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Persistent respiratory failure after SARS-CoV-2 infection: The role of dual energy computed tomography. A case report.
Menale, Silvia; Scheggi, Valentina; Giovacchini, Jacopo; Marchionni, Niccolò.
  • Menale S; Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department Azienda Ospedaliero-Universitaria Careggi and Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50139, Italy.
  • Scheggi V; Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department Azienda Ospedaliero-Universitaria Careggi and Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50139, Italy.
  • Giovacchini J; Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department Azienda Ospedaliero-Universitaria Careggi and Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50139, Italy.
  • Marchionni N; Division of General Cardiology, Careggi Hospital and Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50139, Italy.
Radiol Case Rep ; 17(9): 3179-3184, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1907703
ABSTRACT

Background:

COVID-19 disease is often complicated by respiratory failure, developing through multiple pathophysiological mechanisms, with pulmonary embolism (PE) and microvascular thrombosis as key and frequent components. Newer imaging modalities such as dual-energy computed tomography (DECT) can represent a turning point in the diagnosis and follow-up of suspected PE during COVID-19. Case presentation A 78-year-old female presented to our internal medicine 3 weeks after initial hospitalization for COVID-19 disease, for recrudescent respiratory failure needing oxygen therapy. A computed tomography (CT) lungs scan showed a typical SARSCoV-2 pneumonia. Over the following 15 days, respiratory function gradually improved. Unexpectedly, after 21 days from symptom onset, the patient started complaining of breath shortening with remarkable desaturation requiring high-flow oxygen ventilation. CT pulmonary angiography and transthoracic echocardiography were negative for signs of PE. Thereby, Dual-energy CT angiography of the lungs (DECT) was performed and detected diffuse peripheral microembolism. After 2 weeks, a second DECT was performed, showing a good response to the anticoagulation regimen, with reduced extent of microembolism and some of the remaining emboli partially recanalized.

Discussion:

DECT is an emerging diagnostic technique providing both functional and anatomical information. DECT has been reported to produce a much sharper delineation of perfusion defects than pulmonary scintigraphy, using a significantly lower equivalent dose of mSv. We highlight that DECT is particularly useful in SARS-Cov-2 infection, in order to determine the predominant underlying pathophysiology, particularly when respiratory failure prolongs despite improved lung parenchymal radiological findings.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Cohort study / Prognostic study Topics: Long Covid Language: English Journal: Radiol Case Rep Year: 2022 Document Type: Article Affiliation country: J.radcr.2022.05.031

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Cohort study / Prognostic study Topics: Long Covid Language: English Journal: Radiol Case Rep Year: 2022 Document Type: Article Affiliation country: J.radcr.2022.05.031