How to differentiate COVID-19 pneumonia from heart failure with computed tomography at initial medical contact during epidemic period

ABSTRACTOBJECTIVESTo compare chest CT findings in heart failure with those of Corona Virus Disease 2019 (COVID-19) pneumonia.BACKGROUNDDuring epidemic period, chest computed tomography (CT) has been highly recommended for screening patients with suspected COVID-19. However, the comparison of CT imaging between heart failure and COVID-19 pneumonia has not been fully elucidated.METHODSPatients with heart failure (n=12), COVID-19 pneumonia (n=12) and one patient with both diseases were retrospectively enrolled. Clinical information and imaging of chest CT were collected and analyzed.RESULTSThere was no difference of ground glass opacity (GGO), consolidation, crazy paving pattern, lobes affected and septal thickening between heart failure and COVID-19 pneumonia. However, less rounded morphology (8.3% vs. 67%, p=0.003), more peribronchovascular thickening (75% vs. 33%, p=0.041) and fissural thickening (33% vs. 0%, p=0.028), less peripheral distribution (33% vs. 92%, p=0.003) were found in heart failure group than that in COVID-19 group. Importantly, there were also more patients with upper pulmonary vein enlargement (75% vs. 8.3%, p=0.001), subpleural effusion and cardiac enlargement in heart failure group than that in COVID-19 group (50% vs. 0%, p=0.005, separately). Besides, more fibrous lesions were found in COVID-19 group although there was no statistical difference (25% vs. 0%, P=0.064)CONCLUSIONSAlthough there are some overlaps of CT imaging between heart failure and COVID-19, CT is still a useful tool in differentiating COVID-19 pneumonia.

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Similarities and Differences of CT Features between COVID-19 Pneumonia and Heart Failure

Cardiovascular Innovations and Applications ◽

10.15212/cvia.2021.0016 ◽

2021 ◽

Author(s):

Shenghua Zhou

Keyword(s):

Heart Failure ◽

Statistical Difference ◽

Clinical Information ◽

Ground Glass Opacity ◽

Chest Ct ◽

Failure Group ◽

Patients With Heart Failure ◽

Similarities And Differences ◽

Cardiac Enlargement ◽

Ct Features

Aims: During the COVID-19 epidemic, chest computed tomography (CT) has been highly recommended for screening of patients with suspected COVID-19 because of an unclear contact history, overlapping clinical features, and an overwhelmed health system. However, there has not been a full comparison of CT for diagnosis of heart failure or COVID-19 pneumonia.Methods: Patients with heart failure (n = 23) or COVID-19 pneumonia (n = 23) and one patient with both diseaseswere retrospectively enrolled. Clinical information and chest CT images were obtained and analyzed.Results: There was no difference in ground-glass opacity, consolidation, crazy paving pattern, the lobes affected,and septal thickening between heart failure and COVID-19 pneumonia. However, a less rounded morphology (4% vs.70%, P = 0.00092), more peribronchovascular thickening (70% vs. 35%, P = 0.018) and fissural thickening (43% vs. 4%, P = 0.002), and less peripheral distribution (30% vs. 87%, P = 0.00085) were found in the heart failure group than in the COVID-19 group. Importantly, there were also more patients with upper pulmonary vein enlargement (61% vs. 4%, P = 0.00087), subpleural effusion (50% vs. 0%, P = 0.00058), and cardiac enlargement (61% vs. 4%, P = 0.00075) in the heart failure group than in the COVID-19 group. Besides, more fibrous lesions were found in the COVID-19group, although there was no statistical difference (22% vs. 4%, P = 0.080).Conclusions: Although there is some overlap of CT features between heart failure and COVID-19, CT is still a useful tool for differentiating COVID-19 pneumonia.

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Clinical outcomes of hemodialysis patients infected with severe acute respiratory syndrome coronavirus 2 and impact of proactive chest computed tomography scans

Clinical Kidney Journal ◽

10.1093/ckj/sfaa086 ◽

2020 ◽

Vol 13 (3) ◽

pp. 328-333 ◽

Cited By ~ 3

Author(s):

Rui Wang ◽

Hong He ◽

Cong Liao ◽

Hongtao Hu ◽

Chun Hu ◽

...

Keyword(s):

Computed Tomography ◽

Invasive Mechanical Ventilation ◽

Case Series ◽

Ground Glass Opacity ◽

High Sensitivity ◽

Chest Ct ◽

Maintenance Hemodialysis ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Reactive Protein

Abstract Background Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that first manifested in humans in Wuhan, Hubei Province, China, in December 2019, and has subsequently spread worldwide. Methods We conducted a retrospective, single-center case series of the seven maintenance hemodialysis (HD) patients infected with COVID-19 at Zhongnan Hospital of Wuhan University from 13 January to 7 April 2020 and a proactive search of potential cases by chest computed tomography (CT) scans. Results Of 202 HD patients, 7 (3.5%) were diagnosed with COVID-19. Five were diagnosed by reverse transcription polymerase chain reaction (RT-PCR) because of compatible symptoms, while two were diagnosed by RT-PCR as a result of screening 197 HD patients without respiratory symptoms by chest CT. Thirteen of 197 patients had positive chest CT features and, of these, 2 (15%) were confirmed to have COVID-19. In COVID-19 patients, the most common features at admission were fatigue, fever and diarrhea [5/7 (71%) had all these]. Common laboratory features included lymphocytopenia [6/7 (86%)], elevated lactate dehydrogenase [3/4 (75%)], D-dimer [5/6 (83%)], high-sensitivity C-reactive protein [4/4 (100%)] and procalcitonin [5/5 (100%)]. Chest CT showed bilateral patchy shadows or ground-glass opacity in the lungs of all patients. Four of seven (57%) received oxygen therapy, one (14%) received noninvasive and invasive mechanical ventilation, five (71%) received antiviral and antibacterial drugs, three (43%) recieved glucocorticoid therapy and one (14%) received continuous renal replacement therapy. As the last follow-up, four of the seven patients (57%) had been discharged and three patients were dead. Conclusions Chest CT may identify COVID-19 patients without clear symptoms, but the specificity is low. The mortality of COVID-19 patients on HD was high.

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Amiodarone-induced pulmonary toxicity

Chest Disease Reports ◽

10.4081/cdr.2011.e6 ◽

2011 ◽

Vol 1 (1) ◽

pp. 6

Author(s):

Junichi Ochi ◽

Minoru Ohkouchi ◽

Yoshikazu Tsukada ◽

Shinichiro Tominaga ◽

Satoshi Takayama ◽

...

Keyword(s):

Computed Tomography ◽

Medical Records ◽

Lung Biopsy ◽

Pulmonary Toxicity ◽

Ground Glass Opacity ◽

Chest Ct ◽

Chest Computed Tomography ◽

Ct Findings ◽

The Mean ◽

Foamy Macrophages

Amiodarone-induced pulmonary toxicity is a critical and potentially fatal side effect of amiodarone. Our study was designed to reveal its clinical features, including KL-6, as an interstitial marker. The medical records of eight patients (five men and three women) with amiodarone-induced pulmonary toxicity, who had been referred to our hospital, were examined. The mean age at the initiation of amiodarone was 48 years (range, 54-87 years) and mean duration of medication prior to the development of pulmonary toxicity was 18 months (range, 7-33 months). Serum KL-6 was elevated in six of the eight patients with a range of 525-2915 U/mL. Chest computed tomography (CT) findings showed non-segmental consolidation and/or ground glass opacity. Foamy macrophages were found in bronchoalveolar lavage (BAL) fluids of all examined patients and in transbronchial lung biopsy (TBLB) specimens in half of the examined patients. We concluded that serum KL-6, chest CT findings, and foamy macrophages in BAL fluids and TBLB specimens will be helpful for the diagnosis of amiodarone-induced pulmonary toxicity.

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Chest Computed Tomography Findings in Asymptomatic Patients with COVID-19

Respiration ◽

10.1159/000509334 ◽

2020 ◽

Vol 99 (9) ◽

pp. 748-754 ◽

Cited By ~ 3

Author(s):

Min Cheol Chang ◽

Wonho Lee ◽

Jian Hur ◽

Donghwi Park

Keyword(s):

Computed Tomography ◽

South Korea ◽

Respiratory System ◽

Ground Glass Opacity ◽

Chest Ct ◽

Effective Management ◽

Radiographic Findings ◽

Chest Computed Tomography ◽

Asymptomatic Patients ◽

The Right

Background: Little is known about the damage to the respiratory system in asymptomatic patients with coronavirus disease (COVID-19). Objective: Herein, we evaluate the findings of chest computed tomography (CT) and radiography in patients with COVID-19 who were asymptomatic. Methods: We retrospectively investigated patients with a confirmed diagnosis of COVID-19 but who did not show any symptoms. Among the 139 patients with COVID-19 who were hospitalized in Yeungnam University Hopistal in Daegu, South Korea, 10 (7.2%) were asymptomatic. Their chest CT and radiographic findings were analyzed. Results: In the results, all patients (100%) had ground-glass opacity (GGO) on chest CT. Further, the GGO lesions were predominantly distributed peripherally and posteriorly in all patients. In 9 (90%) patients, the GGO lesions were combined with reticular opacity. Air bronchogram due to bronchiolectasis surrounded by GGO was observed in 8 patients (80%). Additionally, the lung lesions were dominant on the right side in all patients. Conclusions: In conclusion, considering our results that the lung is affected in asymptomatic patients, it will be necessary to extend the indications of COVID-19 testing for effective management of COVID-19 during the pandemic.

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A Rare Cause of Crazy-Paving and Mediastinal Lymphadenopathy: Congestive Heart Failure

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.115762 ◽

2013 ◽

Vol 3 ◽

pp. 30 ◽

Cited By ~ 1

Author(s):

Aysegul Senturk ◽

Aysegul Karalezli ◽

Ayse Nur Soyturk ◽

H. Canan Hasanoglu

Keyword(s):

Heart Failure ◽

Computed Tomography ◽

Congestive Heart Failure ◽

Lymph Nodes ◽

Inflammatory Diseases ◽

Present Report ◽

Ground Glass Opacity ◽

Mediastinal Lymphadenopathy ◽

Reticular Pattern ◽

Computed Tomography Images

Crazy-paving sign is a pattern seen on multislice computed tomography images of the lungs. It is characterized by a reticular pattern superimposed on ground-glass opacity. It was first described in the late 1980s in patients with pulmonary alveolar proteinosis, but has now been described in some other diseases of the lung. Enlarged mediastinal lymph nodes can be seen in infectious and specific inflammatory diseases and malignancies. The present report describes a case of a 44-year-old man in whom congestive heart failure presented with a crazy-paving appearance and enlarged lymph nodes of the lungs on the chest computed tomography scan.

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Electronic Phenotyping to Identify Patients with Heart Failure Using a National Clinical Information Database in Japan

Studies in Health Technology and Informatics - Public Health and Informatics ◽

10.3233/shti210157 ◽

2021 ◽

Author(s):

Masaharu Nakayama ◽

Ryusuke Inoue

Keyword(s):

Public Health ◽

Machine Learning ◽

Heart Failure ◽

Medical Information ◽

Clinical Information ◽

University Hospital ◽

Patients With Heart Failure ◽

Grave Problem ◽

Information Database ◽

Inpatient Database

Heart failure (HF) is a grave problem in the clinical and public health sectors. The aim of this study is to develop a phenotyping algorithm to identify patients with HF by using the medical information database network (MID-NET) in Japan. Methods: From April 1 to December 31, 2013, clinical data of patients with HF were obtained from MID-NET. A phenotyping algorithm was developed with machine learning by using disease names, examinations, and medications. Two doctors validated the cases by manually reviewing the medical records according to the Japanese HF guidelines. The algorithm was also validated with different cohorts from an inpatient database of the Department of Cardiovascular Medicine at Tohoku University Hospital. Results: The algorithm, which initially had low precision, was improved by incorporating the value of B-type natriuretic peptide and the combination of medications related to HF. Finally, the algorithm on a different cohort was verified with higher precision (35.0% → 87.8%). Conclusions: Proper algorithms can be used to identify patients with HF.

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Chest Computed Tomography Findings in a Case Series of Coronavirus Disease 2019 (COVID-19) Patients at Siriraj Hospital

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.05.12395 ◽

2021 ◽

Vol 104 (5) ◽

pp. 866-871

Keyword(s):

Computed Tomography ◽

Medical Records ◽

Case Series ◽

Ground Glass Opacity ◽

Chest Ct ◽

Ground Glass ◽

Chest Computed Tomography ◽

Ct Findings ◽

Siriraj Hospital ◽

Chest Ct Scan

Background: Recent evidence has demonstrated the high sensitivity of chest computed tomography (CT) in coronavirus disease 2019 (COVID-19) case detection. However, considering the cost and infection control issues, the experience of chest CT for COVID-19 diagnosis in Thailand is still limited. Objective: To present the characteristics of chest CT findings in COVID-19 patients at Siriraj Hospital and compare them with other reports. Materials and Methods: The authors retrospectively reviewed the COVID-19 patients’ medical records between April and May 2020. All cases with the presence of chest CT performed during admission were recruited. Clinical data were retrieved from the patients’ medical records. All chest imaging results were reported by consensus between the authors. Results: From 103 cases, four cases with a chest CT scan during the admission were recruited. Consistent with previous reports, the common chest CT findings included a ground-glass opacity and consolidation with bilateral involvement. A round-shaped ground-glass opacity or consolidation was evidenced in half of the cases. The only case with the presence of chest CT scan, which was done 77 days after the onset of COVID-19 symptoms, revealed resolution of the abnormal findings. Conclusion: Chest CT findings in four COVID-19 cases at Siriraj Hospital are consistent with previous reports. Common findings include bilateral ground-glass opacity and consolidation. Keywords: COVID-19, SARS-CoV-2, Computed tomography, Case series

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Abstract 2439: Invasive Right Ventricular Hemodynamics and Tricuspid Annular Plane Systolic Excursion to Predict Right Ventricular Dysfunction After Left Ventricular Assist Device Implantation

Circulation ◽

10.1161/circ.118.suppl_18.s_727-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Elizabeth A Ketner ◽

Paul R Forfia ◽

Stuart R Russell ◽

Ilan S Wittstein ◽

John V Conte ◽

...

Keyword(s):

Heart Failure ◽

Right Ventricular ◽

Left Ventricular ◽

Ventricular Assist ◽

Failure Group ◽

Group I ◽

Left Ventricular Assist ◽

Patients With Heart Failure ◽

Pulmonary Arterial ◽

Rv Function

Introduction : Right ventricular (RV) failure is a major cause of morbidity and mortality in heart failure patients undergoing destination left ventricular assist device (LVAD) implantation. Using tricuspid annular plane systolic excursion (TAPSE; an echo based measure of RV function linked to mortality in patients with pulmonary arterial hypertension) and invasive measurement of RV systolic function (dP/dtmax/IP; dP/dt max normalized to instantaneous pressure) we hypothesized that these parameters correlate with the incidence of RV failure post LVAD implantation. Methods : 65 consecutive patients with heart failure and clinical indication for LVAD implantation were prospectively evaluated. All patients underwent transthoracic echocardiography and right heart catheterization within 14 days prior to implantation. TAPSE was measured by M-mode echocardiography as the mean displacement (cm) of the tricuspid annular plane towards the RV apex from end-diastole to end-systole over 3 to 5 cycles. RVFAC was measured as the percent change in RV area from end diastole to end systole as measured in the apical four chamber view. Pressure-dependent measures of RV function were derived from PA catheterization based RV waveforms analyzed using pressure volume loop software (WinPVAN 3.5.8). RV failure post LVAD was defined as IV inotrope therapy requirement >14 days, inhaled NO use >48 hrs, death due to decompensated RV failure, or RVAD implantation. Clinical, hemodynamic and echo data were compared in patients with RV Failure (group I; n=14) vs. those without RV failure (group II; n=51). Results : Groups I and II had similar mean pulmonary arterial pressure, cardiac index, systolic blood pressure, baseline liver function test values, and renal function (P>0.05). Group I had higher right atrial pressure (14±5vs.11±4 mmHg; *p<0.05). TAPSE of less than 1.8 cm and dP/dt max /IP of less than 10 correlated strongly with RV failure post LVAD implantation (P<0.005 and P<0.001, respectively) while RVFAC showed no correlation. Conclusions : TAPSE and the load-independent index dP/dt max/IP correlate strongly with RV failure post-LVAD implantation. These data provide the basis for future study of these endpoints in patients with heart failure and RV dysfunction.

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Computed tomography coronary angiography for patients with heart failure (CTA-HF): a randomized controlled trial (IMAGE-HF 1C)

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa109 ◽

2020 ◽

Author(s):

Benjamin J W Chow ◽

Doug Coyle ◽

Alomgir Hossain ◽

Mika Laine ◽

Helena Hanninen ◽

...

Keyword(s):

Heart Failure ◽

Computed Tomography ◽

Randomized Controlled Trial ◽

Coronary Computed Tomography Angiography ◽

Controlled Trial ◽

Diagnostic Strategy ◽

Unknown Aetiology ◽

Randomized Controlled ◽

Patients With Heart Failure ◽

The Cost

Abstract Aims This randomized controlled trial sought to determine the financial impact of an initial diagnostic strategy of coronary computed tomography angiography (CCTA) in patients with heart failure (HF) of unknown aetiology. Invasive coronary angiography (ICA) is used to investigate HF patients. CCTA may be a non-invasive cost-effective alternative to ICA. This randomized controlled trial sought to determine the financial impact of an initial diagnostic strategy of coronary computed tomography angiography (CCTA) in patients with heart failure (HF) of unknown aetiology. Methods and results This multicentre, international trial enrolled patients with HF of unknown aetiology. The primary outcome was the cost of CCTA vs. ICA strategies at 12 months. Clinical outcomes were also collected. An ‘intention-to-diagnose’ analysis was performed and a secondary ‘as-tested’ analysis was based on the modality received. Two hundred and forty-six patients were randomized (age = 57.8 ± 11.0 years, ejection fraction = 30.1 ± 10.1%). The severity of coronary artery disease was similar in both groups. In the 121 CCTA patients, 93 avoided ICA. Rates of downstream ischaemia and viability testing were similar for both arms. There were no significant differences in the composite clinical outcomes or quality of life measures. The cost of CCTA trended lower than ICA [CDN −$871 (confidence interval, CI −$4116 to $3028)]. Using an ‘as-tested’ analysis, CCTA was associated with a decrease in healthcare costs (CDN −$2932, 95% CI −$6248 to $746). Conclusion In patients with HF of unknown aetiology, costs were not statistically different between the CCTA and ICA strategies. Clinical Trials.gov NCT01283659

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