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1.
Eur Rev Med Pharmacol Sci ; 24(14): 7801-7803, 2020 07.
Article in English | MEDLINE | ID: covidwho-693476

ABSTRACT

SARS-CoV-2 infection in children is uncommon compared to adult population. However, some children required hospital and/or PICU admission. The aim of this short communication is to share our experience with Point-of-Care Ultrasound (POCUS) when managing these patients. Remarkably, all cases presented pleural and pericardial effusions, detected by POCUS, despite showing an adequate urinary output and prior to receiving any kind of fluid resuscitation. Effusions have been described as rare among SARS-CoV-2 infection in adult population. By performing portable chest X-Ray they would have gone unnoticed in our patients. Other POCUS findings consisted of all types of consolidations and coalescent B-line patterns. POCUS was also performed in order to optimize PEEP, checking adequate endotracheal intubation positioning (avoiding the risk of contagiousness related to auscultation in this framework), and to assess volemia status, cardiac performance, and brain neuro-monitoring. There was not cross-infection. In pediatric SARS-CoV-19 effusions are frequent but easily unnoticed unless lung and echo POCUS are performed.


Subject(s)
Coronavirus Infections/diagnostic imaging , Pericardial Effusion/diagnostic imaging , Pleural Effusion/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Point-of-Care Systems , Ultrasonography , Betacoronavirus , Child , Humans , Pandemics , Pericardial Effusion/virology , Pleural Effusion/virology , Radiography, Thoracic
2.
PLoS One ; 15(7): e0235134, 2020.
Article in English | MEDLINE | ID: covidwho-623754

ABSTRACT

OBJECTIVE: To investigate the computed tomography (CT) characteristics and diagnostic value of novel coronavirus pneumonia (NCP or COVID-19) in pregnancy. METHODS: This study included ten pregnant women infected with COVID-19, treated in the Zhongnan Hospital of Wuhan University from January 20, 2020 to February 6, 2020. Clinical and chest CT data were collected and clinical symptoms, laboratory indicators, and CT images were analyzed to explore CT characteristics and diagnostic value for COVID-19 during pregnancy. RESULTS: Laboratory examination showed that white blood cell count was normal in nine patients, and slightly higher in one patient (10.23 × 109). The lymphocyte ratio decreased in two patients by 12% and 14%, respectively. The levels of C-reactive protein was elevated in seven patients (range, 21.16-60.3 mg/L) and the levels of D-dimer was increased in eight patients (range, 507-2141 ng/mL). Six patients had low levels of total protein (range, 35.3-56.5 mg/L). Two patients showed small patchy ground glass opacity (GGO) involving single lung, while eight patients showed multilobe GGO in both the lungs, with partial consolidation. Peripheral and non-peripheral lesion distributions were seen in ten (100%) and four (40%) patients, respectively. There were four patients who had signs of intra-bronchial air-bronchogram, six patients had small bilateral pleural effusions, while none had lymphadenopathy. Dynamic observations were performed in four patients after COVID-19 treatment. Among these four patients, one patient showed normal on the initial examination, and new lesions were observed after 3 days; 1 patient showed progression after 7 days of treatment, with expansion of the lesion area; and the other 2 patients showed improvement after 14 days of treatment, with reduction in the density and area of lesions and appearance of linear opacity. CONCLUSIONS: The CT characteristics of COVID-19 in pregnancy were mainly observed in early and progressive stages, and multiple new lesions were common. And there were consolidations of varying sizes and degrees within the lesion. Moreover, the original ground glass lesions could be fused or partially absorbed. Six patients had small bilateral pleural effusion. In summary, CT scans can play an important role in early screening, dynamic observation, and efficacy evaluation of suspected or confirmed cases of pregnant women with COVID-19.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Pregnancy Complications, Infectious/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , C-Reactive Protein/analysis , Coronavirus Infections/virology , Disease Progression , Female , Fibrin Fibrinogen Degradation Products/analysis , Follow-Up Studies , Humans , Pandemics , Pleural Effusion/diagnostic imaging , Pleural Effusion/virology , Pneumonia, Viral/virology , Pregnancy , Pregnancy Complications, Infectious/virology , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction
3.
Am J Respir Crit Care Med ; 201(11): 1380-1388, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-436947

ABSTRACT

Rationale: The coronavirus disease (COVID-19) pandemic is now a global health concern.Objectives: We compared the clinical characteristics, laboratory examinations, computed tomography images, and treatments of patients with COVID-19 from three different cities in China.Methods: A total of 476 patients were recruited from January 1, 2020, to February 15, 2020, at three hospitals in Wuhan, Shanghai, and Anhui. The patients were divided into four groups according to age and into three groups (moderate, severe, and critical) according to the fifth edition of the Guidelines on the Diagnosis and Treatment of COVID-19 issued by the National Health Commission of China.Measurements and Main Results: The incidence of comorbidities was higher in the severe (46.3%) and critical (67.1%) groups than in the moderate group (37.8%). More patients were taking angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers in the moderate group than in the severe and critical groups. More patients had multiple lung lobe involvement and pleural effusion in the critical group than in the moderate group. More patients received antiviral agents within the first 4 days in the moderate group than in the severe group, and more patients received antibiotics and corticosteroids in the critical and severe groups. Patients >75 years old had a significantly lower survival rate than younger patients.Conclusions: Multiple organ dysfunction and impaired immune function were the typical characteristics of patients with severe or critical illness. There was a significant difference in the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers among patients with different severities of disease. Involvement of multiple lung lobes and pleural effusion were associated with the severity of COVID-19. Advanced age (≥75 yr) was a risk factor for mortality.


Subject(s)
Coronavirus Infections/physiopathology , Pneumonia, Viral/physiopathology , Adult , Age Factors , Aged , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Betacoronavirus , China/epidemiology , Comorbidity , Coronavirus Infections/mortality , Critical Illness , Female , Hospital Mortality , Humans , Incidence , Lung/pathology , Male , Middle Aged , Multiple Organ Failure/virology , Pandemics , Pleural Effusion/virology , Pneumonia, Viral/mortality , Tomography, X-Ray Computed
4.
Eur J Radiol ; 129: 109092, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-378195

ABSTRACT

PURPOSE: To evaluate the diagnostic accuracy and the imaging features of routine admission chest X-ray in patients suspected for novel Coronavirus 2019 (SARS-CoV-2) infection. METHOD: We retrospectively evaluated clinical and X-ray features in all patients referred to the emergency department for suspected SARS-CoV-2 infection between March 1st and March 13th. A single radiologist with more than 15 years of experience in chest-imaging evaluated the presence and extent of alveolar opacities, reticulations, and/or pleural effusion. The percentage of lung involvement (range <25 % to 75-100 %) was also calculated. We stratified patients in groups according to the time interval between symptoms onset and X-ray imaging (≤ 5 and > 5 days) and according to age (≤ 50 and > 50 years old). RESULTS: A total of 518 patients were enrolled. Overall 314 patients had negative and 204 had positive RT-PCR results. Lung lesions in patients with SARS-Cov2 pneumonia primarily manifested as alveolar and interstitial opacities and were mainly bilateral (60.8 %). Lung abnormalities were more frequent and more severe by symptom duration and by increasing age. The sensitivity and specificity of chest X-ray at admission in the overall cohort were 57 % (95 % CI = 47-67) and 89 % (83-94), respectively. Sensitivity was higher for patients with symptom onset > 5 days compared to ≤ 5 days (76 % [62-87] vs 37 % [24-52]) and in patients > 50 years old compared to ≤ 50 years (59 % [48-69] vs 47 % [23-72]), at the expense of a slightly lower specificity (68 % [45-86] and 82 % [73-89], respectively). CONCLUSIONS: Overall chest X-ray sensitivity for SARS-CoV-2 pneumonia was 57 %. Sensitivity was higher when symptoms had started more than 5 days before, at the expense of lesser specificity, while slightly higher in older patients in comparison to younger ones.


Subject(s)
Betacoronavirus , Clinical Laboratory Techniques/standards , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Adult , Aged , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Diagnostic Tests, Routine/methods , Diagnostic Tests, Routine/standards , Dyspnea/diagnostic imaging , Dyspnea/virology , Emergency Service, Hospital , Female , Fever/diagnostic imaging , Fever/virology , Hospitalization , Humans , Italy , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Patient Admission/standards , Pleural Effusion/diagnostic imaging , Pleural Effusion/virology , Point-of-Care Testing/standards , Pulmonary Alveoli/diagnostic imaging , Radiography , Retrospective Studies , Sensitivity and Specificity , Time-to-Treatment , Tomography, X-Ray Computed , X-Rays , Young Adult
5.
Korean J Radiol ; 21(6): 746-755, 2020 06.
Article in English | MEDLINE | ID: covidwho-262130

ABSTRACT

OBJECTIVE: To identify predictors of pulmonary fibrosis development by combining follow-up thin-section CT findings and clinical features in patients discharged after treatment for COVID-19. MATERIALS AND METHODS: This retrospective study involved 32 confirmed COVID-19 patients who were divided into two groups according to the evidence of fibrosis on their latest follow-up CT imaging. Clinical data and CT imaging features of all the patients in different stages were collected and analyzed for comparison. RESULTS: The latest follow-up CT imaging showed fibrosis in 14 patients (male, 12; female, 2) and no fibrosis in 18 patients (male, 10; female, 8). Compared with the non-fibrosis group, the fibrosis group was older (median age: 54.0 years vs. 37.0 years, p = 0.008), and the median levels of C-reactive protein (53.4 mg/L vs. 10.0 mg/L, p = 0.002) and interleukin-6 (79.7 pg/L vs. 11.2 pg/L, p = 0.04) were also higher. The fibrosis group had a longer-term of hospitalization (19.5 days vs. 10.0 days, p = 0.001), pulsed steroid therapy (11.0 days vs. 5.0 days, p < 0.001), and antiviral therapy (12.0 days vs. 6.5 days, p = 0.012). More patients on the worst-state CT scan had an irregular interface (59.4% vs. 34.4%, p = 0.045) and a parenchymal band (71.9% vs. 28.1%, p < 0.001). On initial CT imaging, the irregular interface (57.1%) and parenchymal band (50.0%) were more common in the fibrosis group. On the worst-state CT imaging, interstitial thickening (78.6%), air bronchogram (57.1%), irregular interface (85.7%), coarse reticular pattern (28.6%), parenchymal band (92.9%), and pleural effusion (42.9%) were more common in the fibrosis group. CONCLUSION: Fibrosis was more likely to develop in patients with severe clinical conditions, especially in patients with high inflammatory indicators. Interstitial thickening, irregular interface, coarse reticular pattern, and parenchymal band manifested in the process of the disease may be predictors of pulmonary fibrosis. Irregular interface and parenchymal band could predict the formation of pulmonary fibrosis early.


Subject(s)
Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Pulmonary Fibrosis/diagnostic imaging , Pulmonary Fibrosis/virology , Adult , Aged , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Female , Humans , Male , Microtomy/methods , Middle Aged , Pandemics , Patient Discharge , Pleural Effusion/pathology , Pleural Effusion/virology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/pathology , Predictive Value of Tests , Pulmonary Fibrosis/pathology , Retrospective Studies , Tomography, X-Ray Computed/methods
6.
Clin Imaging ; 65: 124-132, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-232544

ABSTRACT

OBJECTIVES: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This paper aims to examine the CT imaging characteristics of COVID-19. METHODS: We evaluated CT images obtained between 10 January 2019 and 16 February 2020 at Taihe Hospital. Scans were conducted 2-6 times per patient and the re-testing interval was 2-7 days. Ninety-five patients with positive SARS-CoV-2 nucleic acid test results were included in this study and we retrospectively analysed their CT imaging characteristics. RESULTS: Ninety-five patients underwent 2-3 SARS-CoV-2 nucleic acid tests and received a definitive diagnosis of COVID-19. Fifty-three were male and 42 were female, and their mean age was 42 ± 12 years (range: 10 months to 81 years). Sixty-nine patients (72.6%) experienced fever, fatigue, and dry cough, while 15 (15.8%) had poor appetite and fatigue, and 11 (11.6%) had a dry cough and no fever. On CT imaging, early stage patients (n = 53, 55.8%) showed peripheral subpleural ground-glass opacities; these were mainly local patches (22/53, 41.5%), while some lesions were accompanied by interlobular septal thickening. Thirty-four (35.8%) patients were classified in the 'progression stage' based on CT imaging; these patients typically showed lesions in multiple lung segments and lobes (21/34,61.8%), and an uneven increase in ground-glass opacity density accompanied by consolidation and grid-like or cord-like shadows(30.5%). Two patients (2.1%) showed a severe presentation on CT. These showed diffuse bilateral lung lesions, mixed ground-glass opacities and consolidation with cord-like interstitial thickening and air bronchograms, entire lung involvement with a "white lung" presentation, and mild pleural effusion. Six patients in remission (6.3%), visible lesion absorption, fibrotic lesions. Based on clinical signs, 71 (74.7%), 22 (23.2%), and 2 (2.1%) patients had mild or moderate, severe, and critical disease, respectively. Within the follow-up period, 93 patients recovered and were discharged, including the 53 early stage patients and 34 progression stage patients. The length of hospitalisation was 7-28 days (mean: 10 ± 3.5 days). On discharge, lesions were significantly reduced in area and had in many cases completely disappeared, while slight pulmonary fibrosis was present in some patients. One severe stage patient was still hospitalised at the end of the follow-up period and the other severe stage patient died. The overall mortality rate was 1.05%. CONCLUSIONS: Understanding the CT imaging characteristics of COVID-19 is important for early lesion detection, determining the nature of lesions, and assessing disease severity.


Subject(s)
Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , Child , Child, Preschool , China , Cough/virology , Disease Progression , Female , Fever/virology , Humans , Infant , Length of Stay , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Pandemics , Pleural Effusion/virology , Pulmonary Fibrosis/virology , Retrospective Studies , Young Adult
7.
Pediatr Infect Dis J ; 39(7): e135-e137, 2020 07.
Article in English | MEDLINE | ID: covidwho-209804

ABSTRACT

We report a case of childhood coronavirus disease 2019 infection with pleural effusion complicated by possible secondary Mycoplasma pneumoniae infection. Fever and pulmonary lesions on computed tomography were the early clinical manifestations, and the patient developed nonproductive cough later. The hydrothorax in this coronavirus disease 2019 case was exudative, showing predominantly mature lymphocytes.


Subject(s)
Coronavirus Infections/microbiology , Pleural Effusion/microbiology , Pneumonia, Mycoplasma/virology , Pneumonia, Viral/microbiology , Betacoronavirus/isolation & purification , Child , Coronavirus Infections/virology , Fever/virology , Humans , Lung/diagnostic imaging , Male , Pandemics , Pleural Effusion/pathology , Pleural Effusion/virology , Pneumonia, Mycoplasma/pathology , Pneumonia, Viral/virology
8.
Am J Respir Crit Care Med ; 201(11): 1380-1388, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-47397

ABSTRACT

Rationale: The coronavirus disease (COVID-19) pandemic is now a global health concern.Objectives: We compared the clinical characteristics, laboratory examinations, computed tomography images, and treatments of patients with COVID-19 from three different cities in China.Methods: A total of 476 patients were recruited from January 1, 2020, to February 15, 2020, at three hospitals in Wuhan, Shanghai, and Anhui. The patients were divided into four groups according to age and into three groups (moderate, severe, and critical) according to the fifth edition of the Guidelines on the Diagnosis and Treatment of COVID-19 issued by the National Health Commission of China.Measurements and Main Results: The incidence of comorbidities was higher in the severe (46.3%) and critical (67.1%) groups than in the moderate group (37.8%). More patients were taking angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers in the moderate group than in the severe and critical groups. More patients had multiple lung lobe involvement and pleural effusion in the critical group than in the moderate group. More patients received antiviral agents within the first 4 days in the moderate group than in the severe group, and more patients received antibiotics and corticosteroids in the critical and severe groups. Patients >75 years old had a significantly lower survival rate than younger patients.Conclusions: Multiple organ dysfunction and impaired immune function were the typical characteristics of patients with severe or critical illness. There was a significant difference in the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers among patients with different severities of disease. Involvement of multiple lung lobes and pleural effusion were associated with the severity of COVID-19. Advanced age (≥75 yr) was a risk factor for mortality.


Subject(s)
Coronavirus Infections/physiopathology , Pneumonia, Viral/physiopathology , Adult , Age Factors , Aged , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Betacoronavirus , China/epidemiology , Comorbidity , Coronavirus Infections/mortality , Critical Illness , Female , Hospital Mortality , Humans , Incidence , Lung/pathology , Male , Middle Aged , Multiple Organ Failure/virology , Pandemics , Pleural Effusion/virology , Pneumonia, Viral/mortality , Tomography, X-Ray Computed
9.
Jpn J Radiol ; 38(5): 400-406, 2020 May.
Article in English | MEDLINE | ID: covidwho-28626

ABSTRACT

PURPOSE: To evaluate the diagnostic performance of chest CT to differentiate coronavirus disease 2019 (COVID-19) pneumonia in non-high-epidemic area in Japan. MATERIALS AND METHODS: This retrospective study included 21 patients clinically suspected COVID-19 pneumonia and underwent chest CT more than 3 days after the symptom onset: six patients confirmed COVID-19 pneumonia by real-time reverse-transcription polymerase chain reaction (RT-PCR) and 15 patients proved uninfected. Using a Likert scale and its receiver operating characteristic curve analysis, two radiologists (R1/R2) evaluated the diagnostic performance of the five CT criteria: (1) ground glass opacity (GGO)-predominant lesions, (2) GGO- and peripheral-predominant lesions, (3) bilateral GGO-predominant lesions; (4) bilateral GGO- and peripheral-predominant lesions, and (5) bilateral GGO- and peripheral-predominant lesions without nodules, airway abnormalities, pleural effusion, and mediastinal lymphadenopathy. RESULTS: All patients confirmed COVID-19 pneumonia had bilateral GGO- and peripheral-predominant lesions without airway abnormalities, mediastinal lymphadenopathy, and pleural effusion. The five CT criteria showed moderate to excellent diagnostic performance with area under the curves (AUCs) ranging 0.77-0.88 for R1 and 0.78-0.92 for R2. The criterion (e) showed the highest AUC. CONCLUSION: Chest CT would play a supplemental role to differentiate COVID-19 pneumonia from other respiratory diseases presenting with similar symptoms in a clinical setting.


Subject(s)
Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Diagnosis, Differential , Female , Humans , Japan/epidemiology , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/virology , Male , Middle Aged , Pandemics , Pleural Effusion/diagnostic imaging , Pleural Effusion/virology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction/methods
10.
Clin Radiol ; 75(5): 335-340, 2020 05.
Article in English | MEDLINE | ID: covidwho-9783

ABSTRACT

AIM: To investigate the characteristics and clinical value of chest computed tomography (CT) images of novel coronavirus pneumonia (NCP). MATERIALS AND METHODS: Clinical data and CT images of 80 cases of NCP were collected. The clinical manifestations and laboratory test results of the patients were analysed. The lesions in each lung segment of the patient's chest CT images were characterised. Lesions were scored according to length and diffusivity. RESULTS: The main clinical manifestations were fever, dry cough, fatigue, a little white sputum, or diarrhoea. A total of 1,702 scored lesions were found in the first chest CT images of 80 patients. The lesions were located mainly in the subpleural area of the lungs (92.4%). Most of the lesions were ground-glass opacity, and subsequent fusions could increase in range and spread mainly in the subpleural area. Pulmonary consolidation accounted for 44.1% of all of the lesions. Of the 80 cases, 76 patients (95%) had bilateral lung disease, four (5%) patients had unilateral lung disease, and eight (10%) patients had cord shadow. CONCLUSION: The chest CT of NCP patients is characterised by the onset of bilateral ground-glass lesions located in the subpleural area of the lung, and progressive lesions that result in consolidation with no migratory lesions. Pleural effusions and mediastinal lymphadenopathy are rare. As patients can have inflammatory changes in the lungs alongside a negative early nucleic acid test, chest CT, in combination with epidemiological and laboratory tests, is a useful examination to evaluate the disease and curative effect.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Adolescent , Adult , Aged , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/pathology , Female , Humans , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/pathology , Lymphadenopathy/virology , Male , Mediastinal Diseases/diagnostic imaging , Mediastinal Diseases/pathology , Mediastinal Diseases/virology , Middle Aged , Nucleic Acid Amplification Techniques , Pandemics , Pleural Effusion/diagnostic imaging , Pleural Effusion/pathology , Pleural Effusion/virology , Pneumonia, Viral/pathology , Sputum/virology , Tomography, X-Ray Computed , Young Adult
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