Atypical Course Research Articles

Treatment alternatives for amyopathic MDA5-positive dermatomyositis

We report acase of an atypical course of therapy in amyopathic MDA5-antibody-positive dermatomyositis with interstitial lung disease. Due to the poor prognosis, early therapy with cyclophosphamide followed by rituximab was carried out initially in addition to the administration of prednisolone. Due to therapy failure, treatment was switched to mycophenolate mofetil. This showed asurprisingly rapid positive course in terms of interstitial lung disease, skin manifestation, and general disease activity.

Topical glucocorticosteroids: from high clinical efficacy to the problem of uncontrolled use (case report)

Due to their pronounced biological activity, glucocorticosteroids are widely used in various fields of medical practice. The variety of effects of these hormones makes them an important part of the treatment of dermatological patients. This group of drugs has a pronounced positive effect on various links in the pathogenesis of many chronic dermatoses due to anti-inflammatory, vasoconstrictive, immunosuppressive and antiproliferative effects. The creation of combined external preparations containing a glucocorticosteroid in combination with an antibacterial and/or antifungal component has become a significant achievement in dermatological practice. Due to the rapid relief of signs of inflammation, as well as additional antibacterial and antifungal effects, these external agents have become especially attractive to patients. Widespread advertising and over-the-counter sale of drugs containing glucocorticosteroids leads to the fact that a significant part of patients seek advice from a dermatologist only after their ineffective use. At the same time, their uncontrolled use can lead to a number of side effects, including both pathological changes in the skin and pronounced negative systemic reactions. This fact significantly changes the clinical picture of the disease, limits the possibilities of early laboratory diagnosis of infection, which often prolongs the time for verification of the diagnosis and complicates therapy. The article presents our own clinical observations of patients with skin mycoses who have been using combined topical preparations containing glucocorticosteroids for a long time. This led to an atypical clinical course of the infection and required additional diagnostics using histological examination. The analysis of clinical observations is intended to focus the attention of primary care physicians on this problem, which can increase patient awareness of the risks of using topical drugs containing glucocorticosteroids.

The azygos lobe, an incidental finding in computer tomography.

The azygos lobe is an anatomical variant of the upper lobe, which occurs most often in the right lung. Atypical course of the azygos vein is formed during embryogenesis, while the precursor of this vein migrates through the lung and creates the azygos fissure. Despite its rare occurrence, this variation is well described. This article presents a case of 62-year-old male with the azygos lobe, which was found accidentally in the computer tomography. The knowledge about the azygos vein is significant for surgeons, because it might reduce iatrogenic damage and help them avoid unexpected bleeding during thoracic surgery. The azygos vein might be confused with pathological conditions. It might also be associated with lung cancers, pneumothorax and congenital abnormalities. Despite the fact that the azygos lobe is well known variant, dissemination of knowledge about it is still inadequate.

Extensive metastatic ependymoma with long-term progression-free survival with capecitabine plus temozolomide combination chemotherapy: A case report

ABSTRACT We wanted to present a rare case of metastatic grade 2 spinal ependymoma with an atypical course at the time of diagnosis. Temozolomide plus capecitabine chemotherapy was started in May 2018 on a 30-year-old female patient with sacral ependymoma who had extensive lung metastases at the time of diagnosis. The patient remained in remission for approximately 29 months, and the current chemotherapy was continued until it progressed in November 2020. According to this case report, a combination of temozolomide and capecitabine may be the best treatment option for ependymoma patients.

Chronic Rhinosinusitis with Nasal Polyposis in an Adult with Homozygous Variants of Uncertain Significance in ABCA3 Gene

IntroductionThe role of surfactant proteins in pulmonary diseases has been studied extensively. However, little is known about its contribution in diseases involving the nasal mucosa. Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common disease characterized by persistent inflammation of the nasal passage and paranasal sinuses. We present a case of CRSwNP and interstitial lung disease (ILD) with variants of uncertain significance (VUS) in adenosine triphosphate binding cassette subfamily A member 3 (ABCA3) identified as potential genetic etiology. Case DescriptionPatient was a 42-year-old female with chronic obstructive pulmonary disease (COPD) with oxygen-dependance, bronchiectasis, history of hospitalization for bronchiolitis obliterans organizing pneumonia (BOOP) in infancy, who presented for evaluation of CRSwNP and anosmia. Nasal polyps were first discovered around three years of age, requiring more than 25 nasal polypectomies in her lifetime. Evaluation for cystic fibrosis during childhood was unremarkable. She reported only one episode of wheezing and denied aspirin sensitivity. Despite her significant history of BOOP in infancy, the patient remained without pulmonary infections until four years prior to presentation. Since then, she had two episodes of pneumonia and was diagnosed with COPD, leading to chronic oxygen use. Recent spirometry showed severe airflow obstruction, hyperinflation and decreased diffusing capacity for carbon monoxide. Chest CT revealed diffuse bronchiectasis, mucous plugging, and mild ground glass opacity. Patient had negative sweat test and normal alpha-1 antitrypsin level. Genetic testing with Invitae PCD panel and Neonatal Respiratory Distress panel revealed homozygous VUS [c.155C>T (p. Pro52Leu)] in ABCA3 gene. ConclusionOur patient had an atypical course of ILD, remaining asymptomatic most of her life, and CRSwNP. ABCA3 variants are associated with autosomal recessive pulmonary diseases, such as pulmonary surfactant metabolism dysfunction, pediatric ILD and pulmonary fibrosis1. Surfactant phospholipids are known to lower the surface tension in the alveoli, but they also decrease mucus viscosity and help to eliminate inhaled pathogens2,3,4. The pathophysiology of CRSwNP is unclear and the clinical phenotype of the disease varies widely. While the pathogenicity of the variant is not defined, this case raises a possibility that patient’s ABCA3 genotype may contribute to CRSwNP with recalcitrant nasal polyps.

Atypical course of parvovirus B19 infection with combined infection (clinical observation)

The article describes a clinical case of atypical severe course of parvovirus B19 infection, similar in its manifestations to meningococcal infection, with combined infection with Meningococcus, Hemophilus bacillus, influenza A virus. A patient hospitalized with acute respiratory disease and toxicoderma had new symptoms within 24 hours: headache, hemorrhagic rash, decrease in blood pressure to 80/50 mm Hg, fever up to 39.8 0C. Based on the symptoms, a preliminary clinical diagnosis was made: “Meningococcal infection, generalized form – meningococcemia, severe course. Infectious-toxic shock of the 2nd degree.” During laboratory examination of clinical samples of the patient by bacteriological, serological and molecular genetic methods, there was no growth of bacterial microflora in liquor, blood and smears from the pharynx and nose. Genetic material (DNA and RNA) of Neisseria meningitides, Haemophilus influenza and influenza A/H3N2 was detected in a smear from the nasal cavity. At the same time, parvovirus B19 DNA was isolated in the patient’s cerebrospinal fluid and blood in a high viral load (Ct 21.1 and Ct 4.9, respectively). The patient was found to have not only IgG, but also IgM antibodies to parvovirus B19, which is a confirmation of acute parvovirus B19 infection. A pronounced allergic reaction was confirmed by a high index of total IgE (1068 units/ml). Thus, we have described an atypical case of laboratoryconfirmed parvovirus B19 infection in the presence of bacterial-viral mixed infection and an allergic reaction in the patient.

Atypical Course of Hereditary Spherocytic Anemia With Severely Elevated Liver Enzymes

Atypical Course of Hereditary Spherocytic Anemia With Severely Elevated Liver Enzymes

КЛИНИЧЕСКИЙ СЛУЧАЙ «ЛОНГ-КОВИДА» С ПОРАЖЕНИЕМ ЭНДОКРИННОЙ, СЕРДЕЧНО-СОСУДИСТОЙ И ЛЕГОЧНОЙ СИСТЕМ

Introduction. Coronavirus infection caused by the SARS-CoV-2 virus is characterized by a large range of clinical manifestations, which is associated with the presence of angiotensin-converting enzyme-2 receptors in many organs and tissues of the body. Subacute thyroiditis induced by COVID-19 is difficult to recognize due to the frequent absence of classical symptoms of thyroiditis. Aim. Demonstrate the features of the clinical course of a new coronavirus infection complicated by subacute thyroiditis and pericarditis in the distant period. Material and Methods. A clinical case of patient K., 56 years old, with damage to the pulmonary, cardiovascular and endocrine systems as a result of a new coronavirus infection was presented. Results and discussion. Subacute thyroiditis as a result of SARS-CoV-2 infection may have an atypical course. A pathognomonic feature of subacute thyroiditis is the high rate of erythrocyte sedimentation. The treatment of subacute thyroiditis in most cases requires the prescription of glucocorticoids. In some patients, prescribing nonsteroidal anti-inflammatory drugs may be sufficient to relieve symptoms. There was no clear association of cardiovascular symptoms in long-term COVID-19 with pre-existing cardiovascular pathology.. Conclusion. In the case of subacute thyroiditis developed as a result of SARS-CoV-2 infection, it is necessary to prescribe anti-inflammatory therapy in a timely manner. From a practical point of view, it is important to recognize cardiorespiratory symptoms in time as a non-specific manifestation of the long-term COVID-19 syndrome and the manifestation of cardiovascular pathology.

Histopathology in the Diagnosis of Tinea Capitis: When to Do, How to Interpret?

The diagnosis of tinea capitis is usually made by clinical signs and direct microscopic examination. Early diagnosis of this dermatophytic infection, which may cause permanent hair loss if not treated appropriately, is very crucial. In recent years, the use of dermoscopy has helped with early diagnosis. However, when tinea capitis has an atypical course and develops in adulthood, it can be confused with several diseases, such as psoriasis, seborrheic dermatitis, folliculitis decalvans, acne keloidalis, and dissecting cellulitis. Due to the different treatment approaches and prognoses, it is important to distinguish tinea capitis from invasive dermatoses on the scalp. In this article, histopathological findings of tinea capitis and several advantages and disadvantages of histopathology in the diagnosis of fungal infections are also reviewed and updated.

Difficulties in the Diagnosis of Fibrinogen Aα-Chain Amyloidosis—Literature Review and Case Report of a Patient After Kidney Transplantation

Amyloidosis is a very heterogeneous disease. Correct diagnosis is extremely important because of the various treatment options for different types of amyloidosis. This study presents a case report and literature review of the misdiagnosis of fibrinogen Aα-chain amyloidosis (AFib amyloidosis). We report a 65-year-old man diagnosed with proteinuria in 2009. The kidney biopsy revealed the presence of Congo red-stained amyloid deposits. During differential diagnosis, amyloid deposits were discovered in adipose tissue and gingiva. Bone marrow trephine biopsy showed a predominance of lambda chains presenting plasmocytes. Based on performed medical examination, light chain amyloidosis was identified. Therefore, the patient received high-dose melphalan and underwent successful autologous peripheral blood stem cell transplantation. However, proteinuria, worsening of the kidneys' function, and incorrect levels of free light chains were still observed. In 2019, due to continuous treatment failure, a previously acquired kidney biopsy was examined by mass spectrometry, and numerous fibrinogen deposits were identified. Recommended DNA analysis revealed that the patient had AFib amyloidosis. Therefore, chemotherapy treatment was abandoned, and successful kidney transplantation was performed. Today, it is essential for medical practitioners to remember the possibility of rare and hereditary types of amyloidosis. There are multiple cases where a diagnosis was wrong or delayed because of the atypical course of the disease, the coexistence of another disease, and the rarity of AFib amyloidosis, and all of these reasons may result in the wrong treatment that will delay the right therapy. However, with the new, more precise diagnostics methods, such situations will become rare.

Psychiatric Symptoms & Misdiagnosis Of Frontotemporal Dementia: A Case Report

IntroductionFrontotemporal dementia (FTD) is the second most common type of dementia seen between 45-65 years of age and affects the frontal and/or temporal lobes. FTD is clinically characterized by progressively the change in behavior, personality, and language dysfunctions. Clinical features of FTD include restlessness, disinhibition, apathy, blunted affect, avolition, social withdrawal, impulsiveness, and loss of executive function. Most patients with FTD act as socially inappropriate behaviors, not talking much, compulsive-like acts, poor insight, and psychiatric features including hallucinations and paranoid delusions. According to symptoms, the diagnosis of FTD may be confused with depression, mania, or schizophrenia.ObjectivesIn this case report, we wanted to draw attention that FTD should be considered in the differential diagnosis of late-onset psychosis.MethodsA 53-year-old female, married, uneducated, and not having children patient has applied to our clinic with complaints, that started a year ago, about social withdrawal, activity, decreased sense of purpose, neglecting personal hygiene, not eating well, and acting inappropriately and impulsively.The patient reported that she was walking out of the house for hours, having profanity speeches, and forgetfulness.She was admitted to the psychiatry hospital a year ago and discharged with a diagnosis of bipolar disorder.Brain MRI showed atrophy of frontal and anterior temporal structures bilaterally. PET scan demonstrated left frontal, parietal, and temporal hypo perfusion of the brain.In our clinical observation, she had apathy, inappropriate jokes, lack of eye contact, flat affect, lack of gesturing when communicating, unable to respond to questions, and visual hallucinations.ResultsDue to the similarity of the clinical resemblance of BPAD and FTD, the diagnosis of FTD can be confusing. In this case, amnesia and sudden onset of the symptoms with rapid destruction may help the diagnosis of FTD.Psychosis symptoms in our clinical observation also suggested the diagnosis of psychosis. However, its atypical course and early-onset psychosis symptoms brought us closer to organic pathology. Investigations of structural and functional brain imaging may help support the diagnosis.Image:Image 2:ConclusionsPsychiatric symptoms in FTD may cause misdiagnosis. Organic pathologies should be kept in mind, especially in late and sudden onset symptoms.Disclosure of InterestNone Declared

Cyclic Cushing's syndrome: difficulties of diagnostic search and choice of treatment tactics. A clinical case

Cyclic Cushing's syndrome is a pathological condition characterized by alternating periods of excessive cortisol secretion with corresponding clinical manifestations and periods of spontaneous remission of the disease.To diagnose Cyclic Cushing's syndrome it is necessary to record at least three episodes of excessive cortisol secretion alternating with periods of normalization of its production.In most cases, this pathology is diagnosed in patients with ACTH-secreting pituitary tumor, however, there are rare cases of cyclic hypercorticism with ectopic ACTH secretion by tumors of different localization and without verification of pathological hormonal secretion focus. In addition, cyclic hyperproduction of cortisol can be also observed in ACTH-independent Cushing's syndrome associated with the presence of corticosteroma or adrenal hyperplasia. The exact causes and mechanisms of the cyclic hypercorticism are currently insufficiently studied.Due to the atypical course of the disease, the unpredictability of the occurrence of a new «cycle», the variability of its duration and manifestations (not only in different patients, but also in the same patient), verification of the diagnosis and determination of treatment tactics may be difficult in the daily practice of specialists, and the prevalence of this condition can be undervalued.

Diagnosis of an Acute Anterior Wall Infarction in Dual-Energy CT

Due to its high morbidity and mortality, myocardial infarction is the leading cause of death worldwide. Against this background, rapid diagnosis is of immense importance. Especially in case of an atypical course, the correct diagnosis may be delayed and thus lead to increased mortality rates. In this report, we present a complex case of acute coronary syndrome. A triple-rule-out CT examination was performed in dual-energy CT (DECT) mode. While pulmonary artery embolism and aortic dissection could be ruled out with conventional CT series, the presence of anterior wall infarction was only detectable on DECT reconstructions. Subsequently, adequate and rapid therapy was then initiated leading to survival of the patient.

Clinical case of atypical course of Crohn’s disease

Crohn’s disease (CD) is a chronic recurrent inflammatory bowel disease with a wide variety of clinical manifestations – from classical gastrointestinal phenotypes to predominance of extraintestinal symptoms. Atypical course of CD is observed relatively often and is manifested with a damage to almost all body systems, including hepatobiliary, immune, hematopoietic, cardiovascular, nervous, as well as eyes, skin, lungs and kidneys. Atypical manifestation often precedes intestinal, making diagnosis difficult. The presence of various clinical manifestations of CD, often an atypical course, as well as the absence of standardized diagnostic criteria can be an obstacle for physicians in the timely detection of the disease and effective treatment. Aim: to describe a clinical case of a diagnostically difficult patient of our clinic with an atypical course of CD and complications incompatible with life; highlight the problem of monitoring and possible solutions. Results. In the presented clinical case the patient with an atypical course of CD, with the prevailing displays of defeat of nervous and vascular systems is described. During hospitalization, a full range of diagnostic tests was performed, consultations with related specialists were obtained, but no direct data of inflammatory bowel disease were found. At the same time, the impossibility of performing a colonoscopy with a biopsy, due to the severity of the patient’s condition, delayed the timely diagnosis of CD and contributed to the development of complications incompatible with life. The diagnosis was made posthumously. The patient died as a result of intoxication due to the development of complications of CD – perforation of the intestine, intestinal abscess, development of peritonitis, septicemia. Conclusions. In the described clinical case CD is considered as a complex interdisciplinary problem, and emphasizes the importance of doctor’s awareness of the variants of atypical manifestations and course of inflammatory bowel disease, methods for their assessment and ways of effective management. This case also presents the latest epidemiological data on the prevalence of atypical manifestations of CD, identifies key areas of diagnostic search in case of a difficult patient.

A rare bilateral variant of the coracobrachialis muscle with supernumerary heads and coexisted variant branching patterns of the brachial plexus and the axillary artery

PurposeThe study report describes a rare bilateral variant of a six- and five-headed coracobrachialis muscle (CB). The musculocutaneous nerve (MCN) (bilaterally) and the median nerve (MN) lateral root (unilaterally) pierced CB heads, separating superficial from deep heads.MethodsThe variant bilateral CB was identified in a 78-year-old formalin-embalmed male cadaver, derived from a body donation program after a signed informed consent.ResultsAt the right side: The 6-headed CB was pierced by the MCN, while the MN lateral root pierced the one superficial and deep head. CB was supplied by the lateral cord and the MCN. At the left side: A 5-headed CB was identified with three superficial distinct origins that fused into a common superficial head coursing anterior to MCN. The variant CB bilaterally (with 11 heads in total) coexisted with a MN variant formation, an atypical course of the MN lateral root through CB (right side), a connection of the MN lateral root with the MCN (left side) and a variant axillary artery branching pattern (bilaterally).ConclusionsCourse and direction of the accessory CB heads may occasionally entrap the MCN and/or adjacent structures (brachial artery and MN). The MCN compression results in problems in the glenohumeral joint flexion and adduction, and tingling or numbness of the elbow joint, the forearm lateral parts and the hand.

Late-onset periodic catatonia with atypical course: A diagnostic quandary

ABSTRACT We describe a case of late-onset periodic catatonia with atypical course in an elderly male with onset at the age of 70 years with brief episodes of sudden agitation lasting for a few hours of the day, followed by immobility, mutism, ambitendency, withdrawal, and urinary incontinence for the next few days. Four such episodes with complete recovery over the next few days and no residual behavioral symptoms lasting for several years (up to 7 years) without any long-term prophylactic psychotropic use. During the fourth such episode, the patient presented to our facility with a similar abrupt onset of symptoms. All biochemical investigations and neuroimaging findings were found to be noncontributory. On clinical examination, a diagnosis of periodic catatonia was suspected, which was later confirmed by immediate response to the intravenous diazepam challenge given under vitals monitoring in a high-dependency unit setting.

ДРАКУНКУЛЕЗ ЧЕЛОВЕКА - РЕДКИЙ ТРОПИЧЕСКИЙ ГЕЛЬМИНТОЗ

The review presents current data on the epidemiology, diagnosis, interaction between the parasite and the host, the pathology of dracunculiasis with a description of rare cases of atypical course of the disease. The current status and future prospects for vector control and elimination strategies are also described. The information collected in this article is presented to raise the awareness of medical professionals in order to quickly diagnose and effectively treat patients, as well as to prevent invasion of both humans and animals. Key words: dracunculiasis, Guinea worm disease, Dracunculus medinensis, Africa, spirurida, neglected diseases.

Листериозный менингоэнцефалит: особенности течения и диагностики (клиническое наблюдение)

Listeriosis has drawn the attention of doctors and scientists for many years as methods for typing the pathogen (Listeria monocytogenes), diagnosing and preventing the disease are being improved, and the emergence of new foci is being monitored. However, despite the improvement of diagnostic tools, clinicians still face difficulties in identifying listeriosis, partly due to the lack of awareness of this disease among noncore doctors, particularly during the COVID-19 pandemic. The authors describe a 54-year-old woman with severe neurolisteriosis (Listeria meningoencephalitis) after severe COVID-19 infection treated with immunosuppressants (steroids and biological agents). examination for listeriosis is reasonable in patients with an atypical course of bacterial meningitis, untypical abnormalities in the cerebrospinal fluid, and immunocompromised patients who receive immunosuppressants or comorbid patients. This case report highlights the importance of listeriosis awareness for the differential diagnosis of meningitis and meningoencephalitis of various etiologies. KEYWORDS: listeriosis, Listeria monocytogenes, differential diagnosis, bacterial meningitis, neurolisteriosis, listeriosis meningoencephalitis, COVID-19, immunosuppressive therapy. FOR CITATION: Tagirova Z.G., Nagibina M.V., Makashova V.V., Ponezheva Zh.B., Shabalina S.V., Mitrikova L.Ts. Listeria meningoenceph - alitis: specifics of its course and diagnosis (case report). Russian Medical Inquiry. 2023;7(11):766–770 (in Russ.). DOI: 10.32364/2587- 6821-2023-7-11-9.

ЭПИДЕМИОЛОГИЧЕСКИЕ АСПЕКТЫ КОКЛЮША У ДЕТЕЙ

Objective: To analyze the epidemiological aspects of pertussis (whooping cough) in the Astrakhan region among children in the period from 2020 to 2022. Methods: During the observation period, 33 children’s outpatient medical records between 2020 and 2022 from various medical institutions in the Astrakhan region were analyzed. Results: Whooping cough affected children of different ages but was more common in infants (younger than 1 year): 46% (n=15), slightly less common in toddlers and preschoolers (1 to 6 years of age): 42% (n=14), while the rate of school-aged children was the lowest: 12% (n=4). In the Astrakhan region, contrary to the city of Astrakhan, the rate of cases under one year of age was higher: 62% (n=6); followed by children 1 to 6 years of age: 25% (n=2), with rarer cases in the school-aged group: 13% (n=1). Among the examined cases the following symptoms prevailed: spasmodic cough (100%; n=33), weakness (94%; n=31), and nasal congestion (58%; n=19), which are typical for the classic course of whooping cough. An extremely rare symptom among children was tonic-clonic seizures: 6% (n=2). No cases of whooping cough with atypical courses have been recorded in the Astrakhan region. Conclusion: Over the past few years, the epidemiological situation with whooping cough infection among the population of the Astrakhan region tended to improve. Susceptibility to whooping cough was characteristic of all ages, but most often children under one year of age were affected. The clinical course was dominated by classical manifestations of pertussis: spasmodic cough, weakness, and nasal congestion. Important diagnostic criteria were the presence of posttussive vomiting and the absence of fever. The main reason for infection among children was non-vaccination due to various medical circumstances or parental refusal. Keywords: Whooping cough, children, vaccination, vaccination calendar, morbidity.

ХІРУРГІЧНЕ ЛІКУВАННЯ РІДКІСНИХ ЛЕГЕНЕВИХ УСКЛАДНЕНЬ ВИКЛИКАНИХ COVID-19: КЛІНІЧНИЙ ВИПАДОК ГІГАНТСЬКОЇ НЕСПРАВЖНЬОЇ КІСТИ ЛЕГЕНІ, УСКЛАДНЕНОЇ ГЕМАТОМОЮ

A lung cyst is a pathologic cavity filled with air or fluid content. According to the morphological structure, lung cysts are divided into true and false. The former are always congenital, while false lung cysts are acquired. In the population, lung cysts are found in patients of both sexes equally often. According to statistics, about 76 people per 1000 people have a history of lung cysts. With the onset of the COVID-19 pandemic, the widespread use of chest computed tomography (CT) has made it possible to identify a number of pulmonary pathologies, including rare complications of this viral infection. According to the literature, the incidence of pulmonary cysts in the studied patients was 9.0 %. The authors suggest that COVID-19 causes cyst formation in the lungs due to ischemic damage to the parenchyma or vascular occlusion, pulmonary fibrosis. Another cause is blockage of bronchioles by mucus and mucus plugs, accompanied by excessive alveolar distension and, as a result, rupture of the alveolar septum with subsequent formation of small cysts. The article presents our own experience of surgical treatment of rare pulmonary complications caused by COVID-19, namely false giant lung cyst complicated by hematoma. Conclusions. COVID-19 is a relatively new and poorly understood viral lung disease, and therefore each report of its atypical or complicated course will contribute to the systematization of knowledge about this pathology. Key words: COVID-19, VATS, hematoma, cyst, computed tomography