Multifocal Ground-glass Opacities Research Articles

Pathological T3 Non-Small Cell Lung Cancer with satellite nodules: Number or size, what does matter?

BackgroundNon-small Cell Lung Cancer (NSCLC) with intralobar satellite nodule are defined as T3 (T3SN). We investigated the main features of these tumors and analyzed their impact on Overall Survival (OS). MethodsThis was a retrospective multicentric study including all pT3SN NSCLC operated on between 2005 and 2020, excluding patients with multifocal ground-glass opacities; who received induction therapies; N3 or stage IV. The diameter of largest (LgN) and smallest nodule (SmN), the total diameter (sum of diameter of all nodules, TS), and the number of SN were measured. ResultsAmong 102 patients, 64.7 % were male. 84.3 % of patients had one SN (84.3 %), 9.8 % two SN while 5.9 % more than 2 SN. 63 patients were pN0. LgN (p = 0.001), SN (p = 0.005) and TS (p = 0.014) were significantly related to lymph-node metastasis; the LgN and TS were related to visceral pleural invasion (p < 0.001).Five-year OS was 65.1 %; at univariable analysis more than 2 satellite nodules, LgN and TS were significantly related to worse OS; at multivariable analysis, TS (Hazard Ratio [HR] 1.116 95 % Confidence Interval [CI] 1.008–1.235, p = 0.034) was an independent prognostic factors for OS. No significant prognostic factors were found for DFS at multivariable analysis.In pN0 patients, LgN (HR 1.051, 95 % CI 1.066–1.099, p = 0.027) and non-adenocarcinoma (HR 5.315 CI 95 % 1.494–18.910, p = 0.010) influenced OS. ConclusionsTumor size is related to tumor's local invasiveness. TS is an independent prognostic factor for OS. Patients with more than 2 SN seem to be at higher risk for death and recurrence.

Accurate and non-invasive localization of multi-focal ground-glass opacities via electromagnetic navigation bronchoscopy assisting video-assisted thoracoscopic surgery: a single-center study.

Accurate localization of multi-focal ground-glass opacities (GGOs) is crucial for successful video-assisted thoracoscopic surgery (VATS). Electromagnetic navigation bronchoscopy (ENB) provides a minimally invasive and dependable approach for precise localization. This study assessed the accuracy and safety of ENB-guided localization in cases involving multi-focal GGOs. This retrospective study presents a single-center investigation into ENB-guided localization, utilizing methylene blue, for multi-focal GGOs assisting VATS. Clinical, surgical, and pathological data were collected from patients who underwent ENB-guided localization between 23 December 2019 and 31 August 2022. The study examined 57 patients with multi-focal GGOs who underwent ENB-guided localization and VATS. A total of 150 GGOs were treated, with ENB-guided localization taking a median time of 65min. Following localization, all patients proceeded to VATS, with a median duration of 170min. The median lesion size measured 7.8mm, with a 5-mm distance between GGO and pleura or fissure. When the distance between GGO and pleura/fissure exceeded 1cm, an additional location point was introduced below the pleura or fissure based on GGO location. No complications related to localization were observed. The overall malignancy rate stood at 66%. Location precision was confirmed by measuring the marker-to-GGO lesion distance, resulting in a 94% (141/150) accuracy rate for GGO localization. ENB-guided methylene blue injection is a safe and precise method to treat multi-focal GGOs, potentially minimizing operation time and simplifying lesion detection.

13-Year-Old Female With New Onset Multifocal Pulmonary Ground-Glass Opacities.

A 13-year-old female who recently emigrated from Honduras presented to an emergency department in Texas with a 2-month history of weight loss, fatigue, cough, and progressive shortness of breath. Her symptoms started with a nonproductive cough, and she later developed dyspnea on exertion and orthopnea. On physical examination, she was tachycardic and tachypneic. She had a thin, emaciated body habitus. She was visibly in respiratory distress with nasal flaring, tracheal tugging, and intercostal and subcostal retractions. She had diminished breath sounds at the bases and bibasilar crackles. A computed tomography scan of the chest revealed multifocal ground-glass opacities throughout all lobes of both lungs with small bilateral pleural effusions and prominent bilateral hilar lymph nodes. We will discuss the approach to the initial evaluation and subsequent diagnosis.

Fatal Infections Differentially Involve Allograft and Native Lungs in Single Lung Transplant Recipients.

Respiratory infections complicate lung transplantation and increase the risk of allograft dysfunction. Allograft lungs may have different susceptibilities to infection than native lungs, potentially leading to different disease severity in lungs of single lung transplant recipients (SLTRs). To study whether infections affect allograft and native lungs differently in SLTRs but similarly in double LTRs (DLTRs). Using an institutional database of LTRs, medical records were searched, chest computed tomography studies were systematically reviewed, and histopathologic features were recorded per lung lobe and graded semiquantitatively. A multilobar-histopathology score (MLHS) including histopathologic data from each lung and a bilateral ratio (MLHSratio) comparing histopathologies between both lungs were calculated in SLTRs and compared to DLTRs. Six SLTRs died of infection involving the lungs. All allografts showed multifocal histopathologic evidence of infection, but at least 1 lobe of the native lung was uninvolved. In 4 of 5 DLTRs, histopathologic evidence of infection was seen in all lung lobes. On computed tomography, multifocal ground-glass and/or nodular opacities were found in a bilateral distribution in all DLTRs but in only 2 of 6 SLTRs. In SLTRs, the MLHSAllograft was higher than MLHSNative (P = .02). The MLHSratio values of SLTR and DLTR were significantly different (P < .001). Allograft and native lungs appear to harbor different susceptibilities to infections. The results are important for the management of LTRs.

Epidemiological and Clinical Profile of COVID-19 Patients Hospitalized in University Hospitals in Mali

Introduction: The COVID-19 pandemic has caused a significant number of patients worldwide, associating mortality and sequelae. Its clinical presentation is very polymorphic and its tropism largely explains the different manifestations encountered. In order to determine the sociodemographic characteristics of patients hospitalized in the University Hospitals of Mali (CHU) for COVID-19, we conducted a study in the first year of the COVID-19 pandemic. Methods: This was a retrospective, descriptive, multicenter study over 12 months from March 2020 to February 2021 at the level of the various university hospitals in Mali, namely: Gabriel Touré University Hospital, Point-G University Hospital, Kati, Mali Hospital and Bamako Dermatology Hospital. Results: We collected 1349 patients out of 8376 cases during the period, i.e. 16.10%. Point G University Hospital accounted for 51.2% of admissions. The average age of the patients was 30 years old. The male sex was predominant with a sex ratio of 2.20. The median length of hospitalization was 8 days. The general signs were fatigue (11.6%) and asthenia (5.8%). The symptomatology was dominated by cough (23.1%), dyspnea (11.9%), headache (8.4%), anosmia (4.6%) and vomiting (2.1%). Biological abnormalities were dominated by anemia (13.9%), leucopenia (11.7%), hyperleukocytosis (4.8%), hypercreatinineemia (44.9%), hyperglycemia (9.8 %) and hypertransaminasemia (25.4%). Chest CT was performed in 10 patients, i.e. 0.7%; the most common radiological sign was multifocal ground glass opacities (100%). The evolution was favorable (88.2%), with 7.8% of cases of death. Conclusion: COVID-19 remains a polymorphic condition both in terms of symptoms, biology and imaging, further questioning the systemic nature of the disease.

Myasthenia Gravis Presenting as Sudden–onset Isolated Hypercapnic Respiratory Failure

Myasthenic crisis, which can be life-threatening due to severe respiratory failure, occurs in 15-20% of patients with myasthenia gravis. However, the crisis often develops within 1-2 years after diagnosis and is very rare as a first symptom of myasthenia gravis; isolated sudden-onset hypercapnic respiratory failure without other symptoms of myasthenia gravis is even rarer. A 63-year-old woman presented to the emergency department with fever and dizziness. Chest computed tomography showed multifocal peribronchial ground-glass opacities, and a diagnosis of pneumonia was made. Initially, the patient did not have dyspnea. However, she developed acute hypercapnic respiratory failure and was intubated. After mechanical ventilation, her hypercapnia improved initially, but worsened on initiation of weaning from the ventilator. As she had a high acetylcholine receptor antibody titer, myasthenia gravis was diagnosed. Her hypercapnia improved after treatment with pyridostigmine and methylprednisolone.

Immune-induced pneumonia in patients with advanced solid tumors treated with immunotherapy: a real-world assessment

Aim: To investigate the computed tomography (CT) and clinical characteristics of immunotherapy-induced pneumonitis (IIP) in patients with advanced solid tumors. Patients & methods: CT and clinical data of 254 patients with advanced solid tumors treated with immune checkpoint inhibitors in our hospital were collected retrospectively. Results: The incidences of IIP in patients with non-small-cell lung cancer, lymphoma and gastrointestinal tumors were 19% (19/100), 9.8% (6/61) and 6.2% (4/65), respectively. The median onset time for all 31 IIP patients was 44 days (interquartile range: 24-65). Most IIP patients (21/31) had grade 1-2 disease. Multifocal ground-glass opacities (seen in 21/31 patients) were the main CT findings of IIP. Conclusion: Patients should be alerted to the risk of IIP, an adverse reaction that has a relatively low incidence but which is sometimes life-threatening.

Migratory Pneumonia in Prolonged SARS-CoV-2 Infection in Patients Treated With B-cell Depletion Therapies for B-cell Lymphoma.

To report the clinical and radiological characteristics of patients with underlying B-cell lymphoma and coronavirus disease 2019 (COVID-19) showing migratory airspace opacities on serial chest computed tomography (CT) with persistent COVID-19 symptoms. From January 2020 to June 2022, of the 56 patients with underlying hematologic malignancy who had undergone chest CT more than once at our hospital after acquiring COVID-19, seven adult patients (5 female; age range, 37-71 years; median age, 45 years) who showed migratory airspace opacities on chest CT were selected for the analysis of clinical and CT features. All patients had been diagnosed with B-cell lymphoma (three diffuse large B-cell lymphoma and four follicular lymphoma) and had received B-cell depleting chemotherapy, including rituximab, within three months prior to COVID-19 diagnosis. The patients underwent a median of 3 CT scans during the follow-up period (median 124 days). All patients showed multifocal patchy peripheral ground glass opacities (GGOs) with basal predominance in the baseline CTs. In all patients, follow-up CTs demonstrated clearing of previous airspace opacities with the development of new peripheral and peribronchial GGO and consolidation in different locations. Throughout the follow-up period, all patients demonstrated prolonged COVID-19 symptoms accompanied by positive polymerase chain reaction results from nasopharyngeal swabs, with cycle threshold values of less than 25. COVID-19 patients with B-cell lymphoma who had received B-cell depleting therapy and are experiencing prolonged SARS-CoV-2 infection and persistent symptoms may demonstrate migratory airspace opacities on serial CT, which could be interpreted as ongoing COVID-19 pneumonia.

Consideraciones radiológicas del cáncer de pulmón y Covid-19: una mirada oncológica

Patients with SARS-Cov-2 infection and lung cancer have an unfavorable prognosis, characterized by higher rates of respiratory failure, use of invasive mechanical ventilation and higher mortality rates. Due to similarities in affected organs in Covid-19 and lung cancer, the radiological accurate diagnosis has become a challenge for physicians. Radiologic findings of lung cancer, such as parenchymal consolidation, spiculation and microlobulations are not specific. Imaging findings of Covid-19 in patients with lung cancer consist of multiple patchy multifocal bilateral ground-glass opacities and consolidations, being hardly distinguishable from an underlying lung malignancy. Differential radiological diagnosis in patients with lung cancer and Covid-19 must include pneumonitis and lung toxicity caused by chemotherapy, target therapies and radiotherapy. Follow-up and simulation tomography in radiotherapy have become an unexpected ally in the early detection of Covid-19 in asymptomatic stages in lung cancer patients. Patients with lung cancer should have particular considerations due to their high risk and the adverse effects of systemic therapies and radiotherapy.

Using the robotic platform in the therapy of multifocal ground glass opacities.

Due to their association with invasive adenocarcinoma, ground glass opacities that reach 3 cm in size, develop a solid component ≥2 mm on mediastinal windows, or exhibit ≥25% annual growth warrant operative resection. Minimally invasive techniques are preferred given that approximately one third of patients will present with multifocal focal disease and may require additional operations. A robotic-assisted thoracoscopic surgical approach can be used with percutaneous or bronchoscopic localization techniques and are compatible with developing intraoperative molecular targeting techniques.

DON'T SWEAT IT: A CASE OF PID-LUNG DISEASE MISDIAGNOSED AS CYSTIC FIBROSIS

<h3>Introduction</h3> Chronic lung disease in primary immunodeficiency is common and contributes to significant morbidity and mortality. Bronchiectasis has a broad differential which includes Cystic Fibrosis and several other disease processes. In patients with primary immunodeficiency, this inflammatory destruction of airway walls is a complication of recurrent pneumonia and immune dysregulation. <h3>Case Description</h3> A 16-year-old boy from Bangladesh with history of Cystic Fibrosis (CF) was referred by pulmonology for management of known hypogammaglobulinemia. Patient came to the United States for treatment of CF-associated severe lung disease. His course in Bangladesh had been complicated by multiple episodes of sinopulmonary infections and failure to thrive secondary to severe diarrhea and pancreatic insufficiency. He had been initially diagnosed with CF in 2019 in Thailand with positive sweat chloride test with additional finding of hypogammaglobulinemia. Chest CT at our institution showed severe bronchiectasis with multifocal consolidations and ground glass opacities consistent with CF. Our immunological evaluation revealed agammaglobulinemia with IgG <109, IgA <2, IgM <5, as well as B-cell and T-cell lymphopenia. Pulmonology then performed repeat sweat chloride testing and genetics which were both negative for CF. GI evaluation revealed evidence of colitis with no pancreatic insufficiency. Patient's history could all be explained by primary immunodeficiency (PID). PID gene panel was unrevealing and whole exome sequencing is pending. Following his diagnosis, patient was managed with IVIG, prophylactic antibiotics, and enteral feeds with great improvement. <h3>Discussion</h3> This case illustrates the importance of early recognition of primary immunodeficiency, especially in resource-poor areas. Hypogammaglobulinemia should be on the differential for childhood-onset bronchiectasis.

CAVITARY PNEUMONIA: THE CLOT THICKENS

CAVITARY PNEUMONIA: THE CLOT THICKENS

CRYPTOGENIC ORGANIZING PNEUMONIA: A DIAGNOSTIC DILEMMA IN A WORLD DOMINATED BY COVID-19 PNEUMONIA

CRYPTOGENIC ORGANIZING PNEUMONIA: A DIAGNOSTIC DILEMMA IN A WORLD DOMINATED BY COVID-19 PNEUMONIA

THE USE OF NINTEDANIB IN THE TREATMENT OF POST-COVID-19 FIBROSIS

Pulmonary fibrosis is becoming a recognized complication of coronavirus disease 2019 (COVID-19). We report 2 cases of 2 patients aged 40 and 61 with pulmonary fibrosis due to COVID-19. The clinical examination showed that the 2 patients were dyspneic with a weak oxygen saturation and that there was bilateral crackles of the two pulmonary fields. High-resolution computed tomography showed bilateral multifocal ground glass opacities, subpleural fibrotic bands (between 25-50% and 75% parenchymal involvement). We prescribed them an anti-fibrosant, nintedanib, and there was a significant clinical and radiological improvement after 15 days of treatment. Nintedanib may have a new therapeutic role in the prevention of fibrosis associated with COVID-19.

Possible Alterations of Imaging Patterns in Computed Tomography for Delta-VOC of SARS-CoV-2.

So far, typical findings for COVID-19 in computed tomography (CT) have been described as bilateral, multifocal ground glass opacities (GGOs) and consolidations, as well as intralobular and interlobular septal thickening. On the contrary, round consolidations with the halo sign are considered uncommon and are typically found in fungal infections, such as invasive pulmonary aspergillosis. The authors recently observed several patients with COVID-19 pneumonia presenting with round, multifocal consolidations accompanied by a halo sign. As this may indicate alterations of CT morphology based on the virus variant, the aim of this study was to investigate this matter in more detail. 161 CT scans of patients with confirmed SARS-CoV-2 infection (RT-PCR within 2 days of CT) examined between January 2021 and September 15, 2021 were included. Follow-up examinations, patients with invasive ventilation at the time of CT, and patients with insufficient virus typing for variants of concern (VOC) were excluded. CT scans were assessed for vertical and axial distribution of pulmonary patterns, degree of involvement, uni- vs. bilaterality, reticulations, and other common findings. The mean density of representative lesions was assessed in Hounsfield units. Results were compared using Mann-Whitney U-tests, Student's t-rests, descriptive statistics, and Fisher's exact tests. 75 patients did not meet the inclusion criteria. Therefore, 86/161 CT scans of unique patients were analyzed. PCR VOC testing confirmed manifestation of the Delta-VOC SARS-CoV-2 in 22 patients, 39 patients with Alpha-VOC and the remaining 25 patients with Non-VOC SARS-CoV-2 infections. Three patients with the Delta-VOC demonstrated multiple pulmonary masses or nodules with surrounding halo sign, whereas no patients with either Alpha-VOC (p = 0.043) or non-VOC (p = 0.095) demonstrated these findings. All three patients were admitted to normal wards and had no suspicion of a pulmonary co-infection. Patients with Delta-VOC were less likely to have ground glass opacities compared to Alpha-VOC (7/22 or 31.8 % vs. 4/39 or 10.3 %; p < 0.001), whereas a significant difference has not been observed between Delta-VOC and non-VOC (5/25 or 20 %; p = 0.348). The mean representative density of lesions did not show significant differences between the studied cohorts. In this study 3 out of 22 patients (13.6 %) with Delta-VOC presented with bilateral round pulmonary masses or nodules with surrounding halo signs, which has not been established as a notable imaging pattern in COVID-19 pneumonia yet. Compared to the other cohorts, a lesser percentage of patients with Delta-VOC presented with ground glass opacities. Based on these results Delta-VOC might cause a divergence in CT-morphologic phenotype. · Until recently, CT-morphologic signs of COVID-19 pneumonia have been presumed to be uncontroversially understood. Yet, recently the authors observed diverging pulmonary alterations in patients infected with Delta-VOC.. · These imaging alterations included round pulmonary masses or nodules with surrounding halo sign.. · These imaging alterations have not yet been established as typical for COVID-19 pneumonia, yet.. · Based on these results, Delta-VOC could impose a divergence of CT-morphologic phenotype.. · Yüksel C, Sähn M, Kleines M et al. Possible Alterations of Imaging Patterns in Computed Tomography for Delta-VOC of SARS-CoV-2 . Fortschr Röntgenstr 2022; 194: 1229 - 1241.

CT Features of Lymphatic Plastic Bronchitis in Adults: Correlation with Multimodality Lymphatic Imaging.

To distinguish CT patterns of lymphatic and nonlymphatic causes of plastic bronchitis (PB) through comparison with lymphatic imaging. In this retrospective study, chest CT images acquired prior to lymphatic workup were assessed in 44 patients with PB from January 2014 to August 2020. The location and extent of ground-glass opacity (GGO) was compared with symptoms and lymphatic imaging. Statistical analysis was performed using descriptive statistics, logistic regression, Pearson correlation coefficient, and unweighted κ coefficient for interobserver agreement. Sensitivity and specificity of GGO for lymphatic PB were calculated. Lymphatic imaging was performed in 44 patients (median age, 52 years ± 21 [IQR]; 23 women): 35 with lymphatic PB and nine with nonlymphatic PB. GGO was more frequently observed in patients with lymphatic PB than in those with nonlymphatic PB (91% [32 of 35] vs 33% [three of nine]; P < .001). Univariate logistic regression confirmed this result by showing that GGO was a significant predictor of lymphatic PB (odds ratio, 21 (95% CI: 3.8, 159.7). The model areas under the receiver operating characteristic curve (AUCs) of GGO unadjusted and adjusted for demographics were 0.79 and 0.86, respectively. The location of GGO correlated with lymphatic imaging and bronchoscopic findings. Overall sensitivity and specificity of GGO for lymphatic PB were 91% (32 of 35; 95% CI: 76, 98) and 67% (six of nine; 95% CI: 30, 93), respectively. Patients with lymphatic PB predominantly had multifocal GGO with or without a "crazy paving" pattern; identification of GGO should prompt lymphatic workup in this frequently misdiagnosed condition.Keywords: Lymphography, Lymphatic, CT, Tracheobronchial Tree, Thorax© RSNA, 2022See also commentary by Kligerman and White in this issue.

Pulmonary Tc99m-PSMA uptake in asymptomatic COVID-19 patient: incidental finding in SPECT/CT study

BackgroundAs there are comparative studies between 68Ga-PSMA and 99mTc-PSMA and spectrum of PSMA expression, this is the first case report that notifies distribution of 99mTc-PSMA on COVID-19 pneumonia era on the literature.Case presentationAn asymptomatic 70-Y-old male who is known case of prostate adenocarcinoma underwent initial staging. SPECT/CT of the chest region reveals bilateral peripheral multifocal ground glass opacities which shows 99mTc-PSMA uptake. Diagnosis of corona virus was confirmed by positive RT-PCR.DiscussionUnexclusive role of radiotracers in nuclear medicine has an importance for wide range of applications. Comparison between 68Ga-PSMA and 99mTc-PSMA in detection of metastatic disease in prostate cancer is also under evaluation.ConclusionsThis case implicates possible role of PSMA imaging in inflammation/infection process as well as necessity for lung review in hybrid imaging especially during this recent pandemic.

Cryptogenic organizing pneumonia associated with pregnancy: A case report

BACKGROUNDCryptogenic organizing pneumonia (COP), formerly known as bronchiolitis obliterans organizing pneumonia, is an extremely rare disease in pregnancy. In this case, we report on COP diagnosed in recurrent pneumonia that does not respond to antibiotics in pregnant woman.CASE SUMMARYA 35-year-old woman with no prior lung disease presented with concerns of chest pain with cough, sputum, dyspnea, and mild fever at 11 wk’ gestation. She was diagnosed with community-acquired pneumonia and treated with antibiotics; her symptoms improved temporarily. Four weeks after discharge, she was re-admitted with aggravated symptoms. Chest computed tomography demonstrated multifocal patchy airspace consolidation and ground-glass opacities at the basal segments of the right lower lobe, at the lateral basal segment of the lower lobe, and at the lingular segment of the left upper lobe. Bronchoalveolar lavage revealed an increased lymphocyte count and a decreased CD4/CD8 ratio. Prednisolone (0.5 mg/kg/d) was administered for 10 d after the second admission. Dyspnea improved after 3 d of steroid treatment and other symptoms improved on the 5th day of steroid administration. Post-delivery transbronchial lung biopsy further revealed the presence of granulation tissue with fibroblasts in small-bronchiole lumens.CONCLUSIONThis case suggests that it is important to differentiate COP from atypical pneumonia in the deteriorated condition despite antibiotic treatment.

Semiquantitative CT imaging as a tool in improving detection of ground glass patches in patients with COVID-19 pneumonia and for better follow-up

BackgroundCoronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2 influencing millions of people worldwide. It has clinical symptoms going from mild symptoms in about 80% of patients to a case mortality rate of about 2% in hospitalized patients associated with radiologic findings at chest CT which is showing multifocal bilateral ground glass opacities (GGO) and consolidative patches with subpleural and peri-bronchovascular predominant distribution. The role of chest CT in COVID-19 is very crucial, so this study hypothesized that increasing the accuracy and rapidity of CT in the detection of COVID-19-related pneumonia will offer rapid management and intervention of affected cases and gain better outcomes. The aim of this study is to offer and assess the ability of a software computer program in helping the radiologists in rapid detection of COVID-19 pneumonic criteria.ResultsThis cross-sectional study involved 73 patients with clinical symptoms and real-time polymerase chain reaction test positive results diagnosed as COVID-19. They were referred to perform chest CT; their CT images were sent to a separate workstation to be automated and processed through the COVID-19 detector, and compared the finding of the radiologist and the COVID-19 detector. The median number of lesions was 2 among the studied participants ranging from 1 to 12 lesions. The most common affected site of the lesions was the lower lobes. There was a significant strong agreement (P value < 0.001, kappa = 0.923) between the radiologist and the semiquantitative CT assessment in the detection of GGO among patients with COVID-19 pneumonia. Also, there were 6 patients who underwent follow-up by semiquantitative CT and radiologist; the median number of lesions was 1 among the studied participants ranging from 1 to 8 lesions. There was a significant strong agreement (P value = 0.001, Kappa = 0.856) between the radiologist and the semiquantitative CT assessment in the detection of GGO during follow-up among patients with COVID-19 pneumonia.ConclusionsThe tested computer program can accurately detect COVID-19 pneumonia as it has better visualization in detecting GGO for diagnosing and following up on COVID-19 pneumonia.

One year of COVID-19 pandemic: what we Radiologists have learned about imaging.

Since its outbreak in December 2019, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) hasinfected more than 151 million people worldwide. More than 3.1 million have died from Coronavirus Disease 2019 (COVID-19), the illness caused by SARS-CoV-2. The virus affects mainly the upper respiratory tract and the lungs causing pneumonias of varying severity. Moreover, via direct and indirect pathogenetic mechanisms, SARS-CoV-2 may lead to a variety of extrapulmonary as well as vascular manifestations. Based on a systematic literature search via PubMed, original research articles, meta-analyses, reviews, and case reports representing the current scientific knowledge regarding diagnostic imaging of COVID-19 were selected. Focusing on the imaging appearance of pulmonary and extrapulmonary manifestations as well as indications for imaging, these data were summarized in the present review article and correlated with basic pathophysiologic mechanisms. Typical signs of COVID-19 pneumonia are multifocal, mostly bilateral, rounded, polycyclic or geographic ground-glass opacities and/or consolidations with mainly peripheral distribution. In severe cases, peribronchovascular lung zones are affected as well. Other typical signs are the "crazy paving" pattern and the halo and reversed halo (the latter two being less common). Venous thromboembolism (and pulmonary embolism in particular) is the most frequent vascular complication of COVID-19. However, arterial thromboembolic events like ischemic strokes, myocardial infarctions, and systemic arterial emboli also occur at higher rates. The most frequent extrapulmonary organ manifestations of COVID-19 affect the central nervous system, the heart, the hepatobiliary system, and the gastrointestinal tract. Usually, they can be visualized in imaging studies as well. The most important imaging modality for COVID-19 is chest CT. Its main purpose is not to make the primary diagnosis, but to differentiate COVID-19 from other (pulmonary) pathologies, to estimate disease severity, and to detect concomitant diseases and complications. · Typical signs of COVID-19 pneumonia are multifocal, mostly peripheral ground-glass opacities/consolidations.. · Imaging facilitates differential diagnosis, estimation of disease severity, and detection of complications.. · Venous thromboembolism (especially pulmonary embolism) is the predominant vascular complication ofCOVID-19.. · Arterial thromboembolism (e. g., ischemic strokes, myocardial infarctions) occurs more frequently as well.. · The most common extrapulmonary manifestations affect the brain, heart, hepatobiliary system, and gastrointestinal system.. · Gross A, Albrecht T. One year of COVID-19 pandemic: what we Radiologists have learned about imaging. Fortschr Röntgenstr 2022; 194: 141 - 151.