2019-novel Coronavirus severe adult respiratory distress syndrome in two cases in Italy: An uncommon radiological presentation

Abstract

Introduction: Several recent case reports have described common early chest imaging findings of lung pathology caused by 2019 novel Coronavirus (SARS-COV2) which appear to be similar to those seen previously in SARS-CoV and MERS-CoV infected patients. Objective: We present some remarkable imaging findings of the first two patients identified in Italy with COVID-19 infection travelling from Wuhan, China. The follow-up with chest X-Rays and CT scans was also included, showing a progressive adult respiratory distress syndrome (ARDS). Results: Moderate to severe progression of the lung infiltrates, with increasing percentage of high-density infiltrates sustained by a bilateral and multi-segmental extension of lung opacities, were seen. During the follow-up, apart from pleural effusions, a tubular and enlarged appearance of pulmonary vessels with a sudden caliber reduction was seen, mainly found in the dichotomic tracts, where the center of a new insurgent pulmonary lesion was seen. It could be an early alert radiological sign to predict initial lung deterioration. Another uncommon element was the presence of mediastinal lymphadenopathy with short-axis oval nodes. Conclusions: Although only two patients have been studied, these findings are consistent with the radiological pattern described in literature. Finally, the pulmonary vessels enlargement in areas where new lung infiltrates develop in the follow-up CT scan, could describe an early predictor radiological sign of lung impairment.

Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands

“…The typical CT pattern of COVID-19 pneumonia in Rome, Italy was characterized by the consistent presence of peripheral ground glass opacities associated with multi-lobar and posterior involvement, bilateral distribution, and subsegmental vessel enlargement ( Figure 2). Vessel enlargement was described in the vicinity of areas with GGO, which is compatible with thrombo-inflammatory processes (35)(36)(37)(38)(39)(40). Subsegmental vascular enlargement (more than 3 mm diameter) in areas of lung opacity was observed in 89% of patients with confirmed COVID-19 pneumonia.…”

Extracellular superoxide dismutase, a molecular transducer of health benefits of exercise

“…These findings strongly support that enhanced EcSOD expression from skeletal muscle or other tissues/organ, which can be redistributed to the lung tissue, could be a viable preventative/therapeutic measures in reducing the risk and severity of ALI/ARDS. Considering the current outbreak of the 2019 Novel Corona virus infection (COVID- 19), which is an infectious disease that leads to progressive ALI/ARDS in many patients (6,103,107,113), it is conceivable that regular exercise might be effective in preventing while EcSOD gene/protein therapy might be effective in treating ALI/ARDS under the condition of COVID-19 infection.…”

Viruses of Respiratory Tract: an Observational Retrospective Study on Hospitalized Patients in Rome, Italy

“…As mentioned above, human coronaviruses (HCOV), that were represented in our clinical specimens by the strains HCOV-OC43, HCOV-229E, HCOV-HKU1 and HCOV-NL63, showed a positivity rate similar to those of RSV. HCOV can cause enteric or respiratory disease, which can be severe and life threatening in humans, as observed in the case of the zoonotic coronaviruses causing severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) or in the recent global pandemic caused by the novel coronavirus classified as SARS-CoV-2 and responsible for the respiratory disease named COVID-19 (Corona Virus Disease) [22,23]. Coronaviruses have been associated also with demyelinating diseases [24,25].…”