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1.
Eur Rev Med Pharmacol Sci ; 26(7): 2569-2571, 2022 04.
Article in English | MEDLINE | ID: covidwho-1811977

ABSTRACT

COVID-19 is a disease caused by the SARS-CoV-2 infection which causes pneumonic infiltration in both lungs. This research paper is meant to present our case of a 31-year-old male who experienced bilateral spontaneous pneumothorax. The rarity of this condition cannot be underestimated considering pneumothorax from COVID-19 is quite uncommon.


Subject(s)
COVID-19 , Pneumothorax , Adult , COVID-19/complications , Humans , Lung/diagnostic imaging , Male , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , SARS-CoV-2
3.
Sensors (Basel) ; 22(6)2022 Mar 15.
Article in English | MEDLINE | ID: covidwho-1765833

ABSTRACT

Pneumothorax is a thoracic disease leading to failure of the respiratory system, cardiac arrest, or in extreme cases, death. Chest X-ray (CXR) imaging is the primary diagnostic imaging technique for the diagnosis of pneumothorax. A computerized diagnosis system can detect pneumothorax in chest radiographic images, which provide substantial benefits in disease diagnosis. In the present work, a deep learning neural network model is proposed to detect the regions of pneumothoraces in the chest X-ray images. The model incorporates a Mask Regional Convolutional Neural Network (Mask RCNN) framework and transfer learning with ResNet101 as a backbone feature pyramid network (FPN). The proposed model was trained on a pneumothorax dataset prepared by the Society for Imaging Informatics in Medicine in association with American college of Radiology (SIIM-ACR). The present work compares the operation of the proposed MRCNN model based on ResNet101 as an FPN with the conventional model based on ResNet50 as an FPN. The proposed model had lower class loss, bounding box loss, and mask loss as compared to the conventional model based on ResNet50 as an FPN. Both models were simulated with a learning rate of 0.0004 and 0.0006 with 10 and 12 epochs, respectively.


Subject(s)
Deep Learning , Pneumothorax , Computers , Humans , Pneumothorax/diagnostic imaging , Thorax , X-Rays
5.
J Coll Physicians Surg Pak ; 32(2): 230-232, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1675597

ABSTRACT

Spontaneous pneumomediastinum with COVID pneumonia is a rare occurrence with or without accompanying subcutaneous emphysema or pneumothorax. The aim of this study was to establish relation of this complication to severity of lung disease and its clinical outcome. The study was conducted for a period of seven months from April to October 2020 in the CT Department of Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi, Pakistan. All COVID positive patients having spontaneous pneumomediastinum on high resolution CT (HRCT) chest were included (n=14). These patients were assessed for severity of lung disease as per CT severity score (CTSS), and were followed up for their clinical outcome. All patients with spontaneous pneumomediastinum had moderate to severe degree of COVID pneumonia; mortality in patients with pneumomediastinum was 50%; and was seen in those patients who had greater severity of lung disease as per the CTSS. Key Words: Spontaneous, Pneumomediastinum, COVID, Pneumothorax, Subcutaneous, Emphysema.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Subcutaneous Emphysema , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , SARS-CoV-2 , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiology
6.
Gen Thorac Cardiovasc Surg ; 70(6): 566-574, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1631031

ABSTRACT

OBJECTIVES: The appearance of characteristic pulmonary lesions has been noted after COVID-19, being described as post-COVID-19 pneumo-hematocele. The aim of this study is to describe the clinical, histopathologic, and imaging features of pneumo-hematocele and to suggest a treatment algorithm for these patients. METHODS: A retrospective study was performed in patients admitted with a diagnosis of SARS-CoV2 infection from March 2020 to September 2021 who presented a pneumo-hematocele on imaging studies. Clinical and demographic variables were recorded, and CT scans were analyzed. A secondary analysis was performed to estimate the risk provided by the pneumo-hematocele diameter of developing pneumothorax. RESULTS: 37 patients were diagnosed with pneumo-hematoceles, 97.3% were males with a median age of 41 ± 13 years and 51% were smokers. The mean diameter of the pneumatocele was 6.3 ± 2.8 cm; they were more common on the subpleural surface and in the inferior lobe. Thirty patients had ruptured pneumo-hematoceles and developed pneumothorax (81.1%); a total of 26 patients required surgery (70.3%). Lesions measuring 5 cm had a high risk of rupture (OR 6.8, CI 95% 1.1-42); those measuring 3 cm were prone to this complication. For each centimeter that the pneumo-hematocele diameter increases, the OR for rupture increases 1.5. CONCLUSIONS: It appears that post-COVID-19 pneumo-hematocele occurs secondary to encapsulation of blood accumulation inside the lung, as a result of micro-capillary bleeding, with partial reabsorption of blood and subsequent air filling. We recommend surgery for patients with pneumo-hematoceles of 5 cm and those with persistent lesions of 3 cm. TRIAL REGISTRATION: Clinical Trial Registration: NCT05067881.


Subject(s)
COVID-19 , Pneumothorax , Adult , COVID-19/complications , Female , Hematocele/diagnosis , Hematocele/etiology , Hematocele/surgery , Hemorrhage , Humans , Male , Middle Aged , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , Pneumothorax/therapy , RNA, Viral , Retrospective Studies , Rupture , SARS-CoV-2
7.
Drug Discov Ther ; 15(6): 310-316, 2021.
Article in English | MEDLINE | ID: covidwho-1622789

ABSTRACT

COVID-19 is associated with rarer extra-parenchymal manifestations, namely pneumothorax (PTX) and pneumomediastinum (PM) leading to complications and increased mortality. The study aims to describe the prevalence, risk factors for mortality, radiological characteristics and outcome of PTX/PM in patients admitted with COVID-19. This was a retrospective, single-centre, observational study in patients with confirmed COVID-19 presenting with non-iatrogenic PTX/PM from April 2020 to May 2021. Details pertaining to demographics, presentation, radiological characteristics, management and outcome were collected. Cases were classified into spontaneous and barotraumatic PTX/PM and a between-group comparison was performed using Chi-square and t-test. A total of 45 cases (mean age: 53.2 years, 82% males) out of 8,294 confirmed COVID-19 patients developed PTX/PM, the calculated incidence being 0.54%. 29 cases had spontaneous PTX/PM and the remaining 17 cases were attributed to barotrauma. The most common comorbidities were diabetes-mellitus (65.3%) and hypertension (42.3%). The majority of the cases had large PTX (62.1%) with tension in 8 cases (27.5%). There were predominant right-sided pneumothoraces and five were diagnosed with bronchopleural fistula. 37.7% of cases had associated subcutaneous emphysema. The median duration of PTX/PM from symptom onset was delayed at 22.5 and 17.6 days respectively. The mean CT severity score (CTSS) was 20.5 (± 4.9) with fibrosis (53.8%), bronchiectatic changes (50%) and cystic-cavitary changes (23%). There was no statistically significant difference between the spontaneous and barotrauma cohort. 71% of cases died and the majority belonged to the barotrauma cohort. It is imperative to consider the possibility of PTX/PM in patients having COVID-19, especially in those with deterioration in the disease course, both in spontaneously breathing and mechanically ventilated patients. These patients may also have a high incidence of death, reflecting the gravity of COVID-19.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Female , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Middle Aged , Pneumothorax/diagnostic imaging , Pneumothorax/epidemiology , Pneumothorax/etiology , Respiration, Artificial , Retrospective Studies , SARS-CoV-2 , Tertiary Healthcare
8.
BMJ Case Rep ; 14(12)2021 Dec 08.
Article in English | MEDLINE | ID: covidwho-1560891

ABSTRACT

We report a case of an adult patient with COVID-19 pneumonia presenting as pneumatoceles as a late complication. These pneumatoceles are steroid-resistant and can predispose to cavitary lesions. These cystic lesions need close follow-up with repeat imaging as these can increase the risk of pneumothorax. It can take up to around 12 weeks for the spontaneous resolution of pneumatoceles.


Subject(s)
COVID-19 , Cysts , Pneumothorax , Adult , Humans , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , SARS-CoV-2
9.
Clin Med (Lond) ; 21(6): e615-e619, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1551858

ABSTRACT

BACKGROUND: There are limited data regarding the incidence of pneumothorax in COVID-19 patients as well as the impact of the same on patient outcomes. METHODS: A retrospective review of the medical records at three large tertiary care hospitals in Mumbai was performed to identify patients hospitalised with COVID-19 from March 2020 to October 2020. The presence of pneumothorax and/or pneumomediastinum was noted when chest radiographs or CT scans were performed. Demographic and clinical characteristics of patients who developed air leak were recorded. RESULTS: 4,906 patients with COVID-19 were admitted, with 1,324 (27%) having severe COVID-19 disease. The overall incidence of pneumothorax and/or pneumomediastinum in patients with severe disease was 3.2% (42/1,324). Eighteen patients had pneumothorax, 16 had pneumomediastinum and 8 patients had both. Fourteen patients (33.3%) developed this complication breathing spontaneously, 28 patients (66.6%) developed it during mechanical ventilation. Overall mortality in this cohort was 74%, compared with 17% in the COVID-19 patients without pneumothorax (p<0.001). CONCLUSIONS: Our study demonstrates that air leaks occur with a higher frequency in patients with COVID-19 than in other ICU patients. When present, such air leaks contributed to poor outcomes with almost 74% mortality rates in these patients.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Humans , Intensive Care Units , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Pneumothorax/diagnostic imaging , Pneumothorax/epidemiology , Retrospective Studies , SARS-CoV-2
11.
BMJ Case Rep ; 14(11)2021 Nov 19.
Article in English | MEDLINE | ID: covidwho-1526473

ABSTRACT

Patients with SARS-CoV-2 pneumonia can suffer from pneumothorax and persistent air leak (PAL). The pneumothorax occurs with or without pre-existing lung disease. PAL refers to air leak lasting more than 5-7 days and arises due to bronchopleural or alveolopleural fistula. The management of PAL can be challenging as a standard management guideline is lacking. Here we present the case of a 42-year-old smoker with COVID-19 who presented to the hospital with fever, cough, acute left-sided chest pain and shortness of breath. He suffered from a large left-sided pneumothorax requiring immediate chest tube drainage. Unfortunately, the air leak persisted for 13 days before one-way endobronchial valve (EBV) was used with complete resolution of the air leak. We also review the literature regarding other cases of EBV utilisation for PAL in patients with COVID-19.


Subject(s)
COVID-19 , Emphysema , Pneumothorax , Adult , Bronchoscopy , Humans , Male , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , Pneumothorax/therapy , SARS-CoV-2
13.
J Infect Dev Ctries ; 15(10): 1404-1407, 2021 10 31.
Article in English | MEDLINE | ID: covidwho-1518655

ABSTRACT

INTRODUCTION: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) affects mainly the lungs causing pneumonia and complications like acute respiratory distress syndrome. Pneumothorax is a rare manifestation of the disease. This report is a description of a series of patients with COVID-19 and spontaneous pneumothorax, some of them with associated pulmonary cysts. METHODOLOGY: Cases were collected retrospectively. We included clinical data from medical records and described radiologic findings. Patients that developed pneumothorax during mechanical ventilation were excluded. RESULTS: Ten cases were included in this report, nine of them were male. The median age of our series was 62 years (IQR = 57-68). The median days since the onset of symptoms until the development of pneumothorax was 27 (IQR = 17-31), most cases developed after the second week of the diagnosis of pneumonia. Two cases required invasive mechanical ventilation, but pneumothorax occurred after ventilator weaning. Three cases showed subpleural pulmonary cysts. CONCLUSIONS: Cysts and pneumothorax are rare manifestations of SARS-CoV-2 pneumonia with mechanisms not completely understood. This report highlights the role of CT scan in diagnosis of COVID-19 complications.


Subject(s)
COVID-19/complications , Cysts/etiology , Lung/pathology , Pneumothorax/etiology , Aged , COVID-19/diagnostic imaging , COVID-19/epidemiology , Colombia/epidemiology , Cysts/diagnostic imaging , Cysts/epidemiology , Cysts/virology , Female , Humans , Lung/diagnostic imaging , Lung/virology , Male , Middle Aged , Pneumothorax/diagnostic imaging , Pneumothorax/epidemiology , Retrospective Studies , SARS-CoV-2/pathogenicity , Tomography, X-Ray Computed
15.
Monaldi Arch Chest Dis ; 92(2)2021 Sep 28.
Article in English | MEDLINE | ID: covidwho-1444411

ABSTRACT

Contralateral pneumothorax after percutaneous central venous catheter placement has not been previously reported. Three patients who required intubation and mechanical ventilation for acute respiratory failure due to COVID-19 were identified with a new pneumothorax on routine post-placement chest roentgenogram on the side opposite the catheter placement.  Retrospective review of charts, radiographs, and laboratory studies.  No causative relationship was identified between the percutaneous placement of the central venous catheters and the subsequent pneumothoraces identified on the contralateral side, other than the presence of active COVID-19 viral pneumonia. The timing of the contralateral pneumothoraces were coincidental the placement of the central venous catheters.  We believe these pneumothoraces were a consequence of the pulmonary pathology of the COVID-19 virus.


Subject(s)
COVID-19 , Catheterization, Central Venous , Pneumothorax , COVID-19/complications , Catheterization, Central Venous/adverse effects , Humans , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , Respiration, Artificial/adverse effects , Retrospective Studies
16.
J Am Coll Radiol ; 18(11): 1497-1505, 2021 11.
Article in English | MEDLINE | ID: covidwho-1439355

ABSTRACT

Although interest in artificial intelligence (AI) has exploded in recent years and led to the development of numerous commercial and noncommercial algorithms, the process of implementing such tools into day-to-day clinical practice is rarely described in the burgeoning AI literature. In this report, we describe our experience with the successful integration of an AI-enabled mobile x-ray scanner with an FDA-approved algorithm for detecting pneumothoraces into an end-to-end solution capable of extracting, delivering, and prioritizing positive studies within our thoracic radiology clinical workflow. We also detail several sample cases from our AI algorithm and associated PACS workflow in action to highlight key insights from our experience. We hope this report can help inform other radiology enterprises seeking to evaluate and implement AI-related workflow solutions into daily clinical practice.


Subject(s)
Pneumothorax , Radiology , Algorithms , Artificial Intelligence , Humans , Pneumothorax/diagnostic imaging , Radiography
17.
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
18.
BMJ Case Rep ; 14(9)2021 Sep 21.
Article in English | MEDLINE | ID: covidwho-1435026

ABSTRACT

Although, cardiac injury, pneumothorax and pneumomediastinum are associated with COVID-19, differentiation of their symptoms and signs from those of COVID-19 itself is challenging. Without a high index of suspicion, cardiomyopathy and anterior pneumothorax are easily missed. These complications may be underdiagnosed in patients with COVID-19. Cardiomyopathy and pneumothorax may cause or exacerbate respiratory failure. If their management is delayed, cardiac arrest can occur. To increase the awareness of these issues, we describe the course and imaging of a 39-year-old woman with severe COVID-19 who developed cardiomyopathy and a small anterior pneumothorax with pneumomediastinum. Transthoracic echocardiography is technically challenging in the presence of anterior pneumothorax. Furthermore, although CT is the gold standard for the diagnosis of pneumothorax, this is not always feasible in critically ill patients. Lateral decubitus chest X-rays and lung ultrasound may facilitate the diagnosis of pneumothorax at the bedside of patients with COVID-19.


Subject(s)
COVID-19 , Cardiomyopathies , Mediastinal Emphysema , Pneumothorax , Adult , Female , Humans , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , SARS-CoV-2
19.
Am J Case Rep ; 22: e933405, 2021 Sep 04.
Article in English | MEDLINE | ID: covidwho-1395311

ABSTRACT

BACKGROUND COVID-19 caused by SARS-CoV-2 has become a global pandemic. Diagnosis is based on clinical features, nasopharyngeal swab analyzed with real-time reverse transcription-polymerase chain reaction, and computer tomography (CT) scan pathognomonic signs. The most common symptoms associated with COVID-19 include fever, coughing, and dyspnea. The main complications are acute respiratory distress syndrome, pneumonia, kidney failure, bacterial superinfections, coagulation abnormalities with thromboembolic events, sepsis, and even death. The common CT manifestations of COVID-19 are ground-glass opacities with reticular opacities and consolidations. Bilateral lung involvement can be present, especially in the posterior parts and peripheral areas. Pleural effusion, pericardial effusion, and lymphadenopathy are rarely described. Spontaneous pneumothorax and pneumomediastinum have been observed as complications in patients with SARS-CoV-2 pneumonia during mechanical ventilation or noninvasive positive pressure ventilation, as well as in patients with spontaneous breathing receiving only oxygen therapy via nasal cannula or masks. CASE REPORT We present 2 cases of pneumomediastinum with and without pneumothorax in patients with active SARS-Cov-2 infection and 1 case of spontaneous pneumothorax in a patient with a history of paucisymptomatic SARS-CoV-2 infection. In these 3 male patients, ages 78, 73, and 70 years, respectively, COVID-19 was diagnosed through nasopharyngeal sampling tests and the presence of acute respiratory distress syndrome. CONCLUSIONS Both pneumothorax and pneumomediastinum, although rare, may be complications during or after SARS-CoV-2 infection even in patients who are spontaneously breathing. The aim of this study was to describe an increasingly frequent event whose early recognition can modify the prognosis of patients.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Aged , COVID-19/complications , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/virology , Pandemics , Pneumothorax/diagnostic imaging , Pneumothorax/virology
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