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1.
Pulm Med ; 2021: 4496488, 2021.
Article in English | MEDLINE | ID: covidwho-1495709

ABSTRACT

When managing coronavirus disease 2019 (COVID-19) patients, radiological imaging complements clinical evaluation and laboratory parameters. We aimed to assess the sensitivity of chest radiography findings in detecting COVID-19, describe those findings, and assess the association of positive chest radiography findings with clinical and laboratory findings. A multicentre, cross-sectional study was conducted involving all primary health care corporation-registered patients (2485 patients) enrolled over a 1-month period during the peak of the 2020 pandemic wave in Qatar. These patients had reverse transcription-polymerase chain reaction-confirmed COVID-19 and underwent chest radiography within 72 hours of the swab test. A positive result on reverse transcription-polymerase chain reaction was the gold standard for diagnosing COVID-19. The sensitivity of chest radiography was calculated. The airspace opacities were mostly distributed in the peripheral and lower lung zones, and most of the patients had bilateral involvement. Pleural effusion was detected in some cases. The risk of having positive chest X-ray findings increased with age, Southeast Asian nationality, fever, or a history of fever and diarrhoea. Patients with cardiac disease, obesity, hypertension, diabetes, and chronic kidney disease were at a higher risk of having positive chest X-ray findings. There was a statistically significant increase in the mean serum albumin, white blood cell count, neutrophil count, and serum C-reactive protein, hepatic enzymes, and total bilirubin with an increase in the radiographic severity score.


Subject(s)
COVID-19/diagnosis , Lung/diagnostic imaging , Adolescent , Adult , Age Factors , Aged , Bilirubin/blood , C-Reactive Protein/analysis , COVID-19/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Female , Fever , Humans , Leukocyte Count , Male , Middle Aged , Neutrophils/metabolism , Noncommunicable Diseases , Pandemics , Pleural Effusion/diagnostic imaging , Primary Health Care , Qatar/epidemiology , Race Factors , Retrospective Studies , Sensitivity and Specificity , Serum Albumin , X-Rays , Young Adult
2.
Medicine (Baltimore) ; 100(38): e22571, 2021 Sep 24.
Article in English | MEDLINE | ID: covidwho-1437852

ABSTRACT

BACKGROUND: There are few reports on the chest computed tomography (CT) imaging features of children with coronavirus disease 2019 (COVID-19), and most reports involve small sample sizes. OBJECTIVES: To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice. DATA SOURCES: We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu. METHODS: Reports on chest CT imaging features of children with COVID-19 from January 1, 2020 to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software. RESULTS: Thirty-seven articles (1747 children) were included in this study. The heterogeneity of meta-analysis results ranged from 0% to 90.5%. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8%-70.6%), with a rate of 61.0% (95% CI: 50.8%-71.2%) in China and 67.8% (95% CI: 57.1%-78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7%-48.3%), multiple lung lobe lesions was 65.1% (95% CI: 55.1%-67.9%), and bilateral lung lesions was 61.5% (95% CI: 58.8%-72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported 3 cases of white lung, another reported 2 cases of pneumothorax, and another 1 case of bullae. CONCLUSIONS: The lung CT results of children with COVID-19 are usually normal or slightly atypical. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Thorax/diagnostic imaging , Tomography, X-Ray Computed/statistics & numerical data , Adolescent , Blister/diagnostic imaging , Blister/epidemiology , Blister/virology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Child , Child, Preschool , Data Management , Female , Humans , Incidence , Infant , Lung/pathology , Lung/virology , Male , Pleural Effusion/diagnostic imaging , Pleural Effusion/epidemiology , Pleural Effusion/virology , Pneumothorax/diagnostic imaging , Pneumothorax/epidemiology , Retrospective Studies , SARS-CoV-2/genetics , Solitary Pulmonary Nodule/diagnostic imaging , Solitary Pulmonary Nodule/epidemiology , Solitary Pulmonary Nodule/virology , Tomography, X-Ray Computed/methods , Tomography, X-Ray Computed/trends
3.
BMJ Case Rep ; 14(9)2021 Sep 13.
Article in English | MEDLINE | ID: covidwho-1406642

ABSTRACT

COVID-19 has a broad spectrum of cardiac manifestations, and cardiac tamponade leading to cardiogenic shock is a rare presentation. A 30-year-old man with a history of COVID-19-positive, reverse transcription polymerase chain reaction (RT-PCR) done 1 week ago and who was home-quarantined, came to the emergency department with palpitations, breathlessness and orthopnoea. His ECG showed sinus tachycardia with low-voltage complexes, chest X-ray showed cardiomegaly and left pleural effusion and two-dimensional echocardiography showed large pericardial effusion with features suggestive of cardiac tamponade. He was taken up for emergency pericardiocentesis which showed haemorrhagic pericardial fluid. Intercostal drainage insertion was done for left-sided large pleural effusion. After ruling out all the other causes for haemorrhagic pericardial effusion, the patient was started on colchicine, steroids, ibuprofen and antibiotics to which he responded. Both pericardial and pleural effusions resolved completely on follow-up.


Subject(s)
COVID-19 , Cardiac Tamponade , Pleural Effusion , Adult , Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/etiology , Cardiac Tamponade/surgery , Humans , Male , Pericardiocentesis , Pericardium , Pleural Effusion/diagnostic imaging , Pleural Effusion/etiology , SARS-CoV-2
4.
BMJ Case Rep ; 14(7)2021 Jul 26.
Article in English | MEDLINE | ID: covidwho-1388481

ABSTRACT

Unilateral pleural effusions are uncommonly reported in patients with SARS-CoV-2 pneumonitis. Herein, we report a case of a 42-year-old woman who presented to hospital with worsening dyspnoea on a background of a 2-week history of typical SARS-CoV-2 symptoms. On admission to the emergency department, the patient was severely hypoxic and hypotensive. A chest radiograph demonstrated a large left-sided pleural effusion with associated contralateral mediastinal shift (tension hydrothorax) and typical SARS-CoV-2 changes within the right lung. She was treated with thoracocentesis in which 2 L of serosanguinous, lymphocyte-rich fluid was drained from the left lung pleura. Following incubation, the pleural aspirate sample tested positive for Mycobacterium tuberculosis This case demonstrates the need to exclude non-SARS-CoV-2-related causes of pleural effusions, particularly when patients present in an atypical manner, that is, with tension hydrothorax. Given the non-specific symptomatology of SARS-CoV-2 pneumonitis, this case illustrates the importance of excluding other causes of respiratory distress.


Subject(s)
COVID-19 , Hydrothorax , Mycobacterium tuberculosis , Pleural Effusion , Pneumonia , Adult , Female , Humans , Hydrothorax/diagnostic imaging , Hydrothorax/etiology , Pleura/diagnostic imaging , Pleural Effusion/diagnostic imaging , Pleural Effusion/etiology , SARS-CoV-2
5.
Curr Med Imaging ; 17(6): 775-780, 2021.
Article in English | MEDLINE | ID: covidwho-1357473

ABSTRACT

BACKGROUND: COVID-19 has emerged recently and has become a global concern. Computed tomography (CT) plays a vital role in the diagnosis. OBJECTIVES: To characterize the pulmonary CT findings and distributions of COVID-19 infection in regard to different age groups. METHODS: Chest CT scan of 104 symptomatic patients with COVID-19 infection from 7 Iraqi isolation centers were retrospectively analyzed between March 10th to April 5th, 2020. Patients were sub-classified according to their ages into three groups (young adult:20-39 years, middle age:40-59 years, and old age:60-90 years). RESULTS: The most common findings were ground-glass opacities (GGO) (92.3%, followed by consolidation (27.9%), bronchovascular thickening (15.4%), and crazy-paving (12.5%). Less commonly, there were tree-in-bud (6.7%), pulmonary nodules (5.8%), bronchiectasis (3.8%), pleural effusion (1.9%), and cavitation (1%). There were no hallo signs, reversed hallo signs, and mediastinal lymphadenopathy. Pulmonary changes were unilateral in 16.7% and bilateral in 83.3%, central in 14.6%, peripheral in 57.3%, and diffuse (central and peripheral) in 28.1%. Most cases showed multi- lobar changes (70.8%), while the lower lobe was more commonly involved (17.7%) than the middle lobe/lingula (8.3%) and upper lobe (3.1%). In unilateral involvement, changes were more on the right (68.8%) than the left (31.2%) side. Compared with middle and old age groups, young adult patients showed significantly lesser frequency of consolidation (17% vs. 13.3% and 37%), diffuse changes 28.1% (14.2% vs. 35.3% and 40.5%), bilateral disease (71.4% vs. 94.1% and 85.2%), and multi-lobar involvement (51.4% vs. 82.4% and 81.4%) respectively. CONCLUSION: Bilateral and peripheral GGO were the most frequent findings with the right and lower lobar predilection. The pattern and the distribution of CT changes seem to be age-specific.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Tomography, X-Ray Computed , Adult , Age Distribution , Age Factors , Aged , Aged, 80 and over , Bronchiectasis/diagnostic imaging , COVID-19/epidemiology , Female , Humans , Iraq/epidemiology , Male , Middle Aged , Pleural Effusion/diagnostic imaging , Retrospective Studies , Young Adult
6.
Praxis (Bern 1994) ; 110(9): 508-509, 2021 Jul.
Article in German | MEDLINE | ID: covidwho-1298806

ABSTRACT

CME Sonography 98/Answers: Chest Ultrasound Abstract. Chest sonography has long been an important part of ultrasound diagnostics. Historically, the first evidence found in chest sonography were pleural effusions. Peripheral consolidations (pneumonia, tumors, pulmonary embolism) and pneumothorax were added later. The COVID-19 pandemic with often massive lung infestation has significantly increased the interest in thoracic sonography. The partially specific changes caused by COVID-19 are presented in this article.


Subject(s)
COVID-19 , Pleural Effusion , Pneumothorax , Humans , Pandemics , Pleural Effusion/diagnostic imaging , Pneumothorax/diagnostic imaging , SARS-CoV-2 , Ultrasonography
7.
Praxis (Bern 1994) ; 110(8): 453-459, 2021 Jun.
Article in German | MEDLINE | ID: covidwho-1263460

ABSTRACT

CME Sonography 98: Chest Ultrasound Abstract. Chest sonography has long been an important part of ultrasound diagnostics. Historically, the first evidence found in chest sonography were pleural effusions. Peripheral consolidations (pneumonia, tumors, pulmonary embolism) and pneumothorax were added later. The COVID-19 pandemic with often massive lung infestation has significantly increased the interest in thoracic sonography. The partially specific changes caused by COVID-19 are presented in this article.


Subject(s)
COVID-19 , Pleural Effusion , Pneumothorax , Humans , Pandemics , Pleural Effusion/diagnostic imaging , Pneumothorax/diagnostic imaging , SARS-CoV-2 , Ultrasonography
8.
Forensic Sci Int ; 325: 110851, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1244737

ABSTRACT

BACKGROUND AND AIM: COVID-19 is an extremely challenging disease, both from a clinical and forensic point of view, and performing autopsies of COVID-19 deceased requires adequately equipped sectorial rooms and exposes health professionals to the risk of contagion. Among one of the categories that are most affected by SARS-Cov-2 infection are the elderly residents. Despite the need for prompt diagnoses, which are essential to implement all isolation measures necessary to contain the infection spread, deceased subjects in long-term care facilities are still are often diagnosed post-mortem. In this context, our study focuses on the use of post-mortem computed tomography for the diagnosis of COVID-19 infection, in conjunction with post-mortem swabs. The aim of this study was to assess the usefulness of post-mortem whole CT-scanning in identifying COVID-19 pneumonia as a cause of death, by comparing chest CT-findings of confirmed COVID-19 fatalities to control cases. MATERIALS AND METHODS: The study included 24 deceased subjects: 13 subjects coming from long-term care facility and 11 subjects died at home. Whole body CT scans were performed within 48 h from death in all subjects to evaluate the presence and distribution of pulmonary abnormalities typical of COVID-19-pneumonia, including: ground-glass opacities (GGO), consolidation, and pleural effusion to confirm the post-mortem diagnosis. RESULTS: Whole-body CT scans was feasible and allowed a complete diagnosis in all subjects. In 9 (69%) of the 13 cases from long-term care facility the cause of death was severe COVID 19 pneumonia, while GGO were present in 100% of the study population. CONCLUSION: In the context of rapidly escalating COVID-19 outbreaks, given that laboratory tests for the novel coronavirus is time-consuming and can be falsely negative, the post-mortem CT can be considered as a reliable and safe modality to confirm COVID-19 pneumonia. This is especially true for specific postmortem chest CT-findings that are rather characteristic of COVID-19 fatalities.


Subject(s)
COVID-19/diagnosis , Lung/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Autopsy/methods , Case-Control Studies , Female , Humans , Male , Middle Aged , Pleural Effusion/diagnostic imaging , Retrospective Studies , Sensitivity and Specificity , Whole Body Imaging
9.
Med Intensiva (Engl Ed) ; 44(9): 551-565, 2020 Dec.
Article in Spanish | MEDLINE | ID: covidwho-1243085

ABSTRACT

The clinical picture of SARS-CoV-2 infection (COVID-19) is characterized in its more severe form, by an acute respiratory failure which can worsen to pneumonia and acute respiratory distress syndrome (ARDS) and get complicated with thrombotic events and heart dysfunction. Therefore, admission to the Intensive Care Unit (ICU) is common. Ultrasound, which has become an everyday tool in the ICU, can be very useful during COVID-19 pandemic, since it provides the clinician with information which can be interpreted and integrated within a global assessment during the physical examination. A description of some of the potential applications of ultrasound is depicted in this document, in order to supply the physicians taking care of these patients with an adapted guide to the intensive care setting. Some of its applications since ICU admission include verification of the correct position of the endotracheal tube, contribution to safe cannulation of lines, and identification of complications and thrombotic events. Furthermore, pleural and lung ultrasound can be an alternative diagnostic test to assess the degree of involvement of the lung parenchyma by means of the evaluation of specific ultrasound patterns, identification of pleural effusions and barotrauma. Echocardiography provides information of heart involvement, detects cor pulmonale and shock states.


Subject(s)
COVID-19/diagnostic imaging , SARS-CoV-2 , Ultrasonography, Interventional/methods , Blood Vessels/diagnostic imaging , COVID-19/complications , Critical Care , Critical Illness , Echocardiography , Heart Diseases/diagnostic imaging , Heart Diseases/etiology , Heart Ventricles/diagnostic imaging , Humans , Hypertension, Pulmonary/diagnostic imaging , Intensive Care Units , Intubation, Intratracheal/methods , Lung/diagnostic imaging , Organ Size , Pleura/diagnostic imaging , Pleural Effusion/diagnostic imaging , Pneumothorax/diagnostic imaging , Pulmonary Heart Disease/diagnostic imaging , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Shock/diagnostic imaging , Transducers
10.
Heart Surg Forum ; 24(2): E372-E374, 2021 04 23.
Article in English | MEDLINE | ID: covidwho-1199988

ABSTRACT

The world has suffered over the past year under COVID-19. Unfortunately, people still are getting sick from other, also severe, diseases. Although the COVID-19 infection is present, patients need treatment for other life-threatening conditions. We present the case of a 36-year-old patient with severe infective endocarditis with a large abscess of the aortic root, who also is COVID-19 positive. Definitive diagnostics and treatment were avoided due to COVID-19 infection. In the end, emergent surgery was indicated due to acute cardiac decompensation and the development of heart failure symptoms, and the patient recovered uneventfully after surgery.


Subject(s)
Abscess/microbiology , Abscess/surgery , Aortic Diseases/microbiology , Aortic Diseases/surgery , COVID-19/complications , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/surgery , Heart Failure/etiology , Heart Failure/therapy , Abscess/diagnostic imaging , Adult , Aortic Diseases/diagnostic imaging , Endocarditis, Bacterial/diagnostic imaging , Heart Failure/diagnostic imaging , Humans , Male , Pleural Effusion/diagnostic imaging , Pleural Effusion/microbiology , Pleural Effusion/surgery , Pneumonia, Viral/complications , Pneumonia, Viral/virology , Respiration, Artificial , SARS-CoV-2
11.
Phys Med ; 83: 38-45, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1126812

ABSTRACT

Lung ultrasound (LUS) imaging as a point-of-care diagnostic tool for lung pathologies has been proven superior to X-ray and comparable to CT, enabling earlier and more accurate diagnosis in real-time at the patient's bedside. The main limitation to widespread use is its dependence on the operator training and experience. COVID-19 lung ultrasound findings predominantly reflect a pneumonitis pattern, with pleural effusion being infrequent. However, pleural effusion is easy to detect and to quantify, therefore it was selected as the subject of this study, which aims to develop an automated system for the interpretation of LUS of pleural effusion. A LUS dataset was collected at the Royal Melbourne Hospital which consisted of 623 videos containing 99,209 2D ultrasound images of 70 patients using a phased array transducer. A standardized protocol was followed that involved scanning six anatomical regions providing complete coverage of the lungs for diagnosis of respiratory pathology. This protocol combined with a deep learning algorithm using a Spatial Transformer Network provides a basis for automatic pathology classification on an image-based level. In this work, the deep learning model was trained using supervised and weakly supervised approaches which used frame- and video-based ground truth labels respectively. The reference was expert clinician image interpretation. Both approaches show comparable accuracy scores on the test set of 92.4% and 91.1%, respectively, not statistically significantly different. However, the video-based labelling approach requires significantly less effort from clinical experts for ground truth labelling.


Subject(s)
COVID-19 , Deep Learning , Pleural Effusion , Humans , Lung/diagnostic imaging , Pleural Effusion/diagnostic imaging , SARS-CoV-2 , Ultrasonography
12.
Am J Forensic Med Pathol ; 42(1): 1-8, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1066484

ABSTRACT

ABSTRACT: The 2019 novel coronavirus disease (COVID-19) has spread worldwide, infiltrating, infecting, and devastating communities in all locations of varying demographics. An overwhelming majority of published literature on the pathologic findings associated with COVID-19 is either from living clinical cohorts or from autopsy findings of those who died in a medical care setting, which can confound pure disease pathology. A relatively low initial infection rate paired with a high biosafety level enabled the New Mexico Office of the Medical Investigator to conduct full autopsy examinations on suspected COVID-19-related deaths. Full autopsy examination on the first 20 severe acute respiratory syndrome coronavirus 2-positive decedents revealed that some extent of diffuse alveolar damage in every death due to COVID-19 played some role. The average decedent was middle-aged, male, American Indian, and overweight with comorbidities that included diabetes, ethanolism, and atherosclerotic and/or hypertensive cardiovascular disease. Macroscopic thrombotic events were seen in 35% of cases consisting of pulmonary thromboemboli and coronary artery thrombi. In 2 cases, severe bacterial coinfections were seen in the lungs. Those determined to die with but not of severe acute respiratory syndrome coronavirus 2 infection had unremarkable lung findings.


Subject(s)
COVID-19/mortality , Lung/pathology , Adult , Age Distribution , Aged , Aged, 80 and over , Autopsy , Body Mass Index , Brain Edema/pathology , Cardiomegaly/pathology , Comorbidity , Coronary Thrombosis/pathology , Databases, Factual , Fatty Liver/pathology , Female , Forensic Pathology , Glomerulosclerosis, Focal Segmental/pathology , Hepatomegaly/pathology , Humans , Lung/diagnostic imaging , Male , Middle Aged , Nephrosclerosis/pathology , New Mexico/epidemiology , Overweight/epidemiology , Pandemics , Pleural Effusion/diagnostic imaging , Pleural Effusion/pathology , Pulmonary Edema/diagnostic imaging , Pulmonary Edema/pathology , Sex Distribution , Streptococcus pneumoniae/isolation & purification , Tomography, X-Ray Computed , Vitreous Body/chemistry , Whole Body Imaging
14.
Br J Radiol ; 94(1118): 20200716, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1038510

ABSTRACT

OBJECTIVES: Ground-glass opacity and consolidation are recognized typical features of Coronavirus disease-19 (COVID-19) pneumonia on Chest CT, yet ancillary findings have not been fully described. We aimed to describe ancillary findings of COVID-19 pneumonia on CT, to define their prevalence, and investigate their association with clinical data. METHODS: We retrospectively reviewed our CT chest cases with coupled reverse transcriptase polymerase chain reaction (rt-PCR). Patients with negative rt-PCR or without admission chest CT were excluded. Ancillary findings included: vessel enlargement, subpleural curvilinear lines, dependent subpleural atelectasis, centrilobular solid nodules, pleural and/or pericardial effusions, enlarged mediastinal lymph nodes. Continuous data were expressed as median and 95% confidence interval (95% CI) and tested by Mann-Whitney U test. RESULTS: Ancillary findings were represented by 106/252 (42.1%, 36.1 to 48.2) vessel enlargement, 50/252 (19.8%, 15.4 to 25.2) subpleural curvilinear lines, 26/252 (10.1%, 7.1 to 14.7) dependent subpleural atelectasis, 15/252 (5.9%, 3.6 to 9.6) pleural effusion, 15/252 (5.9%, 3.6 to 9.6) mediastinal lymph nodes enlargement, 13/252 (5.2%, 3 to 8.6) centrilobular solid nodules, and 6/252 (2.4%, 1.1 to 5.1) pericardial effusion. Air space disease was more extensive in patients with vessel enlargement or centrilobular solid nodules (p < 0.001). Vessel enlargement was associated with longer history of fever (p = 0.035) and lower admission oxygen saturation (p = 0.014); dependent subpleural atelectasis with lower oxygen saturation (p < 0.001) and higher respiratory rate (p < 0.001); mediastinal lymph nodes with shorter history of cough (p = 0.046); centrilobular solid nodules with lower prevalence of cough (p = 0.023), lower oxygen saturation (p < 0.001), and higher respiratory rate (p = 0.032), and pericardial effusion with shorter history of cough (p = 0.015). Ancillary findings associated with longer hospital stay were subpleural curvilinear lines (p = 0.02), whereas centrilobular solid nodules were associated with higher rate of intensive care unit admission (p = 0.01). CONCLUSION: Typical high-resolution CT findings of COVID-19 pneumonia are frequently associated with ancillary findings that variably associate with disease extent, clinical parameters, and disease severity. ADVANCES IN KNOWLEDGE: Ancillary findings might reflect the broad range of heterogeneous mechanisms in severe acute respiratory syndrome from viral pneumonia, and potentially help disease phenotyping.


Subject(s)
COVID-19/diagnostic imaging , Incidental Findings , Lung/diagnostic imaging , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , Dilatation, Pathologic/diagnostic imaging , Female , Humans , Lung/blood supply , Lymph Nodes/diagnostic imaging , Lymphadenopathy/diagnostic imaging , Male , Middle Aged , Multidetector Computed Tomography/methods , Observer Variation , Pleural Effusion/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Pulmonary Veins/diagnostic imaging , Retrospective Studies
15.
Am J Forensic Med Pathol ; 42(1): 1-8, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1015415

ABSTRACT

ABSTRACT: The 2019 novel coronavirus disease (COVID-19) has spread worldwide, infiltrating, infecting, and devastating communities in all locations of varying demographics. An overwhelming majority of published literature on the pathologic findings associated with COVID-19 is either from living clinical cohorts or from autopsy findings of those who died in a medical care setting, which can confound pure disease pathology. A relatively low initial infection rate paired with a high biosafety level enabled the New Mexico Office of the Medical Investigator to conduct full autopsy examinations on suspected COVID-19-related deaths. Full autopsy examination on the first 20 severe acute respiratory syndrome coronavirus 2-positive decedents revealed that some extent of diffuse alveolar damage in every death due to COVID-19 played some role. The average decedent was middle-aged, male, American Indian, and overweight with comorbidities that included diabetes, ethanolism, and atherosclerotic and/or hypertensive cardiovascular disease. Macroscopic thrombotic events were seen in 35% of cases consisting of pulmonary thromboemboli and coronary artery thrombi. In 2 cases, severe bacterial coinfections were seen in the lungs. Those determined to die with but not of severe acute respiratory syndrome coronavirus 2 infection had unremarkable lung findings.


Subject(s)
COVID-19/mortality , Lung/pathology , Adult , Age Distribution , Aged , Aged, 80 and over , Autopsy , Body Mass Index , Brain Edema/pathology , Cardiomegaly/pathology , Comorbidity , Coronary Thrombosis/pathology , Databases, Factual , Fatty Liver/pathology , Female , Forensic Pathology , Glomerulosclerosis, Focal Segmental/pathology , Hepatomegaly/pathology , Humans , Lung/diagnostic imaging , Male , Middle Aged , Nephrosclerosis/pathology , New Mexico/epidemiology , Overweight/epidemiology , Pandemics , Pleural Effusion/diagnostic imaging , Pleural Effusion/pathology , Pulmonary Edema/diagnostic imaging , Pulmonary Edema/pathology , Sex Distribution , Streptococcus pneumoniae/isolation & purification , Tomography, X-Ray Computed , Vitreous Body/chemistry , Whole Body Imaging
16.
Curr Med Imaging ; 17(6): 677-685, 2021.
Article in English | MEDLINE | ID: covidwho-1005645

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is highly contagious and has claimed more than one million lives, besides causing hardship and disruptions. The Fleischner Society has recommended chest X-ray (CXR) in detecting cases at high risk of disease progression, for triaging suspected patients with moderate-to-severe illness, and for eliminating false negatives in areas with high pre-test probability or limited resources. Although CXR is less sensitive than real-- time reverse transcription-polymerase chain reaction (RT-PCR) in detecting mild COVID-19, it is nevertheless useful because of equipment portability, low cost and practicality in serial assessments of disease progression among hospitalized patients. OBJECTIVE: This study aims to review the typical and relatively atypical CXR manifestations of COVID-19 pneumonia in a tertiary care hospital. METHODS: The CXRs of 136 COVID-19 patients confirmed through real-time RT-PCR from March to May 2020 were reviewed. A literature search was performed using PubMed. RESULTS: A total of 54 patients had abnormal CXR whilst the others were normal. Typical CXR findings included pulmonary consolidation or ground-glass opacities in a multifocal, bilateral peripheral, or lower zone distribution, whereas atypical CXR features comprised cavitation and pleural effusion. CONCLUSION: Typical findings of COVID-19 infection in chest computed tomography studies can also be seen in CXR. The presence of atypical features associated with worse disease outcome. Recognition of these features on CXR will improve the accuracy and speed of diagnosing COVID-19 patients.


Subject(s)
COVID-19/diagnostic imaging , Radiography, Thoracic , Adult , Aged , Aged, 80 and over , COVID-19 Nucleic Acid Testing , Disease Progression , Female , Humans , Lung/diagnostic imaging , Malaysia , Male , Middle Aged , Pleural Effusion/diagnostic imaging , Risk Factors , Societies, Medical , Tertiary Care Centers , Tomography, X-Ray Computed
17.
Curr Med Imaging ; 17(6): 775-780, 2021.
Article in English | MEDLINE | ID: covidwho-999948

ABSTRACT

BACKGROUND: COVID-19 has emerged recently and has become a global concern. Computed tomography (CT) plays a vital role in the diagnosis. OBJECTIVES: To characterize the pulmonary CT findings and distributions of COVID-19 infection in regard to different age groups. METHODS: Chest CT scan of 104 symptomatic patients with COVID-19 infection from 7 Iraqi isolation centers were retrospectively analyzed between March 10th to April 5th, 2020. Patients were sub-classified according to their ages into three groups (young adult:20-39 years, middle age:40-59 years, and old age:60-90 years). RESULTS: The most common findings were ground-glass opacities (GGO) (92.3%, followed by consolidation (27.9%), bronchovascular thickening (15.4%), and crazy-paving (12.5%). Less commonly, there were tree-in-bud (6.7%), pulmonary nodules (5.8%), bronchiectasis (3.8%), pleural effusion (1.9%), and cavitation (1%). There were no hallo signs, reversed hallo signs, and mediastinal lymphadenopathy. Pulmonary changes were unilateral in 16.7% and bilateral in 83.3%, central in 14.6%, peripheral in 57.3%, and diffuse (central and peripheral) in 28.1%. Most cases showed multi- lobar changes (70.8%), while the lower lobe was more commonly involved (17.7%) than the middle lobe/lingula (8.3%) and upper lobe (3.1%). In unilateral involvement, changes were more on the right (68.8%) than the left (31.2%) side. Compared with middle and old age groups, young adult patients showed significantly lesser frequency of consolidation (17% vs. 13.3% and 37%), diffuse changes 28.1% (14.2% vs. 35.3% and 40.5%), bilateral disease (71.4% vs. 94.1% and 85.2%), and multi-lobar involvement (51.4% vs. 82.4% and 81.4%) respectively. CONCLUSION: Bilateral and peripheral GGO were the most frequent findings with the right and lower lobar predilection. The pattern and the distribution of CT changes seem to be age-specific.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Tomography, X-Ray Computed , Adult , Age Distribution , Age Factors , Aged , Aged, 80 and over , Bronchiectasis/diagnostic imaging , COVID-19/epidemiology , Female , Humans , Iraq/epidemiology , Male , Middle Aged , Pleural Effusion/diagnostic imaging , Retrospective Studies , Young Adult
18.
Acta Med Indones ; 52(4): 375-382, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-995550

ABSTRACT

Coronavirus disease 2019 (COVID-19) is an acute respiratory disease which rapidly disseminated due to Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) virus. Clinical presentations of COVID-19 are fever, non-productive cough, and dyspnea. Although the diagnosis establishment is done by detecting the viral ribonucleic acid (RNA) through reverse transcription-polymerase chain reaction (RT-PCR) method, CT scan has an important role in detection and treatment of COVID-19 especially in high prevalence regions. Chest CT scan has high sensitivity yet low specificity because there are a lot of other pathological spectrums that also present features of COVID-19 such as ground glass opacities (GGO) and consolidation, one of them is CMV infection. The objective of this case report is to raise vigilance towards other diseases that have radiological image similarities with COVID-19, especially in the immunocompromised patients who are susceptible to viral infections like CMV infection so that the delay in the disease treatment can be prevented.


Subject(s)
Cytomegalovirus Infections/diagnosis , Diagnostic Errors , Lung/diagnostic imaging , Pleural Effusion/diagnostic imaging , Aged , COVID-19/diagnosis , Female , Humans , Male , Middle Aged , Radiography , Tomography, X-Ray Computed
19.
Gerontology ; 67(1): 78-86, 2021.
Article in English | MEDLINE | ID: covidwho-992116

ABSTRACT

BACKGROUND: Lung ultrasound (LUS) showed a promising role in the diagnosis and monitoring of patients hospitalized for novel coronavirus disease (COVID-19). However, no data are available on its role in elderly patients. AIMS: The aim of this study was to evaluate the diagnostic and prognostic role of LUS in elderly patients hospitalized for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pneumonia. METHODS: Consecutive elderly patients (age >65 years) hospitalized for COVID-19 were enrolled. Demographics, laboratory, comorbidity, and the clinical features of the patients were collected. All patients underwent LUS on admission to the ward. LUS characteristics have been analyzed. Uni- and multivariate analyses to evaluate predictors for in-hospital death were performed. RESULTS: Thirty-seven hospitalized elderly patients (19 men) with a diagnosis of SARS-CoV-2 infection were consecutively enrolled. The median age was 82 years (interquartile range 74.5-93.5). Ultrasound alterations were found in all patients enrolled; inhomogeneous interstitial syndrome with spared areas (91.9%) and pleural alterations (100%) were the most frequent findings. At univariate analysis, LUS score (hazard ratio [HR] 1.168, 95% CI 1.049-1.301) and pleural effusions (HR 3.995, 95% CI 1.056-15.110) were associated with in-hospital death. At multivariate analysis, only LUS score (HR 1.168, 95% CI 1.049-1.301) was independelty associated with in-hospital death. The LUS score's best cutoff for distinguishing patients experiencing in-hospital death was 17 (at multivariate analysis LUS score ≥17, HR 4.827, 95% CI 1.452-16.040). In-hospital death was significantly different according to the LUS score cutoff of 17 (p = 0.0046). CONCLUSION: LUS could play a role in the diagnosis and prognosis in elderly patients hospitalized for SARS-CoV-2 infection.


Subject(s)
COVID-19/mortality , Lung/diagnostic imaging , Ultrasonography , Aged , Aged, 80 and over , Female , Hospital Mortality , Hospitalization , Humans , Italy/epidemiology , Male , Pleural Effusion/diagnostic imaging , Prognosis , Pulmonary Atelectasis/diagnostic imaging , Sensitivity and Specificity
20.
Postgrad Med J ; 97(1143): 34-39, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-979640

ABSTRACT

Lung ultrasound has been described for over a decade and international protocols exist for its application. It is a controversial area among pulmonologists and has had more uptake with emergency as well as intensive care physicians. We discuss the basics and evidence behind the use of lung ultrasound in respiratory failure, and what role we see it playing in the current 2019 novel coronavirus pandemic.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Pleural Effusion/diagnostic imaging , Respiratory Insufficiency/diagnostic imaging , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , Humans , Point-of-Care Testing , SARS-CoV-2 , Tomography, X-Ray Computed , Ultrasonography
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