Epidemiology
· A retrospective case series conducted by radiologists from Zucker School of Medicine at Hofstra/Northwell in Manhasset, NY evaluated imaging features of six patients (all >65 years old) who presented to the emergency department with PCR-confirmed moderate-to-severe SARS-CoV-2 infection that was complicated by thromboembolic events. These authors suggest a hyper-inflammatory state secondary to SARS-CoV-2 infection may increase susceptibility to systemic thrombosis and recommend venous thromboembolism (VTE) prophylaxis in severe COVID-19 cases.
Understanding the Pathology
· Australian pulmonologists respond to recently published data by Mo et al, 2020 that showed diffusion capacity of carbon monoxide (DLCO) and carbon monoxide transfer coefficient (KCO) in COVID-19 patients reduced by 50% and 25% after recovery, respectively. They caution against interpreting these findings as attributable only to reduced alveolar volume and instead propose that lung fibrosis in COVID-19 associated acute respiratory distress syndrome (ARDS) may lead to loss of alveolar units and disrupt the alveolar-capillary barrier. Since pulmonary vascular abnormalities (i.e. vascular pruning, reduced blood flow) may alter DLCO, authors recommend further studies using more specific measures (i.e. combined DLCO and DLNO measurements or advanced imaging techniques) to clarify the pathophysiology underlying reduced gas exchange.
Management
· Emergency Medicine and Critical Care physicians in Saudi Arabia conducted a prospective observational analysis using a point-of-care ultrasound (POCUS) with the Riyadh Residual Lung Injury in COVID-19 (RELIC) scale to predict the evolution of lung injury in 171 severe COVID-19 patients and found that the combination of the two modalities were able to predict evolving interstitial lung disease with a sensitivity of 0.82 (95% CI: 0.76–0.89) and specificity of 0.91 (95% CI: 0.94–0.95).
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