Elisa Baratella1, Erik Roman-Pognuz2, Verena Zerbato3, Pierluca Minelli1, Marco Francesco Maria Cavallaro4, Maria Assunta Cova1, Roberto Luzzati3, Umberto Lucangelo2, Gianfranco Sanson5, Federica Friso2, Rossana Bussani6, Maurizio Pinamonti6, Marina Busetti7, Francesco Salton8, Marco Confalonieri8, Barbara Ruaro8, Stefano Di Bella3. 1. Department of Radiology, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy. 2. Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria integrata di Trieste ASUGI-Trieste, 34128 Trieste, Italy. 3. Department of Medicine, Surgery and Health Science, University of Trieste, 34128 Trieste, Italy. 4. Department of Radiology, Azienda Sanitaria Universitaria integrata di Trieste ASUGI-Trieste, 34128 Trieste, Italy. 5. Department of Medical, Surgical and Health Sciences, School of Nursing, University of Trieste, 34128 Trieste, Italy. 6. Department of Pathology, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy. 7. Microbiology Unit, Azienda Sanitaria Universitaria integrata di Trieste ASUGI-Trieste, 34128 Trieste, Italy. 8. Department of Pneumology, Cattinara Hospital, 34128 Trieste, Italy.
Abstract
PURPOSE: The aim of this observational study was to highlight high resolution CT scan characteristics of COVID-19-associated pulmonary aspergillosis (CAPA) with a focus on the detection of de-novo appeared or evolved bronchiectasis. METHODS: From March 2020 to May 2021, we enrolled 350 consecutive mechanically ventilated ICU patients with COVID-19. Patients with CAPA and at least one chest CT scan performed within 15 days from the diagnosis were included. Two radiologists were asked to identify typical and atypical signs of COVID-19 pneumonia. Bronchiectasis locations were described and a modified Reiff score was calculated, as severity score. A total of 19 CAPA patients (median age 71.0, Interquartile range (IQR) 62.5-75.0; male 16, 84.2%) were included. RESULTS: According to the 2020 ECMM/ISHAM criteria, 18 patients had probable CAPA and one had proven CAPA. The median time between hospital admission and CT scan was 21 days (IQR 14.5-25.0). The incidence of bronchiectasis in the study population was 57.9% (n = 11). Tubular bronchiectasis was detected in 10 patients and were scored as follows: three patients had a score of 1, three patients had a score of score 2, one patient had a score of 5 and four patients had a score of 6. Eight patients had a previous CT scan (performed at hospital admission), among them: 5 patients developed de-novo bronchiectasis, while 2 patients demonstrated a volumetric increase of bronchiectasis. At the 6-months follow-up, the mortality rate for patients with CAPA was >60%. CONCLUSION: the radiologic detection of de-novo appearance or volumetric increase of bronchiectasis in COVID-19 should lead clinicians to search for fungal superinfections.
PURPOSE: The aim of this observational study was to highlight high resolution CT scan characteristics of COVID-19-associated pulmonary aspergillosis (CAPA) with a focus on the detection of de-novo appeared or evolved bronchiectasis. METHODS: From March 2020 to May 2021, we enrolled 350 consecutive mechanically ventilated ICU patients with COVID-19. Patients with CAPA and at least one chest CT scan performed within 15 days from the diagnosis were included. Two radiologists were asked to identify typical and atypical signs of COVID-19 pneumonia. Bronchiectasis locations were described and a modified Reiff score was calculated, as severity score. A total of 19 CAPA patients (median age 71.0, Interquartile range (IQR) 62.5-75.0; male 16, 84.2%) were included. RESULTS: According to the 2020 ECMM/ISHAM criteria, 18 patients had probable CAPA and one had proven CAPA. The median time between hospital admission and CT scan was 21 days (IQR 14.5-25.0). The incidence of bronchiectasis in the study population was 57.9% (n = 11). Tubular bronchiectasis was detected in 10 patients and were scored as follows: three patients had a score of 1, three patients had a score of score 2, one patient had a score of 5 and four patients had a score of 6. Eight patients had a previous CT scan (performed at hospital admission), among them: 5 patients developed de-novo bronchiectasis, while 2 patients demonstrated a volumetric increase of bronchiectasis. At the 6-months follow-up, the mortality rate for patients with CAPA was >60%. CONCLUSION: the radiologic detection of de-novo appearance or volumetric increase of bronchiectasis in COVID-19 should lead clinicians to search for fungal superinfections.
Authors: Tim Fischer; Yassir El Baz; Nicole Graf; Simon Wildermuth; Sebastian Leschka; Gian-Reto Kleger; Urs Pietsch; Manuel Frischknecht; Giulia Scanferla; Carol Strahm; Stephan Wälti; Tobias Johannes Dietrich; Werner C Albrich Journal: Diagnostics (Basel) Date: 2022-05-11