An estimated 10% of COVID-19 survivors continue to experience symptoms several weeks to months after the appearance of initial symptoms, a condition termed postacute sequelae of SARS-CoV-2 infection (PASC). These patients, also called "long-haulers," most commonly report protracted symptoms of fatigue, cough, dyspnea, chest tightness, diffi culty concentrating, arthralgia, olfactory dysfunction, and headache. While age, comorbid medical conditions, and COVID-19 severity are risk factors, young and previously healthy individuals with mild COVID-19 are also at risk. Recognition of symptoms, evaluation, supportive treatment, and attention to medical comorbidities are the cornerstones of medical management. KEY POINTSIf a patient has COVID-19 symptoms at 4 weeks, assess for pulmonary, cardiac, neurocognitive, and psychiatric complications.In patients with PASC, symptoms may persist for more than 60 days and as long as 6 months.Focus treatment on managing comorbidities, pulmonary rehabilitation, and continued follow-up.
The statements and opinions expressed in COVID-19 Curbside Consults are based on experience and the available literature as of the date posted. While we try to regularly update this content, any offered recommendations cannot be substituted for the clinical judgment of clinicians caring for individual patients.
Background Among the diverse causes of anterior mediastinal masses, thymolipoma is not a common entity. It largely comprises of adipose tissue and remnants of thymus tissue. Most patients are asymptomatic and are diagnosed incidentally. Case Summary Sixty-six-year-old female presented to the Emergency Department with a week of worsening shortness of breath, palpitations, diarrhea, palpitations & over 30 kg of unintentional weight loss in the last 1 year. Her investigations were in line of thyrotoxicosis with other lab findings correlating to the disease. However, during investigations, a chest radiograph showed left lower zone opacity and on follow-up CT scan it was revealed to be a huge fatty mass comprising of soft tissues arising from the anterior mediastinum, pushing the left diaphragm inferiorly and the lower lobe of left lung was entirely collapsed. Conclusion Thymolipoma can occur as a single entity and patients are often clinically asymptomatic. Biopsy is the definitive diagnostic tool, but it can also be challenging, especially if adequate samples are not obtained. CT scan can play an important role in supporting the diagnosis, with findings of fat containing structure arising from the anterior mediastinum along with internal fat stranding & nodularity. Treatment is surgical with excision of the entire mass.
Plastic bronchitis is a rare, underdiagnosed and potentially fatal condition. It is characterised by the formation and expectoration of branching gelatinous plugs that assume the shape of the airways. These airway plugs differ from the allergic mucin that characterises allergic bronchopulmonary aspergillosis and mucoid impaction of the bronchi. Plastic bronchitis is most often encountered in the paediatric population following corrective cardiac surgery, such as the Fontan procedure. It also occurs in adults. Plastic bronchitis in adults is rare, heterogeneous in its aetiology, and can lead to respiratory distress or even life-threatening airway obstruction. Plastic bronchitis in adulthood should not be overlooked, particularly in patients with chronic inflammatory lung diseases. This review presents current understanding of the presentation, aetiology, pathogenesis, pathology and management of plastic bronchitis in adults.
Lung transplant has become definitive treatment for patients with several end-stage lung diseases. Since the first attempted lung transplantation in 1963, survival has significantly improved due to advancement in immunosuppression, organ procurement, ex-vivo lung perfusion, surgical techniques, prevention of chronic lung allograft dysfunction, and bridging to transplant using extra-corporeal membrane oxygenation. Despite a steady increase in number of lung transplantations each year, there is still a huge gap between demand and supply of organs available, and work continues to select recipients with potential for best outcomes. According to review of the literature, there are some rare primary diseases that may recur following transplantation. As the number of lung transplants increase, we continue to identify disease processes at highest risk for recurrence, thus shaping our future approaches. While the aim of lung transplantation is improving survival and quality of life, choosing the best recipients is crucial due to shortage of donated organs. Here we discuss the common disease processes that recur and highlight its impact on overall outcome following lung transplantation.
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