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2.
Eur J Radiol ; 130: 109202, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-684452

ABSTRACT

BACKGROUND: So far, only a few studies evaluated the correlation between CT features and clinical outcome in patients with COVID-19 pneumonia. PURPOSE: To evaluate CT ability in differentiating critically ill patients requiring invasive ventilation from patients with less severe disease. METHODS: We retrospectively collected data from patients admitted to our institution for COVID-19 pneumonia between March 5th-24th. Patients were considered critically ill or non-critically ill, depending on the need for mechanical ventilation. CT images from both groups were analyzed for the assessment of qualitative features and disease extension, using a quantitative semiautomatic method. We evaluated the differences between the two groups for clinical, laboratory and CT data. Analyses were conducted on a per-protocol basis. RESULTS: 189 patients were analyzed. PaO2/FIO2 ratio and oxygen saturation (SaO2) were decreased in critically ill patients. At CT, mixed pattern (ground glass opacities (GGO) and consolidation) and GGO alone were more frequent respectively in critically ill and in non-critically ill patients (p < 0.05). Lung volume involvement was significantly higher in critically ill patients (38.5 % vs. 5.8 %, p < 0.05). A cut-off of 23.0 % of lung involvement showed 96 % sensitivity and 96 % specificity in distinguishing critically ill patients from patients with less severe disease. The fraction of involved lung was related to lactate dehydrogenase (LDH) levels, PaO2/FIO2 ratio and SaO2 (p < 0.05). CONCLUSION: Lung disease extension, assessed using quantitative CT, has a significant relationship with clinical severity and may predict the need for invasive ventilation in patients with COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Image Interpretation, Computer-Assisted/methods , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Critical Illness , Evaluation Studies as Topic , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Research Design , Retrospective Studies , Risk Factors , Sensitivity and Specificity
3.
Medicine (Baltimore) ; 99(30): e21396, 2020 Jul 24.
Article in English | MEDLINE | ID: covidwho-684031

ABSTRACT

A large number of healthcare workers have been infected with coronavirus disease-2019 (COVID-19). We aimed to investigate their clinical and chest computed tomography (CT) characteristics.The clinical, laboratory test and CT features of 43 medical and hospital staff with confirmed COVID-19 (MP group, 26-70 years old) were retrospectively analyzed, and compared to 43 non-medical related patients (non-MP group, 26-71 years old). Follow-up CT characteristics were analyzed to assess the disease progression in the period of hospitalization.At admission, the main complaints of the MP group, including fever (81.4%), fatigue (48.8%) and cough (41.9%), were similar to the non-MP group. The C-reactive protein, erythrocyte sedimentation rate, and lactate dehydrogenase levels were higher in the non-MP group than the MP group (17.5 ±â€Š22.4 mg/L, 20.2 ±â€Š23.4 mm/H and 219 ±â€Š66U/L, respectively, P < .05). Ground-grass opacities, consolidation, interstitial thickening were common CT features of both groups. The severity of opacities on initial CT were less in the MP group (5.3 ±â€Š3.9 scores) than in the non-MP group (9.1 ±â€Š4.8 scores, P < .05). Before regular treatments, the sum score of the opacities showed weak to moderate correlations with duration, C-reactive protein, erythrocyte sedimentation rate and lactate dehydrogenase levels (R ranged from 0.341-0.651, P < .05). In the study time window, the duration from illness onset to when the most obvious pulmonary opacities were observed, according to CT findings, were similar in the MP group (13.3 ±â€Š6.6 days) and the non-MP group (13.8 ±â€Š5.1 days, P = .69). Mild to moderate anxiety and depression were observed in both groups.Despite greater knowledge of how to protect themselves than the general population, healthcare workers are also susceptible to COVID-19 infection. Occupational exposure is a very important factor. Healthcare workers have a higher vigilance about the infection in the early stage of the disease.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Occupational Diseases/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Aged , Coronavirus Infections/transmission , Coronavirus Infections/virology , Female , Health Personnel/statistics & numerical data , Humans , Infectious Disease Transmission, Patient-to-Professional , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Occupational Diseases/virology , Occupational Exposure/adverse effects , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Retrospective Studies
4.
World Neurosurg ; 141: 402-405, 2020 09.
Article in English | MEDLINE | ID: covidwho-633960

ABSTRACT

BACKGROUND: Nonmissile penetrating injuries to the craniocervical junction caused by a glass fragment are rare, and a standard management strategy has not been established. CASE DESCRIPTION: A 75-year-old Japanese man was brought into our emergency department after receiving a left retroauricular stab wound by broken glass fragments. After spinal immobilization, a computed tomography (CT) scan revealed glass fragments penetrating at the right craniocervical junction to the interatlantooccipital subarachnoid space. CT angiography showed that both vertebral arteries were not injured. Magnetic resonance imaging demonstrated that the glass fragments did not penetrate the cervical cord or medulla oblongata. These glass fragments were removed via a midline incision from the external occipital protuberance to the C7 and with laminectomy without suboccipital craniectomy. Five of the glass fragments were found and removed in total. The dural defect was patched with a free fascia autograft. His postoperative course was uneventful. Postoperative CT angiography showed that both vertebral arteries were intact and the glass fragments had been removed completely. CONCLUSIONS: CT graphical diagnosis is useful for the management of penetrating craniocervical junction trauma, and it should be considered in the evaluation of patients who have suffered craniocervical penetrating injury even in the absence of major wounds or bleeding. Spinal immobilization of patients with craniocervical penetrating injuries is crucial to avoid not only secondary neurologic damage but also secondary critical vascular damage. Incomplete or inadequate assessment of craniocervical stab wounds results in unexpected hazards that are preventable.


Subject(s)
Atlanto-Occipital Joint/injuries , Coronavirus Infections , Glass , Pandemics , Pneumonia, Viral , Subarachnoid Space/injuries , Trauma, Nervous System/complications , Trauma, Nervous System/surgery , Aged , Atlanto-Occipital Joint/diagnostic imaging , Humans , Magnetic Resonance Imaging , Male , Subarachnoid Space/diagnostic imaging , Tomography, X-Ray Computed , Trauma, Nervous System/diagnostic imaging , Wounds, Penetrating/complications , Wounds, Penetrating/surgery , Wounds, Stab/therapy
5.
Pol Arch Intern Med ; 130(7-8): 629-634, 2020 08 27.
Article in English | MEDLINE | ID: covidwho-761202

ABSTRACT

INTRODUCTION: Currently, there are known contributing factors but no comprehensive methods for predicting the mortality risk or intensive care unit (ICU) admission in patients with novel coronavirus disease 2019 (COVID­19). OBJECTIVES: The aim of this study was to explore risk factors for mortality and ICU admission in patients with COVID­19, using computed tomography (CT) combined with clinical laboratory data. PATIENTS AND METHODS: Patients with polymerase chain reaction-confirmed COVID­19 (n = 63) from university hospitals in Tehran, Iran, were included. All patients underwent CT examination. Subsequently, a total CT score and the number of involved lung lobes were calculated and compared against collected laboratory and clinical characteristics. Univariable and multivariable proportional hazard analyses were used to determine the association among CT, laboratory and clinical data, ICU admission, and in­hospital death. RESULTS: By univariable analysis, in­hospital mortality was higher in patients with lower oxygen saturation on admission (below 88%), higher CT scores, and a higher number of lung lobes (more than 4) involved with a diffuse parenchymal pattern. By multivariable analysis, in­hospital mortality was higher in those with oxygen saturation below 88% on admission and a higher number of lung lobes involved with a diffuse parenchymal pattern. The risk of ICU admission was higher in patients with comorbidities (hypertension and ischemic heart disease), arterial oxygen saturation below 88%, and pericardial effusion. CONCLUSIONS: We can identify factors affecting in­hospital death and ICU admission in COVID-19. This can help clinicians to determine which patients are likely to require ICU admission and to inform strategic healthcare planning in critical conditions such as the COVID­19 pandemic.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Real-Time Polymerase Chain Reaction , Adult , Age Distribution , Aged , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Humans , Iran , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Poland/epidemiology , Sex Distribution , Tomography, X-Ray Computed , Young Adult
6.
Clin Neuroradiol ; 30(3): 447-452, 2020 Sep.
Article in German | MEDLINE | ID: covidwho-754693

ABSTRACT

BACKGROUND AND PURPOSE: To analyze standard operating procedures (SOP) of acute stroke imaging and interventions during COVID-19 pandemic with special emphasis on chest CT within a multimodal stroke protocol. METHODS: A questionnaire was distributed via email to members of the Professional Organization of German Neuroradiologists (Berufsverband Deutscher Neuroradiologen e.V.). RESULTS: Answers were received from 25 units: eleven of them acquire chest CT, three in any patient and eight, when COVID-19 is suspected due to body temperature increase, patient's history or when the latter cannot be sufficiently obtained. Preliminary data indicate a high sensitivity and moderate negative predictive value. CONCLUSION: Different SOP reflect an uncertainty whether chest CT should be acquired as part of a multimodal stroke protocol. Accuracy of low dose chest CT cannot be determined yet. The strengths and limitations of chest CT are discussed.


Subject(s)
Coronavirus Infections/complications , Lung/diagnostic imaging , Pneumonia, Viral/complications , Practice Patterns, Physicians' , Stroke/diagnostic imaging , Stroke/virology , Clinical Protocols , Germany , Humans , Pandemics , Patient Selection , Surveys and Questionnaires , Tomography, X-Ray Computed
7.
J Coll Physicians Surg Pak ; 30(8): 785-789, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-745630

ABSTRACT

OBJECTIVE: To investigate airway abnormalities on chest CT in adult patients with COVID-19 pneumonia. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China, from January to April, 2020. METHODOLOGY: CT scan images were analysed retrospectively. The main CT findings, including pulmonary opacities, airway wall visibility, wall thickening, luminal changes, and the formation of mucus plugs were evaluated. Airway segments were classified into three types based on the spatial relationship between conducting airways and pulmonary opacities. RESULTS: A total of 275 lesions were detected in 52 patients. Of these, 170 (61.82%) lesions were associated with 243 airway segments, including segments enclosed within lesions (type I, 152, 62.55%), crossing the lesions (type II, 51, 20.99%), and abutting the lesions (type III, 40, 16.46%). The bronchial walls of 154 (63.37%) segments were ill-defined; whereas, the walls of 89 (36.63%) segments were well-defined; in the latter group, 62 (69.66%) showed mild thickening. The bronchial lumen of 183 (75.31%) segments presented mild bronchiectasis and 60 (24.69%) segments appeared normal. Mucus plug was detected in one segment (0.41%). There were no cases of bronchial stenosis, and all bronchial segments located in normal lung regions appeared normal. The appearance of 196 (80.66%) affected bronchi was completely restored before hospital discharge. CONCLUSION: Typical airway changes in adult COVID-19 pneumonia include bronchial wall thickening without significant stenosis of the airway lumen and the absence of bronchial mucus plugs. Moreover, bronchi located in unaffected lung regions have a normal appearance. These characteristics have potential value in differential diagnosis. Key Words: Coronavirus disease, Airway, Computed tomography, Chest.


Subject(s)
Coronavirus Infections/diagnostic imaging , Lung/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Betacoronavirus , Clinical Laboratory Techniques , Coronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Radiography, Thoracic , Retrospective Studies , Thorax
8.
Monaldi Arch Chest Dis ; 90(3)2020 Sep 04.
Article in English | MEDLINE | ID: covidwho-745210

ABSTRACT

'Tree-in-bud' (TIB) appearance in computed tomography (CT) chest is most commonly a manifestation of infection. We here describe an unusual cause of TIB during the COVID-19 pandemic. A young male patient who had a history of fever, cough, and respiratory distress presented in the emergency department. As these symptoms matched with coronavirus infection, the COVID-19 test was done, which was found negative. He was then moved to the intensive care unit where he developed severe acute respiratory distress syndrome and was put on mechanical ventilation. Further workup did not reveal any source of infection, as all his cultures were negative, but his CT chest showed a tree-in-bud appearance. After obtaining a detailed history from his friends, the patient was found a chronic abuser of inhaled cocaine and treated with intravenous steroids. Subsequently, he was weaned from the ventilator and discharged from the intensive care unit after becoming asymptomatic.


Subject(s)
Cocaine Smoking/adverse effects , Cocaine-Related Disorders/diagnosis , Coronavirus Infections/diagnosis , Lung Injury/diagnostic imaging , Lung/diagnostic imaging , Pneumonia, Viral/diagnosis , Respiratory Distress Syndrome, Adult/diagnostic imaging , Adult , Betacoronavirus , Cocaine-Related Disorders/complications , Diagnosis, Differential , Glucocorticoids/therapeutic use , Humans , Lung Injury/etiology , Lung Injury/therapy , Male , Methylprednisolone/therapeutic use , Pandemics , Respiration, Artificial , Respiratory Distress Syndrome, Adult/etiology , Respiratory Distress Syndrome, Adult/therapy , Tomography, X-Ray Computed
9.
BMC Pregnancy Childbirth ; 20(1): 511, 2020 Sep 04.
Article in English | MEDLINE | ID: covidwho-744979

ABSTRACT

BACKGROUND: It has been proposed that pregnant women and their fetuses may be particularly at risk for poor outcomes due to the coronavirus (COVID-19) pandemic. From the few case series that are available in the literature, women with high risk pregnancies have been associated with higher morbidity. It has been suggested that pregnancy induced immune responses and cardio-vascular changes can exaggerate the course of the COVID-19 infection. CASE PRESENTATION: A 26-year old Somalian woman (G2P1) presented with a nine-day history of shortness of breath, dry cough, myalgia, nausea, abdominal pain and fever. A nasopharyngeal swab returned positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Her condition rapidly worsened leading to severe liver and coagulation impairment. An emergency Caesarean section was performed at gestational week 32 + 6 after which the patient made a rapid recovery. Severe COVID-19 promptly improved by the termination of the pregnancy or atypical HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelet Count) exacerbated by concomitant COVID-19 infection could not be ruled out. There was no evidence of vertical transmission. CONCLUSIONS: This case adds to the growing body of evidence which raises concerns about the possible negative maternal outcomes of COVID-19 infection during pregnancy and advocates for pregnant women to be recognized as a vulnerable group during the current pandemic.


Subject(s)
Blood Coagulation Disorders/blood , Cesarean Section , Coronavirus Infections/blood , Liver Diseases/blood , Obesity, Maternal , Pneumonia, Viral/blood , Pregnancy Complications, Infectious/blood , Adult , Antithrombin III/metabolism , Apgar Score , Betacoronavirus , Blood Coagulation Disorders/etiology , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/physiopathology , Diagnosis, Differential , Female , Fibrin Fibrinogen Degradation Products/metabolism , HELLP Syndrome/diagnosis , Humans , Infant, Newborn , Infant, Premature , L-Lactate Dehydrogenase/blood , Liver Diseases/etiology , Lung/diagnostic imaging , Male , Pandemics , Partial Thromboplastin Time , Platelet Count , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/physiopathology , Pregnancy , Pregnancy Complications, Infectious/physiopathology , Sweden , Tomography, X-Ray Computed
10.
Biomed Res Int ; 2020: 2721381, 2020.
Article in English | MEDLINE | ID: covidwho-744899

ABSTRACT

Introduction: Emergency department (ED) triage regarding infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is challenging. During the coronavirus disease 2019 (COVID-19) outbreak in Germany, the diagnostic outcomes of critically ill patients admitted to the resuscitation room in the ED of our academic 754-bed hospital should be analyzed. Methods: All resuscitation room patients between March 1st and April 15th 2020 were included in this retrospective study. Every patient with suspicion of SARS-CoV-2 infection received a pharyngeal swab for real-time polymerase chain reaction (rt-PCR), divided in the clinical subgroups of "highly suspicious for COVID-19" and "COVID-19 as differential diagnosis." All respiratory and infectious symptoms were included as at least "differential diagnosis" as an expanded suspicion strategy. Results: Ninety-five patients were included (trauma n = 14, critically ill n = 81). Of 3 highly suspicious patients, 2 had rt-PCR positive pharyngeal swabs. In 39 patients, COVID-19 was defined as differential diagnosis, and 3 were positive for SARS-CoV-2. Of them, pharyngeal swabs were positive in 1 case, while in 2 cases, only tracheal fluid was rt-PCR positive while the pharyngeal swabs were negative. In one of these 2 cases, chest computed tomography (CT) was also negative for ground-glass opacities but showed a pulmonary abscess and pulmonary embolism. Conclusion: We recommend an expanded suspicion strategy for COVID-19 due to unexpected diagnostic outcomes. Personal protective equipment should be used in every resuscitation room operation due to unexpected cases and initial knowledge gaps. Furthermore, tracheal fluid should be tested for SARS-CoV-2 in every intubated patient due to cases with negative pharyngeal swabs and negative chest CT.


Subject(s)
Betacoronavirus , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Aged , Aged, 80 and over , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/epidemiology , Critical Illness , Diagnosis, Differential , Disease Outbreaks , Emergency Service, Hospital , False Negative Reactions , Female , Germany/epidemiology , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , RNA, Viral/genetics , RNA, Viral/isolation & purification , Real-Time Polymerase Chain Reaction , Resuscitation , Retrospective Studies , Tomography, X-Ray Computed , Triage
13.
Korean J Radiol ; 21(10): 1150-1160, 2020 10.
Article in English | MEDLINE | ID: covidwho-742717

ABSTRACT

OBJECTIVE: To describe the experience of implementing a deep learning-based computer-aided detection (CAD) system for the interpretation of chest X-ray radiographs (CXR) of suspected coronavirus disease (COVID-19) patients and investigate the diagnostic performance of CXR interpretation with CAD assistance. MATERIALS AND METHODS: In this single-center retrospective study, initial CXR of patients with suspected or confirmed COVID-19 were investigated. A commercialized deep learning-based CAD system that can identify various abnormalities on CXR was implemented for the interpretation of CXR in daily practice. The diagnostic performance of radiologists with CAD assistance were evaluated based on two different reference standards: 1) real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) results for COVID-19 and 2) pulmonary abnormality suggesting pneumonia on chest CT. The turnaround times (TATs) of radiology reports for CXR and rRT-PCR results were also evaluated. RESULTS: Among 332 patients (male:female, 173:159; mean age, 57 years) with available rRT-PCR results, 16 patients (4.8%) were diagnosed with COVID-19. Using CXR, radiologists with CAD assistance identified rRT-PCR positive COVID-19 patients with sensitivity and specificity of 68.8% and 66.7%, respectively. Among 119 patients (male:female, 75:44; mean age, 69 years) with available chest CTs, radiologists assisted by CAD reported pneumonia on CXR with a sensitivity of 81.5% and a specificity of 72.3%. The TATs of CXR reports were significantly shorter than those of rRT-PCR results (median 51 vs. 507 minutes; p < 0.001). CONCLUSION: Radiologists with CAD assistance could identify patients with rRT-PCR-positive COVID-19 or pneumonia on CXR with a reasonably acceptable performance. In patients suspected with COVID-19, CXR had much faster TATs than rRT-PCRs.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Deep Learning , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic , Adult , Aged , Female , Humans , Male , Middle Aged , Pandemics , Radiography, Thoracic/methods , Retrospective Studies , Tomography, X-Ray Computed/methods
14.
AJNR Am J Neuroradiol ; 41(7): 1165-1169, 2020 07.
Article in English | MEDLINE | ID: covidwho-742697

ABSTRACT

BACKGROUND AND PURPOSE: Chest CT may be used as a tool for rapid coronavirus disease 2019 (COVID-19) detection. Our aim was to investigate the value of additional chest CT for detection of coronavirus 19 (COVID-19) in patients who undergo head CT for suspected stroke or head trauma in a COVID-19-endemic region. MATERIALS AND METHODS: Our study included 27 patients (mean age, 74 years; range, 54-90 years; 20 men) who underwent head CT for suspected stroke (n = 21) or head trauma (n = 6), additional chest CT for COVID-19 detection, and real-time reverse transcriptase polymerase chain reaction testing in a COVID-19-endemic region. Sensitivity, specificity, and negative and positive predictive values of chest CT in detecting COVID-19 were calculated. RESULTS: Final neurologic diagnoses were ischemic stroke (n = 11), brain contusion (n = 5), nontraumatic intracranial hemorrhage (n = 2), brain metastasis (n = 1), and no primary neurologic disorder (n = 8). Symptoms of possible COVID-19 infection (ie, fever, cough, and/or shortness of breath) were present in 20 of 27 (74%) patients. Seven of 27 patients (26%) had real-time reverse transcriptase polymerase chain reaction confirmed-COVID-19 infection. Chest CT results were 6 true-positives, 15 true-negatives, 5 false-positives, and 1 false-negative. Diagnostic performance values of chest CT were a sensitivity of 85.7%, specificity of 75.0%, negative predictive value of 93.8%, and positive predictive value of 54.6%. CONCLUSIONS: The sensitivity of additional chest CT is fairly high. However, a negative result does not exclude COVID-19. The positive predictive value is poor. Correlation of chest CT results with epidemiologic history and clinical presentation, along with real-time reverse transcriptase polymerase chain reaction, is needed for confirmation.


Subject(s)
Betacoronavirus , Coronavirus Infections , Craniocerebral Trauma/diagnostic imaging , Pandemics , Pneumonia, Viral , Stroke/diagnostic imaging , Aged , Aged, 80 and over , Coronavirus Infections/complications , Craniocerebral Trauma/etiology , Female , Humans , Male , Middle Aged , Pneumonia, Viral/complications , Stroke/etiology , Tomography, X-Ray Computed/methods
15.
BMJ Case Rep ; 13(8)2020 Aug 24.
Article in English | MEDLINE | ID: covidwho-742200

ABSTRACT

A 66-year-old man was admitted to hospital with a right frontal cerebral infarct producing left-sided weakness and a deterioration in his speech pattern. The cerebral infarct was confirmed with CT imaging. The only evidence of respiratory symptoms on admission was a 2 L oxygen requirement, maintaining oxygen saturations between 88% and 92%. In a matter of hours this patient developed a greater oxygen requirement, alongside reduced levels of consciousness. A positive COVID-19 throat swab, in addition to bilateral pneumonia on chest X-ray and lymphopaenia in his blood tests, confirmed a diagnosis of COVID-19 pneumonia. A proactive decision was made involving the patients' family, ward and intensive care healthcare staff, to not escalate care above a ward-based ceiling of care. The patient died 5 days following admission under the palliative care provided by the medical team.


Subject(s)
Coronavirus Infections/complications , Infarction, Anterior Cerebral Artery/diagnostic imaging , Infarction, Anterior Cerebral Artery/virology , Pneumonia, Viral/complications , Aged , Betacoronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Fatal Outcome , Humans , Infarction, Anterior Cerebral Artery/complications , Male , Oxygen Inhalation Therapy , Palliative Care , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Radiography , Tomography, X-Ray Computed
16.
Rev Inst Med Trop Sao Paulo ; 62: e61, 2020.
Article in English | MEDLINE | ID: covidwho-740469

ABSTRACT

In late 2019, a novel coronavirus initially related to a cluster of severe pneumonia cases in China was identified. COVID-19 cases have rapidly spread to multiple countries worldwide. We present a typical laboratory confirmed case of COVID-19 pneumonia, that was hospitalized due to hypoxemia but did not require mechanical ventilation. Although initially the patient was evaluated with a favorable outcome, in the third week of the disease, the symptomatology deteriorated due to a massive hypertensive pneumothorax with no known previous risk factor. Since the first cases of COVID-19 have been described, pneumothorax was characterized as a potential, though uncommon, complication. It has been reported that diffuse alveolar injury caused by SARS-CoV-2 can cause alveolar rupture, produce air leakage and interstitial emphysema. Although uncommon, pneumothorax should be listed as a differential diagnosis for COVID-19 patients with sudden respiratory decompensation. As a life-threatening event, it requires prompt recognition and expeditious treatment.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Mediastinal Emphysema/diagnostic imaging , Pandemics , Pneumonia, Viral/complications , Pneumothorax/diagnostic imaging , China , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/diagnostic imaging , Humans , Lung/pathology , Mediastinal Emphysema/etiology , Pneumonia, Viral/diagnostic imaging , Pneumothorax/etiology , Tomography, X-Ray Computed
17.
Rev Paul Pediatr ; 38: e2020165, 2020.
Article in Portuguese, English | MEDLINE | ID: covidwho-740454

ABSTRACT

OBJECTIVE: Recently, there have been reports of children with severe inflammatory syndrome and multiorgan dysfunction associated with elevated inflammatory markers. These cases are reported as presenting the Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. In this study, we describe with parental permission a case of MIS-C in an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CASE DESCRIPTION: A seven-month-old infant, with SARS-CoV-2 infection and a history of extreme preterm birth and very low weight at birth, with an initial course of mild respiratory symptoms and abrupt progression to vasoplegic shock, myocarditis and hyperinflammation syndrome, shown by high levels of troponin I, ferritin, CRP, D-dimer and hypoalbuminemia. Despite the intensive care provided, the child developed multiple organ dysfunction and died. COMMENTS: Patients with a history of extreme prematurity may present with MIS-C in the presence of COVID-19 and are a group of special concern.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Multiple Organ Failure , Pandemics , Pneumonia, Viral , Resuscitation , Shock , Systemic Inflammatory Response Syndrome , Clinical Deterioration , Clinical Laboratory Techniques/methods , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Fatal Outcome , Female , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Infant, Newborn, Diseases , Multiple Organ Failure/etiology , Multiple Organ Failure/therapy , Pneumonia, Viral/blood , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Premature Birth , Respiration, Artificial/methods , Resuscitation/methods , Risk Factors , Shock/etiology , Shock/therapy , Systemic Inflammatory Response Syndrome/therapy , Systemic Inflammatory Response Syndrome/virology , Tomography, X-Ray Computed/methods
18.
BMC Infect Dis ; 20(1): 644, 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-740367

ABSTRACT

BACKGROUND: To explore the clinical features and CT findings of clinically cured coronavirus disease 2019 (COVID-19) patients with viral RNA positive anal swab results after discharge. METHODS: Forty-two patients with COVID-19 who were admitted to Yongzhou Central Hospital, Hunan, China, between January 20, 2020, and March 2, 2020, were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using anal swab viral RT-PCR. In this report, we present the clinical characteristics and chest CT features of six patients with positive anal swab results and compare the clinical, laboratory, and CT findings between the positive and negative groups. RESULTS: The anal swab positivity rate for SARS-CoV-2 RNA in discharged patients was 14.3% (6/42). All six patients were male. In the positive group, 40% of the patients (2/5) had a positive stool occult blood test (OBT), but none had diarrhea. The median duration of fever and major symptoms (except fever) in the positive patients was shorter than that of the negative patients (1 day vs. 6 days, 4.5 days vs. 10.5 days, respectively). The incidence of asymptomatic cases in the positive group (33.3%) was also higher than that of the negative group (5.6%). There were no significant differences in the CT manifestation or evolution of the pulmonary lesions between the two groups. CONCLUSION: In our case series, patients with viral RNA positive anal swabs did not exhibit gastrointestinal symptoms, and their main symptoms disappeared early. They had similar CT features to the negative patients, which may be easier to be ignored. A positive OBT may indicate gastrointestinal damage caused by SARS-CoV-2 infection.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnostic imaging , Patient Discharge/statistics & numerical data , Pneumonia, Viral/diagnostic imaging , RNA, Viral/analysis , Severe Acute Respiratory Syndrome/diagnostic imaging , Adolescent , Adult , Aged , Anal Canal/virology , Betacoronavirus/genetics , Child , Child, Preschool , China/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Fever , Hospitalization , Hospitals , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Reverse Transcriptase Polymerase Chain Reaction , Severe Acute Respiratory Syndrome/epidemiology , Severe Acute Respiratory Syndrome/virology , Tomography, X-Ray Computed , Young Adult
19.
Medicine (Baltimore) ; 99(35): e21804, 2020 Aug 28.
Article in English | MEDLINE | ID: covidwho-740204

ABSTRACT

INTRODUCTION: Pneumonia is one of the most important characteristics of coronavirus disease 2019 (COVID-19) and imaging findings of COVID-19 pneumonia are diverse and change over disease course. However, the detailed clinical course of organizing pneumonia (OP) caused by COVID-19 has not been clarified. PATIENT CONCERNS: A 60-year-old man and a 61-year-old woman diagnosed with mild COVID-19 were admitted to our hospital. Their respiratory symptoms were deteriorating even after initiating treatment with antiviral drugs. DIAGNOSIS: Chest X-rays and computed tomography scan showed a rapid progression of linear consolidation with reversed halo sign, distributed in subpleural and peri-bronchial regions. They also presented with pulmonary fibrosis findings, including traction bronchiectasis and marked lung volume reduction. They were diagnosed with rapidly progressing OP. INTERVENTIONS: They were treated with systemic corticosteroids. OUTCOMES: The patients' imaging findings and respiratory conditions improved rapidly without any adverse effects. CONCLUSION: Physicians should carefully monitor patients with COVID-19, as they can develop rapidly progressive and fibrotic OP, which respond to corticosteroids.


Subject(s)
Coronavirus Infections , Lung , Pandemics , Pneumonia, Viral , Prednisolone/administration & dosage , Pulmonary Fibrosis , Antiviral Agents/therapeutic use , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Disease Progression , Dose-Response Relationship, Drug , Female , Glucocorticoids/administration & dosage , Humans , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pulmonary Fibrosis/diagnostic imaging , Pulmonary Fibrosis/etiology , Tomography, X-Ray Computed/methods , Treatment Outcome
20.
J Korean Med Sci ; 35(34): e316, 2020 Aug 31.
Article in English | MEDLINE | ID: covidwho-736661

ABSTRACT

BACKGROUND: The predictors of poor prognosis in patients with coronavirus disease 2019 (COVID-19) using computed tomography (CT) have not been investigated in a large cohort. Therefore, the purpose of this study was to investigate the adverse initial CT features to predict poor prognosis in COVID-19. METHODS: From February to April 2020, 281 COVID-19 patients who underwent CT at the time of admission were included. We divided the patients into the severe and non-severe disease groups. The severe group included patients with severe pneumonia or critical events. Intensive care unit admission or death were the critical events in this study. We compared the clinical and CT findings between the severe and non-severe groups and investigated the prognostic factors and critical events of the severe group using the regression analysis. RESULTS: Among the 281 patients, 36 (12.8%) patients were in the severe group and 245 (87.2%) patients were in the non-severe group. Critical events occurred in 10 patients (3.6%). In the severe group, patients showed significantly more pneumonia with consolidation, crazy-paving appearance, pleural effusion, and higher CT scores than those in the non-severe group (all, P < 0.05). In the multivariate regression, pleural effusion (odds ratio [OR], 8.96; 95% confidence interval [CI], 1.81-44.42; P = 0.007), CT score > 5 (OR, 3.70; 95% CI, 1.44-9.53; P = 0.007), old age (> 77 years, OR, 9.96; 95% CI, 3.78-26.28; P < 0.001), and elevated C-reactive protein (OR, 4.15; 95% CI, 1.62-10.6; P = 0.003) were significant prognostic factors of severe disease. CT score > 5 (OR, 7.29; 95% CI, 1.37-38.68; P = 0.020), pleural effusion (OR, 5.67; 95% CI, 1.04-30.8; P = 0.045) and old age (OR, 8.6; 95% CI, 1.80-41.0; P = 0.007) were also significant predictors of critical events. CONCLUSION: Pleural effusion and the extent of pneumonia on initial CT scans are associated with poor prognosis in patients with COVID-19.


Subject(s)
Coronavirus Infections/diagnostic imaging , Coronavirus Infections/pathology , Lung/diagnostic imaging , Lung/pathology , Pleural Effusion/diagnostic imaging , Pleural Effusion/pathology , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/pathology , Aged , Aged, 80 and over , Aging , Betacoronavirus , C-Reactive Protein/analysis , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Female , Humans , Intensive Care Units , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Prognosis , Retrospective Studies , Severity of Illness Index , Tomography, X-Ray Computed
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