Pulmonary sequestration in adult patients: a single-center retrospective study.

BACKGROUND: Pulmonary sequestration (PS) is a rare congenital lower airway malformation. This study presents the clinical and imaging features and surgical outcomes of PS in adults, and compare the safety and feasibility of minimally invasive surgery versus open thoracotomy for PS. METHODS: Adult patients with PS treated at our center from July 2011 to September 2021 were included. Information regarding the patient demographics, clinical and CT features, arterial supply and venous drainage, and surgical outcomes were collected. RESULTS: Ninety seven patients were included. The most common CT findings were mass lesions (50.5%) and cystic lesions (20.6%). The vast majority of the lesions (96 out of 97) were located close to the spine in the lower lobes (left vs. right: 3.6 vs. 1). Arterial supply was mainly provided by the thoracic aorta (87.4%) and abdominal aorta (10.5%). Intralobar and extralobar PS accounted for 90.7% and 9.3% of the patients, respectively. Three (4.5%) patients who underwent minimally invasive surgery were converted to open thoracotomy due to dense adhesions. Though no significant differences regarding operative time (P = 0.133), the minimally invasive surgery group was significantly better than the open thoracotomy group regarding intraoperative blood loss (P = 0.001), drainage volume (P = 0.004), postoperative hospital days (P = 0.017) and duration of chest drainage (P = 0.001). There were no cases of perioperative mortality. Only four (4.1%) patients developed postoperative complications, and no significant difference existed between the two groups. CONCLUSION: Our study revealed PS can present with a variety of different clinical and radiologic manifestations. Clinicians should consider the possibility of PS when diagnosing a lesion in the lower lobes close to the spine. Moreover, minimally invasive surgery is a safe and effective treatment modality for the treatment of PS in an experienced center.

Computed Tomography Lesions and Their Association With Global Outcome in Young People With Mild Traumatic Brain Injury.

Mild traumatic brain injury (mTBI) can be accompanied by structural damage to the brain. Here, we investigated how the presence of intracranial traumatic computed tomography (CT) pathologies relates to the global functional outcome in young patients one year after mTBI. All patients with mTBI (Glasgow Coma Scale: 13-15) ≤24 years in the multi-center, prospective, observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study were included. Patient demographics and CT findings were assessed at admission, and the Glasgow Outcome Scale Extended (GOSE) was evaluated at 12 months follow-up. The association between a "positive CT" (at least one of the following: epidural hematoma, subdural hematoma, traumatic subarachnoid hemorrhage (tSAH), intraventricular hemorrhage, subdural collection mixed density, contusion, traumatic axonal injury) and functional outcome (GOSE) was assessed using multi-variable mixed ordinal and logistic regression models. A total of 462 patients with mTBI and initial brain CT from 46 study centers were included. The median age was 19 (17-22) years, and 322 (70%) were males. CT imaging showed a traumatic intracranial pathology in 171 patients (37%), most commonly tSAH (48%), contusions (40%), and epidural hematomas (37%). Patients with a positive CT scan were less likely to achieve a complete recovery 12 months post-injury. The presence of any CT abnormality was associated with both lower GOSE scores (odds ratio [OR]: 0.39 [0.24-0.63]) and incomplete recovery (GOSE <8; OR: 0.41 [0.25-0.68]), also when adjusted for demographical and clinical baseline factors. The presence of intracranial traumatic CT pathologies was predictive of outcome 12 months after mTBI in young patients, which might help to identify candidates for early follow-up and additional care.

Detection of COVID-19 and its pulmonary stage using Bayesian hyperparameter optimization and deep feature selection methods.

Since the first case of COVID-19 was reported in December 2019, many studies have been carried out on artificial intelligence for the rapid diagnosis of the disease to support health services. Therefore, in this study, we present a powerful approach to detect COVID-19 and COVID-19 findings from computed tomography images using pre-trained models using two different datasets. COVID-19, influenza A (H1N1) pneumonia, bacterial pneumonia and healthy lung image classes were used in the first dataset. Consolidation, crazy-paving pattern, ground-glass opacity, ground-glass opacity and consolidation, ground-glass opacity and nodule classes were used in the second dataset. The study consists of four steps. In the first two steps, distinctive features were extracted from the final layers of the pre-trained ShuffleNet, GoogLeNet and MobileNetV2 models trained with the datasets. In the next steps, the most relevant features were selected from the models using the Sine-Cosine optimization algorithm. Then, the hyperparameters of the Support Vector Machines were optimized with the Bayesian optimization algorithm and used to reclassify the feature subset that achieved the highest accuracy in the third step. The overall accuracy obtained for the first and second datasets is 99.46% and 99.82%, respectively. Finally, the performance of the results visualized with Occlusion Sensitivity Maps was compared with Gradient-weighted class activation mapping. The approach proposed in this paper outperformed other methods in detecting COVID-19 from multiclass viral pneumonia. Moreover, detecting the stages of COVID-19 in the lungs was an innovative and successful approach.

Acute mesenteric ischemia: The diagnostic value of QT parameters and their relationship with CT findings.

Background One of the greatest challenges in the diagnosis of acute mesenteric ischemia (AMI) is the lack of specific laboratory tests that support multidetector computed tomography (CT). Our aim is to investigate the diagnostic value of electrocardiographic QT parameters in AMI and their relationship with CT findings. Materials and methods Patients who were admitted to the emergency department with abdominal pain were recruited retrospectively from the hospital information system . Grouping was carried out on the basis of AMI(n=78) and non-AMI (n=78). In both groups, the corrected QT (QTc) and QT dispersion (QTD) were measured on electrocardiographs, and the qualitative and quantitative CT findings were evaluated on CT examinations. Results The QTc and QTD values were higher in the AMI group. The median QTc values were 456.16 (IQR: 422.88-483.16) for the AMI group and 388.83 (IQR: 359.74-415.83) for the control group (p<0.001), and the median QTD values were 58 (IQR: 50.3-68.25) for the AMI group and 46 (IQR: 42-50) for the control group (p<0.001). In the CT analysis, the QTc values were significantly higher among AMI patients, with images of paper thin bowel walls and the absence of bowel wall enhancement (p=0.042 and p=0.042, respectively). Meanwhile, the QTD values were significantly higher among patients with venous pneumatosis findings on CT (p=0.005). In the regression analysis, a significant relationship was found between the QT parameters and AMI (p<0.001). For QTc, an AUC of 0.903 (95% CI: 0.857-0.950, p<0.001), a sensitivity of 80.8%, and a specificity of 82.3% were found. For QTD, an AUC of 0.821 (95% CI: 0.753-0.889, p<0.001), a sensitivity of 73.1%, and a specificity of 82.3% were found. Conclusion We found the QTc and QTD values to be significantly higher among AMI patients. Furthermore, we found a significant relationship between the CT findings and QTc and QTD as well as a significant relationship between survival and QTc in the AMI group.

Association of Lung CT Findings in Coronavirus Disease 2019 (COVID-19) With Patients' Age, Body Weight, Vital Signs, and Medical Regimen.

Objective: This study aimed to detect possible associations between lung computed tomography (CT) findings in COVID-19 and patients' age, body weight, vital signs, and medical regimen in Jordan. Methods: The present cross-sectional study enrolled 230 patients who tested positive for COVID-19 in Prince Hamza Hospital in Jordan. Demographic data, as well as major lung CT scan findings, were obtained from the hospital records of the COVID-19 patients. Results: The main observed major lung changes among the enrolled COVID-19 patients included ground-glass opacification in 47 (20.4%) patients and consolidation in 22 (9.6%) patients. A higher percentage of patients with major lung changes (24%) was observed among patients above 60 years old, while (50%) of patients with no changes in their lung findings were in the age group of 18-29 years old. Results obtained from the present study showed that only patients with major CT lung changes (9.7%) were prescribed more than three antibiotics. Additionally, 41.6 % of patients with major lung CT scan changes had either dry (31.0%) or productive (10.6%) cough at admission. Conclusion: Several factors have been identified by this study for their ability to predict lung changes. Early assessment of these predictors could help provide a prompt intervention that may enhance health outcomes and reduce the risk for further lung changes.

Periventricular hypodensity is associated with the incidence of pre-shunt seizure in hydrocephalic children.

BACKGROUND: The seizure incidence in hydrocephalic children has been acknowledged in a lot of studies previously; nonetheless, seizure pathogenesis in these children remains unclear. Its high proportion of hydrocephalic children who underwent shunt surgery suggests that the seizure might be associated with the protocol of shunt placement and/or the shunt existence intracranially; however, this hypothesis could not explain the pre-shunt seizure incidence in hydrocephalic children. OBJECTIVE: This study aims to evaluate the patients' characteristics and CT findings in pre-shunt hydrocephalic children to identify the possible seizure etiology in these patients. METHODS: Three hundred and thirty-four children with hydrocephalus were included in this study, including 147 hydrocephalic children with the pre-shunt seizure history and 187 hydrocephalic children presented without the pre-shunt seizure history. The following information was retrieved from the patients' medical records: gender, age, pediatric Glasgow Coma Scale (pGCS) upon admission, and hydrocephalus diagnoses. CT findings were re-evaluated to assess the compression association of sulci and gyri, Sylvian fissures, cisterns, FH/ID ratio, Evan's ratio, and periventricular hypodensity with pre-shunt seizure. RESULTS: The results show that the pre-shunt seizure incidence is significantly higher in hydrocephalic children aged 1 to 5 years old (63/113 (55%), p = 0.0001), diagnosed with communicating hydrocephalus (97/163 (59%), p = 0.0001) or infectious hydrocephalus (80/109 (73%), p = 0.0001). The presence of periventricular hypodensity is significantly associated with the pre-shunt seizure incidence (132/205 (64.3%), p = 0.0001). Results from univariate analyses suggest significant association between periventricular hypodensity in every location and pre-shunt seizure (p < 0.0001). Multivariate analyses identify that temporal horn in the right lateral ventricle as the location of periventricular hypodensity has the strongest association with the pre-shunt seizure. CONCLUSION: The presence of periventricular hypodensity in head CT scan is significantly associated with the pre-shunt seizure incidence. Further investigation to confirm this finding and evaluate the possible roles of inflammation in the pre-shunt seizure in hydrocephalic children is important to seek its possible implication on the treatment of pre-shunt seizure in these children.

Bilateral musculus sternalis - An anatomical and clinical review.

The musculus sternalis is an extremely rare anatomical variant of the anterior chest wall. A detailed review of the anatomy, historical background and prevalence of the sternalis muscle is presented, with both the significant radiological and surgical implications of this variant specifically discussed.

Potentials of post-mortem CT investigations during SARS-COV-2 pandemic: a narrative review.

In December 2019, a new coronavirus, SARS-COV-2, caused a cluster of cases of pneumonia in China, and rapidly spread across the globe. It was declared a pandemic by the World Health Organization on March 11th, 2020. Virtual autopsy by post-mortem CT (PMCT) and its ancillary techniques are currently applied in post-mortem examinations as minimally or non-invasive techniques with promising results. In this narrative review, we speculate on the potentials of PMCT and its ancillary techniques, as a viable investigation technique for analysis of suspected or confirmed SARS-COV-2 deaths. An online literature search was performed by using three prefix search terms (postmortem, post-mortem, post mortem) individually combined with the suffix radiology, imaging, computed tomography, CT and with the search terms 'SARS-CoV-2' and 'COVID-19' to identify papers about PMCT and its ancillary techniques in SARS-COV-2 positive cadavers. PMCT findings suggestive for pulmonary COVID-19 in deceased positive SARS-COV-2 infection are reported in the literature. PMCT ancillary techniques were never applied in such cases. PMCT imaging of the lungs has been proposed as a pre-autopsy screening method for SARS-COV-2 infection. Further studies are needed to ascertain the value of PMCT in determining COVID-19 as the cause of death without autopsy histopathological confirmation. We advocate the application of PMCT techniques in the study of ascertained or suspected SARS-COV-2 infected deceased individuals as a screening technique and as a method of post-mortem investigation, to augment the numbers of case examined and significantly reducing infection risk for the operators.

An audit of CT brain findings in adults with new-onset seizures in a resource restricted setting in South Africa.

BACKGROUND: Globally, adults presenting with seizures account for 1% - 2% of visits to emergency departments (EDs), of which 25% are new-onset seizures. Neuroimaging is essential as part of the initial workup. Multiple studies have demonstrated abnormal CT brain (CTB) findings in these patients. OBJECTIVES: To review the CTB findings in adults presenting with new-onset seizures in a resource restricted setting. METHOD: A retrospective review of 531 CTBs was conducted at a tertiary hospital in Gauteng on adults presenting to the ED with new-onset seizures. RESULTS: The mean age of the patients was 45.6 ± 17.1 years, and the male to female ratio was 1.2:1. Generalised and focal seizure types were almost equally represented. Of the total 531 patients, 168 (31.6%) were HIV positive. The CTB findings were abnormal in 257 (48.4%) patients, albeit vascular pathology accounted for 21.9%. Infective pathology accounted for 14.1% with a statistically significant association with HIV (p = 0.003). Trauma related pathology was 2.4%, whilst neoplastic pathology was seen in 3.0%. Other causes included congenital pathology, calcifications, atrophy and gliosis. Clinical factors associated with abnormal CTB findings were age ≥ 40 years, HIV infection, hypertension, focal seizures, low Glasgow Coma Scale (GCS), raised cerebrospinal fluid (CSF) protein and presence of lymphocytes. CONCLUSION: A high yield of abnormal CTB findings was noted in adult patients who presented with new-onset seizures, supporting the use of urgent CTB in patients with certain clinical risk factors. Patients without these risk factors can be scanned within 24-48 h in a resource restricted setting.

Detection of COVID-19 findings by the local interpretable model-agnostic explanations method of types-based activations extracted from CNNs.

Covid-19 is a disease that affects the upper and lower respiratory tract and has fatal consequences in individuals. Early diagnosis of COVID-19 disease is important. Datasets used in this study were collected from hospitals in Istanbul. The first dataset consists of COVID-19, viral pneumonia, and bacterial pneumonia types. The second dataset consists of the following findings of COVID-19: ground glass opacity, ground glass opacity, and nodule, crazy paving pattern, consolidation, consolidation, and ground glass. The approach suggested in this paper is based on artificial intelligence. The proposed approach consists of three steps. As a first step, preprocessing was applied and, in this step, the Fourier Transform and Gradient-weighted Class Activation Mapping methods were applied to the input images together. In the second step, type-based activation sets were created with three different ResNet models before the Softmax method. In the third step, the best type-based activations were selected among the CNN models using the local interpretable model-agnostic explanations method and re-classified with the Softmax method. An overall accuracy success of 99.15% was achieved with the proposed approach in the dataset containing three types of image sets. In the dataset consisting of COVID-19 findings, an overall accuracy success of 99.62% was achieved with the recommended approach.

Segmentation and quantification of COVID-19 infections in CT using pulmonary vessels extraction and deep learning.

At the end of 2019, the World Health Organization (WHO) reported pneumonia that started in Wuhan, China, as a global emergency problem. Researchers quickly advanced in research to try to understand this COVID-19 and sough solutions for the front-line professionals fighting this fatal disease. One of the tools to aid in the detection, diagnosis, treatment, and prevention of this disease is computed tomography (CT). CT images provide valuable information on how this new disease affects the lungs of patients. However, the analysis of these images is not trivial, especially when researchers are searching for quick solutions. Detecting and evaluating this disease can be tiring, time-consuming, and susceptible to errors. Thus, in this study, we aim to automatically segment infections caused by COVID19 and provide quantitative measures of these infections to specialists, thus serving as a support tool. We use a database of real clinical cases from Pedro Ernesto University Hospital of the State of Rio de Janeiro, Brazil. The method involves five steps: lung segmentation, segmentation and extraction of pulmonary vessels, infection segmentation, infection classification, and infection quantification. For the lung segmentation and infection segmentation tasks, we propose modifications to the traditional U-Net, including batch normalization, leaky ReLU, dropout, and residual block techniques, and name it as Residual U-Net. The proposed method yields an average Dice value of 77.1% and an average specificity of 99.76%. For quantification of infectious findings, the proposed method achieves results like that of specialists, and no measure presented a value of ρ < 0.05 in the paired t-test. The results demonstrate the potential of the proposed method as a tool to help medical professionals combat COVID-19. fight the COVID-19.

Small bowel diverticulitis - Spectrum of CT findings and review of the literature.

PURPOSE: To review the CT findings and complications of small bowel diverticulitis (SBD) and discuss clinical presentations and outcomes. METHODS: A text search of radiology reports within our health system for cases of small bowel diverticulitis yielded 95 cases. All cases were reviewed by an abdominal radiologist with equivocal cases reviewed by a second abdominal radiologist for consensus. Retrospective analysis of CT imaging findings was performed on 67 convincing cases of SBD. RESULTS: Small bowel diverticulitis most often affected the jejunum (58%) and the duodenum (26%). The most common imaging feature was peridiverticular inflammation manifested by peridiverticular edema, diverticular wall thickening, bowel wall thickening, and fascial thickening. Edema was typically seen along the mesenteric border of the bowel with relative sparing of the anti-mesenteric side. When a prior CT was available, the affected diverticulum was identified in 95% of cases. Fecalized content within the affected diverticulum was observed in 51% of cases. Perforation (6%) and abscess (6%) were the most common complications. CONCLUSION: Small bowel diverticulitis is an uncommon cause of abdominal pain which can mimic an array of abdominal pathologies, although the reported mortality rate of 40-50% may no longer be accurate. The "fecalized diverticulum" sign can be helpful in identifying the culprit diverticulum and aid diagnosing SBD. Findings of perforation and or abscess formation are critical as they may impact management.

Analysis of the Combined Computed Tomography Findings Improves the Accuracy of Computed Tomography for Detecting Posterior Ligamentous Complex Injury of the Thoracolumbar Spine as Defined by Magnetic Resonance Imaging.

OBJECTIVE: To determine the diagnostic accuracy of combined computed tomography (CT) findings for detecting posterior ligamentous complex (PLC) injury in thoracolumbar fractures using magnetic resonance imaging as a reference. METHODS: A retrospective review of 263 consecutive patients with thoracolumbar fractures who underwent CT and magnetic resonance imaging within 10 days of injury. Two reviewers evaluated CT for the following findings: facet joint malalignment, facet joint widening, horizontal laminar fracture, spinous process fracture, and interspinous widening. We examined the independent association of CT findings with PLC injury before combining the CT findings to calculate the diagnostic accuracy: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and positive and negative likelihood ratios. PLC injury was defined by black stripe discontinuity caused by supraspinous or ligamentum flavum rupture. RESULTS: Facet joint malalignment, spinous process fracture, horizontal laminar fracture, and interspinous widening were independently associated with PLC injury (adjusted odds ratio range, 4.4e17.4). A single positive CT finding yielded a PPV of 31% and NPV of 66% for PLC injury. Two or more CT findings yielded a PPV of 91% for PLC injury. A negative CT for all the 4 CT sings had a 94% NPV for PLC injury. CONCLUSIONS: Two or more CT findings provided the best combination to confirm PLC injury; thus, this combination could be used as a criterion for injured PLC. A single CT finding lacks sufficient predictive value to confirm or rule out PLC injury. A negative CT for the 4 CT findings provided the highest sensitivity for PLC injuries.

Treatment response assessment following transarterial radioembolization for hepatocellular carcinoma.

Transarterial radioembolization with yttrium-90 microspheres is an established therapy for hepatocellular carcinoma. Post-procedural imaging is important for the assessment of both treatment response and procedural complications. A variety of challenging treatment-specific imaging phenomena complicate imaging assessment, such as changes in tumoral size, tumoral and peritumoral enhancement, and extrahepatic complications. A review of the procedural steps, emerging variations, and timelines for post-treatment tumoral and extra-tumoral imaging changes are presented, which may aid the reporting radiologist in the interpretation of post-procedural imaging. Furthermore, a description of post-procedural complications and their significance is provided.

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.

Correlation between CT and anatomopathological staging of kidney cancer.

Our Moroccan context is experiencing an increase in the frequency of renal tumors. This trend can be explained by the generalization of the use of imaging, in particular abdominal ultrasound, which has become almost systematic among general practitioners (Godley and Ataga, 2000 [1]). The specificity of kidney cancer is anatomopathological heterogenicity: histological type, nuclear grade, tumor stage, these elements constitute the most important prognostic factors. Renal biopsy appears to be a safe and reliable solution with a low risk of tumor seeding and complications, however it cannot provide all the detailed histological information needed. Hence the interest in the abdominal scanner. The abdominal scanner is the reference examination for the evaluation of renal tumors, it diagnoses the tumor, specifies these characteristics, it assesses the loco regional, venous extension. The objective of our study is to correlate pathological and CT findings of 70 kidney cancer in order to determine the reliability of CT in kidney cancer and its extension.

Clinical characteristics, laboratory abnormalities and CT findings of COVID-19 patients and risk factors of severe disease: a systematic review and meta-analysis.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is an emerging pandemic of global public health concern. We aimed to summarize the characteristics of COVID-19 patients in the early stage of the pandemic and explore the risk factors of disease progression. METHODS: We conducted a systematic review with meta-analysis, searching three databases for studies published between January 1, 2020, and March 18, 2020. We used random-effects models to calculate the 95% confidence intervals of pooled estimated prevalence and the odds ratio between the severe and nonsevere cases. RESULTS: Ninety studies involving 16,526 COVID-19 patients were included. Hypertension (19.1%) and diabetes (9.5%) were the most common comorbidities. The most prevalent clinical symptoms were fever (78.4%), cough (58.5%), and fatigue (26.4%). Increased serum ferritin (74.2%), high C-reactive protein (73.3%), and high erythrocyte sedimentation rate (ESR) (72.2%) were the most frequently reported laboratory abnormalities. Most patients had bilateral lung involvement (82.2%) and showed peripheral (66.9%) and subpleural (62.1%) distribution, with multifocal involvement (73.1%). And the most common CT features were vascular enlargement (64.3%), ground-glass opacity (GGO) (60.7%), and thickened interlobular septa (55.1%). Respiratory failure was the most common complication (30.7%) and the overall case-fatality rate (CFR) was 4.2%. Moreover, male, history of smoking, and comorbidities might influence the prognosis. Most clinical symptoms such as fever, high fever, cough, sputum production, fatigue, shortness of breath, dyspnoea, and abdominal pain were linked to the severity of disease. Some specific laboratory indicators implied the deterioration of disease, such as leucocytosis, lymphopenia, platelet, alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, creatinine, creatine kinase (CK), lactic dehydrogenase (LDH), C-reactive protein, procalcitonin (PCT), and D-dimer. Besides, the risk of bilateral pneumonia, consolidation, pleural effusion, and enlarged mediastinal nodes was higher in severe cases. CONCLUSIONS: Most COVID-19 patients have fever and cough with lymphopenia and increased inflammatory indices, and the main CT feature is GGO involved bilateral lung. Patients with comorbidities and worse clinical symptoms, laboratory characteristics, and CT findings tend to have poor disease progression.

Clinical Predictors of Abnormal Head Computed Tomography Findings in Non-trauma Patients Presenting to a South African Emergency Department.

Background: Head computed tomography (head CT) examinations conducted at emergency departments (EDs) for non-trauma patients are expensive and expose patients to ionizing radiation. Identification of symptoms likely to yield abnormal head CT scans can reduce costs and prevent unnecessary patient irradiation. There is limited comprehensive data in the literature concerning the utilization of head CT in low- and middle-income countries (LMICs) EDs. Methods: A retrospective study of successive non-contrasted head CT scans from February 2017 through January 2018 performed on non-trauma ED patients aged 18 years and above without known pre-existing intracranial pathology was conducted. Univariate and multivariate logistic models were used to determine which presenting clinical features were likely to yield abnormal head CT findings. Clinical information was obtained from the history and physical examination findings entered on the requisition form by the ED clinicians and from previous head CT reports if present on the picture archiving and communication system (PACS). Results: A total of 396 consecutive patients who received head CT examinations had a median age of 49 years (IQR: 36-53), and 53.3% were male (n = 211/396). Of the head CT scans included, 73.5% of head CTs included were abnormal (n = 291/396). Age >61 years (aOR:1.54; 95%CI: 1.12-2.10), focal neurologic deficit (aOR: 2.46; 95%CI: 1.42-4.26), and loss of consciousness (aOR 2.82; 95%CI: 1.21-6.57) were the predictors of abnormal head CT findings. Conclusion: A head CT scan in a non-trauma patient presenting to an emergency department in a low-middle income country like South Africa is likely to yield abnormal findings if a patient presented with age above 61 years, loss of consciousness, or focal neurological deficit.

CT findings of severe novel coronavirus disease (COVID-19): A case report of Heilongjiang Province, China.

2019 novel coronavirus disease (COVID-19, previously known as novel coronavirus pneumonia) was first discovered in December 2019 and spread widely in China and all over the world in 2020. The initial symptoms of most patients include fever, cough, and fatigue. Dyspnea may occur with the progress of the disease, and acute respiratory distress syndrome may occur in severe cases. The CT manifestations of this disease are mainly ground-glass opacity (GGO) in the lung, which may be accompanied by patchy consolidation, and fibrous changes may appear in the lung at the later stage of the disease. Combined with typical clinical and imaging findings and positive nucleic acid test results, the disease can be diagnosed. We report the first case of novel coronavirus disease (COVID-19) in Heilongjiang Province, China. The patient was seriously ill, who felt that he suffered from fever, fatigue, cough, and expectoration and sought medical treatment, with a history of contact with Wuhan. The leukocyte count was normal, and the lymphocyte count was decreased. CT imaging showed large GGO and partial patchy consolidation in both lungs. The patient recovered and was discharged after 26 days of treatment. This study is helpful for early diagnosis and timely clinical management by mastering the typical imaging of novel coronavirus disease (COVID-19).

The chest CT features of coronavirus disease 2019 (COVID-19) in China: a meta-analysis of 19 retrospective studies.

OBJECTIVE: Aimed to summarize the characteristics of chest CT imaging in Chinese hospitalized patients with Coronavirus Disease 2019 (COVID-19) to provide reliable evidence for further guiding clinical routine. METHODS: PubMed, Embase and Web of Science databases were searched to identify relevant articles involving the features of chest CT imaging in Chinese patients with COVID-19. All data were analyzed utilizing R i386 4.0.0 software. Random-effects models were employed to calculate pooled mean differences. RESULTS: 19 retrospective studies (1332 cases) were included. The results demonstrated that the combined proportion of ground-glass opacities (GGO) was 0.79 (95% CI 0.68, 0.89), consolidation was 0.34 (95% CI 0.23, 0.47); mixed GGO and consolidation was 0.46 (95% CI 0.37; 0.56); air bronchogram sign was 0.41 (95% CI 0.26; 0.55); crazy paving pattern was 0.32 (95% CI 0.17, 0.47); interlobular septal thickening was 0.55 (95% CI 0.42, 0.67); reticulation was 0.30 (95% CI 0.12, 0.48); bronchial wall thickening was 0.24 (95% CI 0.11, 0.40); vascular enlargement was 0.74 (95% CI 0.64, 0.86); subpleural linear opacity was 0.28 (95% CI 0.12, 0.48); intrathoracic lymph node enlargement was 0.03 (95% CI 0.00, 0.07); pleural effusions was 0.03 (95% CI 0.02, 0.06). The distribution in lung: the combined proportion of central was 0.05 (95% CI 0.01, 0.11); peripheral was 0.74 (95% CI 0.62, 0.84); peripheral involving central was 0.38 (95% CI 0.19, 0.75); diffuse was 0.19 (95% CI 0.06, 0.32); unifocal involvement was 0.09 (95% CI 0.05, 0.14); multifocal involvement was 0.57 (95% CI 0.48, 0.68); unilateral was 0.16 (95% CI 0.10, 0.23); bilateral was 0.83 (95% CI 0.78, 0.89); The combined proportion of lobes involved (> 2) was 0.70 (95% CI 0.61, 0.78); lobes involved (≦ 2) was 0.35 (95% CI 0.26, 0.44). CONCLUSION: GGO, vascular enlargement, interlobular septal thickening more frequently occurred in patients with COVID-19, which distribution features were peripheral, bilateral, involved lobes > 2. Therefore, based on chest CT features of COVID-19 mentioned, it might be a promising means for identifying COVID-19.