Chronic Pulmonary Manifestations of COVID-19 Infection: Imaging                     Evaluation

Murphy, Mark C.; Little, Brent P.

doi:10.1148/radiol.222379

Cited by 17 publications

(9 citation statements)

References 64 publications

(78 reference statements)

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“…Those in our cohort who performed a 22 months follow-up improved radiologically at 10 months but were relatively unchanged or worsened at 2 years, showing in many cases “fibrotic-like” changes but no honeycombing. Previous reports describe at the 2 years follow-up the presence of fibrotic-like changes, such as reticulation, bronchial dilatation, and distortion ( 24 , 25 ). Honeycombing is often considered specific to pulmonary fibrosis and represents damaged lung tissue containing cystic air spaces with thick fibrotic walls, usually localised in the peripheral parts of the lungs ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Residual radiological opacities correlate with disease outcomes in ICU-treated COVID-19

Björnson,

Svensson,

et al. 2024

Front. Med.

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BackgroundFew studies consider both radiological and functional outcomes in COVID-19 survivors treated in the intensive care unit (ICU). We investigated clinical findings and pulmonary abnormalities on chest computed tomography (CT) and compared outcomes of severe versus mild-moderate acute respiratory distress syndrome (ARDS) on long-term follow-up.MethodsThis longitudinal cohort study included 118 COVID-19 patients (median age, 58 years; 79% men). Thoracic CT scans were performed 4, 10, and 22 months after hospital discharge. Two independent blinded radiologists analyzed the 10 months scans and scored the radiology findings semi-quantitatively, as no/minor versus widespread opacities [low-radiology opacity grade (ROG) versus high-ROG]. ARDS severity was based on the PaO2/FiO2 ratio. The 6 min walk test (6MWT) was performed after 3 and 9 months, and lung diffusion capacity for carbon monoxide (DLCO) and lung volume measurement after 9 and 15 months. Dynamic spirometry was done at all time points. Residual symptoms and health-related quality-of-life (HRQL) were evaluated using validated questionnaires.ResultsAt 10 months, most patients (81/118; 69%) were classified as high-ROG, of which 70% had severe ARDS during hospitalisation; 69% of those with mild-moderate ARDS also had high-ROG. Patients with high-ROG had longer ICU stay and lower PaO2/FiO2 during hospitalisation (p < 0.01). At 9 months follow-up, patients with high-ROG had smaller lung volumes as % of predicted values [mean (±CI): 80 (77–84) vs. 93 (88–98) (p < 0.001)], lower DLCO as % of predicted values [74 (70–78) vs. 87 (82–92) (p < 0.001)], lower oxygen saturation during 6MWT (p = 0.02), and a tendency to more severe dyspnoea (p = 0.07), but no difference was found in HRQL compared with no/minor ROG (p = 0.92). A higher opacity score was related to lower DLCO at follow-up (r = −0.48, p < 0.001, Spearman rank test). Severe ARDS patients had slightly more severe fatigue at 9 months compared to mild–moderate, but no differences in dyspnoea or lung function at follow-up. Fibrotic-like changes were found in 93% of patients examined with CT scans at 2 years (55/118; 47%). Severe ARDS could predict widespread opacities (ROG > 25%) in most patients at follow-up at 10 months (AUC 0.74).ConclusionResidual radiological abnormalities in ICU-treated COVID-19 patients, evaluated for up to 2 years, relate to persisting symptoms and impaired lung function, demanding careful follow-up regardless of ARDS severity at hospitalisation.

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Section: Discussionmentioning

confidence: 99%

Residual radiological opacities correlate with disease outcomes in ICU-treated COVID-19

Björnson,

Svensson,

et al. 2024

Front. Med.

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“…In the follow-up CT scans, the extent of findings was compared to each previous CT for progression or regression and the residual findings were further characterised. Fibrotic-like changes referred to perilobular bands, bronchial dilatation and reticulations [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical phenotype and outcome of persistent SARS-CoV-2 replication in immunocompromised hosts: a retrospective observational study in the Omicron era

Götz,

Mathé,

Agarwal

et al. 2023

Infection

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Purpose This study aims to describe clinical, virological and radiological characteristics as well as treatment strategies and outcomes of immunocompromised patients with persistent SARS-CoV-2 replication. Methods We performed a retrospective cohort study of immunocompromised patients at the University Medical Center Freiburg between 01/2022 and 05/2023. Patients with substantial immunosuppression and persistent SARS-CoV-2 detection (Ct-value < 30 after 14 days) were included. Results 36 patients in our cohort reported mainly fever, dyspnoea or continuous cough. Viral load was significantly higher in concurrent samples taken from the lower respiratory tract (Ct-value = 26) than from the upper respiratory tract (Ct-value = 34). Time of detectable viral RNA after start of antiviral treatment was shorter in patients receiving two antivirals (median 15 days vs. 31 days with one antiviral agent). Short-course antiviral therapy (≤ 5 days) was less efficient in reduction of symptoms and viral load than prolonged therapy > 10 days. In 30% (8/27) of patients with repeated CT scans, we found the emergence of chronic pulmonary changes, which were more frequently in patients with B cell depletion (37%, 7/19) compared to patients with organ transplantation (12%, 2/17). Conclusion Ongoing SARS-CoV-2 replication in the lower respiratory tract is a relevant differential diagnosis in patients with severe immunosuppression and continuous cough, fever or dyspnoea even if nasopharyngeal swabs test negative for SARS-CoV-2. Especially in B cell-depleted patients, this may lead to inflammatory or fibrotic-like pulmonary changes, which are partially reversible after inhibition of viral replication. Antiviral therapy seems to be most effective in combination and over a prolonged period of time of > 10 days. Trial registration number DRKS 00027299.

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“…An increased risk of thrombosis was also found in the early and late sub-acute phases [ 143 , 144 ]. Patients with moderate and severe disease are reportedly at an increased risk of developing chronic thromboembolic pulmonary hypertension [ 145 , 146 ]. All the lung complications are summarized in Table 3 .…”

Section: Lung Complicationsmentioning

confidence: 99%

A Pictorial Essay Describing the CT Imaging Features of COVID-19 Cases throughout the Pandemic with a Special Focus on Lung Manifestations and Extrapulmonary Vascular Abdominal Complications

Brogna

Bignardi

Megliola³

et al. 2023

Biomedicines

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With the Omicron wave, SARS-CoV-2 infections improved, with less lung involvement and few cases of severe manifestations. In this pictorial review, there is a summary of the pathogenesis with particular focus on the interaction of the immune system and gut and lung axis in both pulmonary and extrapulmonary manifestations of COVID-19 and the computed tomography (CT) imaging features of COVID-19 pneumonia from the beginning of the pandemic, describing the typical features of COVID-19 pneumonia following the Delta variant and the atypical features appearing during the Omicron wave. There is also an outline of the typical features of COVID-19 pneumonia in cases of breakthrough infection, including secondary lung complications such as acute respiratory distress disease (ARDS), pneumomediastinum, pneumothorax, and lung pulmonary thromboembolism, which were more frequent during the first waves of the pandemic. Finally, there is a description of vascular extrapulmonary complications, including both ischemic and hemorrhagic abdominal complications.

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Chronic Pulmonary Manifestations of COVID-19 Infection: Imaging Evaluation

Cited by 17 publications

References 64 publications

Residual radiological opacities correlate with disease outcomes in ICU-treated COVID-19

Residual radiological opacities correlate with disease outcomes in ICU-treated COVID-19

Clinical phenotype and outcome of persistent SARS-CoV-2 replication in immunocompromised hosts: a retrospective observational study in the Omicron era

A Pictorial Essay Describing the CT Imaging Features of COVID-19 Cases throughout the Pandemic with a Special Focus on Lung Manifestations and Extrapulmonary Vascular Abdominal Complications

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