RESUMEN
We report the case of a middle-aged woman on a background of severe respiratory disease who presented with hemoptysis. Investigations with CT pulmonary angiogram showed evidence of a large pulmonary arterial filling defect which was initially treated as a pulmonary embolism. However, despite being anticoagulated, she experienced ongoing hemoptysis. Further imaging several days later using aortic phase CT confirmed that the filling defect was a false positive; the artifact was due to retrograde filling from a systemic arterial-pulmonary arterial shunt and anticoagulation was stopped. Although PE is the most common cause of filling defects, this case suggests that in the setting of patients with chronic inflammatory parenchymal pulmonary disease, clinicians should consider alternative causes such as systemic arterial-pulmonary arterial shunts.
RESUMEN
BACKGROUND: Descriptions of clinical characteristics of patients hospitalised withCOVID-19, their clinical course and short-term inpatient and outpatient outcomes in deprived urban populations in the UK are still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequelae of patients admitted to two large District General Hospitals across a large East London National Health Service Trust during the first wave of the pandemic. METHODS: A retrospective analysis was carried out on a cohort of 1946 patients with a clinical or laboratory diagnosis of COVID-19, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three respiratory units in the trust. RESULTS: Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow-up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 70% of survivors, with 39% of patients unable to return to work due to ongoing symptoms. CONCLUSIONS: Understanding the acute clinical features, course of illness and outcomes of COVID-19 will be crucial in understanding the effect of differences in risk, as well as the effectiveness of new interventions and vaccination between the successive waves of the pandemic.