Post-COVID-19 pulmonary fibrosis and its predictive factors: a prospective study

Abstract Background We aimed to prospectively assess the lung fibrotic-like changes, as well as to explore their predictive factors, in the patients who survived Coronavirus Disease 2019 (COVID-19) infection. In this prospective cross-sectional study, we recruited patients who had been treated for moderate or severe COVID-19 pneumonia as inpatients and discharged from Rohani hospital in Babol, northern Iran, during March 2020. The clinical severity of COVID-19 pneumonia was classified as per the definition by World Health Organization. We also calculated the CT severity score (CSS) for all patients at admission. Within the 3 months of follow-up, the next chest CT scan was performed. As the secondary outcome, the patients with fibrotic abnormalities in their second CT scan were followed up in the next 3 months. Results Totally, 173 COVID-19 patients were finally included in the study, of whom 57 (32.9%) were male and others were female. The mean age was 53.62 ± 13.67 years old. At 3-month CT follow-up, evidence of pulmonary fibrosis was observed in 90 patients (52.0%). Consolidation (odds ratio [OR] = 2.84), severe disease (OR 2.40), and a higher CSS (OR 1.10) at admission were associated with increased risk of fibrotic abnormalities found at 3-month CT follow-up. Of 62 patients who underwent chest CT scan again at 6 months of follow-up, 41 patients (66.1%) showed no considerable changes in the fibrotic findings, while the rest of 21 patients (33.9%) showed relatively diminished lung fibrosis. Conclusion Post-COVID-19 lung fibrosis was observed in about half of the survivors. Also, patients with severe COVID-19 pneumonia were at a higher risk of pulmonary fibrosis. Moreover, consolidation, as well as a higher CSS, in the initial chest CT scan, was associated with increased risk of post-COVID-19 lung fibrosis. In addition, some patients experienced diminished fibrotic abnormalities in their chest CT on 6-month follow-up, while some others did not.

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Early Radiographic and Tomographic Manifestations of Legionnaires' Disease

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2016.10.005 ◽

2017 ◽

Vol 68 (3) ◽

pp. 328-333 ◽

Cited By ~ 3

Author(s):

Rémi Poirier ◽

Jean Rodrigue ◽

Jasmin Villeneuve ◽

Yves Lacasse

Keyword(s):

Ct Scan ◽

Legionella Pneumophila ◽

Community Acquired Pneumonia ◽

Chest Ct ◽

Quebec City ◽

Bacterial Origin ◽

Increased Risk ◽

Significant Difference ◽

Legionnaires Disease ◽

Chest Ct Scan

Purpose Legionnaires' disease (LD) may occur sporadically or in the course of outbreaks, where the typical radiological manifestations of the disease may better be delineated. We took advantage of a rare community-based epidemic of LD (181 patients) that occurred in 2012 in Quebec City, Canada, to describe the radiographic features of LD and compare the its tomographic presentation with that of community-acquired pneumonia caused by common bacteria other than Legionella pneumophila. Methods From the 181 individuals affected in the outbreak, we obtained the chest radiographs of 159 individuals (mean 63 ± 15 years of age) for detailed analysis; 33 patients had a computed tomography (CT) scan performed during the course of their illness. In a case-control study, we compared the CT scans of patients with LD with those of patients who had received a diagnosis of community-acquired pneumonia caused by a pathogen other than Legionella and confirmed by chest CT scan. Results Overall, LD most often presented as an airspace consolidation involving 1 of the lower lobes. Pleural effusion and mediastinal adenopathies were apparent only in a minority, whereas no pneumothorax or cavitation was noted. We did not find any significant difference in chest CT scan findings in patients with LD vs those with community-acquired pneumonia from other bacterial origin. No radiological finding was clearly associated with an increased risk of intensive care unit admission or mortality. Conclusions The early radiographic and tomographic manifestations of LD are nonspecific and similar to those found in community-acquired pneumonia from other bacterial origin.

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Postoperative follow-up of lung cancer: Randomized trial comparing two follow-up programs in completely resected non-small cell lung cancer (IFCT-0302).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.tps7111 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. TPS7111-TPS7111

Author(s):

Virginie Westeel ◽

Fabrice Barlesi ◽

Jean Domas ◽

Philippe Girard ◽

Pascal Foucher ◽

...

Keyword(s):

Lung Cancer ◽

Physical Examination ◽

Ct Scan ◽

Fiberoptic Bronchoscopy ◽

Chest Ct ◽

Small Cell Lung ◽

X Ray ◽

Chest X Ray ◽

Chest Ct Scan

TPS7111 Background: There are no robust data published on the follow-up after surgery for non-small cell lung cancer (NSCLC). Current international guidelines are informed by expert opinion. Most of them recommend regular follow-up with clinic visit and thoracic imaging, either chest X-ray of Chest CT-scan. The IFCT-0302 trial addresses the question whether a surveillance program with chest CT-scan and fiberoptic bronchoscopy can improve survival compared to a follow-up only based on physical examination and chest x-ray. There is no such trial ongoing over the world. Methods: The IFCT-0302 trial is a multicenter open-label controlled randomized phase III trial. The objective of the trial is to compare two follow-up programs after surgery for stage I-IIIa NSCLC. The primary endpoint is overall survival. Patients are randomly assigned to arm 1, minimal follow-up, including physical examination and chest x-ray; or arm 2, a follow-up consisting of physical examination and chest x-ray plus chest CT scan and fiberoptic bronchoscopy (optional for adenocarcinomas). In both arms, follow-up procedures are performed every 6 months during the first two postoperative years, and every year between the third and the fifth years. The main eligibility criteria include: completely resected stage I-IIIA (6th UICC TNM classification) or T4 (in case of nodules in the same lobe as the tumor) N0 M0 NSCLC, surgery within the previous 8 weeks. Patients who have received and/or who will receive pre/post-operative chemotherapy and/or radiotherapy are eligible. Statistical considerations: 1,744 patients is required. Accrual status: 1,568 patients from 119 French centers had been included. The end of accrual can be expected for September 2012. Ancillary study: Blood samples are collected in 1000 patients for genomic high density SNP micro-array analysis. This collection will contribute to the French genome wide association study (gwas) of lung cancer gene susceptibility, and the genetic factors predictive of survival and lung cancer recurrence will be analyzed.

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Lung Ultrasonography for long-term follow-up of COVID-19 survivors compared to chest CT scan

Respiratory Medicine ◽

10.1016/j.rmed.2021.106384 ◽

2021 ◽

pp. 106384

Author(s):

Guido Giovannetti ◽

Lucrezia De Michele ◽

Michele De Ceglie ◽

Paola Pierucci ◽

Alessandra Mirabile ◽

...

Keyword(s):

Ct Scan ◽

Chest Ct ◽

Lung Ultrasonography ◽

Long Term Follow Up ◽

Chest Ct Scan

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Chest X-Ray Findings and Temporal Lung Changes in Patients with COVID-19 Pneumonia

10.21203/rs.3.rs-45829/v1 ◽

2020 ◽

Author(s):

Liqa A Rousan ◽

Eyhab Elobeid ◽

Musaab Karrar ◽

Yousef Khader

Keyword(s):

Ct Scan ◽

Chest Ct ◽

Common Finding ◽

X Rays ◽

Radiographic Findings ◽

X Ray ◽

Abnormal Chest ◽

Chest X Ray ◽

Chest Ct Scan

Abstract Background: Chest CT scan and chest x-rays show characteristic radiographic findings in patients with COVID-19 pneumonia. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia. The study aims at describing the chest x-ray findings and temporal radiographic changes in COVID-19 patients.Methods: From March 15 to April 20, 2020 patients with positive reverse transcription polymerase chain reaction (RT-PCR) for COVID-19 were retrospectively studied. Patients’ demographics, clinical characteristics, and chest x-ray findings were reported. Radiographic findings were correlated with the course of the illness and patients’ symptoms.Results: A total of 88 patients (50 (56.8%) females and 38 (43.2%) males) were admitted to the hospital with confirmed COVID-19 pneumonia. Their age ranged from 3-80 years (35.2 ±18.2 years). 48/88 (45%) were symptomatic, only 13/88 (45.5%) showed abnormal chest x-ray findings. A total of 190 chest x-rays were obtained for the 88 patients with a total of 59/190 (31%) abnormal chest x-rays. The most common finding on chest x-rays was peripheral ground glass opacities (GGO) affecting the lower lobes. In the course of illness, the GGO progressed into consolidations peaking around 6-11 days (GGO 70%, consolidations 30%). The consolidations regressed into GGO towards the later phase of the illness at 12-17 days (GGO 80%, consolidations 10%). There was increase in the frequency of normal chest x-rays from 9% at days 6- 11 up to 33% after 18 days indicating a healing phase. The majority (12/13, 92.3%) of patients with abnormal chest x-rays were symptomatic (P=0.005).Conclusion: The chest x-ray findings were similar to those reported on chest CT scan in patients with COVID-19, Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia.

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Outcome of Pulmonary Spherical Ground-glass Opacities on Ct in Patients With Coronavirus Disease 2019 (Covid-19): A Retrospective Analysis

10.21203/rs.3.rs-30665/v1 ◽

2020 ◽

Author(s):

Wangjia Li ◽

Liangbo Hu ◽

Junhao Huang ◽

Fajin Lv ◽

Binjie Fu ◽

...

Keyword(s):

Retrospective Study ◽

Ct Scan ◽

Retrospective Analysis ◽

Ct Images ◽

Chest Ct ◽

Ground Glass ◽

Direct Absorption ◽

Simultaneous Decrease ◽

Chest Ct Scan

Abstract Background: Pulmonary spherical ground-glass opacities (GGOs) are commonly detected on initial chest CT scan in patients with coronavirus disease 2019 (COVID-19).We aimed to investigate the evolution of spherical GGOs to better understand their clinical significance.Materials and Methods:A retrospective study of 33 consecutive patients with confirmed COVID-19 and pulmonary spherical GGOs was performed from January 21, 2020, to March 6, 2020. The initial and follow-up CT images and clinical data were reviewed. The initial CT manifestations of spherical GGOs and their subsequent changes were mainly evaluated. Results:A total of 101 pulmonary spherical GGOs, including 38 with and 63 without consolidation, were found in 33 patients. Of the 101 spherical GGOs, 71 (70.3%) and 30 (29.7%) showed progression and direct absorption on follow-up CT images, respectively. GGOs with consolidation were more likely to progress than those without (84.2% vs. 61.9%, p = 0.017). The 71 progressed lesions mainly showed an increase in size and/or density and most (70.4%) of them extended toward the pleura and developed from spherical to patchy. Internal consolidation appeared and increased in 18 (25.4%) and 22 (31.0%) lesions, respectively. During absorption, all the previous progressed and directly absorbed lesions exhibited a simultaneous decrease in size and density. On each patient’s final CT, more lesions with progression had a residual mixed GGO (40.8% vs. 6.7%, p = 0.002) and fewer had pure GGO (39.4% vs. 60.0%, p = 0.016) than those with direct absorption.Conclusion: In patients with COVID-19, most pulmonary spherical ground-glass opacities would progress, especially those with consolidation, and develop into patchy, subpleural lesions.

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Abstract P103: Value of Chest Computed Tomographic Scan Added to Acute Stroke Neuroimaging Protocol for Identifying Coronavirus Disease 2019: A Critical Assessment of a Prospective Protocol

Stroke ◽

10.1161/str.52.suppl_1.p103 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Muhammad F Ishfaq ◽

Sachin Bhagavan ◽

Ammad Ishfaq ◽

Mukaish Kumar ◽

Shruthi Pulimamidi ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Ct Scan ◽

Chest Ct ◽

Nasopharyngeal Swab ◽

Stroke Patients ◽

Computed Tomographic ◽

Ct Angiogram ◽

Increased Risk ◽

Chest Ct Scan

Background: Coronavirus Disease 2019 (COVID-19) is associated with an increased risk for acute ischemic stroke but screening for COVID-19 based on clinical criteria or laboratory testing may be difficult in acute stroke evaluation. Chest computed tomographic (CT) scan may be another time-sensitive option for identification. of COVID-19 in such patients. Objective: We report our experience of incorporating chest CT scan in the initial neuroimaging protocol for evaluation of acute stroke patients. Methods: All acute stroke patients underwent chest CT scan concurrent to CT head, CT angiogram of head and neck and CT perfusion for 4 months. We identified patients who had chest CT scan findings that were suggestive of COVID-19 including bilateral, multilobar ground glass opacification with a peripheral or posterior distribution, and/or consolidation (mainly in the lower lobes). All patients subsequently underwent polymerase chain reaction (PCR) testing of nasopharyngeal swab with contact isolation until COVID-19 could be excluded. Results: A total of 224 consecutive patients (mean age 62.12 years±SD; 15.3) underwent acute stroke evaluation with a concurrent chest CT scan. The chest CT identified findings suggestive of COVID-19 in 11 (4.9%) patients. Subsequent PCR testing did not confirm the diagnosis of COVID-19 in any of the patient. Another 99 patients (44%) without any findings suggestive of COVID-19 on chest CT scan underwent PCR testing. PCR testing did not confirm the diagnosis of COVID-19 in any of the patients. Four patients (4.3%) with chest CT scan findings suggestive of COVID-19 were found to have an ischemic stroke while 7 patients (5.9%) with chest CT scan findings suggestive of COVID-19 did not have any ischemic stroke (stroke mimic). Conclusions: We found a very low yield for identifying COVID-19 in acute stroke patients by performing chest CT scan concurrent to standard acute stroke neuroimaging protocol.

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Follow-up Recommendations for Chest CT Scan Reports of Incidental Pulmonary Nodules

CHEST Journal ◽

10.1378/chest.11-2157 ◽

2012 ◽

Vol 141 (1) ◽

pp. 280-281

Author(s):

Douglas B. Johnson ◽

Mark A. Powers ◽

Shiying Wu ◽

Yuh-Chin T. Huang

Keyword(s):

Ct Scan ◽

Pulmonary Nodules ◽

Chest Ct ◽

Chest Ct Scan

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Are "fibrosis-like" strips on chest CT in patients with COVID-19 pneumonia true fibrosis?

10.21203/rs.3.rs-84236/v2 ◽

2020 ◽

Author(s):

Qiulian Sun ◽

Xinjian Xu ◽

Hai Yang ◽

Guanliang Wang ◽

Jingjing Li ◽

...

Keyword(s):

Ct Scan ◽

Morphological Changes ◽

Chest Ct ◽

Inclusion Criteria ◽

Rapid Absorption ◽

Early Appearance ◽

Process And Outcome ◽

Ct Data ◽

Chest Ct Scan

Abstract Objective: To investigate the evolution and characteristics of "fibrosis-like" strips on chest CT in patients with COVID-19 pneumonia. Methods: From January 17, 2020, to February 27, 2020, inpatients diagnosed with COVID-19 pneumonia in Enze Hospital, Taizhou, Zhejiang Province, were selected. The chest CT data of the patients were collected, and patients were included in the present study according to the predefined inclusion criteria. The dynamic evolution process and outcome of "fibrosis-like" strips on chest CT were analyzed.Results: A total of 36 patients (20 males and 16 females) with COVID-19 were included in the study, all of whom were diagnosed with mild or common COVID-19; "fibrosis-like" strips were observed in 29 patients (80.6%) on the first chest CT scan, and "fibrosis-like" strips were observed in 7 patients (19.4%) on the second chest CT scan, Repeated chest CT during the course of treatment showed that all patients with "fibrosis-like" strips had varying degrees of absorption. "Fibrosis-like" strips in 15 patients demonstrated a trend of first increasing in number, and then decreasing in number; "fibrosis-like" strips in 3 patients demonstrated a trend of first decreasing in number first, followed by an increase in number and then a decrease in number; and "fibrosis-like" strips in 18 patients demonstrated a trend of a gradual decrease in number. Follow-up chest CT after treatment showed that "fibrosis-like" strips in 15 patients completely disappeared in both lungs, and "fibrosis-like" strips completely disappeared in unilateral lung of 8 cases.Conclusion: In the present study, we observed that "fibrosis-like" strips in COVID-19 patients had characteristics of early appearance and rapid morphological changes as well as rapid absorption, suggesting that "fibrosis-like" strips may be a sign of subsegmental atelectasis rather than fibrotic changes.

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538. The Role of N-acetylcysteine on Post Covid-19 Pulmonary Fibrosis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.737 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S370-S371

Author(s):

Bernard Demot ◽

Kristin Ivan Mark Hizon

Keyword(s):

Pulmonary Fibrosis ◽

Ct Scan ◽

Chest Ct ◽

Ct Scans ◽

Ground Glass ◽

Nasopharyngeal Swab ◽

High Dose ◽

Pulmonary Consolidation ◽

Chest Ct Scan

Abstract Background Covid 19 have long lasting complications, from myalgia, body weakness to life debilitating strokes, and pulmonary fibrosis. Several mechanisms had been described but mostly viral or autoimmune which causes damages which leads to Acute respiratory distress syndrome. There is no approved treatment as of this time. Antifibrotic drugs use had been limited due to hepatoxicity, on top of Covid 19 hepatopathy. This study aims to describe the role of N-acetylcysteine on Post COVID 19 pulmonary fibrosis as an alternative treatment. Methods Patients are admitted at Baguio General Hospital and Medical Center at the COVID wards. Patients are COVID confirmed by RT PCR nasopharyngeal swab. Patient who are classified as severe were given Dexamethasone, Enoxaparin and Remdesivir for 5-10 days. Patients who are not weaned off from O2 support underwent Chest CT scan. Patients with Extensive Fibrosis were then consented to undergo High Dose IV Infusion of N-acetylcysteine. (150mg/kg in 1st hour, 50mg/kg next 4 hours and 100mg/kg last 20 hours). Repeat Chest CT Scan was done. Results Peripheral Bilateral Ground Glass Opacities and Pulmonary Consolidation was seen on pre-treatment CT Scans. Repeat CT scans showed significant regression of Ground Glass Opacities and Pulmonary Consolidation. CT SCAN pre and post treatment Conclusion High dose N-acetylcysteine showed promising results on Post COVID 19 Pulmonary Fibrosis. Disclosures All Authors: No reported disclosures

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Post-COVID-19 Patients Who Develop Lung Fibrotic-like Changes Have Lower Circulating Levels of IFN-β but Higher Levels of IL-1α and TGF-β

Biomedicines ◽

10.3390/biomedicines9121931 ◽

2021 ◽

Vol 9 (12) ◽

pp. 1931

Author(s):

Chiara Colarusso ◽

Angelantonio Maglio ◽

Michela Terlizzi ◽

Carolina Vitale ◽

Antonio Molino ◽

...

Keyword(s):

Pulmonary Fibrosis ◽

Ct Scan ◽

Plasma Levels ◽

Lung Fibrosis ◽

Pharyngeal Swab ◽

Reactive Protein ◽

Scan Data ◽

Severity Of The Disease ◽

Circulating Levels ◽

Chest Ct Scan

Purpose: SARS-CoV-2 infection induces in some patients a condition called long-COVID-19, herein post-COVID-19 (PC), which persists for longer than the negative oral-pharyngeal swab. One of the complications of PC is pulmonary fibrosis. The purpose of this study was to identify blood biomarkers to predict PC patients undergoing pulmonary fibrosis. Patients and Methods: We analyzed blood samples of healthy, anti-SARS-CoV-2 vaccinated (VAX) subjects and PC patients who were stratified according to the severity of the disease and chest computed tomography (CT) scan data. Results: The inflammatory C reactive protein (CRP), complement complex C5b-9, LDH, but not IL-6, were higher in PC patients, independent of the severity of the disease and lung fibrotic areas. Interestingly, PC patients with ground-glass opacities (as revealed by chest CT scan) were characterized by higher plasma levels of IL-1α, CXCL-10, TGF-β, but not of IFN-β, compared to healthy and VAX subjects. In particular, 19 out of 23 (82.6%) severe PC and 8 out of 29 (27.6%) moderate PC patients presented signs of lung fibrosis, associated to lower levels of IFN-β, but higher IL-1α and TGF-β. Conclusions: We found that higher IL-1α and TGF-β and lower plasma levels of IFN-β could predict an increased relative risk (RR = 2.8) of lung fibrosis-like changes in PC patients.

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