ABSTRACT
Pneumothorax and pneumomediastinum are life-threatening conditions especially in critically ill patients. One of the most common situations in which they occur is prolonged invasive and non-invasive mechanical ventilation with high end-expiratory pressure. Probably due to the high number of patients with SARS-CoV-2 respiratory infection being treated with mechanical ventilation, increasing number of pulmonary barotrauma cases have been reported.
ABSTRACT
PURPOSE: To assess and correlate pulmonary involvement and outcome of SARS-CoV-2 pneumonia with the degree of coronary plaque burden based on the CAC-DRS classification (Coronary Artery Calcium Data and Reporting System). METHODS: This retrospective study included 142 patients with confirmed SARS-CoV-2 pneumonia (58 ± 16 years; 57 women) who underwent non-contrast CT between January 2020 and August 2021 and were followed up for 129 ± 72 days. One experienced blinded radiologist analyzed CT series for the presence and extent of calcified plaque burden according to the visual and quantitative HU-based CAC-DRS Score. Pulmonary involvement was automatically evaluated with a dedicated software prototype by another two experienced radiologists and expressed as Opacity Score. RESULTS: CAC-DRS Scores derived from visual and quantitative image evaluation correlated well with the Opacity Score (r=0.81, 95% CI 0.76-0.86, and r=0.83, 95% CI 0.77-0.89, respectively; p<0.0001) with higher correlation in severe than in mild stage SARS-CoV-2 pneumonia (p<0.0001). Combined, CAC-DRS and Opacity Scores revealed great potential to discriminate fatal outcomes from a mild course of disease (AUC 0.938, 95% CI 0.89-0.97), and the need for intensive care treatment (AUC 0.801, 95% CI 0.77-0.83). Visual and quantitative CAC-DRS Scores provided independent prognostic information on all-cause mortality (p=0.0016 and p<0.0001, respectively), both in univariate and multivariate analysis. CONCLUSIONS: Coronary plaque burden is strongly correlated to pulmonary involvement, adverse outcome, and death due to respiratory failure in patients with SARS-CoV-2 pneumonia, offering great potential to identify individuals at high risk.
Subject(s)
COVID-19 , Coronary Artery Disease , Plaque, Atherosclerotic , Vascular Calcification , Calcium , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Coronary Vessels/diagnostic imaging , Female , Humans , Lung , Male , Predictive Value of Tests , Prognosis , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , Vascular Calcification/diagnostic imagingABSTRACT
Vaccination plays an important role in the fight against SARS-CoV-2 to minimie the spread of coronavirus disease 2019 (COVID-19) and its life-threatening complications. Myocarditis has been reported as a possible and rare adverse consequence of different vaccines, and its clinical presentation can range from influenza-like symptoms to acute heart failure. We report a case of a 30-year-old man who presented progressive dyspnea and constrictive retrosternal pain after receiving SARS-CoV-2 vaccine. Cardiac magnetic resonance and laboratory data revealed typical findings of acute myopericarditis.
Subject(s)
Aspirin/administration & dosage , BNT162 Vaccine , Bisoprolol/administration & dosage , COVID-19 , Myocarditis , Prednisolone/administration & dosage , Adrenergic beta-1 Receptor Antagonists/administration & dosage , Adult , Anti-Inflammatory Agents/administration & dosage , BNT162 Vaccine/administration & dosage , BNT162 Vaccine/adverse effects , COVID-19/diagnosis , COVID-19/prevention & control , Creatine Kinase, MB Form/blood , Electrocardiography/methods , Humans , Magnetic Resonance Imaging, Cine/methods , Male , Myocarditis/blood , Myocarditis/etiology , Myocarditis/physiopathology , Myocarditis/therapy , SARS-CoV-2 , Treatment Outcome , Troponin I/bloodABSTRACT
PURPOSE: To investigate whether minimum intensity projection (MinIP) reconstructions enable more accurate depiction of pulmonary ground-glass opacity (GGO) compared to standard transverse sections and multiplanar reformat (MPR) series in patients with suspected coronavirus disease 2019 (COVID-19). METHOD: In this multinational study, chest CT scans of 185 patients were retrospectively analyzed. Diagnostic accuracy, diagnostic confidence, image quality regarding the assessment of GGO, as well as subjective time-efficiency of MinIP and standard MPR series were analyzed based on the assessment of six radiologists. In addition, the suitability for COVID-19 evaluation, image quality regarding GGO and subjective time-efficiency in clinical routine was assessed by five clinicians. RESULTS: The reference standard revealed a total of 149 CT scans with pulmonary GGO. MinIP reconstructions yielded significantly higher sensitivity (99.9 % vs 95.6 %), specificity (95.8 % vs 86.1 %) and accuracy (99.1 % vs 93.8 %) for assessing of GGO compared with standard MPR series. MinIP reconstructions achieved significantly higher ratings by radiologists concerning diagnostic confidence (medians, 5.00 vs 4.00), image quality (medians, 4.00 vs 4.00), contrast between GGO and unaffected lung parenchyma (medians, 5.00 vs 4.00) as well as subjective time-efficiency (medians, 5.00 vs 4.00) compared with MPR-series (all P < .001). Clinicians preferred MinIP reconstructions for COVID-19 assessment (medians, 5.00 vs 3.00), image quality regarding GGO (medians, 5.00 vs 3.00) and subjective time-efficiency in clinical routine (medians, 5.00 vs 3.00). CONCLUSIONS: MinIP reconstructions improve the assessment of COVID-19 in chest CT compared to standard images and may be suitable for routine application.