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2.
Clin Nucl Med ; 47(3): e302-e303, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1672450

ABSTRACT

ABSTRACT: We presented here a 71-year-old man with a history of thyroid cancer post total thyroidectomy and 131I ablation and right renal cell carcinoma post right partial nephrectomy. He reported persistent chest tightness and pain after the first dose of the Moderna COVID-19 (mRNA-1273) vaccine. Thus, coronary heart disease was suspected, and the patient was referred for MPI (myocardial perfusion imaging). Focal 201Tl uptake in the left axillary region was found incidentally on MPI, and SPECT/CT revealed enlarged benign-looking lymph nodes. The diagnostic is in favor of reactive hyperplasia after the intramuscular injection of vaccine into left deltoid muscle.


Subject(s)
COVID-19 , Lymphadenopathy , Myocardial Perfusion Imaging , Aged , COVID-19 Vaccines , Humans , Incidental Findings , Iodine Radioisotopes , Male , SARS-CoV-2 , Thallium Radioisotopes , Vaccination
5.
Br J Radiol ; 95(1130): 20211079, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1598426

ABSTRACT

OBJECTIVES: To describe the findings of incidental asymptomatic COVID-19 infection on FDG PET-CT using a case-control design. METHODS: Incidental pulmonary findings suspicious of asymptomatic COVID-19 infection on FDG PET-CT were classified as a confirmed (positive RT-PCR test) or suspected case (no/negative RT-PCR test). Control cases were identified using a 4:1 control:case ratio. Pulmonary findings were re-categorised by two reporters using the BSTI classification. SUV metrics in ground glass opacification (GGO)/consolidation (where present), background lung, intrathoracic nodes, liver, spleen and bone marrow were measured. RESULTS: 7/9 confirmed and 11/15 suspected cases (COVID-19 group) were re-categorised as BSTI 1 (classic/probable COVID-19) or BSTI 2 (indeterminate COVID-19); 0/96 control cases were categorised as BSTI 1. Agreement between two reporters using the BSTI classification was almost perfect (weighted κ = 0.94). SUVmax GGO/consolidation (5.1 vs 2.2; p < 0.0001) and target-to-background ratio, normalised to liver SUVmean (2.4 vs 1.0; p < 0.0001) were higher in the BSTI 1 & 2 group vs BSTI 3 (non-COVID-19) cases. SUVmax GGO/consolidation discriminated between the BSTI 1 & 2 group vs BSTI 3 (non-COVID-19) cases with high accuracy (AUC = 0.93). SUV metrics were higher (p < 0.05) in the COVID-19 group vs control cases in the lungs, intrathoracic nodes and spleen. CONCLUSION: Asymptomatic COVID-19 infection on FDG PET-CT is characterised by bilateral areas of FDG avid (intensity > x2 liver SUVmean) GGO/consolidation and can be identified with high interobserver agreement using the BSTI classification. There is generalised background inflammation within the lungs, intrathoracic nodes and spleen. ADVANCES IN KNOWLEDGE: Incidental asymptomatic COVID-19 infection on FDG PET-CT, characterised by bilateral areas of ground glass opacification and consolidation, can be identified with high reproducibility using the BSTI classification. The intensity of associated FDG uptake (>x2 liver SUVmean) provides high discriminative ability in differentiating such cases from pulmonary findings in a non-COVID-19 pattern. Asymptomatic COVID-19 infection causes a generalised background inflammation within the mid-lower zones of the lungs, hilar and central mediastinal nodal stations, and spleen on FDG PET-CT.


Subject(s)
COVID-19/diagnostic imaging , Fluorodeoxyglucose F18 , Incidental Findings , Lung/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Radiopharmaceuticals , Adult , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Male , Middle Aged , Reproducibility of Results , SARS-CoV-2
7.
Clin Radiol ; 77(3): 231-235, 2022 03.
Article in English | MEDLINE | ID: covidwho-1568610

ABSTRACT

AIM: To follow-up previous work evaluating incidental findings of COVID-19 signs on computed tomography (CT) images of major trauma patients to include the second wave prior to any major effects from vaccines. MATERIALS AND METHODS: The study population included all patients admitted following major trauma between 1 January 2020 and 28 February 2021 with CT including the lungs (n=1776). Major trauma patients admitted pre-COVID-19 from alternate months from January 2019 to November 2019 comprised a control group (n=837). The assessing radiologists were blinded to the time period and used double reading in consensus to determine if the patient had signs of COVID-19. Lung appearances were classified as no evidence of COVID-19, minor signs, or major signs. RESULTS: The method successfully tracked the second wave of the COVID-19 pandemic in London. The estimated population affected by the disease based on those with major signs was similar to estimates of the proportion of the population in London with antibodies (around 30% by end February 2021) and the total of major and minor signs produced a much higher figure of 68%, which may include all those with both antibody and just T-cell responses. CONCLUSIONS: Incidental findings on CT from major trauma patients may provide a novel and sensitive way of tracking the virus. It is recommended that all major trauma units include a simple question on signs of COVID-19 to provide an early warning system for further waves.


Subject(s)
COVID-19/epidemiology , Lung/diagnostic imaging , Tomography, X-Ray Computed , Wounds and Injuries/diagnostic imaging , Wounds and Injuries/epidemiology , Aged, 80 and over , COVID-19/diagnostic imaging , Comorbidity , Female , Humans , Incidental Findings , London/epidemiology , Male , Middle Aged , Pandemics , Prevalence , United Kingdom/epidemiology
8.
Heart Surg Forum ; 24(6): E940-E946, 2021 11 12.
Article in English | MEDLINE | ID: covidwho-1538255

ABSTRACT

BACKGROUND: The aim of this study was to investigate the clinical outcomes of cardiac surgery in patients who were incidentally diagnosed with Covid-19 in the postoperative period. PATIENTS AND METHODS: We performed 826 open cardiac surgeries in five tertiary centers. Most of the surgeries were elective coronary artery bypass grafting (CABG) (93.8%). A preoperative RT-PCR test and transcutaneous oxygen saturation were routinely investigated prior to surgery. We also investigated whether the patients already received Covid-19 treatment or had any contact with a Covid-19 patient in the last two weeks. We analyzed high sensitive C-reactive protein (hs-CRP), d-dimer, and fibrinogen, which plays a main role in the activation of procoagulant state after surgeries. RESULTS: Acute lung injury related to Covid-19 activation was observed in 48 out of 826 patients (5.8%). The median age of 48 patients was 63.9±12.4 years. Euro-Score and body mass index (BMI) were 6.1±1.1 and 29.2±4.1kg/m², respectively. RT-PCR test results were positive in 29 patients (60.4%). We performed thoracic computed tomography (CT) in all patients with or without positive RT-PCR test results. Thoracic CT images showed that there was a different degree of ARDS (mild, moderate, and serious). The median time of extracorporeal circulation (ECC) was 93.2±14.6 min. in on-pump surgery (IQR, 68-155 min.). Common symptoms included dyspnea (N = 22; 45.8%) and fever (N = 12; 25%). Eleven patients needed readmission to ICU. Compared with non-admitted to ICU patients, ICU patients were higher comorbidities and severe laboratory abnormalities (eg, high blood d-dimer and fibrinogen). We also detected significantly low oxygen saturation, hypercapnia, and severe acidosis in readmitted patients. Radiologic investigations showed that there were severe ARDS with bilateral pneumonic infiltration resistant to medical treatment in 6 out of 11 patients who died (54.5%). CONCLUSION: Diffuse pneumonic infiltration related to Covid-19 may develop in asymptomatic cardiac surgery patients with negative RT-PCR test results. Immunologic disorders resulting from ECC, physiologic distress, and anesthesia may activate Covid-19 during the incubation period. We need randomized clinical trials to explain Covid-19 activation in the latent period of the virus, and clinical outcomes in cardiac surgery.


Subject(s)
Acute Lung Injury/diagnosis , Acute Lung Injury/virology , COVID-19/diagnosis , COVID-19/virology , Cardiac Surgical Procedures , Postoperative Period , Acute Lung Injury/diagnostic imaging , Aged , COVID-19/diagnostic imaging , COVID-19 Nucleic Acid Testing , Critical Care , Female , Humans , Incidental Findings , Male , Middle Aged , Patient Readmission , Retrospective Studies , SARS-CoV-2 , Stress, Physiological , Tomography, X-Ray Computed , Virus Activation
9.
Front Endocrinol (Lausanne) ; 12: 727320, 2021.
Article in English | MEDLINE | ID: covidwho-1497068

ABSTRACT

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that has caused a worldwide pandemic. The majority of medullary thyroid cancers present as a thyroid nodule. At the time of diagnosis, cervical lymph nodes and distant metastases are frequently detected. Case Report: Here, we present a case of a 46-year-old man with coronavirus disease (COVID) pneumonia, who had persistently high serum procalcitonin levels despite normal C-reactive protein levels. The attending infectologist happened to be a colleague who spent some time, as part of her internal medicine rotation, in the Endocrine Ward and recalled that medullary thyroid cancer might be the cause. This led to the timely workup and treatment of the medullary cancer.


Subject(s)
COVID-19/complications , Carcinoma, Neuroendocrine/blood , Carcinoma, Neuroendocrine/diagnosis , Endocrinology/methods , Procalcitonin/blood , Thyroid Neoplasms/blood , Thyroid Neoplasms/diagnosis , Biomarkers, Tumor/blood , C-Reactive Protein/biosynthesis , Carcinoma, Neuroendocrine/complications , Humans , Incidental Findings , Lymph Nodes/pathology , Male , Middle Aged , SARS-CoV-2 , Thyroid Neoplasms/complications , Thyroid Nodule
10.
Clin Transl Sci ; 15(2): 524-534, 2022 02.
Article in English | MEDLINE | ID: covidwho-1476158

ABSTRACT

The safety of novel therapeutics and vaccines are typically assessed in early phase clinical trials involving "healthy volunteers." Abnormalities in such individuals can be difficult to interpret and may indicate previously unrecognized medical conditions. The frequency of incidental findings (IFs) in healthy volunteers who attend for clinical trial screening is unclear. To assess this, we retrospectively analyzed data for 1838 "healthy volunteers" screened for enrolment in a UK multicenter, phase I/II severe acute respiratory syndrome-coronavirus 2 (SARS-COV-2) vaccine trial. Participants were predominantly White (89.7%, 1640/1828) with a median age of 34 years (interquartile range [IQR] = 27-44). There were 27.7% of participants (510/1838) who had at least one IF detected. The likelihood of identifying evidence of a potential, new blood-borne virus infection was low (1 in 238 participants) compared with identification of an elevated alanine transaminase (ALT; 1 in 17 participants). A large proportion of participants described social habits that could impact negatively on their health; 21% consumed alcohol in excess, 10% were current smokers, 11% described recreational drug use, and only 48% had body weight in the ideal range. Our data demonstrate that screening prior to enrollment in early phase clinical trials identifies a range of IFs, which should inform discussion during the consent process. Greater clarity is needed to ensure an appropriate balance is struck between early identification of medical problems and avoidance of exclusion of volunteers due to spurious or physiological abnormalities. Debate should inform the role of the trial physician in highlighting and advising about unhealthy social habits.


Subject(s)
COVID-19 Vaccines/immunology , COVID-19/prevention & control , Incidental Findings , SARS-CoV-2/immunology , Adult , Alanine Transaminase/blood , Body Mass Index , Female , Healthy Volunteers , Humans , Male , Retrospective Studies
12.
Ann Vasc Surg ; 63: 461.e1-461.e5, 2020 Feb.
Article in English | MEDLINE | ID: covidwho-1454027

ABSTRACT

A 70-year-old man was scheduled for the robotic resection of a 21×16 × 30 mm thymic nodule incidentally detected by a computed tomography scan (CT) for thoracic trauma after a domestic accident. Positron emission tomography (PET) scan confirmed a low [18F]-FDG uptake (SUVmax = 1,9). During the surgery, the mass showed to be a saccular aneurysm of the left brachiocephalic vein (LBCV). A complete tangential resection of the aneurysm, with the use of EndoGIA stapler (Covidien® Endo GIA™) at its origin, was performed. The patient's recovery was uneventful, and postoperative CT with contrast administration confirmed the patency of the vein.


Subject(s)
Aneurysm/surgery , Brachiocephalic Veins/surgery , Positron-Emission Tomography , Robotic Surgical Procedures , Surgical Stapling , Thymoma/diagnostic imaging , Thymus Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Vascular System Injuries/surgery , Aged , Aneurysm/diagnostic imaging , Brachiocephalic Veins/diagnostic imaging , Diagnosis, Differential , Diagnostic Errors , Humans , Incidental Findings , Male , Predictive Value of Tests , Treatment Outcome , Vascular System Injuries/diagnostic imaging
13.
CMAJ ; 193(38): E1483-E1493, 2021 09 27.
Article in English | MEDLINE | ID: covidwho-1448587

ABSTRACT

BACKGROUND: Risk factors for severe outcomes of SARS-CoV-2 infection are not well established in children. We sought to describe pediatric hospital admissions associated with SARS-CoV-2 infection in Canada and identify risk factors for more severe disease. METHODS: We conducted a national prospective study using the infrastructure of the Canadian Paediatric Surveillance Program (CPSP). Cases involving children who were admitted to hospital with microbiologically confirmed SARS-CoV-2 infection were reported from Apr. 8 to Dec. 31 2020, through weekly online questionnaires distributed to the CPSP network of more than 2800 pediatricians. We categorized hospital admissions as related to COVID-19, incidental, or for social or infection control reasons and determined risk factors for disease severity in hospital. RESULTS: Among 264 hospital admissions involving children with SARS-CoV-2 infection during the 9-month study period, 150 (56.8%) admissions were related to COVID-19 and 100 (37.9%) were incidental infections (admissions for other reasons and found to be positive for SARS-CoV-2 on screening). Infants (37.3%) and adolescents (29.6%) represented most cases. Among hospital admissions related to COVID-19, 52 (34.7%) had critical disease, 42 (28.0%) of whom required any form of respiratory or hemodynamic support, and 59 (39.3%) had at least 1 underlying comorbidity. Children with obesity, chronic neurologic conditions or chronic lung disease other than asthma were more likely to have severe or critical COVID-19. INTERPRETATION: Among children who were admitted to hospital with SARS-CoV-2 infection in Canada during the early COVID-19 pandemic period, incidental SARS-CoV-2 infection was common. In children admitted with acute COVID-19, obesity and neurologic and respiratory comorbidities were associated with more severe disease.


Subject(s)
COVID-19/epidemiology , Hospitalization , Severity of Illness Index , Acute Disease , Adolescent , COVID-19/diagnosis , COVID-19/etiology , COVID-19/therapy , COVID-19 Testing , Canada/epidemiology , Child , Child, Preschool , Comorbidity , Female , Humans , Incidental Findings , Infant , Infant, Newborn , Male , Prospective Studies , Public Health Surveillance , Risk Factors
14.
Medicine (Baltimore) ; 100(35): e26972, 2021 Sep 03.
Article in English | MEDLINE | ID: covidwho-1393505

ABSTRACT

ABSTRACT: There are no standardized methods for collecting and reporting coronavirus disease-2019 (COVID-19) data. We aimed to compare the proportion of patients admitted for COVID-19-related symptoms and those admitted for other reasons who incidentally tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Retrospective cohort studyData were sampled twice weekly between March 26 and June 6, 2020 from a "COVID-19 dashboard," a system-wide administrative database that includes the number of hospitalized patients with a positive SARS-CoV-2 polymerase chain reaction test. Patient charts were subsequently reviewed and the principal reason for hospitalization abstracted.Data collected during a statewide lockdown revealed that 92 hospitalized patients had positive SARS-CoV-2 test results. Among these individuals, 4.3% were hospitalized for reasons other than COVID-19-related symptoms but were incidentally found to be SARS-CoV-2-positive. After the lockdown was suspended, the total inpatient census of SARS-CoV-2-positive patients increased to 128, 20.3% of whom were hospitalized for non-COVID-19-related complaints.In the absence of a statewide lockdown, there was a significant increase in the proportion of patients admitted for non-COVID-19-related complaints who were incidentally found to be SARS-CoV-2-positive. In order to ensure data integrity, coding should distinguish between patients with COVID-19-related symptoms and asymptomatic patients carrying the SARS-CoV-2 virus.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19/epidemiology , Data Management/standards , Hospitalization/statistics & numerical data , COVID-19 Nucleic Acid Testing/statistics & numerical data , Female , Humans , Incidental Findings , Male , Pandemics , Quality Improvement , Retrospective Studies , SARS-CoV-2 , Trust
16.
J Mol Neurosci ; 72(1): 25-26, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1358124

ABSTRACT

Neurological symptoms in COVID-19 patients have attracted the interest of the scientific community, yet their mechanisms remain unknown. In some circumstances, the presence of neurological manifestations may result in an incidental diagnosis after a detailed investigation. In the present letter, we discuss a case published by Demir et al., in which the diagnosis of COVID-19 enabled the diagnosis of a rare neurological disorder, characterized by bilateral brain calcifications, commonly known by the eponym Fahr's syndrome. In addition, we report a case of primary brain calcifications unveiled by a suspected coronavirus infection.


Subject(s)
Basal Ganglia Diseases/diagnostic imaging , COVID-19/complications , Calcinosis/diagnostic imaging , Neurodegenerative Diseases/diagnostic imaging , Neuroimaging , SARS-CoV-2 , Tomography, X-Ray Computed , Basal Ganglia Diseases/complications , Calcinosis/complications , Diagnosis, Differential , Humans , Incidental Findings , Male , Middle Aged , Neurodegenerative Diseases/complications , Seizures/etiology
17.
Nucl Med Rev Cent East Eur ; 24(2): 113-114, 2021.
Article in English | MEDLINE | ID: covidwho-1355149

ABSTRACT

This report presents a case of a 49-year-old woman with complaint of sore throat and front neck pain, who referred to a hospital for thyroid scan due to suppressed TSH level (0.005 mU/L). Diffuse and bilateral lungs uptake in the scan was noticed incidentally. The patient had positive history of COVID-19 symptoms. Multifocal and bilateral ground-glass opacities (GGOs) in both lungs were compatible with typical features of lung involvement in COVID-19-associated pneumonia.


Subject(s)
COVID-19/diagnostic imaging , Incidental Findings , Thyroid Gland/diagnostic imaging , Female , Humans , Middle Aged , Radionuclide Imaging
18.
Nucl Med Rev Cent East Eur ; 24(2): 110-112, 2021.
Article in English | MEDLINE | ID: covidwho-1355148

ABSTRACT

A 31-year-old woman who had multiple orthopedic surgeries on the left lower limb and recently suffered from pain and redness in the lateral left lower thigh was referred to the hospital to rule out osteomyelitis by [99mTc]UBI scintigraphy. Except soft tissue inflammation in the mentioned region, the scan showed significant and diffuse both lungs uptake incidentally. The patient had experienced symptoms of COVID-19 disease recently. Chest HRCT scan also revealed multiple segmental ground-glass opacities (GGOs) which were typical features for lung involvement of COVID-19 associated pneumonia.


Subject(s)
COVID-19/diagnostic imaging , Incidental Findings , Organotechnetium Compounds , Peptide Fragments , Adult , Female , Humans , Radionuclide Imaging
19.
AJR Am J Roentgenol ; 217(4): 857-858, 2021 10.
Article in English | MEDLINE | ID: covidwho-1352775

ABSTRACT

The purpose of this article is to report on 23 women with evidence of axillary adenopathy at breast imaging after recent COVID-19 vaccination. A total of 13% of patients had symptoms (axillary lump), 43% were undergoing screening, and 43% were undergoing diagnostic imaging for other reasons. BI-RADS category 2 was assigned in one case, BI-RADS 3 in 21 (ultrasound in 4-24 weeks), and BI-RADS 4 in one. Radiologist familiarity and evidence-based guidelines are needed to avoid follow-up imaging and biopsies for reactive adenopathy after COVID-19 vaccination.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/etiology , Mammography/methods , Ultrasonography, Mammary/methods , Adult , Axilla , COVID-19 Vaccines/therapeutic use , Female , Follow-Up Studies , Humans , Incidental Findings , Middle Aged , Retrospective Studies , SARS-CoV-2
20.
Asian J Psychiatr ; 63: 102761, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1306832

ABSTRACT

Catatonia is a rare neuropsychiatric syndrome that can accompany various medical conditions, including schizophrenia, autoimmune encephalitis, and infectious diseases. We present two cases of catatonia in males aged 12 and 17 years from Central Asia who tested positive for SARS-Cov-2 antibodies. Detailed medical assessments declined other potential precipitating factors, including schizophrenia or anti-NMDA receptor autoimmune encephalitis. FDG-PET in the younger patient demonstrated focal hypometabolism in left frontotemporal and right associative visual cortex, matching patterns previously seen in adults with catatonia. These isolated findings raise concerns about a possible causal relationship between COVID-19 infection and risk of catatonia manifestation in adolescents.


Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , COVID-19 , Catatonia , Adolescent , Adult , Asia , Catatonia/etiology , Humans , Incidental Findings , Male , SARS-CoV-2
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