Chest Radiographic Findings in High-risk Covid-19 Pneumonia Patients

Background/ objectivesThe severity of Covid-19 pneumonia has shown a positive association with co-existing risk factors. However, the exact nature of lung involvement in high-risk Covid-19 patients is yet to be resolved. Therefore, we evaluated the CXR features, temporal progression, and the factors associated with CXR severity in high-risk patients.MethodsChest X-rays (n=289) of Covid-19 infected high-risk adults (n=228) treated at the Base Hospital Homagama were evaluated to record CXR features, their temporal progression, CXR severity score and the patient outcomes. ResultsThe studies patients (48.2% men) were in mean age(SD) of 59(15) years. The most frequent CXR features were patchy ground-glass opacities (49%; GG) and patchy consolidations (42%; CON). They showed bilateral (100%) involvement, superoinferior gradient (100%) and diffuse (27%), peripheral (18%) or perihilar (10%) distribution. CON was the predominant opacity among the non-survivors and GG among the survivors (χ2=14.73; p=0.001). Right lung predominant (28%) asymmetrical lung involvement was more frequent than bilateral symmetrical (16%) or left lung predominance (7%). Progression into fatal disease was significantly higher when the lung involvement is asymmetrical: right predominance: ODDs:0.502; p=0.023; left predominance: ODDs:0.268; p=0.002. The CXRs were frequently normal in early (66%) and progressive (56%; χ2=36.64; p<0.001) stages than in peak or resolving stages. The predictors of CXR severity included age (β:0.140; 95% CI:0.041–0.233; p=0.004), male gender (β:4.140; 95% CI:1.452–6.481; p=0.003), and disease day (β:0.622; 95% CI:0.301–0.942; p<0.001). ConclusionThis study decoded the CXR features of Covid-19 pneumonia in a high-risk cohort while describing their associations.

Pulmonary Sequelae in Patients After Recovery From Coronavirus Disease 2019: A Follow-Up Study With Chest CT

Objective: The pulmonary sequelae of coronavirus disease 2019 (COVID-19) have not been comprehensively evaluated. We performed a follow-up study analyzing chest computed tomography (CT) findings of COVID-19 patients at 3 and 6 months after hospital discharge.Methods: Between February 2020 and May 2020, a total of 273 patients with COVID-19 at the Shenzhen Third People's Hospital were recruited and followed for 6 months after discharge. Chest CT scanning was performed with the patient in the supine position at end-inspiration. A total of 957 chest CT scans was obtained at different timepoints. A semi-quantitative score was used to assess the degree of lung involvement.Results: Most chest CT scans showed bilateral lung involvement with peripheral location at 3 and 6 months follow-up. The most common CT findings were ground-glass opacity and parenchymal band, which were found in 136 (55.3%) and 94 (38.2%) of the 246 patients at 3 months follow-up, and 82 (48.2%) and 76 (44.7%) of 170 patients at 6 months follow-up, respectively. The number of lobes involved and the total CT severity score declined over time. The total CT score gradually increased with the increasement of disease severity at both 3 months follow-up (trend test P &lt; 0.001) and 6 months follow-up (trend test P &lt; 0.001). Patients with different disease severity represented diverse CT patterns over time.Conclusions: The most common CT findings were ground-glass opacity and parenchymal bands at the 3 and 6 months follow-up. Patients with different disease severity represent diverse CT manifestations, indicating the necessary for long-term follow-up monitoring of patients with severe and critical conditions.

ROLE OF INTERLEUKIN-6 AND PROCALCITONIN AS INFLAMMATORY BIOMARKERS IN EVALUATING COVID-19 DISEASE SEVERITY ON HRCT CHESTAN EXPERIENCE AT CMH QUETTA

Objective: To explore the relation of Interleukin-6 and Procalcitonin with COVID-19 severity on high resolution computerized tomogram (HRCT) chest. Study Design: Randomized Control Trial (NCT04945811). Place and Duration of study: Pathology Department, Combined Military Hospital Quetta, from April 2020 to May 2021. Methodology: Serum Interleukin-6 and Procalcitonin of 100 consenting COVID-19 positive patients from April 2020 to May 2021 were assessed at Pathology department Combined Military Hospital Quetta and their levels were correlated with severity of lung involvement on HRCT Chest Results: Serum Interlukin-6 levels were significantly raised in 97 patients with mean levels of 20.43 ± 19.66 (pg/ml). Serum procalcitonin levels were also significantly raised in 95 patients with mean levels of 0.43 ± 0.24 (ng/ml). Conclusion: Interlukin-6 and procalcitonin are important biomarkers for diagnosis and predicting severity of COVID-19 pneumonia.

Clinical characteristics and outcomes of Korean patients with sarcoidosis

Sarcoidosis is a systemic granulomatous disorder of unknown cause involving multiple organs. Its clinical presentation and prognosis vary among races. We identified the clinical characteristics and outcomes of Korean patients with sarcoidosis. Clinical data of 367 Korean patients with biopsy-proven sarcoidosis diagnosed in 2001–2017 were retrospectively analyzed. Treatment responses included improvement, stability, or progression based on changes in pulmonary sarcoidosis on chest images. The mean age was 47.4 years, and 67.3% of patients were women. The median follow-up period was 80 months. The highest prevalence was observed in individuals aged 50–59 years (30–39 years in men, 50–59 years in women), and the number of diagnoses showed an increasing trend. Lung involvement was the most common (93.5%), followed by the skin, eyes, and extrathoracic lymph nodes. Among patients with lung involvement and a follow-up period of ≥ 3 months, 66.8%, 31.0%, and 2.2% showed improvement, stability, and progression, respectively. Eleven patients (2.9%) died, and the 5-year survival rate was 99%. The number of diagnosed cases showed an increasing trend, and the mean age at diagnosis was increased compared with that in previous reports. Organ involvement was similar to that of Westerners, although the prognosis appeared better.

Bilateral spontaneous pneumothorax in a non-intubated COVID-19 patient

Spontaneous bilateral pneumothorax is a rare condition occurring only in 1,3% of cases of spontaneous pneumothorax. Although spontaneous pneumothorax is recognized complication of COVID it is usually associated with severe cases of COVID pneumonia with massive lung involvement and a high level of inflammatory cytokines – so called "inflammatory storm". Large percentage of this patients requires life support with mechanical ventilation and pneumothorax is usually accompanied with pneumomediastinum. Nevertheless occurrence of spontaneous pneumothorax in non-intubated patients is very low. Therefore the presented case is exceptional in two ways – spontaneous pneumothorax occurred in non-intubated patient and is presented bilaterally. Early diagnosis of spontaneous bilateral pneumothorax can pose a diagnostic dilemma as it mimics progression of lung involvement in the course of COVID, pulmonary embolism or myocardial infarction. In our case apart from COVID pneumonia, patient had typical clinical presentation of myocardial infarction and known coronary artery disease, which initially mislead clinicians toward diagnosis of myocardial infarction (MI). However after exclusion of MI, chest radiograph was requested which revealed bilateral pneumothorax. The exact mechanism of pneumothorax development in non-intubated patients is not clear. Lung inflammation in COVID causes formation of pneumatocele, which can predispose to spontaneous pneumothorax. It is important to note that our patient developed pneumothorax without evident pneumatocele, underlying lung condition or history of trauma. This case shows that bilateral pneumothorax in COVID-19 can develop also in patients with only mild clinical course of COVID pneumonia. Early diagnosis and proper management is essential and can prevent life-threatening complications.

Predictors of the chest CT score in COVID-19 patients: a cross-sectional study

Background Since the COVID-19 outbreak, pulmonary involvement was one of the most significant concerns in assessing patients. In the current study, we evaluated patient’s signs, symptoms, and laboratory data on the first visit to predict the severity of pulmonary involvement and their outcome regarding their initial findings. Methods All referred patients to the COVID-19 clinic of a tertiary referral university hospital were evaluated from April to August 2020. Four hundred seventy-eight COVID-19 patients with positive real-time reverse-transcriptase-polymerase chain reaction (RT-PCR) or highly suggestive symptoms with computed tomography (CT) imaging results with typical findings of COVID-19 were enrolled in the study. The clinical features, initial laboratory, CT findings, and short-term outcomes (ICU admission, mortality, length of hospitalization, and recovery time) were recorded. In addition, the severity of pulmonary involvement was assessed using a semi-quantitative scoring system (0–25). Results Among 478 participants in this study, 353 (73.6%) were admitted to the hospital, and 42 (8.7%) patients were admitted to the ICU. Myalgia (60.4%), fever (59.4%), and dyspnea (57.9%) were the most common symptoms of participants at the first visit. A review of chest CT scans showed that Ground Glass Opacity (GGO) (58.5%) and consolidation (20.7%) were the most patterns of lung lesions. Among initial clinical and laboratory findings, anosmia (P = 0.01), respiratory rate (RR) with a cut point of 25 (P = 0.001), C-reactive protein (CRP) with a cut point of 90 (P = 0.002), white Blood Cell (WBC) with a cut point of 10,000 (P = 0.009), and SpO2 with a cut point of 93 (P = 0.04) was associated with higher chest CT score. Lung involvement and consolidation lesions on chest CT scans were also associated with a more extended hospitalization and recovery period. Conclusions Initial assessment of COVID-19 patients, including symptoms, vital signs, and routine laboratory tests, can predict the severity of lung involvement and unfavorable outcomes.