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2.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artículo en Inglés | MEDLINE | ID: covidwho-963649

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Asunto(s)
Cardiomegalia/diagnóstico por imagen , Infecciones por Coronavirus/diagnóstico por imagen , Corazón/diagnóstico por imagen , Isquemia Miocárdica/diagnóstico por imagen , Miocarditis/diagnóstico por imagen , Derrame Pericárdico/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Betacoronavirus , Cardiomegalia/fisiopatología , Angiografía Coronaria , Infecciones por Coronavirus/fisiopatología , Ecocardiografía , Edema/diagnóstico por imagen , Edema/fisiopatología , Corazón/fisiopatología , Humanos , Imagen por Resonancia Magnética , Isquemia Miocárdica/fisiopatología , Miocarditis/fisiopatología , Pandemias , Derrame Pericárdico/fisiopatología , Neumonía Viral/fisiopatología , Radiografía Torácica , Recuperación de la Función , Tomografía Computarizada por Rayos X , Disfunción Ventricular/diagnóstico por imagen , Disfunción Ventricular/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología
3.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artículo en Inglés | MEDLINE | ID: covidwho-918289

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Asunto(s)
Cardiomegalia/diagnóstico por imagen , Infecciones por Coronavirus/diagnóstico por imagen , Corazón/diagnóstico por imagen , Isquemia Miocárdica/diagnóstico por imagen , Miocarditis/diagnóstico por imagen , Derrame Pericárdico/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Betacoronavirus , Cardiomegalia/fisiopatología , Angiografía Coronaria , Infecciones por Coronavirus/fisiopatología , Ecocardiografía , Edema/diagnóstico por imagen , Edema/fisiopatología , Corazón/fisiopatología , Humanos , Imagen por Resonancia Magnética , Isquemia Miocárdica/fisiopatología , Miocarditis/fisiopatología , Pandemias , Derrame Pericárdico/fisiopatología , Neumonía Viral/fisiopatología , Radiografía Torácica , Recuperación de la Función , Tomografía Computarizada por Rayos X , Disfunción Ventricular/diagnóstico por imagen , Disfunción Ventricular/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología
4.
Chest ; 158(5): 1885-1895, 2020 11.
Artículo en Inglés | MEDLINE | ID: covidwho-764359

RESUMEN

BACKGROUND: Chest CT may be used for the diagnosis of coronavirus disease 2019 (COVID-19), but clear scientific evidence is lacking. Therefore, we systematically reviewed and meta-analyzed the chest CT imaging signature of COVID-19. RESEARCH QUESTION: What is the chest CT imaging signature of COVID-19 infection? STUDY DESIGN AND METHODS: A systematic literature search was performed for original studies on chest CT imaging findings in patients with COVID-19. Methodologic quality of studies was evaluated. Pooled prevalence of chest CT imaging findings were calculated with the use of a random effects model in case of between-study heterogeneity (predefined as I2 ≥50); otherwise, a fixed effects model was used. RESULTS: Twenty-eight studies were included. The median number of patients with COVID-19 per study was 124 (range, 50-476), comprising a total of 3,466 patients. Median prevalence of symptomatic patients was 99% (range, >76.3%-100%). Twenty-seven of the studies (96%) had a retrospective design. Methodologic quality concerns were present with either risk of or actual referral bias (13 studies), patient spectrum bias (eight studies), disease progression bias (26 studies), observer variability bias (27 studies), and test review bias (14 studies). Pooled prevalence was 10.6% for normal chest CT imaging findings. Pooled prevalences were 90.0% for posterior predilection, 81.0% for ground-glass opacity, 75.8% for bilateral abnormalities, 73.1% for left lower lobe involvement, 72.9% for vascular thickening, and 72.2% for right lower lobe involvement. Pooled prevalences were 5.2% for pleural effusion, 5.1% for lymphadenopathy, 4.1% for airway secretions/tree-in-bud sign, 3.6% for central lesion distribution, 2.7% for pericardial effusion, and 0.7% for cavitation/cystic changes. Pooled prevalences of other CT imaging findings ranged between 10.5% and 63.2%. INTERPRETATION: Studies on chest CT imaging findings in COVID-19 suffer from methodologic quality concerns. More high-quality research is necessary to establish diagnostic CT criteria for COVID-19. Based on the available evidence that requires cautious interpretation, several chest CT imaging findings appear to be suggestive of COVID-19, but normal chest CT imaging findings do not exclude COVID-19, not even in symptomatic patients.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Linfadenopatía/diagnóstico por imagen , Derrame Pleural/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Betacoronavirus , Humanos , Pandemias , Derrame Pericárdico/diagnóstico por imagen , Tórax/diagnóstico por imagen
5.
Eur Rev Med Pharmacol Sci ; 24(14): 7801-7803, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-693476

RESUMEN

SARS-CoV-2 infection in children is uncommon compared to adult population. However, some children required hospital and/or PICU admission. The aim of this short communication is to share our experience with Point-of-Care Ultrasound (POCUS) when managing these patients. Remarkably, all cases presented pleural and pericardial effusions, detected by POCUS, despite showing an adequate urinary output and prior to receiving any kind of fluid resuscitation. Effusions have been described as rare among SARS-CoV-2 infection in adult population. By performing portable chest X-Ray they would have gone unnoticed in our patients. Other POCUS findings consisted of all types of consolidations and coalescent B-line patterns. POCUS was also performed in order to optimize PEEP, checking adequate endotracheal intubation positioning (avoiding the risk of contagiousness related to auscultation in this framework), and to assess volemia status, cardiac performance, and brain neuro-monitoring. There was not cross-infection. In pediatric SARS-CoV-19 effusions are frequent but easily unnoticed unless lung and echo POCUS are performed.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Derrame Pericárdico/diagnóstico por imagen , Derrame Pleural/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Sistemas de Atención de Punto , Ultrasonografía , Betacoronavirus , Niño , Humanos , Pandemias , Derrame Pericárdico/virología , Derrame Pleural/virología , Radiografía Torácica
6.
Diagn Interv Radiol ; 26(4): 308-314, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-607982

RESUMEN

PURPOSE: We aimed to demonstrate the computed tomography (CT) findings observed at the initial presentation of coronavirus disease 2019 (COVID-19) pneumonia and reveal the most frequent infiltration and distribution patterns of the disease. METHODS: One hundred and eighty-five patients (87 men, 98 women; mean age, 48.7 years), who underwent RT-PCR sampling and high-resolution CT examination in our hospital between March 15, 2020, and April 15, 2020, and got a definitive diagnosis of COVID-19 disease via initial or follow-up RT-PCR test, were included in the study. We comprehensively analyzed the most common and relatively rare CT imaging features (e.g., distribution pattern, density of the lesions, additional CT signs) in patients diagnosed with COVID-19 pneumonia. RESULTS: Thirty-eight patients (20.6%) had no evidence of pneumonia on their initial high-resolution CT images. Among 147 patients (79.4%) who had parenchymal infiltration consistent with pneumonia, 10 (6.8%) had a negative baseline RT-PCR test, and positivity was detected as a result of repeated tests. Most of the patients had multifocal (89.1%) and bilateral (86.4%) lesions. The most common location, right lower lobe, was affected in 87.8% of the patients. Lesions were distributed predominantly at peripheral (87.1%) and posterior (46.3%) areas of lung parenchyma. Most of the patients had pure ground glass opacity (GGO) (82.3%) followed by GGO with consolidation (32.7%) and crazy paving pattern (21.8%). Pure consolidation, solid nodules, halo sign, reverse halo sign, vascular enlargement, subpleural line, air-bronchogram, and bronchiectasis were the other findings observed in at least 15% of the cases. Halo sign, acinar nodules, air-bubble sign, pleural thickening and effusion, mediastinal and/or hilar lymphadenopathy were seen rarely (2%-12.9%). Pericardial effusion, pneumothorax, cavitation, and tree-in-bud pattern were not detected in our study group. CONCLUSION: Multifocal and bilateral GGO infiltration predominantly distributed in peripheral, posterior, and lower lung areas was the most common infiltration pattern.


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Neumonía/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Bronquiectasia/diagnóstico por imagen , Bronquiectasia/patología , Bronquiectasia/virología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Progresión de la Enfermedad , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/virología , Linfadenopatía/diagnóstico por imagen , Linfadenopatía/patología , Linfadenopatía/virología , Masculino , Mediastino/diagnóstico por imagen , Mediastino/patología , Mediastino/virología , Persona de Mediana Edad , Pandemias , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/patología , Derrame Pericárdico/virología , Neumonía/patología , Neumonía/virología , Neumonía Viral/epidemiología , Neumonía Viral/virología , Neumotórax/diagnóstico por imagen , Neumotórax/patología , Neumotórax/virología , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Turquia/epidemiología
8.
Am J Emerg Med ; 38(7): 1547.e5-1547.e6, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-133252

RESUMEN

A 78-year-old patient with acute respiratory distress was transferred to our hospital with ST segment elevation on electrocardiography. Coronary angiography revealed normal coronary arteries. Thorax computerized tomography showed ground glass opacification with consolidation in the lungs and mild pericardial effusion demonstrating myopericarditis associated with COVID-19.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Miocarditis/diagnóstico por imagen , Derrame Pericárdico/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Anciano , Betacoronavirus , Angiografía Coronaria , Infecciones por Coronavirus/fisiopatología , Electrocardiografía , Humanos , Masculino , Miocarditis/patología , Miocarditis/fisiopatología , Pandemias , Derrame Pericárdico/fisiopatología , Neumonía Viral/fisiopatología , Tomografía Computarizada por Rayos X
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