Lung cavitation in COVID-19 pneumonia

Black Fungus and beyond: COVID-19 associated infections

Globally, many hospitalized COVID-19 patients can experience an unexpected acute change in status, prompting rapid and expert clinical assessment. Superimposed infections can be a significant cause of clinical and radiologic deviations in this patient population, further worsening clinical outcome and muddling the differential diagnosis. As thrombotic, inflammatory, and medication-induced complications can also trigger an acute change in COVID-19 patient status, imaging early and often plays a vital role in distinguishing the cause of patient decline and monitoring patient outcome. While the common radiologic findings of COVID-19 infection are now widely reported, little is known about the clinical manifestations and imaging findings of superimposed infection. By discussing case studies of patients who developed bacterial, fungal, parasitic, and viral co-infections and identifying the most frequently reported imaging findings of superimposed infections, physicians will be more familiar with common infectious presentations and initiate a directed workup sooner. Ultimately, any abrupt changes in the expected COVID-19 imaging presentation, such as the presence of new consolidations or cavitation, should prompt further workup to exclude superimposed opportunistic infection.

Acinetobacter: A Rare Cause of Rapid Development of Cavitary Lung Lesion Following COVID-19 Infection

Cavitary lesions of the lungs are a very frequent picture found in clinical practices resulting from a wide range of pathological processes with variable duration of formation depending on infectious pathogens. Common organisms causing cavitary lesions are Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, typical and atypical Mycobacterium, and Aspergillus. Herein, we are presenting a case that developed cavitary lesions in both lungs colonizing Acinetobacter, a rare causative agent, within less than two months of a positive coronavirus disease 2019 (COVID-19) infection.

Severe COVID-19 Pneumonia and Genetic Susceptibility: A Case Report and Literature Review

Genetic susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) morbidity and mortality continues to evolve. This report presents a case of an apparently healthy male adult who developed severe coronavirus disease 2019 (COVID-19) and a study on relevant genetic mutations, namely, angiotensin-converting enzyme 2 (ACE2-rs4646994 I/D) gene, glutathione S-transferase (GST) M1 and T1 gene, and miR-423 rs6505162 C>A gene polymorphism. Results showed that the ACE-DD genotype of ACE2, (GSTM1+/+) (GSTT1−/−) genotype of GST gene, and CA genotype (heterozygosity) of miR-423 rs6505162 genes, which were found in the patient, could be independent risk factors of severe COVID-19, even without comorbidities. 

COVID-19 in Egypt after a year: the first and second pandemic waves from the radiological point of view; multi-center comparative study on 2000 patients

Background

One year has passed since the announcement of COVID-19 as a pandemic and two waves had already stricken Egypt. The authors witnessed several atypical radiological features through the second pandemic wave, either early at the active infective stage or delayed at the post-infectious convalescent period. They believed every radiologist should be familiar with these features. Therefore, they performed this comparative study on 2000 Egyptian patients using multi-slice computed tomography (MSCT) to highlight the radiological differences between the first and second pandemic waves and correlate them to the clinical status.

Results

This random multi-center comparative study was retrospectively conducted on 2000 COVID-19 Egyptian patients; 1000 patients were registered at the first pandemic wave from April 2020 till September 2020, while the other 1000 patients were registered at the second pandemic wave from October 2020 till March 2020. Follow up CT examinations were performed for 49 and 122 patients through the first and second pandemic waves respectively. MSCT examinations were carefully evaluated by four expert consulting radiologists who came to a consensus. Meanwhile, the correlation with the clinical outcome was performed by two consulting pulmonologists. During the second pandemic wave, the prevalence rate of the “crazy-paving” pattern had significantly increased by 1.3 times (P value = 0.002). Additionally, the prevalence rate of the “air-bubble” sign had significantly increased by 1.9 times (P value = 0.02). Similarly, the presence of enlarged mediastinal lymph nodes (> 1 cm in short-axis diameter) had significantly increased by 1.7 times (P value = 0.036). Furthermore, the prevalence rate of pericardial effusion had significantly increased by 2.5 times (P value = 0.003). The above-mentioned signs were correlated to increased clinical severity and higher rates of hospitalization. Unexpectedly, other atypical radiological signs were only encountered through the second pandemic wave, including bronchiectatic changes (2.5%), “head-cheese” pattern (0.8%), cavitation (0.5%), and “bulls-eye” sign (0.2%). The prevalence rate of post-COVID fibrosis had doubled through the second wave but not in a significant way (P value = 0.234). Secondary fungal infection was only encountered throughout the second pandemic wave in four patients. COVID-19 reinfection was encountered in a single patient only during the second pandemic wave.

Conclusion

After 1 year from the announcement of COVID-19 as a pandemic, the radiological presentation of COVID-19 patients showed some significant differences between its first and second waves.

Simultaneous Giant cavity pulmonary lesion and pneumothorax following COVID-19 pneumonia

Cavitary lung formation with spontaneous pneumothorax has been rarely reported as a complication of COVID-19 pneumonia. We report a rare case of a 38 years-old male patient affected by COVID-19 pneumonia, exceptionally complicated by a simultaneous giant cavity in the right upper lung and a small right pneumothorax in the right hemithorax. Whilst pneumothorax emphysema, giant bullae and pneumothorax with alveolar rupture are known to potentially develop in COVID-19 patients as a result of high-flow O2 support, the exact origin of the giant lung cavitation in our patient could be not confirmed. Cavitary lesions - featured by high mortality rate - are reportedly associated with lung infarctions and can be the aftermaths of pulmonary embolism, a rather common sequela of COVID-19 pneumonia. Radiological imaging is critical to support clinical decision making in the management of COVID-19 pneumonia, since not only it can visualize and stage the disease, but it can also detect and monitor the eventual onset of complications over time, even following patient discharge from hospital.

Chest CT performance and features of COVID-19 in the region of Abu Dhabi, UAE: a single institute study

Objective

We aim to investigate high-resolution CT features of COVID-19 infection in Abu Dhabi, UAE, and to compare the diagnostic performance of CT scan with RT-PCR test.

Methods

Data of consecutive patients who were suspected to have COVID-19 infection and presented to our hospital were collected from March 2, 2020, until April 12, 2020. All patients underwent RT-PCR test; out of which 53.8% had chest CT scan done. Using RT-PCR as a standard reference, the sensitivity and specificity of the CT scan were calculated. We also analyzed the most common imaging findings in patients with positive RT-PCR results.

Results

The typical HRCT findings were seen in 50 scans (65.8%) out of total positive ones; 44 (77.2%) with positive RT-PCR results and 6 (31.6%) with negative results. The peripheral disease distribution was seen in 86%, multilobe involvement in 70%, bilateral in 82%, and posterior in 82% of the 50 scans. The ground glass opacities were seen in 50/74 (89.3%) of the positive RT-PCR group. The recognized GGO patterns in these scans were: rounded 50%, linear 38%, and crazy-paving 24%. Using RT-PCR as a standard of reference, chest HRCT scan revealed a sensitivity of 68.8% and specificity of 70%.

Conclusion

The commonest HRCT findings in patients with COVID-19 pneumonia were peripheral, posterior, bilateral, multilobe rounded ground-glass opacities. The performance of HRCT scan can vary depending on multiple factors.

Spontaneous pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema in a patient with COVID-19

In this paper, we describe a case of COVID-19 pneumonia complicated by alveolar air leakage syndrome without prior positive pressure ventilation. Our patient was a 55-year-old nonsmoker male with a previous history of marginal B-cell lymphoma diagnosed ten years ago who presented to the emergency department with cough, dyspnea, and respiratory distress. The COVID-19 diagnosis was confirmed based on a polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The unenhanced chest computed tomography (CT) obtained on the first day of admission demonstrated bilateral multifocal ground-glass opacities and consolidation, extensive pneumomediastinum, bilateral pneumothorax, a rim of pneumopericardium, and right-sided subcutaneous emphysema. Despite the initiation of supportive care, antiviral and antibiotic therapy, he passed away due to septic shock. In conclusion, spontaneous alveolar air leakage, characterized by spontaneous pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema, is a rare complication of COVID-19, which may be linked with a severe course of the disease.