Clarification on Pleural Effusions in COVID-19
2020; Radiological Society of North America; Volume: 2; Issue: 3 Linguagem: Inglês
10.1148/ryct.2020200330
ISSN2638-6135
Autores Tópico(s)Ultrasound in Clinical Applications
ResumoHomeRadiology: Cardiothoracic ImagingVol. 2, No. 3 Previous Letters to the EditorFree AccessClarification on Pleural Effusions in COVID-19Avinash Aujayeb Avinash Aujayeb Author AffiliationsDepartment of Respiratory and Acute Medicine, Northumbria Healthcare NHS Foundation Trust, Northumbria Way, Cramlington NE23 6NZ, Englande-mail: [email protected]Avinash Aujayeb Published Online:Jun 11 2020https://doi.org/10.1148/ryct.2020200330MoreSectionsPDF ToolsAdd to favoritesCiteTrack Citations ShareShare onFacebookXLinked In Editor:We thank Dr Tabatabaei and colleagues for their recent article in the April 2020 issue of Radiology: Cardiothoracic Imaging on CT characteristics of 120 patients with coronavirus disease 2019 (COVID-19) with a wide range of clinical outcomes (1). A total of 12.5% (19 of 96) of ward patients, 45% (nine of 11) of those in intensive care, and 23% (three of 13) of those deceased had pleural effusions. The authors rightly mention that the incidence of pleural effusions is out of keeping with other published studies and that pleural effusions are uncommon in COVID-19 (2). Therefore, we must dispute this finding in the absence of further explanations. It would be important to know if the effusions were unilateral or bilateral, whether those patients had any coexisting comorbidities such as concurrent heart, renal, or liver failure, or any disseminated malignancies which are by far the most common cause of pleural effusions, and more importantly whether any of those effusions were sampled and what were the resultant biochemical and microbiologic characteristics. So far, in the literature, there is only one report of pleural effusions in deceased COVID-19 patients being positive for the virus (3). However, patient characteristics in that study are also not described. We run a large pleural service in the North East of England, and this would greatly inform local and national practice (4). Current British Thoracic Society guidance suggests that all pleural procedures are potentially aerosol generating and could spread the virus, but the statement mentions that the evidence is poor (5). We believe the case series will be greatly enhanced if the details above are provided. If they cannot be provided, perhaps a note of caution should be added to the article by way of reply to this letter? We would also welcome any chance of international collaboration on the matter.Disclosures of Conflicts of Interest: A.A. disclosed no relevant relationships.References1. Tabatabaei SMH, Talari H, Moghaddas F, Rajebi H. CT Features and Short-term Prognosis of COVID-19 Pneumonia: A Single-Center Study from Kashan, Iran. Radiol Cardiothorac Imaging 2020;2(2):e200130. Google Scholar2. Ng MY, Lee EYP, Yang J, et al. Imaging Profile of the COVID-19 Infection: Radiologic Findings and Literature Review. Radiol Cardiothorac Imaging 2020;2(2):e200034. Google Scholar3. Schaller T, Hirschbühl K, Burkhardt K, et al. Postmortem Examination of Patients With COVID-19. JAMA 2020. 10.1001/jama.2020.8907. Published online May 21, 2020. MedlineGoogle Scholar4. Aujayeb A, Parker S, Bourke S, Miller J, Cooper D. A review of a pleural service. J R Coll Physicians Edinb 2016;46(1):26–31. MedlineGoogle Scholar5. COVID-19: information for the respiratory community. British Thoracic Society. https://brit-thoracic.org.uk/about-us/covid-19-information-for-the-respiratory-community/. Last updated April 21, 2020. Accessed May 22, 2020. Google ScholarReferences1. Tabatabaei SMH, Talari H, Moghaddas F, Rajebi H. CT Features and Short-term Prognosis of COVID-19 Pneumonia: A Single-Center Study from Kashan, Iran. Radiol Cardiothorac Imaging 2020;2(2):e200130. Google Scholar2. Falguera M, Pifarre R, Martin A, Sheikh A, Moreno A. Etiology and outcome of community-acquired pneumonia in patients with diabetes mellitus. Chest 2005;128(5):3233–3239. MedlineGoogle Scholar3. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol 2020. 10.1007/s00330-020-06801-0. Published online March 19, 2020. Google Scholar4. Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020;20(4):425–434. MedlineGoogle ScholarReferences1. Tabatabaei SMH, Talari H, Moghaddas F, Rajebi H. CT Features and Short-term Prognosis of COVID-19 Pneumonia: A Single-Center Study from Kashan, Iran. Radiol Cardiothorac Imaging 2020;2(2):e200130. LinkGoogle Scholar2. Ng MY, Lee EYP, Yang J, et al. Imaging Profile of the COVID-19 Infection: Radiologic Findings and Literature Review. Radiol Cardiothorac Imaging 2020;2(2):e200034. Google Scholar3. Schaller T, Hirschbühl K, Burkhardt K, et al. Postmortem Examination of Patients With COVID-19. JAMA 2020. 10.1001/jama.2020.8907. Published online May 21, 2020. Crossref MedlineGoogle Scholar4. Aujayeb A, Parker S, Bourke S, Miller J, Cooper D. A review of a pleural service. J R Coll Physicians Edinb 2016;46(1):26–31. Crossref MedlineGoogle Scholar5. COVID-19: information for the respiratory community. British Thoracic Society. https://brit-thoracic.org.uk/about-us/covid-19-information-for-the-respiratory-community/. Last updated April 21, 2020. Accessed May 22, 2020. Google ScholarResponseSeyed Mohammad Hossein Tabatabaei*, Hamidreza Talari*, Fahimeh Moghaddas†, Hamid Rajebi‡ Seyed Mohammad Hossein Tabatabaei*, Hamidreza Talari*, Fahimeh Moghaddas†, Hamid Rajebi‡ Author AffiliationsDepartments of Radiology* andPsychiatry,† Kashan University of Medical Sciences, Kashan, IranDepartment of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229‡e-mail: [email protected]We would like to thank the authors for their professional comments on our article (1) and greatly appreciate their suggestions.In our study, a total of 20 patients (out of the 120 patients) had pleural effusion (PE), of which 12 belonged to the routine hospitalization group, five to the intensive care unit (ICU) group, and three to the mortality group. A total of 12 patients had bilateral PE. In 16 of the 20 patients, PE was trace to small, and four had moderate PE. Of the four patients with moderate PE, three had history of congestive heart failure (CHF), and one had no underlying disease but very extensive (> 80%) lung parenchymal involvement. One of the patients with moderate PE underwent diagnostic thoracentesis, results of which showed serous fluid with no microbial growth. Of the 12 patients with PE who were admitted to the routine ward, two had diabetes mellitus (DM) and one had CHF. Of the five patients in the ICU group, one had CHF and one had chronic renal failure and DM. Of the three patients who died, one had CHF and one had DM. It is worth mentioning that PE occurs more commonly in diabetic patients, especially in the setting of community-acquired pneumonia (2).The reported prevalence of PE in COVID-19 pneumonia has been variable in recently published investigations (3). All the 120 patients in our study were inpatients with more pronounced symptoms than outpatients, which can explain the higher prevalence of PE than other studies. According to the study by Shi et al (4), the prevalence of PE varies depending on the stage of the disease, with a reported prevalence of 13% in the 3rd week after symptoms onset. PE may also be predictive of a worse prognosis and can indicate bacterial superinfection in COVID-19 (3).In conclusion, it seems that an accurate comment on the prevalence and cause of PE in COVID-19 infection should be based on the presence or absence of underlying medical conditions, study setting, disease stage, and concurrent superimposed bacterial pneumonia. Hence, the presence of PE cannot always be solely attributed to COVID-19 pneumonia. Disclosures of Conflicts of Interest: S.M.H.T. disclosed no relevant relationships. H.T. disclosed no relevant relationships. F.M. disclosed no relevant relationships. H.R. disclosed no relevant relationships.References1. Tabatabaei SMH, Talari H, Moghaddas F, Rajebi H. CT Features and Short-term Prognosis of COVID-19 Pneumonia: A Single-Center Study from Kashan, Iran. Radiol Cardiothorac Imaging 2020;2(2):e200130. LinkGoogle Scholar2. Falguera M, Pifarre R, Martin A, Sheikh A, Moreno A. Etiology and outcome of community-acquired pneumonia in patients with diabetes mellitus. Chest 2005;128(5):3233–3239. Crossref MedlineGoogle Scholar3. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol 2020. 10.1007/s00330-020-06801-0. Published online March 19, 2020. CrossrefGoogle Scholar4. Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020;20(4):425–434. Crossref MedlineGoogle ScholarArticle HistoryPublished online: June 11 2020 FiguresReferencesRelatedDetailsCited ByAutomatic deep learning-based pleural effusion classification in lung ultrasound images for respiratory pathology diagnosisChung-HanTsai, Jeroenvan der Burgt, DamjanVukovic, NancyKaur, LibertarioDemi, DavidCanty, AndrewWang, AlistairRoyse, ColinRoyse, KaviHaji, JasonDowling, GirijaChetty, DavideFontanarosa2021 | Physica Medica, Vol. 83Spectrum of atypical pulmonary manifestations of COVID-19 on computed tomographyBalasubramanianGurumurthy, Sudha KiranDas, RudreshHiremath, SachinShetty, AnikethHiremath, ThasmaiGowda2021 | Egyptian Journal of Radiology and Nuclear Medicine, Vol. 52, No. 1Recommended Articles Imaging Findings of Thoracic Lymphatic AbnormalitiesRadioGraphics2022Volume: 42Issue: 5pp. 1265-1282Pictorial Review of Pleural Disease: Multimodality Imaging and Differential DiagnosisRadioGraphics2024Volume: 44Issue: 4Comparison of Chest CT Grading Systems in COVID-19 PneumoniaRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 6Detection and Semiquantitative Analysis of Cardiomegaly, Pneumothorax, and Pleural Effusion on Chest RadiographsRadiology: Artificial Intelligence2021Volume: 3Issue: 4Body Imaging of Bacterial and Parasitic Zoonoses: Keys to DiagnosisRadioGraphics2023Volume: 43Issue: 3See More RSNA Education Exhibits Pleural Effusion: What Every Radiologist Should KnowDigital Posters2021Benign Lymphatic Abnormalities In The ThoraxDigital Posters2021Don't Touch the Animals: Chest Radiologists View- ZoonosesDigital Posters2022 RSNA Case Collection Malignant pleural mesotheliomaRSNA Case Collection2020Ovarian hyperstimulation syndrome RSNA Case Collection2021AIDS-associated Kaposi sarcomaRSNA Case Collection2020 Vol. 2, No. 3 Metrics Altmetric Score Open AccessThis article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. 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