Abnormal Chest Computed Tomography Findings Research Articles

Corticosteroid treatment for persistent pulmonary infiltrates following COVID-19 infection: Clearing the fog?

Systemic corticosteroids have been shown to improve outcomes in severe coronavirus disease 2019 (COVID-19) pneumonia; however, their role in post-COVID-19 persistent lung abnormalities is not well defined. Here, we describe our experience with corticosteroids in patients with persistent lung infiltrates following COVID-19 infection. What is the efficacy of systemic corticosteroids in improving lung function and radiological abnormalities in patients following COVID-19 pneumonia? This is a single-center retrospective study evaluating patients with persistent respiratory symptoms and abnormal chest computed tomography findings. Patients were divided into two groups based on treatment with corticosteroids: "steroid group" and "nonsteroid group." Clinical data were collected from the electronic medical records. Between March 2020 and December 2021, 227 patients were seen in the post-COVID-19 pulmonary clinic, of which 75 were included in this study. The mean age was 56 years, 63% were female, and 75% were white. The main physiologic deficit was reduced Diffusing capacity of the Lungs for Carbon Monoxide (DLCO) at 72% (±22). On chest imaging, the most common findings were ground-glass opacities (91%) and consolidation (29%). Thirty patients received corticosteroid (steroid group) and 45 did not (nonsteroid group). Patients treated with corticosteroids had lower DLCO (DLCO [%]: steroid group 63 ± 17, nonsteroid group 78 ± 23; P = 0.005) and all had ground-glass opacities on imaging compared to 84% in the nonsteroid group (P = 0.04). At follow-up, patients in the steroid group (n = 16) had a significant improvement in spirometry and DLCO. In addition, there was a significant improvement with resolution of ground-glass opacities in both the groups (P < 0.05). The use of systemic corticosteroids in patients with persistent respiratory symptoms and radiological abnormalities post-COVID-19 was associated with significant improvement in pulmonary function testing and imaging. Prospective studies are needed to confirm whether these findings are the effect of corticosteroid therapy or disease evolution over time.

Screening Chest CT Prior to Allogenic Hematopoietic Stem Cell Transplantation

Pulmonary complications constitute a major cause of morbidity and mortality in the post-allogenic hematopoietic stem cell transplant (alloHSCT) period. While Chest X-ray (CXR) is customarily used for screening, we have utilized chest computed tomography (CT). To characterize the prevalence of abnormalities and explore their impact on alloHSCT eligibility and outcomes post-transplant, we conducted a retrospective analysis utilizing real-world data collected at our center for adult patients who were evaluated for alloHSCT from January 2013 through December 2020 and identified 511 eligible patients. The most common primary disease was acute myeloid leukemia in 49% of patients, followed by myelodysplastic syndrome in 23%, lymphoma in 11%, and acute lymphocytic leukemia in 10%. Abnormal screening chest CT was found in 199 patients (39%). The most frequent detected abnormality was pulmonary nodule in 78 patients (35%), followed by consolidation in 42 (19%), ground-glass opacification in 33 (15%), bronchitis and bronchiolitis in 25 (11%), pleural effusions in 14 (6%), and new primary cancer in 7 (2%). CXR detected abnormalities in only about half of the patients (48%) with an abnormal chest CT. Among 199 patients with abnormal chest CT, 98 patients (49%) underwent further assessment and/or intervention before transplant. The most common work up was pulmonary consultation in 32%, infectious diseases consultation in 24%. Lung biopsy was obtained in 20% and antimicrobial therapy was initiated after confirming an infection diagnosis in 20% of patients. Patients with abnormal chest CT demonstrated worse overall survival (P= 0.032), non-relapse mortality (P=0.015), and pulmonary related death (P < 0.001) compared to those who had normal chest CT. Our study suggests that pre-transplant screening chest CT is beneficial in uncovering invasive infections and underlying malignancies and allows appropriate interventions before alloHSCT to prevent potentially serious post-transplant complications without causing a delay in alloHSCT. Nevertheless, abnormal CT findings prior to transplant may be associated with overall worse prognosis.

1369. Ten Year Trends of Typhus Fever in North Texas: Epidemiologic Characteristics and Clinical Manifestations

Abstract Background Murine Typhus remains endemic in southern California and in southern Texas where it is transmitted by fleas, with opossums serving as the amplifying host. In Texas, the disease is increasingly recognized in municipalities outside its historic rural range and is spreading in a northward distribution. Since its expansion, we have observed increased cases in the Dallas-Fort Worth (DFW) area and aim to describe murine typhus in North Texas from 2011-2021. Methods Leveraging the electronic health record, we retrospectively identified 482 individuals tested for murine typhus by Rickettsia typhi (R. typhi) serology in 2 Dallas hospitals. We subsequently collected epidemiologic characteristics, clinical features, and outcomes of 58 patients with positive R. typhi serologies ( &amp;gt;1:64). Results Of the 58 patients with positive R. typhi serology, 39 (67%) were male, 45 (78%) were White, and 23 (40%) were Hispanic. Seventy-nine percent had symptom onset between May and November, and 36/58 (62%) were diagnosed in 2020 and 2021. Twenty-six (45%) had exposure to dogs, 18 (31%) to cats, and 13 (22%) to opossums. Twelve (21%) patients were immunocompromised. Fifty-two (90%) had fever, 35 (60%) headache, 26 (45%) nausea and vomiting, 26 (45%) rash, 25 (43%) myalgia, 20 (34%) cough, and 17 (29%) abdominal pain. In 2020 and 2021, 35/36 (97%) patients were additionally tested for COVID-19, and 29/35 (83%) patients had more than one negative SARS-CoV-2 test prior to R. typhi serologies being sent. Twenty-one out of fifty (42%) had an abnormal chest x-ray (CXR) and 28/30 (93%) had an abnormal chest computed tomography (CT). Nine (16%) had hypoxia, 9 (16%) required an intensive care unit, and 3 (5%) required mechanical ventilation. No patients died within 30 days of diagnosis. Conclusion Our study highlights the expansion of murine typhus in North Texas (Figure 1) and demonstrates the heightened need for clinicians to be aware of this disease in the appropriate epidemiologic and clinical settings. We also describe increasing rates of respiratory findings, demonstrated through over half of patients having at least one respiratory symptom, and 93% having an abnormal chest CT (findings traditionally associated with severe disease). Figure 1:Heatmap Distribution of Murine Typhus Cases in the Dallas-Fort Worth Metroplex (2011-2021) Disclosures Christoph U. Lehmann, MD, FAAP, FACMI, FIAHSI, Celanese: Stocks/Bonds|Markel: Stocks/Bonds|Springer: Honoraria Helen L. King, MD, Gilead Sciences: Grant/Research Support.

Abnormal Chest Computed Tomography Findings among Admitted Symptomatic COVID-19 Patients in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

COVID-19 has emerged as a pandemic and has varied clinical presentation. Computed Tomography scans of the chest play an important role in evaluating the lung parenchymal changes and aids in better planning the management of COVID-19 patients. The purpose of this study was to find the prevalence of abnormal chest computed tomography findings among admitted symptomatic COVID-19 patients in a tertiary care centre. This descriptive cross-sectional study was conducted from 25 October 2020 to January 2021 in a tertiary care hospital. Ethical approval was taken from the Institutional Review Committee (Registration number: 348). Convenience sampling method was used. Chest computed tomography findings of the admitted symptomatic COVID-19 patients were evaluated for abnormal findings. Point estimate and 95% Confidence Interval were calculated. Among 153 patients, abnormal chest computed tomography findings were seen in 147 (96.07%) (92.99-99.15, 95% Confidence Interval). The findings of ground-glass opacities with consolidations were seen in 78 (53.06%) patients. The prevalence of abnormal chest findings among symptomatic COVID-19 patients in our study was similar to the studies done in other countries in similar settings. Majority of the symptomatic COVID-19 patients showed abnormal chest computed tomography scan findings in the form of ground glass opacities and consolidations. COVID-19; Nepal; pneumonia; prevalence.

Does the plasma vitamin D level affect the severity of infection in COVID-19 patients of different age groups?

Purpose: SARS-CoV-2 has caused an on-going global pandemic of COVID-19 disease. Vitamin-D has an immunomodulatory effect on the disease by suppressing the adaptive immune system which can lead to a cytokine storm, and boosting the innate immune system. This study evaluated the relationship between both the clinical characteristics of COVID-19 patients and the severity of their infections, and their serum Vitamin D levels. Material and Methods: Forty COVID-19 patients from the period April to July, 2020, and 46 healthy subjects from a similar period in 2019, were included. Serum Vitamin-D level, Clinical findings, comorbidities, chest computed tomography findings, hematological and serum biochemistry analyzes of the patients were evaluated. Results: COVID-19 patients had a significantly lower mean serum 25(OH) Vitamin-D level (12·86 ± 6·27 ng/mL) than healthy subjects (25·4 ± 12·7 ng/mL) (p<<0·001). The prevalence of Vitamin D deficiency in COVID-19 patients was high, not only in the elderly, but also in middle age and young patients. Ground-glass opacification and paving stone sign were the most frequent patterns observed in chest-computed tomography (CT) images. There was a significant negative relationship between Vitamin-D deficiency and C-reactive protein (CRP) level (p=0·0243). In addition, a high CRP level was associated with abnormal CT findings (p=0·001). Conclusion: The authors conclude that determining the Vitamin-D level in COVID-19 patients and administering it at the appropriate dosage can reduce the severity and progression of COVID-19 disease by contributing to the regulation of the cytokine storm and pulmonary inflammatory response.

Fungal biomarker monitoring and CT scans for early detection of invasive fungal disease in neutropenic hematological patients

By using data from the CEDMIC trial (n=413), we conducted a post-hoc analysis of the diagnostic value of biomarker monitoring and chest computed tomography (CT) scans for the early detection of invasive fungal disease (IFD) in neutropenic hematological patients. IFDs were defined in accordance with the EORTC/MSG definition with some modifications. Biomarkers such as Aspergillus galactomannan (GM) and (1→3)-β-D-glucan (βDG) were measured weekly. The positive predictive value (PPV) of GM and βDG in cases of high-risk treatment were 0.70 and 0.69, while those in low-risk treatment were 0.08 and 0, respectively. All of the positive biomarkers that were measured before the development of fever in low-risk treatment were false positives. The proportion of patients who had abnormal chest CT findings was 19% in persistent fever at 4-6 days, 57% at 7 days or later and 36% in recurrent fever. Sixty-nine percent of the patients who had abnormal findings at 7 days or later did not have abnormalities at 4-6 days. Afebrile screening of biomarkers in low-risk treatment is not useful. Chest CT should be reevaluated in persistent fever lasting for 7 days or longer even in patients who did not have abnormalities within 6 days.

Radiological findings in 136 patients suspected of coronavirus disease 2019 (COVID-19)

Purpose: To describe and study the chest computed tomography (CT) and x-ray (CXR) radiological findings in 136 patients with clinical suspicion for COVID-19 infection. Material and Methods: A total number of 136 patients , 84 males and 52 females, aged 21 to 90 years old, who came to the emergency department of our hospital complaining of symptoms similar to Coronavirus disease (COVID-19). After clinical examination and evaluation all these patients underwent PCR Test for COVID-19 and some basic blood tests as well. Since their clinical picture made them suspects for COVID-19 the next step included CXR and CT. The evaluation of CXRs and CTs was performed by three radiologists, without a specific scoring system, in consensus mainly for ground glass opacity (GGO), consolidation, location, lymphadenopathy, pleural effusion and pleural thickening. Results: 66/136 (48.5%) patients were positive to COVID-19, while 70 had negative PCR Test. 52/66 (78.8%) positive patients were over 51 years old (up to 90 years). Radiological findings on chest CT in the 66 positive patients included GGOs (60 cases, 90.9%), while in 6 cases (9.1%) there were no abnormal findings. In most cases (52, 78.8%) the opacities were bilateral and in only 14 cases (21.2%) they were unilateral. GGOs were found mainly in middle and peripheral pulmonary zones, as well as middle and lower lung lobes. Besides GGO, imaging findings commonly included lymphadenopathy (34, 51.5%), pleural effusion and thickening (18, 27.3%). Less frequent findings included crazy paving (10, 15.1 %), septal thickening and lines ( 7 , 10.6 %), air-space consolidation (5, 7.5 %) and reticular pattern (9, 13,6 %). 44/66 (66.7%) positive patients showed abnormal findings on CXR, while 22 (33.3%) had normal CXR. Chest CT in 14/70 (20.0%) negative patients demonstrated lung consolidation and GGO. 54/70 of the negative patients (77.1%) had normal chest x-rays. Conclusions: The majority of patients with positive PCR Test had abnormal findings on CXRs and CT. Abnormal CT findings were mainly bilateral, multi-focal GGO. Abnormal findings in patients with COVID-19 were related to their age, in particular these were milder in younger patients.

Computed tomography features of COVID-19 in children: A systematic review and meta-analysis.

Background:There are few reports on the chest computed tomography (CT) imaging features of children with coronavirus disease 2019 (COVID-19), and most reports involve small sample sizes.Objectives:To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice.Data sources:We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu.Methods:Reports on chest CT imaging features of children with COVID-19 from January 1, 2020 to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software.Results:Thirty-seven articles (1747 children) were included in this study. The heterogeneity of meta-analysis results ranged from 0% to 90.5%. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8%–70.6%), with a rate of 61.0% (95% CI: 50.8%–71.2%) in China and 67.8% (95% CI: 57.1%–78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7%–48.3%), multiple lung lobe lesions was 65.1% (95% CI: 55.1%–67.9%), and bilateral lung lesions was 61.5% (95% CI: 58.8%–72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported 3 cases of white lung, another reported 2 cases of pneumothorax, and another 1 case of bullae.Conclusions:The lung CT results of children with COVID-19 are usually normal or slightly atypical. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool.

Epidemiological characteristics and clinical manifestations of pediatric patients with COVID-19 in China: A multicenter retrospective study.

ABSTRACTImportanceThe Coronavirus disease 2019 (COVID‐19) global pandemic poses a considerable challenge for pediatricians.ObjectiveThis study aimed to identify the epidemiological characteristics and clinical features of pediatric patients with COVID‐19 in China.MethodsThis multicenter retrospective study included pediatric patients from 46 hospitals in China, covering 12 provinces and two municipalities. Epidemiological, demographic, clinical, laboratory, treatment, and outcome data were analyzed.ResultsIn total, 211 pediatric patients with COVID‐19 were included in this study. The median age was 7.0 years (range: 22 days to 18 years). Approximately 16.3% of the patients exhibited asymptomatic infections, 23.0% had upper respiratory tract infections, and 60.7% had pneumonia, including two with severe pneumonia and one with critical illness. Approximately 78.7% of the pediatric patients occurred in familial clusters. The most three common symptoms or signs at onset in children with COVID‐19 were fever (54.5%), cough (49.3%), and pharyngeal congestion (20.8%). Only 17.6% of the patients presented with decreased lymphocyte count, whereas 13.6% had increased lymphocyte count. Among the patients with pneumonia who exhibited abnormal chest computed tomography findings, 18.2% (23/127) of the patients had no other symptoms. Generally, the chest radiographs showed abnormalities that affected both lungs (49.6%); ground‐glass opacity (47.2%) was the most common manifestation. The cure and improvement rates were 86.7% (183/211) and 13.3% (28/211), respectively. Only one patient with an underlying condition received invasive mechanical ventilation; none of the patients died.InterpretationSimilar to adults, children of all age groups are susceptible to COVID‐19. Fortunately, most pediatric patients have mild symptoms or remain asymptomatic, despite the high incidence of pneumonia. Decreased proportions of white blood cells and lymphocytes are less frequent in children than in adults.

Utility of Computed Tomography for the Diagnosis of Invasive Aspergillosis in Hematological Malignancy

Background: Pulmonary computed tomography (CT) scans are commonly used as part of the clinical criteria in diagnostic workup of invasive aspergillosis (IA). Other criteria for diagnosing IA include a combination of host, clinical and mycological factors, such as those recommended in the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. Chest CT criteria include dense, well-circumscribed lesions(s) with or without a halo sign, air-crescent sign, or cavity. We assessed the diagnostic utility of these findings at baseline in a cohort of patients with hematological malignancy and suspected IA who received antifungal treatment.Material/methods: This post hoc analysis assessed data from a prospective, multicenter international trial of voriconazole (with and without anidulafungin) in patients with suspected (possible, probable, or proven using 2008 EORTC/MSG criteria) IA (NCT00531479). Patients who had received at least one dose of study drug and who had at least one CT scan with a description of ‘lung’ at baseline were included in this analysis. Patient records as provided by the investigators were retrospectively reviewed in a blinded manner to identify physician notes describing the presence of observable lesions or abnormalities on CT scan at baseline. The presence of IA was subsequently evaluated to confirm the infection. Patients with proven or probable IA were termed ‘confirmed’ (cIA) and all others as ‘non-confirmed’ (nIA). This assessment was in accordance with 2008 EORTC/MSG criteria, and conducted by an independent review committee.Results: Of 395 patients included, 240 patients (60.8%) were classified as cIA and 155 patients (39.2%) as nIA. Baseline characteristics were comparable between cIA and nIA groups: the mean age was 52.3 years vs 50.5 years, 56.3% vs 60.0% were male, and 71.7% vs 71.0% were white, respectively. The most commonly reported CT scan abnormalities at baseline were pulmonary nodules (46.8% of all patients; Table 1), bilateral lung lesions (37.5%), unilateral lung lesions (28.4%), and consolidation (24.8%). Abnormalities associated with subsequent confirmation of IA were ground-glass attenuation (cIA: 24.2%; nIA: 11.6%; p <0.05) and pulmonary nodules (cIA: 52.5%; nIA: 38.1%; p <0.05). Bilateral lung lesions were more common in cIA (41.3%) than in nIA (31.6%) patients, but this did not reach statistical significance (p=0.0561). No other CT scan abnormality appeared to be associated with confirmation of IA.Conclusions: Generally, chest CT scan abnormalities (including halo signs and air crescent signs) at baseline in patients with hematological malignancy and suspected IA based on the EORTC/MSG criteria were not associated with subsequent confirmation of IA. However, ground-glass attenuation, nodules and, to a lesser degree, bilateral lung lesions were associated with subsequent confirmation of IA. It should be considered that patients with possible IA and abnormal chest CT findings may have had the infection, even if further investigation failed to upgrade the diagnosis to proven/probable; this could result in an underestimation of the discriminative value of chest CT. These findings suggest that chest CT should be interpreted in conjunction with other available clinical data to guide management decisions on individual patients, including whether treatment is reasonable, pending full evaluation. Caution must be taken given this is a post-hoc analysis of a randomized, controlled, prospective trial; further confirmative studies are warranted. [Display omitted] DisclosuresLiu:Pfizer Inc, Beijing: Employment. Pan:Pfizer Inc, Beijing: Employment. Yan:Pfizer Inc, New York: Employment. Aram:Pfizer Inc, New York: Employment. Zhang:Pfizer Inc, Beijing: Employment.

Clinical, laboratory, and chest CT features of severe versus non-severe pediatric patients with COVID-19 infection among different age groups

BackgroundThis study was performed with the intention of comparing the clinical, laboratory, and chest computed tomography (CT) findings between severe and non-severe patients as well as between different age groups composed of pediatric patients with confirmed COVID-19.MethodThis study was carried out on a total of 53 confirmed COVID-19 pediatric patients who were hospitalized in Namazi and Ali Asghar Hospitals, Shiraz, Iran. The patients were divided into two severe (n = 27) and non-severe (n = 28) groups as well as into other three groups in terms of their age: aged less than two years, aged 3–12 years and 13–17 years. It should be noted that CT scans, laboratory, and clinical features were taken from all patients at the admission time. Abnormal chest CT in COVID-19 pneumonia was found to show one of the following findings: ground-glass opacities (GGO), bilateral involvement, peripheral and diffuse distribution.ResultFever (79.2%) and dry cough (75.5%) were the most common clinical symptoms. Severe COVID-19 patients showed lymphocytosis, while the non-severe ones did not (P = 0.03). C-reactive protein (CRP) was shown to be significantly lower in patients aged less than two years than those aged 3–12 and 13–17 years (P = 0.01). It was shown also that O2 saturation experienced a significant increase as did patients’ age (P = 0.01). Severe patients had significantly higher CT abnormalities than non-severe patients (48.0% compared to 17.9%, respectively) (P = 0.02).ConclusionLymphocytosis and abnormal CT findings are among the factors most associated with COVID-19 severity. It was, moreover, showed that the severity of COVID-19, O2 saturation, and respiratory distress were improved as the age of confirmed COVID-19 pediatric patients increased.

Can laboratory findings predict pulmonary involvement in children with COVID-19 infection?

BackgroundStudies investigating clinical and imaging findings of coronavirus disease 2019 (COVID‐19) pneumonia and predictors for lung injury mostly focus on adults. In this study, we aimed to evaluate the role of laboratory findings in predicting lung involvement in children with COVID‐19.MethodsChildren with COVID‐19 confirmed by reverse‐transcription polymerase chain reaction or COVID‐19 IgM and who underwent chest computed tomography (CT) scans were reviewed retrospectively. Admission absolute neutrophil count (ANC), absolute lymphocyte count (ALC), ANC/ALC ratio, platelet count, d‐dimer, fibrinogen, ferritin, procalcitonin, C‐reactive protein (CRP), and lactate dehydrogenase levels were compared in patients with normal and abnormal CT scans.ResultsA total of 101 children were included. Among the patients, 68 (67.3%) had normal CT scans, and 33 (32.7%) had pulmonary involvement. The median CRP, ferritin, and fibrinogen levels were significantly higher in children with abnormal CT findings. The model of binary logistic regression based on the presence of cough, shortness of breath, fibrinogen, ferritin, and CRP levels showed that the possibility of having abnormal CT was 1.021 times more likely for every one unit increase in fibrinogen levels.ConclusionFibrinogen might be useful to predict pulmonary involvement of COVID‐19 in children. Restricting radiological imaging to patients with significant symptoms and high fibrinogen levels might be helpful in children with COVID‐19 infections.

Post-discharge chest CT findings and pulmonary function tests in severe COVID-19 patients

PurposeTo evaluate chest computed tomography (CT) and pulmonary function test (PFT) findings in severe COVID-19 patients after discharge and correlate CT pulmonary involvement with PFT results. MethodsCOVID-19 patients admitted to our hospital between February 25 and May 2, 2020, were retrospectively included according to the following criteria: (a) COVID-19 defined as severe based on the WHO interim guidance (i.e., clinical signs of pneumonia plus respiratory rate > 30 breaths/min, severe respiratory distress, and/or SpO2 < 90 % on room air); (b) chest radiograph in the acute setting; (c) post-discharge unenhanced chest CT; and (d) post-discharge comprehensive PFT. Imaging findings were retrospectively evaluated in consensus by two readers, and volume of abnormal lung was measured on CT using 3D Slicer software. Differences between demographics, comorbidities, acute radiographic findings, PFT, and post-discharge clinical and laboratory data of patients with normal and abnormal CT findings were assessed by Mann-Whitney or Fisher tests, and the compromised lung volume-PFT association by Pearson correlation after removing possible outliers. ResultsAt a median of 105 days from symptom onset, 74/91 (81 %) patients had CT abnormalities. The most common CT pattern was combined ground-glass opacity and reticular pattern (46/74, 62 %) along with architectural distortion (68/74, 92 %) and bronchial dilatation (66/74, 89 %). Compromised lung volume had a median value of 15 % [11–23], was higher in dyspneic patients, and negatively correlated with the percentage of predicted DLCO, VA, and FVC values (r = -0.39, -0.5, and -0.42, respectively). These PFT parameters were significantly lower in patients with CT abnormalities. Impairment of DLCO and KCO was found in 12 (13 %) cases, possibly implying an underlying pulmonary vasculopathy in this subgroup of patients. ConclusionsMost severe COVID-19 survivors still had physiologically relevant CT abnormalities about three months after the disease onset, with an impairment of diffusion capacity on PFT. A pulmonary vasculopathy was suggested in a minor proportion of patients.

Clinical Characteristics and CT Findings in 148 Non-COVID-19 Influenza-Like Illness Cases: A Retrospective Control Study.

Background: This study was to collect clinical features and computed tomography (CT) findings of Influenza-Like Illness (ILI) cases, and to evaluate the correlation between clinical data and the abnormal chest CT in patients with the Influenza-Like Illness symptoms.Methods: Patients with the Influenza-Like Illness symptoms who attended the emergency department of The Six Medical Center of The PLA General Hospital from February 10 to April 1, 2020 were enrolled. Clinical and imaging data of the enrolled patients were collected and analyzed. The association between clinical characteristics and abnormal chest CT was also analyzed.Results: A total of 148 cases were enrolled in this study. Abnormalities on chest CT were detected in 61/148 (41.2%) patients. The most common abnormal CT features were as follows: patchy consolidation 22/61(36.1%), ground-glass opacities 21/61(34.4%), multifocal consolidations 17/61(27.9%). The advanced age and underlying diseases were significantly associated with abnormal chest CT.Conclusions: Abnormal chest CT is a common condition in Influenza-Like Illness cases. The presence of advanced age and concurrent underlying diseases is significantly associated with abnormal chest CT findings in patients with ILI symptoms. The chest CT characteristic of ILI is different from the manifestation of COVID-19 infection, which is helpful for differential diagnosis.

Assessment of COVID-19 severity using computed tomography imaging: A systematic review and meta-analysis

Computed tomography (CT) imaging has been reported to be a reliable tool for the evaluation of suspected cases and follow-up of confirmed cases of coronavirus disease 2019 (COVID-19). Despite the generation of a considerable amount of imaging data related to COVID-19, there is a need for an updated systematic review and meta-analysis pertaining to the questions of clinical significance. We aimed to analyze the correlation between abnormal chest CT findings and disease severity in patients with COVID-19. We searched for case series/studies published in the English language until March 24, 2020 that reported the clinical and chest CT imaging features of confirmed cases of COVID-19 in the PubMed database. A total of 208 studies were screened, and 71 were finally included in the meta-analysis. Study characteristics and relative risk (RR) estimates were extracted from each article and pooled using the random-effects meta-analysis model. There were a total of 6406 patients studied in a total of 71 studies; the male to female ratio was 1.08:1, and the mean age was 45.76 years; of these, 2057 patients from 14 studies were categorized into severe (24.3%) and mild (75.7%) disease groups. Imaging features that were more frequently noted in patients with severe disease than in those with mild disease included bilateral lung involvement (88.7% vs. 49.8%), scattered distribution (80.4% vs. 46.5%), multiple lobe involvement (95.7% vs. 59.6%), consolidation (88.3% vs. 60.3%), crazy-paving pattern (45.4% vs. 27.6%), air-bronchogram sign (29.7% vs. 15.1%), interlobular septal thickening (84.2% vs. 55.8%), and subpleural line (36.8% vs. 26.4%) differences between the two disease groups were statistically significant (P < 0.001). For 3778 patients in 29 studies, a significant pooled RR estimate was associated with abnormal chest CT findings in patients with COVID-19 (RR, 5.46%; 95% confidence interval [CI], 3.72%–8.04%; I2 = 86%). Individual assessment of the CT features revealed that a significant pooled RR estimate was associated with pure ground-glass opacity (GGO) (RR, 1.63%; 95% CI, 1.12%–2.38%; I2 = 79%), while lower pooled RR estimates were associated with CT features like crazy-paving pattern (RR, 1.37%; 95% CI, 1.10%–1.71%; I2 = 60%), consolidation (RR, 0.47%; 95% CI, 0.32%–0.7%; I2 = 83.5%), GGO with consolidation (RR, 0.73%; 95% CI, 0.52%–1.02%; I2 = 75%), and air-bronchogram sign (RR, 0.58%; 95% CI, 0.36%–0.96%; I2 = 94%). In conclusion, the number, location, extent, and type of radiological lesions are associated with COVID-19 progression and severity, suggesting the feasibility of using CT imaging in the assessment of disease severity in all age groups and efficient allocation of resources for patient management at the institutional level.

Three-month outcomes of recovered COVID-19 patients: prospective observational study.

Aims:A novel coronavirus SARS-CoV-2 has resulted in an ongoing global pandemic of Coronavirus disease 2019 (COVID-19). However, the outcomes of recovered patients have not been well defined.Methods:This is a prospective observational follow-up study of survivors with COVID-19 from a designated tertiary center in Hefei, China. We examined chest computed tomography (CT) scanning, pulmonary function, 6-min walk distance (6MWD), and 36 item Short Form General Health Survey (SF-36).Results:Among 81 enrolled patients, 62 (77%) patients and 61 (75%) patients, respectively, completed 1-month and 3-month follow-ups. Abnormal CT findings were still present in 73% of patients at 1 month and 54% at 3 months, whereas chest CT scan scores improved progressively at 1-month (5.0 ± 5.1) and 3-month follow up (3.0 ± 4.5) compared with that during hospitalization (11 ± 6.8). Mild restrictive pulmonary impairment was detected in 11% and 10% of patients at 1-month and 3-month follow up, respectively. The 6MWD was 523 ± 77 m in male patients and 484 ± 58 m in female patients, which was significantly lower than in healthy controls (606 ± 68 m, 568 ± 78 m, p < 0.001). SF-36 scores were significantly impaired in the domains of role physical (RP), role emotional (RE), and social functioning (SF) compared with the normal age-matched population. RP was improved at 3-month compared with 1-month follow up in the 41–64 years group (p < 0.01). Multivariable analysis showed that older age (over 40 years) and steroid administration during hospitalization were independently associated with worse chest CT scores at 3-month follow up.Conclusions:At 3 months, chest CT abnormalities were present in one half of COVID-19 survivors and worse chest CT scores were independently associated with older age and steroid administration during hospitalization. Residual pulmonary function impairments were modest, whereas exercise capacity and SF-36 scores were significantly lower than the general population. Support program and further follow-up evaluations may be needed. The reviews of this paper are available via the supplemental material section.

Impact of the COVID-19 epidemic at a high-volume facility in gynecological oncology in Tokyo, Japan: a single-center experience

BackgroundThe number of cases of novel coronavirus disease 2019 (COVID-19) in Japan have risen since the first case was reported on January 24, 2020, and 6225 infections have been reported as of June 30, 2020. On April 8, 2020, our hospital began screening patients via pre-admission reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and chest computed tomography (CT). Although no patients exhibited apparent pneumonia, treatment delay or changes in treatment plans were required for a few patients based on the results of screening tests. During an emerging infectious disease pandemic, the likelihood of being infected, as well as the disease itself, affects clinical decision making in several ways. We summarized and presented our experience.Case presentationAfter the introduction of pre-admission screening, RT-PCR and CT were performed in 200 and 76 patients, respectively, as of June 30, 2020. The treatment of five patients, including two patients with cervical cancer, two patients with ovarian tumors, and one patient with ovarian cancer, was affected by the results. Two asymptomatic RT-PCR-positive patients did not develop COVID-19, but their treatment was delayed until the confirmation of negative results. The other three patients were RT-PCR-negative, but abnormal CT findings suggested the possibility of COVID-19, which delayed treatment. The patients receiving first-line preoperative chemotherapy for ovarian cancer had clinically evident exacerbations because of the treatment delay.ConclusionDuring the epidemic phase of an emerging infectious disease, we found that COVID-19 has several other effects besides its incidence. The postponing treatment was the most common, therefore, treatment of ovarian tumors and ovarian cancer was considered to be the most likely to be affected among gynecological diseases. Protocols that allow for easy over-diagnosis can be disadvantageous, mainly because of treatment delays, and therefore, the protocols must be developed in light of the local infection situation.

Asymptomatic infection by SARS-CoV-2 in healthcare workers: A study in a large teaching hospital in Wuhan, China

ObjectivesTo investigate the proportion and characteristics of asymptomatic infection among healthcare workers (HCWs). MethodsThis study retrospectively investigated 1407 HCWs who were screened for COVID-19 by chest computed tomography (CT) scans and nasopharyngeal swabs for SARS-CoV-2 nucleic acid. Demographics, CT features, nasopharyngeal swabs, baseline symptoms, and laboratory data were collected. ResultsOf 1407 HCWs, 235 had symptoms and 1172 were asymptomatic close contacts, of which, 107 were symptomatic cases and 84 were close contacts who had abnormal CT findings. Of 152 symptomatic individuals and 908 close contacts tested for SARS-CoV-2 nucleic acid, 122 symptomatic cases and 38 close contacts had positive reverse-transcriptase real-time polymerase chain (RT-PCR) test results. The rate of confirmed asymptomatic infections was 4.2% (38/908). Both symptomatic and asymptomatic infected cases had high titrations of specific IgG or had ≥four-fold increase in IgG during convalescence compared with the acute phase. Combining the RT-PCR tests and serological findings, the rate of asymptomatic infections was 9.7% (88/908). In terms of the duration of viral shedding, there was no significant difference between symptomatic mild/moderate participants and asymptomatic infections. ConclusionsThe findings demonstrated that a high rate of asymptomatic SARS-CoV-2 carriers existed among healthcare worker close contacts during the outbreak of COVID-19.

Computed Tomography (CT) Imaging Features of Patients with COVID-19: Systematic Review and Meta-Analysis.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious disease, and its first outbreak was reported in Wuhan, China. A coronavirus disease (COVID-19) causes severe respiratory distress (ARDS). Due to the primary involvement of the respiratory system, chest CT is strongly recommended in suspected COVID-19 cases, for both initial evaluation and follow-up. Objective The aim of this review was to systematically analyze the existing literature on CT imaging features of patients with COVID-19 pneumonia. Methods A systematic search was conducted on PubMed, Embase, Cochrane Library, Open Access Journals (OAJ), and Google Scholar databases until April 15, 2020. All articles with a report of CT findings in COVID-19 patients published in English from the onset of COVID-19 outbreak to April 20, 2020, were included in the study. Result From a total of 5041 COVID-19-infected patients, about 98% (4940/5041) had abnormalities in chest CT, while about 2% have normal chest CT findings. Among COVID-19 patients with abnormal chest CT findings, 80% (3952/4940) had bilateral lung involvement. Ground-glass opacity (GGO) and mixed GGO with consolidation were observed in 2482 (65%) and 768 (18%) patients, respectively. Consolidations were detected in 1259 (22%) patients with COVID-19 pneumonia. CT images also showed interlobular septal thickening in about 691 (27%) patients. Conclusion Frequent involvement of bilateral lung infections, ground-glass opacities, consolidation, crazy paving pattern, air bronchogram signs, and intralobular septal thickening were common CT imaging features of patients with COVID-19 pneumonia.

Characterization of an Asymptomatic Cohort of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infected Individuals Outside of Wuhan, China.

PurposeWe aimed to further clarify the epidemiological and clinical characteristics of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.MethodsWe identified close contacts of confirmed coronavirus disease 2019 (COVID-19) cases in northeast Chongqing, China, who were confirmed by real-time reverse transcription polymerase chain reaction-positive (RT-PCR+). We stratified this cohort by normal vs abnormal findings on chest computed tomography (CT) and compared the strata regarding comorbidities, demographics, laboratory findings, viral transmission and other factors.ResultsBetween January 2020 and March 2020, we identified and hospitalized 279 RT-PCR+ contacts of COVID-19 patients. 63 (23%) remained asymptomatic until discharge; 29 had abnormal and 34 had normal chest CT findings. The mean cohort age was 39.3 years, and 87.3% had no comorbidities. Mean time to diagnosis after close contact with a COVID-19 index patient was 16.0 days, and it was 13.4 days and 18.7 days for those with abnormal and normal CT findings, respectively (P < .05). Nine patients (14.3%) transmitted the virus to others; 4 and 5 were in the abnormal and normal CT strata, respectively. The median length of time for nucleic acid to turn negative was 13 days compared with 10.4 days in those with normal chest CT scans (P < .05).ConclusionsA portion of asymptomatic individuals were capable of transmitting the virus to others. Given the frequency and potential infectiousness of asymptomatic infections, testing of traced contacts is essential. Studies of the impact of treatment of asymptomatic RT-PCR+ individuals on disease progression and transmission should be undertaken.