Asymptomatic deep vein thromboses in prolonged hospitalized COVID-19 patients.

High incidence of venous thromboembolic (VTE) events in coronavirus disease 2019 (COVID-19) patients has been reported despite pharmacologic thromboprophylaxis. We performed prospective bilateral lower extremity ultrasound evaluation of prolonged hospitalized COVID-19 ward patients from our institution without clinical suspicion of deep vein thrombosis (DVT).A total of 102 patient were included in the study. All patients were receiving pharmacologic thromboprophylaxis, the majority in intermediate or therapeutic doses. Asymptomatic DVT was detected in 26/102 (25.5%) patients: 22 had distal and four had proximal DVT, six had bilateral leg involvement. Pulmonary embolism was highly prevalent (17/70, 24.3%) but similarly grouped among patients with and without asymptomatic DVT. In total 37.2% of patients included in the study were recognized as having VTE.Asymptomatic DVT events were more common in intensive care unit (ICU) survivors (60% in postmechanically ventilated ICU survivors, 21.2% in ward patients, 22% in high-flow oxygen treated patients; P = 0.031), in patients with higher modified International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) VTE risk-score (median 3 vs. 2 points with and without DVT; P = 0.021) and higher body temperature on admission (median 38.7 °C vs. 37.7 °C with and without DVT; P = 0.001). No clear associations with Padua VTE risk score, demographic and other clinical characteristics, intensity of thromboprophylaxis, severity of other COVID-19 symptoms, degree of systemic inflammation or D­dimers on admission were found (P > 0.05 for all analyses).Systematic ultrasound assessment in prolonged hospitalized severe COVID-19 patients prior to hospital discharge is needed, especially in ICU survivors, to timely recognize and appropriately treat patients with asymptomatic DVT.

Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema: Radiological aspects of rare COVID-19 complications in 3 patients.

Spontaneous pneumomediastinum (SPM), pneumothorax (PNX) and subcutaneous emphysema are rare complications of COVID-19 pneumonia. In this paper we describe 3 cases of COVID-19 pneumonia complicated by SPM with or without PNX. Patient 1 was a 56-year-old woman whose medical history was significant for chronic leukemia. She presented with typical clinical signs of COVID-19 pneumonia and after 2 weeks of hospitalization she developed SPM and subcutaneous emphysema. The management of pneumomediastinum (PNM) was conservative and follow-up computed tomography showed resolution of PNM. Patient 2 was a 67-year-old man presenting with fever, cough and dyspnea. Computed tomography pulmonary angiography was performed after 2 weeks of hospitalization and showed bilateral peripheral consolidations together with massive PNM and right-sided PNX. Thoracic drainage catheter was inserted in his right chest. Despite all supportive care, the patient succumbed to illness. Patient 3 was a 74-year-old man who was admitted to our hospital with COVID-19 pneumonia and spontaneous right-sided PNX. A thoracic drainage catheter was inserted immediately and then removed after ten days which has led to progression of subcutaneous emphysema, PNX and newly diagnosed PNM. Patient was carefully monitored for the next 2 weeks. Follow-up chest x-ray showed regression of PNM and PNX. SPM, PNX and subcutaneous emphysema are rare complications of COVID-19 pneumonia. Increased alveolar pressure and diffuse alveolar injury in severe COVID-19 pneumonia may make the alveoli more prone to rupturing which leads to gas dissemination along the peribronchovascular sheath to the mediastinum. Most cases of SPM and PNX resolve with conservative management.

The use of imaging in COVID-19-results of a global survey by the International Society of Radiology.

OBJECTIVES: This survey conducted by the International Society of Radiology and supported by the European Society of Radiology aimed to collect information regarding radiology departments' current practices in the management of patients with COVID-19. METHODS: Responses from 50 radiology departments involved in the management of COVID-19 patients representing 33 countries across all continents were analyzed. The analysis revealed important variations in imaging practices related to COVID-19 across the world for different disease severity and various clinical scenarios. RESULTS: Imaging is usually not performed in asymptomatic patients (69% of institutions do not image) but is used at the end of confinement (in 60% of institutions). In the majority of institutions, chest imaging is used in suspected or confirmed patients with COVID-19 (89% and 94%). All imaging departments involved in this survey reported the use of imaging in COVID-19 patients showing severe symptoms or who were critically ill. However, there is a wide variation in imaging modality type used for each clinical scenario. The use of imaging is applied in line with existing guidelines and recommendations in 98% of institutions with structured reporting recorded in 58% of institutions. The vast majority of institutions reported a significant impact of the COVID-19 pandemic on the imaging department's routine activity (83%). CONCLUSION: We believe that the results of this survey will help to understand current heterogeneities in radiology practice and to identify needs and gaps in the organization and function of radiology departments worldwide in relation to the COVID-19 pandemic. The results of this survey may inform the development of an overall strategy for radiology department organization and imaging protocols in pandemic conditions. KEY POINTS: • The results of this survey, which included responses from 50 radiology departments representing 33 countries, showed important variations in imaging practices related to COVID-19 across the world. • While imaging is usually not performed in asymptomatic patients (69% of institutions), it is used in suspected or confirmed patients with COVID-19, in COVID-19 patients showing severe symptoms or who were critically ill, and at the end of confinement (89%, 94%, 100%, 100%, 60% of institutions, respectively). However, there is a wide variation in imaging modality type used for each clinical scenario. • In 98% of institutions, the use of imaging is applied in line with existing guidelines and recommendations, with structured reporting recorded in 58% of institutions. COVID-19 pandemic made a significant impact on the imaging department's routine activity in 83% of institutions.