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1.
Mycopathologia ; 187(1): 31-37, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1588765

ABSTRACT

Literature on COVID-19-associated pulmonary mucormycosis (CAPM) is sparse. Pulmonary artery pseudoaneurysm (PAP) is an uncommon complication of pulmonary mucormycosis (PM), and rarely reported in CAPM. Herein, we report five cases of CAPM with PAP managed at our center and perform a systematic review of the literature. We diagnosed PM in those with clinico-radiological suspicion and confirmed it by microbiology or histopathology. We encountered five cases of CAPM with PAP (size ranged from 1 × 0.8 cm to ~ 4.9 × 4.8 cm). All subjects had diabetes and were aged 55-62 years (75% men). In two cases, COVID-19 and mucormycosis were diagnosed simultaneously, while in three others, COVID-19 preceded PM. One subject who underwent surgery survived, while all others died (80% mortality). From our systematic review, we identified one additional case of CAPM with PAP in a transplant recipient. CAPM with PAP is rare with high mortality. Early diagnosis and multimodality management are imperative to improve outcomes.


Subject(s)
Aneurysm, False , COVID-19 , Mucormycosis , Aneurysm, False/diagnosis , Aneurysm, False/etiology , Female , Humans , Male , Mucormycosis/complications , Mucormycosis/diagnosis , Pulmonary Artery/diagnostic imaging , SARS-CoV-2
2.
Medicina (Kaunas) ; 57(9)2021 Sep 20.
Article in English | MEDLINE | ID: covidwho-1430921

ABSTRACT

In this article, we present the case of a 38-year-old female who suffered from serious respiratory distress. After an extensive pulmonary artery imaging diagnostic work-up (CTPA, MRA and PET), we were unable to differentiate between chronic thromboembolic pulmonary hypertension (CTEPH) vs. pulmonary artery sarcoma (PAS) due to extensive filling defects and extraluminal findings. Although surgery was postponed for nine months due to the COVID-19 pandemic, CTEPH diagnosis, due to a high-thrombus burden, was finally confirmed after pulmonary endarterectomy (PEA). Conclusively, imaging findings of rare cases of CTEPH might mimic PAS and the surgical removal of the lesion are both needed for a final diagnosis. What is Already Known about This Topic? Pulmonary artery sarcoma (PAS) is a rare but aggressive malignancy, which originates from the intimal layer of the pulmonary artery (PA); Chronic thromboembolic pulmonary hypertension (CTEPH) is based on chronic, organized flow-limiting thrombi inside PA circulation and subsequent pulmonary hypertension. What Does This Study Contribute? Since radiological findings of CTEPH cases might rarely mimic PAS, pulmonary artery endarterectomy and subsequent histopathologic study are needed for a final diagnosis.


Subject(s)
COVID-19 , Hypertension, Pulmonary , Pulmonary Embolism , Sarcoma , Thrombosis , Adult , Chronic Disease , Female , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Pandemics , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , Pulmonary Embolism/diagnosis , Pulmonary Embolism/diagnostic imaging , SARS-CoV-2 , Sarcoma/diagnosis , Sarcoma/diagnostic imaging
4.
Int J Gynaecol Obstet ; 155(3): 450-454, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1400847

ABSTRACT

OBJECTIVE: To evaluate fetal lung development using pulmonary artery Doppler in pregnant women who had recovered from COVID-19. METHODS: The prospective case-control study included 41 pregnant women who had recovered from COVID-19 and 43 healthy pregnant women (control group). All the women in the study group had been diagnosed with COVID-19 and had completed a quarantine period. RESULTS: The demographic data of patients were similar in the groups (P > 0.05). Main pulmonary artery peak systolic velocity was higher and pulsatility indices were lower in pregnant women who recovered from COVID-19 compared to the controls (P < 0.001, P = 0.001). Acceleration time, ejection time, and acceleration/ejection time ratio (PATET) of the fetal MPA Doppler were significantly decreased in pregnant women who recovered from COVID-19 (P < 0.001, P = 0.036, and P = 0.002, respectively). The patients who had recovered from COVID-19 were divided into two groups: those treated with expectant management and those treated in hospital. The pulmonary artery acceleration time and PATET ratio were significantly lower in the group treated in the hospital (P = 0.023 and P = 0.045, respectively). CONCLUSION: Detailed Doppler evaluations of the pulmonary artery may help in evaluating the fetal adverse effects of COVID-19 disease.


Subject(s)
COVID-19 , Pulmonary Artery , Blood Flow Velocity , Case-Control Studies , Female , Humans , Pregnancy , Pregnant Women , Prospective Studies , Pulmonary Artery/diagnostic imaging , SARS-CoV-2 , Ultrasonography, Doppler , Ultrasonography, Prenatal
6.
Echocardiography ; 38(9): 1543-1551, 2021 09.
Article in English | MEDLINE | ID: covidwho-1345950

ABSTRACT

AIM: Chest computed tomography (CT) imaging plays a diagnostic and prognostic role in Coronavirus disease 2019 (COVID-19) patients. This study aimed to investigate and compare predictive capacity of main pulmonary artery diameter (MPA), ascending aorta diameter (AAo), and MPA-to-AAo ratio to determine in-hospital mortality in COVID-19 patients. MATERIALS AND METHODS: This retrospective study included 255 hospitalized severe or critical COVID-19 patients. MPA was measured at the level of pulmonary artery bifurcation perpendicular to the direction of the vessel through transverse axial images and AAo was measured by using the same CT slice at its maximal diameter. MPA-to-AAo ratio was calculated by division of MPA to AAo. RESULTS: Multivariate logistic regression model yielded MPA ≥29.15 mm (OR: 4.95, 95% CI: 2.01-12.2, p = 0.001), MPA (OR: 1.28, 95% CI: 1.13-1.46, p < 0.001), AAo (OR: .90, 95% CI: .81-.99, p = 0.040), and MPA-to-AAo ratio ≥.82 (OR: 4.67, 95% CI: 1.86-11.7, p = 0.001) as independent predictors of in-hospital mortality. Time-dependent multivariate Cox-proportion regression model demonstrated MPA ≥29.15 mm (HR: 1.96, 95% CI: 1.03-3.90, p = 0.047) and MPA (HR: 1.08, 95% CI: 1.01-1.17, p = 0.048) as independent predictors of in-hospital mortality, whereas AAo and MPA-to-AAo ratio did not reach statistical significance. CONCLUSION: Pulmonary artery enlargement strongly predicts in-hospital mortality in hospitalized COVID-19 patients. MPA, which can be calculated easily from chest CT imaging, can be beneficial in the prognostication of these patients.


Subject(s)
COVID-19 , Aorta/diagnostic imaging , Humans , Prognosis , Pulmonary Artery/diagnostic imaging , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
7.
Echocardiography ; 38(8): 1345-1351, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1316883

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) frequently involves cardiovascular manifestations such as right ventricular (RV) dysfunction and alterations in pulmonary hemodynamics. We evaluated the application of the critical care ultrasonography ORACLE protocol to identify the most frequent alterations and their influence on adverse outcomes, especially those involving the RV (dilatation and dysfunction). METHODS: This cross-sectional study included 204 adult patients with confirmed COVID-19 admitted at three centers. Echocardiography and lung ultrasound images were acquired on admission using the ORACLE ultrasonography algorithm. RESULTS: Two-hundred and four consecutive patients were evaluated: 22 (11.9%) demonstrated a fractional shortening of < 35%; 33 (17.1%) a tricuspid annular plane systolic excursion (TAPSE) of < 17 mm; 26 (13.5%) a tricuspid peak systolic S wave tissue Doppler velocity of < 9.5 cm/sec; 69 (37.5%) a RV basal diameter of > 41 mm; 119 (58.3%) a pulmonary artery systolic pressure (PASP) of > 35 mm Hg; and 14 (11%) a TAPSE/PASP ratio of < .31. The in-hospital mortality rate was 37.6% (n = 71). Multiple logistic regression modeling showed that PASP > 35 mm Hg, RV FS of < 35%, TAPSE < 17 mm, RV S wave < 9.5, and TAPSE/PASP ratio < .31 mm/mm Hg were associated with this outcome. PASP and the TAPSE/PASP ratio had the lowest feasibility of being obtained among the investigators (62.2%). CONCLUSION: The presence of RV dysfunction, pulmonary hypertension, and alteration of the RV-arterial coupling conveys an increased risk of in-hospital mortality in patients presenting with COVID-19 upon admission; therefore, searching for these alterations should be routine. These parameters can be obtained quickly and safely with the ORACLE protocol.


Subject(s)
COVID-19 , Ventricular Dysfunction, Right , Adult , Cross-Sectional Studies , Echocardiography, Doppler , Hospital Mortality , Humans , Pulmonary Artery/diagnostic imaging , SARS-CoV-2 , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Function, Right
8.
SLAS Discov ; 26(9): 1079-1090, 2021 10.
Article in English | MEDLINE | ID: covidwho-1314244

ABSTRACT

The recent renascence of phenotypic drug discovery (PDD) is catalyzed by its ability to identify first-in-class drugs and deliver results when the exact molecular mechanism is partially obscure. Acute respiratory distress syndrome (ARDS) is a severe, life-threatening condition with a high mortality rate that has increased in frequency due to the COVID-19 pandemic. Despite decades of laboratory and clinical study, no efficient pharmacological therapy for ARDS has been found. An increase in endothelial permeability is the primary event in ARDS onset, causing the development of pulmonary edema that leads to respiratory failure. Currently, the detailed molecular mechanisms regulating endothelial permeability are poorly understood. Therefore, the use of the PDD approach in the search for efficient ARDS treatment can be more productive than classic target-based drug discovery (TDD), but its use requires a new cell-based assay compatible with high-throughput (HTS) and high-content (HCS) screening. Here we report the development of a new plate-based image cytometry method to measure endothelial barrier function. The incorporation of image cytometry in combination with digital image analysis substantially decreases assay variability and increases the signal window. This new method simultaneously allows for rapid measurement of cell monolayer permeability and cytological analysis. The time-course of permeability increase in human pulmonary artery endothelial cells (HPAECs) in response to the thrombin and tumor necrosis factor α treatment correlates with previously published data obtained by transendothelial resistance (TER) measurements. Furthermore, the proposed image cytometry method can be easily adapted for HTS/HCS applications.


Subject(s)
COVID-19/diagnostic imaging , High-Throughput Screening Assays/methods , Image Cytometry/methods , Respiratory Distress Syndrome/diagnostic imaging , COVID-19/diagnosis , COVID-19/virology , Cell Membrane Permeability/genetics , Drug Discovery , Endothelial Cells/ultrastructure , Endothelial Cells/virology , Humans , Image Processing, Computer-Assisted , Pandemics/prevention & control , Phenotype , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/pathology , Pulmonary Artery/virology , Pulmonary Edema/diagnosis , Pulmonary Edema/diagnostic imaging , Pulmonary Edema/virology , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/virology , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/diagnostic imaging , Respiratory Insufficiency/virology , SARS-CoV-2/pathogenicity , Thrombin/pharmacology , Tumor Necrosis Factor-alpha/pharmacology
10.
J Thromb Thrombolysis ; 52(1): 76-84, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1310591

ABSTRACT

Subpleural consolidations have been found in lung ultrasound in patients with COVID-19, possibly deriving from pulmonary embolism (PE). The diagnostic utility of impact of lung ultrasound in critical-ill patients with COVID-19 for PE diagnostics however is unclear. We retrospectively evaluated all SARS-CoV2-associated ARDS patients admitted to our ICU between March 8th and May 31th 2020. They were enrolled in this study, when a lung ultrasound and a computed tomography pulmonary angiography (CTPA) were documented. In addition, wells score was calculated to estimate the probability of PE. The CTPA was used as the gold standard for the detection of PE. Twenty out of 25 patients met the inclusion criteria. In 12/20 patients (60%) (sub-) segmental PE were detected by CT-angiography. Lung ultrasound found subpleural consolidations in 90% of patients. PE-typical large supleural consolidations with a size ≥ 1 cm were detectable in 65% of patients and were significant more frequent in patients with PE compared to those without (p = 0.035). Large consolidations predicted PE with a sensitivity of 77% and a specificity of 71%. The Wells score was significantly higher in patients with PE compared to those without (2.7 ± 0.8 and 1.7 ± 0.5, respectively, p = 0.042) and predicted PE with an AUC of 0.81. When combining the two modalities, comparing patients with considered/probable PE using LUS plus a Wells score ≥ 2 to patients with possible/unlikely PE in LUS plus a Wells score < 2, PE could be predicted with a sensitivity of 100% and a specificity of 80%. Large consolidations detected in lung ultrasound were found frequently in COVID-19 ARDS patients with pulmonary embolism. In combination with a Wells score > 2, this might indicate a high-risk for PE in COVID-19.


Subject(s)
COVID-19/complications , Clinical Decision Rules , Computed Tomography Angiography , Lung/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Ultrasonography , Aged , COVID-19/diagnosis , Critical Illness , Female , Humans , Male , Middle Aged , Multimodal Imaging , Predictive Value of Tests , Pulmonary Embolism/etiology , Registries , Reproducibility of Results , Retrospective Studies , Risk Assessment , Risk Factors
11.
Radiology ; 301(3): E426-E433, 2021 12.
Article in English | MEDLINE | ID: covidwho-1307983

ABSTRACT

Background Pulmonary embolism (PE) commonly complicates SARS-CoV-2 infection, but incidence and mortality reported in single-center studies, along with risk factors, vary. Purpose To determine the incidence of PE in patients with COVID-19 and its associations with clinical and laboratory parameters. Materials and Methods In this HIPAA-compliant study, electronic medical records were searched retrospectively for demographic, clinical, and laboratory data and outcomes among patients with COVID-19 admitted at four hospitals from March through June 2020. PE found at CT pulmonary angiography and perfusion scintigraphy was correlated with clinical and laboratory parameters. The d-dimer level was used to predict PE, and the obtained threshold was externally validated among 85 hospitalized patients with COVID-19 at a fifth hospital. The association between right-sided heart strain and embolic burden was evaluated in patients with PE undergoing echocardiography. Results A total of 413 patients with COVID-19 (mean age, 60 years ± 16 [standard deviation]; age range, 20-98 years; 230 men) were evaluated. PE was diagnosed in 102 (25%; 95% CI: 21, 29) of 413 hospitalized patients with COVID-19 who underwent CT pulmonary angiography or perfusion scintigraphy. PE was observed in 21 (29%; 95% CI: 19, 41) of 73 patients in the intensive care unit (ICU) versus 81 (24%; 95% CI: 20, 29) of 340 patients who were not in the ICU (P = .37). PE was associated with male sex (odds ratio [OR], 1.74; 95% CI: 1.1, 2.8; P = .02); smoking (OR, 1.86; 95% CI: 1.0, 3.4; P = .04); and increased d-dimer (P < .001), lactate dehydrogenase (P < .001), ferritin (P = .001), and interleukin-6 (P = .02) levels. Mortality in hospitalized patients was similar between patients with PE and those without PE (14% [13 of 102]; 95% CI: 8, 22] vs 13% [40 of 311]; 95% CI: 9, 17; P = .98), suggesting that diagnosis and treatment of PE were not associated with excess mortality. The d-dimer levels greater than 1600 ng/mL [8.761 nmol/L] helped predict PE with 100% sensitivity and 62% specificity in an external validation cohort. Embolic burden was higher in patients with right-sided heart strain among the patients with PE undergoing echocardiography (P = .03). Conclusion Pulmonary embolism (PE) incidence was 25% in patients hospitalized with COVID-19 suspected of having PE. A d-dimer level greater than 1600 ng/mL [8.761 nmol/L] was sensitive for identification of patients who needed CT pulmonary angiography. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Ketai in this issue.


Subject(s)
COVID-19/epidemiology , Inpatients/statistics & numerical data , Pulmonary Embolism/epidemiology , Adult , Aged , Aged, 80 and over , Cohort Studies , Comorbidity , Computed Tomography Angiography/methods , Female , Hospitalization/statistics & numerical data , Humans , Incidence , Male , Middle Aged , New York City/epidemiology , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Retrospective Studies , Risk Factors , SARS-CoV-2 , Young Adult
13.
Echocardiography ; 38(8): 1314-1318, 2021 08.
Article in English | MEDLINE | ID: covidwho-1286671

ABSTRACT

PURPOSE: To determine the effect of SARS-CoV-2 infection on the fetal pulmonary system using the acceleration time (AT), ejection time (ET), and acceleration/ejection time ratio (PATET) of the fetal main pulmonary artery Doppler waveform. METHODS: We prospectively studied pregnant women attending our hospital with confirmed SARS-CoV-2 infection by RT-PCR test and an age-matched control group who admitted for routine prenatal care. An ultrasound examination that included measurements of the AT, ET, and AT/ET ratio (PATET) were performed and the results were compared. RESULTS: Fifty-five SARS-CoV-2-infected and 93 control group pregnant women were included in this study. AT found higher in the COVID-19 positive group when compared with controls. When the ET and PATET parameters were compared, no differences were detected between the groups. Eleven neonates had Neonatal Intensive Care Unit (NICU) requirement in the COVID-19 positive group while there were none in the control group. All fetal pulmonary artery Doppler values were decreased in NICU admitted fetuses. The mean gestational week of this group was lower than non-NICU COVID-19 positive group and the control group. CONCLUSION: COVID-19 infection increases fetal pulmonary blood flow, which appears high AT values on Doppler parameters. NICU admission only occurred in the COVID-19 group and their Doppler values were found significantly lower than non-NICU COVID-19 group. The clinical significance of this result must be evaluated with further studies.


Subject(s)
COVID-19 , SARS-CoV-2 , Female , Fetus , Humans , Infant, Newborn , Pregnancy , Prenatal Care , Prospective Studies , Pulmonary Artery/diagnostic imaging , Ultrasonography, Prenatal
15.
Jpn J Radiol ; 39(6): 589-597, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1144386

ABSTRACT

PURPOSE: To describe the prognostic value of pulmonary artery (PA) trunk enlargement on the admission of in-hospital patients with severe COVID-19 infection by unenhanced CT image. MATERIALS AND METHODS: In-hospital patients confirmed COVID-19 from January 18, 2020, to March 7, 2020, were retrospectively enrolled. PA trunk diameters on admission and death events were collected to calculate the optimum cutoff using a receiver operating characteristic curve. According to the cutoff, the subjects on admission were divided into two groups. Then the in-hospital various parameters were compared between the two groups to assess the predictive value of PA trunk diameter. RESULTS: In the 180 enrolled in-hospital patients (46.99 ± 14.95 years; 93 (51.7%) female, 14 patients (7.8%) died during their hospitalization. The optimum cutoff PA trunk diameter to predict in-hospital mortality was > 29 mm with a sensitivity of 92.59% and a specificity of 91.11%. Kaplan-Meier survival curves for PA trunk diameter on admission showed that a PA trunk diameter > 29 mm was a significant predictor of subsequent death (log-rank < 0.001, median survival time of PA > 29 mm was 28 days). CONCLUSION: PA trunk enlargement can be a useful predictive factor for distinguishing between mild and severe COVID-19 disease progression.


Subject(s)
COVID-19/mortality , COVID-19/pathology , Pulmonary Artery/pathology , Adult , COVID-19/diagnostic imaging , Dilatation, Pathologic/diagnostic imaging , Female , Hospital Mortality , Hospitalization , Humans , Male , Middle Aged , Prognosis , Pulmonary Artery/diagnostic imaging , ROC Curve , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed/methods
16.
Biomed Res Int ; 2021: 8851736, 2021.
Article in English | MEDLINE | ID: covidwho-1140379

ABSTRACT

PURPOSE: This study is aimed at assessing the prevalence of pulmonary artery filling defects (PAFDs) consistent with pulmonary artery embolism (PAE) in patients with SARS-CoV-2 infection and at investigating possible radiological or clinical predictors. MATERIALS AND METHODS: Computed Tomography Pulmonary Angiographies (CTPAs) from 43 consecutive patients with a confirmed COVID-19 infection were retrospectively reviewed, taking into consideration the revised Geneva score and the D-dimer value for each patient. Filling defects within the pulmonary arteries were recorded along with pleural and parenchymal findings such as ground glass opacities, consolidation, crazy paving, linear consolidation, and pleural effusion. All these variables were compared between patients with and without PAFD. The predictive performance of statistically different parameters was investigated using the receiver operating characteristics (ROC). RESULTS: Pulmonary embolism was diagnosed in 15/43 patients (35%), whereas CTPA and parenchymal changes related to pulmonary COVID-19 disease were evident in 39/43 patients (91%). The revised Geneva score and the mean D-dimer value obtained using two consecutive measurements were significantly higher in patients with PAFD. The ROC analysis demonstrated that a mean D-dimer value is the parameter with the higher predictivity (AUC 0.831) that is a cut-off value > 1800 µg/l which predicts the probability of PAFD with a sensitivity and specificity of 70% and 78%, respectively. CONCLUSIONS: This single centre retrospective report shows a high prevalence of pulmonary artery filling defects revealed using CTPA in COVID-19 patients and demonstrates that the mean value of multiple D-dimer measurements may represent a predicting factor of this complication.


Subject(s)
COVID-19/diagnostic imaging , Computed Tomography Angiography/methods , Pulmonary Artery/diagnostic imaging , Adult , Aged , COVID-19/metabolism , COVID-19/virology , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Prevalence , Pulmonary Artery/pathology , Pulmonary Artery/virology , Pulmonary Embolism/diagnosis , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/virology , ROC Curve , Retrospective Studies , SARS-CoV-2/isolation & purification , Sensitivity and Specificity
17.
Interact Cardiovasc Thorac Surg ; 33(1): 150-152, 2021 06 28.
Article in English | MEDLINE | ID: covidwho-1118995

ABSTRACT

We report a rare case of solitary peripheral pulmonary artery aneurysm in a patient who was evaluated for haemoptysis. Incidentally, his total antibodies were positive for Coronavirus 2019 infection. Patient underwent right lower lobectomy uneventfully. Peripheral pulmonary artery aneurysms arising from segmental or intrapulmonary branches are extremely rare. Untreated, the majority end fatally due to sudden rupture and exsanguination. The purpose of this article is to report our rare case and review the pertinent literature.


Subject(s)
Aneurysm/pathology , Pulmonary Artery/pathology , Adult , Aneurysm/diagnostic imaging , Aneurysm/surgery , Humans , Male , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , Tomography, X-Ray Computed
18.
Clin Radiol ; 76(5): 392.e1-392.e9, 2021 05.
Article in English | MEDLINE | ID: covidwho-1101168

ABSTRACT

AIM: To assess differences in qualitative and quantitative parameters of pulmonary perfusion from dual-energy computed tomography (CT) pulmonary angiography (DECT-PA) in patients with COVID-19 pneumonia with and without pulmonary embolism (PE). MATERIALS AND METHODS: This retrospective institutional review board-approved study included 74 patients (mean age 61±18 years, male:female 34:40) with COVID-19 pneumonia in two countries (one with 68 patients, and the other with six patients) who underwent DECT-PA on either dual-source (DS) or single-source (SS) multidetector CT machines. Images from DS-DECT-PA were processed to obtain virtual mono-energetic 40 keV (Mono40), material decomposition iodine (MDI) images and quantitative perfusion statistics (QPS). Two thoracic radiologists determined CT severity scores based on type and extent of pulmonary opacities, assessed presence of PE, and pulmonary parenchymal perfusion on MDI images. The QPS were calculated from the CT Lung Isolation prototype (Siemens). The correlated clinical outcomes included duration of hospital stay, intubation, SpO2 and death. The significance of association was determined by receiver operating characteristics and analysis of variance. RESULTS: One-fifth (20.2%, 15/74 patients) had pulmonary arterial filling defects; most filling defects were occlusive (28/44) located in the segmental and sub-segmental arteries. The parenchymal opacities were more extensive and denser (CT severity score 24±4) in patients with arterial filling defects than without filling defects (20±8; p=0.028). Ground-glass opacities demonstrated increased iodine distribution; mixed and consolidative opacities had reduced iodine on DS-DECT-PA but increased or heterogeneous iodine content on SS-DECT-PA. QPS were significantly lower in patients with low SpO2 (p=0.003), intubation (p=0.006), and pulmonary arterial filling defects (p=0.007). CONCLUSION: DECT-PA QPS correlated with clinical outcomes in COVID-19 patients.


Subject(s)
COVID-19/complications , COVID-19/diagnostic imaging , Computed Tomography Angiography/methods , Lung/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Adult , Aged , Aged, 80 and over , COVID-19/therapy , Contrast Media , Female , Hospital Mortality , Humans , Iodine , Length of Stay , Lung/blood supply , Male , Middle Aged , Pulmonary Circulation , Pulmonary Embolism/etiology , Respiration, Artificial , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Young Adult
19.
Eur J Radiol ; 134: 109442, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1060223

ABSTRACT

PURPOSE: The vascular enlargement (VE) pattern differs from previously described imaging patterns for pneumonia. This study aimed to investigate the incidence, computed tomography (CT) characteristics, and diagnostic value of the VE pattern in coronavirus disease 2019 (COVID-19). METHOD: The CT data of 106 patients with COVID-19 from January 19 to February 29, 2020, and 52 patients with influenza virus pneumonia (IVP) from January 2018 to February 2020 were retrospectively collected. The incidences of the VE pattern between the two groups were compared. The CT manifestations of COVID-19 were analyzed with a particular focus on the VE pattern's specific CT signs, dynamic changes, and relationships with lesion size and disease severity. RESULTS: Peripheral and multilobar ground-glass opacities (GGOs) or mixed GGOs with various sizes and morphologies were typical features of COVID-19 on initial CT. The VE pattern was more common in COVID-19 (88/106, 83.02 %) than in IVP (10/52, 19.23 %) on initial CT (P < 0.001). Three special VE-pattern-specific CT signs, including central vascular sign, ginkgo leaf sign, and comb sign, were identified. Four types of dynamic changes in the VE pattern were observed on initial and follow-up CT, which were closely associated with the evolution of lesions and the time interval from the onset of symptoms to initial CT scan. The VE pattern in COVID-19 was more commonly seen in larger lesions and patients with severe-critical type (all P < 0.001). CONCLUSIONS: The VE pattern is a valuable CT sign for differentiating COVID-19 from IVP, which correlates with more extensive or serious disease. A good understanding of the CT characteristics of the VE pattern may contribute to the early and accurate diagnosis of COVID-19 and prediction of the evolution of lesions.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Pneumonia/diagnostic imaging , Pulmonary Artery/pathology , Pulmonary Veins/diagnostic imaging , Pulmonary Veins/pathology , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/pathology , Child , Diagnosis, Differential , Female , Humans , Influenza, Human/diagnostic imaging , Influenza, Human/pathology , Lung/blood supply , Lung/pathology , Male , Middle Aged , Pneumonia/pathology , Pulmonary Artery/diagnostic imaging , Retrospective Studies , SARS-CoV-2 , Young Adult
20.
BMJ Case Rep ; 14(1)2021 Jan 28.
Article in English | MEDLINE | ID: covidwho-1054633

ABSTRACT

We present a case of a 38-year-old man with a history of chronic thromboembolic pulmonary hypertension on therapeutic anticoagulation and recent hospitalisation for COVID-19 disease who was hospitalised for recurrent acute pulmonary embolism despite therapeutic anticoagulation with warfarin (International Normalized Ratio (INR) of 3.0). Our case highlights the hypercoagulable state associated with COVID-19 disease and the absence of standardised approaches to anticoagulation treatment for this population.


Subject(s)
Anticoagulants/therapeutic use , COVID-19/complications , Pulmonary Embolism/complications , Pulmonary Embolism/drug therapy , Warfarin/therapeutic use , Adult , Chronic Disease , Diagnosis, Differential , Humans , Male , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , SARS-CoV-2 , Tomography, X-Ray Computed/methods
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