Pulmonary fibrotic-like changes on follow-up chest CT exam in patients recovering from COVID-19 pneumonia

Abstract Purpose The aim of the study was to prospectively evaluate the agreement between chest magnetic resonance imaging (MRI) and computed tomography (CT) and to assess the diagnostic performance of chest MRI relative to that of CT during the follow-up of patients recovered from coronavirus disease 2019. Materials and methods Fifty-two patients underwent both follow-up chest CT and MRI scans, evaluated for ground-glass opacities (GGOs), consolidation, interlobular septal thickening, fibrosis, pleural indentation, vessel enlargement, bronchiolar ectasia, and changes compared to prior CT scans. DWI/ADC was evaluated for signal abnormalities suspicious for inflammation. Agreement between CT and MRI was assessed with Cohen’s k and weighted k. Measures of diagnostic accuracy of MRI were calculated. Results The agreement between CT and MRI was almost perfect for consolidation (k = 1.00) and change from prior CT (k = 0.857); substantial for predominant pattern (k = 0.764) and interlobular septal thickening (k = 0.734); and poor for GGOs (k = 0.339), fibrosis (k = 0.224), pleural indentation (k = 0.231), and vessel enlargement (k = 0.339). Meanwhile, the sensitivity of MRI was high for GGOs (1.00), interlobular septal thickening (1.00), and consolidation (1.00) but poor for fibrotic changes (0.18), pleural indentation (0.23), and vessel enlargement (0.50) and the specificity was overall high. DWI was positive in 46.0% of cases. Conclusions The agreement between MRI and CT was overall good. MRI was very sensitive for GGOs, consolidation and interlobular septal thickening and overall specific for most findings. DWI could be a reputable imaging biomarker of inflammatory activity.

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Chest CT as a Complement to RT-PCR to Confirm and Follow-up COVID-19 Patients

Medicinus ◽

10.19166/med.v8i1.3122 ◽

2021 ◽

Vol 8 (1) ◽

pp. 31

Author(s):

Aziza Ghanie Icksan ◽

Muhammad Hafiz ◽

Annisa Dian Harlivasari

Keyword(s):

Chest Ct ◽

Rt Pcr ◽

High Resolution Computed Tomography ◽

X Ray ◽

First Case ◽

Chest X Ray ◽

Polymerase Chain

Background : The first case of COVID-19 in Indonesia was recorded in March 2020. Limitation of reverse-transcription polymerase chain reaction (RT-PCR) has put chest CT as an essential complementary tool in the diagnosis and follow up treatment for COVID-19. Literatures strongly suggested that High-Resolution Computed Tomography (HRCT) is essential in diagnosing typical symptoms of COVID-19 at the early phase of disease due to its superior sensitivity (97%) compared to chest x-ray (CXR).The two cases presented in this case study showed the crucial role of chest CT with HRCT to establish the working diagnosis and follow up COVID-19 patients as a complement to RT-PCR, currently deemed a gold standard.

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

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00632-9 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Mehrdad Nabahati ◽

Soheil Ebrahimpour ◽

Reza Khaleghnejad Tabari ◽

Rahele Mehraeen

Keyword(s):

Pulmonary Fibrosis ◽

Ct Scan ◽

Predictive Factors ◽

Lung Fibrosis ◽

Chest Ct ◽

Clinical Severity ◽

Secondary Outcome ◽

Increased Risk ◽

Chest Ct Scan

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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SUN-932 Successful Response of Temozolomide (TMZ) in two Patients with Metastatic Pheochromocytoma/Paragangliomas (PPGLs)

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1949 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Tobias Skrebsky de Almeida ◽

Roberta P Borges ◽

Janeczko Laís ◽

Giovana Caroline Marx Becker ◽

Ticiana Costa Rodrigues ◽

...

Keyword(s):

Lung Metastases ◽

Left Lung ◽

Vena Cava ◽

Lung Lesion ◽

Chest Ct ◽

Complete Regression ◽

Lung Lesions ◽

The Right ◽

Urinary Metanephrines

Abstract Introduction: PPGLs are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla or their neural crest progenitors, being able to secrete catecholamines. Its treatment is primarily surgical; however, for metastatic/inoperable tumors, effective treatments are lacking. The use of TMZ, an oral alkylating agent, has been scarcely reported with variable response rates. We report 2 patients with reasonable clinical, biochemical and structural responses. Case Reports: Case 1) A 14-year old girl presented with neck pain, sweating, hypertension and tachycardia. Urinary hormonal profile revealed metanephrines 80 (up to 320 ug/24h) and normetanephrines 2983 (up to 390 ug/24h). Abdominal MRI showed a 10x6x5 cm retroperitoneal lesion in close contact with celiac trunk, superior mesenteric artery, renal arteries, aorta, left renal vein and vertebral bodies of T10, T11 and T12. A chest CT revealed multiple lung metastases. After 11 months, both the primary abdominal lesion and lung metastases increased in size.. Due to disease severity, after excluding surgical possibilities and confirming diagnosis by lesion biopsy, rescue treatment with TMZ was started for 5 days on a 28-day cycle. After 11 cycles, lung and abdominal lesions decreased more than 30% in size, and urinary metanephrines decreased 53.4%. After 21 cycles, there is no evidence of disease progression. Case 2) A 44-year old female was first diagnosed at the age of 31 with a right adrenal mass invading the kidney and the inferior vena cava associated with hypertension, sweating, headaches and palpitations. She underwent right adrenalectomy and nephrectomy. Immunohistochemistry confirmed the diagnosis of pheochromocytoma. Seven years later, follow-up CT`s showed a 3 x 2 cm liver metastasis, which was resected, and two lung lesions, one located at the right inferior lobe (1.6 cm) and the other at the left superior lobe (0.9 cm), which initially were just followed-up. At this time, a 7-month sorafenib trial was performed but the drug was stopped due to intolerable side effects. After 3 years of follow-up, the lung lesions increased in size and the right lesion was resected, but the patient refused surgery for the remainder left lung lesion. After 1 year, left lung lesion increased to 2.4 cm and mediastinal and paratracheal lymphadenomegaly developed. TMZ in the same aforementioned schedule was prescribed and after 7 cycles a new chest CT revealed complete regression of the lung and lymph node metastases.. Urinary metanephrines were 2.1 times the upper limit of normal before TMZ and decreased to normal range. Conclusion: These cases highlight the promising role of a well-tolerated single drug chemotherapy regimen in severe cases of metastatic and inoperable PPGLs. TMZ could be considered an alternative strategy for the treatment of these cases and, if possible, should be tested in adequate clinical trials.

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Role of diagnostic imaging in diagnosis by Covid-19

Journal of Advanced Health Care ◽

10.36017/jahc2012-008 ◽

2020 ◽

Author(s):

Coda Marco ◽

Sica Federica ◽

Finelli Mirko ◽

Ungaro Gaetano ◽

Sica Alfonso Marco

Keyword(s):

Differential Diagnosis ◽

Lung Parenchyma ◽

Chest Ct ◽

Initial Assessment ◽

X Rays ◽

Radiological Imaging ◽

Laboratory Examinations ◽

Clinical Conditions

The diagnosis from Covid-19 provides the set of several examinations such as: clinical examinations, laboratory examinations, radiographic examinations. Using radiological imaging, RX and chest CT, it is possible to evaluate the impairment of lung function and thanks to this aspect it is possible to define the severity and clinical conditions of the patient. In this way, it allows timely therapeutic intervention especially if the patient shows a mild condition in such a way as to avoid the onset of further complications. Chest X-rays allow both an initial assessment of patients and the possibility to perform a differential diagnosis towards other possible causes of lung parenchyma involvement. The CT scan, which highlights the peculiar characteristics of COVID pneumonia, is performed both as diagnostic confirmation and in the patient’s follow-up.

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The clinical significance of indeterminate pulmonary nodules in melanoma patients at baseline and during follow-up chest CT

European Journal of Radiology Open ◽

10.1016/j.ejro.2019.02.003 ◽

2019 ◽

Vol 6 ◽

pp. 85-90 ◽

Cited By ~ 4

Author(s):

Magdy Soliman ◽

Teresa Petrella ◽

Pascal Tyrrell ◽

Frances Wright ◽

Nicole J. Look Hong ◽

...

Keyword(s):

Clinical Significance ◽

Pulmonary Nodules ◽

Chest Ct ◽

Melanoma Patients

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Thymus hyperplasia after resolution of hypercortisolism in ACTH-dependent Cushing’s syndrome: the importance of thymic vein catheterization

Acta Endocrinologica ◽

10.1530/eje.1.02154 ◽

2006 ◽

Vol 154 (6) ◽

pp. 807-811 ◽

Cited By ~ 5

Author(s):

Malebranche Berardo C Cunha Neto ◽

Márcio Carlos Machado ◽

Flávia Mesquita ◽

Nina Rosa de Castro Musolino ◽

Andrea Cecília Toscanini ◽

...

Keyword(s):

Differential Diagnosis ◽

Cushing’S Syndrome ◽

Transsphenoidal Surgery ◽

Cushing's Syndrome ◽

Chest Ct ◽

Spontaneous Resolution ◽

Tumor Visualization ◽

Histopathological Studies ◽

Thymic Lobe

Thymic hyperplasia has been described after the resolution of hypercortisolism from several etiologies, causing great diagnostic dilemmas. We describe a case where the catheterization of the thymic vein was essential for the differential diagnosis of a thymic enlargement in an adrenalectomized patient with ACTH-dependent Cushing’s syndrome. The patient was a 48-year-old female with clinical and laboratorial data suggesting Cushing’s disease. She underwent a transsphenoidal surgery with no tumor visualization and no remission of the syndrome. Histopathological studies disclosed a normal pituitary. She underwent a bilateral adrenalectomy and 8 months later a chest CT showed an increase of left thymic lobe, which was previously non-existent. After a negative 111In-pentetreotide scintigraphy, the patient underwent simultaneous and bilateral catheterism of the petrosus sinuses and catheterization of the thymic and inominate veins and no ACTH gradient was shown among the sites of collection. She did not undergo thoracotomy and a follow-up was established. During the evolution, there was a spontaneous regression of the thymic lesion 38 months after the diagnosis. The ACTH gradient during the catheterization of thymic vein was essential for the differential diagnosis of the thymic enlargement tumor after hypercortisolism resolution in ACTH-dependent Cushing’s syndrome, especially in this case, where the ACTH source was occult, thus avoiding an invasive surgical procedure for a benign entity with spontaneous resolution.

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Analysis of Chest CT Results of Coronavirus Disease 2019 (COVID-19) Patients at First Follow-Up

Canadian Respiratory Journal ◽

10.1155/2020/5328267 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Lingshan Zhong ◽

Shuo Zhang ◽

Jigang Wang ◽

Xinqian Zhao ◽

Kai Wang ◽

...

Keyword(s):

Ground Glass Opacity ◽

Chest Ct ◽

Ground Glass ◽

Imaging Data ◽

Exclusion Criteria ◽

Pulmonary Lesions ◽

Normal Chest ◽

Time Of Admission ◽

Better Than

Objective. To investigate the dissipation and outcomes of pulmonary lesions at the first follow-up of patients who recovered from moderate and severe cases of COVID-19. Methods. From January 21 to March 3, 2020, a total of 136 patients with COVID-19 were admitted to our hospital. According to inclusion and exclusion criteria, 52 patients who recovered from COVID-19 were included in this study, including 33 moderate cases and 19 severe cases. Three senior radiologists independently and retrospectively analyzed the chest CT imaging data of 52 patients at the last time of admission and the first follow-up after discharge, including primary manifestations, concomitant manifestations, and degree of residual lesion dissipation. Results. At the first follow-up after discharge, 16 patients with COVID-19 recovered to normal chest CT appearance, while 36 patients still had residual pulmonary lesions, mainly including 33 cases of ground-glass opacity, 5 cases of consolidation, and 19 cases of fibrous strip shadow. The proportion of residual pulmonary lesions in severe cases (17/19) was statistically higher than in moderate cases (19/33) ( χ 2 = 5 . 759 , P < 0.05 ). At the first follow-up, residual pulmonary lesions were dissipated to varying degrees in 47 cases, and lesions remained unchanged in 5 cases. There were no cases of increased numbers of lesions, enlargement of lesions, or appearance of new lesions. The dissipation of residual pulmonary lesions in moderate patients was statistically better than in severe patients (Z = −2.538, P < 0.05 ). Conclusion. Clinically cured patients with COVID-19 had faster dissipation of residual pulmonary lesions after discharge, while moderate patients had better dissipation than severe patients. However, at the first follow-up, most patients still had residual pulmonary lesions, which were primarily ground-glass opacity and fibrous strip shadow. The proportion of residual pulmonary lesions was higher in severe cases of COVID-19, which required further follow-up.

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Incidental finding of bronchial diverticula in a non-smoker population: evaluation on thin-section CT

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2015.743 ◽

2016 ◽

Vol 81 (1-2) ◽

Author(s):

Federica Ciccarese ◽

Giorgio Garzillo ◽

Anna Maria Chiesa ◽

Antonio Poerio ◽

Serena Baroncini ◽

...

Keyword(s):

Thin Section ◽

Healthy Subjects ◽

Respiratory Symptoms ◽

Incidental Finding ◽

Radiological Finding ◽

Chest Ct ◽

Lobe Bronchus ◽

Significant Difference ◽

The Right

Bronchial diverticula have been described as a common radiological finding in smoker patients with COPD, but the specificity of this sign should be further investigated. Thus, the aim of our study was to evaluate the prevalence of diverticula in a cohort of non-smoker subjects. Between February and July 2012, 2438 patients were admitted to our Radiology Unit to undergo a chest CT. Among them, we enrolled 121 non-smoking patients (78/121-64.5% females, 43/121-35.5% males), of different age (57.0±20.7 years-range: 12-88), without any respiratory symptoms, submitted to chest CT for several reasons (oncologic evaluation: 59/121-48.8%; follow up of lung nodules: 27/121-22.3%; screening in connectivitis: 12/121-9.9%; others: 23/121-19.0%). We considered thin-section CT scan on axial, coronal and sagittal plans to evaluate prevalence, numbers and level of bronchial diverticula. Diverticula were found in 41/121-33.9% patients, with a slight major prevalence in males (p=0.048), but no significant difference on age. In 31/41-75.6% the number was <3, whereof 17/31-54.8% with just one diverticulum assessed. Regarding the level, in 30/41-73.2% they were subcarinal, but they were also detected in mainstem (2/41-4.9%) and lobar bronchi (with the right upper lobe bronchus most frequently involved- 12/41-29.3%). Bronchial diverticula can be observed in non-smokers, as well as in smoker patients with COPD. However, their prevalence seems to be lower than in smokers and they tend to be isolated and subcarinal. The age of patients does not influence their finding. More studies should be proposed to better define a cut-off between smokers and healthy subjects.

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Neonatal COVID-19 Pneumonia: Report of the First Case in a Preterm Neonate in Mayotte, an Overseas Department of France

Children ◽

10.3390/children7080087 ◽

2020 ◽

Vol 7 (8) ◽

pp. 87

Author(s):

Soumeth Abasse ◽

Laila Essabar ◽

Tereza Costin ◽

Voninavoko Mahisatra ◽

Mohamed Kaci ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Case Report ◽

Respiratory Distress ◽

Neonatal Intensive Care ◽

Preterm Neonate ◽

Chest Ct ◽

First Case ◽

Chest Ct Scan

We report the first case of COVID-19 pneumonia in a preterm neonate in Mayotte, an overseas department of France. The newborn developed an acute respiratory distress by 14 days of life with bilateral ground glass opacities on a chest CT scan and a 6-week-long stay in the neonatal intensive care unit (NICU). This case report emphasizes the need for a cautious and close follow-up period for asymptomatic neonates born to mothers with COVID-19 infection. Vertical transmission cannot be excluded in this case.

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