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Hiremath A, Viswanathan VS, Bera K, Shiradkar R, Yuan L, Armitage K, Gilkeson R, Ji M, Fu P, Gupta A, Lu C, Madabhushi A. Deep learning reveals lung shape differences on baseline chest CT between mild and severe COVID-19: A multi-site retrospective study. Comput Biol Med 2024; 177:108643. [PMID: 38815485 DOI: 10.1016/j.compbiomed.2024.108643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/10/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
Severe COVID-19 can lead to extensive lung disease causing lung architectural distortion. In this study we employed machine learning and statistical atlas-based approaches to explore possible changes in lung shape among COVID-19 patients and evaluated whether the extent of these changes was associated with COVID-19 severity. On a large multi-institutional dataset (N = 3443), three different populations were defined; a) healthy (no COVID-19), b) mild COVID-19 (no ventilator required), c) severe COVID-19 (ventilator required), and the presence of lung shape differences between them were explored using baseline chest CT. Significant lung shape differences were observed along mediastinal surfaces of the lungs across all severity of COVID-19 disease. Additionally, differences were seen on basal surfaces of the lung when compared between healthy and severe COVID-19 patients. Finally, an AI model (a 3D residual convolutional network) characterizing these shape differences coupled with lung infiltrates (ground-glass opacities and consolidation regions) was found to be associated with COVID-19 severity.
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Affiliation(s)
- Amogh Hiremath
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, OH, USA; Picture Health, Cleveland, OH, USA
| | | | - Kaustav Bera
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
| | | | - Lei Yuan
- Renmin Hospital of Wuhan University, Department of Information Center, Wuhan, Hubei, China
| | - Keith Armitage
- University Hospitals Cleveland Medical Center, Department of Infectious Diseases, Cleveland, OH, USA
| | - Robert Gilkeson
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
| | - Mengyao Ji
- Renmin Hospital of Wuhan University, Department of Gastroenterology, Wuhan, Hubei, China
| | - Pingfu Fu
- Case Western Reserve University, Department of Population and Quantitative Health Sciences, Cleveland, OH, USA
| | - Amit Gupta
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
| | - Cheng Lu
- Guangdong Provincial People's Hospital, Department of Radiology, Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Provincial People's Hospital, Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Provincial People's Hospital, Medical Research Center, Guangdong Academy of Medical Sciences, China
| | - Anant Madabhushi
- Georgia Institute of Technology and Emory University, Radiology and Imaging Sciences, Biomedical Informatics (BMI) and Pathology, GA, USA; Atlanta Veterans Administration Medical Center, GA, USA.
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Aghajanzadeh M, Alavi Foumani A, Tangestaninejad A, Haghighi M, Pourahmadi Y, Jafroudi EH, Mousazadeh M, Asli RH. Spontaneous tension pneumomediastinum with pneumothorax and subcutaneous emphysema as a complication of COVID-19 disease. Clin Case Rep 2023; 11:e7570. [PMID: 37434962 PMCID: PMC10332258 DOI: 10.1002/ccr3.7570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
Recently spontaneous tension pneumomediastinum (STM), were reported as infrequent complications in coronavirus disease 2019 (COVID-19) patients but pneumothorax (PT), and subcutaneous emphysema (SE) are more frequently seen in COVID-19 patients. PT and SE may present after PTM in COVID-19. The aim of this presentation is to show the complications of STM in an Iranian patients with COVID-19 disease with PT and SE, who were hospitalized in Arya hospital, Rasht, Iran. For 3 months, we followed these patients and their condition was good. STM are uncommon complications in COVID-19 patients and were reported frequently in male patients. Early diagnosis and treatment could save the patients as these complications are related to poor prognosis and prolonged hospitalization. Patients with mild COVID-19 and mild pulmonary damage may have a favorable outcome.
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Affiliation(s)
| | - Ali Alavi Foumani
- Department of PulmonologyGuilan University of Medical SciencesRashtIran
| | | | - Mohammad Haghighi
- Department of AnesthesiologyGuilan University of Medical SciencesRashtIran
| | - Yousha Pourahmadi
- Department of Thoracic SurgeryGuilan University of Medical SciencesRashtIran
| | | | - Mahsa Mousazadeh
- Department of Internal Medicine, Inflammatory Lung Diseases Research CenterGuilan University of Medical SciencesRashtIran
| | - Rastin Hosseinzadeh Asli
- Department of Internal Medicine, Inflammatory Lung Diseases Research CenterGuilan University of Medical SciencesRashtIran
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Thuan PQ, Phuong PPP, Anh HPN, Long LP, Khoi LM. Surgical treatment of tension pneumomediastinum in patients with covid-19 at the field hospital: a case series. J Cardiothorac Surg 2022; 17:202. [PMID: 36002853 PMCID: PMC9399585 DOI: 10.1186/s13019-022-01966-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tension pneumomediastinum is one of the most serious complications in COVID-19 patients with respiratory distress requiring invasive mechanical ventilation. This complication can lead to rapid hemodynamic instability and death if it is not recognized in a timely manner and intervenes promptly. CASE PRESENTATION We reported 7 COVID-19 patients with tension pneumomediastinum at a field hospital. All patients were critically ill with ARDS. These 7 patients, including 3 females and 4 males in this series, were aged between 39 and 70 years. Tension pneumomediastinum occurred on the first day of mechanical ventilation in 3 patients and later in the course of hospital stay, even 10 days after being intubated and ventilated. The tension pneumomediastinum caused hemodynamic instability and worsened respiratory mechanics with imminent cardiopulmonary collapse. In this series, we used two surgical techniques: (i) mediastinal decompression by suprasternal drainage with or without simultaneous pleural drainage in the first two cases and (ii) mediastinal drainage via suprasternal and subxiphoid incisions in 5 patients. The surgical procedures were feasible and reversed the pending cardiopulmonary collapse. Four patients had a favorable postprocedural period and were discharged from the intensive care center. Both patients undergoing suprasternal drainage died of failed/recurrent tension pneumomediastinum and nosocomial infection. Only one in five patients who underwent mediastinal drainage via suprasternal and subxiphoid incisions died of septic shock secondary to ventilator-associated pneumonia. CONCLUSION Tension pneumomediastinum was a life-threatening complication in critically ill COVID-19 patients requiring mechanical ventilation. Surgical mediastinal decompression was the salvage procedure. The surgical technique of mediastinal drainage via suprasternal and subxiphoid incisions proved an advantage in tension relief, hemodynamic improvement and mortality reduction.
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Affiliation(s)
- Phan Quang Thuan
- COVID-19 Intensive Care Center, University Medical Center, Ho Chi Minh City, Vietnam.,Department of Cardiovascular Surgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Pham Phan Phuong Phuong
- COVID-19 Intensive Care Center, University Medical Center, Ho Chi Minh City, Vietnam.,Department of Critical Care Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Le Phi Long
- Department of Thoracic and Vascular Surgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Le Minh Khoi
- COVID-19 Intensive Care Center, University Medical Center, Ho Chi Minh City, Vietnam. .,Department of Critical Care Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
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