Rai Deependra, Kumar Subhash, Pandey Sanjay, Vardhan Harsh
Pulmonary Medicine, All India Institute of Medical Sciences Patna, Patna, IND.
Radiodiagnosis, All India Institute of Medical Sciences Patna, Patna, IND.
Cureus. 2022 Jan 19;14(1):e21416. doi: 10.7759/cureus.21416. eCollection 2022 Jan.
The pulmonary sequelae of severe COVID-19 infection are yet to be fully defined. The authors undertook this study to find out the proportion of severe COVID-19 patients having fibrosis-like lung sequelae during a medium-term follow-up period.
This was a retrospective observational study from a dedicated COVID centre of Eastern India. Severe COVID-19 patients who had undergone chest computerized tomography (CT) during the acute phase of illness and at least one follow-up CT with a gap of minimum two months between the two scans were included in the study.
A total of 39 patients who had recovered from severe COVID-19 pneumonia and presented to the pulmonary medicine OPD in the months of July and August 2021 were included. Patients with pre-existing lung disease (n-4), mild to moderate (n-11), and due to unavailability of CT scan (n-2) were excluded. A total of 22 patients (thirteen males, nine females) were thus included for analysis. Follow-up scans were performed with a mean of 2.5 months after the onset of the disease. Out of 22 patients, only one patient's follow-up scan was normal. Predominant fibrotic-like features were present in six (27.2%) patients, though some evidence of fibrosis-like changes were seen in 20 out of 22 (90.9%) patients. The remaining 15 (68.2%) patients with abnormal scans had predominant non-fibrotic changes like ground-glass opacities (GGOs), consolidation, cavity, or nodule. The most common presenting symptoms at the follow-up examination were dyspnoea (81.8%), cough (54.1%) followed by fatigue in 40.9% of patients.
This study concluded that most of the severe COVID-19 patients have some residual radiological findings during medium-term follow-up. Fibrotic-like lesions are present in almost all patients but most of them get resolved with time. True fibrotic features like honeycombing are rarely seen as residual lung sequelae.
重症新型冠状病毒肺炎(COVID-19)感染的肺部后遗症尚未完全明确。作者开展此项研究,以明确在中期随访期间出现纤维化样肺部后遗症的重症COVID-19患者比例。
这是一项来自印度东部一个专门的COVID中心的回顾性观察研究。研究纳入了在疾病急性期接受过胸部计算机断层扫描(CT)且至少进行过一次随访CT(两次扫描间隔至少两个月)的重症COVID-19患者。
共有39例从重症COVID-19肺炎康复且于2021年7月和8月到呼吸内科门诊就诊的患者被纳入研究。排除了既往有肺部疾病的患者(n = 4)、轻度至中度患者(n = 11)以及因无法进行CT扫描的患者(n = 2)。最终共纳入22例患者(13例男性,9例女性)进行分析。随访扫描在疾病发作后平均2.5个月进行。22例患者中,只有1例患者的随访扫描结果正常。6例(27.2%)患者出现了主要的纤维化样特征,不过22例患者中有20例(90.9%)出现了一些纤维化样改变的证据。其余15例(68.2%)扫描结果异常的患者主要表现为非纤维化改变,如磨玻璃影(GGO)、实变、空洞或结节。随访检查中最常见的症状是呼吸困难(81.8%)、咳嗽(54.1%),其次是40.9%的患者出现疲劳。
本研究得出结论,大多数重症COVID-19患者在中期随访期间有一些残留的影像学表现。几乎所有患者都存在纤维化样病变,但大多数会随着时间消退。蜂窝状等真正的纤维化特征作为残留肺部后遗症很少见。