INTRODUCTION: In recent years we have observed various consequences of systemic hyperinflammation associated with COVID-19, including pericardium and pleura involvement. From 2020 to 2022 an increase in the incidence of effusion into the pleural and pericardial cavities was noted in the numerous of breast MRI studies, which could potentially be associated with the COVID-19 pandemic.OBJECTIVE: To objectify this impression a comparative study was planned, which aimed to analyze the occurrence of pleural and pericardial effusion in groups of patients in 2022 compared with a matched group in 2019 and to describe the structures of the identified changes.MATERIALS AND METHODS: Тhe database of breast MRI studies during 2019 and 2022 was processed, data from 220 women were selected, indicating as a complaint for breast pain at a mammologist’s appointment and COVID-19 transferred in the group 2022. The telephone questionnaire of the 2022nd year patients were conducted about the presence of common symptoms of inflammation. Statistic: Statistical analysis was carried out using the program Statistica 13.5.0.17 TIBCO Inc. Quantitative parameters are presented as median, 5th-95th percentiles. A 2-tailed t-test was used to compare quantitative parameters. Binary data correlations were carried out using a contingency table. RESULTS: Age included 46 [33–66] years old. MRI was performed 105 [21–198] days after COVID-19. In the 2022 group, at the time of survey, 36% had general inflammatory symptoms in addition to chest pain. In 2022 vs 2019 increase the chance of encountering a pleural effusion (OR 5 [3–8]), the volume of effusion (5 [2–11] mm vs 2 [2–5] mm), incidence of pericardial (OR 31 [11–89]) and combined effusion (OR 11 [4–28]). The detection and the size of effusion of any localization didn’t correlate with age. Patients with breast implants during the pandemic years turned to a mammologist after 29 [8–44] months, before the pandemic — after 40 [19–56] months after surgery and tended to more frequent detection of effusion of all localizations and an increase in the volume of seromas. In the majority of MRI protocols, the effusion was not described.DISCUSSION: Our study will help to increase the doctors literacy about the frequency and manifestations of serositis associated with COVID-19 in a group of young, non-comorbid women who had a mild infection on an outpatient basis. The barriers to describing a small effusion on an MRI are its probability in physiological conditions, the absence of specific symptoms at the patient and none request from the attending physician. Considering the possibility that effusion into serous cavities may be a sign of pathology that led to chest pain will allow diagnosticians to describe it even with a small amount and will give the attending physician a support for a differential diagnosis. Findings in patients with breast implants confirm the connection of changes with an infectious trigger, and that there is some initial tension of the immune system, which, with additional external provocation, results in a brighter response.CONCLUSIONS: Effusion into the pleural cavity or pericardium is a common finding in patients who have undergone COVID19, which may reflect systemic inflammatory syndrome and cause chest pain.
During the pandemic COVID-19, there has been an increase in the number of patients with non-anginal chest pain at cardiologist appointments.Objective. To assess the incidence of signs of pleurisy and pericarditis after COVID-19 in non-comorbid patients with atypical chest pain and describe their characteristics according to echocardiography and magnetic resonance imaging.Materials and methods. From February 2021 to January 2022, 200 outpatients were prospectively enrolled in the study, all of them suffered from a discomfort in the heart region for the first time after SARS-CoV-2 infection. Inclusion criteria: 18–50 years old, 5–12 weeks after SARS-CoV-2 infection, non-anginal chest pain. Exclusion criteria: pneumonia or signs of pulmonary thromboembolism, coronary heart disease, congestive heart failure or kidney disease, clinical or laboratory signs of myocarditis, oncopathology, radiation or chemotherapy of the chest in past medical history. A survey was conducted (yes/no) for the presence of general malaise, quality of life deterioration, hyperthermia, cough. Ultrasound examination of the pericardium and pleura to detect effusion or postinflammatory changes was performed in accordance with the recommendations. Magnetic resonance imaging was performed if ultrasound imaging was poor or there was no evidence of pericardial or pleural involvement in patients with typical symptoms.Results. 82 women and 118 men were included. Median of age 39 [28–46] years old. Pericarditis was diagnosed in 152 (76%) patients, including effusive pericarditis in 119 (78%), myocarditis in 6 (3%) and myopericarditisin 49 (25%) patients, pleurisy was detected in 22 (11%) patients, exudative pleurisy – in 11 (5.5%) patients with a predominant unilateral lesion of the mediastinal-diaphragmatic region adjacent to the heart. Hyperthermia was recorded in 2.5% of cases, general malaise – in 60% and a decrease in the quality of life – in 84%.Conclusion. Serositis as a cause of atypical chest pain among young non-comorbid patients in early postCOVID was identified in 87% of patients. In the coming years, it is probably worthwhile to perform ultrasound of the pericardium and pleura in all patients with chest pain.
Viruses are the most common etiological agents of myocardium inflammation. Today the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV-2) causes a high incidence of myocarditis and pericarditis. As a hypothetical scenario, we present a clinical case of a patient who underwent viral myocarditis on the background of SARS in 2004, with recurrent myocarditis in ARVI, the last of which was initiated by SARS-CoV-2. A 61-year-old male patient, in 2004 contacted a representative of the People's Republic of China and after 4 days felt the symptoms of ARVI. Before the viral disease, he had excellent health, the absence of cardiovascular diseases and pathological heredity. Fever 38–39 °C, myalgia, headache, general malaise, dry obsessive cough persisted for a week. After the addition of shortness of breath, he was hospitalized. According to the data of X-ray and computed tomography, infiltrates of the lungs of both of the "frosted glass" type were revealed. According to the clinic and laboratory data, a diagnosis of severe “atypical viral pneumonia” was made, and a diagnosis of viral myocarditis was suggested. Echocardiography showed a decrease in the left ventricular ejection fraction up to 50% for the first time, without signs of coronary heart disease based on the results of further examination. Dry cough disturbed in the next 4 months, LVEF 48–50% and 1 functional class of heart failure persisted for 10 years. The patient had a flu with mild respiratory symptoms in 2015, but it triggered a recurrence of myocarditis. The examination revealed a decrease in LVEF up to 35%, the progression of dilatation of the heart cavities also without signs of coronary heart disease according to the results of the treadmill test and coronary angiography. Post-inflammatory cardiopathy progressed relatively quickly during the year. The minimum LVEF was 23%; a cardioverter-defibrillator was implanted for secondary indications; radiofrequency ablation of fascicular tachycardia was performed. It was followed by another period of stabilization: 2 functional class of heart failure, ICD shocks did not occur. The patient underwent COVID-19 with minimal respiratory symptoms in March 2021. It provoked another recurrence of myocarditis, diagnosed with an increase in troponin, cerebral natriuretic peptide, CRP, ESR and increasing heart failure during 3 months. Persistent paroxysms of atrial fibrillation with a decrease of LVEF 15% and anasarсa. A successful radiofrequency isolation of the pulmonary vein was performed in 2021. By November 2021, in the absence of paroxysms, it was possible to achieve compensation for heart failure up to class 1 according to Vasilenko–Strazhesko and NYHA, LVEF 28%.In order to understand the recurrent nature of myocarditis against the background of various respiratory viral infections, an analysis of the literature was carried out, including the described cases of myocardial inflammation against the background of the predecessors of the SARS-CoV-2 strain: SARS-CoV-1 and MERS. We also reviewed the data on the diagnosis of viral myocarditis in the realities of this pandemic. It reveals a large heterogeneity of signs of inflammation of the heart muscle according to different diagnostic methods and large interobserver variability, and challenges us about the need to revise the criteria for myocarditis in the case of COVID-19.
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