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Introduction: Spontaneous pneumothorax is a rare complication of coronavirus disease 2019 (COVID-19), primarily reported in adults. Pediatric cases with bilateral pneumothorax are much less reported. Case Presentation: We presented the case of a five-year-old previously healthy boy who developed persistent fever, abdominal pain, generalized maculopapular rash, and dyspnea before admission. His chest computed tomography (CT) showed a viral involvement pattern of pneumonia suggestive of COVID-19. Subsequently, he was confirmed with multisystem inflammatory syndrome in children (MIS-C). While he responded well to the therapies, on the fifth day of admission, he developed respiratory distress again. A chest roentgenogram showed bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and his condition improved sig-nificantly after five days of admission to the intensive care unit. Two weeks later, he was discharged in good condition. Conclusion(s): Children with MIS-C associated with COVID-19 may develop primary spontaneous pneumothorax. Owing to the clinical picture overlapping with MIS-C associated with COVID-19, the timely diagnosis of pneumothorax may be challenging in such patients.Copyright © 2022, Author(s).
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Objectives: The effectiveness of prone positioning (PP) under VV-ECMO for severe COVID-19 still be unclear. Until now, PP under VV-ECMO was often performed as the trump card for refractory hypoxemia and weaning off ECMO. On the other hand, PP has the effect of promoting homogenization of Lung aeration and leading to prevention of VILI. Combine use of early prone positioning together VV-ECMO may have synergy effects of ultra-lung protective strategy. In this study, we analyzed early PP cases under VV-ECMO for severe COVID-19 in our hospital and examined their efficacy and feasibility. Method(s): We performed a retrospective study of patients with SARS-CoV-2-induced ARDS submitted to early PP during VV-ECMO. During VVECMO, PP was considered in case of "Type-H transition in imaging findings (CT / LUS) " and cases that the physician deemed necessary. The lung aeration is evaluated by LUS before and after each PP. If there is a finding that the dorsal collapsed lung is improved through PP, it is implemented as effective, and it continued. Result(s): From April 2021 to August 2021, there were a total of 10 early PP cases under ECMO, and the age was (average) 56 years. ECMO was implanted with P/F 98 and Murray score 3.3 points, and PP was started 14 hours after the ECMO implantation. The average PP duration is 17.4 hours and PP performed 5.8 times per patient. Comparing blood gas and respiratory mechanics before and after PP showed a significant difference in PaCO2 (before: 46 +/- 8 vs after: 42 +/- 9, p = 0.02). Finally, there were 10 ECMO successful weaning (100%) and 8 surviving discharges (80%). No major complications were observed. Conclusion(s): Early PP under VV-ECMO for severe COVID-19 can be safely performed, and it is suggested that the synergy effect of ultra-lung protective strategy may be associated with a reduction of hospital mortality.
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The development of coronavirus infection outbreak into a pandemic, coupled with the lack of effective COVID-19 therapies, is a challenge for the entire pharmaceutical industry. This study aimed to assess the treatment and preventive efficacy of the amino acid-peptide complex (APC) in male Syrian hamsters infected with SARSCoV-2 (intranasal administration of 26 mul of the virus culture, titer of 4 x 104 TCD50/ml). In a modeled COVID-19 case, APC administered for treatment and preventive purposes reduced lung damage. Compared to the positive control group, test group had the lung weight factor 15.2% smaller (trend), which indicates a less pronounced edema. Microscopic examination revealed no alveolar edema, atypical hypertrophied forms of type II alveolocytes, pulmonary parenchyma fibrinization. The macrophage reaction intensified, which is probably a result of the APC-induced activation of regenerative processes in the lung tissues. Spleens of the animals that received APC for therapeutic and preventive purposes were less engorged and had fewer hemorrhages. The decrease of body weight of the test animals that received APC for treatment and prevention was insignificant (p < 0.05), which indicates a less severe course of COVID-19. Administered following a purely therapeutic protocol, APC proved ineffective against SARS-CoV-2 post-infection. Thus, APC-based drug used as a therapeutic and preventive agent reduces pulmonary edema and makes morphological signs of lung tissue damage less pronounced in male Syrian hamsters infected with SARS-CoV-2.Copyright © Extreme Medicine.All right reserved.
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Background: Aim: Study of lung damage syndromes and extra-respiratory complications in children with CoV-2 infection. Method(s): The study included 53children with CoV-2 infection and were evaluated clinically to identify the evolutionary consequences of these diseases. Laboratory tests, pulmonary CT, brain CT, EcoCG were performed. Diagnostic tests to confirm CoV-2: RT PCR-test and/or serological tests for IgM, IgG Ab to CoV-2. Result(s): COVID-19 infection was confirmed by RT PCR test in 79.2%(CI51.7%-78.5%) children, and in 20.8%(CI 10.8%-34.1%) cases by IgM and IgG Ab to SARS-CoV- 2 virus. The mean age of the patients -6.03+/- 5.68. Respiratory manifestations at the COVID-19 stage had of 81.5% children (bronchitis -14.8%, pneumonia -62.9%), and the evolutionary stages were detected pulmonary fibrosis (30.5%), atelectasis (30.5%), bronchiectasis (11.11%). COVID-19- associated neurological syndromes were found in 39.6% of children-migraine headache (9.4%), toxic encephalopathy (7.5%), psychotic disorders (3.8%), neurotic anorexia (1.9%), but also severe neurological complications -multifocal leukoencephalitis(5.7%), acute cerebellitis (3.8%), polyradiculoneuropathy (3.8%), epilepsy (1.9%). Signs of cardiovascular damage were reported in 21.2% of cases:bouts of tachycardia (7.7%), toxic heart disease (5.7%). Children with CHDs (7.7%) had severe heart failure in the post-Covid- 19 stages. Conclusion(s): Clinical manifestations in the evolutionary stages of Covid-19 in children are dominated by impaired respiratory system with signs of pulmonary fibrosis, atelectasis, which are often associated with neurological complications and sometimes with cardiovascular signs.
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Mechanical ventilation (MV) is a life-support therapy that may predispose to morbid and lethal complications, with ventilator-associated pneumonia (VAP) being the most prevalent. In 2013, the Center for Disease Control (CDC) defined criteria for ventilator-associated events (VAE). Ten years later, a growing number of studies assessing or validating its clinical applicability and the potential benefits of its inclusion have been published. Surveillance with VAE criteria is retrospective and the focus is often on a subset of patients with higher than lower severity. To date, it is estimated that around 30% of ventilated patients in the intensive care unit (ICU) develop VAE. While surveillance enhances the detection of infectious and non-infectious MV-related complications that are severe enough to impact the patient's outcomes, there are still many gaps in its classification and management. In this review, we provide an update by discussing VAE etiologies, epidemiology, and classification. Preventive strategies on optimizing ventilation, sedative and neuromuscular blockade therapy, and restrictive fluid management are warranted. An ideal VAE bundle is likely to minimize the period of intubation. We believe that it is time to progress from just surveillance to clinical care. Therefore, with this review, we have aimed to provide a roadmap for future research on the subject.Copyright © 2022 The Author(s)
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In patients with the Chilaiditi sign, pulmonary lower lobes collapse occurs because of interposition of the bowel between diaphragm and liver. When such patients suffer from COVID-19 pneumonia, clinicians should carefully monitor respiratory status.
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Background: Radiological changes in children with lung damage caused by SARS-CoV-2 can be diagnosed by radiology exams with the identification of interstitial inflammation characterized of viral pneumonia. Aim(s): Evaluation of pulmonary radiological manifestations in children with COVID-19 infection. Method(s): Expected research evaluated pulmonary radiological changes among 315 children with SARS-CoV-2 infection, with moderate and severe form, from the age of 2 days till 18 years. Age distribution of hospitalized children with clinical signs of COVID-19 infection:<28 days-36 children(11,4%:95%CI8,2-15,6),28 days-1year-72 children(22,9%:95%CI18,4-28),1-3years-65 children(20,6%:95%CI16,4-25,6),4-7 years-66 children(21%:95%CI16,7-26),7-18years-76 children(24,1%:95%CI19,6-29,3). Result(s): Chest X-ray in children with SARS-CoV-2 infection found interstitial changes of the ground glass"type among 161 children(52.8%:95%CI 47-58.5) Condensation opacities in 51 children(16.7%:95%CI12.8-21.5)confirmed pneumonia of bacterial etiology associated with COVID-19 infection. Bronchitis was confirmed in 62 cases among hospitalized children(20.3%:95% CI16-25.4),and obstructive bronchitis characterized by imaging of hyperinflation- among 25 children(12.6%:95%CI8,3-18). Young children and infants had a thymus hyperplasia in 21.6%:95%CI17.2- 26.8 cases. At the acute stage of COVID-19 infection signs of fibrosis, atelectasis, traction bronchiectasis were detected in unique cases(0.3%:95%CI0-2.1). Conclusion(s): Lung damage caused by COVID-19 infection in children is generally characterized by changes with interstitial inflammation that are confirmed by Chest X-ray.
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Introduction: West Cheshire houses some of the most affluent and deprived neighbourhoods in England. Currently there is no information regarding radiological recovery from COVID pneumonia in relation to socioeconomic status. Aims and Objective: To explore if radiological recovery among COVID-19 hospitalised patients is affected by their socio-economic status. Method(s): A retrospective analysis of COVID 19 pneumonia patients admitted to a district hospital between 03/2020 & 03/2021 was performed. Patients were identified from Radiology software and coding data. Findings were classified as per Fleischer society glossary. Patients were classified in 3 cohorts (deprived, intermediate and affluent) based on post code aligned English Index of Multiple Deprivation 2019. Result(s): 336 patients were included with a mean age of 66.2 years (18 to 96). Males 51.7% & 48.3% females. All these patients had ground glass opacities, consolidation, reticulation or atelectasis on initial imaging. Patients from deprived region were 157/336 (46.7%), intermediate 38/336 (11.3%) and affluent 141/336 (62.2%). COVID infection prevalence in deprived was 14 per 10,000 and affluent was 9 per 10,000. 106 patients had Persistent Lung Opacities (PLO) on follow up radiology. Of these deprived were 54/106 (50.9%), intermediate 14/106 (13.2%), and affluent 38/106 (35.8%). Prevalence of PLO in deprived was 4.6 per 10,000 and affluent was 2.6 per 10,000. Conclusion(s): We noticed COVID prevalence in our deprived cohort is 1.5 times higher than affluent. PLO in the deprived group were twice higher than affluent group. This confirms the health inequalities highlighted by COVID in prevalence and recovery.
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Introduction: COVID-19 pneumonia usually presents as multifocal infiltrates or consolidation. The British Thoracic Society proposes a Chest X Ray based follow up. We looked at the radiological outcomes of patients admitted with COVID-19 pneumonia to our District General Hospital. Aim and Objectives: To investigate the radiological outcomes of COVID pneumonia and explore if pre-existing respiratory disease affected these outcomes Methods: A retrospective analysis of COVID 19 pneumonia patients admitted between 03/03/2020 & 22/03/2021 was performed. Study cohort identified using Radiology reporting software and clinical coding data. Information collected of repeat imaging, medical comorbidities and categorised as per Fleischer society glossary Results: 293 patients with follow up imaging were included with a mean age of 66.1 years, (17.1 to 99.8 years). Males 50.8% and females 49.2%. 106 (36%) patients had persistent lung opacities (PLO) including consolidation, ground glass opacification or residual changes, 25 (8%) had fibrotic changes and 15 (5%) had atelectasis. Of 106 patients with PLO, 38 (35%) patients had respiratory co-morbidities i.e., 6 emphysema, 14 COPD, 14 asthma, 2 bronchiectasis and 1 fibrosis. 147 (50%) patients who had complete resolution, out of these 30 (20%) patients had respiratory comorbidities i.e., 2 emphysema, 8 COPD, 18 asthma & 2 had bronchiectasis. Out of 25 patients with fibrotic changes 6 (24%) had respiratory co-morbidities. Conclusion(s): The prevalence of PLO in repeat imaging of COVID pneumonia patients in our centre was 36%, out of those 35% patients had pre-existing respiratory disease. COPD patients were at higher risk of having PLO compared to asthma patients.
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Introduction: The interest of respiratory physiotherapy maneuvers during a difficult fibroscopy in the intubated patient, sedated in a context of Covid-19 has not been reported so far. Case presentation: A 50-years-old patient with a severe form of Covid-19, requiring an endotracheal intubation, complicated by a ventilator-associated pneumonia and a complete atelectasis of the left lung. Because of adherent and purulent mucus, chest physiotherapy techniques and fiberoptic bronchoscopy conducted separately showed low effectiveness to remove the atelectasis. Chest physiotherapy manual techniques used during fiberoptic bronchoscopy allowed extracting easier the mucus;they helped to remove the atelectasis and to improve the hematosis as well as the prognosis for survival of the patient. Conclusion(s): Manual maneuvers of respiratory physiotherapy during the fibroscopy procedure could improve the efficiency of aspiration of very adherent secretions. Level of Evidence: 5.Copyright © 2022 Elsevier Masson SAS
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Background: Lockdowns and mask wearing have impacted infectious disease patterns during the COVID-19 pandemic. We investigated changes in the use of bronchoscopy and the results of routine microbiology in bronchial lavage. Method(s): We included bronchoscopies from 2017-2021 at the LMU University Department of Pulmonology. In this we present an initial cohort comparing bronchoscopies in 2017-2018 to the initial phase of the COVID-19 pandemic in 2020. Comparisons used chi-squared and Fischer's exact tests in SPSS. Result(s): We analysed 480 bronchoscopies from before and 85 during the COVID-19 pandemic. Mean age: 62.6 y (+/-14.1) before vs. 55.2 y (+/-16.3) during the pandemic (p<0.001). Indication for bronchoscopy: secretions/atelectasis (n=122), suspected tumor (n=89) and intervention/therapy (n=80) before;suspected tumor (n=30), respiratory deterioration after lung transplant (n=19) and infection (n=7) during the pandemic. Staphylococcus aureus and Pseudomonas aeruginosa were common in both groups. Frequencies of EBV (p<0.001), CMV (p=0.003) and HHV6 (p<0.001) differed significantly. Conclusion(s): There were clinically relevant differences in the use of bronchoscopy before vs. during the COVID-19 pandemic: pandemic patients were younger and interventions such as bronchial stenting and recanalisation less common. Bacterial results were similar but the frequency of common viruses differed. The effect of lockdowns, mask wearing and social distancing on bronchial microbiology in patients with lung cancer or chronic lung disease will be investigated in further detail in this cohort. Clinical relevant differences may support continued mask wearing in some high-risk situations post-pandemic.
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Introduction: Ultrasound (US) has become a more reliable method for lung parenchyma assessment. Precise detecting localization and effective monitoring treatment is crucial in respiratory medicine patients. The aim was to evaluate the accuracy of the US to detect and monitor lung lesions in compliance with lung segmental anatomy in post-COVID patients with associated comorbid respiratory conditions. Materials: We did an evaluation of 30 consecutive patients (25-74?years), who suffered from various chronic respiratory conditions and underwent COVID-19 during the last 3 months. All patients underwent first line lung ultrasound followed by CT and bronchoscopy where needed. Result(s): US can detect correctly in 28/30 cases to verify lesion and segmental localization as confirmed on CT and/or endoscopy. The US was effective to monitor treatment in 24/30 cases without need for follow up CT, including 5 patients after bronchoscopic lavage. Various specific conditions were detected and monitored on US: segmental atelectasis, pneumonia (22 cases);right middle lobe atelectasis (3);bronchiectatic disease (3);lung cirrhosis, post tuberculosis changes (2). Lung compression / atelectasis due to severe scoliosis and thoracic deformities detected in 2 patients. In some cases US was more effective vs CT due to possibility of real time ventilation observation, detecting tissue movement;dorsal areas ventilation was underdetected on CT due to patients'position. Conclusion(s): US can be used for detecting peripheral lung lesions, precise determination of segmental localization, is important for early diagnosis and monitoring.
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Introduction: There is a lack of data on long-term sequelae of severe COVID-19 pneumonia beyond clinical followup at 6 months. Aim(s): To describe the evolution of pulmonary sequelae at 3, 6 and 12 months in severe COVID-19 survivors in terms of pulmonary function and high-resolution computed tomography (HRCT) of the chest. Method(s): 84 subjects (74% male, median age: 63 [49-70]) hospitalized for COVID-19 pneumonia (January 2021- January 2022) were evaluated at 3, 6 and 12 months after discharge with spirometry, lung diffusing capacity (DLCO), 6-minute walking test (6MWT) and HRCT. Result(s): At 3, 6 and 12 months, 64%, 70% and 80% of patients were found to have normal spirometry (FVC: 83+/-6%, 96+/-2%, 97+/-2%]);DLCO <80% was found in 66% (mean 77+/-1%), 63% (mean 74+/-2%) and 43% (mean 81+/-1%) of subjects;6MWT performance was normal in 70% (median 494 m [582-472]), 84% (median 552 m [487- 583]) and 100% (median 557 m [496-588]) of subjects. However, after 1 year of discharge, 50% of patients had persistent oxygen desaturation at the end of the 6MWT. HRCT abnormalities were detected at 3, 6 and 12 months in 87%, 60% and 43% of patients. The most prevalent HRCT patterns at 12 months were ground-glass opacities (71%), subpleural reticulation and atelectasis (35%) and bronchiectasis (10%). Conclusion(s): A high prevalence of persistent lung function and HRCT abnormalities was found in survivors of severe COVID-19 pneumonia. Evaluation at 3, 6 and 12 months showed progressively improving values of spirometry, DLCO and 6MWT over time. However, long-term HRCT anomalies and exercise-induced desaturation suggest persistent interstitial phenomena of unknown implications.
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COVID-19 has led to morbidity in millions of patients, ranging from mild flu-like symptoms to severe respiratory failure, necessitating oxygen supplementation and mechanical ventilation, and ultimately death. The SARS-CoV-2 virus reacts with angiotensin-converting enzyme 2 (ACE2) molecules that are especially found in alveolar epithelial type 2 cells in the lungs and thereby causes a loss in lung surfactant, a protein-lipid mixture that is crucial for both native immunity and reduction of surface ten-sion in the lung alveoli. Lung surfactant insufficiency results in atelectasis and loss of functional lung tissue amid an inflammatory storm and may be countered by treating COVID-19 pneumonia patients with exogenous lung surfactant, preferably by aerosol delivery of a novel dry powder synthetic lung sur-factant. More research on timing, dosing, and delivery of synthetic lung surfactant in patients with COVID-19 pneumonia is of crucial importance to implement this approach in clinical practice.Copyright © 2021 Bentham Science Publishers.
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Background: 49 patients underwent Lung Biopsy due to different indications and Post-COVID Pulmonary Fibrosis(PCPF) was suspected in 25 patients. Objective(s): To document the evidence of PCPF in patients with history of suspected COVID 19 infection (in past oneyear) through Transbronchial Lung Biopsy(TBLB)with flexible bronchoscopy. PFT and HRCT gave variedpresentation. Method(s): we have evaluated patients who underwent Lung Biopsy on flexible Bronchoscopy between 08/07/2021 till31/01/2022 at Metro Hospitals and Heath Institute, Meerut, UP, India. The history of exposure to COVID 19 infectionwas taken. Most of these patients underwent Echocardiography (ECHO) for Left Ventricular Ejection Fraction (LVEF)and Pulmonary Artery Pressure (PAH), Pulmonary Function Test (PFT) and High Resolution CT Scan Chest (HRCTChest). Result(s): 49 patients underwent Lung Biopsy. 25 patients gave the history of exposure to COVID 19 infection with complaint of breathlessness and chest discomfort in the last 1 year. HRCT chest was suggestive of Atelectasis in 3 patients, Interstitial Lung Disease (ILD) in 6, Fibrosis in 8, Pulmonary Nodules in 4 and HRCT was not done in 4 patients. PFT showed Mixed Ventilator Defect in 8, Obstructive in 3, Restrictive in 7, small airway disease in 1 and 6 patients couldn't perform PFT. PAH was normal for 6,mild for 16, moderate for 2 and 1 severe. 4 patients had Coronary Artery Disease. 2 patients had major complications like pneumothorax who underwent TBLB. Conclusion(s): PCPF was detected with the help of TBLB in the patients with history of exposure to COVID 19 infection. However, TBLB may cause major complication like pneumothorax seen in 8% cases.
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Aim: The pandemic period has led to social and individual behavioral changes all over the world. In this study, the differences in the admissions of non-coronavirus disease 2019 (non-COVID-19) community-acquired pneumonia cases during the pandemic lockdown period in Turkey were analyzed. Material(s) and Method(s): Patients with suspected COVID-19 and under the age of 18 were excluded, and non-COVID-19, hospitalized community-acquired pneumonia cases were included in this retrospective, cohort study. The analyzes were carried out by creating two groups as before the pandemic (March-May 2019) and the lockdown period of the pandemic (March-May 2020). The number of admissions and mortality rates were taken into consideration as primary outcomes. Result(s): There were 178 cases in the 2019 group and 63 cases in the 2020 group. Gender and age distribution were similar in these two groups. While the rate of intensive care hospitalization was high in the 2020 group, mortality was low (14.3% vs 19.1%);but these differences were not statistically significant. In addition, bilateral infiltration rates were significantly higher in the 2019 group (80.9% vs. 22.2%;p<0.001). Discussion(s): The low number of admissions during the lockdown period shows that there is awareness of the pandemic in society. Again, it can be said that this closure process plays a role in reducing the transmission of infectious diseases such as pneumonia.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Background & Aims: Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection. Due to their availability and rapid turnaround time, the role of chest computed tomography (CT) scan is growing for early diagnosis of patients with COVID-19. However, due to the low efficiency of viral nucleic acid detection as well as low specificity of chest CT scan for detecting COVID-19 pneumonia, this method shows incomplete clinical performance for proper COVID-19 disease diagnosis. Due to the highly contagious nature of the Coronavirus 2019 and the importance of early detection of the disease, a limited number of nucleic acid test kits, such as rRT-PCR and the possibility of false-negative rRT-PCR results, chest CT scan as a non-invasive method, it can be a highly accurate tool for early detection of suspected COVID-19 cases. The purpose of this study was the Interpretation of chest CT scan of patints with COVID-19 in Imam Khomeini Hospital of Jiroft University of Medical Sciences from December to March 2019 Methods: This research is a retrospective study that was conducted with the aim of interpreting CT scans of the chest in patients with covid-19 in Imam Khomeini Hospital, Jiroft University of Medical Sciences from March 2018 to June 2019. After obtaining permission from the ethics committee of the university, the researcher appeared in the research environment according to the pre-determined schedule for sampling. The desired data were extracted from the patients' files and recorded in a questionnaire form that was designed for this purpose. The criteria for entering the study included cases whose demographic information, clinical and laboratory data were complete and the positive PCR test along with chest CT imaging findings were available in the file, the exclusion criterion was the presence of low quality chest images. The data were extracted from the hospital information system based on clinical electronic medical records. including demographic information including age, sex, level of education and data related to the underlying disease, disease symptoms (cough, fever, phlegm, shortness of breath, chest pain, etc.) and the frequency of imaging findings in the chest CT scan that They were examined and evaluated according to age, gender, level of education, clinical symptoms, underlying disease and based on lymphopenia and lymphocytosis. and chest CT scan report of patients with COVID-19, which was available in the PACS system of this hospital, were evaluated. In this way, all the CT images of the chest by a radiologist as well as a lung specialist who were not aware of the clinical and laboratory data of the patients, in terms of the types of findings include, Patchy ground glass opcification, diffuse ground glass opacification, Air space opacity, Consolidation, pleural effusion, Atelectasis, Bronchiectasis, Fibrotic change, Cavitation, Lymphadenopathy. And the distribution of conflict was investigated as peripheral, central, bilateral, and unilateral. Results: The highest number of people with Covid-19 were in the age range of 30 to 59 years and men. In CT scan findings, the highest CT scan imaging findings as well as the highest mortality rate in patients were PGGO view (63.3%) and peripheral and bilateral involvement and the lowest frequency was related to Cavitation findings. In the examination of CT scan findings, PGGO and peripheral and bilateral involvement were the most frequent and Cavitation was the least frequent. Also, the findings of PGGO, Peripheral and Bilateral in the CT scan of the people who died had the highest frequency. In none of the imaging findings of the chest scan, there was no statistically significant relationship with the level of education, the level of education and death of patients due to COVID-19. There was no significant difference between gender and the findings of PGGO and Cavitation and peripheral involvement and Bilateral, but between the findings of DGGO and gender and there was a significant relationsh
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Aim/Introduction: Multiple extra cardiac findings with increased perfusion have been reported as coincidental findings during myocardial perfusion imaging (MPI) with various radiotracers. At our facility, 15O-H2O-PET MPI was implemented in daily clinical routine in May 2020, and we therefore anticipated similar findings using this radiotracer. The aim of this is therefore to share a case series of our initial experience regarding extra cardiac findings characterized by increased blood flow on 15O-H2O-PET. Material(s) and Method(s): Patient cases with extra cardiac findings observed during clinical 15O-H2O PET MPI scans were collected. All patients were scanned according to facility standards and international guidelines on a GE Discovery MI Digital Ready PET/CT (GE Healthcare, Waukesha, Wisconsin, USA). In contrast to the parametric myocardial 15O-H2O images, summed and gated retention images were used for assessment of extra cardiac perfusion. Biopsy histopathological diagnosis was used as reference standard in all malignant lesions and in some benign lesions. In the remaining patients, other imaging modalities were used as reference standard. Result(s): A variety of malignant lesions with increased perfusion appeared during the scans, including primary tumours of breast cancer, lung cancers, large-celled neuroendocrine tumours, lymphomas and metastases from colonic carcinomas and renal cell carcinomas. Furthermore, a number of benign conditions with increased perfusion were observed: Healing rib fractures, gynecomastia, atelectasis, acute pneumonia (disappeared on subsequent FDG-PET/CT), lung infiltrate with biopsy-verified chronic inflammation and fibrosis (FDG-positive), biopsy-verified benign lung nodulus, chronic diffuse lung infiltrates, pleural plaques and sequelae after recent COVID-19 infection (scan 12 days after positive test). In general, the benign findings were either inflammation or hyperplastic tissue, which are conditions known to be characterized by increased perfusion. Conclusion(s): Both malignant and benign extra cardiac coincidental findings with increased perfusion are readily visible and frequently encountered on 15O-H2O-PET MPI. In most cases, the coincidental findings are also visible on the low-dose attenuation correction CTscan. However, we did observe a 15O-H2O avid breast cancer tumour located outside the CT field of view, underlining the importance of evaluating the entire field of view of the retention 15O-H2O-PET and not just the reconstructed parametric myocardial images.