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      Cavitaciones pulmonares, complicación tardía de la COVID-19 Translated title: Pulmonary cavitations, late complication of COVID-19

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          Resumen

          La aparición de complicaciones graves, como el neumotórax o las cavitaciones pulmonares, en pacientes con infecciones recientes por el SARS-CoV-2 aumenta la morbi-mortalidad, y supone un reto diseñar la estrategia terapéutica más adecuada que permita mejorar su pronóstico. Las cavitaciones pulmonares se suelen asociar a complicaciones secundarias como la hemoptisis y el neumotórax, y confieren mal pronóstico.

          Se presenta el caso de dos pacientes con enfermedad COVID-19 confirmada por PCR nasofaríngea y que, tras evolución inicialmente satisfactoria, reingresaron con afectación pulmonar compatible con cavitaciones pulmonares y con insuficiencia respiratoria. Las lesiones cavitadas pulmonares en pacientes que hayan sufrido COVID-19 deben identificarse de forma precoz y realizar las determinaciones y cultivos necesarios para descartar sobreinfecciones añadidas que puedan empeorar el pronóstico.

          Abstract

          Patients who have recently suffered from SARS-CoV-2 infections may suffer serious complications, such as pneumothorax or pulmonary cavitations that increase morbi-mortality and imply a challenge for the design of the most appropriate therapeutic strategy to improve their prognosis. Pulmonary cavities are usually associated with secondary complications such as hemoptysis and pneumothorax, and so offer a poor prognosis.

          We present the case of two patients with COVID-19 disease confirmed by nasopharyngeal PCR who showed satisfactory evolution before readmission with pulmonary involvement compatible with pulmonary cavitation and respiratory failure. Cavitated lesions in the lungs of patients who recently suffered COVID-19 must be identified early in order to discard additional superinfections that may worsen the prognosis.

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          Most cited references11

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          CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)

          In this retrospective case series, chest CT scans of 21 symptomatic patients from China infected with the 2019 novel coronavirus (2019-nCoV) were reviewed, with emphasis on identifying and characterizing the most common findings. Typical CT findings included bilateral pulmonary parenchymal ground-glass and consolidative pulmonary opacities, sometimes with a rounded morphology and a peripheral lung distribution. Notably, lung cavitation, discrete pulmonary nodules, pleural effusions, and lymphadenopathy were absent. Follow-up imaging in a subset of patients during the study time window often demonstrated mild or moderate progression of disease, as manifested by increasing extent and density of lung opacities. © RSNA, 2020
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            Pulmonary cavitation: an under-recognized late complication of severe COVID-19 lung disease

            Background Pulmonary radiological findings of the novel coronavirus disease 2019 (COVID-19) have been well documented and range from scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, lung cavitation has not been commonly described in these patients. The objective of this study was to assess the incidence of pulmonary cavitation in patients with COVID-19 and describe its characteristics and evolution. Methods We conducted a retrospective review of all patients admitted to our institution with COVID-19 and reviewed electronic medical records and imaging to identify patients who developed pulmonary cavitation. Results Twelve out of 689 (1.7%) patients admitted to our institution with COVID-19 developed pulmonary cavitation, comprising 3.3% (n = 12/359) of patients who developed COVID-19 pneumonia, and 11% (n = 12/110) of those admitted to the intensive care unit. We describe the imaging characteristics of the cavitation and present the clinical, pharmacological, laboratory, and microbiological parameters for these patients. In this cohort six patients have died, and six discharged home. Conclusion Cavitary lung disease in patients with severe COVID-19 disease is not uncommon, and is associated with a high level of morbidity and mortality.
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              Typical and atypical COVID-19 computed tomography findings

              In December 2019 a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 was identified and the disease associated was named coronavirus disease 2019 (COVID-19). Fever, cough, myalgia, fatigue associated to dyspnea represent most common clinical symptoms of the disease. The reference standard for diagnosis of severe acute respiratory syndrome coronavirus 2 infection is real time reverse-transcription polymerase chain reaction test applied on respiratory tract specimens. Despite of lower specificity, chest computed tomography (CT), as reported in manifold scientific studies, showed high sensitivity, therefore it may help in the early detection, management and follow-up of COVID-19 pneumonia. Patients affected by COVID-19 pneumonia usually showed on chest CT some typical features, such as: Bilateral ground glass opacities characterized by multilobe involvement with posterior and peripheral distribution; parenchymal consolidations with or without air bronchogram; interlobular septal thickening; crazy paving pattern, represented by interlobular and intralobular septal thickening surrounded by ground-glass opacities; subsegmental pulmonary vessels enlargement (> 3 mm). Halo sign, reversed halo sign, cavitation and pleural or pericardial effusion represent some of atypical findings of COVID-19 pneumonia. On the other hand lymphadenopathy’s and bronchiectasis’ frequency is unclear, indeed conflicting data emerged in literature. Radiologists play a key role in recognition of high suspicious findings of COVID-19 on chest CT, both typical and atypical ones. Thus, the aim of this review is to illustrate typical and atypical CT findings of COVID-19.
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                Author and article information

                Journal
                An Sist Sanit Navar
                An Sist Sanit Navar
                assn
                Anales del Sistema Sanitario de Navarra
                Gobierno de Navarra. Departamento de Salud
                1137-6627
                2340-3527
                27 April 2022
                Jan-Apr 2022
                : 45
                : 1
                : e0974
                Affiliations
                [1] originalServicio de Medicina Intensiva. Hospital Clínico Universitario Lozano Blesa. Zaragoza. España. normalizedHospital Clínico Universitario Lozano Blesa orgdiv1Servicio de Medicina Intensiva orgnameHospital Clínico Universitario Lozano Blesa Zaragoza, Spain
                Author notes
                [Correspondencia ] Herminia Lozano Gómez. Hospital Clínico Lozano Blesa, Avenida San Juan Bosco, 15, 50009, Zaragoza, España. E-mail: fiex_hermi1990@ 123456hotmail.com

                Conflictos de interés: Los autores declaran no tener conflictos de intereses.

                Article
                10.23938/ASSN.0974
                10112295
                34703033
                741a1da4-99b4-4160-9c40-f09156a4e6ec

                Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons

                History
                : 08 June 2021
                : 11 August 2021
                : 13 September 2021
                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 9, Pages: 0
                Categories
                Notas Clínicas

                cavitación,sars-cov-2,covid-19,absceso pulmonar,sobreinfección,cavitation,lung abscess,superinfection

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