CT features of pulmonary embolism in patients with COVID-19 pneumonia.

OBJECTIVE: The aim of this study was to describe the Computed Tomography (CT) features of pulmonary embolism in patients hospitalized for acute COVID-19 pneumonia and to evaluate the prognostic significance of these features. PATIENTS AND METHODS: This retrospective study included 110 consecutive patients who were hospitalized for acute COVID-19 pneumonia and underwent pulmonary computed tomography angiography (BTPA) on the basis of clinical suspicion. The diagnosis of COVID-19 infection was determined by CT findings typical of COVID-19 pneumonia and/or a positive result of a reverse transcriptase-polymerase chain reaction test. RESULTS: Of the 110 patients, 30 (27.3%) had acute pulmonary embolism and 71 (64.5%) had CT features of chronic pulmonary embolism. Of the 14 (12.7%) patients who died despite receiving therapeutic doses of heparin, 13 (92.9%) had CT features of chronic pulmonary embolism and 1 (7.1%) of acute pulmonary embolism. CT features of chronic pulmonary embolism were more common in deceased patients than in surviving patients (92.9% vs. 60.4%, p=0.01, respectively). Low oxygen saturation and high urine microalbumin creatinine ratio at admission in COVID-19 patients are important determinants of mortality after adjusting for sex and age in logistic procedures. CONCLUSIONS: CT features of chronic pulmonary embolism are common in COVID-19 patients undergoing Computed Tomography Pulmonary Angiography (CTPA) in the hospital. The coexistence of albuminuria, low oxygen saturation and CT features of chronic pulmonary embolism at admission in COVID-19 patients may herald fatal outcomes.

Interobserver Agreement in the Analysis of Different Radiological Classifications of COVID-19 on Computed Tomography

Introduction: Computed tomography (CT) has approximately 98% sensitivity for Coronavirus disease-2019 (COVID-19). Various algorithms were designed using CT images. However, the interobserver agreement of different radiological classifications of COVID-19 is not yet known. Thus, this study aimed to investigate the interobserver agreement of different radiological classifications of COVID-19. Materials and Methods: This study included 212 patients who were positive on the polymerase chain reaction test and eligible for CT. Four radiologists examined all CT images simultaneously. They reached a consensus that CT images can provide definite findings of COVID-19. The Radiological Society of North America (RSNA) consensus statement, the British Society of Thoracic Imaging (BSTI) structured reporting statement, and COVID-19 Reporting and Data System (CO-RADS) were used. Fleiss' Kappa was used to detect interobserver agreement. Kappa values of 0.00- 0.20 were considered as slight, 0.21-0.40 as fair, 0.41-0.60 as moderate, 0.61-0.80 as substantial, and 0.81-1.00 as near-perfect agreement, and p<0.05 was accepted as significant. Results: A total of 137 patients did not have any pathological CT findings. The most prevalent radiological findings were ground-glass opacities and consolidations. The agreements on all classifications were at near-perfect levels: RSNA, 0.86 (0.82-0.90);BSTI, 0.83 (0.79-0.87), and CO-RADS, 0.82 (0.79-0.86). The RSNA classification has the highest consistency rate, followed by BSTI and CO-RADS. However, substantial and moderate agreements were found in the subcategories of each classification. Conclusion: In this study, some subcategories had a lower agreement, despite the high consistency rates for COVID-19 radiological classification systems in the literature. Therefore, improving the items without consensus can lead to the development of better radiological diagnostic approaches.

Urticaria and Angioedema in a Patient Diagnosed with COVID-19: Case Report

Coronavirus disease 2019 (COVID-19) disease caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus, which has affected the whole world, can cause clinical pictures ranging from mild cold symptoms to severe lower respiratory tract infections that can cause mortality. Recently, reports of dermatological findings associated with COVID-19 such as urticaria has been increasing. Here, a COVID-19 case presenting with urticaria and angioedema is described. A 26-year-old female patient, who was found to be SARS-CoV-2 positive by polymerase chain reaction performed for being in contact, presented to our outpatient clinic with complaints of itchy, erythematous lesions on her body and swelling in the eyes and throat for four days. The patient received favipiravir treatment for 5 days and these complaints started 4 days after the treatment ended. History of food and other drug allergies, insect bites and chemicals were questioned in the differential diagnosis for etiology, however, no relationship was detected. Systemic corticosteroid and antihistamine treatment was initiated, and edema in the eyes completely regressed and urticaria plaques faded on the 3rd day of the treatment. Dermatological findings may occur simultaneously with the classic symptoms of the disease or before or after symptoms. Although the pathogenesis between dermatological findings and COVID-19 has not been fully elucidated, studies have suggested that viral infections and SARS-CoV-2 can be an etiological agent for chronic or acute urticaria. It is thought that some rashes may be causally related to the viral effect and others to the immune response. It is emphasized that there may be atypical findings such as urticaria/angioedema in order to diagnose COVID-19 disease early and prevent its spread and should be considered in differential diagnosis.