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1.
Clin Imaging ; 89: 89-91, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1906893

ABSTRACT

While ipsilateral lymphadenopathy following COVID-19 vaccination is a relatively common finding on mammography and breast ultrasound transient ipsilateral breast edema is rare with only a few published case reports. Radiologists should be aware of this potential imaging appearance of the breast and axilla following COVID-19 vaccination given the imaging features of edema such as trabecular thickening, skin thickening, and increased echogenicity can overlap with benign and malignant breast conditions such as mastitis and inflammatory breast cancer. We describe a case of transient ipsilateral breast edema after COVID-19 vaccination followed by a discussion summarizing the current understanding and management of transient ipsilateral breast edema following COVID-19 vaccination.


Subject(s)
Breast Diseases , Breast Neoplasms , COVID-19 , Breast Diseases/diagnostic imaging , Breast Diseases/etiology , Breast Neoplasms/complications , COVID-19 Vaccines/adverse effects , Edema/diagnostic imaging , Edema/etiology , Female , Humans , Vaccination/adverse effects
2.
Ther Adv Respir Dis ; 16: 17534666221096040, 2022.
Article in English | MEDLINE | ID: covidwho-1822140

ABSTRACT

PURPOSE: We aimed to better understand the pathophysiology of SARS-CoV-2 pneumonia in non-critically ill hospitalized patients secondarily presenting with clinical deterioration and increase in oxygen requirement without any identified worsening factors. METHODS: We consecutively enrolled patients without clinical or biological evidence for superinfection, without left ventricular dysfunction and for whom a pulmonary embolism was discarded by computed tomography (CT) pulmonary angiography. We investigated lung ventilation and perfusion (LVP) by LVP scintigraphy, and, 24 h later, left and right ventricular function by Tc-99m-labeled albumin-gated blood-pool scintigraphy with late (60 mn) tomographic albumin images on the lungs to evaluate lung albumin retention that could indicate microvascular injuries with secondary edema. RESULTS: We included 20 patients with confirmed SARS-CoV-2 pneumonia. All had CT evidence of organizing pneumonia and normal left ventricular ejection fraction. No patient demonstrated preserved ventilation with perfusion defect (mismatch), which may discard a distal lung thrombosis. Patterns of ventilation and perfusion were heterogeneous in seven patients (35%) with healthy lung segments presenting a relative paradoxical hypoperfusion and hypoventilation compared with segments with organizing pneumonia presenting a relative enhancement in perfusion and preserved ventilation. Lung albumin retention in area of organizing pneumonia was observed in 12 patients (60%), indicating microvascular injuries, increase in vessel permeability, and secondary edema. CONCLUSION: In hospitalized non-critically ill patients without evidence of superinfection, pulmonary embolism, or cardiac dysfunction, various types of damage may contribute to clinical deterioration including microvascular injuries and secondary edema, inconsistencies in lung segments vascularization suggesting a dysregulation of the balance in perfusion between segments affected by COVID-19 and others. SUMMARY STATEMENT: Microvascular injuries and dysregulation of the balance in perfusion between segments affected by COVID-19 and others are present in non-critically ill patients without other known aggravating factors. KEY RESULTS: In non-critically ill patients without evidence of superinfection, pulmonary embolism, macroscopic distal thrombosis or cardiac dysfunction, various types of damage may contribute to clinical deterioration including 1/ microvascular injuries and secondary edema, 2/ inconsistencies in lung segments vascularization with hypervascularization of consolidated segments contrasting with hypoperfusion of not affected segments, suggesting a dysregulation of the balance in perfusion between segments affected by COVID-19 and others.


Subject(s)
COVID-19 , Clinical Deterioration , Heart Diseases , Pulmonary Embolism , Superinfection , Albumins , Critical Illness , Edema/diagnostic imaging , Edema/etiology , Humans , Lung/diagnostic imaging , Neovascularization, Pathologic , SARS-CoV-2 , Stroke Volume , Ventricular Function, Left
3.
BMC Infect Dis ; 21(1): 678, 2021 Jul 13.
Article in English | MEDLINE | ID: covidwho-1309904

ABSTRACT

BACKGROUND: In this case report, we presented a rare case of maternal death with massive vulvar edema and Covid-19 diagnosis. CASE PRESENTATION: The case was a 20-year-old woman who was referred to with pain and massive vulvar edema by passing 7 days from her labor. The laboratory tests showed leukocytosis, lymphopenia, and elevated C-reactive protein levels. The high-resolution computed tomography was in favor of Covid-19 changes. Finally, she died because of respiratory distress, ON the 8th day postpartum. CONCLUSION: Given the increasing prevalence of Covid-19, it is important and vital to be aware of its potential complications and then to try prevent and manage them, especially during high-risk periods such as pregnancy and postpartum.


Subject(s)
COVID-19/complications , Edema/complications , Edema/diagnostic imaging , Maternal Death , Postpartum Period , SARS-CoV-2/genetics , Vulvar Diseases/complications , Vulvar Diseases/diagnostic imaging , COVID-19/blood , COVID-19/virology , COVID-19 Testing/methods , Fatal Outcome , Female , Humans , Lymphopenia , Pregnancy , Reverse Transcriptase Polymerase Chain Reaction , Tomography, X-Ray Computed/methods , Young Adult
4.
F1000Res ; 9: 1286, 2020.
Article in English | MEDLINE | ID: covidwho-1110755

ABSTRACT

Background: Available data suggest that case fatality rate of COVID-19 patients in Surabaya is higher than global cases. Thus, it is important to identify risk factors to prevent the mortality. This study aimed to assess the factors associated with hospital mortality of COVID-19 patients, and develop a prediction score based on these findings. Methods: We analyzed 111 patients, who were diagnosed with COVID-19 based on reverse-transcriptase polymerase chain reaction. The following patient characteristics were obtained from records: age, gender, type of symptoms, onset of symptoms, neutrophil lymphocyte ratio (NLR), absolute lymphocyte count, chest x-ray abnormalities, lung involvement, type of lesion, radiographic assessment of the quantity of lung edema (RALE) score, and mortality. Data were analyzed using SPSS 25.0. Results Multivariate analysis showed that age >50 years ( p=0.043), NLR score >5.8 ( p=0.016) and RALE score >2 ( p=0.002) can predict the mortality of COVID-19 patients in the hospital. ROC curve analysis of the score ability to predict mortality showed an area under the curve of 0.794. The cut-off point is 4.5, with a sensitivity of 96.7% and specificity of 49.4% to predict the mortality of COVID-19 patient in the hospital. Conclusions Age, NLR score and RALE score were associated with mortality of COVID-19 patients in the hospital and might be used as a predictor for mortality of COVID-19 patients in health care centre where radiologists are available. The prediction score may be useful for frontline physicians to effectively manage patients with a higher score to prevent mortality.


Subject(s)
Age Factors , COVID-19/mortality , Edema/diagnostic imaging , Hospital Mortality , Lymphocytes/cytology , Neutrophils/cytology , Adult , Aged , COVID-19/diagnosis , Female , Humans , Lung/diagnostic imaging , Lung/physiopathology , Male , Middle Aged , Respiratory Sounds , Retrospective Studies
5.
Neurology ; 95(23): e3145-e3152, 2020 12 08.
Article in English | MEDLINE | ID: covidwho-966472

ABSTRACT

OBJECTIVE: To assess the physiopathology of olfactory function loss (OFL) in patients with coronavirus disease 2019 (COVID-19), we evaluated the olfactory clefts (OC) on MRI during the early stage of the disease and 1 month later. METHODS: This was a prospective, monocentric, case-controlled study. Twenty severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)-infected patients with OFL were included and compared to 20 age-matched healthy controls. All infected patients underwent olfactory function assessment and 3T MRI, performed both at the early stage of the disease and at the 1-month follow-up. RESULTS: At the early stage, SARS-CoV2-infected patients had a mean olfactory score of 2.8 ± 2.7 (range 0-8), and MRI displayed a complete obstruction of the OC in 19 of 20 patients. Controls had normal olfactory scores and no obstruction of the OC on MRI. At the 1 month follow-up, the olfactory score had improved to 8.3 ± 1.9 (range 4-10) in patients, and only 7 of 20 patients still had an obstruction of the OC. There was a correlation between olfactory score and obstruction of the OC (p = 0.004). CONCLUSION: OFL in SARS-CoV2-infected patients is associated with a reversible obstruction of the OC.


Subject(s)
Anosmia/diagnosis , Anosmia/etiology , COVID-19/complications , Edema/pathology , Nasal Cavity/pathology , Nasal Obstruction/pathology , Adult , Anosmia/pathology , Anosmia/physiopathology , COVID-19/diagnostic imaging , COVID-19/pathology , COVID-19/physiopathology , Case-Control Studies , Edema/diagnostic imaging , Edema/etiology , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Nasal Cavity/diagnostic imaging , Nasal Obstruction/diagnostic imaging , Nasal Obstruction/etiology , Young Adult
6.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Article in English | MEDLINE | ID: covidwho-963649

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Subject(s)
Cardiomegaly/diagnostic imaging , Coronavirus Infections/diagnostic imaging , Heart/diagnostic imaging , Myocardial Ischemia/diagnostic imaging , Myocarditis/diagnostic imaging , Pericardial Effusion/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Betacoronavirus , COVID-19 , Cardiomegaly/physiopathology , Coronary Angiography , Coronavirus Infections/physiopathology , Echocardiography , Edema/diagnostic imaging , Edema/physiopathology , Heart/physiopathology , Humans , Magnetic Resonance Imaging , Myocardial Ischemia/physiopathology , Myocarditis/physiopathology , Pandemics , Pericardial Effusion/physiopathology , Pneumonia, Viral/physiopathology , Radiography, Thoracic , Recovery of Function , SARS-CoV-2 , Tomography, X-Ray Computed , Ventricular Dysfunction/diagnostic imaging , Ventricular Dysfunction/physiopathology , Ventricular Dysfunction, Left/physiopathology
7.
Radiol Med ; 126(4): 570-576, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-947057

ABSTRACT

PURPOSE: Cerebrovascular disease (CVD) is considered a major risk factor for fatal outcome in COVID-19. We aimed to evaluate the possible association between computed tomography (CT) signs of chronic CVD and mortality in infected patients. MATERIALS AND METHODS: We performed a double-blind retrospective evaluation of the cerebral CT scans of 83 COVID-19 patients looking for CT signs of chronic CVD. We developed a rapid visual score, named CVD-CT, which summarized the possible presence of parietal calcifications and dolichosis, with or without ectasia, of intracranial arteries, areas of chronic infarction and leukoaraiosis. Statistical analysis was carried out with weighted Cohen's K test for inter-reader agreement and logistic regression to evaluate the association of in-hospital mortality with CVD-CT, chest X-ray (CXR) severity score (Radiographic Assessment of Lung Edema-RALE) for radiological assessment of pulmonary disease, sex and age. RESULTS: CVD-CT (odds ratio 1.6, 95% C.I. 1.2-2.1, p = 0.001) was associated with increased risk of mortality. RALE showed an almost significant association (odds ratio 1.05, 95% C.I. 1-1.1, p 0.06), whereas age and sex did not. CONCLUSION: CVD-CT is associated with risk of mortality in COVID-19 patients. The presence of CT signs of chronic CVD may be correlated to a condition of fragility of the circulatory system, which constitutes a key risk factor for death in infected patients.


Subject(s)
COVID-19/diagnostic imaging , COVID-19/mortality , Cerebrovascular Disorders/diagnostic imaging , Cerebrovascular Disorders/virology , Adult , Aged , Aged, 80 and over , COVID-19/complications , Cerebrovascular Disorders/mortality , Double-Blind Method , Edema/diagnostic imaging , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Retrospective Studies , Risk Assessment/methods , SARS-CoV-2 , Tomography, X-Ray Computed
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