Several studies have been published in the past few months describing the CT features of Coronavirus Disease 2019 (COVID-19). There is a great degree of heterogeneity in the study designs, lesion descriptors used and conclusions derived. In our systematic analysis and meta-review, we have attempted to homogenize the reported features and provide a comprehensive view of the disease pattern and progression in different clinical stages. After an extensive literature search, we short-listed and reviewed 49 studies including over 4145 patients with 3615 RT-PCR positive cases of COVID-19 disease. We have found that there is a good agreement among these studies that diffuse bilateral ground-glass opacities (GGOs) is the most common finding at all stages of the disease followed by consolidations and mixed density lesions. 78% of patients with RT-PCR confirmed COVID-19 infections had either ground-glass opacities, consolidation or both. Inter-lobular septal thickening was also found to be a common feature in many patients in advanced stages. The progression of these initial patchy ground-glass opacities and consolidations to diffuse lesions with septal thickening, air bronchograms in the advanced stages, to either diffuse white-out lungs needing ICU admissions or finally resolving completely without or with residual fibrotic strips was also found to be congruent among multiple studies. Prominent juxta-lesional pulmonary vessels, pleural effusion and lymphadenopathy in RT-PCR proven cases were found to have poor clinical prognosis. Additionally, we noted wide variation in terminology used to describe lesions across studies and suggest the use of standardized lexicons to describe findings related to diseases of vital importance.

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This technique reduces cupping and does not make the ear as prominent as it may do after a conventional wedge resection and results in high patient satisfaction.

Wound complications in patients with significant co-morbidities is common; however, in our patient the problem was compounded by the inappropriate placement of negative pressure dressing. A 90-year-old woman was referred to the plastic surgery outpatients clinic with a 3-month history of a non-healing sacral wound following an abdominoperineal resection for a low rectal carcinoma. Following two months of medical optimisation and negative pressure therapy (NPT) with limited success, definitive coverage was attempted with a hemirotational cutaneous flap. Seven days postoperatively the wound edges became dusky around the pressure areas and a small wound dehiscence measuring about 5cm x 4cm appeared. NPT was reapplied. When the dressing was changed, an extensive area of pressure necrosis was observed underneath the site of the rigid NPT tubing (Fig 1). As a result, this area required a more extensive debridement. Over the next year the wound improved slowly with conservative measures. Nevertheless, the misapplication of NPT has prolonged the healing time significantly. discussion For as long as the specialty of medicine has existed, doctors have struggled with chronic wounds. Ann R Coll Surg Engl1 The relative risk of dying is significantly higher for nursing home patients with pressure ulcers than those without.2 Lower extremity ulceration alone is estimated to cost the National Health Service £400 million per year.3 NPT has been proved to be effective in the treatment of acute and chronic wounds. 4 As the population ages and the general health declines, the number of chronic wounds will rise.Chronic wound complications such as this are common. 5However, in our patient the problem was compounded by the tubing from the NPT, which had caused further wound necrosis, thus necessitating a more excessive debridement and coverage. As NPT is the first line of treatment for many chronic wounds, this case serves as a reminder that negative pressure dressing must be used correctly as inappropriate placement can lead to worsening wound breakdown. It should also be noted that this problem is not only found with NPT tubing. Catheters, drains and even monitors (if incorrectly positioned) can increase pressure, worsening wound healing in what is a frail population.Alternatives include the use of flat/soft tubing, ensuring the tubing is padded (with dressing or foam) and, most importantly, ensuring adequate training for bridging procedures for all those involved in negative pressure treatment.

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