The prognostic value of chest X-ray in patients with COVID-19 on admission and when starting CPAP.

OBJECTIVE: The objective was to explore if chest X-ray severity, assessed using a validated scoring system, predicts patient outcome on admission and when starting continuous positive pressure ventilation (CPAP) for COVID-19. DESIGN: The study was a retrospective case-controlled study. PARTICIPANTS: There were 163 patients with COVID-19 deemed candidates for CPAP on admission, including 58 who subsequently required CPAP. OUTCOME MEASURES: On admission, we measured the proportion of patients meeting a composite 'negative' outcome of requiring CPAP, intubation or dying versus successful ward-based care. For those escalated to CPAP, 'negative' outcomes were intubation or death versus successful de-escalation of respiratory support. RESULTS: Our results were stratified into tertiles, those with 'moderate' or 'severe' X-rays on admission had significantly higher odds of negative outcome versus 'mild' (odds ratio (OR) 2.32; 95% confidence interval (CI) 1.121-4.803; p=0.023; and OR 3.600; 95% CI 1.681-7.708; p=0.001, respectively). This could not be demonstrated in those commencing CPAP (OR 0.976; 95% CI 0.754-1.264; p=0.856). CONCLUSIONS: We outline a scoring system to stratify X-rays by severity and directly link this to prognosis. However, we were unable to demonstrate this association in the patients commencing CPAP.

Spontaneous pneumomediastinum as a complication of a COVID-19 related pneumonia: case report and review of literature.

A novel coronavirus, SARS-COV-2, related infection is thought to have originated in Wuhan, China, in November 2019 but spread rapidly to be declared a global pandemic by the WHO in March 2020. The patients typically present with fever and shortness of breath. We describe a case of spontaneous pneumomediastinum at presentation as a complication of severe Covid-19 infection. A 54 year old male patient with no history of smoking, asthma or other underlying chronic lung disease, presented to our emergency department with severe Covid-19 symptoms. His chest x-ray and CT scan on arrival at the emergency department, and prior to any intervention, demonstrated severe bilateral Covid-19 pneumonia complicated by a pneumomediastinum. The aetiology of the pneumomediastinum is thought to be a direct complication of severe covid-19 pneumonia in absence of any previous respiratory history or iatrogenic cause.

Hepatic mesenchymal hamartoma mimicking hemangioma on multiple-phase gadolinium-enhanced MRI.

Mesenchymal Hamartoma [MH] is a cystic benign liver mass occurring in children. Diagnostic confusion with hepatoblastoma may arise when alpha-feto-protein is elevated, and with hemangioendothelioma when imaging shows centripetal filling. We demonstrate one such case with progressive centripetal enhancement of a liver mass with Gadolinium enhanced multiple phase gradient-echo MRI, in a child with raised alpha-feto protein.

Omental lipoblastoma in a child: diagnosis based on CT density measurements.

A 2-year-old girl presented with an abdominal mass which on CT was central and hypodense. Housefield units measured -60 which made the diagnosis of a fatty mass. The diagnosis of an omental lipoblastoma was confirmed after surgery on histology.