ABSTRACT
The current pandemic linked to the emergence of SARS-CoV-2 in 2019 has considerably changed the perception of doctors of the impact of respiratory viruses and their role in community-acquired acute pneumonia (CAP). While more than 25% of CAP in adults were of viral origin, respiratory viruses were often perceived as harmless pathogens. Faced with the challenge that the microbiological documentation of a CAP still represents today, the establishment of empirical antibiotic treatment is often carried out in the emergency room. The COVID-19 pandemic has primarily highlighted the decisive role of molecular biology and chest CT in the diagnostic algorithm of CAP. Indeed, a rapid and reliable diagnosis is the key to improve isolation decisions and reducing the unnecessary prescription of antibiotics. Due to significantly different treatments, it is necessary to distinguish the viral etiology from the bacterial of a CAP. Copyright © 2022 Lavoisier. All rights reserved.
ABSTRACT
Rationale: The long term evolution of Covid-19 pneumonia has still little been evaluated. We herein describe CT features that persist 3 months after Covid-19 symptom onset and correlate them to the extent of disease at diagnosis. Methods: Monocentric retrospective study including consecutive patients with Covid-19 confirmed by RT-PCR who presented to Bichat Hospital, Paris, France, between March and May 2020, and had a follow-up chest-CT 3 months later as part of their usual care. Chest CT analysis at 3 months evaluated ground-glass opacities (GGO, graded according to their extent and density), reticulations, bronchial distortion, honeycombing, band-like atelectasis and air trapping. The grade of persistent GGO and the presence of any sign suggestive of fibrosis were correlated to the extent of disease at presentation.Results;Any residual opacity was observed in 99/142 patients (70%). GGO, band-like atelectasis and reticulations were the most frequent findings, in 87/142 (61%), 53/142 (37%) and 40/142 (28%) patients, respectively. Signs that may suggest a fibrosing evolution, including bronchial distortion and distorted reticulations, were observed in 17/142 patients (12%), whereas no case showed honeycombing. Air trapping was present in 12 out of 80 patients (15%) who had an expiratory CT. The grade of GGO and the presence of reticulations at 3 months were highly correlated to the extent of disease at presentation (p<0.0001 and p=0.020, Kruskall Wallis) but signs suggestive of fibrosis were not (p=0.15)Conclusion: Residual opacities are frequent 3 months after Covid-19 pneumonia onset, chest CT mostly showing GGO, band-like atelectasis and reticulations. Signs that may suggest a fibrosing evolution are observed in only 12% of patients.
ABSTRACT
AIM: To determine whether findings from lung ultrasound and chest high-resolution computed tomography (HRCT) correlate when evaluating COVID-19 pulmonary involvement. MATERIALS AND METHODS: The present prospective single-centre study included consecutive symptomatic patients with reverse transcription polymerase chain reaction (RT-PCR)-proven COVID-19 who were not in the intensive care unit. All patients were assessed using HRCT and ultrasound of the lungs by distinct operators blinded to each other's findings. The number of areas (0-12) with B-lines and/or consolidations was evaluated using ultrasound and compared to the percentage and classification (absent or limited, <10%; moderate, 10-25%; extensive, 25-50%; severe, 50-75%; critical, >75%) of lung involvement on chest HRCT. RESULTS: Data were analysed for 21 patients with COVID-19 (median [range] age 65 [37-90] years, 76% male) and excellent correlation was found between the ultrasound score for B-lines and the classification (p<0.01) and percentage of lung involvement on chest HRCT (r=0.935, p<0.001). In addition, the ultrasound score correlated positively with supplemental oxygen therapy (r=0.45, p=0.041) and negatively with minimal oxygen saturation at ambient air (r=-0.652, p<0.01). CONCLUSION: The present study suggests that among COVID-19 patients, lung ultrasound and HRCT findings agree in quantifying lung involvement and oxygen parameters. In the context of the COVID-19 pandemic, lung ultrasound could be a relevant alternative to chest HRCT.