Pulmonary embolism in COVID-19: Ventilation and perfusion computed tomography

Ierardi, Anna Maria; Angileri, Salvatore Alessio; Arrichiello, Antonio; Meglio, Letizia Di; Gurgitano, Martina; Rodà, Giovanni Maria; Carrafiello, Gianpaolo

doi:10.1016/j.idcr.2020.e00805

Cited by 8 publications

(7 citation statements)

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“…a minor proportion of patients had an impairment of DLCO and KCO, suggesting membrane lesion rather than reduced lung volume as the main cause of impaired diffusion capacity in these cases. Endothelial dysfunction and thrombosis are factors contributing to the pathogenesis of COVID-19[35][36][37][38][39], hence the interest of pulmonary perfusion assessment techniques, such as dual-energy CT, for the evaluation of COVID-19 survivors[40,41].Current results are in line with a previous study investigating SARS outpatients…”

supporting

confidence: 84%

Post-discharge chest CT findings and pulmonary function tests in severe COVID-19 patients

Balbi

Conti

Imeri

et al. 2021

European Journal of Radiology

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To evaluate chest computed tomography (CT) and pulmonary function test (PFT) findings in severe COVID-19 patients after discharge and correlate CT pulmonary involvement with PFT results. Methods: COVID-19 patients admitted to our hospital between February 25 and May 2, 2020, were retrospectively included according to the following criteria: (a) COVID-19 defined as severe based on the WHO interim guidance (i.e., clinical signs of pneumonia plus respiratory rate > 30 breaths/min, severe respiratory distress, and/or SpO 2 < 90 % on room air); (b) chest radiograph in the acute setting; (c) post-discharge unenhanced chest CT; and (d) post-discharge comprehensive PFT. Imaging findings were retrospectively evaluated in consensus by two readers, and volume of abnormal lung was measured on CT using 3D Slicer software. Differences between demographics, comorbidities, acute radiographic findings, PFT, and post-discharge clinical and laboratory data of patients with normal and abnormal CT findings were assessed by Mann-Whitney or Fisher tests, and the compromised lung volume-PFT association by Pearson correlation after removing possible outliers. Results: At a median of 105 days from symptom onset, 74/91 (81 %) patients had CT abnormalities. The most common CT pattern was combined ground-glass opacity and reticular pattern (46/74, 62 %) along with architectural distortion (68/74, 92 %) and bronchial dilatation (66/74, 89 %). Compromised lung volume had a median value of 15 % [11-23], was higher in dyspneic patients, and negatively correlated with the percentage of predicted DLCO, VA, and FVC values (r = -0.39, -0.5, and -0.42, respectively). These PFT parameters were significantly lower in patients with CT abnormalities. Impairment of DLCO and KCO was found in 12 (13 %) cases, possibly implying an underlying pulmonary vasculopathy in this subgroup of patients. Conclusions: Most severe COVID-19 survivors still had physiologically relevant CT abnormalities about three months after the disease onset, with an impairment of diffusion capacity on PFT. A pulmonary vasculopathy was suggested in a minor proportion of patients.

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confidence: 84%

Post-discharge chest CT findings and pulmonary function tests in severe COVID-19 patients

Balbi

Conti

Imeri

et al. 2021

European Journal of Radiology

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“…Whether also fibrosis may be responsible for these microcirculation perfusion defects is worth to investigate. While these complications of the disease are now well recognized during the acute phase of the infection [12][13][14], it is important to notice that this impairment of the microcirculation, we have detected, may affect lung function even in the recovery phase and may last for a long time or even not be healed with time. This evidence should be carefully considered, due to the potential clinical relevance of the problem in the large actual number of patients affected by the SARS-CoV-2 infection worldwide.…”

Section: Discussionmentioning

confidence: 80%

Preliminary detection of lung hypoperfusion in discharged Covid-19 patients during recovery

Patelli

Paganoni

Besana

et al. 2020

European Journal of Radiology

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“…Whether also fibrosis may be responsible for these microcirculation perfusion defects is worth to investigate. While these complications of the disease are now well recognized during the acute phase of the infection[12,13,14], it is important to notice that this impairment of the microcirculation, we have detected, may affect lung function even in the recovery phase and may last for a long time or even not be healed with time. This evidence should be carefully considered, due to the potential clinical relevance of the problem in the large number of patients affected by the SARS-CoV-2 infection during the recovery phase worldwide in this period.…”

Section: Discussionmentioning

confidence: 88%

Detection of lung hypoperfusion in Covid-19 patients during recovery by digital imaging quantification

Patelli

Paganoni

Besana

et al. 2020

Preprint

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Purpose. A large number of patients affected by the SARS-Cov-2 virus worldwide undergo recovery of symptoms in about one month. Among these patients, the healing process is still under observation, with some patients in need of careful clinical monitoring. While the radiological findings have been shown to regress almost completely, little knowledge is available at the moment about other complications in the lung and in other organs. We then investigated the lung perfusion conditions in patients affected by COVID- 19 during recovery. Method. We retrospectively studied 20 patients, from 14 to 60 days after resolution of the COVID-19 symptoms, using chest CT. In a subgroup of 5 patients contrasted CT was used. Beside normal radiological evaluation of lung tissue, perfusion conditions were evaluated by digital image processing in the lung volume automatically segmented. Results. Pulmonary lung evaluation showed that COVID-19 pneumonia almost completely regressed, with mild focal areas affected by fibrous stripes. In patients that reported dyspnea, lung CT showed complete resolution of interstitial changes. Quantification of lung perfusion condition by contrasted CT, showed that dyspnea in 3 patients was associated with areas of hypoperfusion, while in 2 patients not reporting dyspnea perfusion conditions were comparable to normal controls. Conclusions. Although we obtained preliminary data, this is the first report on quantitative evaluation of hypoperfused lung tissue detected in recovering COVID-19 patients. These results suggest the need to further investigate these patients and to redefine the role of CT evaluation for diagnostic purposes as well as for evaluation of potential treatments.

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Pulmonary embolism in COVID-19: Ventilation and perfusion computed tomography

Cited by 8 publications

References 0 publications

Post-discharge chest CT findings and pulmonary function tests in severe COVID-19 patients

Post-discharge chest CT findings and pulmonary function tests in severe COVID-19 patients

Preliminary detection of lung hypoperfusion in discharged Covid-19 patients during recovery

Detection of lung hypoperfusion in Covid-19 patients during recovery by digital imaging quantification

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