ABSTRACT
Background and Aim: SARS-CoV-2 disease is mildly or moderately symptomatic in most cases, but a significant number of patients develop severe interstitial pneumonia. Interstitial pneumonia's symptoms are nonproductive cough and dyspnea, but its course can be also asymptomatic or mildly symptomatic. The gold standard for diagnosis is lung CT. Lung ultrasound (LUS) is very efficient, with sensitivity and specificity being higher than chest X-Ray. LUS requires a fast training and can be performed on an outpatient basis. The aim of the study is to evaluate the prevalence of signs of pneumonia at LUS in asymptomatic or mildly symptomatic patients. Materials and Methods: The CoViD Territorial Center (CTC) in Garbagnate M. evaluates positive CoViD patients sent by the General Practitioner and considered at moderate risk, as defined by the Lombardy DGR (19/11/20). The assessment included the detection of vital signs, physical examination and LUS;arterial blood gas analysis and/or walking-test were also possible when required. Interstitial pneumonia's symptoms and US signs were defined respectively based on ATS criteria and LUS score. A specific database was used. Results: From January to May 2021, 130 consecutive patients were evaluated: 73 (56%) had US signs of interstitial pneumonia, of which 15 (20%) didn't have specific symptoms. Conclusions: Our data, in agreement with literature, show a not negligible prevalence of asymptomatic CoViD pneumonia. These subjects were followed-up as symptomatic patients, also in consideration of a possible onset of long-term complications.
ABSTRACT
Background: The SARS-CoV-2 pandemia has often oriented the diagnosis of complex pathologies towards CoViD with complications while the main diagnosis could be different. Description of the clinical case: A 76 yo man was hospitalized for confusion and heart failure;in the emergency department, CoViD Ab testing and PCR swab were positive with focal interstitial pneumonia;then splenomegaly, bilateral splenic and renal infarcts and thrombosis of the superior mesenteric artery were confirmed by chest-abdomen CT scan, Doppler US found thrombosis of brachial artery. Antithrombotic therapy was intensified but a new episode of confusion with fever occurred. Brain CT revealed multiple target lesions with hemorrhagic areas, suspected to be neoplastic. LMW heparin was suspended, blood cultures came back positive for Enterococcus faecalis;echocardiography showed a vegetation on the aortic valve;thus the patient's history was reconsidered based on the findings of bacterial endocarditis. When he tested negative, he underwent valve replacement with bioprosthesis. A new positive CoViD swab interrupted the cardiological rehabilitation but finally he was discharged. Conclusions: SARS-CoV-2 pneumonia in this patient was complicated by aortic endocarditis with systemic septic embolization. The antibiotic and steroid therapy administered upon admission may have covered or favored sepsis, that could have been perhaps already onsetting at the time of patient presentation in the ER. The patient's overall hospital stay was 80 days due to recurrent swab positivity even though in the absence of specific symptoms.