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American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277801


Introduction:Lung cancer is the leading cause of cancer death and the second most common cancer. Non-small cell lung cancer (NSCLC) is most common type, with adenocarcinoma and squamous cell carcinoma representing the most prevalent subtypes. Here, we present a case of a large lung mass which underscores the importance of considering rare types of lung cancer when formulating a differential diagnosis.Case Report:The patient was 78-year-old man presenting one month after mild COVID-19 infection with persistent chest heaviness felt to be the sequalae of COVID-19. A review of symptoms was significant for appetite change, fatigue, cough, chest tightness, and unexpected weight change. Physical exam showed diminished left breath sounds. Pulmonary function tests showed an FEV1 of 54%;DLCO was not obtained. CT of the chest demonstrated an 11.3 x 7.2 x 15.6 cm necrotic mass of the left upper lobe. Further characterization with MRI demonstrated an 11.8 x 7.9 x 17.5 cm heterogeneously enhancing mixed signal mass with areas of either cystic degeneration or necrosis in the left hemithorax with loss of mediastinal and pericardial fat planes, suggestive of invasion (Figure 1, arrow). Prominent mediastinal lymph nodes and chest wall invasion were also identified. A small pleural effusion was present at that time (dashed arrow). MRI of the brain was negative for metastases. A biopsy was consistent with pulmonary sarcomatoid carcinoma, a rare type of NSCLC. The patient was treated with radiation.Importance:Pulmonary sarcomatoid carcinoma is a rare type of non-small cell lung cancer accounting for 0.4% of cases which carries a poor prognosis and is not sensitive to chemotherapy, rendering surgery the best treatment option. Given that it is poorly differentiated, it is likely to present as a large mass with heterogenous signal and enhancement. Closely related differential considerations include diffuse sarcomatoid malignant mesothelioma and sarcomatoid carcinoma metastatic to lung. Other rare types of lung cancer include adenosquamous carcinoma, large cell neuroendocrine carcinoma, adenoid cystic and mucoepidermoid carcinomas of the lung, granular cell lung cancer, typical and atypical carcinoids. While rare, it is important to consider these less common types of non-small cell lung cancer in the differential diagnosis given differences in treatment options and prognosis.

Acad Radiol ; 28(5): 595-607, 2021 05.
Article in English | MEDLINE | ID: covidwho-1062192


BACKGROUND: COVID-19 commonly presents with upper respiratory symptoms; however, studies have shown that SARS-CoV-2 infection affects multiple organ systems. Here, we review the pathophysiology and imaging characteristics of SARS-CoV-2 infection in organ systems throughout the body and explore commonalities. OBJECTIVE: Familiarity with the underlying pathophysiology and imaging characteristics is essential for the radiologist to recognize these findings in patients with COVID-19 infection. Though pulmonary findings are the most prevalent presentation, COVID-19 may have multiple manifestations and recognition of the extrapulmonary manifestations is especially important because of the potential serious and long-term effects of COVID-19 on multiple organ systems.

COVID-19 , Humans , Peptidyl-Dipeptidase A , SARS-CoV-2
Emerg Radiol ; 27(6): 617-621, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-610772


PURPOSE: The purpose of our research is to evaluate the usefulness of chest X-ray for triaging patients with suspected COVID-19 infection. METHODS: IRB approval was obtained to allow a retrospective review of adult patients who presented to the Emergency Department with a complaint of fever, cough, dyspnea or hypoxia and had a chest X-ray between 12 March 2020 and 26 March 2020. The initial chest X-ray was graded on a scale of 0-3 with grade 0 representing no alveolar opacities, grade 1: < 1/3 alveolar opacities of the lung, Grade 2: 1/3 to 2/3 lung with alveolar opacities and grade 3: > 2/3 alveolar opacities of the lung. Past medical history of diabetes and hypertension, initial oxygen saturation, COVID-19 testing results, intubation, and outcome were also collected. RESULTS: Four hundred ten patient chest X-rays were reviewed. Oxygen saturation and X-ray grade were both significantly associated with the length of stay in hospital, the hazard ratio (HR) of discharge was 1.05 (95% CI [1.01, 1.09], p = 0.017) and 0.61 (95% CI [0.51, 0.73], p < 0.001), respectively. In addition, oxygen saturation and X-ray grade were significant predictors of intubation (odds ratio (OR) of intubation is 0.88 (95% CI [0.81, 0.96], p = 0.004) and 3.69 (95% CI [2.25, 6.07], p < 0.001). CONCLUSIONS: Initial chest X-ray is a useful tool for triaging those subjects who might have poor outcomes with suspected COVID-19 infection and benefit most from hospitalization.

Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic/methods , Triage , Aged , Betacoronavirus , COVID-19 , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2