scholarly journals A single-center comparative study of lung ultrasound versus chest computed tomography during the COVID-19 era

2021 ◽  
Vol 16 ◽  
Author(s):  
Kobalava Zhanna Davidovna ◽  
Ayten Fuad Safarova ◽  
Flora Elisa Cabello Montoya ◽  
Maria Vasilevna Vatsik-Gorodetskaya ◽  
Karaulova Yulia Leonidovna ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Area Under The Curve ◽  
Pulmonary Involvement ◽  
Chest Ct ◽  
Imaging Tool ◽  
Visual Scoring ◽  
Ct Findings ◽  
Severity Scores ◽  
Bilateral Distribution ◽  
B Lines

Background: Lung ultrasound (LUS) is a bedside imaging tool that has proven useful in identifying and assessing the severity of pulmonary pathology. The aim of this study was to determine LUS patterns, their clinical significance, and how they compare to CT findings in hospitalized patients with coronavirus infection.Methods: This observational study included 62 patients (33 men, age 59.3±15.9 years), hospitalized with pneumonia due to COVID-19, who underwent chest CT and bedside LUS on the day of admission. The CT images were analyzed by chest radiographers who calculated a CT visual score based on the expansion and distribution of ground-glass opacities and consolidations. The LUS score was calculated according to the presence, distribution, and severity of anomalies.Results: All patients had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 8.1±2.9%. LUS identified 4 different abnormalities, with bilateral distribution (mean LUS score: 26.4±6.7), focal areas of non-confluent B lines, diffuse confluent B lines, small sub-pleural micro consolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (rho = 0.70; p<0.001). Correlation analysis of the CT and LUS severity scores showed good interclass correlation (ICC) (ICC =0.71; 95% confidence interval (CI): 0.52–0.83; p<0.001). Logistic regression was used to determine the cut-off value of ≥27 (area under the curve: 0.97; 95% CI: 90-99; sensitivity 88.5% and specificity 97%) of the LUS severity score that represented severe and critical pulmonary involvement on chest CT (CT: 3-4).Conclusion: When combined with clinical data, LUS can provide a potent diagnostic aid in patients with suspected COVID-19 pneumonia, reflecting CT findings.

scholarly journals Prevalence and significance of pulmonary disease on lung ultrasonography in outpatients with SARS-CoV-2 infection

2021 ◽  
Vol 8 (1) ◽  
pp. e000947
Author(s):  
Robert M Fairchild ◽  
Audra Horomanski ◽  
Diane A Mar ◽  
Gabriela R Triant ◽  
Rong Lu ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Pulmonary Disease ◽  
Lung Ultrasound ◽  
Pulmonary Involvement ◽  
Adverse Outcomes ◽  
Shortness Of Breath ◽  
Severity Scores ◽  
High Prevalence ◽  
Risk Stratification Tool ◽  
B Lines

BackgroundThe majority of patients with SARS-CoV-2 infection are diagnosed and managed as outpatients; however, little is known about the burden of pulmonary disease in this setting. Lung ultrasound (LUS) is a convenient tool for detection of COVID-19 pneumonia. Identifying SARS-CoV-2 infected outpatients with pulmonary disease may be important for early risk stratification.ObjectivesTo investigate the prevalence, natural history and clinical significance of pulmonary disease in outpatients with SARS-CoV-2.MethodsSARS-CoV-2 PCR positive outpatients (CV(+)) were assessed with LUS to identify the presence of interstitial pneumonia. Studies were considered positive based on the presence of B-lines, pleural irregularity and consolidations. A subset of patients underwent longitudinal examinations. Correlations between LUS findings and patient symptoms, demographics, comorbidities and clinical outcomes over 8 weeks were evaluated.Results102 CV(+) patients underwent LUS with 42 (41%) demonstrating pulmonary involvement. Baseline LUS severity scores correlated with shortness of breath on multivariate analysis. Of the CV(+) patients followed longitudinally, a majority showed improvement or resolution in LUS findings after 1–2 weeks. Only one patient in the CV(+) cohort was briefly hospitalised, and no patient died or required mechanical ventilation.ConclusionWe found a high prevalence of LUS findings in outpatients with SARS-CoV-2 infection. Given the pervasiveness of pulmonary disease across a broad spectrum of LUS severity scores and lack of adverse outcomes, our findings suggest that LUS may not be a useful as a risk stratification tool in SARS-CoV-2 in the general outpatient population.

scholarly journals Lung ultrasound and computed tomography to monitor COVID-19 pneumonia in critically ill patients: a two-center prospective cohort study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Micah L. A. Heldeweg ◽  
Jorge E. Lopez Matta ◽  
Mark E. Haaksma ◽  
Jasper M. Smit ◽  
Carlos V. Elzo Kraemer ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Lung Ultrasound ◽  
Composite Endpoint ◽  
Pulmonary Involvement ◽  
Chest Ct ◽  
Secondary Outcome ◽  
Icu Stay ◽  
Academic Hospitals ◽  
Ultrasound Score

Abstract Background Lung ultrasound can adequately monitor disease severity in pneumonia and acute respiratory distress syndrome. We hypothesize lung ultrasound can adequately monitor COVID-19 pneumonia in critically ill patients. Methods Adult patients with COVID-19 pneumonia admitted to the intensive care unit of two academic hospitals who underwent a 12-zone lung ultrasound and a chest CT examination were included. Baseline characteristics, and outcomes including composite endpoint death or ICU stay > 30 days were recorded. Lung ultrasound and CT images were quantified as a lung ultrasound score involvement index (LUSI) and CT severity involvement index (CTSI). Primary outcome was the correlation, agreement, and concordance between LUSI and CTSI. Secondary outcome was the association of LUSI and CTSI with the composite endpoints. Results We included 55 ultrasound examinations in 34 patients, which were 88% were male, with a mean age of 63 years and mean P/F ratio of 151. The correlation between LUSI and CTSI was strong (r = 0.795), with an overall 15% bias, and limits of agreement ranging − 40 to 9.7. Concordance between changes in sequentially measured LUSI and CTSI was 81%. In the univariate model, high involvement on LUSI and CTSI were associated with a composite endpoint. In the multivariate model, LUSI was the only remaining independent predictor. Conclusions Lung ultrasound can be used as an alternative for chest CT in monitoring COVID-19 pneumonia in critically ill patients as it can quantify pulmonary involvement, register changes over the course of the disease, and predict death or ICU stay > 30 days. Trial registration: NTR, NL8584. Registered 01 May 2020—retrospectively registered, https://www.trialregister.nl/trial/8584

scholarly journals Diagnostic value of 12-zone lung ultrasound protocol for diagnosing COVID-19-associated pneumonia in outpatients

2021 ◽  
Vol 21 (87) ◽  
pp. 271-276
Author(s):  
Dzmitry Haurylenka ◽  
◽  
Victar Damantsevich ◽  
Andrey Filustsin ◽  
Anna Damantsevich ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Quantitative Assessment ◽  
Lung Ultrasound ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Outpatient Setting ◽  
Diagnostic Significance ◽  
Decisive Importance ◽  
Sensitivity Specificity ◽  
B Lines

Introduction: In the SARS-CoV-2 pandemic, lung ultrasound can be of decisive importance for planning further treatment approach in patients with infection. There is still no clear priority for the choice of lung ultrasound protocol in an outpatient setting. Aim: The objective of the study was to evaluate the applicability of 12-zone protocol lung ultrasound for the diagnosis of COVID- 19 associated pneumonia in outpatients. Materials and methods: We examined 39 outpatients meeting the diagnostic criteria of COVID-19 infection (17 men and 22 women) aged 31–75 years (median 49 years). All patients underwent lung ultrasound immediately after chest computed tomography performed by a blinded specialist. Correlation analysis of the results of a quantitative assessment of the detected signs, assessment of the diagnostic significance of lung ultrasound for identifying signs of pneumonia were performed. Results: Pneumonia was diagnosed by computed tomography in 25 (64%; 95% CI 47–79) out of 39 patients. At the same time, ultrasound signs of interstitial abnormalities were detected in 31 patients. Multiple (narrow) B-lines, confluent (wide) B-lines, as well as areas of subpleural consolidation and “white lung” were the most common lung ultrasound abnormalities. When evaluating the method, the optimal sensitivity/ specificity ratio was obtained for a value of ≥2 points, the area under the curve = 0.970 (95% CI 0.858–0.999; p <0.0001). The score of lung ultrasound significantly correlated with computed tomography quantitative assessment (r = 0.928, p <0.001). Conclusion: Despite some limitations, lung ultrasound can be extremely useful in primary care settings, also in the case of a significant number of admitted patients, to detect features of COVID-19 associated pneumonia.

scholarly journals Chest CT scan in patients with contusion and COVID-19, a comparative study with pure lung contusion

2020 ◽  
Author(s):  
Sepideh Sefidbakht ◽  
Seyed Hamed Jafari ◽  
Fariba Zarei ◽  
Hossein Abdolrahimzadeh ◽  
Golnar Sabetian ◽  
...  
Keyword(s):  
Ct Scan ◽  
Time Course ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Chest Ct ◽  
Lung Contusion ◽  
Ground Glass ◽  
Severity Scores ◽  
Significant Difference ◽  
Bilateral Distribution

Abstract Background: Resource allocation for traumatic patients who are positive/negative for COVID-19 challenges the diagnosis. We designed this study to compare the chest CT appearances of COVID-19 patients associated with lung contusion versus patients with lung contusion only, to determine the differentiation capability of CT scan concerning the two conditions. Methods: CT-scans of 9 RT-PCR positive patients of lung contusion due to motor-vehicle-accident (COVID-19 with contusion group) and 16 consecutive patients with lung contusions of comparable severity scores from the pre-COVID-19 era (contusion only group) were revaluated retrospectively and blindly by three radiologists in consensus. The distribution and characteristics of presenting CT-scan findings; including presence, shape and distribution of Ground Glass Opacities and consolidations, presence of subpleural sparing, crazy-paving and Atoll sign. In addition, presence of effusions and cavities were compared between the two groups. Time course of the opacities was compared. Results: Bilateral distribution of opacities was noted in 100% of COVID-19 with contusion and 87.5% of contusion only group. There was no significant difference between Ground Glass Opacities or consolidation shapes (P=0.44 and P=0.66). Both Ground Glass Opacities and consolidations were more diffusely distributed in COVID-19 with contusion, while a predominantly peripheral distribution was more commonly seen in the contusion only group (P=0.03 and P=0.01 respectively). Subpleural sparing was noted in 93.8% of contusion only as compared to 44% of CC group (p=0.04). Appearance resembling Atoll sign was noted in 12.5% of the contusion only groups and none of the COVID-19 with contusion group (P=0.01). Time to resolution was significantly longer in COVID-19 with contusion (15±6 days) comparing to contusion only patients (P=0.02). Conclusion: 'Typical' chest CT findings including bilateral peripheral Ground Glass Opacities and consolidations, also crazy-paving and Atoll signs, as well as less typical findings such as subpleural sparing is seen in both lung contusion and COVID-19 pneumonitis. Time course of the lesions might be a better radiologic discriminator between the two entities.

scholarly journals Correlation Between Chest CT Findings and Clinical Features of 211 COVID-19 Suspected Patients in Wuhan, China

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Songlin Song ◽  
Feihong Wu ◽  
Yiming Liu ◽  
Hongwei Jiang ◽  
Fu Xiong ◽  
...  
Keyword(s):  
Clinical Features ◽  
Area Under The Curve ◽  
High Sensitivity ◽  
Pulmonary Involvement ◽  
Chest Ct ◽  
Chain Reaction ◽  
Basic Model ◽  
Group 4 ◽  
Significant Difference ◽  
Polymerase Chain

Abstract Background Chest computed tomography (CT) has been widely used to assess pulmonary involvement in COVID-19. We aimed to investigate the correlation between chest CT and clinical features in COVID-19 suspected patients with or without fever. Methods We retrospectively enrolled 211 COVID-19 suspected patients who underwent both chest CT and reverse transcription polymerase chain reaction in Wuhan, China. The performance of CT in patients with relevant onset of symptoms, with fever (n = 141) and without fever (n = 70), was assessed respectively. Results The sensitivity of CT for COVID-19 was 97.3%, with area under the curve (AUC) of 0.71 (95% confidence interval [CI], 0.66–0.76). There were 141 suspected patients with fever and 70 without fever. In the fever group, 4 variables were screened to establish the basic model: age, monocyte, red blood cell, and hypertension. The AUC of the basic model was 0.72 (95% CI, 0.63–0.81), while the AUC of the CT-aided model was 0.77 (95% CI, 0.68–0.85), a significant difference (P &lt; .05). In the nonfever group, only dry cough was screened out to establish the basic model. The AUC was 0.76 (95% CI, 0.64–0.88), which was not significantly different than the CT-aided model (P = .08). Conclusions Chest CT has a high sensitivity in patients with COVID-19, and it can improve diagnostic accuracy for COVID-19 suspected patients with fever during the initial screen, whereas its value for nonfever patients remains questionable.

scholarly journals THU0534 LUNG ULTRASOUND IN PATIENTS WITH SECONDARY INTERSTITIAL LUNG DISEASES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 506.2-507
Author(s):  
E. Kirillova ◽  
N. Shamsutdinova ◽  
G. Nurullina
Keyword(s):  
Rheumatic Diseases ◽  
Lung Ultrasound ◽  
Systemic Vasculitis ◽  
Damage Index ◽  
Clinical Manifestations ◽  
Pulmonary Involvement ◽  
Gas Diffusion ◽  
Lung Involvement ◽  
Activity Scale ◽  
B Lines

Background:Currently, lung ultrasound (LUS) is increasingly used in rheumatology.Objectives:To evaluate the relationship between lung ultrasound and pulmonary function and disease activity in patients with rheumatic diseases with secondary lung involvement.Methods:Thirty patients with rheumatic diseases were included in the study, who, according to the data of the high-resolution RCT of lungs (64-slice CT system Philips Diamond Select Brilliance), showed interstitial lung involvement as a type of nonspecific interstitial pneumonia. In 4 patients, mixed connective tissue disease (MCTD) was diagnosed, 20 had systemic vasculitis (SV), and 6 had rheumatoid arthritis (RA). The mean age of the patients was 56,55 ± 10,59, the duration of the disease was 2,3 ± 1,2 years. All patients underwent a standard clinical examination, the following indices and scales were used to assess the activity of the underlying disease: VDI damage index, Bermingham systemic vasculitis activity scale (BVAS), RA activity scale (DAS 28-CRP). The functional state of the lungs was assessed using spirometry, bodipletismography, gas diffusion “single breath”. LUS was carried out for the evaluation of the location and number of B-lines on both right and left hemithoraces using commercially available echographic equipment with a 5-12 MHz linear transducer (Accuvix A30, Samsung Medison).Results:Most patients had an average number of B-lines 24,5[11,5;34,0]. Тhere were no significant differences in the number of В-lines between groups of patients of different nosologies. The total number of В-lines correlated with the index of activity of systemic vasculitis BVAS (р<0,05; r=0,83). There were no statistically significant correlations with clinical manifestations of pulmonary involvement.Conclusion:Lung ultrasound may be useful in screening secondary lung involvement in patients with rheumatic diseases with high activity.References:[1]Dietrich CF, Mathis G, Blaivas M, Volpicelli G, Seibel A, Wastl D, Atkinson NS, Cui XW, FanM, Yi D. Lung B-line artefacts and their use. J Thorac Dis 2016;8(6):1356-1365. doi: 10.21037/jtd.2016.04.55[2]Tatiana Barskova, Luna Gargani, Serena Guiducci, et al. Lung ultrasound for the screening of interstitial lung disease in very early systemic sclerosis Ann Rheum Dis 2013 72: 390-395 originally published online May 15 2012 doi: 10.1136/annrheumdis-2011-201072Disclosure of Interests:None declared

scholarly journals Laryngotracheobronchial papillomatosis: chest CT findings

2017 ◽  
Vol 43 (4) ◽  
pp. 259-263 ◽  
Author(s):  
Helena Ribeiro Fortes ◽  
Felipe Mussi von Ranke ◽  
Dante Luiz Escuissato ◽  
Cesar Augusto Araujo Neto ◽  
Gláucia Zanetti ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Lung Parenchyma ◽  
Pulmonary Involvement ◽  
Chest Ct ◽  
Ct Scans ◽  
Lung Nodules ◽  
Inclusion Criteria ◽  
Air Trapping ◽  
Recurrent Respiratory Infections ◽  
Ct Findings

ABSTRACT To evaluate the findings on chest CTs in 16 patients (8 men and 8 women) with laryngotracheobronchial papillomatosis. Methods: This was a retrospective study involving patients ranging from 2 to 72 years of age. The evaluation of the CT scans was independently performed by two observers, and discordant results were resolved by consensus. The inclusion criteria were presence of abnormalities on the CT scans, and the diagnosis was confirmed by anatomopathological examination of the papillomatous lesions. Results: The most common symptoms were hoarseness, cough, dyspnea, and recurrent respiratory infections. The major CT findings were nodular formations in the trachea, solid or cavitated nodules in the lung parenchyma, air trapping, masses, and consolidation. Nodular formations in the trachea were observed in 14 patients (87.5%). Only 2 patients had lesions in lung parenchyma without tracheal involvement. Only 1 patient had no pulmonary dissemination of the disease, showing airway involvement only. Solid and cavitated lung nodules were observed in 14 patients (87.5%) and 13 (81.2%), respectively. Masses were observed in 6 patients (37.5%); air trapping, in 3 (18.7%); consolidation in 3 (18.7%); and pleural effusion, in 1 (6.3%). Pulmonary involvement was bilateral in all cases. Conclusions: The most common tomography findings were nodular formations in the trachea, as well as solid or cavitated nodules and masses in the lung parenchyma. Malignant transformation of the lesions was observed in 5 cases.

scholarly journals One year of SARS-CoV-2 and lung ultrasound: what has been learned and future perspectives

2021 ◽  
Author(s):  
Andrea Boccatonda ◽  
Giulio Cocco ◽  
Eugenia Ianniello ◽  
Marco Montanari ◽  
Damiano D’Ardes ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Relevant Information ◽  
Pulmonary Involvement ◽  
Future Perspectives ◽  
Interstitial Syndrome ◽  
Current Infection ◽  
Good Diagnostic Accuracy ◽  
One Year ◽  
B Lines ◽  
Over Time

AbstractA first screening by ultrasound can be relevant to set a specific diagnostic and therapeutic route for a patient with a COVID-19 infection. The finding of bilateral B-lines and white lung areas with patchy peripheral distribution and sparing areas is the most suggestive ultrasound picture of COVID-19 pneumonia. Failure to detect bilateral interstitial syndrome (A pattern) on ultrasound excludes COVID-19 pneumonia with good diagnostic accuracy, but does not exclude current infection. The use of shared semiotic and reporting schemes allows the comparison and monitoring of the COVID-19 pulmonary involvement over time. This review aims to summarise the main data on pulmonary ultrasound and COVID-19 to provide accurate and relevant information for clinical practice.

scholarly journals OP0167 THE ROLE OF LUNG ULTRASOUND IN THE DIAGNOSIS OF INTERSTITIAL LUNG DISEASE IN CHILDREN WITH DERMATOMYOSISTIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 100.3-100
Author(s):  
R. Dertkgil ◽  
C. Cappello ◽  
S. Dertkigil ◽  
R. Marini ◽  
S. Appenzeller
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Gold Standard ◽  
Lung Ultrasound ◽  
Pulmonary Involvement ◽  
High Resolution Computed Tomography ◽  
B Lines ◽  
Transthoracic Ultrasound

Background:Dermatomyositis is a multi organ autoimmune disease wich is commonly complicated with interstitial lung disease. Chest high-resolution computed tomography (HRCT) is still considered the diagnostic gold standard for interstitial lung disease and is quantification, however he increasing use of lung ultrasound may play an important role in the future.Objectives:The aim of our study was to determine the diagnostic value of lung ultrasound in the detection and progression of interstitial pulmonary disease in patients with dermatomyositis.Methods:Twenty two subjects with dermatomyositis diagnosed according to the American College of Rheumatology criteria were enrolled (6 males, 16 females; mean age: 15,8 ± 8.8 years; range: 6 to 29 years). All subjects underwent high resolution computed tomography followed by transthoracic ultrasound for comet tail sign detection and pleural irregularity in order to predict the degree of interstitial lung disease. The modified transthoracic ultrasound assessment was performed at 06 thoracic regions each side. The Warrick score was calculated according standard high-resolution chest computed tomography images that were evaluated independently from each other by two thoracics radiologists.Results:A significantly positive correlation between transthoracic ultrasound and the severity of pulmonary involvement, as seen by the number of B lines (Spearman ‘s correlation coefficient = 0.80, p < 0.001), and the number of positive areas (regions wih more than 3 B lines) (Spearman ‘s correlation coefficient = 0.75, p < 0.001) were found. When compared with high-resolution chest computed tomography as the gold standard method, the sensitivity, specificity, of transthoracic ultrasound was 96.4%, 83,3% respectively. Addicionally the number of B lines (sum of 35 or more B lines) and a number of B lines positive areas (7 or more regions with at least 3 B lines) cut of allowed to discriminate the inflamatory pattern (ground glass) to those with structural pattern (honeycomb and pulmonary cysts).Conclusion:Our study showed that transthoracic ultrasound comet tails scoring system could be useful in the assessment of the pulmonary involvement in patients with dermatomyositis, and should be considered as a primary screening exam to exclude lung involvement, rather than routine chest CT scans in assimptomatic patients.Disclosure of Interests:None declared

scholarly journals Overview of chest involvement at computed tomography in children with coronavirus disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Xuehua Peng ◽  
Yu Guo ◽  
Han Xiao ◽  
Wei Xia ◽  
Aiguo Zhai ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Young Children ◽  
Pulmonary Involvement ◽  
Chest Ct ◽  
Chi Square ◽  
Asymptomatic Group ◽  
Lung Lesions ◽  
Viral Shedding ◽  
Ct Findings ◽  
Asymptomatic Patients

Abstract Background Chest computed tomography (CT) findings in children with coronavirus disease 2019 (COVID-19) have been rarely reported in a comprehensive and systematic manner. Objective We investigated the chest CT findings in children with COVID-19, and explored the differences in these findings between symptomatic patients and asymptomatic patients. Materials and methods Demographic findings, clinical characteristics, duration of hospital stay and viral shedding, and chest CT findings in 201 children infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were retrospectively analyzed from January 15 to March 20, 2020, and divided into two groups: symptomatic group (n=136) and asymptomatic group (n=65). Chi-square test and Student’s t-test were used for statistical analysis. Results Symptomatic patients were mainly young children ≤3 years old (54/63, 86%),while asymptomatic patients were mainly children ≥ 6 years old (51/111, 46%). Fever (41%) and cough (41%) were the most common symptoms. Overall, 119/201 (59%) patients had chest CT findings, and symptomatic patients accounted for 82% (98/119). The CT findings presented as bilateral multiple lesions (60/119, 50.4%), ground-glass opacities (83/119, 70%) and/or consolidation (44/119, 37%) with a peripheral and subpleural distribution (62/83, 75%). Fifteen of 87 (7.2%) patients with lung lesions showed complete lesion absorption, and 42/87 (48%) improved within a mean of 9.1 (standard deviation [SD] 3.2) days. The mean duration of viral shedding was 8.7 (SD 4.9) days. Pleural effusion was very rare. No lymphadenopathy was found in either group. Conclusion Symptoms associated with pulmonary involvement were most common in infants and young children. The lung lesions of most patients were absorbed and improved in about 9 days.

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