Características de neumonía por Covid-19 en tc de tórax: revisión de la literatura actual / Features of Covid-19 pneumonia in chest ct: current literature review

INTRODUCCIÓN: Desde diciembre de 2019 la neumonía por SARS-CoV-2 ha experimentado un fuerte avance presentando a la fecha más de nueve millones de casos a nivel mundial. El objetivo de esta revisión es describir las principales características de la neumonía por COVID-19 en la tomografía computada (TC) de tórax en pacientes adultos. MATERIALES Y MÉTODOS: Se buscaron en PubMed artículos que se centraran en las características de la infección por COVID-19 en la tomografía computada de tórax en adultos durante el último año, en inglés y español. Las palabras clave fueron: "COVID-19", "chest CT manifestations" "chest CT findings" y "chest CT features", excluyendo estudios en población pediátrica, cartas al editor y casos clínicos. Se examinaron títulos y resúmenes de artículos obtenidos y se descartaron estudios no atingentes al objetivo de la investigación. RESULTADOS: Se obtuvieron 21 artículos. Una gran variedad de hallazgos en la TC de tórax han sido reportados en los distintos artículos revisados, siendo los más característicos las opacidades en "vidrio esmerilado" de predominio periférico y bilateral; con o sin consolidaciones, que además pueden asociarse a engrosamiento septal interlobulillar, conformando un patrón en empedrado (crazy paving) y a engrosamiento perivascular. Menos frecuentes son el compromiso central, la presencia de nódulos, quistes y derrame pleural. CONCLUSIONES: La tomografía computada de tórax tiene un papel fundamental en la evaluación y manejo de los pacientes con COVID-19, con un evidente rol diagnóstico en ciertas situaciones. El conocimiento de sus características imagenológicas resulta de suma importancia en el contexto actual

Introduction: The new Coronavirus Disease 2019 (COVID-19) has become an unprecedented global health emergency. The World Health Organization estimates global mortality from COVID-19 at 3.4%, however it will be higher in patients with comorbidities such as Cancer (5.6%), High Blood Pressure (6.0%), Chronic respiratory disease (6.3%), Diabetes (7.3%) and Cardiovascular Disease (10.5%). These diseases are among the most prevalent in the world, for this reason we pretend to synthesize their pathophysiology and role in COVID-19, in order to identify effective measures that decrease morbidity and mortality in these high risk groups. Methodology: A review was performed using the databases MEDLINE, PubMed and Google Scholar. Original articles and bibliographic review articles were considered, prioritizing the articles published this year. Results: SARS-CoV-2 uses the enzyme ACE2 as a functional receptor, which allows its entry into the host cell. Eventually, regulates its expression downward, with Angiotensin-II prevailing with its profibrotic, prothrombotic and proinflammatory functions, leading to the deleterious effects of the disease. Chronic non-transmissible diseases (NTCD) would have baseline alteration in ACE2 levels, dysregulation of the immune system, endothelial dysfunction, and chronic inflammation, which would be associated with increased susceptibility and severity in COVID-19. Conclusion: Prevention and identification of risk patients remains the main measure against COVID-19. It is necessary to emphasize efforts in the prevention of NTCD and the promotion of healthy lifestyles. The negative effects of prolonged confinement and suspension of health care services must be considered.

Perfil epidemiológico de pacientes com nódulos pulmonares em acompanhamento ambulatorial no período de 2013 a 2015 / Epidemiological profile of patients with pulmonary nodules in clinic follow-up in the period from 2013 to 2015

Este artigo teve como objetivo conhecer o perfil epidemiológico dos pacientes com nódulos pulmonares descobertos de forma acidental e seu desfecho durante o acompanhamento no ambulatório de pneumologia de Criciúma/SC entre os anos de 2013 a 2015. Realizou-se um estudo observacional, longitudinal, retrospectivo, de abordagem quantitativa, com coleta de dados de 250 prontuários de pacientes com diagnóstico de nódulo pulmonar ao acaso. As características clínicas estudadas foram: gênero, idade, tabagismo, carga tabágica e o exame de diagnóstico. As características radiográficas avaliadas em relação ao nódulo foram: presença de margens espiculadas, tamanho nodular, localização anatômica e, posteriormente, os nódulos foram classificados em: provavelmente benigno, maligno ou indeterminado. Como resultado, percebeu-se que 58,8%dos casos de nódulo pulmonar foram observados em mulheres, sendo a faixa etária mais comum, independente de gênero, entre 51-70 anos. Em 60,6% dos pacientes, o raio-X de tórax foi o exame que detectou esses nódulos. Observou-se, também, que 60,8% dos nódulos foram classificados como provavelmente benigno e 44,8% dos nódulos localizaram-se em lobos superiores. Houve associação significativa entre malignidade do nódulo e tamanho do mesmo (p = 0,001).Portanto, conclui-se que a prevalência dos nódulos incidentais foi maior na faixa etária de 51-70 anos, sendo que as mulheres alcançaram porcentagem 17,6% superior ao sexo masculino. Verificou-se predomínio da distribuição dos nódulos em lobos superiores e da categorização dos nódulos como provavelmente benignos. Além disso, significância estatística foi constatada em relação aos maiores tamanhos nodulares e provável desfecho maligno (p = 0,001).

This article had as objective to know the epidemiological profile of patients with accidentally discovered pulmonary nodules and their outcome during the follow-up in the Criciúma/SC pneumology clinic between 2013 and 2015. An observational, longitudinal, retrospective study, with quantitative approach was performed with data collection of 250 medical records of patients with diagnosis of incidental pulmonary nodules. The clinical characteristics studied were: gender, age, smoking, smoking load and diagnostic examination. The radiographic characteristics evaluated in relation to the nodule were: presence of spiculated margins, nodular size, anatomical location and, later, the nodules were classified in: probably benign, malignant or undetermined. As a result, it was observed that 58,8% of the cases of pulmonary nodule were observed in women, being the most common age group, independent of gender, between 51-70 years. In 60,6% of the patients, the chest xray was the test that detected theses nodules. It was also observed that 60,8% of the nodules were classified as probably benign and 44,8% of the nodules were located in upper lobes. There was a significant association between nodule malignancy and size of the nodule (p = 0.001). Therefore, it is concluded that the prevalence of incidental nodules was higher in the age group of 51-70 years, and women reached percentage 17.6% higher than male sex. There was a predominance of nodal distribution in upper lobes and the categorization of nodules as probably benign. Furthermore, statistical significance was observed in relation to the larger nodular sizes and probable malignant outcome (p = 0.001).