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Inicio Radiología (English Edition) Persistent pulmonary abnormalities after 18 months of SARS-CoV-2 pneumonia
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Vol. 66. Issue S1.
Suplement “"Advances in Thoracic Radiology”
Pages S47-S56 (April 2024)
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Vol. 66. Issue S1.
Suplement “"Advances in Thoracic Radiology”
Pages S47-S56 (April 2024)
Original articles
Persistent pulmonary abnormalities after 18 months of SARS-CoV-2 pneumonia
Alteraciones pulmonares persistentes tras 18 meses de neumonía por SARS-CoV-2
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212
C. Valenzuelaa, L. de la Fuenteb, S. Hernándezb, M.J. Oliverab, C. Molinab, N. Montesc, C. Benavidesb, P. Caballerob,
Corresponding author
palomacsr@hotmail.com

Corresponding author.
a Servicio de Neumología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
b Servicio de Radiología, Hospital Universitario La Princesa. Universidad Autónoma de Madrid, Madrid, Spain
c Unidad de Apoyo Metodológico, Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain
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Table 1. Clinical characteristics of 31 patients and HRCT findings at 18 months in 62 observations.
Special issue
This article is part of special issue:
Vol. 66. Issue S1

Suplement “"Advances in Thoracic Radiology”

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Abstract
Objective

To describe persistent pulmonary abnormalities detected on HRCT after 18 months of SARS-CoV-2 pneumonia, and to determine their extension and correlation with pulmonary function.

Patients and methods

A prospective cross-sectional study with an initial cohort of 90 patients in follow-up due to persisting lung abnormalities on imaging, functional respiratory impairment and/or respiratory symptoms. Of these, 31 (34%) were selected for analysis due to the persistence of their lung abnormalities on HRCT at 18 months after infection. A double reading was performed for each HRCT (62 observations).

Results

Of the 31 patients included: 20 (65%) were men; mean age was 67 years; 17 (55%) were smokers/ex-smokers. The mean hospitalisation time was 38 days. Eighteen (58%) patients were admitted to intensive care units. Five patients (16%) suffered an acute pulmonary thromboembolism and three (9.7%) had a pneumothorax. The mean time between the onset of pneumonia and the follow-up HRCT was 20.34 months. Nineteen percent of patients suffered from total lung function abnormalities; and ground-glass opacities and reticulation were present in 12% and 4.5% respectively. The findings of the 62 readings were: ground-glass opacities (100%), reticulation (83%), subpleural curvilinear lines (62%), parenchymal bands (34%), traction bronchiectasis (69%), displacement of vessels/fissures (46%) and honeycombing (4.9%).

Pulmonary function 18 months after the acute episode revealed a mean FVC of 92% of predicted value, with an FVC < 80% of predicted value in 11 patients (35.4%). Mean DLCO was 71% of predicted value, with a DLCO < 80% in 22 patients (70%).

We observed a statistically significant relationship between total lung function abnormalities on HRCT and FVC (P < 0.05), and a trend towards statistical significance with DLCO (P = 0.051); there was a statistically significant relationship between the presence of ground-glass opacities and FEV1/FVC (P < 0.01). The relationships between reticulation and FVC, FVC%, FEV1, FEV1% and DLCO% were also considered statistically significant (P < 0.05).

Conclusion

Persistent interstitial lung abnormalities are seen on HRCT for a subset of patients infected with SARS-CoV-2 pneumonia. Seventy percent of these patients suffered a slight decrease in DLCO.

Keywords:
SARS-CoV-2
COVID-19
Lung HRCT
Pulmonary sequelae
Post-COVID-fibrosis
Resumen
Objetivo

Describir después de 18 meses, de una neumonía por SARS-CoV-2, las alteraciones pulmonares persistentes en la TCAR, valorar la extensión de las lesiones y su relación con la función respiratoria.

Pacientes y método

Estudio transversal prospectivo de 90 pacientes en seguimiento por persistencia de alteraciones radiológicas, funcionales y/o síntomas respiratorios. Se seleccionaron 31 pacientes (34%) que mantenían alteraciones pulmonares en la TCAR a los 18 meses. Se realizó una doble lectura de las tomografías (62 observaciones).

Resultados

De los 31 pacientes: 20 eran hombres (65%), edad media 67 años; 17 pacientes (55%) eran exfumadores o fumadores; el tiempo medio de hospitalización fue de 38 días, necesidad de cuidados respiratorios intermedios en 18 pacientes (58%). Cinco pacientes (16%) tuvieron tromboembolismo pulmonar agudo, y tres neumotórax (9,7%). El tiempo medio desde la neumonía hasta la TCAR fue de 20,3 meses. La extensión de las alteraciones pulmonares totales, de las opacidades de vidrio deslustrado y de la reticulación fue del 19%, 12% y 4,5%, respectivamente. Los hallazgos de las 62 lecturas fueron vidrio deslustrado (100%), reticulación (83%), opacidades curvilíneas subpleurales (62%), bandas parenquimatosas (34%), bronquiectasias por tracción (69%), desplazamiento de vasos o cisuras (46%) y panalización (4,9%).

La situación funcional respiratoria a los 18 meses mostró una FVC media de 92% del valor predicho, con FVC menor del 80% del valor predicho en 11 pacientes (35,4%), y una DLCO media del 71% del valor predicho, con una DLCO menor del 80% en 22 pacientes (70% ).

Se observó relación significativa entre la extensión total de las alteraciones en la TCAR con la FVC (P < 0,05), con la DLCO hubo una tendencia a la relación significativa (P = 0,051); existió una relación significativa entre la extensión de las opacidades de vidrio deslustrado y FEV1/FVC (P<0,01). La extensión de la reticulación presentó asociación significativa (P < 0,05) con la FVC, la FVC%, la FEV1, la FEV1% y la DLCO%.

Conclusión

Un porcentaje de pacientes que han padecido neumonía por SARS-CoV-2 persisten con alteraciones intersticiales en la TCAR. El 70% mostró una disminución leve de la DLCO.

Palabras clave:
SARS-CoV-2
COVID-19
TCAR pulmonar
Secuelas pulmonares
Post-COVID-fibrosis

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