A direct comparison between five lung-US and chest-CT-scans in a patient infected by SARS-CoV-2

The gold standard for SARS-CoV-2 pneumonia diagnosis is chest Computed Tomography (CT), but Lung Ultrasound (LUS) is also useful in differential diagnosis and in-hospital monitoring of patients with infection by new Coronavirus 2019 disease (COVID-19). We present a case of a young man who was infected with SARS-CoV-2 pneumoniae and underwent five steps of chest imaging, including LUS aeration scorings and chest CT scans. Each decrease or increase in LUS scoring could accurately predict CT scan changes.

Standardized 3- and 12-months imaging and clinicalfunctional pulmonary follow-up in patients hospitalized for COVID-19

Introduction: Natural history of COVID-19 is yet unknown. A standardized follow-up may allow evaluating different patterns of COVID-19 evolution. AIM: To describe imaging and clinical-functional pulmonary data at 3- (T3) and 12-months (T12) follow-up in COVID19 patients. Method(s): COVID-19 patients discharged from Pisa University Hospital, Italy, from March to September 2020 were evaluated. Expert radiologists qualitatively assessed the evolution of COVID-19 pneumonia CT signs (PS) (baseline acute disease vs. T3) by using an original coding system. A chest CT at T12 was performed only in patients who had persistent PS at T3. Both at T3 and T12, all the patients underwent spirometry, plethysmography, DLCO and pulmonary visit. Result(s): Among 307 discharged patients, 57% and 44.3% were followed up at T3 and T12, respectively, while 12.4% died within T3. Followed patient's characteristics were: 62.9% men;median age 60.3 yrs;11.3% smokers and 30.6% ex-smokers;mean BMI 29.1 kg/mq;43.8% had 1+ comorbidities;median hospitalization 15 days;17.4% stayed 3+ days in ICU. At T3, 52.1% of patients showed resolution of PS, 82.8% had normal spirometry and 76.7% normal DLCO. Among patients with persistent PS at T3 (47.9%), 59.4% showed stability or improvement and 39.1% resolution of PS at T12. 31.6% had persistent PS at T12. An increased proportion of patients with normal lung function was observed at T12, but 5.6% and 20.4% had a restrictive pattern and reduced DLCO, respectively. Conclusion(s): About a third of patients show persistence of PS and about a fifth has DLCO abnormalities at 12- months from the acute COVID-19. Further follow-up is planned for these patients.

Standardized Clinical, Functional, and Radiological Pulmonary Follow-Up in Patients Discharged with Diagnosis of COVID-19 from an Italian Hospital -Preliminary Data

Aim: To describe the standardized methodology of the clinical-functional-radiological pulmonary follow-up (F-up) planned for COVID-19 patients discharged from the Pisa University Hospital, Italy. Methods: COVID-19 patients are identified by Hospital Discharge Form code. One month after discharge (T1), symptoms are assessed through a telephone questionnaire. Three months after discharge (T3), patients are proposed to undergo: pulmonary visit, spirometry, plethysmography, DLCO, ABG analysis (if SpO2<95%), chest CT, chest ultrasound, blood test, salivary test. Subsequent F-up for individual patients is based on the combination of standardized comparisons of chest CT (T3 vs. baseline), lung function (presence/absence of spirometric and/or DLCO abnormalities at T3) and respiratory symptoms (T3 vs. T1), as follows: (A) worsening/occurrence of COVID-19 pneumonia chest CT signs, regardless of functional abnormalities and/or respiratory symptoms;F-up is planned at 6 months (T6), with chest CT and clinical-functional evaluation. (B) stability/improvement of COVID-19 pneumonia, with (B1) or without (B2) functional abnormalities and/or respiratory symptoms;F-up is planned at 12 months (T12) with chest CT for both (B1) and (B2), and at T6 with clinical-functional evaluation for (B1). (C) complete resolution of COVID-19 pneumonia, regardless of functional abnormalities and/or respiratory symptoms;F-up is planned at T12, with clinical-functional evaluation. Results: Up to 08/10/2020, n=316 patients were discharged (17% hospitalized ≥3 days in ICU). Up to 01/12/2020, n=162/316 (51,3%) underwent T3-F-up;n=60/316 patients (18.9%) waiting for T3-F-up;n=38/316 (18%) lost to F-up;n=31/316 (9.8%) refusing F-up;n=20/316 (6.3%) died after discharge. Among patients who completed T3-F-up, n=12/162 (7,4%), n=33/162 (20,4%), n=32/162 (19,7%), and n=85/162 (52,5%) were assigned to F-up (A), (B1), (B2), and (C), respectively. The worse the radiological imaging, the higher the median age of the patients (74-, 67-, 68-, and 56-years median age, respectively). In n=65/162 (40,1%) patients, chest CT detected collateral findings (e.g., pulmonary nodules). 57,4% of patients showed normal lung function tests, while 24.5% showed a reduction of DLCO. 64,1% of patients were asymptomatic, 32.7% showed improved/stable, and 3% showed worsening respiratory symptoms. Conclusions: More than half hospitalized COVID-19 patients shows complete resolution of pneumonia chest CT signs and normal lung function at T3-F-up. For a disease whose natural history is yet unknown, a standardized clinical-functional-radiological pulmonary evaluation may serve as tentative guideline for planning F-up. To date such an approach is ongoing and under evaluation.