POST-COVID-19 SYNDROME IMAGING FINDINGS IN SEVERE COVID-19 WITH PULMONARY CAVITATION: A CASE REPORT

  • Adi Soekardi Consultant Cardiothoracic Radiologist, Department of Radiology, Faculty of Medicine, Prima Indonesia University, Royal Prima Hospital Medan
  • Ricky Suryamin Resident, Department of Radiology, Department of Radiology, Faculty of Medicine, Prima Indonesia University, Royal Prima Hospital Medan
Keywords: post-COVID syndrome, ground glass opacity, fibrotic-like changes, pulmonary cavitary, bronchiectasis

Abstract

In the fourth year of the SARS-CoV-2 pandemic, there is corresponding increase in the proportion exhibiting long-term symptoms and chronic respiratory complication associated with the disease. The British Medical Journal consider post-COVID syndrome as to symptoms continuing for more than 12 weeks. The most prevalent findings were "ground glass opacity" and "fibrotic-like changes”. The term "fibrotic-like changes" exhibited variations across studies, encompassing architectural distortion with traction bronchiectasis, honeycombing, or both, as well as traction bronchiectasis/bronchiolectasis, volume loss, or both. Other descriptions included evidence of stripe-like fibrosis without reticular opacity and the presence of honeycombing, reticulation, and traction bronchiectasis. Bronchial abnormalities, such as wall thickening and dilation, are frequently observed in patients during the acute and early convalescent phases of COVID-19 pneumonia, but their frequency and severity tend to decrease over time.1 However, in a subset of patients, bronchial dilation continues to persist even after recovery from COVID-19 pneumonia. Pulmonary cavitary lesions are uncommon occurrences in cases of COVID-19 pneumonia. Based on a case series, it has been found that approximately 3% of patients who develop COVID-19 pneumonia experience this complication. Despite ongoing research, the exact mechanisms behind the development of pulmonary cavitary lesions in COVID-19 remain unknown. At present, there is no single effective treatment for long COVID. However, low-dose naltrexone, β-blockers, and intravenous immunoglobulin can be considered for treating different symptoms and conditions.

References

Franquet T, Giménez A, Ketai L, et al. Air trapping in COVID-19 patients following hospital discharge: retrospective evaluation with paired inspiratory/expiratory thin-section CT. Eur Radiol. 2022;32(7):4427-4436. doi:10.1007/s00330-022-08580-2

Hope AA, Evering TH. Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Infectious Disease Clinics of North America. 2022;36(2):379-395. doi:10.1016/j.idc.2022.02.004

Mahase E. Covid-19: What do we know about “long covid”? BMJ. Published online July 14, 2020:m2815. doi:10.1136/bmj.m2815

Marchiori E, Nobre LF, Hochhegger B, Zanetti G. Pulmonary cavitation in patients with COVID-19. Clinical Imaging. 2022;88:78-79. doi:10.1016/j.clinimag.2021.04.038

Kanne JP, Little BP, Schulte JJ, Haramati A, Haramati LB. Long-term Lung Abnormalities Associated with COVID-19 Pneumonia. Radiology. 2023;306(2):e221806. doi:10.1148/radiol.221806

Castanares-Zapatero D, Chalon P, Kohn L, Daurvin M, et al. Pathophysiology and mechanism of long COVID: a comprehensive review. Annals of Medicine. 2022. Vol. 51. No. 1. 1473-87. doi: 10.1080/07853890.2022.2076901

Zhao Y, Yang C, An X, et al. Follow-up study on COVID-19 survivors one year after discharge from hospital. International Journal of Infectious Diseases. 2021;112:173-182. doi:10.1016/j.ijid.2021.09.017

Watanabe A, So M, Iwagami M, et al. One‐year follow‐up CT findings in COVID ‐19 patients: A systematic review and meta‐analysis. Respirology. 2022;27(8):605-616. doi:10.1111/resp.14311

Murphy MC, Little BP. Chronic Pulmonary Manifestations of COVID-19 Infection: Imaging Evaluation. Radiology. 2023;307(2):e222379. doi:10.1148/radiol.222379

Besutti G, Monelli F, Schirò S, et al. Follow-Up CT Patterns of Residual Lung Abnormalities in Severe COVID-19 Pneumonia Survivors: A Multicenter Retrospective Study. Tomography. 2022;8(3):1184-1195. doi:10.3390/tomography8030097

Bazdar S, Kwee AKAL, Houweling L, et al. A Systematic Review of Chest Imaging Findings in Long COVID Patients. JPM. 2023;13(2):282. doi:10.3390/jpm13020282

Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology. 2008;246(3):697-722. doi:10.1148/radiol.2462070712

Grist JT, Collier GJ, Walters H, et al. Lung Abnormalities Detected with Hyperpolarized 129 Xe MRI in Patients with Long COVID. Radiology. 2022;305(3):709-717. doi:10.1148/radiol.220069

Avdeev S, Nuralieva G, Nekludova G. Large Cavitary Lung Lesions in a Patient with Severe COVID-19 Pneumonia. The American Journal of Tropical Medicine and Hygiene. 2022;106(1):6-7. doi:10.4269/ajtmh.21-0949

Davis HE, McCorkell L, Vogel JM, et al. LONG COVID: major findings, mechanisms and recommendations. Nature Review Microbiology. 2023, Vol 1, 133-46. https://doi.org/10.1038/s41579-022-00846-2

Published
2024-07-06
How to Cite
Soekardi, A., & Suryamin, R. (2024). POST-COVID-19 SYNDROME IMAGING FINDINGS IN SEVERE COVID-19 WITH PULMONARY CAVITATION: A CASE REPORT. Ibnu Sina: Jurnal Kedokteran Dan Kesehatan - Fakultas Kedokteran Universitas Islam Sumatera Utara, 23(2), 245-251. https://doi.org/10.30743/ibnusina.v23i2.654
Section
Laporan Kasus