Chest CT Findings Research Articles

Serum D-Dimer Level and Chest CT Scoring in SARS-Cov-2 Virus Patients - It’s Relevance in Prognostication and Severity of the Disease

Background: COVID -19 has wide range of presentation, from asymptomatic infection to severe viral pneumonia and death. D-dimer >1μg/ml is one of the risk factors for mortality. CT chest plays an important role in early detection and monitoring of disease. Objectives: 1. To compare D-dimer value and CT chest findings in Covid-19 patients. 2. To study platelet count, PT, aPTT and CRP in Covid-19 patients. Methodology: RT-PCR confirmed Covid- 19 patients admitted in hospital investigated with D-dimer and CT chest were included in the study. Case details retrieved from medical records. Venous blood collected and plasma processed in coagulation analyser for PT, aPTT, INR and D-dimer. Platelet count was performed using auto analyser. CT findings were retrieved from radiology software (PACS). Statistical tests used were mean, percentage and Fisher’s exact test (SPSS Version 20). Results: During study period of January-June 2021, 38 patients were included. Mean age was 51.1±15.6 years and M:F ratio 2.8:1. 65.8% patients had comorbidities (25/38). D-dimer elevated in 60.5% (23/38) patients. CT showed 10.53%, 28.94%, 60.53% of patients had affected lungs of <15%, 15%-49% and ≥50% of the total area and showed significant association with D- dimer (P=0.018). 17.4% (4/23) patients with elevated D-dimer did not survive. 15.8% (6/38) patients had low platelet, 23.7% (9/38) had abnormal PT, 70.3% had abnormal aPTT and 89.5% (34/38) had elevated CRP. There was no significant correlation between platelet, PT, aPTT, CRP and D-dimer. Conclusion: D-Dimer is elevated in COVID -19 patients and shows significant association with lung involvement and can be used as prognostic marker.

Chest CT Findings in Marijuana Smokers.

Background Global consumption of marijuana is increasing, but there is a paucity of evidence concerning associated lung imaging findings. Purpose To use chest CT to investigate the effects of marijuana smoking in the lung. Materials and Methods This retrospective case-control study evaluated results of chest CT examinations (from October 2005 to July 2020) in marijuana smokers, nonsmoker control patients, and tobacco-only smokers. We compared rates of emphysema, airway changes, gynecomastia, and coronary artery calcification. Age- and sex-matched subgroups were created for comparison with tobacco-only smokers older than 50 years. Results were analyzed using χ2 tests. Results A total of 56 marijuana smokers (34 male; mean age, 49 years ± 14 [SD]), 57 nonsmoker control patients (32 male; mean age, 49 years ± 14), and 33 tobacco-only smokers (18 male; mean age, 60 years ± 6) were evaluated. Higher rates of emphysema were seen among marijuana smokers (42 of 56 [75%]) than nonsmokers (three of 57 [5%]) (P < .001) but not tobacco-only smokers (22 of 33 [67%]) (P = .40). Rates of bronchial thickening, bronchiectasis, and mucoid impaction were higher among marijuana smokers compared with the other groups (P < .001 to P = .04). Gynecomastia was more common in marijuana smokers (13 of 34 [38%]) than in control patients (five of 32 [16%]) (P = .039) and tobacco-only smokers (two of 18 [11%]) (P = .040). In age-matched subgroup analysis of 30 marijuana smokers (23 male), 29 nonsmoker control patients (17 male), and 33 tobacco-only smokers (18 male), rates of bronchial thickening, bronchiectasis, and mucoid impaction were again higher in the marijuana smokers than in the tobacco-only smokers (P < .001 to P = .006). Emphysema rates were higher in age-matched marijuana smokers (28 of 30 [93%]) than in tobacco-only smokers (22 of 33 [67%]) (P = .009). There was no difference in rate of coronary artery calcification between age-matched marijuana smokers (21 of 30 [70%]) and tobacco-only smokers (28 of 33 [85%]) (P = .16). Conclusion Airway inflammation and emphysema were more common in marijuana smokers than in nonsmokers and tobacco-only smokers, although variable interobserver agreement and concomitant cigarette smoking among the marijuana-smoking cohort limits our ability to draw strong conclusions. © RSNA, 2022 See also the editorial by Galvin and Franks in this issue.

Nocardia spp. isolation in chronic lung diseases: Are there differences between patients with pulmonary nocardiosis and Nocardia colonization?

Chronic lung diseases are a recognized risk factor for Nocardia spp. Nocardia spp. isolation does not inevitably imply disease, and thus colonization must be considered. Here, we aimed to analyse the differences between pulmonary nocardiosis (PN) and Nocardia spp. colonization in patients with chronic lung diseases. A retrospective study of patients with laboratory confirmation of isolation of Nocardia spp. in at least one respiratory sample was performed. Patients with PN and Nocardia spp. colonization were compared. There were 71 patients with Nocardia spp. identification, 64.8% were male, with a mean age of 67.7 ± 11.2 years. All patients had ≥1 pre-existing chronic lung disease, and 19.7% of patients were immunocompromised. PN and Nocardia spp. colonization were considered in 26.8% and 73.2% of patients, respectively. Symptoms and chest CT findings were significantly more frequent in patients with PN (p < 0.001). During follow-up time, 12 (16.9%) patients died, 6 in PN group. Immunosuppression, constitutional symptoms, haematological malignancy and PN diagnosis were associated with significantly shorter survival times, despite only immunosuppression (HR 3.399; 95% CI 1.052-10.989) and PN diagnosis (HR 3.568; 95% CI 1.078-11.910) remained associated with a higher death risk in multivariate analysis. PN was associated with clinical worsening, more chest CT findings and worse clinical outcomes. Nocardia spp. isolation in chronic lung disease patients is more common than expected and the differentiation between colonization and disease is crucial.

ODP390 Metastatic Gestational Trophoblastic Neoplasia Masquerading as Thyroid Storm in a Girl with Molar Pregnancy and Hyperthyroidism

Abstract The Case Patient is a 16-year-old female with molar pregnancy, admitted for D&amp;C, referred for hyperthyroidism, concern for thyroid storm. A month prior, she presented with heavy vaginal bleeding, morning sickness. Ultrasound showed blighted ovum. HCG was significantly elevated, 668,123 mIU/mL. TSH was low at 0. 01 mIU/L, Free T4 elevated 2.3 ng/dL. No family history of thyroid dysfunction. She was for was noted to have respiratory distress, hypoxia, and tachycardia in the 120s post-operatively. LFTs normal, no fever, jaundice or CNS manifestations. Chest CT showed bilateral lower lobe localized pulmonary edema concerning for trophoblastic fluid embolism vs thyroid storm. BWPS = 40. She was placed on PTU, beta blockade, Lugol's iodine, and hydrocortisone. Repeat chest CT showed diffuse pulmonary nodules consistent with gestational trophoblastic neoplasm (GTN). No other metastasis on further imaging (chest, abdomen, pelvis, brain). Clinical status improved, FT4 normalized 5 days after starting treatment. TRAbs negative. She was discharged on Methimazole and Atenolol, which were eventually discontinued. HCG levels significantly decreased after D&amp;C but remained detectable on follow-up. Endocervix/uterine curettage showed intraplacental choriocarcinoma arising within a complete hydatidiform mole. She is followed by Oncology and currently undergoing chemotherapy. Discussion HCG-mediated hyperthyroidism include gestational transient thyrotoxicosis, hyperemesis gravidarum, and trophoblastic hyperthyroidism (TH). Due to significant homology between TSH and the beta-subunit of HCG, HCG can cause hyperthyroidism. 2-60% of women with trophoblastic disease may have symptomatic hyperthyroidism at time of diagnosis which can be severe. Patients with GTN (choriocarcinoma in our case) have a higher likelihood of TH, as HCG exceeds 100,000 mIU/mL. Choriocarcinoma is the most aggressive type of GTN characterized by vascular invasion and widespread metastases, of which the most common sites are vagina and lungs. Patients with pulmonary metastasis my present with respiratory distress, chest pain, cough or hemoptysis. Our patient was initially thought to have impending thyroid storm mainly from findings of pulmonary edema, respiratory distress, tachycardia, and precipitant history (D&amp;C), and was managed as such while further workup was being undertaken. Realization that the initial chest CT findings of pulmonary edema were actually related to multiple pulmonary nodules and GTN made thyroid storm less likely. Hyperthyroidism typically resolves with decreasing HCG levels in TH. Indeed, our patient no longer needed ATD once her HCG levels subsided s/p D&amp;C. Conclusion One of the most common sites of metastasis in GTN is the lungs. An acute presentation of respiratory distress and pulmonary findings on chest imaging upon simultaneous discovery of TH may complicate management as thyroid storm needs to be considered. Although a higher index of suspicion for metastatic GTN should be made in this situation, a conservative management approach of treating for possible impending thyroid storm until definitive diagnosis has been established is prudent. Presentation: No date and time listed

Chest CT Findings and SARS-CoV-2 Infection in Trauma Patients-Is There a Prediction towards Higher Complication Rates?

Background: Polytrauma patients with SARS-CoV-2 infections may be associated with an increased complication rate. The main goal of this study was to analyze the clinical course of trauma patients with COVID infection and a positive CT finding. Methods: This was a retrospective in-hospital study. Polytrauma patients diagnosed with SARS-CoV-2 infections were included in our analysis. The outcome parameters were pulmonary complication during admission, pulmonary embolism, pleural effusion, pneumonia, mortality, length of stay and readmission < 30 days. Results: 48 patients were included in the study. Trauma patients in the age-adjusted matched-pair analysis with typical changes in SARS-CoV-2 infection in CT findings showed significantly more pulmonary complications in general and significantly more cases of pneumonia (complications: 56% vs. 11%, p = 0.046; pneumonia 44% vs. 0%, p = 0.023). In addition, the clinical course of polytrauma patients with SARS-CoV-2 infection showed a high rate of pulmonary complications in the inpatient course (53%). Conclusion: The results of our study show that the changes in the CT findings of trauma patients with SARS-CoV-2 infection are a good indicator of further inpatient outcomes. Similarly, polytrauma patients with a SARS-CoV-2 infection and positive CT findings are shown to have increased risk for pulmonary complications.

Temporal changes of lung computed tomography findings pulmonary COVID-19 infection

ObjectivesCOVID-19 infection demonstrates characteristic findings in chest CT. The optimal timing of repeated CT scans still needs to be clarified, and the optimal time to assess imaging clearance in COVID-19 is still unknown. It is crucial to have a roadmap of the imaging course of COVID-19 pneumonia to develop guidelines for prompt diagnosis of pulmonary complications, especially fibrosis, at the earliest stage. PurposeTo assess the temporal changes of chest CT findings in patients with COVID-19 pneumonia and evaluate the rate of a complete resolution and determine the patients are at excessive risk for residual parenchymal abnormalities. Materials and MethodsThis retrospective observational study included 48 patients with real-time polymerase chain reaction–confirmed COVID-19 who were admitted to three academic hospitals. These patients underwent at least one initial chest CT before or after admission and at least one follow-up CT scan four weeks or more after the onset of the symptoms. All chest CTs were categorized according to time of performance into four groups, including the first week, second week, third-fourth week, and more than 28 days. Lung involvement was categorized as predominantly alveolar (ground-glass opacity and consolidation), organizing pneumonia, and reticular patterns. The severity of involvement was also evaluated by the reader. ResultsForty-eight patients and a total of 130 chest CT scans were evaluated. The alveolar pattern showed a gradual decrease in frequency from 91% in the first week to 9% after the fourth week of the disease but the organizing pneumonia pattern gradually increased with disease progression and the frequency of reticular pattern increased significantly after third week. Complete resolution of CT findings was seen in 17 patients (13.1%) and was significantly more prevalent in patients of younger age (p value<0.001) and with lower initial CT severity scores (p value=0.048). CT severity scores in the second week were significantly higher in ICU admitted patients (p value=0.003). ConclusionThere are temporal patterns of lung abnormalities in patients with COVID-19 pneumonia. The predominant CT pattern was alveolar infiltrate in the first and second weeks of the disease, replaced with an organizing pneumonia pattern in the third and fourth weeks. Progression of lung involvement was correlated with ICU admission due to the highest CT severity score in the second and third weeks of presentation but not in the first week in patients who were admitted at ICU. Complete CT resolution was significantly more common in patients of younger age and lower initial CT severity scores.

Pulmonary function tests reveal unrecognised lung dysfunction and have independent prognostic significance in patients with systemic AL amyloidosis

Background Lung involvement in AL amyloidosis is not very common, but post-mortem data and retrospective studies suggest it is likely underrecognized. Aim To perform a comprehensive evaluation of lung function with pulmonary function tests (PFTs) in patients with newly diagnosed AL amyloidosis. Methods A prospective, non-interventional study of 139 consecutive patients with newly diagnosed AL amyloidosis. Results PFTs indicated normal breathing physiology in 68% of patients, obstructive in 9% and restrictive in 23%; the latter was associated with worse survival (28.6 vs 76 months for obstructive/normal physiology, p = 0.002) and remained significant after adjustment for Mayo stage and abnormal chest-CT. Forced vital capacity <80% of predicted value, forced expiratory volume <80% of predicted value, and carbon monoxide diffusion capacity <70% were independently associated with poorer survival. Respiratory muscle strength (as assessed by maximal expiratory (Pe) and inspiratory (Pi) pressure) was affected in most patients (64% had Pi < 55% and 57% had Pe < 70% of predicted values). Pe% was an independent prognostic factor for survival (HR: 0.984 per 1% unit increase, p = 0.007). Conclusions Pulmonary dysfunction, as assessed with PFTs, is common and underrecognized in patients with systemic AL amyloidosis, with significant prognostic and potentially therapeutic implications, independent of the degree of cardiac dysfunction or chest-CT findings.

Clinical profile and outcomes of hospitalized patients in a Covid-19 referral center in Rio de Janeiro

Objective: To assess the profile of patients hospitalized in a public Covid-19 referral center in Rio de Janeiro. Methods: An observational, cross-sectional, retrospective study was conducted at a public hospital during April 2021. 1413 patients with suspected Covid-19 were included in the study and data were collected from electronic medical records. Results: There was a predominance of older patients (59.12 years of age ± 13.79; mean ± SD) being hospitalized, with no significant male/female difference and the majority of patients came from emergency units. 44.09% of patients occupied intensive care beds. Out of those, 74.52% reported dyspnea, 49.68% had more than 50% pulmonary involvement and the most present chest CT finding was ground-glass opacity. 84.27% had some type of comorbidity and systemic arterial hypertension was the most reported one. The median time elapsed from the onset of symptoms to hospital admission was 8 days (IQR 6-11). Conclusion: Most of those hospitalized with Covid-19 in the analyzed period were elderly, of both sexes. The delay between the onset of symptoms and hospitalization, severe pulmonary involvement and the presence of comorbidities were identified in the records of patients with severe evolution.

ANTI-JO-1 ANTIBODY-ASSOCIATED CLINICALLY AMYOPATHIC DERMATOMYOSITIS WITH RAPIDLY PROGRESSIVE INTERSTITIAL LUNG DISEASE

ANTI-JO-1 ANTIBODY-ASSOCIATED CLINICALLY AMYOPATHIC DERMATOMYOSITIS WITH RAPIDLY PROGRESSIVE INTERSTITIAL LUNG DISEASE

Heat shock protein-90

Background It has recently been shown that the heat shock protein (HSP) is implicated in the pathogenesis of pulmonary fibrosis. The current trial was achieved to detect the relation of HSP-90 in usual interstitial pneumonia (UIP)-associated rheumatoid arthritis (RA). Results Sixty RA patients were studied. Their mean age was 49.63 ± 9.22 years with a mean disease duration of 7.5 (2–14) years. High-resolution computed tomography (HRCT) chest was performed on all patients. Thirty four (56.6%) patients had abnormal radiological findings in CT chest and 26 (43.3%) had normal CT chest findings. In patients with pulmonary involvement by HRCT, the most common abnormality found was small airway disease in 23 (38.3%), followed by UIP in nine (15%), and rheumatoid nodules in two (3.3%) patients. Patients with UIP pattern in HRCT chest has a significant higher level of HSP-90 level in comparison with those with RA-associated small airway disease pattern, P=0.003, and in comparison with other RA patients with no pulmonary involvement by HRCT, P=0.006. Conclusions HSP-90 was significantly elevated in UIP-associated RA and hence studying its inhibition in further studies would have a promising therapeutic role in this subset of patients.

S2301 Dysphagia: An Unusual Primary Presentation of Non-Small Cell Lung Cancer

Introduction: Respiratory symptoms predominate in patients with lung malignancies. Dysphagia as a presenting symptom is rare with only about 1%-2% of patients presenting with dysphagia as their cardinal symptom. We describe a rare case of a 56-year-old male presenting with only dysphagia in the setting of extrinsic esophageal compression secondary to non-small cell lung cancer. Case Description/Methods: A 56-year-old male with past medical history of hypertension, chronic obstructive pulmonary disease, and chronic tobacco use presented to the emergency department with complaint of persistent emesis for the past 3 months. The patient described the emesis as occurring minutes after eating a meal. He also admitted to loss of appetite, unintentional weight loss, and dysphagia to solids. On admission, the patient was normotensive and tachycardic to a heart rate of 108. CT chest was performed and revealed an 8.0 x 7.5 cm right mediastinal mass with obliteration of the right main pulmonary artery and right main bronchus along with multiple irregular and nodular opacities in the right lung and left lower lobe concerning for metastases. Pulmonology was consulted and performed a bronchoscopy which showed a large obstructing endobronchial lesion of the right mainstem bronchus; biopsies of the lesion were sent. The patient was diagnosed with metastatic non-small cell lung cancer. The patient’s hospital course was complicated by intractable emesis and development of shock. Repeat CT was performed and was remarkable for a moderate volume pneumomediastinum and a small to moderate size right pneumothorax. Gastroenterology was consulted for concerns of esophageal perforation vs. invasion. Esophagogastroduodenoscopy was performed and showed severe extrinsic stenosis 30-32 cm from the incisors. The area of stenosis measured 2 cm in length and was dilated. A 23mm x 120mm EndoMAXX fully covered stent was placed at the 26 cm to 38 cm region of the esophagus. Following stabilization, the patient was able to tolerate mechanical soft diet and thin liquids (Figure). Discussion: Dysphagia associated with lung cancer can occur via 3 mechanisms: mediastinal extrinsic esophageal compression, upper esophageal compression by lymph nodes, and radiation induced esophageal stenosis. Patients may experience decreased quality of life due to poor oral intake, malnutrition, and increased risk for infection. Lung malignancy associated dysphagia can be improved by both surgical and non-surgical interventions such as dilatation or esophageal stenting.Figure 1.: (A) Initial CT Chest findings of a right 8.0 x 7.5 cm mediastinal mass (B) Repeat CT Chest remarkable for a moderate volume pneumomediastinum and a small to moderate size right pneumothorax and (C) EGD imaging of a 23mm x 120mm EndoMAXX fully covered stent placed at the area of severe esophageal stenosis.

Systemic Inflammatory Biomarkers and Chest CT Findings as Predictors of Acute Limb Ischemia Risk, Intensive Care Unit Admission, and Mortality in COVID-19 Patients.

Background: Numerous tools, including inflammatory biomarkers and lung injury severity scores, have been evaluated as predictors of thromboembolic events and the requirement for intensive therapy in COVID-19 patients. This study aims to verify the predictive role of inflammatory biomarkers [monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)] and the CT Severity Score in acute limb ischemia (ALI) risk, intensive unit care (ICU) admission, and mortality in COVID-19 patients.; Methods: The present study was designed as an observational, analytical, retrospective cohort study and included all patients older than 18 years of age with a diagnosis of COVID-19 infection, confirmed through real time-polymerase chain reaction (RT-PCR), and admitted to the County Emergency Clinical Hospital of Targu-Mureș, Romania, and Modular Intensive Care Unit of UMFST “George Emil Palade” of Targu Mures, Romania between January 2020 and December 2021. Results: Non-Survivors and “ALI” patients were associated with higher incidence of cardiovascular disease [atrial fibrillation (AF) p = 0.0006 and p = 0.0001; peripheral arterial disease (PAD) p = 0.006 and p < 0.0001], and higher pulmonary parenchyma involvement (p < 0.0001). Multivariate analysis showed a high baseline value for MLR, NLR, PLR, SII, SIRI, AISI, and the CT Severity Score independent predictor of adverse outcomes for all recruited patients (all p < 0.0001). Moreover, the presence of AF and PAD was an independent predictor of ALI risk and mortality. Conclusions: According to our findings, higher MLR, NLR, PLR, SII, SIRI, AISI, and CT Severity Score values at admission strongly predict ALI risk, ICU admission, and mortality. Moreover, patients with AF and PAD had highly predicted ALI risk and mortality but no ICU admission.

Chest CT Findings in Patients with HIV Presenting to the Emergency Department: A Single Institute Experience

The aim of this study was to analyze chest CT imaging findings and relevant clinical factors in patients with HIV presenting to the emergency department (ED). A retrospective review was performed to identify patients with HIV who received chest CT imaging evaluation in the acute ED setting. Analyzed patients included adults with a known diagnosis of HIV who presented to the ED at a single tertiary care center between 2004 and 2020 and received chest CT imaging. Chest CT findings were assessed by 2 radiologist readers, and relevant clinical data were gathered. Statistical analysis was performed to determine if imaging and clinical factors demonstrate significant associations with CD4 count, viral load, and antiretroviral therapy status. A total of 113 patients with HIV were identified who presented to the ED and underwent chest CT imaging evaluation (mean age 47 ± 11 years). Frequently detected chest CT findings included infectious pneumonia (24%), malignancy (11%), pleural effusion (17%), pericardial effusion (13%), and pulmonary embolism (4%). CD4 count, viral load, and active retroviral therapy demonstrated statistically significant associations with a number of key imaging and clinical factors, including presence of pneumonia, malignancy, average length of hospital admission, and survival. Patients with HIV present with a wide range of imaging findings when presenting in the acute ED setting. CD4 count, viral load, and active retroviral therapy status demonstrate statistically significant associations with multiple key imaging findings and clinical factors. Chest CT plays an integral role in the clinical management of this unique patient population.

EP07.01-020 Pulmonary MALT Lymphoma: Detailed CT Findings

Pulmonary mucosa associated lymphoid tissue (MALT) lymphoma is a rare and malignant neoplasm affecting the lung. Its CT characteristics have been described in previous studies but due to their nonspecific and heterogeneous description, radiological diagnosis is still largely difficult, often being mistaken as lung primary adenocarcinomas or sarcoidosis. We performed an analysis to describe the detailed chest CT findings with pulmonary MALT lymphoma, with emphasis on the presence of extrapulmonary involvement.

Chest CT findings in COVID 19 disease in relation with duration of illness: A study of two hundred cases.

Chest CT scans of 200 symptomatic patients infected with COVID 19 from different health facilities and home were reviewed for common CT findings in relationship with their clinical symptoms, comorbidities and the time between symptom onset and the initial CT scan was studied in this cross-sectional study. Cases were categorized into three groups according to the timing of HRCT, 10 cases were in early (0-2days), 56 cases in intermediate (3-5days) and 110 cases were in late (6-12days) groups. Chest CT scan images showed bilateral peripheral ground glass opacities 96.63%, pulmonary consolidations 15.9%. Notably 29.54% patient had normal CT scan chest and 60% of them were imaged at early phase. With a longer duration of symptoms, chest CT findings were more typical including GGO, consolidation with greater total lung involvement. Bilateral peripheral GGO was observed in 20% patients at early phase while 53.57% and 64.54% were observed at intermediate and late phase of illness. Among the symptoms cough and dyspnea were observed more related with typical CT changes (95%). Diabetes and Hypertension (58% of patients) were the leading comorbidities that were found related with GGO and other typical CT findings. Mean time duration between symptom onset and positive RT PCR, CT scan changes were 4.79 and 7.55 respectively.&#x0D; Central Medical College Journal Vol 5 No 2 Jul 2021 PP 70-75

Chest CT Severity Score and Systemic Inflammatory Biomarkers as Predictors of the Need for Invasive Mechanical Ventilation and of COVID-19 Patients' Mortality.

Background: Numerous tools, including inflammatory biomarkers and lung injury severity scores, have been evaluated as predictors of disease progression and the requirement for intensive therapy in COVID-19 patients. This study aims to verify the predictive role of inflammatory biomarkers [monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), Aggregate Index of Systemic Inflammation (AISI), and interleukin-6 (IL-6)] and the total system score (TSS) in the need for invasive mechanical ventilation (IMV) and mortality in COVID-19 patients. Methods: The present study was designed as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with a diagnosis of COVID-19 pneumonia, confirmed through real time-polymerase chain reaction (RT-PCR) and radiological chest CT findings admitted to County Emergency Clinical Hospital of Targu-Mureș, Romania, and Modular Intensive Care Unit of UMFST “George Emil Palade” of Targu Mures, Romania between January 2021 and December 2021. Results: Non-Survivors patients were associated with higher age (p = 0.01), higher incidence of cardiac disease [atrial fibrillation (AF) p = 0.0008; chronic heart failure (CHF) p = 0.01], chronic kidney disease (CKD; p = 0.02), unvaccinated status (p = 0.001), and higher pulmonary parenchyma involvement (p < 0.0001). Multivariate analysis showed a high baseline value for MLR, NLR, SII, SIRI, AISI, IL-6, and TSS independent predictor of adverse outcomes for all recruited patients. Moreover, the presence of AF, CHF, CKD, and dyslipidemia were independent predictors of mortality. Furthermore, AF and dyslipidemia were independent predictors of IMV need. Conclusions: According to our findings, higher MLR, NLR, SII, SIRI, AISI, IL-6, and TSS values at admission strongly predict IMV requirement and mortality. Moreover, patients above 70 with AF, dyslipidemia, and unvaccinated status highly predicted IMV need and fatality. Likewise, CHF and CKD were independent predictors of increased mortality.

Clinical features and high-resolution chest computerized tomography findings of children infected by the B.1.617.2 variant of coronavirus disease 2019

Purpose To analyse the clinical symptoms, laboratory examinations and chest CT findings of children infected by the B.1.617.2 variant of COVID-19 and to compare the differences between clinical subtypes. Methods Fifty-three children (28 males, 25 females; age ranging from 4 months to 17 years) were included with B.1.617.2 variant infection in Nanjing, China, from July 21 to August 12 2021. Clinical data from patients were collected and analysed in groups of mild and common types. Imaging data were divided into three stages for evaluation: early, intermediate and late stages. Results In our study, fever (53%), cough (34%) and pharyngeal discomfort (28%) were the main symptoms. There were no differences in clinical symptoms between the mild and common type. The most common laboratory test items outside the normal range were decreased mean corpuscular volume (68%), lymphocyte percentage (64% elevated and 2% decreased) and decreased serum alkaline phosphatase concentration (66%). The differences in haemoglobin and monocyte percentages between the mild and common types were statistically significant (p = .037 and .033, respectively). No influencing factor was statistically significant in the regression analysis of both symptoms and clinical subtypes. The main CT findings were ground-glass opacity and consolidation located in the periphery and bilateral multilobed involvement. The mean CT score was 1.6. CT score correlated with packet cell volume, haemoglobin, mean erythrocyte volume, mean platelet volume and platelet distribution width. Conclusion The pathogenetic condition of children with B.1.617.2 variant infection is mild. Although there were intergroup differences in some blood cell analyses, T-lymphocyte counts, and comprehensive biochemical indicators, no factors had a significant effect on clinical typing and the presence or absence of symptoms. CT findings and CT scores reflect disease stage and pathological changes and correlate moderately with laboratory tests, making them of good value for disease diagnosis and monitoring. Key Messages Paediatric patients infected with B.1.617.2 variant have a milder clinical and imaging presentation than adults and are similar to the prototype infection. CT findings and scores which reflect disease stages and pathological changes. There is a correlation between chest CT and laboratory tests, which can be useful for the diagnosis and follow-up of the disease.

Cardiopulmonary Imaging Utilization and Findings among Hospitalized COVID-19 Patients in Latin America: (From "RIMAC: Registry IMAging Cardiopulmonary among Hospitalized COVID-19 Patients in LATAM").

Objectives:Describe the use and findings of cardiopulmonary imaging—chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)—in COVID-19 hospitalizations in Latin America (LATAM).Background:There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM.Methods:Multicenter, prospective, observational study of COVID-19 inpatients, conducted from March to December 2020, from 12 high-complexity centers, in nine LATAM countries. Adults (>18 years) with at least one imaging modality performed, followed from admission until discharge and/or in-hospital death, were included.Results:We studied 1,435 hospitalized patients (64% males) with a median age of 58 years classified into three regions: Mexico (Mx), 262; Central America and Caribbean (CAC), 428; and South America (SAm), 745. More frequent comorbidities were overweight/obesity, hypertension, and diabetes. During hospitalization, 58% were admitted to the ICU. The in-hospital mortality was 28%, and it was highest in Mx (37%).The most frequent images performed were cCT (61%), mostly in Mx and SAm, and cX-ray (46%), significant in CAC. The cEcho was carried out in 18%, similarly among regions, and LUS was carried out in 7%, with a higher frequently in Mx. Abnormal findings on the cX-ray were peripheral or basal infiltrates, and in cCT abnormal findings were the ground glass infiltrates, more commonly in Mx. In LUS, interstitial syndrome was the most abnormal finding, predominantly in Mx and CAC.Renal failure was the most prevalent complication (20%), predominant in Mx and SAm. Heart failure developed in 13%, predominant in Mx and CAC. Lung thromboembolism was higher in Mx while myocardial infarction was in CAC.Logistic regression showed associations of abnormal imaging findings and their severity, with comorbidities, complications, and evolution.Conclusions:The use and findings of cardiopulmonary imaging in LATAM varied between regions and had a great impact on diagnosis and prognosis.

Evaluation of patients admitted to our hospital with a possible diagnosis of COVID-19

We aimed to evaluate the clinical characteristics, laboratory and imaging findings, and outcomes associated with the severity of illness of patients admitted to our hospital with possible COVID-19 diagnosis. The patients admitted to our hospital with a possible diagnosis of COVID-19 between March 25 and December 3, 2020, were evaluated retrospectively. In terms of their clinical, laboratory, imaging findings, and mortality were compared between patients discharged and hospitalized with died and survivors. 12470 patients admitted to our hospital with a possible diagnosis of COVID-19 tested by SARS-CoV-2 RT-PCR. Of those tested, 3116 (24.9%) were positive. Of the patients, 2529 (81.2%) were discharged, 587 (18.8%) hospitalized, and 92 (3%) were died. In the comparison of discharged, and hospitalized groups, a significant difference was found in age, symptoms, comorbid diseases, chest CT, laboratory findings, and mortality (p&lt; 0.05). In the comparison of survivor, and dead, the risk of mortality analysis showed similar characteristics. Older age, male gender, comorbidities, lymphopenia, thrombocytopenia, increased levels of CRP, NLR, D-dimer, ferritin, and chest CT findings were significant risk factors. Of the patients who died, 23 (25%) were female and 69 (75%) were male. The outbreak of COVID-19 is a significantly health problem. We were experienced with high numbers of COVID-19 cases and found that age, symptoms, comorbid diseases, chest CT, laboratory findings of inflammation are significant predictors for admission to hospital. Therefore, these risk factors should consider routinely for patients with a high risk of developing severe and critical diseases by clinicians.

Loss of smell in COVID-19 patients: is it related to clinical-radiological disease severity?

Objective: Olfactory dysfunction (OD) is one of the most prominent predictive symptoms in the early detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19), it may be the first symptom or accompany other symptoms. The predictive value of OD is unknown in terms of the overall prognosis of COVID-19. We aimed to investigate the relationship between OD and the clinical-radiological severity of the disease. &#x0D; Material and Method: Data of 208 COVID-19 patients (105 inpatients and 103 outpatients) who had positive Real-Time Polymerase Chain Reaction (PCR) tests between December 1, 2020, and January 15, 2021, were collected retrospectively. Presence of OD, symptoms on admission other than OD, days of hospital stay, peripheral blood analysis values, COVID-19 disease severity [World Health Organization (WHO) 2020 “Clinical management of COVID-19”] and radiologic classifications [Radiological Society of North America Expert Consensus Statement on Reporting (RSNA) Chest CT Findings Related to COVID-19] were retrospectively collected.&#x0D; Results: Analysis of 208 patients revealed that there were 105 (50.48%) inpatients and 103 (49.52%) outpatients. Among 102 patients who had OD, 68 were outpatients and 34 were inpatients. It was determined that the patients with OD were mostly followed up on an outpatient basis, and they did not need hospitalization (p