Features of the long-term course of community-acquired viral pneumonia COVID-19 according to computed tomography (clinical cases)

Abstract

Objective — to study the dynamics of pathological changes of lungs in patients with a long course of viral pneumonia of COVID-19 by the analysis of data of a computer tomography (CT) of thoracic organs (ТО).
 Materials and methods. Analyzed in the dynamics of CT of TO patients with changes in the lungs with a long course of community-acquired viral pneumonia COVID-19. Patients were examined at the SI «National Institute of Tuberculosis and Pulmonology F.G. Yanovsky NAMS of Ukraine» (NIFP NAMS) on the CT scanner Aquilion TSX-101A «Tochiba» (Japan), as well as analyzed the archival data of the CT TO.The diagnosis of COVID-19 was established in accordance with the current protocols for the treatment of coronavirus disease «Provision of medical care for the treatment of coronavirus disease (COVID-19)», approved by the Order of the Ministry of Health of Ukraine dated April 2, 2020 N 762 ).
 Results and discussion. CT of TO was analyzed in 120 patients with community-acquired pneumonia of viral etiology (COVID-19), who were examined at various intervals for 6—12 months. It was found that in 30 patients (19 men and 11 women aged 24 to 72 years) with long-term pneumonia (COVID-19), there are significant structural changes in the lung parenchyma that are diagnosed on CT of TO.The ways of regression of the detected changes, as a result of which there is a resorption of pathological changes or the development of «disappearing lung syndrome», requires differential diagnosis and dynamic monitoring with densitometric studies using CT of TO. Clinical cases are given. The first case shows how after a mild acute period of COVID-19, developed more severe Long COVID with a long course of community-acquired viral pneumonia COVID-19. On the first CT of TO «fibrotic-like changes» were revealed, but at the subsequent monitoring (within 8 months) against the background of the carried-out pathogenetic treatment, there was a full restoration of pneumatization of a pulmonary parenchyma without formation of fibrosis. The second case demonstrates how after a severe course of acute COVID-19, developed Long COVID with a long course of community-acquired viral pneumonia COVID-19. The second case demonstrates how after a severe course of acute COVID-19, developed Long COVID with a long course of community-acquired viral pneumonia COVID-19. CT of TO after the acute period of the disease revealed changes that during monitoring (for 7 months) despite the treatment, led to the development of degenerative-destructive changes in the lungs and continue to progress.
 Conclusions. In patients with Long COVID -19 it is advisable to monitor CT of TO. The frequency of the study should be decided personally, taking into account the clinical course of the disease. Due to the high rate of degenerative pulmonary parenchymal COVID-19 viral pneumonia in patients with long-term nosocomial viral pneumonia, new methods of treating patients with «disappearing lung syndrome» need to be developed.