Postmortem Chest Computed Tomography in Fatal COVID-19: A Valuable Diagnostic Tool for Minimally Invasive Autopsy

Abstract Background We diagnosed a clinical case of pulmonary infection involving Mycobacterium tuberculosis and Tropheryma whipplei in a patient with acute respiratory distress syndrome. The diagnosis was assisted by metagenomic next-generation sequencing of bronchoalveolar lavage fluid. Case presentation A 44-year-old Han Chinese inmate was transferred to the emergency department because of dry cough, chest tightness, and shortness of breath. The patient’s body temperature rose to 39.3 °C following empirical cephalosporin treatment for 1 week. The blood CD4+/CD8+ ratio was 0.7, suggesting immunodeficiency. Routine microbiological tests were performed, and tuberculosis interferon gamma release assays were positive. Mycobacterium tuberculosis polymerase chain reaction was also positive. Chest computed tomography scan revealed miliary nodules and ground-glass opacifications, which were in accordance with tuberculosis. To fully examine the etiology, we performed routine laboratory tests and metagenomic sequencing, the results of which indicated the presence of Mycobacterium tuberculosis and Tropheryma whipplei. We administered anti-tuberculosis regimen in combination with trimethoprim/sulfamethoxazole. The patient recovered, with chest computed tomography scan showing absorption of lesions. Conclusions Compared with traditional diagnostic methods such as culture and serology, metagenomic next-generation sequencing has the advantage of detecting a wide array of microorganisms in a single test and therefore can be used for clinical diagnosis of rare pathogens and microbial coinfections. It is particularly useful for immunocompromised patients as they are more prone to infection by opportunistic microorganisms.

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SARS-CoV-2 infection in an infant with non-respiratory manifestations: a case report

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-020-00047-7 ◽

2021 ◽

Vol 69 (1) ◽

Author(s):

Muhammad Adel ◽

Ahmed Magdy

Keyword(s):

Computed Tomography ◽

Aplastic Anemia ◽

Rt Pcr ◽

Positive Real ◽

Case Presentation ◽

Chest Computed Tomography ◽

High Incidence ◽

Laboratory Investigations ◽

High Index Of Suspicion ◽

Specific Symptoms

Abstract Background Coronavirus disease (COVID-19) presents in children usually with less severe manifestations than in adults. Although fever and cough were reported as the most common symptoms, children can have non-specific symptoms. We describe an infant with aplastic anemia as the main manifestation. Case presentation We describe a case of SARS-CoV-2 infection in an infant without any respiratory symptoms or signs while manifesting principally with pallor and purpura. Pancytopenia with reticulocytopenia was the predominant feature in the initial laboratory investigations, pointing to aplastic anemia. Chest computed tomography surprisingly showed typical findings suggestive of SARS-CoV-2 infection. Infection was later confirmed by positive real-time reverse transcription polymerase chain reaction assay (RT-PCR) for SARS-CoV-2. Conclusions Infants with COVID-19 can have non-specific manifestations and a high index of suspicion should be kept in mind especially in regions with a high incidence of the disease. Chest computed tomography (CT) and testing for SARS-CoV-2 infection by RT-PCR may be considered even in the absence of respiratory manifestations.

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Airway Foreign Body Mimicking an Endobronchial Tumor Presenting with Pneumothorax in an Adult: A Case Report

Medicina ◽

10.3390/medicina57010050 ◽

2021 ◽

Vol 57 (1) ◽

pp. 50

Author(s):

Jun-Ho Ha ◽

Byeong-Ho Jeong

Keyword(s):

Computed Tomography ◽

Foreign Body ◽

Chest Tube ◽

Biopsy Forceps ◽

Chest Computed Tomography ◽

Contrast Enhanced ◽

Lobar Bronchus ◽

Green Pea ◽

Airway Foreign Body ◽

The Right

Foreign body (FB) aspiration occurs less frequently in adults than in children. Among the complications related to FB aspiration, pneumothorax is rarely reported in adults. Although the majority of FB aspiration cases can be diagnosed easily and accurately by using radiographs and bronchoscopy, some patients are misdiagnosed with endobronchial tumors. We describe a case of airway FB that mimicked an endobronchial tumor presenting with pneumothorax in an adult. A 77-year-old man was referred to our hospital due to pneumothorax and atelectasis of the right upper lobe caused by an endobronchial nodule. A chest tube was immediately inserted to decompress the pneumothorax. Chest computed tomography with contrast revealed an endobronchial nodule that was seen as contrast-enhanced. Flexible bronchoscopy was performed to biopsy the nodule. The bronchoscopy showed a yellow spherical nodule in the right upper lobar bronchus. Rat tooth forceps were used, because the lesion was too slippery to grasp with ellipsoid cup biopsy forceps. The whole nodule was extracted and was confirmed to be a FB, which was determined to be a green pea vegetable. After the procedure, the chest tube was removed, and the patient was discharged without any complications. This case highlights the importance of suspecting a FB as a cause of pneumothorax and presents the possibility of misdiagnosing an aspirated FB as an endobronchial tumor and selecting the appropriate instrument for removing an endobronchial FB.

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Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

Pathogens ◽

10.3390/pathogens10040412 ◽

2021 ◽

Vol 10 (4) ◽

pp. 412

Author(s):

Natalia Rakislova ◽

Lorena Marimon ◽

Mamudo R. Ismail ◽

Carla Carrilho ◽

Fabiola Fernandes ◽

...

Keyword(s):

Minimally Invasive ◽

Cause Of Death ◽

Diffuse Alveolar Damage ◽

The Body ◽

Protective Equipment ◽

Safe Alternative ◽

Minimally Invasive Autopsy ◽

Postmortem Studies ◽

Death Investigation ◽

Insight Into

Postmortem studies are crucial for providing insight into emergent diseases. However, a complete autopsy is frequently not feasible in highly transmissible diseases due to biohazard challenges. Minimally invasive autopsy (MIA) is a needle-based approach aimed at collecting samples of key organs without opening the body, which may be a valid alternative in these cases. We aimed to: a) provide biosafety guidelines for conducting MIAs in COVID-19 cases, b) compare the performance of MIA versus complete autopsy, and c) evaluate the safety of the procedure. Between October and December 2020, MIAs were conducted in six deceased patients with PCR-confirmed COVID-19, in a basic autopsy room, with reinforced personal protective equipment. Samples from the lungs and key organs were successfully obtained in all cases. A complete autopsy was performed on the same body immediately after the MIA. The diagnoses of the MIA matched those of the complete autopsy. In four patients, COVID-19 was the main cause of death, being responsible for the different stages of diffuse alveolar damage. No COVID-19 infection was detected in the personnel performing the MIAs or complete autopsies. In conclusion, MIA might be a feasible, adequate and safe alternative for cause of death investigation in COVID-19 cases.

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Correlation between age, sex, and severity of Coronavirus disease-19 based on chest computed tomography severity scoring system

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00408-1 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Shimaa Farghaly ◽

Marwa Makboul

Keyword(s):

Computed Tomography ◽

Scoring System ◽

Fatal Outcome ◽

Age Groups ◽

Significant Risk ◽

Chest Ct ◽

Age Group ◽

Severity Scoring ◽

Chest Computed Tomography ◽

Severity Of The Disease

Abstract Background Coronavirus disease 2019 (COVID-19) is the most recent global health emergency; early diagnosis of COVID-19 is very important for rapid clinical interventions and patient isolation; chest computed tomography (CT) plays an important role in screening, diagnosis, and evaluating the progress of the disease. According to the results of different studies, due to high severity of the disease, clinicians should be aware of the different potential risk factors associated with the fatal outcome, so chest CT severity scoring system was designed for semi-quantitative assessment of the severity of lung disease in COVID-19 patients, ranking the pulmonary involvement on 25 points severity scale according to extent of lung abnormalities; this study aims to evaluate retrospectively the relationship between age and severity of COVID-19 in both sexes based on chest CT severity scoring system. Results Age group C (40–49 year) was the commonest age group that was affected by COVID-19 by 21.3%, while the least affected group was group F (≥ 70 years) by only 6.4%. As regards COVID-RADS classification, COVID-RADS-3 was the most commonly presented at both sexes in all different age groups. Total CT severity lung score had a positive strong significant correlation with the age of the patient (r = 0.64, P < 0.001). Also, a positive strong significant correlation was observed between CT severity lung score and age in both males and females (r = 0.59, P < 0.001) and (r = 0.69, P < 0.001) respectively. Conclusion We concluded that age can be considered as a significant risk factor for the severity of COVID-19 in both sexes. Also, CT can be used as a significant diagnostic tool for the diagnosis of COVID-19 and evaluation of the progression and severity of the disease.

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Relationship Between Chest Computed Tomography Findings and Clinical Conditions of Coronavirus Disease (COVID‐19): A Multicentre Experience

International Journal of Clinical Practice ◽

10.1111/ijcp.14459 ◽

2021 ◽

Author(s):

Nilgün Yılmaz Demirci ◽

Asiye Uğraş Dikmen ◽

Cantürk Taşçı ◽

Deniz Doğan ◽

Yakup Arslan ◽

...

Keyword(s):

Computed Tomography ◽

Chest Computed Tomography ◽

Clinical Conditions

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