COVID-19 and pneumothorax: a multicentre retrospective case series

Introduction: Pneumothorax and pneumomediastinum have both been noted to complicate cases of coronavirus disease 2019 (COVID-19) requiring hospital admission. We report the largest case series yet described of patients with both these pathologies (including nonventilated patients). Methods: Cases were collected retrospectively from UK hospitals with inclusion criteria limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum. Patients included in the study presented between March and June 2020. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management and survival. Results: 71 patients from 16 centres were included in the study, of whom 60 had pneumothoraces (six with pneumomediastinum in addition) and 11 had pneumomediastinum alone. Two of these patients had two distinct episodes of pneumothorax, occurring bilaterally in sequential fashion, bringing the total number of pneumothoraces included to 62. Clinical scenarios included patients who had presented to hospital with pneumothorax, patients who had developed pneumothorax or pneumomediastinum during their inpatient admission with COVID-19 and patients who developed their complication while intubated and ventilated, either with or without concurrent extracorporeal membrane oxygenation. Survival at 28 days was not significantly different following pneumothorax (63.1 +/- 6.5%) or isolated pneumomediastinum (53.0 +/- 18.7%;p=0.854). The incidence of pneumothorax was higher in males. 28-day survival was not different between the sexes (males 62.5 +/- 7.7% versus females 68.4 +/- 10.7%;p=0.619). Patients aged >= 70 years had a significantly lower 28-day survival than younger individuals (>= 70 years 41.7 +/- 13.5% survival versus <70 years 70.9 +/- 6.8% survival;p=0.018 log-rank). Conclusion: These cases suggest that pneumothorax is a complication of COVID-19. Pneumothorax does not seem to be an independent marker of poor prognosis and we encourage continuation of active treatment where clinically possible.

COVID-19: looking beyond the peak. Challenges and tips for radiologists in follow-up of a novel patient cohort.

As the coronavirus pandemic evolves, the focus of radiology departments has begun to change. The acute phase of imaging a new disease entity whilst rationalising radiology services in the face of lockdown has passed. Radiologists are now becoming familiar with the complications of COVID-19, particularly the lung parenchymal and pulmonary vascular sequelae and are considering the impact follow-up imaging may have on departments already struggling with a backlog of suspended imaging in the face of reduced capacity. This review from the British Society of Thoracic Imaging explores both the thoracic and extra-thoracic complications of COVID-19, recognising the importance of a holistic approach to patient follow-up. The British Thoracic Society guidelines for respiratory follow-up of COVID-19 will be discussed, together with newly developed reporting templates, which aim to provide consistency for clinicians as well as an opportunity for longer-term data collection.

Imaging tests for the diagnosis of COVID-19

Objectives: This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows:. The primary objective is to determine the diagnostic accuracy of chest imaging (computed tomography (CT), chest X-ray and ultrasound) in the evaluation of people suspected to have COVID-19. This may also refer to specific signs, such as a particular CT finding. Secondary objectives To evaluate whether these imaging tests are sufficiently accurate to rule out COVID-19 (main measure of interest will be the negative predictive value) To evaluate the rate of positive imaging in patients with initial RT-PCR negative results who have a positive result on a follow-up RT-PCR test To determine if there is an association between number of days after symptom onset, symptom severity and the findings on chest imaging for patients with COVID-19 To determine the rate of discrepancy or agreement between CT, chest X-ray and ultrasound findings To evaluate for ‘threshold’ effects of imaging findings of COVID-19 and accuracy measures To determine the rate of alternative diagnoses identified by chest imaging.

Validation of the British Society of Thoracic Imaging guidelines for COVID-19 chest radiograph reporting.

AIM: To validate the British Society of Thoracic Imaging issued guidelines for the categorisation of chest radiographs for coronavirus disease 2019 (COVID-19) reporting regarding reproducibility amongst radiologists and diagnostic performance. MATERIALS AND METHODS: Chest radiographs from 50 patients with COVID-19, and 50 control patients with symptoms consistent with COVID-19 from prior to the emergence of the novel coronavirus were assessed by seven consultant radiologists with regards to the British Society of Thoracic Imaging guidelines. RESULTS: The findings show excellent specificity (100%) and moderate sensitivity (44%) for guideline-defined Classic/Probable COVID-19, and substantial interobserver agreement (Fleiss' k=0.61). Fair agreement was observed for the "Indeterminate for COVID-19" (k=0.23), and "Non-COVID-19" (k=0.37) categories; furthermore, the sensitivity (0.26 and 0.14 respectively) and specificity (0.76, 0.80) of these categories for COVID-19 were not significantly different (McNemar's test p=0.18 and p=0.67). CONCLUSION: An amalgamation of the categories of "Indeterminate for COVID-19" and "Non-COVID-19" into a single "not classic of COVID-19" classification would improve interobserver agreement, encompass patients with a similar probability of COVID-19, and remove the possibility of labelling patients with COVID-19 as "Non-COVID-19", which is the presenting radiographic appearance in a significant minority (14%) of patients.