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SESSION TITLE: Pathologies of the Post-COVID-19 World SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Cavitary lung lesions are a relatively common finding on imaging with a vast differential diagnosis. CASE PRESENTATION: A 36-year-old female with history of gestational diabetes, preeclampsia and obesity presented to an outside hospital for evaluation of acute onset shortness of breath and chest pain. The patient tested positive for COVID19 two weeks prior. She initially developed some mild symptoms including headache, nasal congestion, generalized body aches, cough with mild sputum production and shortness of breath. Despite improvement in these symptoms, she suddenly developed chest discomfort that radiated to the back and was worse with inspiration and cough. The patient had been fully vaccinated against COVID-19 and had received a booster dose as well. Upon evaluation in the emergency room, she was afebrile, respiratory rate was 20, blood pressure was 144/90 mmHg, heart rate was 88 and her oxygen saturation was 99% on room air. Her physical exam was unremarkable. Basic laboratory work up including CBC and chemistry was normal. EKG and troponins were normal as well. A chest x-ay was performed which showed bilateral nodular densities with possible cavitation. A CT chest was later performed and showed multiple bilateral subsolid pulmonary nodules, some with apparent central cavitation. The patient was admitted for further work up at our institution. The patient's subsequent evaluation was largely unrevealing. An autoimmune panel testing for SLE, rheumatoid arthritis, ANCA vasculitis, and Goodpasture's syndrome revealed only a weakly positive ANA with negative anti-DNA and anti-Smith antibody. HIV and QuantiFERON tests were negative. Blood cultures were negative as well. Unfortunately, the patient was not able to expectorate and therefore no sputum cultures were obtained. Due to the patient's clinical improvement and absence of hypoxemia, diagnostic bronchoscopy was deferred, and the patient was subsequently recommended to undergo short interval chest imaging. Repeat chest computed tomography scan one month later showed complete resolution of the previously seen cavitary pulmonary nodules. At the time of outpatient clinical follow up, the patient remained asymptomatic from a respiratory perspective. DISCUSSION: Cavitary pulmonary nodules on chest imaging is an atypical presentation of COVID19 pneumonia that has been rarely described in the literature. In our patient, the temporal correlation between her pulmonary nodules and COVID19 infection as well as her negative work up for other common infectious and inflammatory causes known to cause cavitary lung lesions, makes COVID19 the most plausible cause for her findings. The pathophysiology of these findings remains unclear but may be explained by endothelialitis and small vessel vasculitis may be implicated in the formation of these lesions. [1] CONCLUSIONS: We presented a rare case of cavitary pulmonary nodules due to COVID19 pneumonia. Reference #1: Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, Vanstapel A, Werlein C, Stark H, Tzankov A, Li WW, Li VW, Mentzer SJ, Jonigk D. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med. 2020 Jul 9;383(2):120-128. DISCLOSURES: No relevant relationships by Karim Anis No relevant relationships by Carolyn Garcia
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Introduction. The SARS-CoV-2 pandemic modified the provision of health services to prioritize the management of emerging cases. The Colombian Association of Surgery was one of the first to lead these initiatives. This study describes the behavior of the health services of a center specialized in head and neck pathology in Medellín, Colombia. Methods. This is a retrospective analysis of a prospective cohort, in which the administrative database was used. The variables analyzed were the number and type of consultations and procedures, carried out in the period from January to July 2019 and their comparison with the same period in 2020. A descriptive analysis was carried out using percentages, average and standard deviation. Results. On the database, 3,521 consultations and 866 surgical procedures were analyzed. A drop in the number of consultations was observed, reaching its lowest point in the month of April, with a 33.9% decrease. The percentage of telemedicine consultations increased since March 2020, reaching 98% in the month of April. A drop in the number of procedures was observed, with a compensatory increase in June of 62.5%. To date, no patient or member of the health care team has developed a COVID-19 infection. Discussion. The COVID-19 pandemic had a significant effect on the number of consultations and head and neck surgical procedures. The telemedicine strategy helped to compensate the decrease in access to specialized care. © 2021, Asociacion Colombiana de Cirugia. All rights reserved.