X-ray diagnostics of pneumonia in cancer patients during a pandemic COVID-19. A сase from practice

Abstract

Background. The outbreak of the new coronavirus disease in 2019 (COVID19) has been the largest global health threat in the world, that infected more than 60 million people and killed more than 1,400,000. At the same time, cancer remains a widespread disease, from which more than 9.6 million patients in the world die each year. Accumulating data suggest that cancer patients are at higher risk of infection COVID-19 and severe course of the disease. This is due to immunosuppression, which is due to both the malignant tumor and antitumor therapy. Clinical manifestations of lung damage in cancer patients are not pathognomonic, because they can be caused by any pathological processes: metastatic lesions, inflammatory processes of viral and bacterial etiology, vascular disorders in the small circulation, etc. This requires not only to determine the nature of pathological changes in the lungs, but also to carry out their differential diagnosis in order to prescribe timely and adequate therapy. Purpose – elucidation of the relevance of X-ray diagnosis of pneumonia in cancer patients during the COVID-19 pandemic. Materials and methods. Follow-up of a patient K., 72 years old, who had coronavirus pneumonia along with complications (febrile neutropenia) resulting from chemoteraphy of recurrent endometrial leiomyosarcoma. The treatment was provided on the premises of Clinical Oncology and Hematology Department of State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine». Results and discussion. Over a period of 6 month, the patient was undergoing polychemotherapy (with complications like febrile neutropenia) of recurrent endometrial leiomyosarcoma. The control CT study detected pulmonary involvement. After receiving laboratory confirmation of COVID-19, was treated in the infectious department. The course of the disease was severe. Analyzing this clinical case of a patient with cancer in the process of special treatment, it is impossible to exclude the presence of progression in the lungs or drug pulmonitis. A favorable treatment result (negative PCR test, positive dynamics on CT) proves the non-metastatic nature of lung damage. Conclusions.. Diagnosis of COVID-19 infection should be based on the integrated application of clinical, radiological and laboratory research methods. Chest computed tomography, taking into account its high sensitivity, helps in diagnosis, control of the disease, playing an important role in the differential diagnosis and treatment tactics of COVID-19.