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1.
Acta Radiol ; 63(3): 291-310, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1105634

ABSTRACT

Quick screening patients with COVID-19 is the most important way of controlling transmission by isolation and medical treatment. Chest computed tomography (CT) has been widely used during the initial screening process, including pneumonia diagnosis, severity assessment, and differential diagnosis of COVID-19. The course of COVID-19 changes rapidly. Serial CT imaging could observe the distribution, density, and range of lesions dynamically, monitor the changes, and then guide towards appropriate treatment. The aim of the review was to explore the chest CT findings and dynamic CT changes of COVID-19 using systematic evaluation methods, instructing the clinical imaging diagnosis. A systematic literature search was performed. The quality of included literature was evaluated with a quality assessment tool, followed by data extraction and meta-analysis. Homogeneity and publishing bias were analyzed. A total of 109 articles were included, involving 2908 adults with COVID-19. The lesions often occurred in bilateral lungs (74%) and were multifocal (77%) with subpleural distribution (81%). Lesions often showed ground-glass opacity (GGO) (68%), followed by GGO with consolidation (48%). The thickening of small vessels (70%) and thickening of intralobular septum (53%) were also common. The dynamic changes of chest CT manifestations showed that lesions were absorbed and improved gradually after reaching the peak (80%), had progressive deterioration (55%), were absorbed and improved gradually (46%), fluctuated (22%), or remained stable (26%). The review showed the common and key CT features and the dynamic imaging change patterns of COVID-19, helping with timely management during COVID-19 pandemic.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/therapy , Confidence Intervals , Diagnosis, Differential , Disease Progression , Female , Humans , Male , Middle Aged , Publication Bias , Young Adult
2.
Clin Med Insights Case Rep ; 14: 1179547621996306, 2021.
Article in English | MEDLINE | ID: covidwho-1097078

ABSTRACT

INTRODUCTION: Adult Still's disease (ASD) is an uncommon inflammatory disorder characterized by fevers, a salmon-colored rash, and arthritis. Cytokines storm syndrome related to Coronavirus-19 (COVID-19) usually occur in acute period of COVID-19 and can mimic clinical features of ASD. CASE REPORT: We present a case of a 27-year-old male who was hospitalized in July 2020 due to fever, sore throat, multiple joint pain, and body rash for 2 weeks. Patient recovered from COVID-19 8 weeks ago but his nasopharyngeal SARS CoV-2 PCR was still positive on current hospitalization. Post COVID-19 cytokines storm syndrome post COVID-19 was suspected but after further assessment and investigations, diagnosis of ASD was established and patient was treated with corticosteroids therapy and had favorable outcome. CONCLUSION: During COVID-19 pandemic, diagnosis of many other diseases either were delayed or missed. We encourage all clinicians to have a broader differential diagnosis to improve patient care and outcome.

3.
World J Clin Cases ; 8(22): 5501-5512, 2020 Nov 26.
Article in English | MEDLINE | ID: covidwho-994296

ABSTRACT

Coronavirus disease-2019 (COVID-19) is spreading throughout the world. Chest radiography and computed tomography play an important role in disease diagnosis, differential diagnosis, severity evaluation, prognosis prediction, therapeutic effects assessment and follow-up of patients with COVID-19. In this review, we summarize knowledge of COVID-19 pneumonia that may help improve the abilities of radiologists to diagnose and evaluate this highly infectious disease, which is essential for epidemic control and preventing new outbreaks in the short term.

4.
Rheumatology (Oxford) ; 60(2): 911-917, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-944404

ABSTRACT

OBJECTIVES: The objectives of this study were (i) to describe the clinical presentation, treatment and outcome of paediatric inflammatory multisystem syndrome temporally related to Sars-CoV-2 (PIMS-TS) in children; (ii) to propose a framework to guide multidisciplinary team (MDT) management; and (iii) to highlight the role of the paediatric rheumatologist in this context. METHODS: This study involved a retrospective case notes review of patients referred to a single specialist paediatric centre with suspected PIMS-TS, with a focus on clinical presentation, laboratory parameters, treatment, and outcome in the context of an MDT framework. RESULTS: Nineteen children of median age 9.1 years fulfilled the definition of PIMS-TS and were managed within an MDT framework: 5/19 were female; 14/19 were of Black, Asian or minority ethnicity; 9/19 also fulfilled diagnostic criteria for complete or incomplete Kawasaki disease (KD). Severe systemic inflammation, shock, and abdominal pain were ubiquitous. Treatment was stratified within an MDT framework and included CSs in all; i.v. immunoglobulin in all; anakinra in 4/19; infliximab in 1/19; and antiviral (aciclovir) in 4/19. CONCLUSIONS: We observed significant diagnostic equipoise using a current definition of PIMS-TS, overlapping with KD. Outside of clinical trials, an MDT approach is vital. The role of the paediatric rheumatologist is to consider differential diagnoses of hyperinflammation in the young, to advise on empiric immunomodulatory therapy, to set realistic therapeutic targets, to gauge therapeutic success, to oversee timely step-down of immunomodulation, and to contribute to the longer-term MDT follow-up of any late inflammatory sequelae.


Subject(s)
Abdominal Pain/therapy , Adrenal Cortex Hormones/therapeutic use , Antirheumatic Agents/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/therapy , Immunologic Factors/therapeutic use , Mucocutaneous Lymph Node Syndrome/diagnosis , Shock/therapy , Systemic Inflammatory Response Syndrome/therapy , Abdominal Pain/physiopathology , Acyclovir/therapeutic use , Adolescent , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/physiopathology , Child , Diagnosis, Differential , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Inflammation , Infliximab/therapeutic use , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Male , Patient Care Team , Physician's Role , Retrospective Studies , Rheumatologists , SARS-CoV-2 , Severity of Illness Index , Shock/physiopathology , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/physiopathology , United Kingdom
5.
Zhongguo Fei Ai Za Zhi ; 23(4): 255-260, 2020 Apr 20.
Article in Chinese | MEDLINE | ID: covidwho-17439

ABSTRACT

The worldwide epidemic of three coronaviruses and one influenza virus in 21st century have seriously threatened human health. Infection with these viruses can cause respiratory symptoms. The patients with lung cancer are more susceptible to viral infection and have a worse prognosis due to the advanced age and the systemic immunosuppressive state caused by malignancy itself and the anticancer treatments. In addition, without sufficient clinical awareness, a missed diagnosis of viral pneumonia may occur due to the fever and respiratory symptoms caused by lung cancer and its secondary diseases. Furthermore, control measures against viral outbreaks may interfere with routine diagnosis and treatment of lung cancer patients. Therefore, scientific protection and individualized management of lung cancer patients are particularly important during virus epidemic prevention and control. Here, we systematically reviewed the epidemiological and clinical characteristics of viral pneumonia, its impact on patients with lung cancer and the differential diagnosis of lung cancer-related respiratory manifestations, aiming to provide guidance for the individual management of lung cancer patients during the prevention and control of viral pneumonia epidemic.


Subject(s)
Lung Neoplasms/complications , Pneumonia, Viral/complications , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/therapy , Pandemics , Pneumonia, Viral/epidemiology , Precision Medicine
6.
Eur Radiol ; 30(8): 4398-4406, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-15825

ABSTRACT

OBJECTIVES: To systematically analyze CT findings during the early and progressive stages of natural course of coronavirus disease 2019 and also to explore possible changes in pulmonary parenchymal abnormalities during these two stages. METHODS: We retrospectively reviewed the initial chest CT data of 62 confirmed coronavirus disease 2019 patients (34 men, 28 women; age range 20-91 years old) who did not receive any antiviral treatment between January 21 and February 4, 2020, in Chongqing, China. Patients were assigned to the early-stage group (onset of symptoms within 4 days) or progressive-stage group (onset of symptoms within 4-7 days) for analysis. CT characteristics and the distribution, size, and CT score of pulmonary parenchymal abnormalities were assessed. RESULTS: In our study, the major characteristic of coronavirus disease 2019 was ground-glass opacity (61.3%), followed by ground-glass opacity with consolidation (35.5%), rounded opacities (25.8%), a crazy-paving pattern (25.8%), and an air bronchogram (22.6%). No patient presented cavitation, a reticular pattern, or bronchial wall thickening. The CT scores of the progressive-stage group were significantly greater than those of the early-stage group (p = 0.004). CONCLUSIONS: Multiple ground-glass opacities with consolidations in the periphery of the lungs were the primary CT characteristic of coronavirus disease 2019. CT score can be used to evaluate the severity of the disease. If these typical alterations are found, then the differential diagnosis of coronavirus disease 2019 must be considered. KEY POINTS: • Multiple GGOs with consolidations in the periphery of the lungs were the primary CT characteristic of COVID-19. • The halo sign may be a special CT feature in the early-stage COVID-19 patients. • Significantly increased CT score may indicate the aggravation of COVID-19 in the progressive stage.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Thorax/diagnostic imaging , Adult , Aged , Aged, 80 and over , COVID-19 , China , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed , Young Adult
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