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1.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472801

RESUMO

We report a case of a 42-year-old man who presented with acute epigastric and retrosternal chest pain and exertional dyspnoea, and was subsequently diagnosed with polyserositis secondary to post-Streptococcal mitis infection. A CT scan showed a large pericardial effusion requiring pericardiocentesis, small bilateral pleural effusions and small amount of ascites. Several serological tests were done, which were all found to be normal. Pericardial and pleural fluid aspirates revealed an exudate. Culture of the pleural fluid yielded growth of S.  mitis and this was deemed the cause of the polyserositis, which is rare. The patient made a spontaneous recovery. He was started on colchicine by the cardiologists to help prevent pericardial fluid recurrence and this was continued for 3 months. A dental review confirmed the presence of dental caries, the possible source of infection. On follow-up, the patient remained well with no further relapses.


Assuntos
Ascite/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Serosite/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico , Adulto , Anti-Inflamatórios/uso terapêutico , Ascite/etiologia , Colchicina/uso terapêutico , Humanos , Masculino , Derrame Pericárdico/etiologia , Derrame Pericárdico/terapia , Pericardiocentese , Derrame Pleural/etiologia , Derrame Pleural/microbiologia , Serosite/etiologia , Infecções Estreptocócicas/complicações , Streptococcus mitis , Tomografia Computadorizada por Raios X
2.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472808

RESUMO

We report a rare case of cardiac angiosarcoma in a young boy who presented with cardiac tamponade. His initial symptoms were non-specific. He was initially being managed in the line of fungal infection, with a possibility of malignancy. Cardiac imaging was also not conclusive and he worsened on antibiotics and antifungals and succumbed to the illness. After his death tissue biopsy from heart and lung was done and histopathological examination revealed the diagnosis of metastatic angiosarcoma. The case highlights the importance of considering the diagnosis of cardiac angiosarcoma in the patients presenting with haemorrhagic pericardial effusion and non-specific symptoms.


Assuntos
Tamponamento Cardíaco/etiologia , Neoplasias Cardíacas/complicações , Hemangiossarcoma/complicações , Derrame Pericárdico/etiologia , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/terapia , Drenagem , Ecocardiografia , Evolução Fatal , Átrios do Coração , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/patologia , Hemangiossarcoma/secundário , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Imagem por Ressonância Magnética , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/terapia , Choque/etiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
3.
Clin Nucl Med ; 46(3): 236-237, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33323742

RESUMO

ABSTRACT: Lymphangiomyomas are relatively rare, benign neoplasms. Many patients present with symptoms including effusions, and some cases are incidentally detected. Surgical excision is the treatment of choice, but because of its location, complete surgical resection of a lymphangioma can be technically difficult, and recurrent cases can present with symptoms including effusions. 99mTc-sulfur colloid scan can be used to confirm the leak and nature of the effusion fluid. Here, we present an 8-year-old girl with recurrent pleural and pericardial effusions after lymphocele excision and total pericardiectomy. 99mTc-sulfur colloid lymphoscintigraphy was done to rule out secondary chylopericardium.


Assuntos
Linfangiomioma/complicações , Linfocintigrafia , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Coloide de Enxofre Marcado com Tecnécio Tc 99m , Criança , Feminino , Humanos , Neoplasia Residual/complicações
5.
Med. intensiva (Madr., Ed. impr.) ; 44(9): 534-541, dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198559

RESUMO

OBJETIVO: Pocos estudios han evaluado el impacto en el diagnóstico y tratamiento de la ecocardiografía transtorácica básica en los pacientes postoperados de cirugía cardíaca. El objetivo de nuestro estudio fue valorar el impacto de la ecocardiografía transtorácica básica en el manejo diagnóstico y terapéutico de estos pacientes. DISEÑO: Durante 18 meses se estudiaron prospectivamente todos los pacientes postoperados de cirugía cardíaca que ingresaron en el Servicio de Medicina Intensiva de un hospital universitario. Se realizó una valoración clínica a todos ellos para establecer un diagnóstico y un tratamiento inicial. Se realizó una ecocardiografía transtorácica básica para valoración diagnóstica, que se comparó con la valoración clínica. En caso de discrepancia, se valoró cambiar el tratamiento en función a la ecocardiografía y se evaluó la respuesta terapéutica. Se realizó un análisis descriptivo de los hallazgos. RESULTADOS: Se incluyeron 136 pacientes y se realizaron 203 ecocardiografías. La ecocardiografía transtorácica difería del diagnóstico inicial en 101 (49,8%) ecocardiografías. En 56 de estas (55,44%) se obtuvo un diagnóstico alternativo, lo que comportó un cambio en el tratamiento en 30pacientes (53,6%). Encontramos mejoría clínica significativa en 26 de estos pacientes (86,76%) en los siguientes 30-60min. CONCLUSIONES: La ecocardiografía transtorácica básica es útil en el manejo diagnóstico y terapéutico de los pacientes postoperados de cirugía cardíaca. En la mitad de las ecocardiografías realizadas no se pudo confirmar el diagnóstico clínico. En la mayoría de los pacientes en que observamos cambio en el diagnóstico debido a la ecocardiografía, se observó mejoría clínica tras el cambio de tratamiento


OBJECTIVE: Few studies have evaluated the impact in diagnosis and therapeutic management of basic transthoracic echocardiography in postoperated cardiac surgery. The aim of our study was to evaluate the impact of basic transthoracic echocardiography in the management of this kind of patients. DESIGN: Over an 18-month period, we prospectively studied all patients admitted to a university hospital Intensive Care Unit following heart surgery. We evaluated clinically all of them to establish a diagnosis and an initial treatment. We performed basic transthoracic echocardiography for a diagnosis evaluation that was compared with clinical diagnosis. If they differed, we assessed to change treatment and evaluate the therapeutic response. We performed a descriptive analysis. RESULTS: We included 136 patients and performed 203 echocardiographies. Transthoracic echocardiography differed of initial diagnosis in 101 (49.8%) echocardiographies. In 56 of these echocardiographies (55.44%), we could give an alternative diagnosis with a change in the treatment in 30patients (53,6%). We found clinical improvement in 26 patients (86.76%) in the following 30-60minutes. CONCLUSIONS: Basic transthoracic echocardiography is useful in diagnostic and therapeutic management of postoperative cardiac surgery patients. We could not confirm the clinical diagnosis in half of the performed echocardiographies. In most patients in whom we observe a change in the diagnosis due to echocardiography, we observed a clinical improvement after changing the treatment


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Ecocardiografia/métodos , Unidades de Terapia Intensiva/estatística & dados numéricos , Cardiografia de Impedância/métodos , Ecocardiografia/tendências , Estudos Prospectivos , Cirurgia Torácica/métodos , Protocolos Clínicos , Ecocardiografia/normas , Derrame Pericárdico/diagnóstico por imagem , Tamponamento Cardíaco/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem
6.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372015

RESUMO

We describe the case of an 86-year-old man with a background of severe left ventricular dysfunction and ischaemic cardiomyopathy who, having been optimised for heart failure therapy in hospital, unexpectedly deteriorated again with hypotension and progressive renal failure over the course of 2 days. Common causes of decompensation were ruled out and a bedside echocardiogram unexpectedly diagnosed new pericardial effusion with tamponade physiology. The patient underwent urgent pericardiocentesis and 890 mL of haemorrhagic fluid was drained. Common causes for haemopericardium were ruled out, and the spontaneous haemopericardium was thought to be related to introduction of rivaroxaban anticoagulation. The patient made a full recovery and was well 2 months following discharge. This case highlights the challenges of diagnosing cardiac tamponade in the presence of more common disorders that share similar non-specific clinical features. In addition, this case adds to growing evidence that therapy with direct oral anticoagulants can be complicated by spontaneous haemopericardium, especially when coadministered with other agents that affect clotting, renal dysfunction and cytochrome P3A5 inhibitors.


Assuntos
Anticoagulantes/efeitos adversos , Tamponamento Cardíaco/etiologia , Insuficiência Cardíaca/complicações , Isquemia Miocárdica/complicações , Derrame Pericárdico/complicações , Rivaroxabana/efeitos adversos , Lesão Renal Aguda/etiologia , Idoso de 80 Anos ou mais , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/terapia , Inibidores do Citocromo P-450 CYP3A/efeitos adversos , Diagnóstico Diferencial , Drenagem , Ecocardiografia , Humanos , Hipotensão/etiologia , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/terapia , Disfunção Ventricular Esquerda/complicações
7.
Pan Afr Med J ; 35(Suppl 2): 139, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193954

RESUMO

Thiamine-responsive megaloblastic anaemia (TRMA) is a syndrome associated with megaloblastic anaemia, diabetes mellitus and sensorineural deafness, due to mutations in the SLC19A2gene, which codes for a thiamine carrier protein. Oral thiamine supplementation is the main treatment. We report the case of a 19-year-old man known for TRMA, who presented in the emergency department with bicytopenia (haemoglobin 5,4 g/dL, thrombocytes 38×109/L) revealed by dyspnea and chest pain. Investigations excluded bleeding, hemolysis, coagulopathy and iron deficiencies. A recent infection and an acute coronary syndrome have also been eliminated. We later found out that thiamine treatment had been discontinued three months before, due to general confinement in Tunisia during the COVID-19 pandemic. Parenteral administration of 100 mg of thiamine daily resulted in the recovery of haematopoiesis within three weeks.


Assuntos
Anemia Megaloblástica/sangue , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/sangue , Perda Auditiva Neurossensorial/sangue , Pandemias , Pneumonia Viral/epidemiologia , Deficiência de Tiamina/congênito , Trombocitopenia/etiologia , Síndrome Coronariana Aguda/diagnóstico , Anemia Megaloblástica/tratamento farmacológico , Anemia Megaloblástica/fisiopatologia , Dor no Peito/etiologia , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/fisiopatologia , Diagnóstico Diferencial , Hemoglobina A Glicada/análise , Acesso aos Serviços de Saúde , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Neurossensorial/fisiopatologia , Hemoglobinas/análise , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Recidiva , Tiamina/provisão & distribução , Tiamina/uso terapêutico , Deficiência de Tiamina/sangue , Deficiência de Tiamina/tratamento farmacológico , Deficiência de Tiamina/fisiopatologia , Tunísia , Adulto Jovem
8.
Kyobu Geka ; 73(11): 955-957, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130723

RESUMO

Pericardial effusion due to malignancy often needs drainage, however, it is difficult to repeat pericardiocentesis. We report a case of malignant pericardial effusion in a 55-year-old female, who had been diagnosed with sigmoid colon cancer and treated with surgical resection and chemotherapy 2 years before. She developed multiple organ metastasis and suffered from dyspnea due to increasing pericardial effusion. We performed pericardiocentesis repeatedly, but the pericardial effusion continuously increased. Therefore, we inserted a drainage catheter into the pericardial space, which was connected to a subcutaneously placed port system. She was discharged from the hospital, but expired 12 days later. In the case of malignant pericardial effusion, subcutaneous placing of a port system may be safe and useful.


Assuntos
Tamponamento Cardíaco , Neoplasias , Derrame Pericárdico , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Drenagem , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Derrame Pericárdico/cirurgia , Pericardiocentese , Pericárdio
9.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33169595

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Assuntos
Cardiomegalia/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico por imagem , Coração/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Miocardite/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Betacoronavirus , Cardiomegalia/fisiopatologia , Angiografia Coronária , Infecções por Coronavirus/fisiopatologia , Ecocardiografia , Edema/diagnóstico por imagem , Edema/fisiopatologia , Coração/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Isquemia Miocárdica/fisiopatologia , Miocardite/fisiopatologia , Pandemias , Derrame Pericárdico/fisiopatologia , Pneumonia Viral/fisiopatologia , Radiografia Torácica , Recuperação de Função Fisiológica , Tomografia Computadorizada por Raios X , Disfunção Ventricular/diagnóstico por imagem , Disfunção Ventricular/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia
10.
J Card Surg ; 35(10): 2802-2803, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33043656

RESUMO

We present the clinical case of a 60-year-old woman complained of dyspnea on exertion. Echocardiogram showed a giant mass in the right ventricle (RV) with obstruction to the outflow tract. Thorax computed tomography confirmed a mass of greater than 60 mm infiltrating RV and causing severe stenosis in the pulmonary artery, with severe pericardial effusion. Cardiac surgery was performed for tumor resection and pulmonary root replacement with a biological valved conduit. Histological analysis diagnosed a poorly differentiated large-cell neuroendocrine carcinoma. The patient had no immediate postoperative complications and has completed radiotherapy at a 9-month follow-up.


Assuntos
Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Tomografia Computadorizada por Raios X , Implante de Prótese Vascular/métodos , Carcinoma Neuroendócrino/complicações , Carcinoma Neuroendócrino/patologia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Feminino , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/patologia , Ventrículos do Coração/patologia , Humanos , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Artéria Pulmonar/patologia , Índice de Gravidade de Doença , Resultado do Tratamento
12.
Eur Rev Med Pharmacol Sci ; 24(14): 7801-7803, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32744707

RESUMO

SARS-CoV-2 infection in children is uncommon compared to adult population. However, some children required hospital and/or PICU admission. The aim of this short communication is to share our experience with Point-of-Care Ultrasound (POCUS) when managing these patients. Remarkably, all cases presented pleural and pericardial effusions, detected by POCUS, despite showing an adequate urinary output and prior to receiving any kind of fluid resuscitation. Effusions have been described as rare among SARS-CoV-2 infection in adult population. By performing portable chest X-Ray they would have gone unnoticed in our patients. Other POCUS findings consisted of all types of consolidations and coalescent B-line patterns. POCUS was also performed in order to optimize PEEP, checking adequate endotracheal intubation positioning (avoiding the risk of contagiousness related to auscultation in this framework), and to assess volemia status, cardiac performance, and brain neuro-monitoring. There was not cross-infection. In pediatric SARS-CoV-19 effusions are frequent but easily unnoticed unless lung and echo POCUS are performed.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Betacoronavirus , Criança , Humanos , Pandemias , Derrame Pericárdico/virologia , Derrame Pleural/virologia , Radiografia Torácica
13.
Am J Cardiol ; 129: 95-101, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32624190

RESUMO

The high prevalence of pulmonary hypertension (PH) in elderly patients is well known. However, much remains unknown about those population. We sought to find the clinical characteristics of echocardiographic PH and the prognostic factors in patients ≥90 years of age. We retrospectively reviewed 310 patients ≥90 years of age (median age 92 years, 64% women) diagnosed as echocardiographic PH (peak systolic pulmonary arterial pressure ≥40 mm Hg) with normal left ventricular systolic function. We defined left heart disease (LHD) as significant left-sided valve diseases, left ventricular hypertrophy and left ventricular diastolic dysfunction by using echocardiography. The endpoint was all-cause death at 2,000 days after diagnosis. LHD was found in 92% of patients. During the median follow-up of 367 days (interquartile range, 39-1,028 days), 151 all-cause deaths (49%) occurred. Multivariable Cox regression analysis demonstrated that right ventricular fraction area change <35% (adjusted hazard ratio [HR]: 2.31; p <0.001), pericardial effusion (adjusted HR: 2.28; p <0.001), serum albumin <3.5 g/dL (adjusted HR: 1.76; p = 0.001), chronic obstructive pulmonary disease (adjusted HR: 1.93; p = 0.001) and New York Heart Association (NYHA) class ≥II (adjusted HR: 1.73; p = 0.004) were associated with mortality after adjusted for age. In conclusion, LHD was significantly associated with echocardiographic PH in most patients ≥90 years of age. Also, the co-morbid factors at diagnosis (right ventricular systolic dysfunction, pericardial effusion, hypoalbuminemia, chronic obstructive pulmonary disease, and NYHA class ≥II) were independently associated with mortality.


Assuntos
Hipertensão Pulmonar/epidemiologia , Hipertrofia Ventricular Esquerda/epidemiologia , Mortalidade , Disfunção Ventricular Esquerda/epidemiologia , Função Ventricular Esquerda , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/epidemiologia , Comorbidade , Diástole , Ecocardiografia , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipoalbuminemia/epidemiologia , Masculino , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/epidemiologia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/epidemiologia , Análise Multivariada , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Albumina Sérica , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/epidemiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/epidemiologia
14.
J Card Surg ; 35(8): 2087-2088, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652665

RESUMO

A 58-year-old man with a history of hypertension, dyslipidemia, and an obtuse marginal branch coronary stent developed the sudden onset of chest pain. A contrast computed tomography demonstrated a penetrating ulcer of nondilating ascending aorta and a small pericardial effusion. Coronary angiography showed three-vessel disease. At emergency surgery, there was blood in the pericardial sac and the whole of the ascending aorta had hematoma with no evidence of tamponade. We performed a hemiarch replacement under circulatory arrest and concomitant coronary artery bypass grafting. The left side of the proximal arch had ruptured just beyond the pericardial reflection.


Assuntos
Aorta/cirurgia , Ruptura Aórtica/cirurgia , Aorta/diagnóstico por imagem , Ruptura Aórtica/complicações , Ruptura Aórtica/diagnóstico por imagem , Implante de Prótese Vascular/métodos , Dor no Peito/etiologia , Ponte de Artéria Coronária/métodos , Emergências , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/complicações , Derrame Pericárdico/diagnóstico por imagem , Ruptura Espontânea , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Chest ; 158(5): 1885-1895, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32592709

RESUMO

BACKGROUND: Chest CT may be used for the diagnosis of coronavirus disease 2019 (COVID-19), but clear scientific evidence is lacking. Therefore, we systematically reviewed and meta-analyzed the chest CT imaging signature of COVID-19. RESEARCH QUESTION: What is the chest CT imaging signature of COVID-19 infection? STUDY DESIGN AND METHODS: A systematic literature search was performed for original studies on chest CT imaging findings in patients with COVID-19. Methodologic quality of studies was evaluated. Pooled prevalence of chest CT imaging findings were calculated with the use of a random effects model in case of between-study heterogeneity (predefined as I2 ≥50); otherwise, a fixed effects model was used. RESULTS: Twenty-eight studies were included. The median number of patients with COVID-19 per study was 124 (range, 50-476), comprising a total of 3,466 patients. Median prevalence of symptomatic patients was 99% (range, >76.3%-100%). Twenty-seven of the studies (96%) had a retrospective design. Methodologic quality concerns were present with either risk of or actual referral bias (13 studies), patient spectrum bias (eight studies), disease progression bias (26 studies), observer variability bias (27 studies), and test review bias (14 studies). Pooled prevalence was 10.6% for normal chest CT imaging findings. Pooled prevalences were 90.0% for posterior predilection, 81.0% for ground-glass opacity, 75.8% for bilateral abnormalities, 73.1% for left lower lobe involvement, 72.9% for vascular thickening, and 72.2% for right lower lobe involvement. Pooled prevalences were 5.2% for pleural effusion, 5.1% for lymphadenopathy, 4.1% for airway secretions/tree-in-bud sign, 3.6% for central lesion distribution, 2.7% for pericardial effusion, and 0.7% for cavitation/cystic changes. Pooled prevalences of other CT imaging findings ranged between 10.5% and 63.2%. INTERPRETATION: Studies on chest CT imaging findings in COVID-19 suffer from methodologic quality concerns. More high-quality research is necessary to establish diagnostic CT criteria for COVID-19. Based on the available evidence that requires cautious interpretation, several chest CT imaging findings appear to be suggestive of COVID-19, but normal chest CT imaging findings do not exclude COVID-19, not even in symptomatic patients.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Betacoronavirus , Humanos , Pandemias , Derrame Pericárdico/diagnóstico por imagem , Tórax/diagnóstico por imagem
16.
Diagn Interv Radiol ; 26(4): 308-314, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32558645

RESUMO

PURPOSE: We aimed to demonstrate the computed tomography (CT) findings observed at the initial presentation of coronavirus disease 2019 (COVID-19) pneumonia and reveal the most frequent infiltration and distribution patterns of the disease. METHODS: One hundred and eighty-five patients (87 men, 98 women; mean age, 48.7 years), who underwent RT-PCR sampling and high-resolution CT examination in our hospital between March 15, 2020, and April 15, 2020, and got a definitive diagnosis of COVID-19 disease via initial or follow-up RT-PCR test, were included in the study. We comprehensively analyzed the most common and relatively rare CT imaging features (e.g., distribution pattern, density of the lesions, additional CT signs) in patients diagnosed with COVID-19 pneumonia. RESULTS: Thirty-eight patients (20.6%) had no evidence of pneumonia on their initial high-resolution CT images. Among 147 patients (79.4%) who had parenchymal infiltration consistent with pneumonia, 10 (6.8%) had a negative baseline RT-PCR test, and positivity was detected as a result of repeated tests. Most of the patients had multifocal (89.1%) and bilateral (86.4%) lesions. The most common location, right lower lobe, was affected in 87.8% of the patients. Lesions were distributed predominantly at peripheral (87.1%) and posterior (46.3%) areas of lung parenchyma. Most of the patients had pure ground glass opacity (GGO) (82.3%) followed by GGO with consolidation (32.7%) and crazy paving pattern (21.8%). Pure consolidation, solid nodules, halo sign, reverse halo sign, vascular enlargement, subpleural line, air-bronchogram, and bronchiectasis were the other findings observed in at least 15% of the cases. Halo sign, acinar nodules, air-bubble sign, pleural thickening and effusion, mediastinal and/or hilar lymphadenopathy were seen rarely (2%-12.9%). Pericardial effusion, pneumothorax, cavitation, and tree-in-bud pattern were not detected in our study group. CONCLUSION: Multifocal and bilateral GGO infiltration predominantly distributed in peripheral, posterior, and lower lung areas was the most common infiltration pattern.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/patologia , Bronquiectasia/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Progressão da Doença , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/virologia , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/patologia , Linfadenopatia/virologia , Masculino , Mediastino/diagnóstico por imagem , Mediastino/patologia , Mediastino/virologia , Pessoa de Meia-Idade , Pandemias , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/patologia , Derrame Pericárdico/virologia , Pneumonia/patologia , Pneumonia/virologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Pneumotórax/diagnóstico por imagem , Pneumotórax/patologia , Pneumotórax/virologia , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Turquia/epidemiologia
17.
Rev. patol. respir ; 23(2): 66-68, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197582

RESUMO

Presentamos el caso de una mujer puérpera de 34 años, sin antecedentes de interés, que fue estudiada por un cuadro de fiebre y palpitaciones, con un posible síndrome constitucional asociado. En el estudio se detectó un derrame pericárdico masivo, que requirió la realización de ventana pleuropericárdica, y una masa pulmonar. El estudio anatomopatológico de la biopsia aguja gruesa de dicha masa proporcionó el diagnóstico de linfoma de Hodgkin (LH), por lo que se instauró tratamiento con quimioterápico tras completar el estudio de extensión. Hasta el momento actual se han descrito pocos casos similares en la literatura médica, ninguno en nuestro país. No obstante, a pesar de tratarse de una manifestación torácica poco frecuente, con este trabajo queremos resaltar la importancia de contemplar el LH en el diagnóstico diferencial de las masas pulmonares con derrame pericárdico asociado, pues se trata de una entidad curable que requiere de un diagnóstico precoz


We present the case of a 34-year-old puerperal woman, with no history of interest, who was studied for a fever and palpitations picture, with a possible associated constitutional syndrome. The study detected a massive pericardial effusion, which required a pleuropericardial window, and a pulmonary mass. The pathologic study of the thick needle biopsy of this mass provided the diagnosis of Hodgkin's lymphoma (HL), and therefore chemotherapy treatment was initiated after completing the extension study. To date, few similar cases have been described in the medical literature, none in our country. However, despite being a rare thoracic manifestation, with this work we want to highlight the importance of contemplating HL in the differential diagnosis of pulmonary masses with associated pericardial effusion, since it is a curable entity that requires an early diagnosis


Assuntos
Humanos , Feminino , Adulto , Doença de Hodgkin/complicações , Doença de Hodgkin/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Tomografia Computadorizada por Raios X
19.
Am J Emerg Med ; 38(7): 1547.e5-1547.e6, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360119

RESUMO

A 78-year-old patient with acute respiratory distress was transferred to our hospital with ST segment elevation on electrocardiography. Coronary angiography revealed normal coronary arteries. Thorax computerized tomography showed ground glass opacification with consolidation in the lungs and mild pericardial effusion demonstrating myopericarditis associated with COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Miocardite/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Idoso , Betacoronavirus , Angiografia Coronária , Infecções por Coronavirus/fisiopatologia , Eletrocardiografia , Humanos , Masculino , Miocardite/patologia , Miocardite/fisiopatologia , Pandemias , Derrame Pericárdico/fisiopatologia , Pneumonia Viral/fisiopatologia , Tomografia Computadorizada por Raios X
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