Multifocal Ground-glass Opacities Research Articles

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.

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

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

AMIKACIN-INDUCED HYPERSENSITIVITY PNEUMONITIS IN A PATIENT WITH PULMONARY MYCOBACTERIUM AVIUM COMPLEX INFECTION

TOPIC: Diffuse Lung Disease TYPE: Fellow Case Reports INTRODUCTION: Inhaled amikacin is FDA approved in the treatment of pulmonary Mycobacterium avium complex (MAC). Here we present a case of acute hypersensitivity pneumonitis after initiating therapy with inhaled amikacin. CASE PRESENTATION: An 82 year old male with a history of pulmonary MAC infection and chronic hypoxemia on 2L oxygen presented with progressive non-productive cough and dyspnea. He had been diagnosed with pulmonary MAC three years prior to presentation and had been treated with azithromycin, rifampin, and ethambutol. CT chest imaging demonstrated multifocal bronchiectasis, tree in bud nodules, and cavitary lesions. Respiratory AFB cultures were positive for MAC. He was prescribed oral rifampin and azithromycin. Intravenous amikacin was considered given cavitary disease but deferred in light of age and comorbidities. Inhaled amikacin was prescribed but unable to be started as an outpatient. One week later, he was admitted with new fevers, progressive dry cough, dyspnea, and increased oxygen requirement. CT chest was negative for pulmonary embolism and showed new multifocal ground glass opacities (Image #1). He was admitted for suspected superimposed bacterial or viral pneumonia. COVID-19 and respiratory viral testing were negative. Sputum culture was unable to be obtained due to non-productive cough. Rifampin and azithromycin were continued and nebulized amikacin was initiated. Broad spectrum antibiotics were started to cover for bacterial pneumonia. He initially defervesced but on hospital day #5, his dyspnea and hypoxemia worsened. He required up to 15 liters 100% oxygen via non-rebreather mask. He was empirically diuresed and antibiotic coverage was broadened without improvement. Echocardiogram showed unchanged cardiac function. CT chest imaging on hospital day #7 demonstrated progressive multifocal ground glass opacities with intralobular and interlobular septal thickening (Image #2). Clinical picture was concerning for drug induced pneumonitis. Amikacin was discontinued and oral prednisone was started. His respiratory symptoms improved and he was weaned to 2L via nasal cannula prior to discharge. Nebulized amikacin was not restarted. DISCUSSION: In this patient, initiation of inhaled amikacin was temporally related to the development of an acute hypersensitivity pneumonitis associated with significant hypoxemia which improved promptly with the discontinuation of inhaled amikacin and initiation of corticosteroids. Trial data investigating inhaled liposomal amikacin in pulmonary MAC has reported a 3% incidence of hypersensitivity pneumonitis. CONCLUSIONS: Inhaled amikacin is a useful adjunctive therapy in the treatment of refractory pulmonary MAC infection. The development of hypersensitivity pneumonitis should prompt immediate discontinuation of the drug and consideration for corticosteroid therapy in severe cases. REFERENCE #1: Griffith DE, Eagle G, Thomson R, et al. CONVERT Study Group Amikacin liposome inhalation suspension for treatment-refractory lung disease caused by Mycobacterium avium complex (CONVERT): A prospective, open-label, randomized study. Am J Respir Crit Care Med 2018; 198:1559–69. REFERENCE #2: Swenson, C, Lapinel NC, and Ali J. Clinical Management of Respiratory Adverse Events Associated With Amikacin Liposome Inhalation Suspension: Results From a Patient Survey. Open Forum Infect Dis. 2020 Apr; 7(4): ofaa079 DISCLOSURES: No relevant relationships by Casey Graziani, source=Web Response No relevant relationships by Ali Jiwani, source=Web Response

PNEUMATOCELE FORMATION DUE TO SARS-COV2: A CASE REPORT

PNEUMATOCELE FORMATION DUE TO SARS-COV2: A CASE REPORT

GROUND GLASS OPACITIES: IT'S NOT ALL COVID

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: During the COVID-19 pandemic, superimposed infections with both bacterial and fungal organisms have been shown to complicate the viral process. Aspergillus and candida are the most common fungal organisms reported [2];but there have also been a few case reports with co-infection from Pneumocystis jirovecii pneumonia (PJP) [1,3]. We present a COVID patient with lymphopenia and diffuse ground glass opacities who was also diagnosed with PJP. CASE PRESENTATION: A 58-year-old male with past medical history of emphysema liver cirrhosis presented to the hospital with nausea, vomiting and abdominal distention. On examination he was afebrile, hypotensive with a blood pressure of 88/56, SpO2 was 96% on room air. His lungs were clear on auscultation and abdominal exam was notable for moderate ascites. There was 2+ pedal edema bilaterally. Laboratory work-up showed a WBC count of 12000/µL, only 7% of which were lymphocytes. Chest X-ray did not reveal any acute pathology and screening COVID-19 PCR was negative. He was admitted to the medical ward for management of alcohol withdrawal and decompensated liver cirrhosis. He developed hypoxic respiratory failure within 24 hours of presentation. CT chest (Figure 1) showed multifocal ground glass opacities along with bilateral pleural effusions and consolidative airspace disease at bases. A repeat COVID PCR resulted positive. His respiratory failure progressively worsened over the next two weeks despite being treated with remdesivir, dexamethasone and empiric broad spectrum antibiotics. He was intubated and placed on mechanical ventilation. Repeat imaging (Figure 2) showed worsening diffuse ground glass opacities now with more predominant cystic changes. Bronchoscopy with broncho-alveolar lavage (BAL) was performed, PCR testing of the BAL sample detected Pneumocystis jirovecii. He was then started on Bactrim in conjunction with steroids for the high A-a gradient. HIV antibody was negative, CD4 lymphocyte count was low at 304/µL and CD8 counts were normal at 311/µL. The patient slowly started to improve and was successfully extubated after three weeks. However, he later on developed septic shock from candidemia and was placed on hospice care by family due to his poor functional status. DISCUSSION: As with many viral infections, patient's with COVID-19 have demonstrated considerable risk for developing concomitant bacterial and fungal infections. We speculate that lymphopenia with low absolute CD4 count, combined with the use of corticosteroids may play a role in susceptibility to opportunistic infections in otherwise immunocompetent hosts. CONCLUSIONS: When critically ill COVID patient's fail to improve and have persistent lymphopenia, co-infections should be considered and appropriately worked up. REFERENCE #1: A case of COVID-19 and Pneumoncystis jirovecii Coinfection. A. Menon et al. Am J Respir Crit Care Med. 2020 Jul REFERENCE #2: Invasive Fungal Disease Complicating Coronavirus Disease 2019: When It Rains, It Spores. M.Hoenigl. Clinical infectious diseases. 2020 September REFERENCE #3: Pneumocystis and Severe Acute Respiratory Syndrome Coronavirus 2 Coinfection: A Case Report and Review of an Emerging Diagnostic Dilemma. C. Rubiano. Open Forum Infectious Diseases. January 2021. DISCLOSURES: No relevant relationships by Ahmed Mahgoub, source=Web Response No relevant relationships by Joseph Meharg, source=Web Response No relevant relationships by Leandro Ramirez, source=Web Response No relevant relationships by Ajit Thota, source=Web Response

Pulmonary cavitation – an unexpected finding in late stage COVID-19 pneumonia (case report)

The typical CT features of COVID-19 pneumonia include multifocal and bilateral ground-glass opacities with or without consolidation, found in both lungs, predominantly at peripheral, and posterior regions, bronchovascular thickening, crazy pavement appearance (ground-glass opacities with superimposed interlobular septal thickening). Atypical imagistic findings such as lung cavitation were rarely reported. In this report we describe the case of a 42 years old, healthy man with severe COVID-19 pneumonia who developed two pulmonary cavities during recovery. The pulmonary cavitations formed in the aria of the lung where patchy air space opacification was seen in early stages. There were no signs of invasive fungal or bacterial infection and the complementary investigations have ruled out other possible etiology for lung cavitation. Although the pathophysiological mechanism involved in the origin of the pulmonary cavities is not fully known, it could be closely related to diffuse alveolar damage in severe COVID-19 pneumonia.

Relationship between chest CT scan findings with SOFA score, CRP, comorbidity, and mortality in ICU patients with COVID-19.

ObjectiveThis study aimed to investigate the relationship between chest computed tomography (CT) scan findings with sequential organ failure assessment (SOFA) score, C‐reactive protein (CRP), comorbidity, and mortality in intensive care unit (ICU) patients with coronavirus disease 19 (COVID‐19).MethodAdult patients (≥18 years old) with COVID‐19 who were consecutively admitted to the Imam‐Reza Hospital, Tabriz, East‐Azerbaijan Province, North‐West of Iran between March 2020 and August 2020 were screened and total of 168 patients were included. Demographic, clinical, and mortality data were gathered. Severity of disease was evaluated using the SOFA score system. CRP levels were measured and chest CT scans were performed.ResultsMost of patients had multifocal and bilateral ground glass opacity (GGO) pattern in chest CT scan. There were significant correlations between SOFA score on admission with multifocal and bilateral GGO (P = .010 and P = .011, respectively). Significant relationships were observed between unilateral and bilateral GGO patterns with CRP (P = .049 and P = .046, respectively). There was significant relationship between GGO patterns with comorbidities including overweight/obesity, heart failure, cardiovascular diseases, and malignancy (P < .05). No significant relationships were observed between chest CT scan results with mortality (P > .05).ConclusionMultifocal bilateral GGO was the most common pattern. Although chest CT scan characteristics were significantly related with SOFA score, CRP, and comorbidity in ICU patients with COVID‐19, a relationship with mortality was not significant.

"Pulmonary target sign" as a diagnostic feature in chest computed tomography of COVID-19.

BACKGROUNDIn chest computed tomography (CT) scan, bilateral peripheral multifocal ground-glass opacities, linear opacities, reversed halo sign, and crazy-paving pattern are suggestive for coronavirus disease 2019 (COVID-19) in clinically suspicious cases, but they are not specific for the diagnosis, as other viral pneumonias, like influenza and some viral pneumonia may show similar imaging findings.AIMTo find a specific imaging feature of the disease would be a welcome guide in diagnosis and management of challenging cases. METHODSChest CT imaging findings of 650 patients admitted to a university Hospital in Tehran, Iran between January 2020 and July 2020 with confirmed COVID-19 infection by RT-PCR were reviewed by two expert radiologists. In addition to common non-specific imaging findings of COVID-19 pneumonia, radiologic characteristics of “pulmonary target sign” (PTS) were assessed. PTS is defined as a circular appearance of non-involved pulmonary parenchyma, which encompass a central hyperdense dot surrounded by ground-glass or alveolar opacities.RESULTSPTS were presented in 32 cases (frequency 4.9%). The location of the lesions in 31 of the 32 cases (96.8%) was peripheral, while 4 of the 31 cases had lesions both peripherally and centrally. In 25 cases, the lesions were located near the pleural surface and considered pleural based and half of the lesions (at least one lesion) were in the lower segments and lobes of the lungs. 22 cases had multiple lesions with a > 68% frequency. More than 87% of cases had an adjacent bronchovascular bundle. Ground-glass opacities were detectable adjacent or close to the lesions in 30 cases (93%) and only in 7 cases (21%) was consolidation adjacent to the lesions.CONCLUSIONAlthough it is not frequent in COVID-19, familiarity with this feature may help radiologists and physicians distinguish the disease from other viral and non-infectious pneumonias in challenging cases.

EVALI versus MIS-C, one more overlapping diagnosis to consider.

We describe six teenagers presenting with fever and severe abdominal symptoms admitted with concerns for multisystem inflammatory syndrome in children (MIS-C). Laboratory evaluation revealed elevated markers of inflammation, lymphopenia, and increased D-dimers. Imaging studies revealed multifocal airspace disease and ground-glass opacities. SARS-CoV-2 polymerase chain reaction and serologies were negative. All patients reported a history of vaping, prompting E-cigarette, or vaping, product use-associated lung injury (EVALI) diagnosis. MIS-C has overlapping clinical and laboratory features highlighting the added challenge of diagnosing EVALI during the COVID-19 pandemic. Keywords COVID-19 pandemic, EVALI, MIS-C.

Early CT features of COVID-19 pneumonia, association with patients\u2019 age and duration of presenting complaint

BackgroundCoronavirus disease (COVID-19) is a respiratory syndrome with a variable degree of severity. Imaging is a vital component of disease monitoring and follow-up in coronavirus pulmonary syndromes. The study of temporal changes of CT findings of COVID-19 pneumonia can help in better understanding of disease pathogenesis and prediction of disease prognosis. In this study, we aim to determine the typical and atypical CT imaging features of COVID-19 and discuss the association of typical CT imaging features with the duration of the presenting complaint and patients’ age.ResultsThe lesions showed unilateral distribution in 20% of cases and bilateral distribution in 80% of cases. The lesions involved the lower lung lobes in 30% of cases and showed diffuse involvement in 58.2% of cases. The lesions showed peripheral distribution in 74.5% of cases. The most common pattern was multifocal ground glass opacity found in 72.7% of cases. Atypical features like cavitation and pleural effusion can occur early in the disease course. There was significant association between increased number of the lesions, bilaterality, diffuse pattern of lung involvement and older age group (≥ 50 years old) and increased duration of presenting complaint (≥ 4 days). There was significant association between crazy-paving pattern and increased duration of presenting complaint. No significant association could be detected between any CT pattern and increased patient age.ConclusionThe most common CT feature of COVID-19 was multifocal ground glass opacity. Atypical features like cavitation and pleural effusion can occur early in the course of the disease. Our cases showed more extensive lesions with bilateral and diffuse patterns of distribution in the older age group and with increased duration of presenting complaint. There was a significant association between crazy-paving pattern and increased duration of presenting complaint. No significant association could be detected between any CT pattern and increased patient age.

Epidemiological, imaging, laboratory, and clinical characteristics and factors related to mortality in patients with COVID-19: a single-center study.

ObjectivesCoronavirus disease 2019 (COVID-19) is a novel pandemic. Considerable differences in disease severity and the mortality rate have been observed in different parts of the world. The present study investigated the characteristics and outcomes of patients hospitalized with COVID-19 in Iran.MethodsWe established a retrospective cohort to study hospitalized COVID-19 patients in Iran. Epidemiological, imaging, laboratory, and clinical characteristics and outcomes were recorded from medical documents. The chi-square test, t-test, and logistic regression models were used to analyze the data. A p<0.05 was considered to indicate statistical significance.ResultsIn total, 364 cases (207 males and 157 females) were analyzed. The most common symptoms were cough, fever, and dyspnea. Multifocal bilateral ground-glass opacities with peripheral distribution were the predominant imaging finding. The mean age of patients was 54.28±18.81 years. The mean age of patients who died was 71.50±14.60 years. The mortality rate was 17.6%. The total proportion of patients with a comorbidity was 47.5%, and 84.4% of patients who died had a comorbidity. Sex, history of diabetes mellitus, and dyslipidemia were not significantly associated with mortality (p>0.05). However, mortality showed significant relationships with body mass index; age; history of hypertension, chronic kidney disease (CKD), ischemic heart disease, cerebrovascular accident (CVA), pulmonary disease, and cancer; and abnormal high-resolution computed tomography (HRCT) findings (p<0.05 for all). Cancer had the highest odds ratio.ConclusionComorbidities (especially cancer, CKD, and CVA), severe obesity, old age, and abnormal HRCT findings affected the health outcomes of patients hospitalized with COVID-19.

La maladie associée aux IgG4 : une cause rare de pneumopathie infiltrante hypoxémiante sévère

The intrathoracic manifestations of IgG4-related disease include a range of conditions and severity, and can on occasion cause acute respiratory failure as reported in the case described here. A 69-year-old male former smoker, was admitted to our hospital with dyspnea, fever, cough, fatigue, and a 3-month history of weight loss. He received high flow oxygen therapy and non-invasive ventilation for severe respiratory failure. Chest computed tomography revealed multifocal condensations and ground glass opacities, accompanied by thickening of the perilymphatic interstitium, mediastinal lymphadenopathy and bilateral pleural effusion. Elevated serum concentrations of IgG4 suggested an IgG4-Related Disease. He developed renal failure and underwent a renal biopsy. Histopathological analysis of which supported the diagnosis by showing dense lymphocytic infiltrate with a count of IgG4+ cells/hpf higher than 60, and storiform fibrosis - a swirling, "cartwheel" pattern of fibrosis which may have a patchy distribution. The patient responded well to steroid therapy. Although respiratory symptoms are usually mild in IgG4-relatd disease, thoracic features can evolve into acute respiratory failure with few extra thoracic manifestations.

Effect of serial awake prone positioning on oxygenation in patients admitted to intensive care with COVID-19

IntroductionAwake prone positioning (APP) might benefit patients with COVID-19 by improving oxygenation, but it is unknown whether this improvement can be sustained with serial proning episodes.MethodsWe conducted a retrospective review...

Pulmonary Manifestations and Management of COVID-19 Pediatric Patients Admitted in a Tertiary Government Hospital

Background. Coronavirus Disease 2019 (COVID-19) presents with respiratory signs and symptoms in children. Presently, there are no local studies on the pulmonary manifestations and management of COVID-19 among children.&#x0D; Objective. Our study aimed to identify and describe the presenting respiratory signs and symptoms, oxygenation status, radiologic findings, blood gas analysis, and pulmonary interventions among children admitted for COVID-19. We also analyzed the clinical and radiologic variables associated with mortality.&#x0D; Methodology. This is a retrospective study using data obtained from a review of medical records from April 1, 2020, to June 30, 2020, at a tertiary government institution in the Philippines. All pediatric patients (0-18 years) hospitalized for probable or confirmed COVID-19 during the said time period were included in this study. Univariate and multivariate logistic regression was applied to determine factors affecting mortality.&#x0D; Results. A total of 25 pediatric patients with a mean age of 7 years old (age range: 11 days to 18 years) were admitted for COVID-19. Cough (44%) and dyspnea (24%) were the most common presenting respiratory symptoms, while tachypnea (68%), crackles (36%), and peripheral oxygen desaturation (36%) were the most common respiratory signs. Indeterminate findings for COVID-19 such as multifocal or diffuse ground-glass opacities and/or consolidations were the most common radiographic abnormalities. Invasive ventilatory support was administered to 6 cases of severe COVID-19 and 4 critical cases. There were no variables that correlated significantly with mortality.&#x0D; Conclusion. Respiratory signs and symptoms were prominent in our cohort of children admitted due to COVID-19. Mechanical ventilation was required in more severe cases. Larger prospective studies may help identify variables that significantly correlate with poor outcomes among children with COVID-19.

Nintedanib in the management of pulmonary fibrosis after COVID-19: a case report

Pulmonary fibrosis is becoming a recognized complication of coronavirus disease 2019 (COVID-19). Patients with pulmonary fibrosis may present with dry cough, shortness of breath, nail clubbing, low oxygen saturation. We report a case of a 40-year-old male patient with pulmonary fibrosis due to COVID- 19. Clinical examination showed that the patient was dyspneic with low oxygen saturation and there was bilateral inspiratory crepitation in the lower part of his chest. High resolution computed tomography showed bilateral multifocal patchy ground-glass opacities, consolidation with peripheral and basal distribution, sub-pleural fibrotic bands and vascular thickening (almost 40-45% of parenchymal involvement). We prescribed him an antifibrotic drug, nintedanib and there was a significant clinical and radiological improvement after 15 days of treatment. Nintedanib may have novel therapeutic role in preventing COVID-19 associated fibrosis.&#x0D; Birdem Med J 2021; 11(2): 148-152

Computed tomography manifestation of novel corona virus pneumonia

Since December 2019, the outbreak of the novel corona virus has impacted nearly &gt;60 million peoples in more than 150 countries. In this case report, we aim to define the chest computed tomography findings of 2019-novel corona virus associated with pneumonia. A 47-year-old female patient, who is known case of hypertension and diabetes, presented with chief complaints of fever and shortness of breath since, two days. Chest computed tomography was performed and showed bilateral multifocal ground glass opacities with consolidation which suggested viral pneumonia as a differential diagnosis, and subsequent 2019-novel corona virus pneumonia nucleic acid test was positive.

A Hybrid Model for COVID-19 Monitoring and Prediction

COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has a case-fatality rate of 2–3%, with higher rates among elderly patients and patients with comorbidities. Radiologically, COVID-19 is characterised by multifocal ground-glass opacities, even for patients with mild disease. Clinically, patients with COVID-19 present respiratory symptoms, which are very similar to other respiratory virus infections. Our knowledge regarding the SARS-CoV-2 virus is still very limited. These facts make it vitally important to establish mechanisms that allow to model and predict the evolution of the virus and to analyze the spread of cases under different circumstances. The objective of this article is to present a model developed for the evolution of COVID in the city of Manizales, capital of the Department of Caldas, Colombia, focusing on the methodology used to allow its application to other cases, as well as on the monitoring tools developed for this purpose. This methodology is based on a hybrid model which combines the population dynamics of the SIR model of differential equations with extrapolations based on recurrent neural networks. This combination provides self-explanatory results in terms of a coefficient that fluctuates with the restraint measures, which may be further refined by expert rules that capture the expected changes in such measures.

Diagnostic accuracy of chest computed tomography in improving the false negative rate as compared to reverse transcriptase polymerase chain reaction in coronavirus disease 2019 pneumonia: A cross sectional analysis of 348 cases from India.

Background:Early differentiation between emergency department (ED) patients with and without coronavirus disease 2019 (COVID-19) is very important. The diagnosis of COVID-19 depends on real-time reverse transcriptase polymerase chain reaction (RT-PCR). On imaging, computed tomography (CT) manifestations resemble those seen in viral pneumonias, with multifocal ground-glass opacities and consolidation in a peripheral distribution being the most common findings. Although these findings lack specificity for COVID-19 diagnosis on imaging grounds, CT could be used to provide objective assessment about the extension of the lung opacities, which could be used as an imaging surrogate for disease burden. We set out to investigate the diagnostic accuracy of chest CT scanning in detecting COVID-19 in a population with suspected COVID-19 patients.Materials and Methods:In this cross-sectional single-center study performed on 348 cases with clinical suspicion of COVID-19, all adult symptomatic ED patients had both a CT scan and a PCR upon arrival at. CT results were compared with PCR test (s) and diagnostic accuracy was calculated.Results:Between February 15, 2020, and June 30, 2020, 348 symptomatic patients were included. In total, 62.3% of patients had a positive PCR and 69.8% had a positive CT, resulting in a sensitivity of 94.2%, specificity of 76.7%, likelihood ratio (LR) of +2.94 and (LR) −0.18. The sensitivity of the CT tended to be higher in those with acute respiratory distress syndrome (100.0%, P = 0.017) and severe COVID-19 (98.5%, P = 0.027) than in patients with mild (82.5%, P = 0.047) and moderate COVID-19 (89.3%, P = 0.039). The diagnostic ability of chest CT was found to be high with 86.3% concordance between findings of CT and PCR. In 48 (13.7%) patients, discordant findings between CT and PCR were observed. In most cases, the CT scan was considered suspicious for COVID-19, while the PCR was negative (37/48, 77.0%). In the majority of these, the diagnosis at discharge was pulmonary infection (n = 26; 54.1%).Conclusion:The accuracy of chest CT in symptomatic COVID suspect patients is high, but when used as a single diagnostic test, CT cannot accurately diagnose or exclude COVID-19. Therefore, we recommend a combination of both CT and RT-PCR for future follow-up, management, and medical surveillance.

Immunotherapy-induced pneumonitis in non-small cell lung cancer patients: current concern in treatment with immune-check-point inhibitors.

Purpose Immune-related adverse events (IrAEs) are auto-immune reactions associated with immune checkpoint inhibitor-based therapy (ICI). To date, little is known about immunotherapy-induced pneumonitis (IIP). In this study, we investigated the clinical and CT features of IIP in non-small cell lung cancer (NSCLC) patients treated with ICI. Methods CT images and clinical data of 98 NSCLC patients in our hospital were retrospectively analyzed after ICI therapy, and the incidence, onset time, CT findings, grade, treatment and prognosis of IIP were recorded. Results Nineteen patients developed IIP, which occurred 42∼210 days after ICI therapy, and the median time was 97 days. The CT findings for IIP showed multifocal ground-glass opacity (GGO) in 5 cases, patchy shadows in 6 cases, mixed distribution of patchy and strip-like shadows in 4 cases, and patchy shadows with honeycomb lung in 4 cases. The mean age and proportions of smokers, CD3+ and CD4+ of T lymphocyte subset in patients with IIP were significantly higher than those in patients without IIP (all p < 0.05). Among 19 patients with IIP, there were 10 patients with grade 1 ~ 2 and 9 patients with grade 3 ~ 4; 13 patients received hormone therapy, 12 of them were improved or stable, and 1 patient got worse after hormone therapy. No deaths from IIP were found. Conclusion IIP is a relatively rare but serious adverse event, and it is sensitive to hormone therapy. Its CT manifestations are diverse, and timely detection and treatment are the keys to reduce IIP.

Diagnostic accuracy and false-positive rate of chest CT as compared to RT-PCR in coronavirus disease 2019 (COVID-19) pneumonia: A prospective cohort of 612 cases from India and review of literature.

Background:At present, the diagnosis of COVID-19 depends on real-time reverse transcriptase polymerase chain reaction (RT-PCT). On imaging, computed tomography (CT) manifestations resemble those seen in viral pneumonias, with multifocal ground-glass opacities and consolidation in a peripheral distribution being the most common findings. Although these findings lack specificity for COVID-19 diagnosis on imaging grounds, CT could be used to provide objective assessment about the extension of the lung opacities, which could be used as an imaging surrogate for disease burden. Chest CT scan may be helpful in early diagnosing of COVID-19.Objective:The current study investigated the diagnostic accuracy and false-positive rate of chest CT in detecting COVID-19 pneumoniain a population with clinical suspicion using RT-PCR testing as reference standard.Materials and Methods:In this prospective single centerstudy performed on 612 cases with clinical suspicion of COVID-19, all adult symptomatic ED patients had both a CT scan and a PCR upon arrival at the hospital. CT results were compared with PCR test (s) and diagnostic accuracy was calculated.Results:Between February 15, 2020 to July 15, 2020, 612 symptomatic ED patients were included. In total, 78.5% of patients had a positive PCR and 82.8% a positive CT, resulting in a sensitivity of 94.2%, specificity 76.4%, likelihood ratio (LR) + 2.94 and (LR) - 0.18. The PPV was 76.7% and NPV 94.1%. The sensitivity of the CT tended to be higher (100.0%) in those with severe risk pneumonia than in patients with low/medium risk pneumonia (90.3%, P = 0.42). In patients with sepsis, sensitivity was significantly higher than in those without sepsis (99.5 vs. 63.5%, P < 0.001). The diagnostic ability of chest CT was found to be rather high with 92.1%, concordance rate between findings of CT and PCR. In 48 (7.8%) patients discordant findings between CT and PCR were observed. The positive predictive values (PPV) and accuracy of chest CT in diagnosing COVID-19 were higher in patients ≥60 years than that in patients <60 years (P = 0.001 and 0.004, respectively). The specificity and NPV of chest CT in diagnosing COVID-19 were greater for women than that for men (P = 0.007 and 0.03, respectively); and no difference existed for sensitivity, PPV and accuracy (P = 0.43, 0.69 and 0.31, respectively). In most cases, the CT scan was considered suspicious for COVID-19, while the PCR was negative (37/48, 70.8%). In the majority of these, the diagnosis at discharge was pulmonary infection (n = 26; 74.3%). The current study included repeated PCRs and explored discordant test results, which showed that in about 45.9% of patients with false-positive CT scans, other viral pathogens were detected. The false-positive rate of CT findings in the diagnosis of COVID-19 pneumonia was 7.2%.Conclusion:High diagnostic accuracy of chest CT findings with typical and relatively atypical CT manifestations of COVID-19 leads to a low rate of missed diagnosis. Normal chest CT can be found in RT-PCR positive COVID-19 cases, and typical CT manifestations can be found in RT-PCR negative cases. Therefore, a combination of both CT and RT-PCR for future follow-up, management and medical surveillance is recommended considering the false-positive results of chest CT in the diagnosis of COVID-19 pneumonia.