Signs of tracheobronchitis may constitute the principal finding on the lung SPECT/CT images of COVID-19 patients

Bahloul, Achraf; Verger, Antoine; Mandry, Damien; Jeulin, Hélène; Goehringer, François; Karcher, Gilles; Imbert, Laëtitia; Marié, Pierre

doi:10.1007/s00259-020-05139-5

“…A re ex vascular and bronchial constriction out of these involved areas might increase the dead space, reduce the functional lung capacity, and impair the compensatory respiratory capacity thus contributing to worsen hypoxia. It must be emphasized that our patients did not demonstrate clinical or biological evidence of lung superinfection despite three of them had tracheobronchial tract uptake of Technegas R that could suggest tracheobronchitis as previously reported [23,34].…”

Section: Discussionsupporting

confidence: 48%

“…Nevertheless, for a clinical use, PS is considered the best method to detect small distal pulmonary embolism and its results can be considered as a surrogate of lung vascularization evaluation. LVPS has been previously used in SARS-CoV-2 pneumonia to discard pulmonary embolism when CTPA was not indicated [20,21,22] or to evidence tracheobronchitis [23]. Furthermore, in case of normal CTPA and typically abnormal LVPS (i.e area with preserved ventilation and perfusion defect), impairment of distal vasculature might be detected whatever the mechanism (very distal and small pulmonary embolism or local thrombosis).…”

Section: Discussionmentioning

confidence: 99%

Microvascular Injury With Secondary Edema, Bronchoconstriction and Vasoconstriction of Non-involved Lung Parenchymal Segments May Contribute to Clinical Deterioration of Non-critically Ill Patients Hospitalized for SARS-CoV-2 Pneumonia Without Evidence of Pulmonary Embolism: A Preliminary Study.

Maincent

¹

,

Perrin

²

,

Chironi

³

et al. 2021

Preprint

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Purpose: We aimed to better understand the pathophysiology of SARS-CoV-2 pneumonia in non-critically ill hospitalized patients secondarily presenting with clinical deterioration and increase in oxygen requirement.Methods: We consecutively enrolled patients without clinical or biological evidence for superinfection, without left ventricular (LV) dysfunction and for whom a pulmonary embolism was discarded by computed tomography pulmonary angiography. We investigated lung ventilation and perfusion (LVP) by LVP scintigraphy, and, 24 hours later, left and right ventricular function by 99mTc-labelled albumin gated-blood-pool scintigraphy with late (60 mn) tomographic albumin images on the lungs to evaluate lung albumin retention that could indicate microvascular injuries with secondary edema. Results: We included 13 patients with confirmed SARS-CoV-2 pneumonia. All had CT evidence of organizing pneumonia and normal LV ejection fraction.No patient demonstrated preserved ventilation with perfusion defect (mismatch), which may eliminate a distal lung thrombosis. Patterns of ventilation and perfusion were heterogeneous with sometimes healthy lung segments paradoxically hypoperfused and hypoventilated while both normal perfusion and ventilation were maintained in segments with organizing pneumonia (n=4). Lung albumin retention in area of organizing pneumonia was observed in 9 patients, indicating microvascular injuries, vessel permeability increase and secondary edema.Conclusion: In hospitalized non-critically ill patients without pulmonary embolism or LV dysfunction, various types of damage may contribute to clinical deterioration including microvascular injuries and secondary edema, broncho and vasoconstriction of area not involved by organizing pneumonia while no evidence was found for significant distal thrombosis detectable by LVP scintigraphy.

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“…LVPS has been previously used in SARS-CoV-2 pneumonia to discard pulmonary embolism when CTPA was not indicated 22 – 24 or to evidence tracheobronchitis. 25 Furthermore, in case of normal CTPA and typically abnormal LVPS (i.e. area with preserved ventilation and perfusion defect), impairment of distal vasculature might be detected whatever the mechanism (very distal and small pulmonary embolism or local thrombosis).…”

Section: Discussionmentioning

confidence: 99%

Microvascular injuries, secondary edema, and inconsistencies in lung vascularization between affected and nonaffected pulmonary segments of non-critically ill hospitalized COVID-19 patients presenting with clinical deterioration

Maincent

¹

,

Perrin

²

,

Chironi

³

et al. 2022

Ther Adv Respir Dis

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Purpose: We aimed to better understand the pathophysiology of SARS-CoV-2 pneumonia in non-critically ill hospitalized patients secondarily presenting with clinical deterioration and increase in oxygen requirement without any identified worsening factors. Methods: We consecutively enrolled patients without clinical or biological evidence for superinfection, without left ventricular dysfunction and for whom a pulmonary embolism was discarded by computed tomography (CT) pulmonary angiography. We investigated lung ventilation and perfusion (LVP) by LVP scintigraphy, and, 24 h later, left and right ventricular function by Tc-99m-labeled albumin-gated blood-pool scintigraphy with late (60 mn) tomographic albumin images on the lungs to evaluate lung albumin retention that could indicate microvascular injuries with secondary edema. Results: We included 20 patients with confirmed SARS-CoV-2 pneumonia. All had CT evidence of organizing pneumonia and normal left ventricular ejection fraction. No patient demonstrated preserved ventilation with perfusion defect (mismatch), which may discard a distal lung thrombosis. Patterns of ventilation and perfusion were heterogeneous in seven patients (35%) with healthy lung segments presenting a relative paradoxical hypoperfusion and hypoventilation compared with segments with organizing pneumonia presenting a relative enhancement in perfusion and preserved ventilation. Lung albumin retention in area of organizing pneumonia was observed in 12 patients (60%), indicating microvascular injuries, increase in vessel permeability, and secondary edema. Conclusion: In hospitalized non-critically ill patients without evidence of superinfection, pulmonary embolism, or cardiac dysfunction, various types of damage may contribute to clinical deterioration including microvascular injuries and secondary edema, inconsistencies in lung segments vascularization suggesting a dysregulation of the balance in perfusion between segments affected by COVID-19 and others. Summary Statement Microvascular injuries and dysregulation of the balance in perfusion between segments affected by COVID-19 and others are present in non-critically ill patients without other known aggravating factors. Key Results In non-critically ill patients without evidence of superinfection, pulmonary embolism, macroscopic distal thrombosis or cardiac dysfunction, various types of damage may contribute to clinical deterioration including 1/ microvascular injuries and secondary edema, 2/ inconsistencies in lung segments vascularization with hypervascularization of consolidated segments contrasting with hypoperfusion of not affected segments, suggesting a dysregulation of the balance in perfusion between segments affected by COVID-19 and others.

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“…Bahloul et al [16], two studies by Evbuomwan et al [24,25], Le Roux et al [29], Sajal et al [34], and Tan et al [37] reported pulmonary embolism prevalence by lung scintigraphy (VQ SPECT/CT). The prevalence ranged from 10.7% to 33.8%.…”

Section: Prevalence Of Pulmonary Embolism With Q or V/q Criteriamentioning

confidence: 99%

Diagnostic importance of lung perfusion/ventilation scans in the evaluation of pulmonary embolism in COVID-19 patients: systematic review of the literature

Rahmanipour

¹

,

Ghorbani

²

,

Sadeghi

³

et al. 2022

Nuclear Medicine Communications

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Objective To investigate the outcomes of ventilation/ perfusion scintigraphy on the diagnosis of pulmonary embolism in coronavirus disease 2019 (COVID-19) patients, we performed a systematic review of the available literature. Materials and methodsPubMed and Scopus were systematically searched up to 4 June 2022, for relevant studies. We included studies on patients with COVID-19 who have performed ventilation/perfusion scintigraphy for diagnosis of pulmonary embolism to describe any diagnosis outcome. Irrelevant and non-English articles were excluded. ResultsOverall, 27 articles were included in our review. The database search yielded studies from PubMed, Scopus, and studies identified through reviewing the reference list of included studies. Extracted information from the included studies could be categorized into several aspects: Diagnosis of pulmonary embolism with Q single-photon emission computed tomography (SPECT) CT, Tracheobronchial uptake, Diagnostic value of V/Q rather than Q at diagnosis pulmonary embolism, Different characteristics (morphological alterations) of COVID-19 in ventilation orperfusion scan, the prevalence of pulmonary embolism with Q or V/Q criteria, and Design of radiotherapy planning in lung cancer patients with COVID-19. ConclusionDifferent perfusion patterns in COVID-19 are challenging but can be alleviated by adding SPECT/ computed tomography (CT) to lung perfusion scans. Although perfusion only SPECT/CT can rule out or rule in others in considerable number of patients, ventilation scan is still needed in certain patients. Nucl Med Commun

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Signs of tracheobronchitis may constitute the principal finding on the lung SPECT/CT images of COVID-19 patients

Cited by 4 publications

References 9 publications

Microvascular Injury With Secondary Edema, Bronchoconstriction and Vasoconstriction of Non-involved Lung Parenchymal Segments May Contribute to Clinical Deterioration of Non-critically Ill Patients Hospitalized for SARS-CoV-2 Pneumonia Without Evidence of Pulmonary Embolism: A Preliminary Study.

Microvascular Injury With Secondary Edema, Bronchoconstriction and Vasoconstriction of Non-involved Lung Parenchymal Segments May Contribute to Clinical Deterioration of Non-critically Ill Patients Hospitalized for SARS-CoV-2 Pneumonia Without Evidence of Pulmonary Embolism: A Preliminary Study.

Microvascular injuries, secondary edema, and inconsistencies in lung vascularization between affected and nonaffected pulmonary segments of non-critically ill hospitalized COVID-19 patients presenting with clinical deterioration

Diagnostic importance of lung perfusion/ventilation scans in the evaluation of pulmonary embolism in COVID-19 patients: systematic review of the literature

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