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1.
Ann Am Thorac Soc ; 17(10): 1231-1237, 2020 10.
Article in English | MEDLINE | ID: covidwho-858611

ABSTRACT

Rationale: Many clinical studies have focused on the epidemiological and clinical characteristics of inpatients with coronavirus disease (COVID-19). However, there are few reports about the clinical follow-up of discharged patients.Objectives: To describe the follow-up of patients with COVID-19 in Wenzhou City, Zhejiang, China.Methods: We retrospectively reviewed 4-week follow-ups in patients with COVID-19, including computed tomographic (CT) chest scanning, blood testing, and oropharyngeal-swab testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid. The chest CT scans and blood tests were performed on the last day before discharge and 2 weeks and 4 weeks after discharge. The oropharyngeal-swab tests were performed at both 1 week and 2 weeks after discharge. Fifty-one patients with common COVID-19 were enrolled in the study. All the CT and clinical data were collected between January 23 and March 28, 2020.Results: Compared with the abnormalities found on the the last CT scans before discharge, the abnormalities in the lungs at the first and second follow-ups after discharge had been gradually absorbed. The cases with focal ground-glass opacity were reduced from 17.7% to 9.8% of cases. The cases with multiple ground-glass opacities decreased from 80.4% to 23.5%. The cases with consolidation were reduced from 49.0% to 2.0%. The cases with interlobular septal thickening were reduced from 80.4% to 35.3%. The cases with subpleural lines were reduced from 29.4% to 7.8%. The cases with irregular lines were reduced from 41.2% to 15.7%. The lung lesions of 25.5% patients were shown to be fully absorbed on the first CT scans after discharge, and the rate of lung recovery increased to 64.7% after the second follow-up. Nucleic-acid test results became recurrently positive in 17.6% of discharged patients, of whom only 33.3% complained of clinical symptoms. There were no differences in the characteristics of the last CT scans before discharge between the patients with recurrently positive test results and the patients with negative test results. The lung damage was fully absorbed in 55.6% of discharged patients with recurrence of positive test results for SARS-CoV-2 ribonucleic acid.Conclusions: The lung damage due to COVID-19 could be reversible for patients with common COVID-19. A few cases showed recurring positive results of nucleic-acid tests after discharge.


Subject(s)
Aftercare , Clinical Laboratory Techniques , Coronavirus Infections , Lung/diagnostic imaging , Pandemics , Patient Discharge/statistics & numerical data , Pneumonia, Viral , Tomography, X-Ray Computed/methods , Aftercare/methods , Aftercare/statistics & numerical data , Betacoronavirus/isolation & purification , China/epidemiology , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/statistics & numerical data , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Female , Humans , Male , Middle Aged , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Retrospective Studies
2.
Dtsch Arztebl Int ; 117(22-23): 389-395, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-846024

ABSTRACT

BACKGROUND: Only limited evidence has been available to date on the accuracy of systematic low-dose chest computed tomography (LDCT) use in the diagnosis of COVID-19 in patients with non-specific clinical symptoms. METHODS: The COVID-19 Imaging Registry Study Aachen (COVID-19-Bildgebungs-Register Aachen, COBRA) collects data on imaging in patients with COVID-19. Two of the COBRA partner hospitals (RWTH Aachen University Hospital and Dueren Hospital) systematically perform reverse transcriptase polymerase chain reaction (RT-PCR) from nasopharyngeal swabs as well as LDCT in all patients presenting with manifestations that are compatible with COVID-19. In accordance with the COV-RADS protocol, the LDCT scans were prospectively evaluated before the RT-PCR findings were available in order to categorize the likelihood of COVID-19. RESULTS: From 18 March to 5 May 2020, 191 patients with COVID-19 manifestations (117 male, age 65 ± 16 years) underwent RT-PCR testing and LDCT. The mean time from the submission of the sample to the availability of the RT-PCR findings was 491 minutes (interquartile range [IQR: 276-1066]), while that from the performance of the CT to the availability of its findings was 9 minutes (IQR: 6-11). A diagnosis of COVID-19 was made in 75/191 patients (39%). The LDCT was positive in 71 of these 75 patients and negative in 106 of the 116 patients without COVID-19, corresponding to 94.7% sensitivity (95% confidence interval [86.9; 98.5]), 91.4% specificity [84.7; 95.8], positive and negative predictive values of 87.7% [78.5; 93.9] and 96.4% [91.1; 98.6], respectively, and an AUC (area under the curve) of 0.959 [0.930; 0.988]. The initial RT-PCR test results were falsely negative in six patients, yielding a sensitivity of 92.0% [83.4; 97.0]; these six patients had positive LDCT findings. 47.4% of the LDCTs that were negative for COVID-19 (55/116) exhibited pathological pulmonary changes, including infiltrates, that were correctly distinguished from SARS-CoV-2 related changes. CONCLUSION: In patients with symptoms compatible with COVID-19, LDCT can esablish the diagnosis of COVID-19 with comparable sensitivity to RT-PCR testing. In addition, it offers a high specificity for distinguishing COVID-19 from other diseases associated with the same or similar clinical symptoms. We propose the systematic use of LDCT in addition to RT-PCR testing because it helps correct false-negative RT-PCR results, because its results are available much faster than those of RT-PCRtesting, and because it provides additional diagnostic information useful for treatment planning regardless of the type of the infectious agent.


Subject(s)
Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Thorax/diagnostic imaging , Tomography, X-Ray Computed/methods , Humans , Pandemics
4.
BMJ Case Rep ; 13(10)2020 Oct 07.
Article in English | MEDLINE | ID: covidwho-840503

ABSTRACT

A 13-year-old boy presented to hospital with 3-day self-limited fever, followed by dry cough, persistent asthenia and impaired general condition of 2 weeks' duration. Blood analyses showed a severe inflammatory status and chest X-ray images were consistent with bilateral COVID-19 pneumonia. He developed an acute respiratory failure that required paediatric intensive care admission and non-invasive ventilation. A targeted COVID-19 treatment was initiated with hydroxicloroquine, corticosteroids, enoxaparine and a single dose of tocilizumab. Repeated serological tests and real-time reverse transcription PCR for SARS-CoV-2 were negative. Other infectious pathogens were also ruled out. Thoracic high resolution CT showed an intense bilateral pulmonary dissemination with lytic vertebral bone lesions. After diagnostic investigations, Ewing's sarcoma with metastatic pulmonary dissemination was diagnosed. Nowadays, in the context of SARS-CoV-2 community pandemic, we cannot forget that COVID-19 clinical presentation is not specific and other entities can mimic its clinical features.


Subject(s)
Coronavirus Infections/diagnosis , Lung Neoplasms , Multiple Pulmonary Nodules , Pneumonia, Viral/diagnosis , Sarcoma, Ewing , Tomography, X-Ray Computed/methods , Adolescent , Antineoplastic Combined Chemotherapy Protocols , Bone Marrow Examination/methods , Clinical Laboratory Techniques/methods , Coronavirus Infections/blood , Coronavirus Infections/physiopathology , Diagnosis, Differential , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/physiopathology , Lung Neoplasms/secondary , Male , Multiple Pulmonary Nodules/diagnostic imaging , Multiple Pulmonary Nodules/pathology , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Sarcoma, Ewing/diagnosis , Sarcoma, Ewing/physiopathology , Tomography, Emission-Computed, Single-Photon/methods
5.
J Med Internet Res ; 22(8): e19673, 2020 08 19.
Article in English | MEDLINE | ID: covidwho-836083

ABSTRACT

BACKGROUND: Coronavirus disease (COVID-19) is a serious infectious disease that causes severe respiratory illness. This pandemic represents a serious public health risk. Therefore, early and accurate diagnosis is essential to control disease progression. Radiological examination plays a crucial role in the early identification and management of infected patients. OBJECTIVE: The aim of this review was to identify the diagnostic value of different imaging modalities used for diagnosis of COVID-19. METHODS: A comprehensive literature search was conducted using the PubMed, Scopus, Web of Science, and Google Scholar databases. The keywords diagnostic imaging, radiology, respiratory infection, pneumonia, coronavirus infection and COVID-19 were used to identify radiology articles focusing on the diagnosis of COVID-19 and to determine the diagnostic value of various imaging modalities, including x-ray, computed tomography (CT), ultrasound, and nuclear medicine for identification and management of infected patients. RESULTS: We identified 50 articles in the literature search. Studies that investigated the diagnostic roles and imaging features of patients with COVID-19, using either chest CT, lung ultrasound, chest x-ray, or positron emission topography/computed tomography (PET/CT) scan, were discussed. Of these imaging modalities, chest x-ray and CT scan are the most commonly used for diagnosis and management of COVID-19 patients, with chest CT scan being more accurate and sensitive in identifying COVID-19 at early stages. Only a few studies have investigated the roles of ultrasound and PET/CT scan in diagnosing COVID-19. CONCLUSIONS: Chest CT scan remains the most sensitive imaging modality in initial diagnosis and management of suspected and confirmed patients with COVID-19. Other diagnostic imaging modalities could add value in evaluating disease progression and monitoring critically ill patients with COVID-19.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/diagnostic imaging , Coronavirus/pathogenicity , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Humans , Pandemics
6.
J Med Case Rep ; 14(1): 191, 2020 Oct 07.
Article in English | MEDLINE | ID: covidwho-835873

ABSTRACT

BACKGROUND: Determining the infectiousness of patients with coronavirus disease 2019 is crucial for patient management. Medical staff usually refer to the results of reverse transcription polymerase chain reaction tests in conjunction with clinical symptoms and computed tomographic images. CASE PRESENTATION: We report a case of a 62-year-old Japanese man who twice had positive and negative test results by polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 over 48 days of hospitalization, including in intensive care. His respiratory symptoms and computed tomographic imaging findings consistent with coronavirus disease 2019 improved following initial intensive care, and the result of his polymerase chain reaction test became negative 3 days before discharge from the intensive care unit. However, 4 days after this first negative result, his polymerase chain reaction test result was positive again, and another 4 days later, he had a negative result once more. Eight days after the second polymerase chain reaction negative test result, the patient's test result again became positive. Finally, his polymerase chain reaction results were negative 43 days after his first hospitalization. CONCLUSIONS: This case emphasizes the importance of repeat polymerase chain reaction testing and diagnosis based on multiple criteria, including clinical symptoms and computed tomographic imaging findings. Clinical staff should consider that a negative result by polymerase chain reaction does not necessarily certify complete coronavirus disease 2019 recovery.


Subject(s)
Betacoronavirus/isolation & purification , Clinical Laboratory Techniques/methods , Coronavirus Infections , Lung/diagnostic imaging , Pandemics , Pneumonia, Viral , Symptom Assessment/methods , Clinical Decision-Making , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Critical Care/methods , False Negative Reactions , Humans , Male , Middle Aged , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Tomography, X-Ray Computed/methods , Treatment Outcome
7.
BMJ Case Rep ; 13(6)2020 Jun 14.
Article in English | MEDLINE | ID: covidwho-832843

ABSTRACT

A 57-year-old man presented with a progressive flaccid symmetrical motor and sensory neuropathy following a 1-week history of cough and malaise. He was diagnosed with Guillain-Barré syndrome secondary to COVID-19 and started on intravenous immunoglobulin. He proceeded to have worsening respiratory function and needed intubation and mechanical ventilation. This is the first reported case of this rare neurological complication of COVID-19 in the UK, but it adds to a small but growing body of international evidence to suggest a significant association between these two conditions. Increasing appreciation of this by clinicians will ensure earlier diagnosis, monitoring and treatment of patients presenting with this.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Guillain-Barre Syndrome , Immunoglobulins, Intravenous/administration & dosage , Pandemics , Pneumonia, Viral , Respiration, Artificial/methods , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Early Diagnosis , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/physiopathology , Guillain-Barre Syndrome/therapy , Humans , Immunologic Factors/administration & dosage , Lung/diagnostic imaging , Male , Middle Aged , Neurologic Examination/methods , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Tomography, X-Ray Computed/methods , Treatment Outcome
9.
BMC Pregnancy Childbirth ; 20(1): 587, 2020 Oct 06.
Article in English | MEDLINE | ID: covidwho-818079

ABSTRACT

BACKGROUND: There are no published cases of tonic-clonic seizures and posterior bilateral blindness during pregnancy and Severe Acute Respiratory Syndrome (SARS) Coronavirus (COV) 2 (SARS-COV-2) infection. We do not just face new and unknown manifestations, but also how different patient groups are affected by SARS-COV-2 infection, such as pregnant women. Coronavirus Disease 2019 (COVID-19), preeclampsia, eclampsia and posterior reversible leukoencephalopathy share endothelium damage and similar pathophysiology. CASE PRESENTATION: A 35-year-old pregnant woman was admitted for tonic-clonic seizures and SARS-COV-2 infection. She had a normal pregnancy control and no other symptoms before tonic-clonic seizures development. After a Caesarean section (C-section) she developed high blood pressure, and we initiated antihypertensive treatment with labetalol, amlodipine and captopril. Few hours later she developed symptoms of cortical blindness that resolved in 72 h with normal brain computed tomography (CT) angiography. CONCLUSION: The authors conclude that SARS COV-2 infection could promote brain endothelial damage and facilitate neurological complications during pregnancy.


Subject(s)
Antihypertensive Agents/administration & dosage , Betacoronavirus/isolation & purification , Blindness, Cortical , Cesarean Section/methods , Coronavirus Infections , Eclampsia , Fibrinolytic Agents/administration & dosage , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Seizures , Adult , Blindness, Cortical/diagnosis , Blindness, Cortical/virology , Brain/diagnostic imaging , Computed Tomography Angiography/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Diagnosis, Differential , Eclampsia/diagnosis , Eclampsia/therapy , Eclampsia/virology , Female , Humans , Neurologic Examination/methods , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/etiology , Pregnancy Complications, Infectious/physiopathology , Pregnancy Outcome , Seizures/diagnosis , Seizures/etiology , Seizures/therapy , Tomography, X-Ray Computed/methods , Treatment Outcome
10.
Pan Afr Med J ; 36: 257, 2020.
Article in English | MEDLINE | ID: covidwho-814265

ABSTRACT

Since asymptomatic infections as "covert transmitter", and some patients can progress rapidly in the short term, it is essential to pay attention to the diagnosis and surveillance of asymptomatic patients with SARS-COV2 infection. CT scan has great value in screening and detecting patients with COVID-19 pneumonia, especially in the highly suspected or probable asymptomatic cases with negative RT-PCR for SARS-COV2. This study aimed to detect incidentally COVID-19 pneumonia on medical imaging for patients consulting for other reasons.


Subject(s)
Betacoronavirus , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnostic imaging , Lung/diagnostic imaging , Pandemics , Pneumonia, Viral/diagnostic imaging , Abdominal Pain/complications , Adolescent , Adult , Aged , Aged, 80 and over , Asymptomatic Diseases , Brain Injuries/complications , Chest Pain/complications , Child , Child, Preschool , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Female , Humans , Incidental Findings , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/etiology , Male , Middle Aged , Pleural Effusion/diagnostic imaging , Pleural Effusion/etiology , Pneumonia, Viral/complications , Prospective Studies , Tomography, X-Ray Computed/methods , Tunisia/epidemiology , Young Adult
11.
Nat Commun ; 11(1): 4968, 2020 10 02.
Article in English | MEDLINE | ID: covidwho-811547

ABSTRACT

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread to become a worldwide emergency. Early identification of patients at risk of progression may facilitate more individually aligned treatment plans and optimized utilization of medical resource. Here we conducted a multicenter retrospective study involving patients with moderate COVID-19 pneumonia to investigate the utility of chest computed tomography (CT) and clinical characteristics to risk-stratify the patients. Our results show that CT severity score is associated with inflammatory levels and that older age, higher neutrophil-to-lymphocyte ratio (NLR), and CT severity score on admission are independent risk factors for short-term progression. The nomogram based on these risk factors shows good calibration and discrimination in the derivation and validation cohorts. These findings have implications for predicting the progression risk of COVID-19 pneumonia patients at the time of admission. CT examination may help risk-stratification and guide the timing of admission.


Subject(s)
Coronavirus Infections/diagnosis , Disease Progression , Pneumonia, Viral/diagnosis , Pneumonia , Tomography, X-Ray Computed/methods , Adult , Betacoronavirus , China , Clinical Laboratory Techniques , Coinfection , Coronavirus Infections/pathology , Coronavirus Infections/physiopathology , Female , Hospitalization , Humans , Lung/diagnostic imaging , Lung/pathology , Lymphocytes , Male , Middle Aged , Neutrophils , Pandemics , Pneumonia, Viral/pathology , Pneumonia, Viral/physiopathology , Regression Analysis , Retrospective Studies , Risk Assessment , Risk Factors
12.
Radiographics ; 40(6): 1574-1599, 2020 10.
Article in English | MEDLINE | ID: covidwho-810605

ABSTRACT

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) results in coronavirus disease 2019 (COVID-19), which was declared an official pandemic by the World Health Organization on March 11, 2020. The infection has been reported in most countries around the world. As of August 2020, there have been over 21 million cases of COVID-19 reported worldwide, with over 800 000 COVID-19-associated deaths. It has become apparent that although COVID-19 predominantly affects the respiratory system, many other organ systems can also be involved. Imaging plays an essential role in the diagnosis of all manifestations of the disease, as well as its related complications, and proper utilization and interpretation of imaging examinations is crucial. With the growing global COVID-19 outbreak, a comprehensive understanding of the diagnostic imaging hallmarks, imaging features, multisystemic involvement, and evolution of imaging findings is essential for effective patient management and treatment. To date, only a few articles have been published that comprehensively describe the multisystemic imaging manifestations of COVID-19. The authors provide an inclusive system-by-system image-based review of this life-threatening and rapidly spreading infection. In part 1 of this article, the authors discuss general aspects of the disease, with an emphasis on virology, the pathophysiology of the virus, and clinical presentation of the disease. The key imaging features of the varied pathologic manifestations of this infection that involve the pulmonary and peripheral and central vascular systems are also described. Part 2 will focus on key imaging features of COVID-19 that involve the cardiac, neurologic, abdominal, dermatologic and ocular, and musculoskeletal systems, as well as pediatric and pregnancy-related manifestations of the virus. Vascular complications pertinent to each system will be also be discussed in part 2. Online supplemental material is available for this article. ©RSNA, 2020.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections/diagnostic imaging , Lung/diagnostic imaging , Pandemics , Pneumonia, Viral/diagnostic imaging , Thromboembolism/diagnostic imaging , Thrombosis/diagnostic imaging , Angiography/methods , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Cytokine Release Syndrome/etiology , Cytokine Release Syndrome/physiopathology , Disease Progression , Fibrin Fibrinogen Degradation Products/analysis , Humans , Inflammation , Peptidyl-Dipeptidase A/physiology , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Pulmonary Artery/diagnostic imaging , Receptors, Virus/physiology , Respiratory Distress Syndrome, Adult/diagnostic imaging , Respiratory Distress Syndrome, Adult/etiology , Symptom Assessment , Thromboembolism/blood , Thromboembolism/etiology , Thrombosis/blood , Thrombosis/etiology , Thrombotic Microangiopathies/diagnostic imaging , Thrombotic Microangiopathies/etiology , Tomography, X-Ray Computed/methods , Ultrasonography/methods
14.
J Med Imaging Radiat Oncol ; 64(5): 649-659, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-809071

ABSTRACT

To describe the chest CT features reported in children with confirmed COVID-19 infection, published in English literature. A systematic review was completed on PubMed, Embase and Scopus databases on the 1st of June 2020 using the PICO strategy. The NIH Quality Assessment Tool was used to assess the quality of the selected articles. The systematic review was evaluated by Case Series Studies and the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA). The extracted data were assessed and compared with those reported in the adult population. Seventy-two articles were retrieved from the database search and screened by the title, abstract and keywords. Eleven articles were deemed eligible for full-text assessment. Nine articles were included for the data extraction and in the final analysis. Chest CT features in children with COVID-19 differ from those in adults. 'Ground-grass opacities' (GGOs) are the most commonly described abnormalities, but closely followed by a combination of GGO and consolidation, not usual in adults. Children tend to have a more variable involvement than the subpleural and posterior and basal topography described in adults. Interlobular thickening and air bronchogram found in adults with COVID-19 are not frequent in children. Pulmonary embolism reported in up to 30% of adults has not been yet reported in children. Original articles describing chest CT features in children with COVID-19 in the English literature are limited to small populations of Chinese children. Chest CT imaging features are very diverse across the selected studies and globally different from those reported in adults. Data from children of different countries would provide a more comprehensive description of chest CT features in children with COVID-19.


Subject(s)
Coronavirus Infections/diagnostic imaging , Lung Diseases/diagnostic imaging , Lung Diseases/virology , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , Betacoronavirus , Child , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Humans , Pandemics , Pneumonia, Viral/diagnosis , Reverse Transcriptase Polymerase Chain Reaction
15.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(1): 198-202, 2020 May 25.
Article in Chinese | MEDLINE | ID: covidwho-807608

ABSTRACT

OBJECTIVE: To analyze the CT findings of patients with different clinical types of coronavirus disease 2019 (COVID-19). METHODS: A total of 67 patients diagnosed as COVID-19 by nucleic acid testing were included and divided into 4 groups according to the clinical staging based on Diagnosis and treatment of novel coronavirus pneumonia (Trial version 6). The CT imaging characteristics were analyzed among patients with different clinical types. RESULTS: Among 67 patients, 3 (4.5%) were mild cases, 35 (52.2%) were ordinary cases, 22 (32.8%) were severe cases, and 7 (10.4%) were critically ill. There were no abnormal CT findings in mild cases. In 35 ordinary cases, there were single lesions in 3 cases (8.6%) and multiple lesions in 33 cases (91.4%), while in severe case 1 case had single lesion (4.5%) and 21 had multiple lesions (95.5%). CT images of ordinary patients were mainly manifested as solid plaque shadow and halo sign (18/35, 51.4%); while fibrous strip shadow with ground glass shadow was more frequent in severe cases (7/22, 31.8%). Consolidation shadow as the main lesion was observed in 7 cases, and all of them were severe or critical ill patients. CONCLUSIONS: CT images in patients with different clinical types of COVID-19 have characteristic manifestations, and solid shadow may predict severe and critical illness.


Subject(s)
Coronavirus Infections/diagnostic imaging , Lung/pathology , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Betacoronavirus , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Humans , Lung/diagnostic imaging , Pneumonia, Viral/pathology , Severity of Illness Index
16.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 58-64, 2020.
Article in English | MEDLINE | ID: covidwho-797446

ABSTRACT

OBJECTIVES: The 2019 Novel coronavirus disease puts a serious burden on the health system. Therefore, the detection of particularly serious patients at an early stage is extremely important in terms of controlling the outbreak and improving the prognosis. We investigated the role of inflammatory markers studied in patients suspected of COVID-19 at an emergency department in predicting PCR and CT results. METHODS: This retrospective study was carried out with 133 patients who were admitted between 13 March and 1st April 2020 with suspicion of COVID-19. The patients were divided into four groups according to CT and RT-PCR results and evaluated. RESULTS: Considering all patients, no specific findings were found in the hematological and biochemical values of patients in the laboratory analyses. Although all of the results remained within the reference range, there was a significant difference in white blood cell, neutrophil, platelet, and lymphocyte values when the groups were compared [p = 0.000; p = 0.004; p = 0.022; p = 0.023]. CONCLUSION: Laboratory is not specific enough in the pre-diagnosis. In addition, this result does not alter with PCR or CT positivity. However, minimal changes observed in laboratory results may be partially guiding in patients in whom both PCR and CT are positive.


Subject(s)
Clinical Laboratory Techniques/methods , Coronavirus/isolation & purification , Pneumonia, Viral/diagnosis , Thorax/diagnostic imaging , Tomography, X-Ray Computed/methods , Betacoronavirus , Coronavirus/genetics , Coronavirus Infections/diagnosis , Emergency Service, Hospital , Fever/etiology , Humans , Pandemics , Pneumonia, Viral/epidemiology , Real-Time Polymerase Chain Reaction , Retrospective Studies
17.
Am J Case Rep ; 21: e927452, 2020 Sep 25.
Article in English | MEDLINE | ID: covidwho-796268

ABSTRACT

BACKGROUND COVID-19 is an infectious disease caused by SARS-CoV-2. It has spread rapidly through the world, endangering human life. The main target of COVID-19 is the lungs; however, it can involve other organs, including the liver. Patients with severe COVID-19 have an increased incidence of abnormal liver function, and patients with liver disorders are considered to be at a higher risk of severe COVID-19 infection. The mechanism of liver injury reported in 14% to 53% of COVID-19 patients is poorly recognized and several possibilities need to be considered (cytokine storm, direct viral action, hypoxia). The incidence of underlying liver comorbidities in patients with a COVID-19 infection ranges from 1% to 11%. CASE REPORT This is a report of 2 nosocomial COVID-19 infections and severe COVID-19 pneumonia in 2 patients who were hospitalized during treatment for alcoholic liver disease (ALD). Case 1 and case 2 were a 31-year-old woman and a 40-year-old woman, respectively, with decompensated ALD and symptoms of the COVID-19 infection. Both patients were transferred from another hospital to our hospital after confirmation of COVID-19 during their hospitalization. The course of the infection progressed rapidly in both patients with the development of multiple-organ failure and death over a short period. CONCLUSIONS There are no clear recommendations on the management of ALD in the COVID-19 pandemic. Alcoholic hepatitis may be a risk factor for severe COVID-19 and a poor outcome. A high percentage of nosocomial COVID-19 infections are observed; therefore, special precautions should be taken to minimize the risk of COVID-19 exposure.


Subject(s)
Coronavirus Infections/diagnosis , Cross Infection/diagnosis , Liver Diseases, Alcoholic/therapy , Pneumonia, Viral/diagnosis , Severe Acute Respiratory Syndrome/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Combined Modality Therapy , Coronavirus Infections/complications , Cross Infection/therapy , Disease Progression , Fatal Outcome , Female , Hospitalization , Humans , Liver Diseases, Alcoholic/diagnosis , Multiple Organ Failure , Pandemics , Pneumonia, Viral/complications , Radiography, Thoracic/methods , Respiration, Artificial , Risk Assessment
18.
Am J Case Rep ; 21: e926785, 2020 Sep 24.
Article in English | MEDLINE | ID: covidwho-792612

ABSTRACT

BACKGROUND In corona virus disease 2019 (COVID-19), which emerged in December 2019 and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most case presentations have been related to the respiratory tract. Several recent studies reveal that angiotensin-converting enzyme 2 (ACE2), which was found in the target cells of the virus, is highly expressed in the lungs, small bowel, and vasculature. CASE REPORT A 29-year-old male construction worker from India presented with left-sided colicky abdominal pain. He tested positive for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription-polymerase chain reaction (RT-PCR). Isolated superior mesenteric vein thrombosis was diagnosed by CT (computed tomography) scan. He was managed by anti-coagulants and clinically improved. CONCLUSIONS This case report indicates that isolated venous thrombosis of the abdominal vessels without concurrent arterial thrombosis can be a complication of the hyper-coagulability state in COVID-19 patients. Hence, early evaluation of abdominal vessels in covid-19 patients who present with any abdominal symptoms should be considered, especially when found to have an elevated D-dimer level, as early treatment of thrombosis with low-molecular-weight heparin can have a significant impact on the therapeutic outcome.


Subject(s)
Anticoagulants/administration & dosage , Coronavirus Infections/complications , Mesenteric Vascular Occlusion/diagnostic imaging , Pneumonia, Viral/complications , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Adult , Clinical Laboratory Techniques/methods , Construction Industry , Coronavirus Infections/diagnosis , Humans , India , Male , Mesenteric Vascular Occlusion/drug therapy , Mesenteric Vascular Occlusion/virology , Mesenteric Veins , Pandemics , Pneumonia, Viral/diagnosis , Radiography, Thoracic/methods , Real-Time Polymerase Chain Reaction/methods , Risk Assessment , Severity of Illness Index , Tomography, X-Ray Computed/methods , Treatment Outcome , Venous Thrombosis/complications
19.
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
20.
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
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