Rapidly progressive COVID-19 viral pneumonia: a report of two patients with a focus on imaging findings

BackgroundThe novel coronavirus causes viral pneumonia characterized by lower respiratory tract symptoms and 19severe inflammatory response syndrome. Studies have suggested that the virus has a clinical course with the stepwise progression of clinical signs and symptoms and radiologic alterations.Case presentationIn the present case report, we discuss two patients who presented with mild symptoms and CT imaging not suggestive of COVID-19, but subsequently had a rapid deterioration, with severe involvement happening in CT imaging. One of the patients survived the initial deterioration, but the other passed away.ConclusionWe suggest that the clinical course of the virus may be rapidly progressive in some patients, and special attention should be paid to patients being treated for the virus outside of the hospital as an outpatient.

A practical artificial intelligence system to diagnose COVID-19 using computed tomography: A multinational external validation study.

Computed tomography has gained an important role in the early diagnosis of COVID-19 pneumonia. However, the ever-increasing number of patients has overwhelmed radiology departments and has caused a reduction in quality of services. Artificial intelligence (AI) systems are the remedy to the current situation. However, the lack of application in real-world conditions has limited their consideration in clinical settings. This study validated a clinical AI system, COVIDiag, to aid radiologists in accurate and rapid evaluation of COVID-19 cases. 50 COVID-19 and 50 non-COVID-19 pneumonia cases were included from each of five centers: Argentina, Turkey, Iran, Netherlands, and Italy. The Dutch database included only 50 COVID-19 cases. The performance parameters namely sensitivity, specificity, accuracy, and area under the ROC curve (AUC) were computed for each database using COVIDiag model. The most common pattern of involvement among COVID-19 cases in all databases were bilateral involvement of upper and lower lobes with ground-glass opacities. The best sensitivity of 92.0% was recorded for the Italian database. The system achieved an AUC of 0.983, 0.914, 0.910, and 0.882 for Argentina, Turkey, Iran, and Italy, respectively. The model obtained a sensitivity of 86.0% for the Dutch database. COVIDiag model could diagnose COVID-19 pneumonia in all of cohorts with AUC of 0.921 (sensitivity, specificity, and accuracy of 88.8%, 87.0%, and 88.0%, respectively). Our study confirmed the accuracy of our proposed AI model (COVIDiag) in the diagnosis of COVID-19 cases. Furthermore, the system demonstrated consistent optimal diagnostic performance on multinational databases, which is critical to determine the generalizability and objectivity of the proposed COVIDiag model. Our results are significant as they provide real-world evidence regarding the applicability of AI systems in clinical medicine.

Expanding spontaneous pneumothorax in COVID-19 pneumonia: Case report and review of literature.

Coronavirus disease 2019 has presented itself with a variety of clinical signs and symptoms. One of these has been the accordance of spontaneous pneumothorax which in instances has caused rapid deterioration of patients. Furthermore pneumothorax may happen secondary to intubation and the resulting complications. Not enough is discussed regarding cases with COVID-19 related pneumothorax and proper management of these patients. The present article reports an elderly patient with spontaneous pneumothorax secondary to COVID-19 and reviews the existing literature.

Alveolar hemorrhage in the setting of COVID-19: Report of a successful vascular intervention and embolization.

The coronavirus disease 2019 (COVID-19) is characterized by viral pneumonia with mild to moderate symptoms. Emerging studies suggest that some patients may experience uncommon complications, such as thrombotic or hemorrhagic episodes. Here we present a 59-year-old male patient who had a hemorrhage episode from a branch of the pulmonary arteries and was treated by interventional embolization. Our case report demonstrates the importance of early diagnosis of hemorrhagic complications of COVID-19 and the possible benefits of early vascular intervention.

Computed tomography imaging findings in hospitalized patients with coronavirus disease 2019 (COVID-19): a descriptive study of 81 cases.

PURPOSE: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has proven to be a diagnostic challenge. Early studies have shown that computed tomography (CT) imaging may be useful in diagnosis of these patients. We aim to report CT findings in a series of hospitalized patients. MATERIAL AND METHODS: A total of 81 patients were included in this study. All of the patients were hospitalized and had SARS-CoV-2 infection proven by molecular assay. All patients had a CT scan on the first day of admission. Imaging results were reviewed by two separate radiologists, and imaging findings were documented. RESULTS: Seventy-eight patients had abnormal CT imaging, while 3 had normal CT imaging. The sensitivity of CT in diagnosing coronavirus disease 2019 (COVID-19) was estimated to be 96%. The most common imaging finding was ground glass opacities, followed by septal thickening. Most lesions were located at the periphery and posterior of the lungs. Most lesions were multifocal, and involved the right lower lobe more frequently. Chest X-rays were normal in 38 patients, and the sensitivity of chest X-ray in diagnosing SARS-Cov-2 was 54%. CONCLUSIONS: CT scans could be used in diagnosis of patients with a high sensitivity (93%). No common imaging findings may also be seen alongside ground glass opacities, based on the degree of disease progression.

Successful vascular interventional management of superior mesenteric vein thrombosis in a patient with COVID-19: A case report and review of literature.

Coronavirus disease (COVID-19) is associated with thrombosis formation in various vessels, including those in the abdomen. In this case report, we present a COVID-19 infected patient who had developed abdominal discomfort. The patient underwent magnetic resonance imaging, which showed signs of thrombosis formation in the superior mesenteric vein (SMV). After conservative treatment failed, the patient was considered for vascular intervention. The SMV clot underwent thrombolysis via the infusion of reteplase (dose 6 mg stat, followed by 1 mg every hour) through a 5F perfusion Cather (Cragg-McNamara, 20 cm). Control venography showed near-complete recanalization. The patient was discharged with oral anticoagulants. Our case report is one of the first incidents of successful vascular intervention in SMV thrombosis in the setting of COVID-19.

The risk factors associated with MERS-CoV patient fatality: A global survey.

Risk factors associated with Middle East respiratory syndrome coronavirus (MERS-CoV) infection outcome were established by analyses of WHO data from September 23, 2012 to 18 June 2018. Of the 2220 reported cases, 1408 cases, including 451 MERS-CoV deaths, were analyzed. The case fatality rate was 32% (95% CI: 29.4-34.5). Compared to MERS patients ≤30 years old, those with >30 years had the adjusted odds ratio estimate for death of 2.38 [95% CI: 1.75-3.22]. This index was 1.43 [95% CI: 1.06-1.92] for Saudi patients in comparison to non-Saudi; 1.76 [95% CI: 1.39-2.22] for patient with comorbidity in comparison to those without comorbidity; 0.58 [95% CI: 0.44-0.75] for those who had close contact to a camel in the past 14 days and 0.42 [95% CI: 0.31-0.57] for patients with >14 days with onset of signs and hospital admission compared to patients with ≤14 days.

Angiotensin-converting enzyme as a new immunologic target for the new SARS-CoV-2.

The coronavirus disease 2019 (COVID-19) pandemic has affected the daily lives of millions of people worldwide and had caused significant mortality; hence, the assessment of therapeutic options is of great interest. The leading cause of death among COVID-19 patients is acute respiratory distress syndrome caused by hyperinflammation secondary to cytokine release syndrome (CRS). Cytokines, such as tumor necrosis factor-α, interleukin-6, interferon-γ and interleukin-10, are the main mediators of CRS. Based on recent evidence, the angiotensin-converting enzyme (ACE) II is known to be the target of the COVID-19 spike protein, which enables the virus to penetrate human cells. ACE II also possesses an anti-inflammatory role in many pathologies such as cardiovascular disease, hypertension, diabetes mellitus and other conditions, which are the main risk factors of poor prognosis in COVID-19 infection. Changes in tissue ACE II levels are associated with many diseases and hyperinflammatory states, and it is assumed that elevated levels of ACE II could aggravate the course of COVID-19 infection. Therefore, the use of renin-angiotensin-aldosterone system inhibitors (RASis) in COVID-19 patients could be hypothetically considered, though sufficient evidence is not presented by the scientific community. In this work, based on the most recent pieces of evidence, the roles of RAS and RASi in immunologic interactions are addressed. Furthermore, the molecular and immunologic aspects of RASi and their potential significance in COVID-19 are discussed.

Predictors of coronavirus disease 19 (COVID-19) pneumonitis outcome based on computed tomography (CT) imaging obtained prior to hospitalization: a retrospective study.

PURPOSE: Computed tomography (CT) has been utilized as a diagnostic modality in the coronavirus disease 19 (COVID-19), while some studies have also suggested a prognostic role for it. This study aimed to assess the diagnostic and prognostic value of computed tomography (CT) imaging in COVID-19 patients. METHODS: This was a retrospective study of fifty patients with COVID-19 pneumonia. Twenty-seven patients survived, while 23 passed away. CT imaging was performed in all of the patients on the day of admission. Imaging findings were interpreted based on current guidelines by two expert radiologists. Imaging findings were compared between surviving and deceased patients. Lung scores were assigned to patients based on CT chest findings. Then, the receiver operating characteristic curve was used to determine cutoff values for lung scores. RESULTS: The common radiologic findings were ground-glass opacities (82%) and airspace consolidation (42%), respectively. Air bronchogram was more commonly seen in deceased patients (p = 0.04). Bilateral and multilobar involvement was more frequently found in deceased patients (p = 0.049 and 0.014, respectively). The mean number of involved lobes was 3.46 ± 1.80 lobes in surviving patients and 4.57 ± 0.60 lobes in the deceased patients (p = 0.009). The difference was statistically significant. The area under the curve for a lung score cutoff of 12 was 0.790. CONCLUSION: Air bronchogram and bilateral and multilobar involvement were more frequently seen in deceased patients and may suggest a poor outcome for COVID-19 pneumonia.

Clinical and radiological characteristics of pediatric patients with COVID-19: focus on imaging findings.

PURPOSE: CT imaging has been a detrimental tool in the diagnosis of COVID-19, but it has not been studied thoroughly in pediatric patients and its role in diagnosing COVID-19. METHODS: 27 pediatric patients with COVID-19 pneumonia were included. CT examination and molecular assay tests were performed from all participants. A standard checklist was utilized to extract information, and two radiologists separately reviewed the CT images. RESULTS: The mean age of patients was 4.7 ± 4.16 (mean ± SD) years. Seventeen patients were female, and ten were male. The most common imaging finding was ground-glass opacities followed by consolidations. Seven patients had a single area of involvement, five patients had multiple areas of involvement, and four patients had diffuse involvement. The sensitivity of CT imaging in diagnosing infections was 66.67%. Also, some uncommon imaging findings were seen, such as a tree-in-bud and lung collapse. CONCLUSION: CT imaging shows less involvement in pediatric compared to adult patients, due to pediatric patients having a milder form of the disease. CT imaging also has a lower sensitivity in detecting abnormal lungs compared to adult patients. The most common imaging findings are ground-glass opacities and consolidations, but other non-common imaging findings also exist.