Achados clínicos e radiológicos, perfil e evolução de pacientes internados com COVID-19 em uma enfermaria de referência em Salvador - BA / Clinical and radiological findings, profile and evolution of patients hospitalized for COVID-19 in a reference nurse in Salvador - BA

COVID-19 é a doença causada pelo coronavírus SARS-CoV-2. Esta doença foi responsável por uma pandemia no ano de 2020, que resultou em uma grande quantidade de óbitos. Nesse contexto, os exames radiológicos de pacientes com COVID-19 comumente demonstram distribuição bilateral de opacidades em vidro fosco, podendo existir consolidação periférica. Tais achados variam com a idade do paciente, progressão da doença, status da imunidade, comorbidades e intervenção médica inicial. Ademais, existem casos em que a sintomatologia do paciente não condiz com a gravidade das manifestações pulmonares. Objetivo: Analisar o perfil clínico radiológico e evolução de pacientes internados com diagnóstico de COVID-19, em uma enfermaria de um hospital de referência em Salvador-BA. Métodos: Estudo observacional, descritivo e analítico. Os dados foram coletados, por meio de análise de prontuário, acessados pelo computador (banco de dados) do Hospital Geral Ernesto Simões Filho (HGESF). Resultados: Foram coletados dados de um total de 70 pacientes. Destes, 29 (41,4%) participantes do sexo feminino e 41 (58,6%) do sexo masculino com idade variando entre menor que 60 anos (32,9%) e maior ou igual a 60 anos (67,1%), havendo 31 (44,3%) portadores de Diabetes Mellitus. Com relação aos sintomas apresentados, 59 (84,3%) pacientes cursaram com dispneia, 50 (71,4%) manifestaram tosse e 36 (51,4%) tiveram febre. Outros parâmetros clínicos como leucocitose foram evidenciados em 50 (71,4%) participantes, além da dessaturação (<90% spO2) presente em 25 (35,7%) participantes. Durante o internamento, 46 (65,7%) pacientes receberam tratamento com Azitromicina, 60(85,7%) pacientes foram transferidos para Unidade de Terapia Intensiva (UTI), 34 (48,6%) evoluíram com necessidade de intubação orotraqueal (IOT) e 32 (45,7%) foram a óbito. Tais variáveis foram analisadas junto ao percentual de acometimento pulmonar tomográfico que variou entre menor ou igual a 25% em 19 (27,1%) participantes, 26-49% em 19 (27,1%) participantes, 50-74% em 23 (32,9%) participantes e maior ou igual a 75% em 9 (12,9%) participantes. O envolvimento pulmonar foi preditor de óbito e acarretou mudança de conduta quanto ao tempo de internamento. Além disso, a presença de tosse foi constatada como um fator de alerta para o acometimento pulmonar mais grave. Ademais, o uso de azitromicina não predispôs menores percentuais de acometimento pulmonar.

COVID-19 is the disease caused by the coronavirus SARS-CoV-2. This disease was responsible for a pandemic in the year 2020, which resulted in a large number of deaths. In this context, it was noticed that the radiological examinations of patients with COVID-19 commonly demonstrate bilateral distribution of ground glass opacities, with the possibility of peripheral consolidation. Such findings vary with the patient's age, disease progression, immunity status, comorbidities and initial medical intervention. In addition, there are cases in which the patient's symptoms do not match the severity of the pulmonary manifestations. Objective: To analyze the clinical-radiological findings, profile and evolution of patients hospitalized with COVID-19 in a referral ward in Salvador-BA. MethodS: Observational, descriptive and analytical study. Data were collected through medical record analysis, accessed by the computer (database) of the Hospital Geral Ernesto Simões Filho (HGESF). Results: Data were collected from a total of 70 patients. Of these, 29 (41.4%) female participants and 41 (58.6%) male participants, aged between less than 60 years (32.9%) and greater than or equal to 60 years (67.1%), with 31 (44.3%) patients with Diabetes Mellitus. Regarding the symptoms presented, 59 (84.3%) patients had dyspnea, 50 (71.4%) had cough and 36 (51.4%) had fever. Other clinical parameters such as leukocytosis were evidenced in 50 (71.4%) participants, in addition to desaturation (<90% spO2) present in 25 (35.7%) participants. During hospitalization, 46 (65.7%) patients received treatment with Azithromycin, 60 (85.7%) patients were transferred to the intensive care unit (ICU), 34 (48.6%) envolved with the need for cheal intubation and 32 (45.7%) they died. These variables were analyzed along with the percentage of tomographic pulmonary involvement, which ranged from less than or equal to 25% in 19 (27.1%) participants, 26-49% in 19 (27.1%) participants, 50-74% in 23 (32.9%) participants and greater than or equal to 75% in 9 (12.9%) participants. Pulmonary involvement was a predictor of death and led to a change in conduct regarding the length of stay. In addition, the presence of cough was found to be an alert factor for the most severe pulmonary involvement. Furthermore, the use of azithromycin did not predispose lower percentages to pulmonary involvement

Relación de las medidas de mecánica ventilatoria y radiográficas con el tiempo de conexión a ventilación mecánica en pacientes COVID-19: un análisis preliminar / Relations of ventilatory mechanical and radiographic measures with the connection time to mechanical ventilation in patients COVID-19: a preliminary analysis

RESUMEN: Los pulmones son el sitio predominante en la infección por COVID-19. Esta puede conducir al síndrome distrés respiratorio agudo (SDRA). Frente a su sintomatología severa, la ventilación mecánica (VM), y sus valores de mecánica ventilatoria aparecen como una herramienta fundamental. Un complemento, para analizar el estado de avance de esta patología es la radiografía de tórax (RT), aunque en ocasiones esta depende de la experiencia del equipo de salud. Así el objetivo de esta investigación fue explorar la relación de las medidas de mecánica ventilatoria y radiográficas con el tiempo de conexión a VM en pacientes COVID-19. Estudio retrospectivo, que incluyó a 23 pacientes en VM. Se recolectó información de variables de mecánica ventilatoria; PEEP, presión plateau, presión de distensión y compliance estática. Desde la RT se midió, altura y ancho pulmonar, ángulo costodiafragmático y espacio intercostal. Los resultados indicaron que las variables de mecánica ventilatoria tales como el PEEP y el plateau se relacionaron significativamente con el tiempo de conexión a VM (r=0,449; p=0,035 y r=0,472; p=0,026), mientras que las variables radiográficas construidas en base al ángulo costodiafragmático y el espacio intercostal presentaron similares comportamientos (r= 0,462; p=0,046 y r=-0,543; p=0,009). En conclusión, la presión resultante de la programación del ventilador mecánico junto a cambios estructurales observados en la RT, se relacionan con el tiempo de conexión a VM.

SUMMARY: The lungs are the predominant site of COVID-19 infection. This can lead to severe acute respiratory síndrome (ARDS). In view of its severe symptoms, mechanical ventilation (MV) and its ventilatory mechanics values appear as a fundamental tool. Chest radiography (CR) is a complement to analyze the state of progress of this pathology, although this sometimes depends on the experience of the health team. Thus, the aim of this research was to explore the relationship of ventilatory mechanics and radiographic measures with connection time to MV in COVID-19 patients. Retrospective study, which included 23 patients on MV. Information on ventilatory mechanics variables was collected; PEEP, plateau pressure, distension pressure and static compliance. And from CR, lung height and width, costodiaphragmatic angle and intercostal space were measured. The results indicated that ventilatory mechanics variables such as PEEP and plateau were significantly related to connection time to MV (r = 0.449; p = 0.035 and r = 0.472; p = 0.026), while the radiographic variables Constructed on the basis of the costodiaphragmatic angle and the intercostal space, they showed similar behaviors (r = 0.462; p = 0.046 and r = -0.543; p = 0.009). In conclusion, the pressure resulting from mechanical ventilator programming, together with the structural changes observed in CR, are related to the connection time to MV.

Métodos diagnósticos para la infección por SARS-CoV-2 / Diagnostic methods for SARS-CoV-2 infection

En diciembre de 2019 se identificó el virus SARS-CoV-2, cuya rápida propagación global puso en estado de emergencia al mundo entero, llevando al ser humano a una situación sin antecedente cercano. El objetivo de esta revisión es describir los métodos diagnósticos utilizados actualmente para identificar la infección por SARS-CoV-2. Las manifestaciones clínicas y el espectro imagenológico de la enfermedad son muy inespecíficos y no permiten realizar un diagnóstico certero. Por esta razón, es esencial una apropiada toma de muestra respiratoria en el momento y sitio anatómico adecuado para un diagnóstico preciso de COVID-19. La técnica de muestreo más utilizada es el hisopado nasofaríngeo y la prueba diagnóstica más fiable se basa en la retrotranscripción seguida por reacción en cadena de la polimerasa en tiempo real (RT-PCR). No obstante, existen otras técnicas moleculares, como también tests serológicos para detectar anticuerpos o fragmentos antigénicos del SARS-CoV-2. Más allá de la precisión diagnóstica, es importante tener en cuenta la probabilidad basal (pretest) para interpretar correctamente el resultado obtenido y aislar aquellos posibles falsos negativos. Con el objetivo de evitar la saturación del sistema de salud es imprescindible contar con información y métodos diagnósticos precisos para detectar tempranamente los focos de infección y reducir la transmisión comunitaria, utilizando eficazmente los diferentes recursos diagnósticos. (AU)

In December 2019, the SARS-CoV-2 virus was identified for the first time, whose rapid global spread put the entire world in a state of emergency, leading humans to an unprecedented situation with no immediate history. The main purpose of this review is to describe the diagnostic methods currently used to identify SARS-CoV-2 infection. The clinical manifestations and the imaging spectrum of the disease are nonspecific and do not allow an accurate diagnosis to be made. For this reason, an appropriate respiratory sampling at the right time and anatomical site is essential for an accurate diagnosis of COVID-19. The most widely used sampling technique is nasopharyngeal swab, and the most reliable diagnostic test is by reverse transcription followed by real-time polymerase chain reaction (RT-PCR). However, there are other molecular techniques, as well as serological tests to detect antibodies or antigenic fragments of SARS-CoV-2. Beyond the diagnostic precision, it is important to take into account the baseline probability (pre-test) to correctly interpret the result obtained and isolate those possible false negatives. In order to avoid saturation of the health system, it is essential to have accurate information and diagnostic methods to detect outbreaks of infection in early stages and to reduce communitary transmission, making effective use of the various diagnostic resources. Coronavirus infections/diagnosis, viral/diagnosis, pandemics, clinical laboratory techniques, real-time polymerase chain reaction, antigens, viral/analysis. (AU)

Hallazgos por imágenes en COVID-19: actualización y guía práctica / Imaging findings in COVID-19: update and practical guide

El cuadro clínico de la enfermedad conocida como COVID-19, causada por el nuevo coronavirus SARS-CoV-2 puede variar desde síntomas respiratorios leves hasta una insuficiencia respiratoria severa. Sus efectos en el organismo, especialmente la afección pulmonar, pueden ser visualizados a través de los estudios por imágenes. Si bien el diagnóstico de certeza se confirma mediante la reacción en cadena de la polimerasa con transcriptasa reversa (RT-PCR), los estudios por imágenes, especialmente la radiografía y la tomografía computarizada (TC) de tórax, desempeñan un papel fundamental en el manejo clínico de estos pacientes. Conocer su utilidad, casos de uso y hallazgos esperables brinda herramientas para el equipo de salud, temas que serán abordados en esta actualización y guía práctica. (AU)

The clinical pattern of the disease known as COVID-19, caused by the new coronavirus SARS-Cov-2 can range from mild respiratory symptoms to severe respiratory failure. Its effects on the body, especially the lung condition, can be visualized through imaging studies. While the diagnosis of certainty is confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR), imaging studies, especially chest xray and computed tomography (CT), play a critical role in the clinical management of these patients. Knowing their usefulness, use cases, and expected findings provides tools for the health care team, topics that will be addressed in this update, and practical guide. (AU)

Infusion of convalescent plasma is associated with clinical improvement in critically ill patients with Covid-19: a pilot study

ABSTRACT Background: The ideal treatment of coronavirus disease (COVID)-19 has yet to be defined, but convalescent plasma (CoPla) has been successfully employed. Objective: The objective of the study was to study the safety and outcomes of the administration of CoPla to individuals with severe COVID-19 in an academic medical center. Methods: Ten patients were prospectively treated with plasma from COVID-19 convalescent donors. Results: Over 8 days, the sequential organ failure assessment score dropped significantly in all patients, from 3 to 1.5 (p = 0.014); the Kirby index (PaO2/FiO2) score increased from 124 to 255, (p < 0.0001), body temperature decreased significantly from 38.1 to 36.9°C (p = 0.0058), and ferritin levels also dropped significantly from 1736.6 to 1061.8 ng/ml (p = 0.0001). Chest X-rays improved in 7/10 cases and in 6/10, computerized tomography scans also revealed improvement of the lung injury. Decreases in C-reactive protein and D-dimer levels were also observed. Three of five patients on mechanical ventilation support could be extubated, nine were transferred to conventional hospital floors, and six were sent home; two patients died. The administration of CoPla had no side effects and the 24-day overall survival was 77%. Conclusions: Although other treatments were also administered to the patients and as a result data are difficult to interpret, it seems that the addition of CoPla improved pulmonary function.

Uso de exames de imagem de tórax na COVID-19: guia de aconselhamento rápido, 11 junho 2020 / Use of chest imaging in COVID-19: a rapid advice guide, 11 June 2020

Desde sua identificação na China em dezembro de 2019, o novo coronavírus responsável pela COVID-19 evoluiu rapidamente para uma pandemia. A COVID-19 se manifesta com sintomas respiratórios inespecíficos de gravidade variável e pode exigir suporte respiratório avançado. Atualmente, o diagnóstico de COVID- 19 é confirmado por testes laboratoriais através da identificação de RNA viral na reação em cadeia da polimerase com transcriptase reversa (RT-PCR). Os exames de imagem de tórax foram considerados como parte da investigação diagnóstica de pacientes com suspeita ou probabilidade de COVID-19, nos lugares em que a RT-PCR não está disponível ou em que os resultados demoram ou são inicialmente negativos na presença de sintomas sugestivos de COVID-19. Os exames de imagem também foram considerados na complementação da avaliação clínica e dos parâmetros laboratoriais no tratamento de pacientes já diagnosticados com COVID-19. Antes de iniciar o desenvolvimento deste guia, vários estados-membros solicitaram um parecer da OMS sobre o papel dos exames de imagem do tórax em pacientes com suspeita ou confirmação de COVID-19. Uma revisão das práticas de exames de imagem em pacientes com suspeita ou confirmação de COVID-19 em todo o mundo encontrou grandes variações. Isso motivou o desenvolvimento de diretrizes globais sobre o uso de exames de imagem de tórax para apoiar os estados membros na resposta à pandemia da COVID-19. Este guia de aconselhamento rápido examina as evidências e faz recomendações para o uso de exames de imagem do tórax em pacientes agudos com suspeita, probabilidade ou confirmação de COVID-19, incluindo radiografia de tórax, tomografia computadorizada (TC) e ultrassonografia pulmonar. Destina-se a ser um guia prático para os profissionais de saúde envolvidos na evolução da atenção à COVID-19, desde o momento de chegada a um estabelecimento de saúde até a alta hospitalar. A orientação é relevante para pacientes com diferentes níveis de gravidade da doença, desde indivíduos assintomáticos a pacientes críticos...

Ultrasonido Pulmonar en COVID-19 / Lung Ultrasound in COVID-19

Resumen: La llegada de la pandemia COVID-19 originada por el virus SARS-CoV-2 ha requerido de una rápida respuesta de múltiples especialidades médicas, incluída la Imagenología. El Ultrasonido pulmonar es una técnica que previamente ha demostrado utilidad en otras patologías pulmonares, la cual ofrece alta disponibilidad, bajo costo, ausencia de radiaciones ionizantes y la posibilidad de evaluar al paciente in situ. En algunos de los países afectados más temprana e intensamente por la pandemia, como China e Italia, se ha utilizado como estudio imagenológico complementario para evaluación y seguimiento de los pacientes afectados por esta patología. Para obtener un resultado satisfactorio es necesario seleccionar el equipamiento, protección, desinfección y protocolo adecuados. Los hallazgos ecográficos descritos hasta el momento en la literatura son de carácter inespecífico, pero su combinación y distribución anatómica en un contexto clínico y epidemiológico compatible, los hacen sugerentes de esta enfermedad y permiten evaluar en forma seriada la evolución del cuadro. La literatura disponible es incipiente y es necesaria la generación de más evidencia para cuantificar adecuadamente el aporte de esta modalidad de estudio en los pacientes con COVID-19.

Abstract: The arrival of the COVID-19 pandemic originated by the SARS-CoV-2 virus has required a quick response by multiple medical specialties, including Imaging. Lung Ultrasound is an exam that has previously demonstrated its utility in other lung diseases, with high availability, low cost, absence of ionizing radiation and the possibility to have a bed-side assessment. In some of the countries that experienced earlier and more intense effects of the pandemic, as China and Italy, it has been used as an imaging modality for evaluation and follow-up for COVID-19 patients. In order to achieve a satisfactory result, adequate equipment, protection, disinfection and protocol must be chosen. The US findings described so far in the literature are nonspecific, but their combination and anatomical distribution in a compatible clinical and epidemiologic context, made them highly suggestive of this disease and allow for a serial follow-up. The current literature is scarce and more evidence is needed to truly estimate the usefulness of this imaging modality in the evaluation of COVID-19 patients.

Interpretación de patrones radiológicos sugerentes de COVID-19 en pediatría / Interpretation of radiological patterns suggesting COVID-19 in pediatrics

The CoVID-19 pandemic has impacted in a lesser extent and intensity to patients younger than 15 years. The role of different imaging studies of lung involvement has been extensively addressed, from the first cases of severe pneumonia and respiratory distress syndrome in adults. There are fewer reports of the comparative usefulness of conventional radiology, ultrasound, and computed axial tomography in children. Of those, ground glass opacities, crazy paving pattern and surrounding halo consolidation are the most characteristic. Even though none of them allows diagnostic confirmation, their correct interpretation helps in decision flows. Computed axial tomography is more accurate for defining the type and extent of lung parenchymal involvement. The role of the ultrasound in early stages in the emergency department is clearer in adults than in children, in whom there is a good correlation with chest tomography. This article addresses the different radiological patterns, their pathophysiological representation and differential diagnoses, in order to alert pediatricians of their interpretation, as well as the potential role of imaging diagnoses most frequently used in children with low acute respiratory infection.

La pandemia CoVID-19 ha impactado en una proporción e intensidad menor a los pacientes menores de 15 años. El rol de los diferentes estudios por imágenes del compromiso pulmonar ha sido extensamente abordado, desde los primeros casos de neumonías graves y síndrome de distrés respiratorio en adultos. En niños existen menos reportes de la utilidad de la radiología convencional, ecografía y tomografía axial computarizada. Sin embargo, los patrones más característicos observados en adultos se repiten en los niños. De ellos, el vidrio esmerilado, el patrón en empedrado y la consolidación con halo circundante son los más característicos. Aun cuando ninguno de ellos permite confirmación diagnóstica, su correcta interpretación ayuda en los flujos de decisiones. La tomografía axial computarizada es más certera para la definición de tipo y extensión del compromiso parenquimatoso pulmonar. El rol en los estadios tempranos en el servicio de urgencia de la ecografía es más claro en adultos que en niños, donde existe buena correlación con la tomografía de tórax. Este artículo aborda los diferentes patrones radiológicos, su representación fisiopatológica y diagnósticos diferenciales, con el objeto de apoyar a los pediatras en su interpretación, como también reconocer el rol de las técnicas de imágenes diagnósticas más frecuentemente utilizadas en niños con infección respiratoria aguda baja.

El diagnóstico imagenológico en la atención al paciente con infección por SARS-CoV-2 / Imaging diagnosis in SARS-CoV-2 patient care

Introducción: La pandemia de la COVID-19 ha requerido de una rápida respuesta de la especialidad Imagenología. Objetivo: Ofrecer un referente respecto a la expresión de la COVID-19 en la tomografía computarizada del pulmón y en la radiografía simple de tórax. Método: En el Hospital General Docente "Dr. Agostinho Neto", entre junio y octubre de 2020 se realizó una revisión narrativa sobre este tema a través de una búsqueda en diferentes bases de datos bibliográficas: Pubmed/Medline, Science Direct y SciELO. La búsqueda se realizó con el buscador Google Académico, y se usó palabras clave y conectores COVID-19 AND imaging; SARS-CoV-2 AND radiography; 2019-nCOV AND Computed tomography; SARS-CoV-2, COVID-19, y los términos equivalentes en español. Resultados: Los hallazgos más frecuentes en la tomografía pulmonar son la presencia de opacidades pulmonares con densidad en vidrio esmerilado (53-100 por ciento), su asociación a focos de condensación (27-72 por ciento) y engrosamiento intersticial con patrón de tipo empedrado (crazy-paving) (19 por ciento). La expresión en la radiografía de pulmón es similar a la que se refleja en la tomografía computada. Conclusiones: Estos medios diagnósticos son útiles para identificar la lesión pulmonar en la COVID-19. La afectación en vidrio deslustrado, aislada o en combinación con consolidaciones pulmonares es el hallazgo imagenológico más común. Las imágenes se deben interpretar con la consideración de las manifestaciones clínicas y el contexto epidemiológico con riesgo de infección por SARS-CoV-2. No obstante, sobre su base se han propuestos diversas escalas pronósticas que requieren ser validadas(AU)

Introduction: COVID-19 pandemic has required a rapid-response capacity of the imaging services. Objective: To offer a reference regarding COVID-19 lesions in lungs and thorax based on computed tomography (CT) scan and radiographic image. Method: A narrative review was carried out at the General Teaching Hospital "Dr. Agostinho Neto" from June to October 2020, through the following databases (Pubmed/Medline, Science Direct y SciELO). Google scholar was the search engine used in the research, with the following keywords and links: COVID-19 AND imaging; SARS-CoV-2 AND radiography; 2019-nCOV AND Computed tomography; SARS-CoV-2, COVID-19, and the equivalent terms in Spanish. Results: The most frequent findings in lung CT scan were lung ground-glass opacities (53 percent-100 percent), with association to pulmonary consolidation (27 percent-72 percent) and interstitial thickening with a cobblestone pattern (crazy paving) (19 percent). Lung radiographic images are similar to the images obtained via computed tomography. Conclusions: These diagnostic tools are useful to identify lung lesions caused by COVID-19. Ground-glass opacity in combination with pulmonary consolidations is the most common imaging finding. The images should be interpreted taking into account the clinical manifestations and the epidemiologic context in which SARS-CoV-2 remains a risk of infection. However, several prognostic scales based on imaging have been proposed that still need to be validated(AU)

El diagnóstico imagenológico en la atención al paciente con infección por SARS-CoV-2 / Imaging diagnosis in SARS-CoV-2 patient care

RESUMEN Introducción: La pandemia de la COVID-19 ha requerido de una rápida respuesta de la especialidad Imagenología. Objetivo: Ofrecer un referente respecto a la expresión de la COVID-19 en la tomografía computarizada del pulmón y en la radiografía simple de tórax. Método: En el Hospital General Docente Dr. Agostinho Neto, entre junio y octubre de 2020 se realizó una revisión narrativa sobre este tema a través de una búsqueda en diferentes bases de datos bibliográficas: Pubmed/Medline, Science Direct y SciELO. La búsqueda se realizó con el buscador Google Académico, y se usó palabras clave y conectores COVID-19 AND imaging; SARS-CoV-2 AND radiography; 2019-nCOV AND Computed tomography; SARS-CoV-2, COVID-19, y los términos equivalentes en español. Resultados: Los hallazgos más frecuentes en la tomografía pulmonar son la presencia de opacidades pulmonares con densidad en vidrio esmerilado (53-100 por ciento), su asociación a focos de condensación (27-72 por ciento) y engrosamiento intersticial con patrón de tipo empedrado (crazy-paving) (19 por ciento). La expresión en la radiografía de pulmón es similar a la que se refleja en la tomografía computada. Conclusiones: Estos medios diagnósticos son útiles para identificar la lesión pulmonar en la COVID-19. La afectación en vidrio deslustrado, aislada o en combinación con consolidaciones pulmonares es el hallazgo imagenológico más común. Las imágenes se deben interpretar con la consideración de las manifestaciones clínicas y el contexto epidemiológico con riesgo de infección por SARS-CoV-2. No obstante, sobre su base se han propuestos diversas escalas pronósticas que requieren ser validadas.

ABSTRACT Introduction: COVID-19 pandemic has required a rapid-response capacity of the imaging services. Objective: To offer a reference regarding COVID-19 lesions in lungs and thorax based on computed tomography (CT) scan and radiographic image. Method: A narrative review was carried out at the General Teaching Hospital Dr. Agostinho Neto from June to October 2020, through the following databases (Pubmed/Medline, Science Direct y SciELO). Google scholar was the search engine used in the research, with the following keywords and links: COVID-19 AND imaging; SARS-CoV-2 AND radiography; 2019-nCOV AND Computed tomography; SARS-CoV-2, COVID-19, and the equivalent terms in Spanish. Results: The most frequent findings in lung CT scan were lung ground-glass opacities (53-100 per cent), with association to pulmonary consolidation (27-72 per cent) and interstitial thickening with a cobblestone pattern (crazy paving) (19 per cent). Lung radiographic images are similar to the images obtained via computed tomography. Conclusions: These diagnostic tools are useful to identify lung lesions caused by COVID-19. Ground-glass opacity in combination with pulmonary consolidations is the most common imaging finding. The images should be interpreted taking into account the clinical manifestations and the epidemiologic context in which SARS-CoV-2 remains a risk of infection. However, several prognostic scales based on imaging have been proposed that still need to be validated.

Uso de ultrasonido pulmonar para la detección de neumonía intersticial en COVID-19 / Lung ultrasound for the identification of COVID-19 pneumonia

Resumen La infección por SARS-CoV-2 tiene como manifestación clínica la enfermedad conocida como COVID-19. Si bien el conocimiento de la naturaleza de la enfermedad es dinámico, publicándose cada día decenas de artículos científicos sobre nuevas características de COVID-19, la presentación típica es la de neumonía intersticial. A pesar de la gran cantidad de información que se ha desarrollado en las últimas semanas, se ha estimado que esta enfermedad puede llegar a tener hasta un 72% de infradiagnóstico, por lo que se requieren herramientas clínicas que sean simples, de fácil acceso, que incrementen la detección de casos de forma factible y que arrojen información con valor pronóstico. Ante esta necesidad, han surgido algunas propuestas para poder realizar el diagnóstico, seguimiento y respuesta al tratamiento de los pacientes con COVID-19, tales como el ultrasonido pulmonar (USP). Cabe mencionar que el USP ha probado ser una técnica eficiente y de fácil reproducibilidad para diagnosticar insuficiencia cardiaca y patologías pleuro-pulmonares, sobre todo en pacientes críticamente enfermos. La evidencia de la utilidad de USP en COVID-19 es aún escasa, aunque de forma preliminar, parece ser una técnica sensible cuyos hallazgos tienen una elevada gold-standard. En esta breve revisión haremos énfasis en sus aspectos técnicos, las ventajas y desventajas, y por último una propuesta para el abordaje en este tipo de pacientes.

Abstract The SARS-CoV-2 infection has as a clinical manifestation the disease known as COVID-19. Although knowledge of the nature of the disease is dynamic, with dozens of scientific articles being published every day about new features of COVID-19, the typical presentation is that of interstitial pneumonia. Despite the large amount of information that has been developed in recent weeks, it has been estimated that this disease can have up to 72% underdiagnosis, which requires clinical tools that are simple, easily accessible, and increase the detection of cases in a feasible way and that yield information with prognostic value. Given this need, some proposals have emerged to be able to diagnose, monitor and respond to the treatment of patients with COVID-19, such as pulmonary ultrasound (USP). It is worth mentioning that the USP has proven to be an efficient and easily reproducible technique for diagnosing heart failure and pleuro-pulmonary pathologies, especially in critically ill patients. Evidence of the usefulness of USP in COVID-19 is still scarce, although preliminary, it seems to be a sensitive technique whose findings have a high gold standard. In this brief review we will emphasize its technical aspects, the advantages and disadvantages, and finally a proposal for the approach in this type of patient.

Imaging findings in COVID-19 pneumonia

The coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan city and was declared a pandemic in March 2020. Although the virus is not restricted to the lung parenchyma, the use of chest imaging in COVID-19 can be especially useful for patients with moderate to severe symptoms or comorbidities. This article aimed to demonstrate the chest imaging findings of COVID-19 on different modalities: chest radiography, computed tomography, and ultrasonography. In addition, it intended to review recommendations on imaging assessment of COVID-19 and to discuss the use of a structured chest computed tomography report. Chest radiography, despite being a low-cost and easily available method, has low sensitivity for screening patients. It can be useful in monitoring hospitalized patients, especially for the evaluation of complications such as pneumothorax and pleural effusion. Chest computed tomography, despite being highly sensitive, has a low specificity, and hence cannot replace the reference diagnostic test (reverse transcription polymerase chain reaction). To facilitate the confection and reduce the variability of radiological reports, some standardizations with structured reports have been proposed. Among the available classifications, it is possible to divide the radiological findings into typical, indeterminate, atypical, and negative findings. The structured report can also contain an estimate of the extent of lung involvement (e.g., more or less than 50% of the lung parenchyma). Pulmonary ultrasonography can also be an auxiliary method, especially for monitoring hospitalized patients in intensive care units, where transfer to a tomography scanner is difficult.

Concordance of chest ct and nucleic acid testing in diagnosing coronavirus disease outside its district of origin (Wuhan, China)

OBJECTIVES: This study aimed to determine the concordance between CT and nucleic acid testing in diagnosing coronavirus disease (COVID-19) outside its district of origin (Wuhan, China). METHODS: Twenty-three consecutive patients with COVID-19, confirmed by nucleic acid testing, were enrolled from two designated hospitals outside the district of disease origin. We collected clinical, laboratory, and CT data and assessed the concordance between CT manifestations and nucleic acid test results by comparing the percentage of patients with and without abnormal CT findings. Furthermore, using Chi-square tests, we analyzed the differences in CT manifestations between patients with and without an exposure history or symptoms. RESULTS: Multiple ground-glass opacities (GGOs), with or without consolidation, were observed on the initial CT scans of 19 patients (82.6%), whereas the remaining 4 (17.4%) showed no CT abnormalities, indicating that the initial chest CT findings were not entirely concordant with the nucleic acid test results in diagnosing COVID-19. Among the latter 4 patients, we observed multiple GGOs with and without consolidation in 2 patients on the follow-up chest CT scans taken on days 7 and 14 after admission, respectively. The remaining 2 patients showed no abnormalities on the follow-up CT scans. Furthermore, abnormal CT findings were found more frequently in patients who had been exposed to COVID-19 in its district of origin than in those who had not been exposed and in symptomatic patients than in asymptomatic patients (all p<0.05). CONCLUSIONS: Patients with positive results on nucleic acid testing may or may not have the abnormal CT manifestations that are frequently found in symptomatic patients with a history of exposure to the district of COVID-19 origin.