Sri Devaraj Urs Medical College, Kolar 563101, India;
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.O.); (M.M.); (P.I.B.)
| | - Emanuela Tudorache
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.O.); (M.M.); (P.I.B.)
| | - Monica Marc
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.O.); (M.M.); (P.I.B.)
| | - Felix Bratosin
- Discipline of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.B.); (O.R.)
| | - Iulia Bogdan
- Discipline of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.B.); (O.R.)
| | - Ovidiu Rosca
- Discipline of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.B.); (O.R.)
| | - Paula Irina Barata
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.O.); (M.M.); (P.I.B.)
| | - Laurentiu Tony Hangan
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (R.-E.C.); (L.T.H.); (S.I.C.); (A.-P.F.)
| | - Sergiu Ioachim Chirilă
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (R.-E.C.); (L.T.H.); (S.I.C.); (A.-P.F.)
| | - Ariadna-Petronela Fildan
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (R.-E.C.); (L.T.H.); (S.I.C.); (A.-P.F.)
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Qiao Z, Liu D, Fu F, Ye A, Hu C. Clinical Characterizations and Radiological Findings of COVID-19: A 4 Case Report. Curr Med Imaging 2022; 18:1536-1539. [PMID: 35379139 DOI: 10.2174/1573405618666220404161324] [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: 01/11/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19, previously known as novel coronavirus [2019-nCoV]), first reported in China, has now been declared a global health emergency by World Health Organization. The clinical severity ranges from asymptomatic individuals to death. Here, we report clinical features and radiological changes of a cured family cluster infected with COVID-19. CASE PRESENTATION In this report, we enrolled a family of 4 members who were admitted to our hospital in January 2020. We performed a detailed analysis of each patient's records. All patients underwent chest computed tomography (CT) examination with 120 kilovolts peak and 150 kilovolt-ampere. Realtime polymerase chain reaction (RT-PCR) examinations for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid were done using nasopharyngeal swabs. CONCLUSION In the family members infected with COVID-19 who were accompanied by other diseases or had low immunity, the pneumonia was prone to be aggravated.
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Affiliation(s)
- Zhenguo Qiao
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Dong Liu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fangfang Fu
- Department of Radiology, Henan Provincial People\'s Hospital, Zhengzhou, China
| | - Aihua Ye
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Kanne JP, Little BP, Schulte JJ, Haramati A, Haramati LB. Long-term Lung Abnormalities Associated with COVID-19 Pneumonia. Radiology 2022; 306:e221806. [PMID: 36040336 PMCID: PMC9462591 DOI: 10.1148/radiol.221806] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the 3rd year of the SARS-CoV-2 pandemic, much has been learned about the long-term effects of COVID-19 pneumonia on the lungs. Approximately one-third of patients with moderate-to-severe pneumonia, especially those requiring intensive care therapy or mechanical ventilation, have residual abnormalities at chest CT 1 year after presentation. Abnormalities range from parenchymal bands to bronchial dilation to frank fibrosis. Less is known about the long-term pulmonary vascular sequelae, but there appears to be a persistent, increased risk of venothromboembolic events in a small cohort of patients. Finally, the associated histologic abnormalities resulting from SARS-CoV-2 infection are similar to those seen in patients with other causes of acute lung injury.
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Pednekar P, Amoah K, Homer R, Ryu C, Lutchmansingh DD. Case Report: Bullous Lung Disease Following COVID-19. Front Med (Lausanne) 2021; 8:770778. [PMID: 34869488 PMCID: PMC8635639 DOI: 10.3389/fmed.2021.770778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/12/2021] [Indexed: 12/24/2022] Open
Abstract
More than 87% of patients report the persistence of at least one symptom after recovery from the Coronavirus disease 2019 (COVID-19). Dyspnea is one of the most frequently reported symptoms following severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) infection with persistent chest radiological abnormalities up to 3 months after symptom onset. These radiological abnormalities are variable and most commonly include ground-glass opacities, reticulations, mosaic attenuation, parenchymal bands, interlobular septal thickening, bronchiectasis, and fibrotic-like changes. However, in this case report, we describe findings of bullous lung disease as a complication of SARS CoV-2 infection. As the pandemic continues, there is a need to understand the multiple respiratory manifestations of post-acute sequelae of COVID-19. We, therefore, present this case to add to the current body of literature describing pulmonary disease as a consequence of SARS CoV-2 infection.
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Affiliation(s)
- Prachi Pednekar
- Department of Internal Medicine, Bridgeport Hospital, Bridgeport, CT, United States
| | - Kwesi Amoah
- Section of Pulmonary, Critical Care, and Sleep Medicine, Bridgeport Hospital, Bridgeport, CT, United States
| | - Robert Homer
- Department of Pathology, Yale School of Medicine, New Haven, CT, United States
| | - Changwan Ryu
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Denyse D Lutchmansingh
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, United States
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Sultan OM, Alghazali DM, Al-Tameemi H, Abed M, Hawiji DA, Abu Ghniem MN, Al-Obaidi L, Abedtwfeq RH. Pattern and Age Distribution of COVID-19 on Pulmonary Computed Tomography. Curr Med Imaging 2021; 17:775-780. [PMID: 33357198 DOI: 10.2174/1573405616666201223144539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/11/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND COVID-19 has emerged recently and has become a global concern. Computed tomography (CT) plays a vital role in the diagnosis. OBJECTIVES To characterize the pulmonary CT findings and distributions of COVID-19 infection in regard to different age groups. METHODS Chest CT scan of 104 symptomatic patients with COVID-19 infection from 7 Iraqi isolation centers were retrospectively analyzed between March 10th to April 5th, 2020. Patients were sub-classified according to their ages into three groups (young adult:20-39 years, middle age:40-59 years, and old age:60-90 years). RESULTS The most common findings were ground-glass opacities (GGO) (92.3%, followed by consolidation (27.9%), bronchovascular thickening (15.4%), and crazy-paving (12.5%). Less commonly, there were tree-in-bud (6.7%), pulmonary nodules (5.8%), bronchiectasis (3.8%), pleural effusion (1.9%), and cavitation (1%). There were no hallo signs, reversed hallo signs, and mediastinal lymphadenopathy. Pulmonary changes were unilateral in 16.7% and bilateral in 83.3%, central in 14.6%, peripheral in 57.3%, and diffuse (central and peripheral) in 28.1%. Most cases showed multi- lobar changes (70.8%), while the lower lobe was more commonly involved (17.7%) than the middle lobe/lingula (8.3%) and upper lobe (3.1%). In unilateral involvement, changes were more on the right (68.8%) than the left (31.2%) side. Compared with middle and old age groups, young adult patients showed significantly lesser frequency of consolidation (17% vs. 13.3% and 37%), diffuse changes 28.1% (14.2% vs. 35.3% and 40.5%), bilateral disease (71.4% vs. 94.1% and 85.2%), and multi-lobar involvement (51.4% vs. 82.4% and 81.4%) respectively. CONCLUSION Bilateral and peripheral GGO were the most frequent findings with the right and lower lobar predilection. The pattern and the distribution of CT changes seem to be age-specific.
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Affiliation(s)
- Omar Muayad Sultan
- College of Medicine, Lecturer of radiodiagnosis, Director of Medical Education Unit (MEU), Tikrit University, Tikrit, Iraq
| | - Dhia Mahdey Alghazali
- Department of Degnostic Imaging, Al-Imam Al-Hussein Medical City. Karbala 56001, Iraq
| | | | - Mohammed Abed
- Department of Radiology, Al-Yarmuk Teaching Hospital, Baghdad 10001, Iraq
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Gidaro A, Samartin F, Brambilla AM, Cogliati C, Ingrassia S, Banfi F, Cupiraggi V, Bonino C, Schiuma M, Giacomelli A, Rusconi S, Currà J, Brucato AL, Salvi E. Correlation between continuous Positive end-expiratory pressure (PEEP) values and occurrence of Pneumothorax and Pneumomediastinum in SARS-CoV2 patients during non-invasive ventilation with Helmet. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2021; 38:e2021017. [PMID: 34316257 PMCID: PMC8288205 DOI: 10.36141/svdld.v38i2.11222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/02/2021] [Indexed: 12/12/2022]
Abstract
Background: Acute Hypoxemic Respiratory Failure is a common complication of SARS-CoV2 related pneumonia, for which non-invasive ventilation (NIV) with Helmet Continuous Positive Airway Pressure (CPAP) is widely used. The frequency of pneumothorax in SARS-CoV2 was reported in 0.95% of hospitalized patients in 6% of mechanically ventilated patients, and in 1% of a post-mortem case series. Objectives: Aim of our retrospective study was to investigate the incidence of pneumothorax and pneumomediastinum (PNX/PNM) in SARS-CoV2 pneumonia patients treated with Helmet CPAP. Moreover, we examined the correlation between PNX/PNM and Positive end-expiratory pressure (PEEP) values. Methods: We collected data from patients admitted to “Luigi Sacco” University Hospital of Milan from 2 February to 5 May 2020 with SARS-CoV2 pneumonia requiring CPAP. Patients, who need NIV with bi-level pressure or endotracheal intubation (ETI) for any reason except those who needed ETI after PNX/PNM, were excluded. Population was divided in two groups according to PEEP level used (≤10 cmH2O and >10 cmH20). Results: 154 patients were enrolled. In the overall population, 42 patients (27%) were treated with High-PEEP (>10 cmH2O), and 112 with Low-PEEP (≤10 cmH2O). During hospitalization 3 PNX and 2 PNM occurred (3.2%). Out of these five patients, 2 needed invasive ventilation after PNX and died. All the PNX/PNM occurred in the High-PEEP group (5/37 vs 0/112, p<0,001). Conclusion: The incidence of PNX appears to be lower in SARS-CoV2 than SARS and MERS. Considering the association of PNX/PNM with high PEEP we suggest using the lower PEEP as possible to prevent these complications.
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Affiliation(s)
- Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Federica Samartin
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Anna Maria Brambilla
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Stella Ingrassia
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Francesco Banfi
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Viola Cupiraggi
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Cecilia Bonino
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Marco Schiuma
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Andrea Giacomelli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Stefano Rusconi
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Jaqueline Currà
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Antonio Luca Brucato
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Emanuele Salvi
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
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Ramdani H, Allali N, Chat L, El Haddad S. Covid-19 imaging: A narrative review. Ann Med Surg (Lond) 2021; 69:102489. [PMID: 34178312 PMCID: PMC8214462 DOI: 10.1016/j.amsu.2021.102489] [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: 04/20/2021] [Revised: 05/31/2021] [Accepted: 06/05/2021] [Indexed: 01/08/2023] Open
Abstract
Background The 2019 novel coronavirus disease (COVID-19) imaging data is dispersed in numerous publications. A cohesive literature review is to be assembled. Objective To summarize the existing literature on Covid-19 pneumonia imaging including precautionary measures for radiology departments, Chest CT's role in diagnosis and management, imaging findings of Covid-19 patients including children and pregnant women, artificial intelligence applications and practical recommendations. Methods A systematic literature search of PubMed/med line electronic databases. Results The radiology department's staff is on the front line of the novel coronavirus outbreak. Strict adherence to precautionary measures is the main defense against infection's spread. Although nucleic acid testing is Covid-19's pneumonia diagnosis gold standard; kits shortage and low sensitivity led to the implementation of the highly sensitive chest computed tomography amidst initial diagnostic tools. Initial Covid-19 CT features comprise bilateral, peripheral or posterior, multilobar ground-glass opacities, predominantly in the lower lobes. Consolidations superimposed on ground-glass opacifications are found in few cases, preponderantly in the elderly. In later disease stages, GGO transformation into multifocal consolidations, thickened interlobular and intralobular lines, crazy paving, traction bronchiectasis, pleural thickening, and subpleural bands are reported. Standardized CT reporting is recommended to guide radiologists. While lung ultrasound, pulmonary MRI, and PET CT are not Covid-19 pneumonia's first-line investigative diagnostic modalities, their characteristic findings and clinical value are outlined. Artificial intelligence's role in strengthening available imaging tools is discussed. Conclusion This review offers an exhaustive analysis of the current literature on imaging role and findings in COVID-19 pneumonia.
Chest computed tomography is a highly sensitive Covid −19 pneumonia's diagnostic tool. Initial Covid-19 CT features are bilateral, multifocal, peripheral or posterior ground-glass opacities, mainly in the lower lobes. Multifocal consolidations, bronchiectasis, pleural thickening, and subpleural bands are late disease stages features. Standardized CT reporting is recommended to guide radiologists. Artificial intelligence could strengthen available imaging tools.
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Affiliation(s)
- Hanae Ramdani
- Radiology Department, Childrens' Hospital - Ibn Sina University Hospital-Rabat, Lamfadel Cherkaoui Street, 10010, Rabat, Morocco
| | - Nazik Allali
- Radiology Department, Childrens' Hospital - Ibn Sina University Hospital-Rabat, Lamfadel Cherkaoui Street, 10010, Rabat, Morocco
| | - Latifa Chat
- Radiology Department, Childrens' Hospital - Ibn Sina University Hospital-Rabat, Lamfadel Cherkaoui Street, 10010, Rabat, Morocco
| | - Siham El Haddad
- Radiology Department, Childrens' Hospital - Ibn Sina University Hospital-Rabat, Lamfadel Cherkaoui Street, 10010, Rabat, Morocco
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Chong WH, Saha BK, Hu K, Chopra A. The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review. Heart Lung 2021; 50:599-608. [PMID: 34087677 PMCID: PMC8088235 DOI: 10.1016/j.hrtlng.2021.04.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 01/08/2023]
Abstract
Background Pneumothorax has been frequently described as a complication of COVID-19 infections. Objective In this systematic review, we describe the incidence, clinical characteristics, and outcomes of COVID-19-related pneumothorax. Methods Studies were identified through MEDLINE, Pubmed, and Google Scholar databases using keywords of “COVID-19,” “SARS-CoV-2,” “pneumothorax,” “pneumomediastinum,” and “barotrauma” from January 1st, 2020 to January 30th, 2021. Results Among the nine observational studies, the incidence of pneumothorax is low at 0.3% in hospitalized COVID-19 patients. However, the incidence of pneumothorax increases to 12.8–23.8% in those requiring invasive mechanical ventilation (IMV) with a high mortality rate up to 100%. COVID-19-related pneumothorax tends to be unilateral and right-sided. Age, pre-existing lung diseases, and active smoking status are not shown to be risk factors. The time to pneumothorax diagnosis is around 9.0–19.6 days from admission and 5.4 days after IMV initiation. COVID-19-related pneumothoraces are associated with prolonged hospitalization, increased likelihood of ICU admission and death, especially among the elderly. Conclusion COVID-19-related pneumothorax likely signify greater disease severity. With the high variability of COVID-19-related pneumothorax incidence described, a well-designed study is required to better assess the significance of COVID-19-related pneumothorax.
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Affiliation(s)
- Woon H Chong
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, United States.
| | - Biplab K Saha
- Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, Missouri, United States
| | - Kurt Hu
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Amit Chopra
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, United States
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Li Y, Wu J, Wang S, Li X, Zhou J, Huang B, Luo D, Cao Q, Chen Y, Chen S, Ma L, Peng L, Pan H, Travis WD, Nie X. Progression to fibrosing diffuse alveolar damage in a series of 30 minimally invasive autopsies with COVID-19 pneumonia in Wuhan, China. Histopathology 2021; 78:542-555. [PMID: 32926596 PMCID: PMC8848295 DOI: 10.1111/his.14249] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023]
Abstract
AIMS Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), infection has been deemed as a global pandemic by the World Health Organisation. While diffuse alveolar damage (DAD) is recognised to be the primary manifestation of COVID-19 pneumonia, there has been little emphasis on the progression to the fibrosing phase of DAD. This topic is of great interest, due to growing concerns regarding the potential long-term complications in prolonged survivors. METHODS AND RESULTS Here we report a detailed histopathological study of 30 autopsy cases with COVID-19 virus infection, based on minimally invasive autopsies performed between February and March, 2020. The mean age was 69 years, with 20 (67%) males and 10 (33%) females and frequent (70.0%) underlying comorbidities. The duration of illness ranged from 16 to 82 (median = 42) days. Histologically, the most common manifestation was diffuse alveolar damage (DAD) in 28 (93.3%) cases which showed predominantly acute (32%), organising (25%) and/or fibrosing (43%) patterns. Patients with fibrosing DAD were one decade younger (P = 0.034) and they had a longer duration of illness (P = 0.033), hospitalisation (P = 0.037) and mechanical ventilation (P = 0.014) compared to those with acute DAD. Patients with organising DAD had a longer duration of illness (P = 0.032) and hospitalisation (P = 0.023) compared to those with acute DAD. CONCLUSIONS COVID-19 pneumonia patients who develop DAD can progress to the fibrosing pattern. While we observed fibrosing DAD in fatal cases, whether or not surviving patients are at risk for developing pulmonary fibrosis and the frequency of this complication will require further clinical and radiological follow-up studies.
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Affiliation(s)
- Yan Li
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junhua Wu
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sihua Wang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Li
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junjie Zhou
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Huang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danju Luo
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qin Cao
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yajun Chen
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuo Chen
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Ma
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Peng
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huaxiong Pan
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiu Nie
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Karimian M, Azami M. Chest computed tomography scan findings of coronavirus disease 2019 (COVID-19) patients: a comprehensive systematic review and meta-analysis. Pol J Radiol 2021; 86:e31-e49. [PMID: 33708271 PMCID: PMC7934744 DOI: 10.5114/pjr.2021.103379] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Numerous cases of pneumonia caused by coronavirus disease 2019 (COVID-19) were reported in Wuhan, China. Chest computed tomography (CT) scan is highly important in the diagnosis and follow-up of lung disease treatment. The present meta-analysis was performed to evaluate chest CT scan findings in COVID-19 patients. MATERIAL AND METHODS All research steps were taken according to the Meta-Analysis of Observational Studies In Epidemiology (MOOSE) protocol and the final report was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We registered this review at the International Prospective Register of Systematic Reviews (PROSPERO, CRD42019127858). RESULTS Forty eligible studies including 4598 patients with COVID-19 were used for meta-analysis. The rate of positive chest CT scan in patients with COVID-19 was 94.5% (95% CI: 91.7-96.3). Bilateral lung involvement, pure ground-glass opacity (GGO), mixed (GGO pulse consolidation or reticular), consolidation, reticular, and presence of nodule findings in chest CT scan of COVID-19 pneumonia patients were respectively estimated to be 79.1% (95% CI: 70.8-85.5), 64.9% (95% CI: 54.1-74.4), 49.2% (95% CI: 35.7-62.8), 30.3% (95% CI: 19.6-43.6), 17.0% (95% CI: 3.9-50.9) and 16.6% (95% CI: 13.6-20.2). The distribution of lung lesions in patients with COVID-19 pneumonia was peripheral (70.0% [95% CI: 57.8-79.9]), central (3.9% [95% CI: 1.4-10.6]), and peripheral and central (31.1% [95% CI: 19.5-45.8]). The pulmonary lobes most commonly involved were the right lower lobe (86.5% [95% CI:57.7-96.8]) and left lower lobe (81.0% [95% CI: 50.5-94.7]). CONCLUSIONS The most important outcomes in chest CT scan of patients with COVID-19 pneumonia were bilateral lung involvement, GGO or mixed (GGO pulse consolidation or reticular) patterns, thickened interlobular septa, vascular enlargement, air bronchogram sign, peripheral distribution, and left and right lower lobes involvement. Our study showed that chest CT scan has high sensitivity in the diagnosis of COVID-19, and may therefore serve as a standard method for diagnosis of COVID-19.
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Affiliation(s)
- Mohammad Karimian
- Department of General Surgery, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Milad Azami
- Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
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11
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Azab SM, Zytoon AA, Kasemy ZAA, Omar SF, Ewida SF, Sakr KA, Ella TFA. Learning from pathophysiological aspects of COVID-19 clinical, laboratory, and high-resolution CT features: a retrospective analysis of 128 cases by disease severity. Emerg Radiol 2021; 28:453-467. [PMID: 33417113 PMCID: PMC7791339 DOI: 10.1007/s10140-020-01875-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The classic chest CT imaging features of COVID-19 pneumonia have low specificity due to their similarity with a number of other conditions. So, the goal of the present study is to learn from the pathophysiology of COVID-19 clinical features, laboratory results, and high-resolution CT manifestations in different stages of disease severity to provide significant reference values for diagnosis, prevention, and treatment. METHODS This was a multicentered study that included 128 patients. Demographic, clinical, and laboratory data, in addition to chest HRCT findings, were evaluated. According to chest HRCT features, radiologic scoring were grade 1 and 2 for mild grades of the disease, 3 and 4 for moderate grades of the disease, and 5 and 6 for severe grades of the disease. RESULTS Patient clinical symptoms ranged between fever, dry cough, muscle ache (myalgia)/fatigue, dyspnea, hyposomia, sore throat, and diarrhea. Lymphocytes and WBCs were significantly lower in patients with severe COVID-19. A significant negative correlation was found with WBCs (r = - 0.245, P = 0.005), lymphocytes% (r = - 0.586, P < 0.001), RBCs (r = - 0.2488, P = 0.005), Hb (gm/dl) (r = - 0.342, P < 0.001), and HCT (r = - 0.377, P < 0.001). Transferrin and CRP were significantly higher in moderate and severe COVID-19 than mild degree and showed a significant positive correlation with CT score (r = 0.356, P < 0.001) and (r = 0.429, P < 0.001), respectively. The most common CT features were peripheral pulmonary GGO and air space consolidation. CONCLUSION Clinical features, laboratory assessment, and HRCT imaging had their characteristic signs and performances. Correlating them can make it possible for physicians and radiologists to quickly obtain the final diagnosis and staging of the COVID-19 pneumonia.
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Affiliation(s)
- Sameh Mostafa Azab
- Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ashraf Anas Zytoon
- Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
| | - Zeinab Abdel Aziz Kasemy
- Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Suzan Fouad Omar
- Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Suzy Fayez Ewida
- Clinical Physiology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Karim Ayman Sakr
- School of Health Sciences, Western University, London, Ontario, Canada
| | - Tarek Fawzy Abd Ella
- Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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12
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Song WL, Zou N, Guan WH, Pan JL, Xu W. Clinical characteristics of COVID-19 in family clusters: a systematic review. World J Pediatr 2021; 17:355-363. [PMID: 34170503 PMCID: PMC8229253 DOI: 10.1007/s12519-021-00434-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the world and reports of children during early epidemic period showed features of family clusters. The aim of this study is to assess clinical profiles of COVID-19 in family clusters with children. METHODS We performed a systematic literature review of English database (PubMed, Web of Science) and Chinese database (" www.cnki.net ", " www.cqvip.com " and " www.Wanfangdata.com.cn ") to identify papers on family clusters of COVID-19 with children and their family members. RESULTS Eighteen studies involving 34 children and 98 adults from 28 families were included. Fever, cough and ground-grass opacity change of chest computed tomography (CT) were the dominant features, whereas proportion of asymptomatic infections for children was higher than adults with statistical significance (32.4% and 13.3%, respectively, P < 0.05). Median time of longer incubation period (10 days) and shorter duration of pharyngeal swab nucleic acid test positive period (11 days) were seen in children than adults (7 and 17 days, respectively) with statistical significance (P < 0.05). There were statistically significant differences in lymphopenia, increased C-reactive protein and abnormal chest CT between children and adult patients (P < 0.05). Twenty-seven families reported adults as first case of COVID-19 in family clusters. CONCLUSIONS The same virus strain can cause milder disease in children compared with their caregivers. Children of COVID-19 were infected by adults in family during the early epidemic period. Asymptomatic patients can transmit the virus.
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Affiliation(s)
- Wen-Liang Song
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang, 110004 China
| | - Ning Zou
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang, 110004 China
| | - Wen-He Guan
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang, 110004 China
| | - Jia-Li Pan
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang, 110004 China
| | - Wei Xu
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang, 110004, China.
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P KM, Sivashanmugam K, Kandasamy M, Subbiah R, Ravikumar V. Repurposing of histone deacetylase inhibitors: A promising strategy to combat pulmonary fibrosis promoted by TGF-β signalling in COVID-19 survivors. Life Sci 2020; 266:118883. [PMID: 33316266 PMCID: PMC7831549 DOI: 10.1016/j.lfs.2020.118883] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 01/18/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has rapidly spread around the world causing global public health emergency. In the last twenty years, we have witnessed several viral epidemics such as severe acute respiratory syndrome coronavirus (SARS-CoV), Influenza A virus subtype H1N1 and most recently Middle East respiratory syndrome coronavirus (MERS-CoV). There were tremendous efforts endeavoured globally by scientists to combat these viral diseases and now for SARS-CoV-2. Several drugs such as chloroquine, arbidol, remdesivir, favipiravir and dexamethasone are adopted for use against COVID-19 and currently clinical studies are underway to test their safety and efficacy for treating COVID-19 patients. As per World Health Organization reports, so far more than 16 million people are affected by COVID-19 with a recovery of close to 10 million and deaths at 600,000 globally. SARS-CoV-2 infection is reported to cause extensive pulmonary damages in affected people. Given the large number of recoveries, it is important to follow-up the recovered patients for apparent lung function abnormalities. In this review, we discuss our understanding about the development of long-term pulmonary abnormalities such as lung fibrosis observed in patients recovered from coronavirus infections (SARS-CoV and MERS-CoV) and probable epigenetic therapeutic strategy to prevent the development of similar pulmonary abnormalities in SARS-CoV-2 recovered patients. In this regard, we address the use of U.S. Food and Drug Administration (FDA) approved histone deacetylase (HDAC) inhibitors therapy to manage pulmonary fibrosis and their underlying molecular mechanisms in managing the pathologic processes in COVID-19 recovered patients.
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Affiliation(s)
- Krishna Murthy P
- Cancer Biology Laboratory, Department of Biochemistry, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | | | - Mahesh Kandasamy
- Laboratory of Stem Cells and Neuroregeneration, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India; Faculty Recharge Programme, University Grants Commission (UGC-FRP), New Delhi, India
| | - Rajasekaran Subbiah
- Department of Biochemistry, ICMR-National Institute for Research in Environmental Health, Bhauri, Madhya Pradesh, India
| | - Vilwanathan Ravikumar
- Cancer Biology Laboratory, Department of Biochemistry, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India.
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Landete P, Loaiza CAQ, Aldave-Orzaiz B, Muñiz SH, Maldonado A, Zamora E, Cerna ACS, Cerro ED, Alonso RC, Couñago F. Clinical features and radiological manifestations of COVID-19 disease. World J Radiol 2020; 12:247-260. [PMID: 33362916 PMCID: PMC7745468 DOI: 10.4329/wjr.v12.i11.247] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/24/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) was discovered after unusual cases of severe pneumonia emerged in December 2019 in Wuhan Province (China). Coronavirus is a family of single-stranded RNA viruses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted from person to person. Although asymptomatic individuals can transmit the virus, symptomatic patients are more contagious. The incubation period ranges from 3-7 d and symptoms are mainly respiratory, including pneumonia or pulmonary embolism in severe cases. Elevated serum levels of interleukins (IL)-2, IL-6, IL-7 indicate the presence of cytokine release syndrome, which is associated with disease severity. The disease has three main phases: Viral infection, pulmonary involvement, and hyperinflammation. To date, no treatment has proved to be safe or effective. Chest X-ray and computed tomography (CT) are the primary imaging tests for diagnosis of SARS-CoV-2 pneumonia, follow-up, and detection of complications. The main radiological findings are ground-glass opacification and areas of consolidation. The long-term clinical course is unknown, although some patients may develop pulmonary fibrosis. Positron emission tomography-computed tomography (PET-CT) is useful to assess pulmonary involvement, to define the affected areas, and to assess treatment response. The pathophysiology and clinical course of COVID-19 infection remain poorly understood. However, patterns detected on CT and PET-CT may help to diagnose and guide treatment. In this mini review, we analyze the clinical manifestations and radiological findings of COVID-19 infection.
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Affiliation(s)
- Pedro Landete
- Department ofPulmonology, H. U. La Princesa, Madrid 28006, Spain
| | | | | | | | - Antonio Maldonado
- Department of Nuclear Medicine, Hospital Universitario Quironsalud Madrid, Madrid 28223, Spain
| | - Enrique Zamora
- Department ofPulmonology, H. U. La Princesa, Madrid 28006, Spain
| | | | - Elia del Cerro
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Department of Radiation Oncology, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid 28670, Spain
| | - Raquel Cano Alonso
- Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid 28223, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Department of Radiation Oncology, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid 28670, Spain
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15
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Andrejak C, Cottin V, Crestani B, Debieuvre D, Gonzalez-Bermejo J, Morelot-Panzini C, Stach B, Uzunhan Y, Maitre B, Raherison C. [Guide for management of patients with possible respiratory sequelae after a SARS-CoV-2 pneumonia. Support proposals developed by the French-speaking Respiratory Medicine Society. Version of 10 November 2020]. Rev Mal Respir 2020; 38:114-121. [PMID: 33280941 PMCID: PMC7691188 DOI: 10.1016/j.rmr.2020.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/24/2020] [Indexed: 11/09/2022]
Abstract
La Société de Pneumologie de Langue Française (SPLF) propose un guide pour la prise en charge thérapeutique des patients ayant d’éventuelles séquelles respiratoires après avoir présenté une pneumonie à SARS-CoV-2 (COVID-19). Les propositions s’appuient sur les données connues des précédentes épidémies, les données préliminaires publiées sur le suivi après COVID-19 et les avis d’experts. Les propositions ont été élaborées par un groupe d’experts puis soumises selon la méthode Delphi à un panel composé de 22 pneumologues. Dix-sept propositions ont été validées, qui vont des examens complémentaires à réaliser après le bilan minimal proposé dans le guide de suivi de la SPLF à la place de la corticothérapie inhalée ou systémique et des médicaments antifibrosants. Ces propositions pourront évoluer dans le temps au fil des connaissances sur le sujet. Ce guide insiste sur l’importance de la discussion multidisciplinaire.
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Affiliation(s)
- C Andrejak
- Service de pneumologie, CHU Amiens-Picardie, UR 4294 AGIR, université Picardie Jules-Verne, 80054 Amiens, France.
| | - V Cottin
- Service de pneumologie, centre de référence des maladies pulmonaires rares, Hospices Civils de Lyon, université de Lyon, INRAE, Lyon, France
| | - B Crestani
- Service de pneumologie, hôpital Bichat, université de Paris, inserm UMR1152, 75108 Paris, France
| | - D Debieuvre
- Service de pneumologie, groupe hospitalier de la région Mulhouse Sud-Alsace, hôpital Émile-Muller, Mulhouse, France
| | - J Gonzalez-Bermejo
- Service de pneumologie, médecine intensive et réanimation Pitié-Salpêtrière, Sorbonne Université, inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - C Morelot-Panzini
- Service de pneumologie, médecine intensive et réanimation Pitié-Salpêtrière, Sorbonne Université, inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - B Stach
- Cabinet médical Saint Michel, 59300 Valenciennes, France
| | - Y Uzunhan
- Service de pneumologie, hôpital Avicenne, Assistance Publique - hôpitaux de Paris, Inserm U1272, Laboratoire "Hypoxie et Poumon", université Paris Nord, Bobigny, France
| | - B Maitre
- Service de pneumologie, centre hospitalier intercommunal de créteil, université Paris Est Créteil, 94000 Créteil, France
| | - C Raherison
- Service des maladies respiratoires, CHU de Bordeaux, U1219 Epicene université de Bordeaux, France
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16
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Porcel JM. Pleural diseases and COVID-19: ubi fumus, ibi ignis. Eur Respir J 2020; 56:13993003.03308-2020. [PMID: 32943411 PMCID: PMC7507586 DOI: 10.1183/13993003.03308-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 12/26/2022]
Abstract
More than 45 000 articles in the PubMed database and around 3200 studies registered in ClinicalTrials.gov, of which greater than half are clinical trials, are the result of ongoing and relentless research into the global pandemic nature of an acute respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which made its initial appearance in December 2019 in China. As of 28 August 2020, the total confirmed cases of coronavirus disease 2019 (COVID-19) surpasses 24.5 million, with more than 830 000 global deaths [1]. An estimated 40% to 45% of persons infected with SARS-CoV-2 will remain asymptomatic, but they can transmit the virus to others for an extended period, perhaps longer than 14 days [2]. The primary presentation of symptomatic infection is that of an influenza-like illness or viral pneumonia, with about 20% of these patients developing severe or critical manifestations [3]. There is both direct and circumstantial evidence that SARS-CoV-2 is responsible for the generation of pleural effusions and secondary spontaneous pneumothorax/pneumomediastinumhttps://bit.ly/3gZqA7Z
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Affiliation(s)
- José M Porcel
- Pleural Medicine Unit, Dept of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
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17
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José RJ, Manuel A, Gibson-Bailey K, Lee L. Post COVID-19 bronchiectasis: a potential epidemic within a pandemic. Expert Rev Respir Med 2020; 14:1183-1184. [PMID: 33054432 DOI: 10.1080/17476348.2020.1804366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ricardo J José
- Respiratory Medicine (Host Defence), Royal Brompton Hospital , Chelsea, UK.,Centre for Inflammation and Tissue Repair, UCL Respiratory , London, UK
| | - Ari Manuel
- Department of Respiratory Medicine, University Hospital Aintree , Liverpool, UK
| | - Katie Gibson-Bailey
- Department of Respiratory Medicine, University of Liverpool of Medical School Cedar House , Liverpool, UK
| | - Lydia Lee
- Department of Respiratory Medicine, University of Liverpool of Medical School Cedar House , Liverpool, UK
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Cafiero C, Re A, Micera A, Palmirotta R, Monaco D, Romano F, Fabrizio C, Di Francia R, Cacciamani A, Surico PL, D'Amato G, Pisconti S. Pharmacogenomics and Pharmacogenetics: In Silico Prediction of Drug Effects in Treatments for Novel Coronavirus SARS-CoV2 Disease. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2020; 13:463-484. [PMID: 33116761 PMCID: PMC7568633 DOI: 10.2147/pgpm.s270069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022]
Abstract
The latest developments in precision medicine allow the modulation of therapeutic approaches in different pathologies on the basis of the specific molecular characterization of the patient. This review of the literature coupled with in silico analysis was to provide a selected screening of interactions between single-nucleotide polymorphisms (SNPs) and drugs (repurposed, investigational, and biological agents) showing efficacy and toxicityin counteracting Covid-19 infection. In silico analysis of genetic variants related to each drug was performed on such databases as PharmGKB, Ensembl Genome Browser, www.drugs.com, and SNPedia, with an extensive literature review of papers (to May 10, 2020) on Covid-19 treatments using Medline, Embase, International Pharmaceutical Abstracts, PharmGKB, and Google Scholar. The clinical relevance of SNPs, known as both drug targets and markers, considering genetic variations with known drug responses, and the therapeutic consequences are discussed. In the context of clinical treatment of Covid-19, including infection prevention, control measures, and supportive care, this review highlights the importance of a personalized approach in the final selection of therapy, which is probably essential in the management of the Covid-19 pandemic.
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Affiliation(s)
| | - Agnese Re
- CNR-IASI, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandra Micera
- Research Laboratories in Ophthalmology, IRCCS - Fondazione Bietti, Rome, Italy
| | - Raffaele Palmirotta
- Department of Biomedical Sciences and Clinical Oncology, Oncogenomic Research Center, Aldo Moro University of Bari, Bari, Italy
| | | | - Francesca Romano
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Napoli, Italy
| | | | - Raffaele Di Francia
- Italian Association of Pharmacogenomics and Molecular Diagnostics, Ancona, Italy
| | - Andrea Cacciamani
- Research Laboratories in Ophthalmology, IRCCS - Fondazione Bietti, Rome, Italy
| | - Pier Luigi Surico
- Oncology and Hematology Department, F Miulli Hospital, Acquaviva delle Fonti, Italy
| | - Gerardo D'Amato
- Endocrine and Metabolic Surgery, A Gemelli Polyclinic Foundation, Rome, Italy
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Fu F, Lou J, Xi D, Bai Y, Ma G, Zhao B, Liu D, Bao G, Lei Z, Wang M. Chest computed tomography findings of coronavirus disease 2019 (COVID-19) pneumonia. Eur Radiol 2020; 30:5489-5498. [PMID: 32435925 PMCID: PMC7237879 DOI: 10.1007/s00330-020-06920-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To retrospectively analyze the chest computed tomography (CT) features in patients with coronavirus disease 2019 (COVID-19) pneumonia. METHODS From January 9, 2020, to February 26, 2020, totally 56 laboratory-confirmed patients with COVID-19 underwent chest CT. For 40 patients, follow-up CT scans were obtained. The CT images were evaluated for the number, type and distribution of the opacity, and the affected lung lobes. Furthermore, the initial CT scan and the follow-up CT scans were compared. RESULTS Forty patients (83.6%) had two or more opacities in the lung. Eighteen (32.7%) patients had only ground-glass opacities; twenty-nine patients (52.7%) had ground-glass and consolidative opacities; and eight patients (14.5%) had only consolidation. A total of 43 patients (78.2%) showed two or more lobes involved. The opacities tended to be both in peripheral and central (30/55, 54.5%) or purely peripheral distribution (25/55, 45.5%). Fifty patients (90.9%) had the lower lobe involved. The first follow-up CT scans showed that twelve patients (30%) had improvement, 26 (65%) patients had mild-moderate progression, and two patients (5%) had severe progression with "white lungs." The second follow-up CT showed that 22 patients (71%) showed improvement compared with the first follow-up CT, four patients (12.9%) had aggravated progression, and five patients (16.1%) showed unchanged radiographic appearance. CONCLUSIONS The common CT features of COVID-19 pneumonia are multiple lung opacities, multiple types of the opacity (ground-glass, ground-glass and consolidation, and consolidation alone), and multiple lobes especially the lower lobe involved. Follow-up CT could demonstrate the rapid progression of COVID-19 pneumonia (either in aggravation or absorption). KEY POINTS • The predominant CT features of COVID-19 pneumonia are multiple ground-glass opacities with or without consolidation and, with both lungs, multiple lobes and especially the lower lobe affected. • CT plays a crucial role in early diagnosis and assessment of COVID-19 pneumonia progression. • CT findings of COVID-19 pneumonia may not be consistent with the clinical symptoms or the initial RT-PCR test results.
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Affiliation(s)
- Fangfang Fu
- Department of Medical Imaging, Henan Provincial People's Hospital & People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Jianghua Lou
- Department of Medical Imaging, Henan Provincial People's Hospital & People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Deyan Xi
- Department of Radiology, Taikang People's Hospital, Zhoukou, Henan, China
| | - Yan Bai
- Department of Medical Imaging, Henan Provincial People's Hospital & People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Gongbao Ma
- Department of Radiology, Gongyi People's Hospital, Zhengzhou, Henan, China
| | - Bin Zhao
- Department of Radiology, Xincai People's Hospital, Zhumadian, Henan, China
| | - Dong Liu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Guofeng Bao
- Department of Radiology, Yihe Hospital in Zhengzhou, Zhengzhou, Henan, China
| | - Zhidan Lei
- Department of Medical Imaging, Henan Provincial People's Hospital & People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Meiyun Wang
- Department of Medical Imaging, Henan Provincial People's Hospital & People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China.
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Chen X, Zhang G, Hao SY, Bai L, Lu JJ. Similarities and Differences of Early Pulmonary CT Features of Pneumonia Caused by SARS-CoV-2, SARS-CoV and MERS-CoV: Comparison Based on a Systemic Review. ACTA ACUST UNITED AC 2020; 35:254-261. [PMID: 32972503 PMCID: PMC7521866 DOI: 10.24920/003727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To compare the similarities and differences of early CT manifestations of three types of viral pneumonia induced by SARS-CoV-2 (COVED-19), SARS-CoV (SARS) and MERS-CoV (MERS) using a systemic review. Methods Electronic database were searched to identify all original articles and case reports presenting chest CT features for adult patients with COVID-19, SARS and MERS pneumonia respectively. Quality of literature and completeness of presented data were evaluated by consensus reached by three radiologists. Vote-counting method was employed to include cases of each group. Data of patients' manifestations in early chest CT including lesion patterns, distribution of lesions and specific imaging signs for the three groups were extracted and recorded. Data were compared and analyzed using SPSS 22.0. Results A total of 24 studies were included, composing of 10 studies of COVED-19, 5 studies of MERS and 9 studies of SARS. The included CT exams were 147, 40, and 122 respectively. For the early CT features of the 3 pneumonias, the basic lesion pattern with respect to “mixed ground glass opacity (GGO) and consolidation, GGO mainly, or consolidation mainly” was similar among the 3 groups (χ2 = 7.966, p > 0.05). There were no significant differences on the lesion distribution (χ2= 13.053, p > 0.05) and predominate involvement of the subpleural area of bilateral lower lobes (χ2 = 4.809, p > 0.05) among the 3 groups. The lesions appeared more focal in COVID-19 pneumonia at early phase (χ2= 23.509, p < 0.05). The proportions of crazy-paving pattern (χ2 = 23.037, p < 0.001), organizing pneumonia pattern (p < 0.05) and pleural effusions (p < 0.001) in COVID-19 pneumonia were significantly lower than the other two. Although rarely shown in the early CT findings of all three viral pneumonias, the fibrotic changes were more frequent in SAKS than COVID-19 and MERS (χ2 = 6.275, P<0.05). For other imaging signs, only the MERS pneumonia demonstrated tree-in-buds, cavitation, and its incidence rate of interlobular or intralobular septal thickening presented significantly increased as compared to the other two pneumonia (χ2 = 22.412, p < 0.05). No pneumothorax, pneumomediastinum and lymphadenopathy was present for each group. Conclusions Imaging findings on early stage of these three coronavirus pneumonias showed similar basic lesion patterns, including GGO and consolidation, bilateral distribution, and predominant involvement of the subpleural area and the lower lobes. Early signs of COVID-19 pneumonia showed less severity of inflammation. Early fibrotic changes appeared in SAKS only, MERS had more severe inflammatory changes including cavitation and pleural effusion. The differences may indicate the specific pathophysiological processes for each coronavirus pneumonia.
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Affiliation(s)
- Xu Chen
- Department of Radiology, Beijing United Family Hospital, Beijing 100015, China
| | - Gang Zhang
- Department of Radiology, Beijing United Family Hospital, Beijing 100015, China
| | - Shuai Ying Hao
- Department of Radiology, Beijing United Family Hospital, Beijing 100015, China
| | - Lin Bai
- Department of Radiology, Beijing United Family Hospital, Beijing 100015, China
| | - Jing Jing Lu
- Department of Radiology, Beijing United Family Hospital, Beijing 100015, China
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Guo T, Liu X, Xu C, Wang J, Yang L, Shi H, Dai M. Fangcang Shelter Hospital in Wuhan: A radiographic report on a cohort of 98 COVID-19 patients. Int J Med Sci 2020; 17:2125-2132. [PMID: 32922173 PMCID: PMC7484669 DOI: 10.7150/ijms.48074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/22/2020] [Indexed: 11/05/2022] Open
Abstract
Objectives: To present the temporal changes of CT manifestations in COVID-19 patients from a single fangcang shelter hospital and to facilitate the understanding of the disease course. Materials and Methods: This retrospective study included 98 patients (males: females, 43:55, mean year, 49±12 years) with confirmed COVID-19 at Jianghan fangcang shelter hospital admitted between Feb 05, 2020, and Feb 09, 2020, who had initial chest CTs at our hospital. Radiographic features and CT scores were analyzed. Results: A total of 267 CT scans of 98 patients were evaluated. Our study showed a high median total CT score of 7 within the first week from symptom onset, peaked in the 2nd week at 10, followed by persistently high levels of CT score with 9.5, 7 and 7 for the week 3, 4, and >4, respectively, and a prolonged median disease course (30 days, the median interval between the onset of initial symptoms and discharge). Ground-glass opacity (GGO) (58%, 41/71) was the earliest and most frequent finding in week 1. Consolidation (26%, 14/53) and mixed pattern (40%, 21/53) were predominant patterns in 2nd week. GGO and reticular were the main patterns of later phase CT scans in patients with relatively advanced diseases who had longer illness duration (≥4 weeks). Among the 94 CT abnormalities obtained within 3 days from the twice RT-PCR test turned negative, the mixed pattern was mainly presented in patients with disease duration of 2-3 weeks, for GGO and reticular were common during the whole course. Conclusion: Discharged patients from fangcang shelter hospital demonstrated a high extent of lung abnormalities on CT within the first week from symptom onset, peaked at 2nd week, followed by persistence of high levels and a prolonged median disease course. GGO was the predominant pattern in week 1, consolidation and mixed pattern in 2nd week, whereas GGO and reticular patterns in later stages (≥4 weeks).
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Affiliation(s)
- Tingting Guo
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiaoming Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Cihao Xu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jiazheng Wang
- MSC Clinical & Technical Solutions, Philips Healthcare, Beijing, 100000, China
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Meng Dai
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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Jiang H, Guo W, Shi Z, Jiang H, Zhang M, Wei L, Pan Y. Clinical imaging characteristics of inpatients with coronavirus disease-2019 in Heilongjiang Province, China: a retrospective study. Aging (Albany NY) 2020; 12:13860-13868. [PMID: 32688346 PMCID: PMC7425485 DOI: 10.18632/aging.103633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
Objective: To investigate the clinical, laboratory, and radiological characteristics of patients with coronavirus disease-2019 (COVID-19) in Heilongjiang Province. Results: Patients in the ICU group were older and their incidence of cardiovascular disease was higher than those in the non-ICU group. Lymphocyte levels were lower and neutrophil and D-dimer levels were higher in the ICU than that in the non-ICU group. Compared to the non-ICU group, the incidence of pulmonary consolidation and ground-glass opacity with consolidation was significantly higher in the ICU group, all lung lobes were more likely to be involved, with higher number of lung lobes and areas surrounding the bronchi. Of the 59 patients with COVID-19 in this group, 15 received mechanical ventilation. All intubated patients involved lung lobes, and a large number of lesions were observed in the area around the bronchial vessels. Conclusion: Significant differences were observed in clinical symptoms, laboratory tests, and computed tomography features between the ICU and non-ICU groups. Methods: A total of 59 patients with COVID-19, comprising 44 patients in the intensive care unit (ICU) and 15 in the non-ICU, were retrospectively analyzed. Characteristics of the two groups of patients were compared.
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Affiliation(s)
- Hao Jiang
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Guo
- Department of Ultrasound, Harbin The First Hospital, Harbin, China
| | - Zhongxing Shi
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huijie Jiang
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mingyu Zhang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Affiliated to Capital Medical University, Beijing, China
| | - Lai Wei
- Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yongmei Pan
- Department of Radiology, Harbin Hong'an Hospital, Harbin, China
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Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, Peng Z, Pan H. Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China. J Clin Virol 2020; 127:104364. [PMID: 32311650 PMCID: PMC7194884 DOI: 10.1016/j.jcv.2020.104364] [Citation(s) in RCA: 435] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In late December 2019, an outbreak of acute respiratory illness, coronavirus disease 2019 (COVID-19), emerged in Wuhan, China. We aimed to study the epidemiology, clinical features and short-term outcomes of patients with COVID-19 in Wuhan, China. METHODS We performed a single center, retrospective case series study in 221 patients with laboratory confirmed SARS-CoV-2 pneumonia at a university hospital, including 55 severe patients and 166 non-severe patients, from January 2, 2020 to February 10, 2020. RESULTS Of the 221 patients with COVID-19, the median age was 55.0 years and 48.9% were male and only 8 (3.6%) patients had a history of exposure to the Huanan Seafood Market. Compared to the non-severe pneumonia patients, the median age of the severe patients was significantly older, and they were more likely to have chronic comorbidities. Most common symptoms in severe patients were high fever, anorexia and dyspnea. On admission, 33.0% patients showed leukopenia and 73.8% showed lymphopenia. In addition, the severe patients suffered a higher rate of co-infections with bacteria or fungus and they were more likely to developing complications. As of February 15, 2020, 19.0% patients had been discharged and 5.4% patients died. 80% of severe cases received ICU (intensive care unit) care, and 52.3% of them transferred to the general wards due to relieved symptoms, and the mortality rate of severe patients in ICU was 20.5%. CONCLUSIONS Patients with elder age, chronic comorbidities, blood leukocyte/lymphocyte count, procalcitonin level, co-infection and severe complications might increase the risk of poor clinical outcomes.
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Affiliation(s)
- Guqin Zhang
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Chang Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Linjie Luo
- College of Medicine, Texas A&M University Health Science Center, College Station 77807, USA
| | - Fang Fang
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yongfeng Chen
- Division of Medical Affairs, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jianguo Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Zhiyong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Huaqin Pan
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
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24
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Zhang L, Kong X, Li X, Zhu J, Liu S, Li W, Xu C, Du H, Jing H, Xu J, Shi T, Xie Y. CT imaging features of 34 patients infected with COVID-19. Clin Imaging 2020; 68:226-231. [PMID: 32425337 PMCID: PMC7229931 DOI: 10.1016/j.clinimag.2020.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 02/04/2023]
Abstract
Objective To retrospectively analyze the CT findings in patients infected with Coronavirus disease 2019 (COVID-19). Materials and methods The thirty-four cases, 15 females and 19 males, with an age ranging from 7 to 88 years old, confirmed by real-time reverse-transcriptase-polymerase chain reaction (RT-PCR), were used for our study. All thin-section CT scans of the lungs were performed in all of patients. The clinical, laboratory and CT imaging were available to evaluate in all patients. Results The patients present with fever (85.29%, n = 29), cough (67.65%, n = 23), fatigue or myalgia (26.47%, n = 9), and pharyngalgia (8.82%, n = 3). The 4 patients (11.76%) with no symptoms were identified during screening for close contacts, who had typical CT findings. On initial CT scans, the bilateral lung involved was shown in 24 cases (70.59%), while 29 (82.35%) cases were distributed in peripheral. The pure ground glass opacity (GGO) was shown in 18 cases (52.94%), the GGO with consolidation was in 12 cases (35.29%), and full consolidation only in 3 cases. The lesion with air bronchogram was seen in 14 (41.18%) cases, with enlarged blood vessel in 17 (50.00%) cases, with crazy-paving pattern in 8 (23.53%) cases, with fine reticular pattern in 4 (11.77%) cases, and with intralesional vacuole sign in 6 (17.65%) cases. The pleural effusion was seen in one patient. Follow-up imaging in 19 patients during the study time window demonstrated mild, moderate or severe progression of disease, as manifested by increasing extent and density of lung opacities. Conclusions The bilateral GGO with air bronchogram, enlarged blood vessel, fine reticular pattern, and peripheral distribution are the early CT findings of COVID-19. The crazy-paving pattern and intralesional vacuole sign are the features of progressive stage.
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Affiliation(s)
- Litao Zhang
- Department of Radiology, Tai'an Central Hospital, Shandong First Medical University, Tai'an 271000, Shandong, China
| | - Xue Kong
- Department of Radiology, Qilu Hospital, Shandong University, Jinan 250012, Shandong, China
| | - Xiujuan Li
- Department of Radiology, Tai'an Central Hospital, Shandong First Medical University, Tai'an 271000, Shandong, China
| | - Jianzhong Zhu
- Department of Radiology, the 2nd Affiliated Hospital, Shandong First Medical University, Tai'an 271000, Shandong, China
| | - Shanping Liu
- Department of Radiology, Xintai People Hospital, Shandong First Medical University, Tai'an 271200, Shandong, China
| | - Weiwei Li
- Department of Radiology, Tai'an Hospital of Infectious Diseases, Tai'an 271000, Shandong, China
| | - Chunlin Xu
- Department of Radiology, Feicheng Hospital of Bureau of Mines, Tai'an 271600, Shandong, China
| | - Huanwang Du
- Department of Radiology, Ningyang Firs Hospital, Tai'an 271400, Shandong, China
| | - Hui Jing
- Department of Radiology, Dongping People Hospital, Tai'an 271500, Shandong, China
| | - Jiahuan Xu
- Department of Radiology, Tai'an Central Hospital, Shandong First Medical University, Tai'an 271000, Shandong, China
| | - Tongtong Shi
- Department of Radiology, Tai'an Central Hospital, Shandong First Medical University, Tai'an 271000, Shandong, China
| | - Yuanzhong Xie
- Department of Radiology, Tai'an Central Hospital, Shandong First Medical University, Tai'an 271000, Shandong, China.
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Ullah MA, Islam H, Rahman A, Masud J, Shweta DS, Araf Y, Sium SMA, Sarkar B. A Generalized Overview of SARS-CoV-2: Where Does the Current Knowledge Stand? ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/8258] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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26
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Mohseni Afshar Z, Ebrahimpour S, Javanian M, Vasigala VR, Masrour-Roudsari J, Babazadeh A. Vital role of chest CT in diagnosis of coronavirus disease 2019 (COVID-19). CASPIAN JOURNAL OF INTERNAL MEDICINE 2020; 11:244-249. [PMID: 32874430 PMCID: PMC7442454 DOI: 10.22088/cjim.11.3.244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/19/2020] [Accepted: 04/28/2020] [Indexed: 12/23/2022]
Abstract
In December 2019, a new virus called coronavirus disease 2019 (COVID-19) causing severe acute respiratory syndrome emerged in Wuhan, China, and rapidly spread to other areas of China and other regions of the world. Since it was a discovery, COVID-19 has spread to several countries and to this date, affecting about 2,329,651 people and caused about 160,721 deaths. Since most COVID-19 infected cases were diagnosed with pneumonia and characteristic chest computed tomography (CT) scan patterns, radiological examinations have become an important tool in early diagnosis. Nowadays, CT findings combined with normal blood cells (WBCs), lymphopenia and a history of epidemiological exposure have been used as criteria for clinical diagnosis of COVID-19. It is noteworthy that reverse transcription polymerase chain reaction (RT-PCR) test is still gold standard for the diagnosis. This review focuses on role of chest CT in the clinical evaluation of disease progression and more accurate diagnosis.
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Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mostafa Javanian
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Jila Masrour-Roudsari
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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27
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Wu J, Wu X, Zeng W, Guo D, Fang Z, Chen L, Huang H, Li C. Chest CT Findings in Patients With Coronavirus Disease 2019 and Its Relationship With Clinical Features. Invest Radiol 2020; 55:257-261. [PMID: 32091414 PMCID: PMC7147284 DOI: 10.1097/rli.0000000000000670] [Citation(s) in RCA: 375] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the chest computed tomography (CT) findings in patients with confirmed coronavirus disease 2019 (COVID-19) and to evaluate its relationship with clinical features. MATERIALS AND METHODS Study sample consisted of 80 patients diagnosed as COVID-19 from January to February 2020. The chest CT images and clinical data were reviewed, and the relationship between them was analyzed. RESULTS Totally, 80 patients diagnosed with COVID-19 were included. With regards to the clinical manifestations, 58 (73%) of the 80 patients had cough, and 61 (76%) of the 80 patients had high temperature levels. The most frequent CT abnormalities observed were ground glass opacity (73/80 cases, 91%), consolidation (50/80 cases, 63%), and interlobular septal thickening (47/80, 59%). Most of the lesions were multiple, with an average of 12 ± 6 lung segments involved. The most common involved lung segments were the dorsal segment of the right lower lobe (69/80, 86%), the posterior basal segment of the right lower lobe (68/80, 85%), the lateral basal segment of the right lower lobe (64/80, 80%), the dorsal segment of the left lower lobe (61/80, 76%), and the posterior basal segment of the left lower lobe (65/80, 81%). The average pulmonary inflammation index value was (34% ± 20%) for all the patients. Correlation analysis showed that the pulmonary inflammation index value was significantly correlated with the values of lymphocyte count, monocyte count, C-reactive protein, procalcitonin, days from illness onset, and body temperature (P < 0.05). CONCLUSIONS The common chest CT findings of COVID-19 are multiple ground glass opacity, consolidation, and interlobular septal thickening in both lungs, which are mostly distributed under the pleura. There are significant correlations between the degree of pulmonary inflammation and the main clinical symptoms and laboratory results. Computed tomography plays an important role in the diagnosis and evaluation of this emerging global health emergency.
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Affiliation(s)
- Jiong Wu
- From the Department of Radiology, Chongqing Three Gorges Central Hospital
| | | | - Wenbing Zeng
- From the Department of Radiology, Chongqing Three Gorges Central Hospital
| | | | | | | | - Huizhe Huang
- Office of Academic Research, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Zhang S, Li H, Huang S, You W, Sun H. High-resolution computed tomography features of 17 cases of coronavirus disease 2019 in Sichuan province, China. Eur Respir J 2020; 55:13993003.00334-2020. [PMID: 32139463 PMCID: PMC7098481 DOI: 10.1183/13993003.00334-2020] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/22/2020] [Indexed: 02/05/2023]
Abstract
The city of Wuhan, in Hubei province, China is the focus of global attention due to the coronavirus disease 2019 (COVID-19) outbreak [1]. Sichuan, as a province near Hubei, also has been involved. As of February 12, 2020, 59 741 confirmed cases of COVID-19 have been reported in China, of which 451 cases have been identified in Sichuan province. This disease is caused by infection of a new coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the World Health Organization (WHO). According to the latest research, the novel coronavirus is 96% identical at the whole-genome level to a bat coronavirus, leading to speculation that this new coronavirus may originate from bats [2, 3]. Current epidemiological data indicate that person-to-person transmission of COVID-19 is occurring [4]. Bilateral ground-glass opacities and a combination of consolidation and ground-glass opacities mainly in the subpleural lung regions is a noteworthy HRCT feature of coronavirus disease 2019, which may help in the early diagnosis of the diseasehttp://bit.ly/2IgXcel
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Affiliation(s)
- Simin Zhang
- Dept of Radiology, West China Hospital of Sichuan University, Chengdu, China.,These authors contributed equally to this study
| | - Huaqiao Li
- Dept of Radiology, West China - Guang'an Hospital of Sichuan University, Guang'an, China.,These authors contributed equally to this study
| | - Songtao Huang
- Dept of Radiology, West China - Guang'an Hospital of Sichuan University, Guang'an, China
| | - Wei You
- Dept of Infectious Diseases, West China - Guang'an Hospital of Sichuan University, Guang'an, China
| | - Huaiqiang Sun
- Dept of Radiology, West China Hospital of Sichuan University, Chengdu, China
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Pediatric SARS, H1N1, MERS, EVALI, and Now Coronavirus Disease (COVID-19) Pneumonia: What Radiologists Need to Know. AJR Am J Roentgenol 2020; 215:736-744. [PMID: 32352308 DOI: 10.2214/ajr.20.23267] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE. The purpose of this article is to review new pediatric lung disorders-including disorders that have occurred in recent years years such as severe acute respiratory syndrome (SARS), swine-origin influenza A (H1N1), Middle East respiratory syndrome (MERS), e-cigarette or vaping product use-associated lung injury (EVALI), and coronavirus disease (COVID-19) pneumonia-to enhance understanding of the characteristic imaging findings. CONCLUSION. Although the clinical symptoms of SARS, H1N1, MERS, EVALI, and COVID-19 pneumonia in pediatric patients may be nonspecific, some characteristic imaging findings have emerged or are currently emerging. It is essential for radiologists to have a clear understanding of the characteristic imaging appearances of these lung disorders in pediatric patients to ensure optimal patient care.
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30
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Wang J, Xu Z, Wang J, Feng R, An Y, Ao W, Gao Y, Wang X, Xie Z. CT characteristics of patients infected with 2019 novel coronavirus: association with clinical type. Clin Radiol 2020; 75:408-414. [PMID: 32327229 PMCID: PMC7138387 DOI: 10.1016/j.crad.2020.04.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/01/2020] [Indexed: 12/24/2022]
Abstract
AIM To summarise the features of chest computed tomography (CT) of a series of patients infected with 2019 novel coronavirus (2019-nCov) to speed up recognition and have a better understanding of COVID-19 disease. MATERIALS AND METHODS The clinical information and chest CT images of 93 patients infected with 2019-nCov from multiple centres were reviewed. RESULTS Of the 93 cases, abnormalities in 91 cases were located at the subpleural level, presenting with ground-glass opacity (GGO; n=69, 74.2%) and consolidation (n=56, 60.2%) in multiple lobes. Other CT features included vascular dilatation (n=83, 89.2%), interlobular septal thickening (n=29, 31.2%), bronchodilatation (n=44, 47.3%), the crazy-paving sign (n=34, 36.6%), the sieve-hole sign (n=12, 12.9%), pleural thickening (n=21, 22.6%), and pleural effusion (n=8, 8.6%). Multiple lobe involvement, including the presence of consolidation, the crazy-paving sign, interlobular septal thickening, pleural thickening and pleural effusion, was more common in critical patients with heavy/critical infection (p<0.05), whereas the presence of GGO, involvement of one or two lobes, and the halo sign were more common in patients with mild/common-type infections (p<0.05). Moreover, older age, higher body temperature, complaints of chest tightness and breathlessness, and lymphopenia was associated with heavy/critical infections. CONCLUSION The CT and clinical appearances of COVID-19 are variable and reflect the severity of COVID-19 to some extent.
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Affiliation(s)
- J Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Z Xu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - J Wang
- Department of Radiology, XiXi Hospital of Hangzhou, Zhejiang Province, China
| | - R Feng
- Department of Radiology, XiXi Hospital of Hangzhou, Zhejiang Province, China
| | - Y An
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - W Ao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Y Gao
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, China
| | - X Wang
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, China
| | - Z Xie
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, China.
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Li B, Shen J, Li L, Yu C. Radiographic and Clinical Features of Children With Coronavirus Disease (COVID-19) Pneumonia. Indian Pediatr 2020. [PMID: 32255437 PMCID: PMC7240239 DOI: 10.1007/s13312-020-1816-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective: The purpose of this study was to investigate chest computed tomography (CT) findings in children with coronavirus disease-19 (COVID-19) pneumonia in our hospital. Methods: This study included 22 pediatric patients with confirmed COVID-19 from January to March, 2020. The chest CT images and clinical data were reviewed. Results: The most prevalent presenting symptoms were fever (64%) and cough (59%), and a mildly elevated mean (SD) C-reactive protein (CRP) level of 11.22(11.06) and erythrocyte sedimentation rateof 18.8(15.17) were detected. The major CT abnormalities observed were mixed ground-glass opacity and consolidation lesions (36%), consolidations (32%), and groundglass opacities (14%). Peripheral distribution (45%) of lung lesions was predominant. Most of the lesions were multilobar(68%), with an average of three lung segments involved. Conclusion: Children with COVID-19 had relatively milder symptoms and less severe lung inflammation than adults.Chest CT plays an important role in the management of children with COVID-19 pneumonia.
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Affiliation(s)
- Bo Li
- Department of Radiology, The First College of Clinical Medical Science of China, Three Gorges University and Yichang Central People's Hospital, Yichang, China
| | - Jie Shen
- Department of Radiology, The Affiliated Jiujiang Hospital of Nanchang University and Jiu Jiang No.1 People's and Water of Life Hospital, Jiangxi, China
| | - Liang Li
- Department of Radiology, The First College of Clinical Medical Science of China, Three Gorges University and Yichang Central People's Hospital, Yichang, China
| | - Chengxin Yu
- Department of Radiology, The First College of Clinical Medical Science of China, Three Gorges University and Yichang Central People's Hospital, Yichang, China
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Albarello F, Pianura E, Di Stefano F, Cristofaro M, Petrone A, Marchioni L, Palazzolo C, Schininà V, Nicastri E, Petrosillo N, Campioni P, Eskild P, Zumla A, Ippolito G. 2019-novel Coronavirus severe adult respiratory distress syndrome in two cases in Italy: An uncommon radiological presentation. Int J Infect Dis 2020; 93:192-197. [PMID: 32112966 PMCID: PMC7110436 DOI: 10.1016/j.ijid.2020.02.043] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Several recent case reports have described common early chest imaging findings of lung pathology caused by 2019 novel Coronavirus (SARS-COV2) which appear to be similar to those seen previously in SARS-CoV and MERS-CoV infected patients. OBJECTIVE We present some remarkable imaging findings of the first two patients identified in Italy with COVID-19 infection travelling from Wuhan, China. The follow-up with chest X-Rays and CT scans was also included, showing a progressive adult respiratory distress syndrome (ARDS). RESULTS Moderate to severe progression of the lung infiltrates, with increasing percentage of high-density infiltrates sustained by a bilateral and multi-segmental extension of lung opacities, were seen. During the follow-up, apart from pleural effusions, a tubular and enlarged appearance of pulmonary vessels with a sudden caliber reduction was seen, mainly found in the dichotomic tracts, where the center of a new insurgent pulmonary lesion was seen. It could be an early alert radiological sign to predict initial lung deterioration. Another uncommon element was the presence of mediastinal lymphadenopathy with short-axis oval nodes. CONCLUSIONS Although only two patients have been studied, these findings are consistent with the radiological pattern described in literature. Finally, the pulmonary vessels enlargement in areas where new lung infiltrates develop in the follow-up CT scan, could describe an early predictor radiological sign of lung impairment.
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Affiliation(s)
- Fabrizio Albarello
- Lazzaro Spallanzani, National Institute for Infectious Diseases - IRCCS, Via Portuense, 292, cap 00148 Rome, Italy
| | - Elisa Pianura
- Lazzaro Spallanzani, National Institute for Infectious Diseases - IRCCS, Via Portuense, 292, cap 00148 Rome, Italy
| | - Federica Di Stefano
- Lazzaro Spallanzani, National Institute for Infectious Diseases - IRCCS, Via Portuense, 292, cap 00148 Rome, Italy
| | - Massimo Cristofaro
- Lazzaro Spallanzani, National Institute for Infectious Diseases - IRCCS, Via Portuense, 292, cap 00148 Rome, Italy
| | - Ada Petrone
- Lazzaro Spallanzani, National Institute for Infectious Diseases - IRCCS, Via Portuense, 292, cap 00148 Rome, Italy
| | - Luisa Marchioni
- Lazzaro Spallanzani, National Institute for Infectious Diseases - IRCCS, Via Portuense, 292, cap 00148 Rome, Italy
| | - Claudia Palazzolo
- Lazzaro Spallanzani, National Institute for Infectious Diseases - IRCCS, Via Portuense, 292, cap 00148 Rome, Italy
| | - Vincenzo Schininà
- Lazzaro Spallanzani, National Institute for Infectious Diseases - IRCCS, Via Portuense, 292, cap 00148 Rome, Italy.
| | - Emanuele Nicastri
- Lazzaro Spallanzani, National Institute for Infectious Diseases - IRCCS, Via Portuense, 292, cap 00148 Rome, Italy
| | - Nicola Petrosillo
- Lazzaro Spallanzani, National Institute for Infectious Diseases - IRCCS, Via Portuense, 292, cap 00148 Rome, Italy
| | - Paolo Campioni
- Lazzaro Spallanzani, National Institute for Infectious Diseases - IRCCS, Via Portuense, 292, cap 00148 Rome, Italy
| | - Petersen Eskild
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman; Institute for Clinical Medicine, Faculty of Health Science, University of Aarhus, Denmark; ESCMID Emerging Infections Task Force, Basel, Switzerland
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Giuseppe Ippolito
- Lazzaro Spallanzani, National Institute for Infectious Diseases - IRCCS, Via Portuense, 292, cap 00148 Rome, Italy
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Kanne JP. Chest CT Findings in 2019 Novel Coronavirus (2019-nCoV) Infections from Wuhan, China: Key Points for the Radiologist. Radiology 2020; 295:16-17. [PMID: 32017662 PMCID: PMC7233362 DOI: 10.1148/radiol.2020200241] [Citation(s) in RCA: 381] [Impact Index Per Article: 76.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Jeffrey P. Kanne
- From the Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792
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Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, Dai J, Sun Q, Zhao F, Qu J, Yan F. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020; 80:388-393. [PMID: 32112884 PMCID: PMC7102539 DOI: 10.1016/j.jinf.2020.02.016] [Citation(s) in RCA: 595] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Little is known about COVID-19 outside Hubei. The aim of this paper was to describe the clinical characteristics and imaging manifestations of hospitalized patients with confirmed COVID-19 infection in Wenzhou, Zhejiang, China. METHODS In this retrospective cohort study, 149 RT-PCR confirmed positive patients were consecutively enrolled from January 17th to February 10th, 2020 in three tertiary hospitals of Wenzhou. Outcomes were followed up until Feb 15th, 2020. FINDINGS A total of 85 patients had Hubei travel/residence history, while another 49 had contact with people from Hubei and 15 had no traceable exposure history to Hubei. Fever, cough and expectoration were the most common symptoms, 14 patients had decreased oxygen saturation, 33 had leukopenia, 53 had lymphopenia, and 82 had elevated C-reactive protein. On chest computed tomography (CT), lung segments 6 and 10 were mostly involved. A total of 287 segments presented ground glass opacity, 637 presented mixed opacity and 170 presented consolidation. Lesions were more localized in the peripheral lung with a patchy form. No significant difference was found between patients with or without Hubei exposure history. Seventeen patients had normal CT on admission of these, 12 had negative findings even10 days later. INTERPRETATION Most patients presented with a mild infection in our study. The imaging pattern of multifocal peripheral ground glass or mixed opacity with predominance in the lower lung is highly suspicious of COVID-19 in the first week of disease onset. Nevetheless, some patients can present with a normal chest finding despite testing positive for COVID-19. FUNDING We did not receive any fundings.
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Affiliation(s)
- Wenjie Yang
- Department of Radiology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, No.197 Ruijin Er Road, Shanghai 200025, China
| | - Qiqi Cao
- Department of Radiology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, No.197 Ruijin Er Road, Shanghai 200025, China
| | - Le Qin
- Department of Radiology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, No.197 Ruijin Er Road, Shanghai 200025, China
| | - Xiaoyang Wang
- Department of Radiology, Ruian People's Hospital, Ruian 325200, Zhejiang province, China
| | - Zenghui Cheng
- Department of Radiology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, No.197 Ruijin Er Road, Shanghai 200025, China
| | - Ashan Pan
- Department of Radiology, Yueqing People's Hospital, Yueqing 325600, Zhejiang province, China
| | - Jianyi Dai
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang province, China
| | - Qingfeng Sun
- Department of Infectious Diseases, Ruian People's Hospital, Ruian 325200, Zhejiang province, China
| | - Fengquan Zhao
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang province, China
| | - Jieming Qu
- Department of Respiratory and Critical Care Medicine, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, No.197 Ruijin Er Road, Shanghai 200025, China.
| | - Fuhua Yan
- Department of Radiology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, No.197 Ruijin Er Road, Shanghai 200025, China.
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Zhao X, Liu B, Yu Y, Wang X, Du Y, Gu J, Wu X. The characteristics and clinical value of chest CT images of novel coronavirus pneumonia. Clin Radiol 2020; 75:335-340. [PMID: 32199619 PMCID: PMC7156121 DOI: 10.1016/j.crad.2020.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 12/02/2022]
Abstract
AIM To investigate the characteristics and clinical value of chest computed tomography (CT) images of novel coronavirus pneumonia (NCP). MATERIALS AND METHODS Clinical data and CT images of 80 cases of NCP were collected. The clinical manifestations and laboratory test results of the patients were analysed. The lesions in each lung segment of the patient's chest CT images were characterised. Lesions were scored according to length and diffusivity. RESULTS The main clinical manifestations were fever, dry cough, fatigue, a little white sputum, or diarrhoea. A total of 1,702 scored lesions were found in the first chest CT images of 80 patients. The lesions were located mainly in the subpleural area of the lungs (92.4%). Most of the lesions were ground-glass opacity, and subsequent fusions could increase in range and spread mainly in the subpleural area. Pulmonary consolidation accounted for 44.1% of all of the lesions. Of the 80 cases, 76 patients (95%) had bilateral lung disease, four (5%) patients had unilateral lung disease, and eight (10%) patients had cord shadow. CONCLUSION The chest CT of NCP patients is characterised by the onset of bilateral ground-glass lesions located in the subpleural area of the lung, and progressive lesions that result in consolidation with no migratory lesions. Pleural effusions and mediastinal lymphadenopathy are rare. As patients can have inflammatory changes in the lungs alongside a negative early nucleic acid test, chest CT, in combination with epidemiological and laboratory tests, is a useful examination to evaluate the disease and curative effect.
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Affiliation(s)
- X Zhao
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, China
| | - B Liu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, China
| | - Y Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, China
| | - X Wang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, China
| | - Y Du
- Department of Radiology, Fuyang Second People's Hospital, China
| | - J Gu
- Department of Radiology, Fuyang Second People's Hospital, China
| | - X Wu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, China.
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Clinical Features and Chest CT Manifestations of Coronavirus Disease 2019 (COVID-19) in a Single-Center Study in Shanghai, China. AJR Am J Roentgenol 2020; 215:121-126. [PMID: 32174128 DOI: 10.2214/ajr.20.22959] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE. Confronting the new coronavirus infection known as coronavirus disease 2019 (COVID-19) is challenging and requires excluding patients with suspected COVID-19 who actually have other diseases. The purpose of this study was to assess the clinical features and CT manifestations of COVID-19 by comparing patients with COVID-19 pneumonia with patients with non-COVID-19 pneumonia who presented at a fever observation department in Shanghai, China. MATERIALS AND METHODS. Patients were retrospectively enrolled in the study from January 19 through February 6, 2020. All patients underwent real-time reverse transcription-polymerase chain reaction (RT-PCR) testing. RESULTS. Eleven patients had RT-PCR test results that were positive for severe acute respiratory syndrome coronavirus 2, whereas 22 patients had negative results. No statistical difference in clinical features was observed (p > 0.05), with the exception of leukocyte and platelet counts (p < 0.05). The mean (± SD) interval between onset of symptoms and admission to the fever observation department was 4.40 ± 2.00 and 5.52 ± 4.00 days for patients with positive and negative RT-PCR test results, respectively. The frequency of opacifications in patients with positive results and patients with negative results, respectively, was as follows: ground-glass opacities (GGOs), 100.0% versus 90.9%; mixed GGO, 63.6% versus 72.7%; and consolidation, 54.5% versus 77.3%. In patients with positive RT-PCR results, GGOs were the most commonly observed opacification (seen in 100.0% of patients) and were predominantly located in the peripheral zone (100.0% of patients), compared with patients with negative results (31.8%) (p = 0.05). The median number of affected lung lobes and segments was higher in patients with positive RT-PCR results than in those with negative RT-PCR results (five vs 3.5 affected lobes and 15 vs nine affected segments; p < 0.05). Although the air bronchogram reticular pattern was more frequently seen in patients with positive results, centrilobular nodules were less frequently seen in patients with positive results. CONCLUSION. At the point during the COVID-19 outbreak when this study was performed, imaging patterns of multifocal, peripheral, pure GGO, mixed GGO, or consolidation with slight predominance in the lower lung and findings of more extensive GGO than consolidation on chest CT scans obtained during the first week of illness were considered findings highly suspicious of COVID-19.
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Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients. AJR Am J Roentgenol 2020; 215:87-93. [PMID: 32174129 DOI: 10.2214/ajr.20.23034] [Citation(s) in RCA: 850] [Impact Index Per Article: 170.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. Available information on CT features of the 2019 novel coronavirus disease (COVID-19) is scattered in different publications, and a cohesive literature review has yet to be compiled. MATERIALS AND METHODS. This article includes a systematic literature search of PubMed, Embase (Elsevier), Google Scholar, and the World Health Organization database. RESULTS. Known features of COVID-19 on initial CT include bilateral multilobar ground-glass opacification (GGO) with a peripheral or posterior distribution, mainly in the lower lobes and less frequently within the right middle lobe. Atypical initial imaging presentation of consolidative opacities superimposed on GGO may be found in a smaller number of cases, mainly in the elderly population. Septal thickening, bronchiectasis, pleural thickening, and subpleural involvement are some of the less common findings, mainly in the later stages of the disease. Pleural effusion, pericardial effusion, lymphadenopathy, cavitation, CT halo sign, and pneumothorax are uncommon but may be seen with disease progression. Follow-up CT in the intermediate stage of disease shows an increase in the number and size of GGOs and progressive transformation of GGO into multifocal consolidative opacities, septal thickening, and development of a crazy paving pattern, with the greatest severity of CT findings visible around day 10 after the symptom onset. Acute respiratory distress syndrome is the most common indication for transferring patients with COVID-19 to the ICU and the major cause of death in this patient population. Imaging patterns corresponding to clinical improvement usually occur after week 2 of the disease and include gradual resolution of consolidative opacities and decrease in the number of lesions and involved lobes. CONCLUSION. This systematic review of current literature on COVID-19 provides insight into the initial and follow-up CT characteristics of the disease.
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Lin X, Gong Z, Xiao Z, Xiong J, Fan B, Liu J. Novel Coronavirus Pneumonia Outbreak in 2019: Computed Tomographic Findings in Two Cases. Korean J Radiol 2020; 21:365-368. [PMID: 32056397 PMCID: PMC7039714 DOI: 10.3348/kjr.2020.0078] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 02/06/2023] Open
Abstract
Since the 2019 novel coronavirus (2019-nCoV or officially named by the World Health Organization as COVID-19) outbreak in Wuhan, Hubei Province, China in 2019, there have been a few reports of its imaging findings. Here, we report two confirmed cases of 2019-nCoV pneumonia with chest computed tomography findings of multiple regions of patchy consolidation and ground-glass opacities in both lungs. These findings were characteristically located along the bronchial bundle or subpleural lungs.
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Affiliation(s)
- Xiaoqi Lin
- Department of Radiology, Jiangxi Provincial People's Hospital, Jiangxi, China
| | - Zhenyu Gong
- Department of Prevention and Health Care, Jiangxi Provincial People's Hospital, Jiangxi, China
| | - Zuke Xiao
- Department of Respiratory, Jiangxi Provincial People's Hospital, Jiangxi, China
| | - Jingliang Xiong
- Department of Radiology, Jiangxi Chest Hospital, Jiangxi, China
| | - Bing Fan
- Department of Radiology, Jiangxi Provincial People's Hospital, Jiangxi, China.
| | - Jiaqi Liu
- Department of Radiology, Jiangxi Provincial People's Hospital, Jiangxi, China
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Abstract
Coronavirus disease 2019 (COVID-19) (previously known as novel coronavirus [2019-nCoV]), first reported in China, has now been declared a global health emergency by the World Health Organization. As confirmed cases are being reported in several countries from all over the world, it becomes important for all radiologists to be aware of the imaging spectrum of the disease and contribute to effective surveillance and response measures. © RSNA, 2020 See editorial by Kay and Abbara in this issue.
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Affiliation(s)
- Weifang Kong
- From the Department of Radiology, Sichuan Academy of Medical Science, Sichuan Provincial People’s Hospital, Chengdu, China (W.K.); and Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, CVC 5383, Ann Arbor, MI 48109 (P.P.A.)
| | - Prachi P. Agarwal
- From the Department of Radiology, Sichuan Academy of Medical Science, Sichuan Provincial People’s Hospital, Chengdu, China (W.K.); and Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, CVC 5383, Ann Arbor, MI 48109 (P.P.A.)
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Wu X, Dong D, Ma D. Thin-Section Computed Tomography Manifestations During Convalescence and Long-Term Follow-Up of Patients with Severe Acute Respiratory Syndrome (SARS). Med Sci Monit 2016; 22:2793-9. [PMID: 27501327 PMCID: PMC4982531 DOI: 10.12659/msm.896985] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background SARS is not only an acute disease, but also leads to long-term impaired lung diffusing capacity in some survivors. However, there is a paucity of data regarding long-term CT findings in survivors after SARS. The aim of this study was to assess the changes in lung function and lung thin-section computed tomography (CT) features in patients recovering from severe acute respiratory syndrome (SARS), especially the dynamic changes in ground-glass opacity (GGO). Material/Methods Clinical and radiological data from 11 patients with SARS were collected. The serial follow-up thin-section CTs were evaluated at 3, 6, and 84 months after SARS presentation. The distribution and predominant thin-section CT findings of lesions were evaluated. Results The extent of the lesions on the CT scans of the 11 patients decreased at 6 and 84 months compared to 3 months. The number of segments involved on 84-month follow-up CTs was less than those at 6 months (P<0.05). The predominant thin-section CT manifestation at 84 months (intralobular and interlobular septal thickening) was different than that at 6 months, at which GGO was predominant. Conclusions During convalescence after SARS, GGO and intralobular and interlobular septal thickening were the main thin-section CT manifestation. Intralobular and interlobular septal thickening predominated over GGO at 84 months.
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Affiliation(s)
- Xiaohua Wu
- Department of Radiology, Beijng Friendship Hospital, Capital Medical University, Beijng, China (mainland)
| | - Dawei Dong
- Department of Radiology, Beijng Xiaotangshan Hospital, Beijng, China (mainland)
| | - Daqing Ma
- Department of Radiology, Beijng Friendship Hospital, Capital Medical University, Beijng, China (mainland)
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Li P, Zhang JF, Xia XD, Su DJ, Liu BL, Zhao DL, Liu Y, Zhao DH. Serial evaluation of high-resolution CT findings in patients with pneumonia in novel swine-origin influenza A (H1N1) virus infection. Br J Radiol 2011; 85:729-35. [PMID: 22167502 DOI: 10.1259/bjr/85580974] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The purpose of our study was to review the changes in the serial high-resolution CT (HRCT) findings from patients with novel swine-origin influenza A (H1N1) virus (S-OIV) infection. METHODS HRCT findings of 70 patients with presumed or laboratory-confirmed novel S-OIV infection were reviewed. The pattern (consolidation, ground glass, fibrosis and air trapping), distribution and extent of abnormality of the lesions on the HRCT were evaluated at different time points. To assess changes that occurred over time, the CT scans in 56 patients were examined in sequence. RESULTS The most common CT findings in patients with S-OIV infection are ground-glass opacities with or without consolidation at the first week. The abnormalities peaked at the second week and resolved after that time, which resulted in substantial reduced residual disease at 4 weeks or later. The development of fibrosis was noted in the first week and peaked at the third week of illness (34.7%), then decreased slowly after that time. The mean time of air trapping being noted after the onset of symptoms was 55.5 ± 20.6 days. Comparing the findings of initial CT, most results (96.4%) of follow-up chest CT findings showed improvement (p<0.01). CONCLUSION The abnormalities of ground-glass opacities and/or consolidation on initial CT scans tended to resolve to fibrosis, which then resolved completely or displayed substantially reduced residual disease. HRCT may show more changes in disease progression and play an important role in the evaluation of severe S-OIV.
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Affiliation(s)
- P Li
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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Wong CKK, Lai V, Wong YC. Comparison of initial high resolution computed tomography features in viral pneumonia between metapneumovirus infection and severe acute respiratory syndrome. Eur J Radiol 2011; 81:1083-7. [PMID: 21439753 PMCID: PMC7127279 DOI: 10.1016/j.ejrad.2011.02.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 02/24/2011] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To review and compare initial high resolution computed tomography (HRCT) findings in patients with metapneumovirus pneumonia and severe acute respiratory syndrome (SARS-Coronovirus). MATERIALS AND METHODS 4 cases of metapneumovirus pneumonia (mean age of 52.3 years) in an institutional outbreak (Castle Peak Hospital) in 2008 and 38 cases of SARS-coronovirus (mean age of 39.6 years) admitted to Tuen Mun hospital during an epidemic outbreak in 2003 were included. HRCT findings of the lungs for all patients were retrospectively reviewed by two independent radiologists. RESULTS In the metapneumovirus group, common HRCT features were ground glass opacities (100%), consolidation (100%), parenchymal band (100%), bronchiectasis (75%). Crazy paving pattern was absent. They were predominantly subpleural and basal in location and bilateral involvement was observed in 50% of patients. In the SARS group, common HRCT features were ground glass opacities (92.1%), interlobular septal thickening (86.8%), crazy paving pattern (73.7%) and consolidation (68%). Bronchiectasis was not seen. Majority of patient demonstrated segmental or lobar in distribution and bilateral involvement was observed in 44.7% of patients. Pleural effusion and lymphadenopathy were of consistent rare features in both groups. CONCLUSION Ground glass opacities, interlobular septal thickening and consolidations were consistent HRCT manifestations in both metapneumovirus infection and SARS. The presence of bronchiectasis (0% in SARS) may point towards metapneumovirus while crazy paving pattern is more suggestive of SARS.
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Li P, Su DJ, Zhang JF, Xia XD, Sui H, Zhao DH. Pneumonia in novel swine-origin influenza A (H1N1) virus infection: high-resolution CT findings. Eur J Radiol 2010; 80:e146-52. [PMID: 20566254 PMCID: PMC7185744 DOI: 10.1016/j.ejrad.2010.05.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 05/26/2010] [Indexed: 11/29/2022]
Abstract
Objective The purpose of our study was to review the initial high-resolution CT (HRCT) findings in pneumonia patients with presumed/laboratory-confirmed novel swine-origin influenza A (H1N1) virus (S-OIV) infection and detect pneumonia earlier. Materials and methods High-resolution CT (HRCT) findings of 106 patients with presumed/laboratory-confirmed novel S-OIV (H1N1) infection were reviewed. The 106 patients were divided into two groups according to the serious condition of the diseases. The pattern (consolidation, ground-glass, nodules, and reticulation), distribution, and extent of abnormality on the HRCT were evaluated in both groups. The dates of the onset of symptoms of the patients were recorded. Results The predominant CT findings in the patients at presentation were unilateral or bilateral multifocal asymmetric ground-glass opacities alone (n = 29, 27.4%), with unilateral or bilateral consolidation (n = 50, 47.2%). The consolidation had peribronchovascular and subpleural predominance. The areas of consolidation were found mainly in the posterior, middle and lower regions of the lungs. Reticular opacities were found in 6 cases of the initial MDCT scan. The extent of disease was greater in group 1 patients requiring advanced mechanical ventilation, with diffuse involvement in 19 patients (63.3%) of group 1 patients, and only 15/76 (19.7%) of group 2 patients (p < 0.01, χ2 test). 20 cases (19%) of the 106 patients had small bilateral or unilateral pleural effusions. None had evidence of hilar or mediastinal lymph node enlargement on CT performed at admission or later. Conclusions The most common radiographic and CT findings in patients with S-OIV infection are unilateral or bilateral ground-glass opacities with or without associated focal or multifocal areas of consolidation. On HRCT, the ground-glass opacities had a predominant peribronchovascular and subpleural distribution. CT plays an important role in the early recognition of severe S-OIV (H1N1).
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Affiliation(s)
- Ping Li
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue Fu Road, Harbin 150086, China.
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Marchiori E, Zanetti G, Hochhegger B, Rodrigues RS, Fontes CAP, Nobre LF, Mançano AD, Meirelles G, Irion KL. High-resolution computed tomography findings from adult patients with Influenza A (H1N1) virus-associated pneumonia. Eur J Radiol 2010; 74:93-8. [DOI: 10.1016/j.ejrad.2009.11.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 11/02/2009] [Accepted: 11/04/2009] [Indexed: 11/25/2022]
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Ajlan AM, Khashoggi K, Nicolaou S, Müller NL. CT Utilization in the Prospective Diagnosis of a Case of Swine-Origin Influenza A (H1N1) Viral Infection. J Radiol Case Rep 2010; 4:24-30. [PMID: 22470716 DOI: 10.3941/jrcr.v4i3.427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this paper is to demonstrate the potential role of CT in the early diagnosis of swine-origin influenza A (H1N1) virus (S-OIV) pneumonia. We present a case of acute influenza-like illness in which the CT findings of peribronchovascular and subpleural ground-glass opacities and consolidation resembled organizing pneumonia, and lead the radiologist to prospectively and correctly suggest the diagnosis of S-OIV infection.
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Affiliation(s)
- Amr M Ajlan
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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Swine-origin influenza A (H1N1) viral infection: radiographic and CT findings. AJR Am J Roentgenol 2010; 193:1494-9. [PMID: 19933639 DOI: 10.2214/ajr.09.3625] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to review the chest radiographic and CT findings in patients with swine-origin influenza A (H1N1) virus (S-OIV) infection. CONCLUSION The most common radiographic and CT findings in seven patients with S-OIV infection are unilateral or bilateral ground-glass opacities with or without associated focal or multifocal areas of consolidation. On MDCT, the ground-glass opacities and areas of consolidation had a predominant peribronchovascular and subpleural distribution, resembling organizing pneumonia.
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Lachman RS. S. TAYBI AND LACHMAN'S RADIOLOGY OF SYNDROMES, METABOLIC DISORDERS AND SKELETAL DYSPLASIAS 2007. [PMCID: PMC7315357 DOI: 10.1016/b978-0-323-01931-6.50027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Severe acute respiratory distress syndrome (SARS) caused by SARS-associated coronavirus (SARS-CoV) is a systemic infection that clinically manifests as progressive pneumonia. During the initial phases of infection the virus causes pauci-inflammatory alveolar and interstitial edema that result in imaging abnormalities dominated by ground glass opacities (GGO). Severe SARS cases can develop radiologic and pathologic findings of diffuse alveolar damage. Although radiologic evidence of acute bronchiolitis is absent, SARS-CoV also infects ciliated airway epithelium, probably accounting for respiratory transmissibility of the virus. Radiologic recovery from SARS can be complete, but computed tomography images often show persistent GGO and reticular opacities, some of which reflect pathologic findings of fibrosis. Long-term follow-up imaging of survivors shows gradual decrease of GGO and reticulation with persistent air trapping in some patients. The latter is evidence of small airway disease that is not radiologically evident at the onset of the disease.
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Affiliation(s)
- Loren Ketai
- Department of Radiology, University of New Mexico Health Science Center, Albuquerque, NM 87131-0001, USA.
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Schueller-Weidekamm C, Wassermann E, Redl H, Prokop M, Zimpfer M, Herold C, Germann P, Ullrich R. Dynamic CT Measurement of Pulmonary Enhancement in Piglets with Experimental Acute Respiratory Distress Syndrome. Radiology 2006; 239:398-405. [PMID: 16641350 DOI: 10.1148/radiol.2392042177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate whether analysis of a washout curve of contrast material obtained with serial computed tomography (CT) enables differentiation between hydrostatic pulmonary edema and pulmonary edema caused by increased capillary permeability. MATERIALS AND METHODS The institutional committee on animal experiments approved this study, which was performed in accordance with designated guidelines. Chest CT was performed in 12 piglets after induction of anesthesia and start of mechanical ventilation. Dynamic CT was performed before and after induction of hydrostatic edema (n = 5) or oleic acid-induced increased vascular permeability edema (n = 7). Scans were obtained over 240 seconds during inspiratory breath holding at a single representative subcarinal level in the lungs. This anatomic level was kept constant and included areas of normal ventilation before and after induction of pulmonary edema and areas of ground-glass opacity and consolidation after induction of pulmonary edema. Measured lung attenuation in the regions of interest was normalized to that before contrast material injection and plotted as a function of time. Statistical analysis was performed by using two-way analysis of variance with repeated measures. RESULTS In general, before induction of pulmonary edema, attenuation of normally aerated lung areas did not increase after the initial peak of enhancement during the first pass of contrast material. In animals with hydrostatic edema, no attenuation changes in areas of ground-glass opacity were observed after the initial peak. Conversely, lung attenuation increased continuously in animals with oleic acid-induced high-permeability pulmonary edema (P = .002). After induction of lung edema, pulmonary enhancement measured in lung regions with normal ventilation or consolidation did not change in either group. Pulmonary fluid accumulation 90 minutes after induction of edema did not significantly differ between groups. CONCLUSION Dynamic contrast-material enhanced CT can help differentiate between permeability and hydrostatic lung edema in an animal model.
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Affiliation(s)
- Claudia Schueller-Weidekamm
- Department of Radiology, Medical University of Vienna, Vienna General Hospital, 18-20 Waehringer Guertel, 1090 Vienna, Austria
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Roberts A, Paddock C, Vogel L, Butler E, Zaki S, Subbarao K. Aged BALB/c mice as a model for increased severity of severe acute respiratory syndrome in elderly humans. J Virol 2005; 79:5833-8. [PMID: 15827197 PMCID: PMC1082763 DOI: 10.1128/jvi.79.9.5833-5838.2005] [Citation(s) in RCA: 171] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Advanced age has repeatedly been identified as an independent correlate of adverse outcome and a predictor of mortality in cases of severe acute respiratory syndrome (SARS). SARS-associated mortality may exceed 50% for persons aged 60 years or older. Heightened susceptibility of the elderly to severe SARS and the ability of SARS coronavirus to replicate in mice led us to examine whether aged mice might be susceptible to disease. We report here that viral replication in aged mice was associated with clinical illness and pneumonia, demonstrating an age-related susceptibility to SARS disease in animals that parallels the human experience.
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Affiliation(s)
- Anjeanette Roberts
- LID, NIAID, NIH, 50 South Dr., Room 6351, MSC 8007, Bethesda, MD 20892, USA.
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