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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.

Thorax ; 29:29, 2021.
Article in English | MEDLINE | ID: covidwho-1209856


The risk factors for development of fibrotic-like radiographic abnormalities after severe COVID-19 are incompletely described and the extent to which CT findings correlate with symptoms and physical function after hospitalisation remains unclear. At 4 months after hospitalisation, fibrotic-like patterns were more common in those who underwent mechanical ventilation (72%) than in those who did not (20%). We demonstrate that severity of initial illness, duration of mechanical ventilation, lactate dehydrogenase on admission and leucocyte telomere length are independent risk factors for fibrotic-like radiographic abnormalities. These fibrotic-like changes correlate with lung function, cough and measures of frailty, but not with dyspnoea.

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