1/17
🫁 COVID-19 (nearly) three years on: what do we know about its effects on the lungs? And where do we go from here?
A major review published in @radiology_rsna at doi.org/10.1148/radiol…
A #RadInTraining #TWEETORIAL thread
🫁 COVID-19 (nearly) three years on: what do we know about its effects on the lungs? And where do we go from here?
A major review published in @radiology_rsna at doi.org/10.1148/radiol…
A #RadInTraining #TWEETORIAL thread
2/17
First, a quiz! What proportion of patients (with any disease severity) still have residual COVID-19 lung changes 12 months after diagnosis?
First, a quiz! What proportion of patients (with any disease severity) still have residual COVID-19 lung changes 12 months after diagnosis?
3/17
⭐️Correct answer⭐️30% have residual lung changes on CT up to 12 months after diagnosis. What is the most common finding?
⭐️Correct answer⭐️30% have residual lung changes on CT up to 12 months after diagnosis. What is the most common finding?
4/17
Correct answer: 🥇GGO and ‘fibrotic-like changes’ were the commonest findings (21%),🥈followed by bronchiectasis (10%) and🥉interlobular septal thickening (8%).
Correct answer: 🥇GGO and ‘fibrotic-like changes’ were the commonest findings (21%),🥈followed by bronchiectasis (10%) and🥉interlobular septal thickening (8%).
5/17
A 63 year-old diagnosed with COVID.
➡️Arrows = perilobular thickening, ▶️arrowheads = bronchial dilatation
A 63 year-old diagnosed with COVID.
➡️Arrows = perilobular thickening, ▶️arrowheads = bronchial dilatation
6/17
Unsurprisingly, residual lung changes on 12-month CT were more likely in patients diagnosed with severe or critical disease (38%) compared with cases of moderate disease (24%).
❓But what about the airways specifically❓
Unsurprisingly, residual lung changes on 12-month CT were more likely in patients diagnosed with severe or critical disease (38%) compared with cases of moderate disease (24%).
❓But what about the airways specifically❓
7/17
COVID-19 affects the airways both acutely and chronically, causing bronchiectasis, air trapping, and mosaicism, though these can be reversible, as in this patient 👇👇👇
COVID-19 affects the airways both acutely and chronically, causing bronchiectasis, air trapping, and mosaicism, though these can be reversible, as in this patient 👇👇👇
8/17
77 year-old woman who required hospitalization for COVID shows typical findings of alveolar damage.
➡️Arrow = varicoid bronchial dilation and an air cyst
77 year-old woman who required hospitalization for COVID shows typical findings of alveolar damage.
➡️Arrow = varicoid bronchial dilation and an air cyst
9/17
The same patient at follow-up continues to show bronchiectasis on a background of residual ground glass opacity, peripheral parenchymal bands, and reticulation
➡️Arrow = varicoid bronchial dilation and an air cyst
The same patient at follow-up continues to show bronchiectasis on a background of residual ground glass opacity, peripheral parenchymal bands, and reticulation
➡️Arrow = varicoid bronchial dilation and an air cyst
10/17
⚕️Given the possibility that certain changes are reversible, the authors advise caution in diagnosing ‘fibrosis’ in these patients based on these changes.⚕️
⚕️Given the possibility that certain changes are reversible, the authors advise caution in diagnosing ‘fibrosis’ in these patients based on these changes.⚕️
11/17
❓What about pulmonary embolus (PE)? We all know there was an increase in acute PEs, what about in long COVID patients❓
❓What about pulmonary embolus (PE)? We all know there was an increase in acute PEs, what about in long COVID patients❓
12/17
Studies show that people who recovered from COVID-19 are twice as likely to be diagnosed with a PE within one year than those who did not. ncbi.nlm.nih.gov/pmc/articles/P…
Studies show that people who recovered from COVID-19 are twice as likely to be diagnosed with a PE within one year than those who did not. ncbi.nlm.nih.gov/pmc/articles/P…
13/17
But what’s happening on a histopathological level? It seems COVID-19 adheres to a typical pattern of diffuse alveolar disease with hyaline membrane formation in the acute phase, followed by an organizing phase, which may improve, or progress to fibrosis.
But what’s happening on a histopathological level? It seems COVID-19 adheres to a typical pattern of diffuse alveolar disease with hyaline membrane formation in the acute phase, followed by an organizing phase, which may improve, or progress to fibrosis.
14/17
Despite having a lot more data now than we did in early 2020, it’s worth noting that what we have so far are biased toward severe disease and positive studies.
Despite having a lot more data now than we did in early 2020, it’s worth noting that what we have so far are biased toward severe disease and positive studies.
15/17
🔮Future directions: we have no consensus guidelines on imaging follow-up for COVID-19 patients, and further studies are needed to provide the supporting data.
🔮Future directions: we have no consensus guidelines on imaging follow-up for COVID-19 patients, and further studies are needed to provide the supporting data.
16/17
In summary, COVID-19 can have long-term effects including persistent lung changes on CT and a higher risk of PE.
We’ve come a long way in understanding the natural history and management of the disease, but more data will continue to inform our practice.
In summary, COVID-19 can have long-term effects including persistent lung changes on CT and a higher risk of PE.
We’ve come a long way in understanding the natural history and management of the disease, but more data will continue to inform our practice.
17/17
This is the end of the TWEETORIAL. Read the full article at:
doi.org/10.1148/radiol…
A #RadInTraining #TWEETORIAL thread.
This is the end of the TWEETORIAL. Read the full article at:
doi.org/10.1148/radiol…
A #RadInTraining #TWEETORIAL thread.
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