CT of Post-Acute Lung Complications of COVID-19

Abstract

The acute course of coronavirus disease 2019 (COVID-19) is variable and ranges from asymptomatic infection to fulminant respiratory failure. Patients recovering from COVID-19 can have persistent symptoms and computed tomography (CT) abnormalities of variable severity. At 3 months after acute infection, a subset of patients will have CT abnormalities that include ground glass abnormalities (GGO) and subpleural bands with concomitant pulmonary function abnormalities. At 6 months after acute infection, some patients have persistent CT changes to include the resolution of GGOs seen in the early recovery phase and the persistence or development of changes suggestive of fibrosis such as reticulation with or without parenchymal distortion. Predictors of post-COVID lung disease include need for intensive care unit (ICU) admission, mechanical ventilation, higher inflammatory markers, longer hospital stay and a diagnosis of acute respiratory distress syndrome (ARDS). Treatments of post-COVID lung disease are being investigated with anti-fibrotic agents being investigated for the prevention of post-COVID lung fibrosis. The etiology of post-COVID lung disease may be a sequela of prolonged mechanical ventilation, COVID-induced ARDS or direct injury from the virus. Future research is needed to determine the long-term persistence of post-COVID lung disease, its impact on patients and ways to prevent or treat it.

Combined Use of Electrocardiography and Ultrasound to Detect Cardiac and Pulmonary Involvement after Recovery from COVID-19 Pneumonia: A Case Series

“…Conversely, at least 70% of them displayed radiological sequelae of chronic lung injury. Indeed, a variety of CT lung abnormalities have been reported in patients after COVID-19 pneumonia [7], from ground glass areas to signs of reticulation and parenchymal distortion occurring up to 6 months after acute infection [7]. Although prolonged mechanical ventilation and direct or indirect viralmediated injury might be associated with post-COVID-19 lung disease [7], in our study 73% of patients not requiring NIV and/or ETI during the acute phase showed signs of emphysema, bronchiectasis and/or fibrosis on CT scan as soon as a few weeks from full recovery.…”

“…Indeed, a variety of CT lung abnormalities have been reported in patients after COVID-19 pneumonia [7], from ground glass areas to signs of reticulation and parenchymal distortion occurring up to 6 months after acute infection [7]. Although prolonged mechanical ventilation and direct or indirect viralmediated injury might be associated with post-COVID-19 lung disease [7], in our study 73% of patients not requiring NIV and/or ETI during the acute phase showed signs of emphysema, bronchiectasis and/or fibrosis on CT scan as soon as a few weeks from full recovery. Moreover, these radiological abnormalities were clearly associated with an altered DT ratio and/or DE on LUS, and more importantly, signs of diaphragmatic thickness/excursion were clearly abnormal, even in patients with no radiological evidence of pulmonary sequelae.…”

“…Although the virus is well known to lead to a variety of multiorgan clinical manifestations during the acute phase [1][2][3][4][5], preliminary clinical [6] and radiological [7] data have recently reported mid-term cardiopulmonary sequelae in fully recovered patients.…”

Pulmonary Cystic Disease Associated With COVID 19 Pneumonia: An Emerging Atypical Manifestation

“…Its spectrum ranges from asymptomatic to ventilatory failure. Chronologically, on chest CT in the first five days, ground-glass opacities, mixed infiltrate of ground-glass, and consolidation, with subpleural and peripheral in location are observed, with a peak of these findings around day 10 [6]. Other frequent chest CT findings in COVID-19 are vascular enlargement, crazy paving, interlobular septal thickening, and air bronchogram [5,7,8].…”

Pulmonary fibrosis from molecular mechanisms to therapeutic interventions: lessons from post-COVID-19 patients

“…Recently, Solomon et al have reviewed the main papers about post-acute lung complications of COVID-19 [147] . They have summarized the etiology of lung fibrosis after COVID-19 in different mechanisms: i) known consequence of ARDS; ii) effects of mechanical ventilation with direct injury of lung alveoli; iii) improved response to fibrotic stimuli due to virus damage; iv) direct virus induction of fibrosis.…”