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da Silva LNM, Filho AGO, Guimarães JB. Musculoskeletal manifestations of COVID-19. Skeletal Radiol 2024; 53:2009-2022. [PMID: 38117308 DOI: 10.1007/s00256-023-04549-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
During the COVID-19 pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected millions of people worldwide, with acute respiratory distress syndrome (ARDS) being the most common severe condition of pulmonary involvement. Despite its involvement in the lungs, SARS-CoV-2 causes multiple extrapulmonary manifestations, including manifestations in the musculoskeletal system. Several cases involving bone, joint, muscle, neurovascular and soft tissues were reported shortly after pandemic onset. Even after the acute infection has resolved, many patients experience persistent symptoms and a decrease in quality of life, a condition known as post-COVID syndrome or long COVID. COVID-19 vaccines have been widely available since December 2020, preventing millions of deaths during the pandemic. However, adverse reactions, including those involving the musculoskeletal system, have been reported in the literature. Therefore, the primary goal of this article is to review the main imaging findings of SARS-CoV-2 involvement in the musculoskeletal system, including acute, subacute, chronic and postvaccination manifestations.
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Affiliation(s)
- Lucas N M da Silva
- Department of Musculoskeletal Radiology, Grupo Fleury, Sao Paulo, Brazil
| | | | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Grupo Fleury, Sao Paulo, Brazil.
- Department of Radiology, Universidade Federal de Sao Paulo, UNIFESP-EPM, Sao Paulo, Brazil.
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.
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Zhai X, Wu W, Zeng S, Miao Y. Advance in the mechanism and clinical research of myalgia in long COVID. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL IMMUNOLOGY 2024; 13:142-164. [PMID: 39310121 PMCID: PMC11411160 DOI: 10.62347/txvo6284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 07/18/2024] [Indexed: 09/25/2024]
Abstract
As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to evolve, mortality rates of coronavirus disease 2019 (COVID-19) have significantly decreased. However, a variable proportion of patients exhibit persistent prolonged symptoms of COVID-19 infection (long COVID). This virus primarily attacks respiratory system, but numerous individuals complain persistent skeletal muscle pain or worsening pre-existing muscle pain post COVID-19, which severely affects the quality of life and recovery. Currently, there is limited research on the skeletal muscle pain in long COVID. In this brief review, we review potential pathological mechanisms of skeletal muscle pain in long COVID, and summarize the various auxiliary examinations and treatments for skeletal muscle pain in long COVID. We consider abnormal activation of inflammatory response, myopathy, and neurological damages as pivotal pathological mechanisms of skeletal muscle pain in long COVID. A comprehensive examination is significantly important in order to work out effective treatment plans and relieve skeletal muscle pain. So far, rehabilitation interventions for myalgia in long COVID contain but are not limited to drug, nutraceutical therapy, gut microbiome-targeted therapy, interventional therapy and strength training. Our study provides a potential mechanism reference for clinical researches, highlighting the importance of comprehensive approach and management of skeletal muscle pain in long COVID. The relief of skeletal muscle pain will accelerate rehabilitation process, improve activities of daily living and enhance the quality of life, promoting individuals return to society with profound significance.
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Affiliation(s)
- Xiuyun Zhai
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiaotong UniversityNo. 100, Haining Road, Shanghai 200080, China
| | - Weijun Wu
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiaotong UniversityNo. 100, Haining Road, Shanghai 200080, China
| | - Siliang Zeng
- Department of Rehabilitation Therapy, School of Health, Shanghai Normal University Tianhua CollegeNo. 1661, North Shengxin Road, Shanghai 201815, China
| | - Yun Miao
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiaotong UniversityNo. 100, Haining Road, Shanghai 200080, China
- Department of Rehabilitation, School of International Medical Technology, Shanghai Sanda UniversityNo. 2727, Jinhai Road, Shanghai 201209, China
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Antar SA, Ashour NA, Hamouda AO, Noreddin AM, Al-Karmalawy AA. Recent advances in COVID-19-induced liver injury: causes, diagnosis, and management. Inflammopharmacology 2024:10.1007/s10787-024-01535-7. [PMID: 39126569 DOI: 10.1007/s10787-024-01535-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/29/2024] [Indexed: 08/12/2024]
Abstract
Since the start of the pandemic, considerable advancements have been made in our understanding of the effects of SARS-CoV-2 infection and the associated COVID-19 on the hepatic system. There is a broad range of clinical symptoms for COVID-19. It affects multiple systems and has a dominant lung illness depending on complications. The progression of COVID-19 in people with pre-existing chronic liver disease (CLD) has also been studied in large multinational groups. Notably, SARS-CoV-2 infection is associated with a higher risk of hepatic decompensation and death in patients with cirrhosis. In this review, the source, composition, mechanisms, transmission characteristics, clinical characteristics, therapy, and prevention of SARS-CoV-2 were clarified and discussed, as well as the evolution and variations of the virus. This review briefly discusses the causes and effects of SARS-CoV-2 infection in patients with CLD. As part of COVID-19, In addition, we assess the potential of liver biochemistry as a diagnostic tool examine the data on direct viral infection of liver cells, and investigate potential pathways driving SARS-CoV-2-related liver damage. Finally, we explore how the pandemic has had a significant impact on patient behaviors and hepatology services, which may increase the prevalence and severity of liver disease in the future. The topics encompassed in this review encompass the intricate relationships between SARS-CoV-2, liver health, and broader health management strategies, providing valuable insights for both current clinical practice and future research directions.
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Affiliation(s)
- Samar A Antar
- Center for Vascular and Heart Research, Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA, 24016, USA
- Department of Pharmacology, Faculty of Pharmacy, Horus University-Egypt, New Damietta, 34518, Egypt
| | - Nada A Ashour
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta, 31527, Egypt
| | - Amir O Hamouda
- Department of Biochemistry, Faculty of Pharmacy, Horus University-Egypt, New Damietta, 34518, Egypt
| | - Ayman M Noreddin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ahram Canadian University, 6Th of October City, Giza, 12566, Egypt
- Department of Internal Medicine, School of Medicine, University of California -Irvine, Irvine, USA
| | - Ahmed A Al-Karmalawy
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Horus University-Egypt, New Damietta, New Damietta, 34518, Egypt.
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Ahram Canadian University, 6Th of October City, Giza, 12566, Egypt.
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Ibrahim I, Škoch A, Dezortová M, Adla T, Flusserová V, Nagy M, Douchová I, Fialová M, Filová V, Pajuelo D, Ibrahimová M, Tintěra J. Evaluation of microstructural brain changes in post-coronavirus disease 2019 (COVID-19) patients with neurological symptoms: a cross-sectional study. Quant Imaging Med Surg 2024; 14:5499-5512. [PMID: 39144056 PMCID: PMC11320515 DOI: 10.21037/qims-24-162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/12/2024] [Indexed: 08/16/2024]
Abstract
Background Changes in both the vascular system and brain tissues can occur after a prior episode of coronavirus disease 2019 (COVID-19), detectable through modifications in diffusion parameters using magnetic resonance imaging (MRI) techniques. These changes in diffusion parameters may be particularly prominent in highly organized structures such as the corpus callosum (CC), including its major components, which have not been adequately studied following COVID-19 infection. Therefore, the study aimed to evaluate microstructural changes in whole-brain (WB) diffusion, with a specific focus on the CC. Methods A total of 101 probands (age range from 18 to 69 years) participated in this retrospective study, consisting of 55 volunteers and 46 post-COVID-19 patients experiencing neurological symptoms. The participants were recruited from April 2022 to September 2023 at the Institute for Clinical and Experimental Medicine in Prague, Czech Republic. All participants underwent MRI examinations on a 3T MR scanner with a diffusion protocol, complemented by additional MRI techniques. Two volunteers and five patients were excluded from the study due to motion artefacts, severe hypoperfusion or the presence of lesions. Participants were selected by a neurologist based on clinical examination and a serological test for COVID-19 antibodies. They were then divided into three groups: a control group of healthy volunteers (n=28), an asymptomatic group (n=25) with a history of infection but no symptoms, and a symptomatic group (n=41) with a history of COVID-19 and neurological symptoms. Symptomatic patients did not exhibit neurological symptoms before contracting COVID-19. Diffusion data underwent eddy current and susceptibility distortion corrections, and fiber tracking was performed using default parameters in DSI studio. Subsequently, various diffusion metrics, were computed within the reconstructed tracts of the WB and CC. To assess the impact of COVID-19 and its associated symptoms on diffusion indices within the white matter of the WB and CC regions, while considering age, we employed a statistical analysis using a linear mixed-effects model within the R framework. Results Statistical analysis revealed a significant difference in mean diffusivity (MD) between the symptomatic and control groups in the forceps minor (P=0.001) and CC body (P=0.003). In addition to changes in diffusion, alterations in brain perfusion were observed in two post-COVID-19 patients who experienced a severe course. Furthermore, hyperintense lesions were identified in subcortical and deep white matter areas in the vast majority of symptomatic patients. Conclusions The main finding of our study was that post-COVID-19 patients exhibit increased MD in the forceps minor and body of the CC. This finding suggests a potential association between microstructural brain changes in post-COVID-19 patients and reported neurological symptoms, with significant implications for research and clinical applications.
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Affiliation(s)
- Ibrahim Ibrahim
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Antonín Škoch
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Monika Dezortová
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Theodor Adla
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vlasta Flusserová
- Specialised Outpatient Care Division, Department of Neurology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Markéta Nagy
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Irena Douchová
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Martina Fialová
- Laboratory Methods Division, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vanda Filová
- Laboratory Methods Division, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Dita Pajuelo
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Markéta Ibrahimová
- Laboratory of Immunology, Thomayer University Hospital, Prague, Czech Republic
| | - Jaroslav Tintěra
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Bitar R, Kaur M, Crandall I, McNamara R, Revzin MV. Ultrasound evaluation of portal venous gas and its mimics. Abdom Radiol (NY) 2024; 49:2756-2769. [PMID: 38735019 DOI: 10.1007/s00261-024-04328-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024]
Abstract
Portal venous gas on abdominal ultrasound classically represents an indirect indicator of bowel ischemia, a critical condition which poses a high patient mortality and therefore warrants emergent corrective action. While the classic appearance of portal venous gas on ultrasound is well-described in the literature, the characteristic descriptors are nonspecific and may actually represent other less emergent mimics. Therefore, while radiologists should remain vigilant for the detection of findings corresponding to portal venous gas, they should also be aware of similar-appearing entities in order to provide the most accurate diagnosis. This pictorial essay will open with imaging examples of true portal venous gas attributable to bowel ischemia and describe the classic features which should alert radiologists to this specific diagnosis. Subsequently, this pictorial essay will provide imaging examples of other various other clinical entities which on ultrasound may share similar imaging characteristics. An important objective of this pictorial essay is to highlight distinguishing imaging features along with specific clinical circumstances for each pathological entity which can direct radiologists into identifying the correct diagnosis.
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Affiliation(s)
- Ryan Bitar
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Manroop Kaur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Ian Crandall
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert McNamara
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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刘 鑫, 石 雪, 李 军. [A case of COVID-19 associated ischemic colitis]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2024; 56:362-365. [PMID: 38595259 PMCID: PMC11004963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Indexed: 04/11/2024]
Abstract
Ischemic colitis is a disease in which local tissue in the intestinal wall dies to varying degrees due to insufficient blood supply to the colon. Risk factors include cardiovascular disease, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, etc. Typical clinical manifestations of the disease are abdominal pain and hematochezia. The most common locations are the watershed areas of splenic flexure and rectosigmoid junction. The lesions are segmental and clearly demarcated from normal mucosa under endoscopy. The digestive tract is a common extra-pulmonary organ affected by the novel coronavirus, which can be directly damaged by the virus or indirectly caused by virus-mediated inflammation and hypercoagulability. The corona virus disease 2019 (COVID-19) associated intestinal injury can be characterized by malabsorption, malnutrition, intestinal flora shift, etc. CT can show intestinal ischemia, intestinal wall thickening, intestinal wall cystoid gas, intestinal obstruction, ascites, intussusception and other signs. In this study, we reported a case of ischemic colitis in a moderate COVID-19 patient. The affected area was atypical and the endoscope showed diffuse lesions from the cecum to the rectosigmoid junction. No signs of intestinal ischemia were found on imaging and clear thrombosis in small interstitial vessels was found in pathological tissue. Combined with the fact that the patient had no special risk factors in his past history, the laboratory tests indicated elevated ferritin and D-dimer, while the autoantibodies and fecal etiology results were negative, we speculated that the hypercoagulability caused by novel coronavirus infection was involved in the occurrence and development of the disease in this patient. After prolonged infusion support and prophylactic anti-infection therapy, the patient slowly resumed diet and eventually went into remission. Finally, we hoped to attract clinical attention with the help of this case of moderate COVID-19 complicated with ischemic colitis which had a wide range of lesions and a slow reco-very. For patients with abdominal pain and blood in the stool after being diagnosed as COVID-19, even if they are not severe COVID-19, they should be alert to the possibility of ischemic colitis, so as not to be mistaken for gastrointestinal reactions related to COVID-19.
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Affiliation(s)
- 鑫 刘
- 北京大学第三医院消化科，北京 100191Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - 雪迎 石
- 北京大学第三医院病理科，北京 100191Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - 军 李
- 北京大学第三医院消化科，北京 100191Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
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Pezzutti DL, Makary MS. Role of Imaging in Diagnosis and Management of COVID-19: Evidence-Based Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1457:237-246. [PMID: 39283430 DOI: 10.1007/978-3-031-61939-7_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Imaging has been demonstrated to play a crucial role in both the diagnosis and management of COVID-19. Depending on resources, pre-test probability, and risk factors for severe disease progression, real-time polymerase chain reaction (RT-PCR) testing may be followed by chest radiography (CXR) or chest computed tomography (CT) to further aid in diagnosis or excluding COVID-19 disease. SARS-CoV-2 has been shown not only to pathologically impact the pulmonary system, but also the cardiovascular, gastrointestinal, and neurological systems to name a few. Imaging has again proven useful in further investigating and managing extrapulmonary disease, with the use of echocardiogram, CT angiography of the cardiovascular and cerebrovascular structures, MRI of the brain, as well as ultrasound of the abdomen and CT of the abdomen and pelvis proving particularly useful. Research in artificial intelligence and its application in the diagnosis of COVID-19 and disease severity prediction is underway, and point-of-care ultrasound is an emerging bedside technique that may allow for more efficient and timely diagnosis of COVID-19.
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Affiliation(s)
- Dante L Pezzutti
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, 4th Floor, Columbus, OH, 43210, USA
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, 4th Floor, Columbus, OH, 43210, USA.
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8
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Idilman IS, Karcaaltincaba M. COVID-19 and the vessels: from micro- to macroangiopathy. Eur Radiol 2023; 33:8540-8541. [PMID: 37432404 DOI: 10.1007/s00330-023-09898-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Ilkay S Idilman
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
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Banerjee A, Somasundaram I, Das D, Jain Manoj S, Banu H, Mitta Suresh P, Paul S, Bisgin A, Zhang H, Sun XF, Duttaroy AK, Pathak S. Functional Foods: A Promising Strategy for Restoring Gut Microbiota Diversity Impacted by SARS-CoV-2 Variants. Nutrients 2023; 15:nu15112631. [PMID: 37299594 DOI: 10.3390/nu15112631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
Natural herbs and functional foods contain bioactive molecules capable of augmenting the immune system and mediating anti-viral functions. Functional foods, such as prebiotics, probiotics, and dietary fibers, have been shown to have positive effects on gut microbiota diversity and immune function. The use of functional foods has been linked to enhanced immunity, regeneration, improved cognitive function, maintenance of gut microbiota, and significant improvement in overall health. The gut microbiota plays a critical role in maintaining overall health and immune function, and disruptions to its balance have been linked to various health problems. SARS-CoV-2 infection has been shown to affect gut microbiota diversity, and the emergence of variants poses new challenges to combat the virus. SARS-CoV-2 recognizes and infects human cells through ACE2 receptors prevalent in lung and gut epithelial cells. Humans are prone to SARS-CoV-2 infection because their respiratory and gastrointestinal tracts are rich in microbial diversity and contain high levels of ACE2 and TMPRSS2. This review article explores the potential use of functional foods in mitigating the impact of SARS-CoV-2 variants on gut microbiota diversity, and the potential use of functional foods as a strategy to combat these effects.
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Affiliation(s)
- Antara Banerjee
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai 603103, Tamil Nadu, India
| | - Indumathi Somasundaram
- Department of Biotechnology Engineering, Kolhapur Institute of Technology's College of Engineering, Kolhapur 416012, Maharashtra, India
| | - Diptimayee Das
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai 603103, Tamil Nadu, India
| | - Samatha Jain Manoj
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai 603103, Tamil Nadu, India
| | - Husaina Banu
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai 603103, Tamil Nadu, India
| | - Pavane Mitta Suresh
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai 603103, Tamil Nadu, India
| | - Sujay Paul
- School of Engineering and Sciences, Tecnologico de Monterrey, Campus Queretaro, San Pablo 76130, Mexico
| | - Atil Bisgin
- Department of Medical Genetics, Medical Faculty, Cukurova University, Adana 01250, Turkey
| | - Hong Zhang
- Department of Medical Sciences, School of Medicine, Orebro University, SE-701 82 Orebro, Sweden
| | - Xiao-Feng Sun
- Division of Ocology, Department of Biomedical and Clinical Sciences, Linkoping University, SE-581 83 Linkoping, Sweden
| | - Asim K Duttaroy
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0313 Oslo, Norway
| | - Surajit Pathak
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai 603103, Tamil Nadu, India
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Boraschi P, Donati F, Ambrosini I, Bruni L, Mazzeo ML, Tintori R, Tonerini M, Neri E. Diagnostic and Therapeutic Radiology of the GI Tract, Liver, and Pancreas in Patients with COVID. Gastroenterol Clin North Am 2023; 52:185-200. [PMID: 36813425 PMCID: PMC9626443 DOI: 10.1016/j.gtc.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coronavirus disease 2019 (COVID-19) pulmonary involvement has been extensively reported in the literature. Current data highlight how COVID-19 is a systemic disease, affecting many other organs, including the gastrointestinal, hepatobiliary, and pancreatic organs. Recently, these organs have been investigated using imaging modalities of ultrasound and particularly computed tomography. Radiological findings of the gastrointestinal, hepatic, and pancreatic involvement in patients with COVID-19 are generally nonspecific but are nonetheless helpful to evaluate and manage COVID-19 patients with involvement of these organs.
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Affiliation(s)
- Piero Boraschi
- 2nd Unit of Radiology, Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy.
| | - Francescamaria Donati
- 2nd Unit of Radiology, Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Ilaria Ambrosini
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Luciana Bruni
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Maria Letizia Mazzeo
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Rachele Tintori
- 2nd Unit of Radiology, Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Michele Tonerini
- Unit of Emergency Radiology, Department of Surgical, Medical, Molecular and Critical Area Pathology, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Emanuele Neri
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, Pisa 56126, Italy
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Mogensen MA, Filippi CG. Coronavirus Disease: Subacute to Chronic Neuroimaging Findings. Neuroimaging Clin N Am 2023; 33:69-82. [PMID: 36404048 PMCID: PMC9288999 DOI: 10.1016/j.nic.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Several neurologic disorders are associated with coronavirus disease 2019 (COVID-19). In this article, clinical syndromes typically occurring in the subacute to chronic phase of illness and their neuroimaging findings are described with discussion of their COVID-19 specific features and prognosis. Proposed pathogenic mechanisms of these neuroimaging findings and challenges in determining etiology are reviewed.
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Affiliation(s)
- Monique A. Mogensen
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA,Corresponding author
| | - Christopher G. Filippi
- Department of Radiology, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, USA
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12
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Laino ME, Ammirabile A, Motta F, De Santis M, Savevski V, Francone M, Chiti A, Mannelli L, Selmi C, Monti L. Advanced Imaging Supports the Mechanistic Role of Autoimmunity and Plaque Rupture in COVID-19 Heart Involvement. Clin Rev Allergy Immunol 2023; 64:75-89. [PMID: 35089505 PMCID: PMC8796606 DOI: 10.1007/s12016-022-08925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 01/26/2023]
Abstract
The cardiovascular system is frequently affected by coronavirus disease-19 (COVID-19), particularly in hospitalized cases, and these manifestations are associated with a worse prognosis. Most commonly, heart involvement is represented by myocarditis, myocardial infarction, and pulmonary embolism, while arrhythmias, heart valve damage, and pericarditis are less frequent. While the clinical suspicion is necessary for a prompt disease recognition, imaging allows the early detection of cardiovascular complications in patients with COVID-19. The combination of cardiothoracic approaches has been proposed for advanced imaging techniques, i.e., CT scan and MRI, for a simultaneous evaluation of cardiovascular structures, pulmonary arteries, and lung parenchyma. Several mechanisms have been proposed to explain the cardiovascular injury, and among these, it is established that the host immune system is responsible for the aberrant response characterizing severe COVID-19 and inducing organ-specific injury. We illustrate novel evidence to support the hypothesis that molecular mimicry may be the immunological mechanism for myocarditis in COVID-19. The present article provides a comprehensive review of the available evidence of the immune mechanisms of the COVID-19 cardiovascular injury and the imaging tools to be used in the diagnostic workup. As some of these techniques cannot be implemented for general screening of all cases, we critically discuss the need to maximize the sustainability and the specificity of the proposed tests while illustrating the findings of some paradigmatic cases.
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Affiliation(s)
- Maria Elena Laino
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Angela Ammirabile
- Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca Motta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maria De Santis
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Victor Savevski
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Francone
- Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Arturo Chiti
- Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Lorenzo Monti
- Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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13
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Brandi N, Spinelli D, Granito A, Tovoli F, Piscaglia F, Golfieri R, Renzulli M. COVID-19: Has the Liver Been Spared? Int J Mol Sci 2023; 24:1091. [PMID: 36674607 PMCID: PMC9866733 DOI: 10.3390/ijms24021091] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
The liver is a secondary and often collateral target of COVID-19 disease but can lead to important consequences. COVID-19 might directly cause a high number of complications in patients with pre-existing chronic liver disease, increasing their risk of hepatic decompensation. Moreover, it also determines indirect consequences in the management of patients with liver disease, especially in those suffering from decompensated cirrhosis and HCC, as well as in the execution of their follow-up and the availability of all therapeutic possibilities. Liver imaging in COVID-19 patients proved to be highly nonspecific, but it can still be useful for identifying the complications that derive from the infection. Moreover, the recent implementation of telemedicine constitutes a possible solution to both the physical distancing and the re-organizational difficulties arising from the pandemic. The present review aims to encompass the currently hypothesized pathophysiological mechanisms of liver injury in patients with COVID-19 mediated by both the direct invasion of the virus and its indirect effects and analyze the consequence of the pandemic in patients with chronic liver disease and liver tumors, with particular regard to the management strategies that have been implemented to face this worldwide emergency and that can be further improved.
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Affiliation(s)
- Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Daniele Spinelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Alessandro Granito
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Francesco Tovoli
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
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14
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DePace NL, Colombo J. Long-COVID Syndrome and the Cardiovascular System: A Review of Neurocardiologic Effects on Multiple Systems. Curr Cardiol Rep 2022; 24:1711-1726. [PMID: 36178611 PMCID: PMC9524329 DOI: 10.1007/s11886-022-01786-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Long-COVID syndrome is a multi-organ disorder that persists beyond 12 weeks post-acute SARS-CoV-2 infection (COVID-19). Here, we provide a definition for this syndrome and discuss neuro-cardiology involvement due to the effects of (1) angiotensin-converting enzyme 2 receptors (the entry points for the virus), (2) inflammation, and (3) oxidative stress (the resultant effects of the virus). RECENT FINDINGS These effects may produce a spectrum of cardio-neuro effects (e.g., myocardial injury, primary arrhythmia, and cardiac symptoms due to autonomic dysfunction) which may affect all systems of the body. We discuss the symptoms and suggest therapies that target the underlying autonomic dysfunction to relieve the symptoms rather than merely treating symptoms. In addition to treating the autonomic dysfunction, the therapy also treats chronic inflammation and oxidative stress. Together with a full noninvasive cardiac workup, a full assessment of the autonomic nervous system, specifying parasympathetic and sympathetic (P&S) activity, both at rest and in response to challenges, is recommended. Cardiac symptoms must be treated directly. Cardiac treatment is often facilitated by treating the P&S dysfunction. Cardiac symptoms of dyspnea, chest pain, and palpitations, for example, need to be assessed objectively to differentiate cardiac from neural (autonomic) etiology. Long-term myocardial injury commonly involves P&S dysfunction. P&S assessment usually connects symptoms of Long-COVID to the documented autonomic dysfunction(s).
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Affiliation(s)
- Nicholas L. DePace
- Franklin Cardiovascular Associates, PA – Autonomic Dysfunction and POTS Center, Sicklerville, NJ USA
- Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, PA USA
- Neuro-Cardiology Research Corporation, LLC, Wilmington, DE USA
| | - Joe Colombo
- Franklin Cardiovascular Associates, PA – Autonomic Dysfunction and POTS Center, Sicklerville, NJ USA
- Neuro-Cardiology Research Corporation, LLC, Wilmington, DE USA
- CTO and Sr. Medical Director, Physio PS, Inc, Atlanta, GA USA
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15
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Shetty ND, Dhande RP, Nagendra V, Unadkat BS, Shelar SS. Post-COVID-19 Myositis Based on Magnetic Resonance Imaging: A Case Report. Cureus 2022; 14:e30293. [PMID: 36407178 PMCID: PMC9657587 DOI: 10.7759/cureus.30293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
The severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) causes COVID-19, which is known to cause fever, dry cough, exhaustion, headache, and loss of taste and smell. Although fever, sore throat, and cough have historically been the utmost characteristic symptoms of the illness, published case reports have recently started to emphasize additional uncommon and unusual presentations of infection with the coronavirus. In COVID, the musculoskeletal system is seldomly involved. In addition to reviewing the causes and imaging characteristics of COVID-19-related illnesses of the musculoskeletal system, we elaborate on a case of a middle-aged man who developed myositis as sequelae to the COVID-19 infection.
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16
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Zhao R, Saab H, Propson A, Moritani T, Kim J. Facial myonecrosis following COVID-19. Radiol Case Rep 2022; 17:3659-3662. [PMID: 35936875 PMCID: PMC9340454 DOI: 10.1016/j.radcr.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/09/2022] Open
Abstract
Myositis and myonecrosis are rare sequela of coronavirus disease 2019 (COVID-19). Until now, it has not been seen in muscles of the head and neck. We present a 22-year-old male with 4 months of retroauricular headaches following COVID-19 infection. Magnetic resonance imaging revealed rim-enhancing fluid collections in the bilateral masticator spaces which were sampled by fine-needle aspiration. We also discuss this case in the context of the current understanding of COVID-19-related myositis.
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17
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Alexander AJ, Joshi A, Mehendale A. The Musculoskeletal Manifestations of COVID-19: A Narrative Review Article. Cureus 2022; 14:e29076. [PMID: 36249619 PMCID: PMC9557238 DOI: 10.7759/cureus.29076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/12/2022] [Indexed: 12/15/2022] Open
Abstract
The coronavirus pandemic has caused a devastating impact across the planet. Millions of lives lost and economic structures are struggling to remain afloat. Clinical effects of SARS CoV-2 virus include tiredness, fatigue, headache, cough, loss of appetite, fever, loss of sensations of taste, and smell as well as other respiratory difficulties. Pulmonary complications of coronavirus infections result in severe pneumonia with the final sequelae being sepsis, and end-stage respiratory failure. Further cardiovascular, neurological, hematological, and gastrointestinal complications build up to cause the demise of the immune system ultimately leading to death of the affected individual. The attack of the virus and the resultant reaction of the epithelial cells lining the respiratory tract have been in the limelight of most studies pertaining to the pandemic. However, a lesser number of studies have detailed the muscular and osseous pathologies that appear post-coronavirus infection. Inflammation post-infection, across the organ systems, may appear as a link to bone and joint pathology. Myalgia is a typical COVID-19 infection symptom. On the contrary, other musculoskeletal signs have very seldom been reported. Multimodality imaging techniques stand a chance at showing the diagnosis and the degree of follow-up after evaluation. Apart from myalgia, there are cases of arthralgia, myopathies, and neuropathies. According to numerous reports, there is the possibility of a link between the current drug regimen used to treat the SARS-CoV-2 infection and the musculoskeletal manifestations observed. In this study, we aim to shed light on the coronavirus pandemic and its association to various musculoskeletal manifestations, provide a different perspective of the infected patients, and address the major points that a clinician must take care while administering care to the patient. We will also address the present treatment in line with the various musculoskeletal symptoms observed.
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18
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Rashidi A, Fritz J. Sports Imaging of COVID-19: A Multi-Organ System Review of Indications and Imaging Findings. Sports Health 2022; 14:618-631. [PMID: 35746891 PMCID: PMC9460088 DOI: 10.1177/19417381221106448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China. Although coronavirus disease-19 (COVID-19) affects every population group, the sports community and athletes require special consideration of the effects on cardiovascular, musculoskeletal, neurologic, and respiratory systems. A comprehensive understanding of imaging indications, findings, and features of COVID-19 supports appropriate imaging utilization and effective patient management and treatment. PURPOSE To review the spectrum of sports imaging in COVID-19 infection, organ system manifestations, vaccine effects, and complications in recreational and competitive athletes. STUDY DESIGN Narrative review. LEVEL OF EVIDENCE Levels 4 and 5. METHODS Based on a PubMed database search, studies describing the imaging findings of COVID-19 infection, organ system manifestations, vaccine effects, and complications in recreational and competitive athletes were included. RESULTS On March 11, 2020, World Health Organization officially declared COVID-19 a global pandemic. As of May 9, 2022, more than 515 million confirmed cases of COVID-19 were reported globally. While the multisystem effects of COVID-19 are incompletely understood, the role of imaging in diagnosing, monitoring, and prognosticating active disease, long-term effects, and complications is evolving. In the respiratory system, imaging plays an important role in diagnosing, characterizing, and monitoring pulmonary COVID-19 infections, barotrauma, and COVID-19-associated chronic pulmonary opacities and fibrotic-like lung changes. Ultrasonography, computed tomography, and magnetic resonance imaging aid in the timely diagnosis of ischemic, embolic, and thrombotic peripheral and central cardiovascular events, including deep venous thrombosis, pulmonary embolism, myocarditis, and stroke. COVID-19-associated musculoskeletal and peripheral nervous system manifestations include rhabdomyolysis and myonecrosis, plexus and peripheral neuropathies, Guillain-Barré syndrome, and shoulder injury related to vaccine administration. CONCLUSION In athletes, COVID-19 infections and associated effects on cardiovascular, musculoskeletal, neurologic, and respiratory systems require special consideration. With the increasing understanding of the multisystem effects of COVID-19, the role of imaging in diagnosing, monitoring, and prognosticating active disease, long-term effects, and complications is evolving. A comprehensive understanding of imaging indications, COVID-19 imaging features, and organ system effects aids in appropriate imaging utilization and effective patient management and treatments.
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Affiliation(s)
- Ali Rashidi
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA
| | - Jan Fritz
- Department of Radiology, NYU Grossman School of Medicine, New York, New York
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19
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Godoy IRB, Rodrigues TC, Zamariolli GDS, Dias GPDF, Yamada AF, Skaf AY. Imaging findings of lower limb involvement following COVID-19. BJR Case Rep 2022; 8:20210219. [PMID: 36211610 PMCID: PMC9518738 DOI: 10.1259/bjrcr.20210219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/21/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is known mainly by the severe acute respiratory syndrome, with myalgia as a common clinical symptom. Recent reports described musculoskeletal complications related to COVID-19 such as myositis, neuropathy and arthropathy. Radiologists and ordering physicians should be aware of lower limb complications following severe COVID-19 for optimal patient care.
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Affiliation(s)
- Ivan Rodrigues Barros Godoy
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil
- Department of Diagnostic Imaging, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | | | | | | | - André Fukunishi Yamada
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil
- Department of Diagnostic Imaging, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | - Abdalla Youssef Skaf
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
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20
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Al-Khudairi N, Dulay GS, Witham F. Covid-19 associated shoulder girdle calcific myositis: a novel entity. Br J Radiol 2022; 95:20220411. [PMID: 35867893 PMCID: PMC10996957 DOI: 10.1259/bjr.20220411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the prevalence, describe the radiological features, and consider the clinical sequelae of COVID-19- associated shoulder girdle calcific myositis. METHODS All patients who underwent a CT pulmonary angiogram study at our institution (Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom) in April and May 2020, January 2021, and July 2021 were included. A total of 1239 CT pulmonary angiogram studies for 1201 patients were reviewed. Patients with COVID-19 and associated shoulder girdle calcific myositis were identified. Their electronic patient records were reviewed. The patients' demographics, serum inflammatory markers, and proning history were recorded. RESULTS Of the 364 patients in Wave 1, 71 patients (19.5%) had COVID-19, and of those, 2 patients (2.8%) had shoulder girdle calcific myositis. Of the 521 patients in Wave 2, 354 patients (67.9%) had COVID-19, and of those, 3 patients (0.8%) had shoulder girdle calcific myositis. Of the 316 patients in Wave 3, 37 patients (11.7%) had COVID-19, and of those, 1 patient (2.7%) had shoulder girdle calcific myositis. The overall prevalence was 1.3%. The most common site of calcific myositis was within the subscapularis muscle. CONCLUSION COVID-19-associated shoulder girdle calcific myositis is a rare extrapulmonary musculoskeletal manifestation of COVID-19. Early recognition and increased awareness of this disease entity, in our experience, aids in reducing patient morbidity and improving long-term functional outcome. ADVANCES IN KNOWLEDGE We have reported a novel disease entity associated with COVID-19, in the form of shoulder girdle calcific myositis. We have described the common imaging features and discussed our experience of management and clinical sequelae.
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Affiliation(s)
- Naji Al-Khudairi
- Queen Alexandra Hospital, Portsmouth Hospitals University NHS
Trust, Portsmouth, United
Kingdom
| | - Gurdeep S Dulay
- Queen Alexandra Hospital, Portsmouth Hospitals University NHS
Trust, Portsmouth, United
Kingdom
| | - Fiona Witham
- Queen Alexandra Hospital, Portsmouth Hospitals University NHS
Trust, Portsmouth, United
Kingdom
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21
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Octavius GS, Wijaya JH, Tan AO, Muljono MP, Chandra S, Juliansen A. Autopsy findings of pediatric COVID-19: a systematic review. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022; 12:32. [PMID: 35855892 PMCID: PMC9281196 DOI: 10.1186/s41935-022-00288-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/26/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Little is known how COVID-19 is affecting children. Autopsies help gain an understanding of the pathophysiology of new and developing diseases. Numerous post-mortem studies had been conducted in adults with COVID-19, but few in children. Thereby, this systematic review aims to investigate the autopsy findings from pediatric COVID-19 patients. RESULTS There were a total of 15 patients from eight studies. COVID-19 mainly affects the heart and lungs. Pathology findings from the heart of COVID-19 pediatric patients include diffuse inflammatory infiltrate, myocarditis, cardiomyocyte necrosis, pericarditis, and interstitial edema. Histopathology abnormalities observed in the lungs are diffuse alveolar damage, cytopathic changes, thrombi in arterioles and septal capillaries, lung congestion, focal acute hemorrhage and edema, focal exudative changes, and mild pneumocyte hyperplasia. In addition, pathological findings from other organs, such as the liver, kidney, brain, bone marrow, lymph node, skin, spleen, muscle, colon, parotid gland, and adrenal of COVID-19 pediatric patients are also included in this review. CONCLUSION Cardiomyocyte necrosis, interstitial edema, lung congestion, and diffuse alveolar damage are the most significant pathologic findings of the heart and lung in pediatric COVID-19 patients. More studies are needed to elucidate the pathophysiology of SARS-CoV-2 in autopsy findings and to determine the exact cause of death since it could be related to COVID-19 or other comorbidities.
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Affiliation(s)
- Gilbert Sterling Octavius
- Department of Pediatrics, Faculty of Medicine, Universitas Pelita Harapan, MH Thmarin Boulevard 1100, Karawaci, Tangerang, Banten 15811 Indonesia
| | - Jeremiah Hilkiah Wijaya
- Department of Pediatrics, Faculty of Medicine, Universitas Pelita Harapan, MH Thmarin Boulevard 1100, Karawaci, Tangerang, Banten 15811 Indonesia
| | - Alexa Ovilia Tan
- Department of Pediatrics, Faculty of Medicine, Universitas Pelita Harapan, MH Thmarin Boulevard 1100, Karawaci, Tangerang, Banten 15811 Indonesia
| | - Michelle Patricia Muljono
- Department of Pediatrics, Faculty of Medicine, Universitas Pelita Harapan, MH Thmarin Boulevard 1100, Karawaci, Tangerang, Banten 15811 Indonesia
| | - Shally Chandra
- Department of Pediatrics, Faculty of Medicine, Universitas Pelita Harapan, MH Thmarin Boulevard 1100, Karawaci, Tangerang, Banten 15811 Indonesia
| | - Andry Juliansen
- Department of Pediatrics, Faculty of Medicine, Universitas Pelita Harapan, MH Thmarin Boulevard 1100, Karawaci, Tangerang, Banten 15811 Indonesia
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22
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Special Issue “COVID-19: Diagnostic Imaging and Beyond—Part II”. J Clin Med 2022; 11:jcm11133786. [PMID: 35807071 PMCID: PMC9267225 DOI: 10.3390/jcm11133786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 02/01/2023] Open
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23
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Ippolito D, Vernuccio F, Maino C, Cannella R, Giandola T, Ragusi M, Bigiogera V, Capodaglio C, Sironi S. Multiorgan Involvement in SARS-CoV-2 Infection: The Role of the Radiologist from Head to Toe. Diagnostics (Basel) 2022; 12:1188. [PMID: 35626344 PMCID: PMC9140872 DOI: 10.3390/diagnostics12051188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 01/08/2023] Open
Abstract
Radiology plays a crucial role for the diagnosis and management of COVID-19 patients during the different stages of the disease, allowing for early detection of manifestations and complications of COVID-19 in the different organs. Lungs are the most common organs involved by SARS-CoV-2 and chest computed tomography (CT) represents a reliable imaging-based tool in acute, subacute, and chronic settings for diagnosis, prognosis, and management of lung disease and the evaluation of acute and chronic complications. Cardiac involvement can be evaluated by using cardiac computed tomography angiography (CCTA), considered as the best choice to solve the differential diagnosis between the most common cardiac conditions: acute coronary syndrome, myocarditis, and cardiac dysrhythmia. By using compressive ultrasound it's possible to study the peripheral arteries and veins and to exclude the deep vein thrombosis, directly linked to the onset of pulmonary embolism. Moreover, CT and especially MRI can help to evaluate the gastrointestinal involvement and assess hepatic function, pancreas involvement, and exclude causes of lymphocytopenia, thrombocytopenia, and leukopenia, typical of COVID-19 patients. Finally, radiology plays a crucial role in the early identification of renal damage in COVID-19 patients, by using both CT and US. This narrative review aims to provide a comprehensive radiological analysis of commonly involved organs in patients with COVID-19 disease.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, PD, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Via del Vespro, 129, 90127 Palermo, PA, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro, 129, 90127 Palermo, PA, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
| | - Maria Ragusi
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
| | - Vittorio Bigiogera
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Carlo Capodaglio
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy
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24
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Deif MA, Mounir AM, Abo-Hedibah SA, Abdel Khalek AM, Elmokadem AH. Outcome of percutaneous drainage for septic complications coexisted with COVID-19. World J Radiol 2022; 14:91-103. [PMID: 35646292 PMCID: PMC9124979 DOI: 10.4329/wjr.v14.i4.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/13/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The resulting tissue hypoxia and increased inflammation secondary to severe coronavirus disease 2019 (COVID-19) combined with viral load, and other baseline risk factors contribute to an increased risk of severe sepsis or co-existed septic condition exaggeration.
AIM To describe the clinical, radiological, and laboratory characteristics of a small cohort of patients infected by severe acute respiratory syndrome coronavirus 2 who underwent percutaneous drainage for septic complications and their post-procedural outcomes.
METHODS This retrospective study consisted of 11 patients who were confirmed to have COVID-19 by RT-PCR test and required drain placement for septic complications. The mean age ± SD of the patients was 48.5 ± 14 years (range 30-72 years). Three patients underwent cholecystostomy for acute acalculous cholecystitis. Percutaneous drainage was performed in seven patients; two peripancreatic collections; two infected leaks after hepatic resection; one recurrent hepatic abscess, one psoas abscess and one lumbar abscess. One patient underwent a percutaneous nephrostomy for acute pyelonephritis.
RESULTS Technical success was achieved in 100% of patients, while clinical success was achieved in 4 out of 11 patients (36.3%). Six patients (54.5%) died despite proper percutaneous drainage and adequate antibiotic coverage. One patient (9%) needed operative intervention. Two patients (18.2%) had two drainage procedures to drain multiple fluid collections. Two patients (18.2%) had repeat drainage procedures due to recurrent fluid collections. The average volume of the drained fluid immediately after tube insertion was 85 mL. Follow-up scans show a reduction of the retained content and associated inflammatory changes after tube insertion in all patients. There was no significant statistical difference (P = 0.6 and 0.4) between the mean of WBCs and neutrophils count before drainage and seven days after drainage. The lymphocyte count shows significant increased seven days after drainage (P = 0.03).
CONCLUSION In this study, patients having septic complications associated with COVID-19 showed relatively poor clinical outcomes despite technically successful percutaneous drainage.
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Affiliation(s)
- Mohamed A Deif
- Department of Radiology, National Liver Institute, Menoufia University, Shibin Al Kawm 32521, Egypt
| | - Ahmad M Mounir
- Department of Radiology, Mansoura University, Mansoura 35516, Egypt
| | | | | | - Ali H Elmokadem
- Department of Radiology, Mansoura University, Mansoura 35516, Egypt
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25
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Ilieva E, Boyapati A, Chervenkov L, Gulinac M, Borisov J, Genova K, Velikova T. Imaging related to underlying immunological and pathological processes in COVID-19. World J Clin Infect Dis 2022; 12:1-19. [DOI: 10.5495/wjcid.v12.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/09/2021] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
The introduction of coronavirus disease-2019 (COVID-19) as a global pandemic has contributed to overall morbidity and mortality. With a focus on understanding the immunology and pathophysiology of the disease, these features can be linked with the respective findings of imaging studies. Thus, the constellation between clinical presentation, histological, laboratory, immunological, and imaging results is crucial for the proper management of patients. The purpose of this article is to examine the role of imaging during the particular stages of severe acute respiratory syndrome coronavirus 2 infection – asymptomatic stage, typical and atypical COVID-19 pneumonia, acute respiratory distress syndrome, multiorgan failure, and thrombosis. The use of imaging methods to assess the severity and duration of changes is crucial in patients with COVID-19. Radiography and computed tomography are among the methods that allow accurate characterization of changes.
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Affiliation(s)
- Elena Ilieva
- Department of Diagnostic Imaging, University Emergency Hospital (UMHATEM) "N. I. Pirogov”, Sofia 1606, Bulgaria
| | - Alexandra Boyapati
- Department of Diagnostic Imaging, University Emergency Hospital (UMHATEM) "N. I. Pirogov”, Sofia 1606, Bulgaria
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University, Plovdiv, University Hospital "St George", Plovdiv 4000, Bulgaria
| | - Milena Gulinac
- Department of General and Clinical Pathology, Medical University, Plovdiv, University Hospital "St George", Plovdiv 4000, Bulgaria
| | - Jordan Borisov
- Department of Diagnostic Imaging, MBAL-Dobrich” AD, Dobrich 9300, Bulgaria
| | - Kamelia Genova
- Department of Diagnostic Imaging, University Emergency Hospital (UMHATEM) "N. I. Pirogov”, Sofia 1606, Bulgaria
| | - Tsvetelina Velikova
- Department of Clinical Immunology, University Hospital “Lozenetz”, Sofia 1407, Bulgaria
- Medical Faculty, Sofia University “St. Kliment Ohridski”, Sofia 1407, Bulgaria
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Systemic Emergencies in COVID-19 Patient: A Pictorial Review. Tomography 2022; 8:1041-1051. [PMID: 35448718 PMCID: PMC9031887 DOI: 10.3390/tomography8020084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Since the first report of the outbreak in Wuhan, China in December 2019, as of 1 September 2021, the World Health Organization has confirmed more than 239 million cases of the novel coronavirus (SARS-CoV-2) infectious disease named coronavirus disease 2019 (COVID-19), with more than 4.5 million deaths. Although SARS-CoV-2 mainly involves the respiratory tract, it is considered to be a systemic disease. Imaging plays a pivotal role in the diagnosis of all manifestations of COVID-19 disease, as well as its related complications. The figure of the radiologist is fundamental in the management and treatment of the patient. The authors try to provide a systematic approach based on an imaging review of major multi-organ manifestations of this infection.
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Bhola S, Trisal J, Thakur V, Kaur P, Kulshrestha S, Bhatia SK, Kumar P. Neurological toll of COVID-19. Neurol Sci 2022; 43:2171-2186. [PMID: 35034236 PMCID: PMC8761097 DOI: 10.1007/s10072-022-05875-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/04/2022] [Indexed: 02/08/2023]
Abstract
The first case of coronavirus illness was discovered in Wuhan, China, in January 2020 and quickly spread worldwide within the next couple of months. The condition was initially only linked with respiratory disorders. After the evolution of various variants of the SARS-CoV-2, the critical impact of the virus spread to multiple organs and soon, neurological disorder manifestations started to appear in the infected patients. The review is focused on the manifestation of various neurological disorders linked with both the central nervous system and peripheral nervous system. Disorders such as cytokine release syndrome, encephalitis, acute stroke, and Bell's palsy are given specific attention and psychological manifestations are also investigated. For a clear conclusion, cognitive impairment, drug addiction disorders, mood and anxiety disorders, and post-traumatic stress disorder are all fully examined. The association of the SARS-CoV-2 with neurological disorders and pathway is yet to be clear. For better understanding, the explanation of the possible mechanism of viral infection influencing the nervous system is also attempted in the review. While several vaccines and drugs are already involved in treating the SARS-CoV-2 condition, the disease is still considered fatal and more likely to leave permanent neurological damage, which leads to an essential requirement for more research to explore the neurological toll of the COVID-19 disease.
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Affiliation(s)
- Shivam Bhola
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Jhillika Trisal
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Vikram Thakur
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin-160012, India
| | - Parneet Kaur
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Saurabh Kulshrestha
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Shashi Kant Bhatia
- Department of Biological Engineering, Konkuk University, Seoul, 05029, Republic of Korea
| | - Pradeep Kumar
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India.
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Brandi N, Ciccarese F, Rimondi MR, Balacchi C, Modolon C, Sportoletti C, Renzulli M, Coppola F, Golfieri R. An Imaging Overview of COVID-19 ARDS in ICU Patients and Its Complications: A Pictorial Review. Diagnostics (Basel) 2022; 12:846. [PMID: 35453894 PMCID: PMC9032937 DOI: 10.3390/diagnostics12040846] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
A significant proportion of patients with COVID-19 pneumonia could develop acute respiratory distress syndrome (ARDS), thus requiring mechanical ventilation, and resulting in a high rate of intensive care unit (ICU) admission. Several complications can arise during an ICU stay, from both COVID-19 infection and the respiratory supporting system, including barotraumas (pneumothorax and pneumomediastinum), superimposed pneumonia, coagulation disorders (pulmonary embolism, venous thromboembolism, hemorrhages and acute ischemic stroke), abdominal involvement (acute mesenteric ischemia, pancreatitis and acute kidney injury) and sarcopenia. Imaging plays a pivotal role in the detection and monitoring of ICU complications and is expanding even to prognosis prediction. The present pictorial review describes the clinicopathological and radiological findings of COVID-19 ARDS in ICU patients and discusses the imaging features of complications related to invasive ventilation support, as well as those of COVID-19 itself in this particularly fragile population. Radiologists need to be familiar with COVID-19's possible extra-pulmonary complications and, through reliable and constant monitoring, guide therapeutic decisions. Moreover, as more research is pursued and the pathophysiology of COVID-19 is increasingly understood, the role of imaging must evolve accordingly, expanding from the diagnosis and subsequent management of patients to prognosis prediction.
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Affiliation(s)
- Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Federica Ciccarese
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Maria Rita Rimondi
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Caterina Balacchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Cecilia Modolon
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Camilla Sportoletti
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Francesca Coppola
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, Via della Signora 2, 20122 Milano, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
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29
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Assessment of Gastrointestinal Symptoms and Dyspnea in Patients Hospitalized due to COVID-19: Contribution to Clinical Course and Mortality. J Clin Med 2022; 11:jcm11071821. [PMID: 35407430 PMCID: PMC8999487 DOI: 10.3390/jcm11071821] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 01/08/2023] Open
Abstract
Gastrointestinal manifestations may accompany the respiratory symptoms of COVID-19. Abdominal pain (AP) without nausea and vomiting is one of the most common. To date, its role and prognostic value in patients with COVID-19 is still debated. Therefore, we performed a retrospective analysis of 2184 individuals admitted to hospital due to COVID-19. We divided the patients into four groups according to presented symptoms: dyspnea, n = 871 (39.9%); AP, n = 97 (4.4%); AP with dyspnea together, n = 50 (2.3%); and patients without dyspnea and AP, n = 1166 (53.4%). The patients with AP showed tendency to be younger than these with dyspnea, but without AP (63.0 [38.0−70.0] vs. 65.0 [52.0−74.0] years, p = 0.061), and they were more often females as compared to patients with dyspnea (57.7% vs. 44.6%, p = 0.013, for females). Patients with AP as a separate sign of COVID-19 significantly less often developed pneumonia as compared to individuals with dyspnea or with dyspnea and AP together (p < 0.0001). Patients with AP or AP with dyspnea were significantly less frequently intubated or transferred to the intensive care unit (p = 0.003 and p = 0.031, respectively). Individuals with AP alone or with dyspnea had significantly lower rate of mortality as compared to patients with dyspnea (p = 0.003). AP as a separate symptom and also as a coexisting sign with dyspnea does not predispose the patients with COVID-19 to the worse clinical course and higher mortality.
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30
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dos Santos PK, Sigoli E, Bragança LJ, Cornachione AS. The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection. Front Physiol 2022; 13:813924. [PMID: 35492595 PMCID: PMC9040683 DOI: 10.3389/fphys.2022.813924] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, has been drastically affecting the daily lives of millions of people. COVID-19 is described as a multiorgan disease that affects not only the respiratory tract of infected individuals, but it has considerable effects on the musculoskeletal system, causing excessive fatigue, myalgia, arthralgia, muscle weakness and skeletal muscle damage. These symptoms can persist for months, decreasing the quality of life of numerous individuals. Curiously, most studies in the scientific literature focus on patients who were hospitalized due to SARS-CoV-2 infection and little is known about the mechanism of action of COVID-19 on skeletal muscles, especially of individuals who had the mild to moderate forms of the disease (non-hospitalized patients). In this review, we focus on the current knowledge about the musculoskeletal system in COVID-19, highlighting the lack of researches investigating the mild to moderate cases of infection and pointing out why it is essential to care for these patients. Also, we will comment about the need of more experimental data to assess the musculoskeletal manifestations on COVID-19-positive individuals.
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Affiliation(s)
- Patty K. dos Santos
- Muscle Physiology and Biophysics Laboratory, Department of Physiological Sciences, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| | | | | | - Anabelle S. Cornachione
- Muscle Physiology and Biophysics Laboratory, Department of Physiological Sciences, Federal University of São Carlos (UFSCar), São Carlos, Brazil
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31
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Hwang M, Tierradentro-García LO, Haddad S, Poznick L, Kilbaugh T, Chiotos K. Feasibility of Contrast-Enhanced Ultrasound for Assessing Cardiac and Renal Microvascular Flow in Patients With Multisystem Inflammatory Syndrome in Children. Clin Pediatr (Phila) 2022; 61:241-247. [PMID: 35081803 DOI: 10.1177/00099228211073288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Misun Hwang
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania Health System, Philadelphia, PA, USA
| | | | - Sophie Haddad
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura Poznick
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Todd Kilbaugh
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Kathleen Chiotos
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania Health System, Philadelphia, PA, USA
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32
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Patel Z, Franz CK, Bharat A, Walter JM, Wolfe LF, Koralnik IJ, Deshmukh S. Diaphragm and Phrenic Nerve Ultrasound in COVID-19 Patients and Beyond: Imaging Technique, Findings, and Clinical Applications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:285-299. [PMID: 33772850 PMCID: PMC8250472 DOI: 10.1002/jum.15706] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/03/2021] [Accepted: 03/13/2021] [Indexed: 05/23/2023]
Abstract
The diaphragm, the principle muscle of inspiration, is an under-recognized contributor to respiratory disease. Dysfunction of the diaphragm can occur secondary to lung disease, prolonged ventilation, phrenic nerve injury, neuromuscular disease, and central nervous system pathology. In light of the global pandemic of coronavirus disease 2019 (COVID-19), there has been growing interest in the utility of ultrasound for evaluation of respiratory symptoms including lung and diaphragm sonography. Diaphragm ultrasound can be utilized to diagnose diaphragm dysfunction, assess severity of dysfunction, and monitor disease progression. This article reviews diaphragm and phrenic nerve ultrasound and describes clinical applications in the context of COVID-19.
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Affiliation(s)
- Zaid Patel
- AMITA Health Saint Francis HospitalEvanstonIllinoisUSA
| | - Colin K. Franz
- Shirley Ryan Ability Lab (Formerly the Rehabilitation Institute of Chicago)ChicagoIllinoisUSA
- Department of Physical Medicine and RehabilitationNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Division of Pulmonary and Critical Care, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - James M. Walter
- Division of Pulmonary and Critical Care, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Lisa F Wolfe
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Division of Pulmonary and Critical Care, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Igor J. Koralnik
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Swati Deshmukh
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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33
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Romeih M, Mahrous MR, El Kassas M. Incidental radiological findings suggestive of COVID-19 in asymptomatic patients. World J Radiol 2022; 14:1-12. [PMID: 35126873 PMCID: PMC8788167 DOI: 10.4329/wjr.v14.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/09/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Despite routine screening of patients for coronavirus disease 2019 (COVID-19) symptoms and signs at hospital entrances, patients may slip between the cracks and be incidentally discovered to have lung findings that could indicate COVID-19 infection on imaging obtained for other reasons. Multiple case reports and case series have been published to identify the pattern of this highly infectious disease. This article addresses the radiographic findings in different imaging modalities that may be incidentally seen in asymptomatic patients who carry COVID-19. In general, findings of COVID-19 infection may appear in computed tomography (CT), magnetic resonance imaging, positron emission tomography-CT, ultrasound, or plain X-rays that show lung or only apical or basal cuts. The identification of these characteristics by radiologists and clinicians is crucial because this would help in the early recognition of cases so that a rapid treatment protocol can be established, the immediate isolation to reduce community transmission, and the organization of close monitoring. Thus, it is important to both the patient and the physician that these findings are highlighted and reported.
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Affiliation(s)
- Marwa Romeih
- Department of Radiodiagnosis, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Mary R Mahrous
- Department of Radiodiagnosis, National Heart institute, Cairo 11795, Egypt
| | - Mohamed El Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
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34
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Alkhotani AM, AlSindi TS, Alqurashi AA, Masarit RM, Gazzaz RT, Saggat RZ, Halawani MA. Public awareness of the neurological manifestation of COVID-19 in Saudi Arabia. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2022; 27:10-15. [PMID: 35017285 PMCID: PMC9037562 DOI: 10.17712/nsj.2022.1.20210089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/20/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess awareness of the neurological manifestation of COVID-19 on the Saudi population. METHODS This was a cross-sectional study conducted using a Google Form survey to obtain responses randomly from the Saudi population between February and March 2021 using social media. RESULTS A total of 831 participants completed the questionnaire. The distribution of the identified isolated neurological manifestations of COVOD-19 infections by participants' age was assessed among the respondents. Loss of smell (88.9%), loss of taste (86.8%), and headache (72.6%) were the most identified first manifestations among all the age groups, while stroke (13.4%) was the least identified for all ages with no statistical significance (p>0.05 for all). Regarding COVID-19 related neurological symptoms, the same was reported: loss of smell, taste, and headache were the most identified symptoms among all the age groups, while stroke was the least identified for all ages with no statistical significance (p>0.05 for all). CONCLUSION The study concluded that awareness of COVID-19's neurological symptoms could help detect an atypical case, which can help in early intervention and its medical treatment. Moreover, the study also suggested conducting educational programs that emphasize the early identification of neurological symptoms of COVID-19.
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Affiliation(s)
- Amal M Alkhotani
- From the Department of Medicine (Alkhotani), Umm AlQura University, from Faculty of Medicine (AlSindi, Alqurashi, Masarit, Gazzaz, Saggat, Halawani), Umm AlQura University, Makkah, Kingdom of Saudi Arabia
| | - Tala S AlSindi
- From the Department of Medicine (Alkhotani), Umm AlQura University, from Faculty of Medicine (AlSindi, Alqurashi, Masarit, Gazzaz, Saggat, Halawani), Umm AlQura University, Makkah, Kingdom of Saudi Arabia
| | - Atheer A Alqurashi
- From the Department of Medicine (Alkhotani), Umm AlQura University, from Faculty of Medicine (AlSindi, Alqurashi, Masarit, Gazzaz, Saggat, Halawani), Umm AlQura University, Makkah, Kingdom of Saudi Arabia
| | - Roaa M Masarit
- From the Department of Medicine (Alkhotani), Umm AlQura University, from Faculty of Medicine (AlSindi, Alqurashi, Masarit, Gazzaz, Saggat, Halawani), Umm AlQura University, Makkah, Kingdom of Saudi Arabia
| | - Ruba T Gazzaz
- From the Department of Medicine (Alkhotani), Umm AlQura University, from Faculty of Medicine (AlSindi, Alqurashi, Masarit, Gazzaz, Saggat, Halawani), Umm AlQura University, Makkah, Kingdom of Saudi Arabia
| | - Renad Z Saggat
- From the Department of Medicine (Alkhotani), Umm AlQura University, from Faculty of Medicine (AlSindi, Alqurashi, Masarit, Gazzaz, Saggat, Halawani), Umm AlQura University, Makkah, Kingdom of Saudi Arabia
| | - Mayar A Halawani
- From the Department of Medicine (Alkhotani), Umm AlQura University, from Faculty of Medicine (AlSindi, Alqurashi, Masarit, Gazzaz, Saggat, Halawani), Umm AlQura University, Makkah, Kingdom of Saudi Arabia
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35
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Bezerra CS, Leite AA, da Costa TR, Lins EM, Godoi ETAM, Cordeiro LHDO, Raposo MCF, Brandão SCS. Ultrasound findings in severe COVID-19: a deeper look through the carotid arteries. Radiol Bras 2022; 55:329-336. [PMID: 36514683 PMCID: PMC9743257 DOI: 10.1590/0100-3984.2022.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/25/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate vascular and perivascular abnormalities in the carotid arteries using ultrasound, as well as to evaluate their association with mortality and clinical variables in hospitalized patients with coronavirus disease 2019 (COVID-19). Materials and Methods This was a prospective study in which 53 hospitalized patients with severe COVID-19 were evaluated and underwent carotid ultrasound. We documented the carotid ultrasound findings in these patients. Clinical, demographic, laboratory, and imaging features were analyzed and compared by statistical analysis to detect correlations between them. Results Carotid ultrasound demonstrated luminal surface irregularity in 29 patients (55%), carotid plaques in 30 (57%), perivascular infiltration in four (8%), and increased intima-media thickness (IMT) in 31 (58%). Of the 31 patients with increased IMT, 19 (61%) died, and the association between increased IMT and COVID-19-related mortality was significant (p = 0.03). Logistic regression showed that the risk of death was 85% in patients who had increased IMT in combination with acute kidney injury at admission or a history of chronic kidney disease (p < 0.05). Conclusion In hospitalized patients with severe COVID-19, carotid ultrasound can show increased IMT, luminal surface irregularity, carotid plaques, and perivascular infiltrates. The combination of increased IMT and kidney damage appears to increase the risk of death in such patients.
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Affiliation(s)
- Camila Silva Bezerra
- Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil. , Instituto de Medicina Integral Professor Fernando Figueira (IMIP),
Recife, PE, Brazil. , Faculdade Pernambucana de Saúde, Recife, PE, Brazil. ,Correspondence: Correspondence: Dra. Camila Silva Bezerra. Programa
de Pós-Graduação em Cirurgia – Universidade Federal de
Pernambuco (PPGC-UFPE), Hospital das Clínicas, Campus UFPE. Avenida
Professor Moraes Rego, s/nº, Bloco A, Cidade Universitária. Recife, PE,
Brazil, 50670-420. ;
| | - Alice Abath Leite
- Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil. , Instituto de Medicina Integral Professor Fernando Figueira (IMIP),
Recife, PE, Brazil. , Faculdade Pernambucana de Saúde, Recife, PE, Brazil.
| | - Thaís Ramos da Costa
- Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil. , Instituto de Medicina Integral Professor Fernando Figueira (IMIP),
Recife, PE, Brazil. , Hospital Barão de Lucena, Recife, PE, Brazil.
| | - Esdras Marques Lins
- Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil. , Instituto de Medicina Integral Professor Fernando Figueira (IMIP),
Recife, PE, Brazil. , Faculdade Pernambucana de Saúde, Recife, PE, Brazil.
| | | | | | | | - Simone Cristina Soares Brandão
- Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil. , Hospital das Clínicas da Universidade Federal de Pernambuco
(HC-UFPE), Recife, PE, Brazil.
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Cárdenas G, Salgado P, Laura-Foronda E, Popoca-Rodriguez I, Delgado-Hernández RD, Rojas R, Palacios E. Neglected and (re-)emergent infections of the CNS i n low-/middle-income countries. LE INFEZIONI IN MEDICINA 2021; 29:513-525. [PMID: 35146359 PMCID: PMC8805465 DOI: 10.53854/liim-2904-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
Low- and middle-income countries (LMIC) have suffered from long-term health system deficiencies, worsened by poor living conditions, lack of sanitation, a restricted access to health facilities and running water, overcrowding, and overpopulation. These factors favor human displacement and deepen marginalization; consequently, their population endures a high burden of infectious diseases. In this context, the current epidemiological landscape and its impact on health and economic development are not promissory, despite the commitment by the international community to eradicate neglected tropical infections - especially tuberculosis and malaria, by 2030. Neglected and (re)-emerging infectious diseases affecting the central nervous system (CNS) are a major public health concern in these countries, as they cause a great morbidity and mortality; furthermore, survivors often suffer from severe neurological disabilities. Herein, we present a retrospective review focused on some neglected and (re)-emerging infectious diseases, including neurocysticercosis, malaria, rabies, West Nile virus encephalitis, tuberculosis, neuroborreliosis, and SARS-CoV-2 in LMIC. A retrospective review of studies on selected neglected and (re)-emerging infectious diseases in LMIC was performed, including reports by the World Health Organization (WHO) published within the last five years. Data on infection by SARS-CoV-2 were provided by the John Hopkins University Coronavirus Resource Center. CNS neglected and (re)-emerging infectious diseases remain as important causes of disease in LMIC. An alarming increase in the prevalence of malaria, tuberculosis, and cysticercosis is observed in the region, compounded by the recent COVID-19 pandemic. The WHO is currently supporting programs/efforts to cope with these diseases. Herein, we highlight the epidemiological burden of some CNS infections in LMIC, and their clinical and neuroimaging features, to facilitate an accurate diagnosis, considering that most of these diseases will not be eradicated in the short term; instead, their incidence will likely increase along with poverty, inequality, and related socioeconomic problems.
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Affiliation(s)
- Graciela Cárdenas
- Neuro-infectious Diseases Department, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Perla Salgado
- Neuroimaging Department, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Enrique Laura-Foronda
- Neuro-infectious Diseases Department, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Ignacio Popoca-Rodriguez
- Neuro-infectious Diseases Department, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | | | - Rafael Rojas
- Neuroimaging Department, The Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusett, USA
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Saleh RA, Shaban E. COVID-19 neurological manifestations: correlation of cerebral MRI imaging and lung imaging—Observational study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC8488926 DOI: 10.1186/s43055-021-00630-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background During the current pandemic, there is an increased incidence of neurologic/neuropsychiatric manifestations in patients with the novel coronavirus (COVID-19). Neurologic manifestations may be coincident or result of disease and its therapy. In the emergency department, orientation of the clinician with this issue is crucial for accurate decision making to limit the spread of infection during neurologic treatment. This study aimed to be familiar with MRI findings in patients with Neuro-COVID. Seventy patients presented with neurologic/neuropsychiatric manifestation either post COVID or during hospitalization underwent cerebral MRI from April 2020 to June 2021 (39 men and 31women; mean age 43.27, age range from 16 to 69 years). Results Headache (80%), is the most prevalent neurological manifestations followed by smell and taste impairment (62.9%) and stroke symptoms (45.7%). Low mood and anxiety (17.1%), prolonged fatigue (14.3%) and depression (7.1%) are the most common psychiatric symptoms. Infarctions, hematoma and demyelinating disease are the most prevalent findings. There is a week positive correlation between MRI findings and CT chest finding but without statistical significance (P-value 0.2). Conclusions Cerebrovascular disease and demyelinating lesions are common manifestations of COVID 19. Familiarity of neurologists and radiologist in the emergency department and in-patient with this issue is crucial to avoid misdiagnosis and the spread of infection.
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Fajar JK, Ilmawan M, Mamada SS, Mutiawati E, Husnah M, Yusuf H, Nainu F, Sirinam S, Keam S, Ophinni Y, Rosiello F, Fahriani M, Rosa SGV. Global prevalence of persistent neuromuscular symptoms and the possible pathomechanisms in COVID-19 recovered individuals: A systematic review and meta-analysis. NARRA J 2021; 1:e48. [PMID: 38450213 PMCID: PMC10914045 DOI: 10.52225/narra.v1i3.48] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/26/2021] [Indexed: 02/05/2023]
Abstract
This study was conducted to determine the prevalence of prolonged neuromuscular symptoms, including fatigue, anosmia, headache, myalgia, and joint pain in COVID-19 survivors hospitalized with mild, moderate, or severe infections worldwide. The search was conducted up to January 30th, 2021 using three databases (PubMed, Scopus, and Web of Science) to identify potentially eligible studies. Data on study characteristics, follow-up characteristics, and severity of COVID-19 during hospitalization were collected in accordance with PRISMA guidelines. The Newcastle-Ottawa scale was used to assess the quality of relevant articles. The estimated prevalence of specific prolonged neuromuscular symptoms and the association between COVID-19 severity and occurrence of prolonged neuromuscular symptoms was analyzed wherever appropriate. Database search yielded 4,050 articles and 22 articles were included for meta-analysis. The estimated prevalence of prolonged fatigue was recorded in 21.2% (95%CI: 11.9%- 34.8%) of 3,730 COVID-19 survivors. Persistent anosmia was recorded in 239 of 2,600 COVID-19 survivors (9.7%, 95%CI: 6.1%-15.2%). In 84 out of 2,412 COVID-19 survivors (8.9%, 95%CI: 3.2%-22.6%), prolonged headache was observed. A total of 53 out of 1,125 COVID-19 patients (5.6%, 95%CI: 2.1%-14.2%) complained of persistent myalgia even after being discharged from the hospital. The prevalence of prolonged joint pain was in 15.4% (95%CI: 8.2%-27.2%) of subjects. Due to data scarcity on COVID-19 severity and prolonged neuromuscular symptoms, association analysis could not be conducted. Widespread concern regarding long-term impacts of COVID-19 was raised after several studies reported prolonged symptoms in COVID-19 survivors. Numerous theories have been proposed to address this concern; however, as the research on this pandemic is still ongoing, no explanation is definitive yet. Therefore, follow-up studies in COVID-19 survivors after recovery from COVID-19 are warranted to determine the pathogenesis of prolonged symptoms. PROSPERO registration: CRD42021242332.
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Affiliation(s)
- Jonny K Fajar
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | | | - Sukamto S Mamada
- Faculty of Pharmacy, Hasanuddin University, Tamalanrea, Makassar, Indonesia
| | - Endang Mutiawati
- Department of Neurology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Milda Husnah
- Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Hanifah Yusuf
- Department of Pharmacology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Firzan Nainu
- Faculty of Pharmacy, Hasanuddin University, Tamalanrea, Makassar, Indonesia
| | - Salin Sirinam
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Synat Keam
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Youdiil Ophinni
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Harvard University, Cambridge, MA, USA
- Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Francesco Rosiello
- Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy
| | - Marhami Fahriani
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Sandro G V Rosa
- Diretoria de Patentes, Divisão De Farmácia - Instituto Nacional Da Propriedade Industrial, Rio de Janeiro, Brasil
- Programa De Pós-Graduação Em Ciências Aplicadas a Produtos Para Saúde, Faculdade De Farmácia, Universidade Federal Fluminense, Brasil
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Kanmaniraja D, Kurian J, Holder J, Gunther MS, Chernyak V, Hsu K, Lee J, Mcclelland A, Slasky SE, Le J, Ricci ZJ. Review of COVID-19, part 1: Abdominal manifestations in adults and multisystem inflammatory syndrome in children. Clin Imaging 2021; 80:88-110. [PMID: 34298343 PMCID: PMC8223038 DOI: 10.1016/j.clinimag.2021.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/23/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID -19) pandemic caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has affected almost every country in the world, resulting in severe morbidity, mortality and economic hardship, and altering the landscape of healthcare forever. Although primarily a pulmonary illness, it can affect multiple organ systems throughout the body, sometimes with devastating complications and long-term sequelae. As we move into the second year of this pandemic, a better understanding of the pathophysiology of the virus and the varied imaging findings of COVID-19 in the involved organs is crucial to better manage this complex multi-organ disease and to help improve overall survival. This manuscript provides a comprehensive overview of the pathophysiology of the virus along with a detailed and systematic imaging review of the extra-thoracic manifestation of COVID-19 with the exception of unique cardiothoracic features associated with multisystem inflammatory syndrome in children (MIS-C). In Part I, extra-thoracic manifestations of COVID-19 in the abdomen in adults and features of MIS-C will be reviewed. In Part II, manifestations of COVID-19 in the musculoskeletal, central nervous and vascular systems will be reviewed.
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Affiliation(s)
- Devaraju Kanmaniraja
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Jessica Kurian
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Justin Holder
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Molly Somberg Gunther
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Victoria Chernyak
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Kevin Hsu
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Jimmy Lee
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Andrew Mcclelland
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Shira E Slasky
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America
| | - Jenna Le
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Zina J Ricci
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
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Patel RK, Chandel K, Mittal S, Tripathy T. Abdominal Computed Tomography Findings among COVID-19 Patients with Index Gastrointestinal Manifestations: A Preliminary Single-center Experience. Euroasian J Hepatogastroenterol 2021; 11:76-80. [PMID: 34786360 PMCID: PMC8566161 DOI: 10.5005/jp-journals-10018-1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background About 20% of COVID-19 patients can have digestive symptoms, apart from the typical chest-related symptoms, and 10% of patients may have only gastrointestinal (GI) symptoms during their entire disease course. Aim and objective The purpose of this study was to describe the spectrum of abdominal computed tomographic (CT) findings in a cohort of 15 COVID-19 patients (confirmed on reverse transcription polymerase chain reaction (RT-PCR)) who presented with various GI presentations without preceding respiratory symptoms. Materials and methods A total of 93 patients with COVID-19 (confirmed on RT-PCR) who underwent CT imaging (between September 28, 2020 and March 20, 2021) in our center were retrospectively searched from the existing database. Among those, 15 patients having index presentation with abdominal symptoms and underwent CT abdomen were further evaluated. Results Biliary stasis in the form of distended gallbladder and wall thickening was the most common finding, seen in 66.7% (n = 10) patients, followed by bowel wall thickening. Small bowel and large bowel thickenings were seen in 26.7% (n = 4) and 20% (n = 3) patients, respectively. Other findings include fluid-filled colon (n = 1), mesenteric venous thrombosis (MVT) (n = 2), paper-thin bowel wall and pneumatosis (n = 1), acute pancreatitis (n = 1), and ascites (n = 2). One patient who presented with abdominal pain did not show any obvious imaging findings on CT. Conclusion Patients with COVID-19 can present with initial GI symptoms preceding typical respiratory symptoms. CT imaging helps in identifying the GI involvement, to rule out alternate etiologies, and also aids in appropriate management planning. How to cite this article Patel RK, Chandel K, Mittal S, et al. Abdominal Computed Tomography Findings among COVID-19 Patients with Index Gastrointestinal Manifestations: A Preliminary Single-center Experience. Euroasian J Hepato-Gastroenterol 2021;11(2):76–80.
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Affiliation(s)
- Ranjan K Patel
- Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Shruti Mittal
- Institute of Liver and Biliary Sciences, New Delhi, India
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Mogensen MA, Wangaryattawanich P, Hartman J, Filippi CG, Hippe DS, Cross NM. Special report of the RSNA COVID-19 task force: systematic review of outcomes associated with COVID-19 neuroimaging findings in hospitalized patients. Br J Radiol 2021; 94:20210149. [PMID: 33914618 PMCID: PMC8553187 DOI: 10.1259/bjr.20210149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We reviewed the literature to describe outcomes associated with abnormal neuroimaging findings among adult COVID-19 patients. METHODS We performed a systematic literature review using PubMed and Embase databases. We included all studies reporting abnormal neuroimaging findings among hospitalized patients with confirmed COVID-19 and outcomes. Data elements including patient demographics, neuroimaging findings, acuity of neurological symptoms and/or imaging findings relative to COVID-19 onset (acute, subacute, chronic), and patient outcomes were recorded and summarized. RESULTS After review of 775 unique articles, a total of 39 studies comprising 884 COVID-19 patients ≥ 18 years of age with abnormal neuroimaging findings and reported outcomes were included in our analysis. Ischemic stroke was the most common neuroimaging finding reported (49.3%, 436/884) among patients with mortality outcomes data. Patients with intracranial hemorrhage (ICH) had the highest all-cause mortality (49.7%, 71/143), followed by patients with imaging features consistent with leukoencephalopathy (38.5%, 5/13), and ischemic stroke (30%, 131/436). There was no mortality reported among COVID-19 patients with acute disseminated encephalomyelitis without necrosis (0%, 0/8) and leptomeningeal enhancement alone (0%, 0/12). Stroke was a common acute or subacute neuroimaging finding, while leukoencephalopathy was a common chronic finding. CONCLUSION Among hospitalized COVID-19 patients with abnormal neuroimaging findings, those with ICH had the highest all-cause mortality; however, high mortality rates were also seen among COVID-19 patients with ischemic stroke in the acute/subacute period and leukoencephalopathy in the chronic period. ADVANCES IN KNOWLEDGE Specific abnormal neuroimaging findings may portend differential mortality outcomes, providing a potential prognostic marker for hospitalized COVID-19 patients.
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Affiliation(s)
- Monique A Mogensen
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | | | - Jason Hartman
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Christopher G Filippi
- Department of Radiology, Tufts University School of Medicine, Boston, MA, United States
| | - Daniel S Hippe
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Nathan M Cross
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
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Gulsin GS, McVeigh N, Leipsic JA, Dodd JD. Cardiovascular CT and MRI in 2020: Review of Key Articles. Radiology 2021; 301:263-277. [PMID: 34491130 DOI: 10.1148/radiol.2021211002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite the global coronavirus pandemic, cardiovascular imaging continued to evolve throughout 2020. It was an important year for cardiac CT and MRI, with increasing prominence in cardiovascular research, use in clinical decision making, and in guidelines. This review summarizes key publications in 2020 relevant to current and future clinical practice. In cardiac CT, these have again predominated in assessment of patients with chest pain and structural heart diseases, although more refined CT techniques, such as quantitative plaque analysis and CT perfusion, are also maturing. In cardiac MRI, the major developments have been in patients with cardiomyopathy and myocarditis, although coronary artery disease applications remain well represented. Deep learning applications in cardiovascular imaging have continued to advance in both CT and MRI, and these are now closer than ever to routine clinical adoption. Perhaps most important has been the rapid deployment of MRI in enhancing understanding of the impact of COVID-19 infection on the heart. Although this review focuses primarily on articles published in Radiology, attention is paid to other leading journals where published CT and MRI studies will have the most clinical and scientific value to the practicing cardiovascular imaging specialist.
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Affiliation(s)
- Gaurav S Gulsin
- From the Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, Canada (G.S.G., J.A.L.); Department of Cardiovascular Sciences, University of Leicester and the Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, England (G.S.G.); Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (N.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (J.D.D.)
| | - Niall McVeigh
- From the Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, Canada (G.S.G., J.A.L.); Department of Cardiovascular Sciences, University of Leicester and the Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, England (G.S.G.); Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (N.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (J.D.D.)
| | - Jonathon A Leipsic
- From the Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, Canada (G.S.G., J.A.L.); Department of Cardiovascular Sciences, University of Leicester and the Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, England (G.S.G.); Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (N.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (J.D.D.)
| | - Jonathan D Dodd
- From the Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, Canada (G.S.G., J.A.L.); Department of Cardiovascular Sciences, University of Leicester and the Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, England (G.S.G.); Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (N.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (J.D.D.)
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Gross A, Albrecht T. One year of COVID-19 pandemic: what we Radiologists have learned about imaging. ROFO-FORTSCHR RONTG 2021; 194:141-151. [PMID: 34649291 DOI: 10.1055/a-1522-3155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Since its outbreak in December 2019, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected more than 151 million people worldwide. More than 3.1 million have died from Coronavirus Disease 2019 (COVID-19), the illness caused by SARS-CoV-2. The virus affects mainly the upper respiratory tract and the lungs causing pneumonias of varying severity. Moreover, via direct and indirect pathogenetic mechanisms, SARS-CoV-2 may lead to a variety of extrapulmonary as well as vascular manifestations. METHODS Based on a systematic literature search via PubMed, original research articles, meta-analyses, reviews, and case reports representing the current scientific knowledge regarding diagnostic imaging of COVID-19 were selected. Focusing on the imaging appearance of pulmonary and extrapulmonary manifestations as well as indications for imaging, these data were summarized in the present review article and correlated with basic pathophysiologic mechanisms. RESULTS AND CONCLUSION Typical signs of COVID-19 pneumonia are multifocal, mostly bilateral, rounded, polycyclic or geographic ground-glass opacities and/or consolidations with mainly peripheral distribution. In severe cases, peribronchovascular lung zones are affected as well. Other typical signs are the "crazy paving" pattern and the halo and reversed halo (the latter two being less common). Venous thromboembolism (and pulmonary embolism in particular) is the most frequent vascular complication of COVID-19. However, arterial thromboembolic events like ischemic strokes, myocardial infarctions, and systemic arterial emboli also occur at higher rates. The most frequent extrapulmonary organ manifestations of COVID-19 affect the central nervous system, the heart, the hepatobiliary system, and the gastrointestinal tract. Usually, they can be visualized in imaging studies as well. The most important imaging modality for COVID-19 is chest CT. Its main purpose is not to make the primary diagnosis, but to differentiate COVID-19 from other (pulmonary) pathologies, to estimate disease severity, and to detect concomitant diseases and complications. KEY POINTS · Typical signs of COVID-19 pneumonia are multifocal, mostly peripheral ground-glass opacities/consolidations.. · Imaging facilitates differential diagnosis, estimation of disease severity, and detection of complications.. · Venous thromboembolism (especially pulmonary embolism) is the predominant vascular complication of COVID-19.. · Arterial thromboembolism (e. g., ischemic strokes, myocardial infarctions) occurs more frequently as well.. · The most common extrapulmonary manifestations affect the brain, heart, hepatobiliary system, and gastrointestinal system.. CITATION FORMAT · Gross A, Albrecht T. One year of COVID-19 pandemic: what we Radiologists have learned about imaging. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1522-3155.
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Affiliation(s)
- Alexander Gross
- Radiology and Interventional Therapy, Vivantes-Klinikum Neukölln, Berlin, Germany
| | - Thomas Albrecht
- Radiology and Interventional Therapy, Vivantes-Klinikum Neukölln, Berlin, Germany
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Neves TR, Lourenço AL, Alves P, Teiga C, Caetano AP. Bilateral shoulder arthritis in COVID-19 patient after prolonged mechanical ventilation assist: a case report. Radiol Case Rep 2021; 16:2894-2898. [PMID: 34367388 PMCID: PMC8325760 DOI: 10.1016/j.radcr.2021.06.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
Prolonged immobilization and, in particular, mechanical ventilation, have been linked to muscle atrophy. Anecdotal reports in the literature describe rhabdomyolysis as a potential late complication of COVID-19 infection which, in severe cases, may coexist with fluid collections. We report a case of a 28-year-old patient that had been recently hospitalized with SARS-CoV-2 pneumonia, with need for invasive ventilation support. Days after being discharged, the patient presents with retrosternal thoracalgia irradiating to the left upper limb. On physical examination, abduction and external rotation were limited due to pain complaints and there was soft tissue swelling of the corresponding shoulder and arm. Imaging evaluation was essential to establish the underlying condition, revealing bilateral arthritis communicating with large rotator cuff collections, which was considered of septic nature.
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Affiliation(s)
- Teresa Resende Neves
- Radiology Department, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Luísa Lourenço
- Radiology Department, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
| | - Pedro Alves
- Radiology Department, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
| | - Carlos Teiga
- Radiology Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
| | - António Proença Caetano
- Radiology Department, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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Abohamr SI, Abdulrahim AE, Hussein NM, Elsheikh E, ALhindi DA, Saadeddin HM, Abazid RM. Multimodality imaging in COVID19 patient with large mobile RV thrombus protruding into the pulmonary trunk with bilateral pulmonary embolism. J Cardiol Cases 2021; 24:215-217. [PMID: 34518773 PMCID: PMC8426289 DOI: 10.1016/j.jccase.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/08/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022] Open
Abstract
Inflammation related to coronavirus disease (COVID)-19 can promote a pro-thrombotic process and subsequent thrombosis. We report a confirmed COVID-19 case in a 51-year-old patient who presented with chest pain and severe hypoxemia. Although the right heart chambers are unusual locations for a thrombus, an echocardiogram demonstrated a large mobile right ventricular thrombus protruding into the right ventricle outflow tract. A computed tomography angiogram and cardiac magnetic resonance image showed the extension of the thrombus into the pulmonary trunk. A continuous intravenous unfractionated heparin infusion resulted in a dramatic clinical and echocardiographic improvement. <Learning objective: With COVID-19 infection, the thrombus phenomenon is becoming more common. Since thromboembolic complications are common in patients with severe COVID-19 who need intensive care unit care, heparin infusion is recommended for patients who are unlikely to need procedures. Multimodality imaging can be useful in determining the diagnosis, prognosis, and treatment plan.>.
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Affiliation(s)
- Samah I Abohamr
- Department of Cardiology, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt.,Heart Health Center, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Nada M Hussein
- Heart Health Center, King Saud Medical City, Riyadh, Saudi Arabia
| | - Eman Elsheikh
- Department of Cardiology, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt.,Internal Medicine Department, King Faisal University, Alahsa, Saudi Arabia
| | - Duaa A ALhindi
- Radiology Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Hiba M Saadeddin
- Heart Health Center, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rami M Abazid
- Division of Nuclear Medicine, Section of Cardiac Hybrid Imaging, Victoria Hospital, London Health Sciences Centre, London, Ontario, Canada.,Prince Sultan Cardiac Center Qassim (PSCCQ), Buraydah, Al-Qassim, Saudi Arabia
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Qahtani MA, Uddin MS, fulayyih SA, Baridi SA, Hamid Z. An 11-Year-Old Saudi Arabian Girl Who Presented with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection with Coronary Artery Aneurysm and Cardiac Involvement: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933053. [PMID: 34510156 PMCID: PMC8450426 DOI: 10.12659/ajcr.933053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/03/2021] [Accepted: 07/21/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Early in the COVID-19 pandemic, children who were infected with severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) with vascular inflammation were described as having a vasculitis similar to Kawasaki's disease. There are now consensus clinical guidelines that have described the presentation and diagnosis of multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection. This report aims to describe a case of MIS-C in an 11-year-old Saudi Arabian girl who presented with coronary artery aneurysm and cardiac involvement. CASE REPORT We describe an 11-year-old Saudi girl who was asymptomatic for 3 weeks after contracting SARS-CoV-2. Three weeks after suffering a mild flulike illness, she developed a high fever, cough, and severe clinical deterioration within 12 h of admission, including shock, rash, pleural effusion, high inflammatory markers, and a coronary aneurysm. As per current practice, the diagnosis was confirmed as multisystem inflammatory syndrome based on a SARS-CoV-2 test with reverse transcription polymerase chain reaction (RT-PCR) from 2 nasopharyngeal aspirates. Her condition was successfully treated with antibiotics, inotropes, IVIG, aspirin, and Tocilizumab, in addition to high-flow oxygen therapy. Eventually, she was able to return home after fully recovering. CONCLUSIONS The findings in this report suggest that children with MIS-C due to SARS-CoV-2 infection can have a good prognosis, even when they suffer from coronary artery and cardiac involvement. The increasing number of emerging SARS-CoV-2 variants that affect children supports the importance of RT-PCR for the COVID-19 diagnostic test for children with multisystem or cardiovascular inflammation, which may guide the most appropriate clinical management of the variants of MIS-C.
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Ramani SL, Samet J, Franz CK, Hsieh C, Nguyen CV, Horbinski C, Deshmukh S. Musculoskeletal involvement of COVID-19: review of imaging. Skeletal Radiol 2021; 50:1763-1773. [PMID: 33598718 PMCID: PMC7889306 DOI: 10.1007/s00256-021-03734-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 02/02/2023]
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) has revealed a surprising number of extra-pulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. While myalgia is a common clinical feature of COVID-19, other musculoskeletal manifestations of COVID-19 were infrequently described early during the pandemic. There have been emerging reports, however, of an array of neuromuscular and rheumatologic complications related to COVID-19 infection and disease course including myositis, neuropathy, arthropathy, and soft tissue abnormalities. Multimodality imaging supports diagnosis and evaluation of musculoskeletal disorders in COVID-19 patients. This article aims to provide a first comprehensive summary of musculoskeletal manifestations of COVID-19 with review of imaging.
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Affiliation(s)
| | - Jonathan Samet
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Colin K Franz
- Shirley Ryan Ability Lab (Formerly the Rehabilitation Institute of Chicago), 355 E Erie St, Chicago, IL, 60611, USA
- Departments of Physical Medicine and Rehabilitation and Neurology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Christine Hsieh
- Department of Rheumatology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Craig Horbinski
- Division of Pathology, Department of Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Swati Deshmukh
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA.
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Palabiyik F, Akcay N, Sevketoglu E, Hatipoglu N, Sari EE, Inci E. Imaging of Multisystem Inflammatory Disease in Children (MIS-C) Associated With COVID-19. Acad Radiol 2021; 28:1200-1208. [PMID: 34284918 PMCID: PMC8179194 DOI: 10.1016/j.acra.2021.05.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 01/16/2023]
Abstract
RATIONALE AND OBJECTIVES To retrospectively evaluate imaging findings in multisystem inflammatory disease in children associated with COVID-19 (MIS-C). MATERIALS AND METHODS The radiological imaging findings of 45 pediatric patients aged between 52 days and 16 years, who were diagnosed with MIS-C according to the World Health Organization (WHO) criteria, were evaluated. All the patients underwent chest X-ray and echocardiography. The findings obtained from 25 abdominal radiographs, 24 abdominal US, 7 abdominal CT, 16 thorax CT, 21 cranial MRI and one spinal MRI, MR cholangiography (MRCP) and cardiac MRI examinations were categorized and evaluated according to the affected systems. RESULTS While the most common findings in chest X-ray were perihilar opacity and peribronchial thickening, pleural effusion was the most finding in thorax CT. Echocardiography findings of myocarditis were observed in 31% of the cases. The most common findings in abdominal radiological evaluation were hepatomegaly and splenomegaly, edema in the gallbladder wall and periportal area, mesenteric lymph nodes in the right lower quadrant, thickening of the intestinal walls, and free fluid. Reversible splenial lesion syndrome (RESLES) was the most common neurological finding. Acute disseminated encephalomyelitis (ADEM)-like lesions, acute hemorrhagic necrotizing encephalomyelitis, and radiological findings consistent with Guillain-Barré syndrome were found in one case each. CONCLUSION Radiological findings seen in MIS-C in pediatric cases are correlated with the affected system. According to the system involved, there is no specific finding for this disease. Radiological findings are not the primary diagnostic tool but can assist in the evaluation of the affected systems and to guide treatment.
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Affiliation(s)
- Figen Palabiyik
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Pediatric Radiology, Istanbul, Turkey.
| | - Nihal Akcay
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Pediatric Intensive Care, Istanbul, Turkey
| | - Esra Sevketoglu
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Pediatric Intensive Care, Istanbul, Turkey
| | - Nevin Hatipoglu
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Pediatric Infection, Istanbul, Turkey
| | - Emine Ergul Sari
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Pediatric Diseases, Istanbul, Turkey
| | - Ercan Inci
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
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Review of COVID-19, part 2: Musculoskeletal and neuroimaging manifestations including vascular involvement of the aorta and extremities. Clin Imaging 2021; 79:300-313. [PMID: 34388683 PMCID: PMC8349444 DOI: 10.1016/j.clinimag.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has affected almost every country in the world resulting in severe morbidity, mortality and economic hardship, altering the landscape of healthcare forever. Its devastating and most frequent thoracic and cardiac manifestations have been well reported since the start of the pandemic. Its extra-thoracic manifestations are myriad and understanding them is critical in diagnosis and disease management. The role of radiology is growing in the second wave and second year of the pandemic as the multiorgan manifestations of COVID-19 continue to unfold. Musculoskeletal, neurologic and vascular disease processes account for a significant number of COVID-19 complications and understanding their frequency, clinical sequelae and imaging manifestations is vital in guiding management and improving overall survival. The authors aim to provide a comprehensive overview of the pathophysiology of the virus along with a detailed and systematic imaging review of the extra-thoracic manifestation of COVID-19. In Part I, abdominal manifestations of COVID-19 in adults and multisystem inflammatory syndrome in children will be reviewed. In Part II, manifestations of COVID-19 in the musculoskeletal, central nervous and vascular systems will be reviewed.
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Alshoabi SA, Haider KH, Mostafa MA, Hamid AM, Daqqaq TS. An unusual and atypical presentation of the novel coronavirus: A case report and brief review of the literature. J Taibah Univ Med Sci 2021; 16:637-642. [PMID: 33867909 PMCID: PMC8038890 DOI: 10.1016/j.jtumed.2021.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 12/25/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) is a highly contagious novel infection that predominantly presents with fever and respiratory symptoms. However, COVID-19 can masquerade as an acute coronary syndrome, leg pain or swelling with venous thrombosis, loss of consciousness with cerebral venous thrombosis, confusion, limb weakness with brain infarction, facial neuralgia, acute conjunctivitis, acute appendicitis, and testicular pain. We report on a 42-year-old man who presented with mild symptoms of COVID-19. The patient's electrocardiogram showed an ST-segment elevation myocardial infarction (STEMI) due to a left coronary thrombosis. The patient was managed conservatively with medicines and had an uneventful recovery. Emergency physicians should have a high index of suspicion for the unusual presentations of COVID-19.
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Affiliation(s)
- Sultan A. Alshoabi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, KSA
| | - Kamel H. Haider
- Cardiology Department, Prince Mohammed Bin Nasser Hospital, Jazan, KSA
| | | | | | - Tareef S. Daqqaq
- Department of Radiology, Faculty of Medicine, Taibah University, Almadinah Almunawwarah, KSA
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