Prognostic Effect of Chest Computed Tomography Scan in COVID-19: a Retrospective Study / Efeito Prognóstico da Tomografia Computadorizada de Tórax na COVID-19: um Estudo Retrospectivo

The number of COVID-19 disease cases and deaths reached the scale of millions worldwide. Determining risk and prognosis factors are fundamental to allow the development of personalized management strategies. The aim of this study was to correlate lung computed tomographic (CT) findings in patients affected by COVID-19 with the clinical staging of the disease and laboratory findings, and to evaluate whether these findings were effective in predicting disease evolution. Then, laboratory findings and chest CT scans of 309/616 COVID-19 positive patients were analyzed and classified according to the degree of extension of pulmonary involvement. Ground glass opacities predominated in earlyphase, while crazy-paving pattern, consolidation, and fibrosis characterized late-phase disease. CT findings were significantly higher among late than early stages (p<0,05), although the indeterminate patterns were significantly associated with early-phase disease(p=0.00216). The groundglass pattern was significantly associated with TTPA (p=0,0234), and elevated leukocyte counting (p=0,008) and D-dimer levels(p=0.001). ROC curve analysis showed an area of 0.57(95% CI 0·890­0.0623) to early disease stage, 0.764(95%CI 0.817­0.764) to the progressive stage, and 0.816(0.717­0.915) to later stages, suggesting a relevance role of chest CT findings to this disease diagnosis. The data strongly suggested the potential role of chest CT as a technique for enhancing qPCR COVID-19 positiveness capacity by speeding-up diagnosis in symptomatic cases, and predicting the outcome of SARS CoV2 infected patients. The CT findings were also correlated with laboratory findings and disease severity, and may be of great prognostic value for stratifying the evolution of this infectious disease in hospitalized patients. (AU)

O número de casos e mortes pela COVID-19 atingiu a escala de milhões em todo o mundo. A determinação de fatores de risco e prognóstico ainda são de fundamental importância para permitir o desenvolvimento de estratégias de manejo personalizadas. O objetivo foi correlacionar achados tomográficos (TC) pulmonares em pacientes acometidos por COVID-19 com o estadiamento clínico da doença e os achados laboratoriais, e avaliar se os mesmos são efetivos para a predição da evolução da doença. Então, os achados laboratoriais e resultados de TC de tórax de 309/616 pacientes positivos para COVID-19 foram analisados e associados, e classificados de acordo com o grau de extensão do acometimento pulmonar. Opacidades em vidro fosco predominaram na fase inicial da doença, enquanto o padrão de pavimentação em mosaico, consolidação e fibrose caracterizaram a doença na fase tardia. Os achados tomográficos foram significativamente maiores para os estágios tardios em relação aos iniciais (p<0,05), embora os padrões indeterminados tenham sido significativamente associados com a doença em estágio inicial (p=0,00216). O padrão em vidro fosco estava significativamente associado com o TTPA (p=0,0234), a contagem elevada de leucócitos (p=0,008) e os níveis elevados de dímero D (p=0,001). A análise da curva ROC mostrou uma área de 0,57 (95% CI 0,890­0,0623) para o estágio inicial da doença, 0,764 (95% CI 0,817­0,764) para o estágio progressivo e 0,816 (0,717­0,915) para os estágios tardios, sugerindo uma relevância dos achados da TC de tórax para o diagnóstico efetivo dessa doença. Os dados fortemente sugerem o papel potencial da TC de tórax como uma técnica a ser associada ao teste de qPCR positivo para a COVID-19, a fim de acelerar o diagnóstico em casos sintomáticos e prever o desfecho de pacientes infectados. Os achados tomográficos também foram correlacionados com os achados laboratoriais e a gravidade da doença, se mostrando de importante valor prognóstico para estratificar a evolução dessa doença infecciosa em pacientes hospitalizados. (AU)

Lung ultrasound versus chest computed tomography for pregnant inpatients with COVID-19.

PURPOSE: To compare lung ultrasound (US) and computed tomography (CT) in the assessment of pregnant women with COVID-19. METHODS: Prospective study comprising 39 pregnant inpatients with COVID-19 who underwent pulmonary assessment with CT and US with a maximum span of 48 h between the exams. The thorax was divided into 12 regions and assessed in terms of the following: the presence of B-lines (>2), coalescent B-lines, consolidation on US; presence of interlobular thickening, ground glass, consolidation on CT. The two methods were scored by adding up the scores from each thoracic region. RESULTS: A significant correlation was found between the scores obtained by the two methods (rICC = 0.946; p < 0.001). They were moderately in agreement concerning the frequency of altered pulmonary regions (weighted kappa = 0.551). In US, a score over 15, coalescent B-lines, and consolidation were predictors of the need for oxygen, whereas the predictors in CT were a lung score over 16 and consolidation. The two methods, US (p < 0.001; AUC = 0.915) and CT (p < 0.001; AUC = 0.938), were fairly accurate in predicting the need for oxygen. CONCLUSION: In pregnant women, lung US and chest CT are of similar accuracy in assessing lungs affected by COVID-19 and can predict the need for oxygen.

How accurate are radiography and computed tomography in the diagnosis of COVID-19?-A Bayesian approach.

Background: The role of radiology in patients with clinical suspicion of COVID-19 is evolving with scientific evidence, but there are differences in opinion on when and how the technique should be used for clinical diagnosis. Purpose: To estimate the pre-test and post-test probability that a patient has COVID-19 in the event of a positive and/or negative result from chest X-ray and chest computed tomography (CT) radiological studies, comparing with those of real time polymerase chain reaction (RT-PCR) tests. Methods: The literature on the sensitivity and specificity of the chest X-ray, chest CT, and RT-PCR was reviewed. Based on these reported data, the likelihood ratios (LR) were estimated and the pre-test probabilities were related to the post-test probabilities after positive or negative results. Results: The chest X-ray has only a confirmatory value in cases of high suspicion. Chest CT analyses showed that when it is used as a general study, it has almost confirmatory value under high clinical suspicion. A chest CT classified with CO-RADS ≥ 4 has almost a diagnostic certainty of COVID-19 even with moderate or low clinical presumptions, and the CO-RADS 5 classification is almost pathognomonic before any clinical presumption. To rule out COVID-19 completely is only possible in very low clinical assumptions with negative RT-PCR and/or CT. Conclusions: Chest X-ray and especially CT are fast studies that have the capacity to report high probability of COVID-19, being a real contribution to the concept of "probable case" and allowing support to be installed in an early and timely manner.

Evaluation of pectus excavatum indexes during standard cardiac magnetic resonance: Potential for single preoperative tool.

PURPOSE: Preoperative assessment of patients with pectus excavatum (PE) demands evaluation of malformation indexes, generally with chest computed tomography (CT). In addition, assessment of the cardiac impact of sternal depression has become a rule in high referral centers, thus requiring two independent imaging modalities and use ionizing radiation in a very young population. The objective of this study was to explore the agreement between chest CT and standard cardiac MR (CMR) for the evaluation of chest wall malformation indexes. METHODS: We included consecutive patients with PE referred to undergo chest CT and CMR to establish surgical candidacy and/or to define treatment strategies. Both CT and CMR were performed at full-expiration. In both modalities, the Haller index (HI) and the Correction index (CI) were calculated by two independent observers. In CMR, only scout images were used. Agreement was evaluated using intra-class correlation coefficients (ICC). RESULTS: Fifty patients comprised the study population (median age 19.0 years) and underwent chest CT and CMR within the same month. CMR assessment of chest malformation indexes was reproducible, with a very good inter-observer agreement for HI [ICC 0.93 (0.88-0.96), p < 0.0001] and CI [ICC 0.91 (0.83-0.95), p < 0.0001]. CMR also had a very good agreement with chest CT for HI [ICC 0.90 (0.82-0.94), p < 0.0001] and CI measurements [ICC 0.93 (95% CI 0.88-0.96), p < 0.0001]. CONCLUSIONS: We demonstrated an excellent agreement between chest CT and standard CMR for the assessment of chest wall malformations, thus potentially enabling preoperative assessment of PE severity and cardiac involvement with a single diagnostic tool.

Características clínicas y epidemiológicas de los pacientes hospitalizados con derrame pleural / Clinical and epidemiological characteristics of patients hospitalized with pleural effusion

El derrame pleural tiene una prevalencia mundial de aproximadamente 400 de cada 100.000 habitantes y Venezuela tiene cifras similares. Se relaciona con múltiples patologías, por lo que determinar sus características podría ayudar a obtener un mejor diagnóstico y tratamiento. Métodos: Se realizó un estudio de casos, retrospectivo y descriptivo, obteniendo información de las historias de pacientes hospitalizados con derrame pleural en el servicio de Medicina Interna del Hospital Dr. Domingo Luciani en el período Enero 2010- Abril 2015. Resultados: La edad promedio fue de 49±19 años, género masculino (53%). Motivo de consulta: disnea (81%), dolor torácico (44%) y tos (37%). Los síntomas: disnea (92%), dolor pleurítico (58%) y fiebre (54%). Antecedentes personales: HTA (32%), DM (22%) e IC (20%). Radiografía de tórax: (60%) derrame pleural derecho y (26%) izquierdo. Tomografía de tórax realizada en (77%). Citoquímicos: (85%) exudado (53% mononuclear y 32% polimorfonucleares). La prueba de ADA positiva en 25%, cultivo para bacterias realizado en 89 casos, positivos 18%. Bloque celular con resultado inflamatorio (80%). Biopsia pleural realizada (22%): inflamatorio (36,4%), seguido por ADC metástasico (31,8%). Estancia hospitalaria > 15 días (76%) y el diagnóstico final fue infeccioso (51%). Conclusión: Contando con estos datos clínicos- epidemiológicos se puede caracterizar el comportamiento del derrame pleural en nuestro centro para el rápido y acertado diagnóstico, igualmente proponer una investigación prospectiva donde se analice el comportamiento de dicha enfermedad, y crear protocolos de actuación(AU)

Pleural effusion has a worldwide prevalence of approximately 400 per 100,000 inhabitants and Venezuela has similar statistics. It is related to multiple pathologies, which determine their characteristics which could help for better diagnosis and treatment. Methods: A retrospective descriptive case study was conducted, obtaining information from the charts of hospitalized patients with pleural effusion in Internal Medicine Dr. Domingo Luciani Hospital Venezuela in the period January 2010-April 2015. Results: Mean age 49 ± 19 years, male genre (53%). Complaints: dyspnea (81%), chest pain (44%) and cough (37%). Symptoms: dyspnea (92%), pleuritic pain (58%) and fever (54%). Personal history: hypertension (32%), DM (22%) and HF (20%). Chest x-ray: right pleural effusion (60%), left (26%). Chest tomography performed on (77%). Cytochemical: exudate: 85% (53% mononuclear and polymorphonuclear 32%). ADA testing positive in 25%. For bacteria culture: performed in 89 cases, 18% positive. Cell block inflammatory (80%). Pleural followed by metastatic ADC (31.8%). Hospital stay> 15 days (76%) and final diagnosis was infection (51%). Cause of discharge from hospital: improvement (80%). Conclusion: Having these clinical and epidemiological data can characterize the behavior of pleural effusion for quick and accurate diagnosis(AU)

Should preoperative chest computed tomography be performed in all patients with colorectal cancer?

AIM: This study evaluated the accuracy of chest computed tomography (CCT) in the preoperative staging of patients with potentially resectable colorectal cancer (CRC). An attempt was made to determine whether CCT has a significant influence on management and clinical outcome. METHOD: A review was conducted of all preoperative CCTs and X-rays performed in patients submitted to elective resection of CRC at our institution between 2005 and 2012. All scans were revised by an independent radiologist who was unaware of the circumstances of each case. The findings were classified as benign, malignant or indeterminate. Patients were followed for at least 12 months after surgery to assess the clinical evolution of any lesion found on CCT and the oncological outcome. RESULTS: Two hundred and twenty-three patients were included. The CCT showed normal or benign findings in 157 (70.4%) patients, a malignant lesion in 17 (7.6%), and an indeterminate lung lesion (ILL) in 49 (22%). Of the 30 patients with proven lung metastases, a plain X-ray detected lesions in only 11 (36.7%) patients. During the postoperative follow-up, 14 (28.6%) of the 49 patients with ILL demonstrated malignant progression of the lung lesions. Among all 223 patients, only six (2.7%) underwent lung resection. CONCLUSION: CCT is superior to plain X-ray for the detection of lung metastases. Despite the medical and financial implications of preoperative CCT, only a small number of patients will eventually undergo lung resection. We call into question the role of routine CCT in the staging of patients with CRC. A more selective approach, reserving CT for patients at high risk of lung metastases, is suggested.

Quiste broncogéiico: reporte de dos casos y revisión de la literatura

El quiste broncogénico es una malformación de la porción ventral del intestino primitivo que ocasiona alteración en el desarrollo del árbol traqueo bronquial. Reportamos dos casos de quistes broncogénicos en niños, ambos con síntomas respiratorios crónicos, uno de localización mediastinal a nivel paratraqueal derecho y, el otro, intraperenquimatoso en lóbulo superior derecho. La radiográfia y tomografía de tórax permitieron evaluar el tipo de lesión, localización y tamaño, así como la compresión de la vía áerea. Ambos pacientes fueron intervenidos quirúrgicamente no se presentaron complicaciones y los síntomas respiratorios desaparecieron. El estudio histopatológico confirmó el diagnóstico.

Bronchogenic cyst arises from abnormal budding of the diverticulum of the foregut that leads to abnormality of the tracheobronquial tree. We report two cases of these cysts in children with respiratory chronic symptom. One was localized in paratraqueal mediastinum and other, intrapulmonary in lower upper right side. The chest radiography and computed tomography allowed evaluation as to the type, site and size of lesion as well as airway compression. Both patients underwent surgery; there were no complications and the respiratory symptoms disappeared. Histologic features confirm the diagnosis.