Persistent interstitial lung abnormalities in post-COVID-19 patients: a case series

Lago, Vanessa Carvalho do; Prudente, Robson; Luzia, Dayane Araujo; Franco3, Estefânia Thomé; Cezare, Talita Jacon; Peralta, Amanda; Ferreira, Eloara Vieira Machado; Albuquerque, André Luís Pereira de; Okoshi, Marina Politi; Baldi, Bruno Guedes; Tanni, Suzana Erico

doi:10.1590/1678-9199-jvatitd-2020-0157

Cited by 10 publications

(8 citation statements)

References 23 publications

(28 reference statements)

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“…A total of 70 studies were included in the quantitative synthesis (figure 1). Among the manuscripts included, 60 reported infections by SARS-CoV-24 24–83; 18 by SARS-CoV13 14 84–100; 1 by MERS-CoV101; 16 by Influenza (11 subtype H1N1, 1 subtype H5N1, 1 subtype H3N2, 2 subtype H7N9 and 1 study both H1N1 and H7N9) 102–117. All studies were observational in design, with the exception of a single randomised control trial 97.…”

Section: Resultsmentioning

confidence: 99%

Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: a systematic review and meta-analysis

Fabbri

Moss

Khan

et al. 2022

Thorax

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IntroductionPersisting respiratory symptoms in COVID-19 survivors may be related to development of pulmonary fibrosis. We assessed the proportion of chest CT scans and pulmonary function tests consistent with parenchymal lung disease in the follow-up of people hospitalised with COVID-19 and viral pneumonitis.MethodsSystematic review and random effects meta-analysis of proportions using studies of adults hospitalised with SARS-CoV-2, SARS-CoV, MERS-CoV or influenza pneumonia and followed up within 12 months. Searches performed in MEDLINE and Embase. Primary outcomes were proportion of radiological sequelae on CT scans; restrictive impairment; impaired gas transfer. Heterogeneity was explored in meta-regression.ResultsNinety-five studies (98.9% observational) were included in qualitative synthesis, 70 were suitable for meta-analysis including 60 SARS-CoV-2 studies with a median follow-up of 3 months. In SARS-CoV-2, the overall estimated proportion of inflammatory sequelae was 50% during follow-up (0.50; 95% CI 0.41 to 0.58; I2=95%), fibrotic sequelae were estimated in 29% (0.29; 95% CI 0.22 to 0.37; I2=94.1%). Follow-up time was significantly associated with estimates of inflammatory sequelae (−0.036; 95% CI −0.068 to –0.004; p=0.029), associations with fibrotic sequelae did not reach significance (−0.021; 95% CI −0.051 to 0.009; p=0.176). Impaired gas transfer was estimated at 38% of lung function tests (0.38 95% CI 0.32 to 0.44; I2=92.1%), which was greater than restrictive impairment (0.17; 95% CI 0.13 to 0.23; I2=92.5%), neither were associated with follow-up time (p=0.207; p=0.864).DiscussionSequelae consistent with parenchymal lung disease were observed following COVID-19 and other viral pneumonitis. Estimates should be interpreted with caution due to high heterogeneity, differences in study casemix and initial severity.PROSPERO registration numberCRD42020183139.

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Section: Resultsmentioning

confidence: 99%

Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: a systematic review and meta-analysis

Fabbri

Moss

Khan

et al. 2022

Thorax

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“…Frequency of lung imaging abnormalities per different evaluation setting. References [ 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ] are cited in the Supplementary Materials…”

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confidence: 99%

A Systematic Review of Chest Imaging Findings in Long COVID Patients

Bazdar

Kwee

Houweling

et al. 2023

JPM

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Long COVID is the persistence of one or more COVID-19 symptoms after the initial viral infection, and there is evidence supporting its association with lung damage. In this systematic review, we provide an overview of lung imaging and its findings in long COVID patients. A PubMed search was performed on 29 September 2021, for English language studies in which lung imaging was performed in adults suffering from long COVID. Two independent researchers extracted the data. Our search identified 3130 articles, of which 31, representing the imaging findings of 342 long COVID patients, were retained. The most common imaging modality used was computed tomography (CT) (N = 249). A total of 29 different imaging findings were reported, which were broadly categorized into interstitial (fibrotic), pleural, airway, and other parenchymal abnormalities. A direct comparison between cases, in terms of residual lesions, was available for 148 patients, of whom 66 (44.6%) had normal CT findings. Although respiratory symptoms belong to the most common symptoms in long COVID patients, this is not necessarily linked to radiologically detectable lung damage. Therefore, more research is needed on the role of the various types of lung (and other organ) damage which may or may not occur in long COVID.

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“…3 Acute pulmonary complications of this respiratory virus include viral pneumonia, acute respiratory distress syndrome (ARDS), pulmonary embolism whereas long term complications include but not limited to persistent interstitial abnormalities, bronchiectasis and pulmonary fibrosis. [4][5][6][7][8] Follow-up data from other studies report persistent physiological and parenchymal abnormalities, especially in hospitalized patients with severe initial SARS-CoV-2 infection. [9][10][11] However, there are only limited number of studies reporting evidence of functional small airway disease (fSAD) after SARS-CoV-2 infection.…”

Section: Introductionmentioning

confidence: 95%

Small Airway Disease as long-term Sequela of COVID-19: Use of Expiratory CT despite Improvement in Pulmonary Function test

Garg

Nagpal

Goyal

et al. 2021

Preprint

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BackgroundIt is important to understand the spectrum of pulmonary diseases that patients are presenting after recovery from initial SARS-CoV-2 infection. We aim to study small airway disease and changes in Computed Tomography (CT)and pulmonary function tests (PFTs) with time.MethodsThis is retrospective observation study including adult patients with confirmed SARS-CoV-2 infection with at-least two CT scans either during acute (defined as <1 month) or subacute (1-3 months) or chronic (>3months) phase after positive test. Radiological features and follow up PFTs were obtained.Results22 patients met the inclusion criteria with mean age 57.6 years (range 36-83). Out of these,18 (81.81%) were hospitalized. Mean duration of diagnosis to CT and PFT was 192.68(112-385) days and 161.54(31-259) days respectively. On PFTs, restrictive pulmonary physiology was predominant finding during subacute 56.25% (9/16) and chronic phases 47% (7/15). PFTs improved significantly with time {FEV1((p=0.0361), FVC (p=0.0341), FEF 25%-75% (p=0.0259) and DLCO (p=0.0019)}, but there was persistent air trapping in the expiratory chronic phase CT. There was resolution of ground glass opacity, consolidation, and bronchiectasis however air trapping increased with time in 41.61% (10/21) of subacute CTs compared to 81.25% (13/16) in chronic CTs.ConclusionOur study shows evidence of airway as well as parenchymal disease as relatively long-term sequel of SARS-CoV-2 infection. It also highlights the natural course and spontaneous recovery of some radiological and pulmonary function test abnormalities over time with evidence of persistent small airway disease (air trapping) on expiratory CT imaging months after infection.HighlightsLong term pulmonary complication of SARS-CoV-2 infection include small airway diseaseThere is role of inspiratory and expiratory Computed tomography (CT) scan to identify air trapping in patients with persistent respiratory symptoms after SARS-CoV-2 infectionNormal spirometry and normal routine CT may not be sufficient to characterize and identify cause of persistent respiratory complains in patients after COVID-19This study highlights persistent parenchymal and physiological airway abnormalities more than six months after recovery from initial SARS-CoV-2 infection

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Persistent interstitial lung abnormalities in post-COVID-19 patients: a case series

Cited by 10 publications

References 23 publications

Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: a systematic review and meta-analysis

Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: a systematic review and meta-analysis

A Systematic Review of Chest Imaging Findings in Long COVID Patients

Small Airway Disease as long-term Sequela of COVID-19: Use of Expiratory CT despite Improvement in Pulmonary Function test

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