Barotrauma in COVID-19 Patients

Clinical manifestations of COVID 19 is still unknown. We performed this study to determine the occurrence of pulmonary barotrauma as a complication of this disease. In this retrospective study, a total of 955 COVID 19 patients with respiratory insufficiency requiring oxygen support or invasive ventilation admitted to ICU of Sina Hospital from 20 March 2020 to 9 June 2021, were included and their chest imaging reviewed. Here, we report results of chest imaging of first 92 patients of this group. Barotrauma (pneumothorax, pneumomediastinum, pneumopericardium) occurred in 11 (11.9%) of 92 patients with coronavirus disease 2019 (COVID-19) infection requiring ICU admission for respiratory support and monitoring. It seems barotrauma is a common complication of COVID 19 disease. The role of increased respiratory efforts, patient or ventilation induced lung injury, viral and host response should be assessed. It needs to consider the occurrence of barotrauma in Patients with COVID-19, before expansion of dead space for treatment and limiting the ventilation effects.

Tuberculosis of the Rare Azygos Lobe of Lung

Background: The azygos lobe is a rare anatomical variant seen in the upper lobe of right lung. It occurs during embryological development due to the failure of posterior cardinal vein to migrate supero-medially. It is often an incidental finding on imaging and is asymptomatic in majority of cases. Tuberculosis involving the azygos lobe is extremely rare. Only a few cases of tuberculosis involving the azygos lobe have been reported in literature.Case presentation: We present a rare case report of tuberculosis infection involving the azygos lobe in a 57-year-old Indian male with history of chronic cough, fever, haemoptysis and weight loss.Conclusions: The azygos lobe is usually asymptomatic, but it may be misdiagnosed as bulla, lung cyst or abscess. In rare cases it may be associated with certain pathology such as tuberculosis, other infections, and lung cancer. Hence, it is pertinent for a radiologist to be aware of this variant when reporting chest imaging cases.

A Systematic Review of Persistent Symptoms and Residual Abnormal Functioning following Acute COVID-19: Ongoing Symptomatic Phase vs. Post-COVID-19 Syndrome

Objective: To compare the two phases of long COVID, namely ongoing symptomatic COVID-19 (OSC; signs and symptoms from 4 to 12 weeks from initial infection) and post-COVID-19 syndrome (PCS; signs and symptoms beyond 12 weeks) with respect to symptomatology, abnormal functioning, psychological burden, and quality of life. Design: Systematic review. Data Sources: Electronic search of EMBASE, MEDLINE, ProQuest Coronavirus Research Database, LitCOVID, and Google Scholar between January and April 2021, and manual search for relevant citations from review articles. Eligibility Criteria: Cross-sectional studies, cohort studies, randomised control trials, and case-control studies with participant data concerning long COVID symptomatology or abnormal functioning. Data Extraction: Studies were screened and assessed for risk of bias by two independent reviewers, with conflicts resolved with a third reviewer. The AXIS tool was utilised to appraise the quality of the evidence. Data were extracted and collated using a data extraction tool in Microsoft Excel. Results: Of the 1145 studies screened, 39 were included, all describing adult cohorts with long COVID and sample sizes ranging from 32 to 1733. Studies included data pertaining to symptomatology, pulmonary functioning, chest imaging, cognitive functioning, psychological disorder, and/or quality of life. Fatigue presented as the most prevalent symptom during both OSC and PCS at 43% and 44%, respectively. Sleep disorder (36%; 33%), dyspnoea (31%; 40%), and cough (26%; 22%) followed in prevalence. Abnormal spirometry (FEV1 < 80% predicted) was observed in 15% and 11%, and abnormal chest imaging was observed in 34% and 28%, respectively. Cognitive impairments were also evident (20%; 15%), as well as anxiety (28%; 34%) and depression (25%; 32%). Decreased quality of life was reported by 40% in those with OSC and 57% with PCS. Conclusions: The prevalence of OSC and PCS were highly variable. Reported symptoms covered a wide range of body systems, with a general overlap in frequencies between the two phases. However, abnormalities in lung function and imaging seemed to be more common in OSC, whilst anxiety, depression, and poor quality of life seemed more frequent in PCS. In general, the quality of the evidence was moderate and further research is needed to understand longitudinal symptomatology trajectories in long COVID. Systematic Review Registration: Registered with PROSPERO with ID #CRD42021247846.

Chest Imaging in the Diagnosis and Management of Pulmonary Tuberculosis: The Complementary Role of Thoraci Ultrasound

Tuberculosis (TB) is a severe infectious disease that still represents a major cause of mortality and morbidity worldwide. For these reasons, clinicians and radiologists should use all the available diagnostic tools in the assessment of the disease in order to provide precise indications about starting an anti-tubercular treatment and reduce risk of TB transmission and complications especially in developing countries where the disease is still endemic. As TB mycobacteria are mainly transmitted through respiratory droplets, the pulmonary parenchyma is usually the first site of infection. As a result, chest imaging plays a central role in the diagnostic process. Thoracic ultrasound (TUS) is a portable, non-invasive, radiation-free, and cost-contained technology which could be easily available in resource-limited settings. This perspective article focuses on the potential role of TUS in the diagnosis and management of patients with pulmonary TB. Unfortunately, there are still insufficient evidence and too contrasting data to judge TUS as an appropriate diagnostic method for the screening of the disease. Despite this, TUS may have a useful role in identifying pleural and anterior pericardial effusions or in the identification of abscesses of the anterior chest wall and paraspinal collections in low- and middle-income settings. In addition, TUS seems to have a milestone role in guiding minimally invasive interventional procedures, such as placement of chest tubes, drainage of loculated collections, thoracentesis and pericardiocentesis, and percutaneous biopsy of subpleural pulmonary consolidations or pleural plaques.

Spectral Photon-Counting CT Technology in Chest Imaging

The X-ray imaging field is currently undergoing a period of rapid technological innovation in diagnostic imaging equipment. An important recent development is the advent of new X-ray detectors, i.e., photon-counting detectors (PCD), which have been introduced in recent clinical prototype systems, called PCD computed tomography (PCD-CT) or photon-counting CT (PCCT) or spectral photon-counting CT (SPCCT) systems. PCD allows a pixel up to 200 microns pixels at iso-center, which is much smaller than that can be obtained with conventional energy integrating detectors (EID). PCDs have also a higher dose efficiency than EID mainly because of electronic noise suppression. In addition, the energy-resolving capabilities of these detectors allow generating spectral basis imaging, such as the mono-energetic images or the water/iodine material images as well as the K-edge imaging of a contrast agent based on atoms of high atomic number. In recent years, studies have therefore been conducted to determine the potential of PCD-CT as an alternative to conventional CT for chest imaging.

CLINICAL CHARACTERISTICS AND SHORT-TERM OUTCOMES IN COVID-19 POSITIVE PATIENTS REQUIRING HEMODIALYSIS AT A TERTIARY HOSPITAL IN A DEVELOPING COUNTRY

Background: The presence of comorbidities and relative immunosuppression in chronic kidney disease patients on hemodialysis raises concerns that these patients may have an increased risk of severe COVID-19. We aimed to examine the presentation and in-hospital outcomes of COVID-19 patients with end stage renal disease requiring hemodialysis. Methods:To examine presentation and in-hospital outcomes of COVID-19 in patients with end stage renal disease requiring hemodialysis. The study was conducted in a tertiary care centre from June 2020 to December 2020. We collected clinical & laboratory data of 126 COVID-19 positive in-patients requiring hemodialysis. CKD patients referred to our centre for hemodialysis patients were also included. Patients requiring invasive ventilation and management in intensive care units were excluded. Patients were categorised into two groups based on their outcomes; survivors and non-survivors. Detailed history & biochemistry results were recorded and analysed using SPSS 20.0. Results: A total of 126 patients were included in our study, with male predominance, n=91(72.2%). The median age of our study population was 53 years. The main presenting complaints were fever, n=78(61.9%); cough, n=69(54.8%), dyspnea, n= 62(49.2%), fatigue, n=102(81%) and myalgia, n=51(40.5%). Eighty nine(70.6%) patients were hypertensives, 48 (38.1%) known diabetics and 13 (10.3%) had pre-existing chronic obstructive pulmonary disease. Lung involvement in CT imaging at the time of admission, were found in 93(85.5%) patients. On comparison between survivor and non-survivors, there was no statistical difference in the biochemical prole, however there was signicant chest imaging ndings (p<0.001) and requirement of ventilator (p<0.001) in the non-survivor group. Conclusion: In our study, mortality was high in patients showing chest imaging ndings and also in those requiring non-invasive ventilation even in non-intensive care setting, at admission. The high mortality in CKD patients on hemodialysis emphasizes the need of dedicated COVID hemodialysis units,to prevent interruption in routine outpatient stable dialysis patients.