Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 12 de 12
Filter
1.
Healthcare (Basel) ; 10(3)2022 Mar 14.
Article in English | MEDLINE | ID: covidwho-1742408

ABSTRACT

Pulmonary involvement is the most common cause of death among patients with systemic sclerosis (SSc). The current coronavirus disease 2019 (COVID-19) is particularly problematic to manage in SSc patients since they may experience a more severe evolution of COVID-19 due to the pre-existent interstitial lung disease (ILD) and the administration of immunosuppressive treatments. In addition, the remarkable radiological similarities between SSc-ILD and COVID-19 complicate the differential diagnosis between these two entities. Herein, we present the first case of spontaneous pneumo-mediastinum in a post-COVID-19 patient with SSc. In our patient, both smoking and pulmonary fibrosis could lead to cyst formation, which possibly spontaneously broke and caused pneumo-mediastinum. Moreover, megaesophagus perforation due to the smooth muscle atrophy, replacement with fibrosis, and achalasia may extend into the mediastinum or pleural space and has also been described as a rare case of spontaneous pneumo-pericardium. Finally, spontaneous pneumo-mediastinum and pneumothorax have been recently reported as an established complication of severe COVID-19 pneumonia and among COVID-19 long-term complication. This case report underlines that the worsening of respiratory symptoms in SSc patients, especially when recovered from COVID-19, requires further investigations for ruling out other tentative diagnoses besides the evolution of the SSc-ILD.

2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-319901

ABSTRACT

Objectives: The aim of our study was to assess the frequency distribution of relevant and incidental vascular events in a retrospective cohort of 42 COVID-19 patients. Methods: All patients were studied by whole-body CT angiography.Twenty-three out of 42 patients were admitted to the intensive care unit (ICU). Results: Relevant vascular events were recorded in the 71.4% of the whole study population. Pulmonary embolism was the most frequent one both in ICU and no-ICU cases (56.5% vs 10.5%, p=0.002). Ischemic infarction of other organs was affecting with an increasing prevalence the gut, the spleen, the liver, the brain and the kidney, with a simultaneous ischemic occurrence in some cases. Multi-focal venous thrombosis was also represented especially in ICU patients (p=0.005). Among incidental findings, splanchnic vessels little-size aneurysms were reported in the 40% of the whole population, with relative frequencies similarly distributed in ICU and no-ICU patients. Conclusions: Vascular involvement is not negligible in COVID-19 and should be carefully investigated as may significantly affect disease behavior and prognosis.

3.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-319532

ABSTRACT

As lung ultrasound (LUS) is a noninvasive, radiation-free, repeatable and portable imaging tool suitable for a point-of-care use, several recent literature reports have emphasized its role as the ideal screening tool for SARS-CoV2 pneumonia. To evaluate the actual diagnostic accuracy of LUS for this purpose, we performed a systematic comparative study between LUS and CT scan findings in a population of 82 patients hospitalized because of COVID-19. LUS and Chest CT have been performed in all patients within 6-12 hours from the admission. The sensitivity of LUS in assessing typical CT findings was 60%. Despite LUS detected consolidations adherent to pleural surface in all cases, it was not able to detect all the consolidations assessed at CT scan (p=0.002), showing a risk to underestimate the actual disease’s extent. Moreover, only 70% of pleural surface is visible by LUS. Considering that the specificity and the positive predictive value of the same LUS signs may be lowered in a normal setting of non epidemic COVID-19 and in case of pre-existing cardio-pulmonary diseases, LUS use should not be indicated for diagnosis of COVID-19. However, it may be very useful for the assessment of pleural effusion and to guide safer fluid drainage.

4.
Front Med (Lausanne) ; 8: 709402, 2021.
Article in English | MEDLINE | ID: covidwho-1405417

ABSTRACT

The pandemic spread of the new severe acute respiratory syndrome coronavirus 2 has raised the necessity to identify an appropriate imaging method for early diagnosis of coronavirus disease 2019 (COVID-19). Chest computed tomography (CT) has been regarded as the mainstay of imaging evaluation for pulmonary involvement in the early phase of the pandemic. However, due to the poor specificity of the radiological pattern and the disruption of radiology centers' functionality linked to an excessive demand for exams, the American College of Radiology has advised against CT use for screening purposes. Lung ultrasound (LUS) is a point-of-care imaging tool that is quickly available and easy to disinfect. These advantages have determined a "pandemic" increase of its use for early detection of COVID-19 pneumonia in emergency departments. However, LUS findings in COVID-19 patients are even less specific than those detectable on CT scans. The scope of this perspective article is to discuss the great number of diseases and pathologic conditions that may mimic COVID-19 pneumonia on LUS examination.

5.
Front Med (Lausanne) ; 8: 707602, 2021.
Article in English | MEDLINE | ID: covidwho-1344275

ABSTRACT

Background: In the current coronavirus disease-2019 (COVID-19) pandemic, lung ultrasound (LUS) has been extensively employed to evaluate lung involvement and proposed as a useful screening tool for early diagnosis in the emergency department (ED), prehospitalization triage, and treatment monitoring of COVID-19 pneumonia. However, the actual effectiveness of LUS in characterizing lung involvement in COVID-19 is still unclear. Our aim was to evaluate LUS diagnostic performance in assessing or ruling out COVID-19 pneumonia when compared with chest CT (gold standard) in a population of SARS-CoV-2-infected patients. Methods: A total of 260 consecutive RT-PCR confirmed SARS-CoV-2-infected patients were included in the study. All the patients underwent both chest CT scan and concurrent LUS at admission, within the first 6-12 h of hospital stay. Results: Chest CT scan was considered positive when showing a "typical" or "indeterminate" pattern for COVID-19, according to the RSNA classification system. Disease prevalence for COVID-19 pneumonia was 90.77%. LUS demonstrated a sensitivity of 56.78% in detecting lung alteration. The concordance rate for the assessment of abnormalities by both methods increased in the case of peripheral distribution and middle-lower lung location of lesions and in cases of more severe lung involvement. A total of nine patients had a "false-positive" LUS examination. Alternative diagnosis included chronic heart disease (six cases), bronchiectasis (two cases), and subpleural emphysema (one case). LUS specificity was 62.50%. Collateral findings indicative of overlapping conditions at chest CT were recorded also in patients with COVID-19 pneumonia and appeared distributed with increasing frequency passing from the group with mild disease (17 cases) to that with severe disease (40 cases). Conclusions: LUS does not seem to be an adequate tool for screening purposes in the ED, due to the risk of missing some lesions and/or to underestimate the actual extent of the disease. Furthermore, the not specificity of LUS implies the possibility to erroneously classify pre-existing or overlapping conditions as COVID-19 pneumonia. It seems more safe to integrate a positive LUS examination with clinical, epidemiological, laboratory, and radiologic findings to suggest a "virosis." Viral testing confirmation is always required.

6.
Eur Radiol ; 31(10): 7363-7370, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1188091

ABSTRACT

OBJECTIVES: Increasing evidence suggests that SARS-CoV-2 infection may lead to severe and multi-site vascular involvement. Our study aimed at assessing the frequency of vascular and extravascular events' distribution in a retrospective cohort of 42 COVID-19 patients. METHODS: Patients were evaluated by whole-body CT angiography between March 16 and April 30, 2020. Twenty-three out of the 42 patients evaluated were admitted to the intensive care unit (ICU). Vascular and extravascular findings were categorized into "relevant" or "other/incidental," first referring to the need for immediate patient care and management. Student T-test, Mann-Whitney U test, or Fisher exact test was used to compare study groups, where appropriate. RESULTS: Relevant vascular events were recorded in 71.4% of cases (n = 30). Pulmonary embolism was the most frequent in both ICU and non-ICU cases (56.5% vs. 10.5%, p = 0.002). Ischemic infarctions at several sites such as the gut, spleen, liver, brain, and kidney were detected (n = 20), with multi-site involvement in some cases. Systemic venous thrombosis occurred in 30.9% of cases compared to 7.1% of systemic arterial events, the first being significantly higher in ICU patients (p = 0.002). Among incidental findings, small-sized splanchnic arterial aneurysms were reported in 21.4% of the study population, with no significant differences in ICU and non-ICU patients. CONCLUSIONS: Vascular involvement is not negligible in COVID-19 and should be carefully investigated as it may significantly affect disease behavior and prognosis. KEY POINTS: • Relevant vascular events were recorded in 71.4% of the study population, with pulmonary embolism being the most frequent event in ICU and non-ICU cases. • Apart from the lung, other organs such as the gut, spleen, liver, brain, and kidneys were involved with episodes of ischemic infarction. Systemic venous and arterial thrombosis occurred in 30.9% and 7.1% of cases, respectively, with venous events being significantly higher in ICU patients (p = 0.002). • Among incidental findings, small-sized splanchnic arterial aneurysms were reported in 21.4% of the whole population.


Subject(s)
COVID-19 , Pulmonary Embolism , Computed Tomography Angiography , Humans , Pulmonary Embolism/diagnostic imaging , Retrospective Studies , SARS-CoV-2
7.
Medicina (Kaunas) ; 57(3)2021 Mar 04.
Article in English | MEDLINE | ID: covidwho-1124744

ABSTRACT

Background and Objectives: The potential role of lung ultrasound (LUS) in characterizing lung involvement in Coronavirus disease 2019 (COVID-19) is still debated. The aim of the study was to estimate sensitivity of admission LUS for the detection of SARS-CoV-2 lung involvement using Chest-CT (Computed Tomography) as reference standard in order to assess LUS usefulness in ruling out COVID-19 pneumonia in the Emergency Department (ED). Methods: Eighty-two patients with confirmed COVID-19 and signs of lung involvement on Chest-CT were consecutively admitted to our hospital and recruited in the study. Chest-CT and LUS examination were concurrently performed within the first 6-12h from admission. Sensitivity of LUS was calculated using CT findings as a reference standard. Results: Global LUS sensitivity in detecting COVID-19 pulmonary lesions was 52%. LUS sensitivity ranged from 8% in case of focal and sporadic ground-glass opacities (mild disease), to 52% for a crazy-paving pattern (moderate disease) and up to 100% in case of extensive subpleural consolidations (severe disease), although LUS was not always able to detect all the consolidations assessed at Chest-CT. LUS sensitivity was higher in detecting a typical Chest-CT pattern (60%) and abnormalities showing a middle-lower zone predominance (79%). Conclusions: As admission LUS may result falsely negative in most cases, it should not be considered as a reliable imaging tool in ruling out COVID-19 pneumonia in patients presenting in ED. It may at least represent an expanded clinical evaluation that needs integration with other diagnostic tests (e.g., nasopharyngeal swab, Chest-CT).


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Tomography, X-Ray Computed , Ultrasonography , Adult , Aged , Aged, 80 and over , COVID-19/physiopathology , Female , Hospitalization , Humans , Male , Middle Aged , SARS-CoV-2 , Sensitivity and Specificity , Young Adult
8.
SSRN; 2020.
Preprint | SSRN | ID: ppcovidwho-925

ABSTRACT

Background: A novel coronavirus named SARS-CoV-2 diagnosed in China in December 2019 is rapidly spreading through Europe and US. Computed Tomography emerged as

9.
J Immunother Cancer ; 8(2)2020 08.
Article in English | MEDLINE | ID: covidwho-713881

ABSTRACT

BACKGROUND: The inflammatory pathology observed in severe COVID-19 disease caused by the 2019 novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by elevated serum levels of C reactive protein (CRP) and cytokines, including interferon gamma, interleukin 8 (IL-8), and interleukin 6 (IL-6). Initial reports from the outbreak in Italy, China and the USA have provided anecdotal evidence of improved outcomes with the administration of anti-IL-6 agents, and large-scale trials evaluating these therapies are ongoing. STUDY DESCRIPTION: In this retrospective case series, clinical outcomes and correlates of response to treatment with the IL-6 receptor antagonist sarilumab are described for 15 patients with COVID-19 from a single institution in Southern Italy. Among 10 patients whose symptoms improved after sarilumab treatment, rapid decreases in CRP levels corresponded with clinical improvement. Lower levels of IL-6 at baseline as well as lower neutrophil to lymphocyte ratio as compared with patients whose COVID-19 did not improve with treatment were associated with sarilumab-responsive disease. CONCLUSIONS: This observation may reflect a possible clinical benefit regarding early intervention with IL-6-modulatory therapies for COVID-19 and that CRP could be a potential biomarker of response to treatment.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Biomarkers, Pharmacological/blood , Coronavirus Infections/drug therapy , Interleukin-6/blood , Pneumonia, Viral/drug therapy , Aged , Antiviral Agents/therapeutic use , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Female , Humans , Italy , Lymphocyte Count , Male , Middle Aged , Neutrophils , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Receptors, Interleukin-6/antagonists & inhibitors , Retrospective Studies , Treatment Outcome
12.
Radiol Med ; 125(8): 738-753, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-597679

ABSTRACT

Ultrasound is the most disruptive innovation in intensive care life, above all in this time, with a high diagnostic value when applied appropriately. In recent years, point-of-care lung ultrasound has gained significant popularity as a diagnostic tool in the acutely dyspnoeic patients. In the era of Sars-CoV-2 outbreak, lung ultrasound seems to be strongly adapting to the follow-up for lung involvement of patients with ascertaining infections, till to be used, in our opinion emblematically, as a screening test in suspected patients at the emergency triage or at home medical visit. In this brief review, we discuss the lung ultrasound dichotomy, certainties and uncertainties, describing its potential role in validated clinical contexts, as a clinical-dependent exam, its limits and pitfalls in a generic and off-label clinical context, as a virtual anatomical-dependent exam, and its effects on the clinical management of patients with COVID-19.


Subject(s)
Artifacts , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Ultrasonography/methods , Betacoronavirus , COVID-19 , Diagnosis, Differential , Humans , Pandemics , Point-of-Care Systems , SARS-CoV-2 , Sensitivity and Specificity
SELECTION OF CITATIONS
SEARCH DETAIL