COVID-19 RT-PCR pozitif olgularda akciğer anatomisi pnömoni gelişimini öngörebilir mi?

Year 2024, Volume: 49 Issue: 3, 570 - 579, 30.09.2024

Türker Acar , Raşit Eren Büyüktoka Elif Aylin Yüce Yörük , Hülya Özkan Özdemir , Ali Murat Koç , Levent Altın , Mahmut Öksüzler , Mete Ertürk

https://doi.org/10.17826/cumj.1434628

Abstract

Amaç: COVID-19 pandemisi süreci başlangıcında ters transkripsiyon-polimeraz zincir reaksiyonu (RT-PCR) pozitif olan hastalarda, trakeobronşiyal ve fissür varyasyonları, sağ/sol ana bronş açısı, karina açısı, geniş hava yolu çapı gibi anatomik işaretlerle COVID-19 pnömonisinin ilişkisini belirlemek amaçlanmıştır.
Gereç ve Yöntem: Bu kesitsel çalışmada Mart- Haziran 2020 tarihleri arasında hastanemize başvuran ve ardından ince kesit kontrastsız thoraks bilgisayarlı tomografisi (BT) ile taranan, RT-PCR testleri pozitif olan 165 vaka incelenmiştir. Thoraks BT görüntüleri değerlendirilen vakalar pnömoni varlığına göre iki gruba ayrıldı.
Bulgular: Toplam 165 olgunun incelendiği çalışmamızda 76 kadın hastanın 35'inde (%46,05) ve 89 erkek hastanın 51'inde (%57,30) pnömoni saptandı. İleri yaş gruplarında COVID-19 pnömonisi daha fazla görüldü. Anatomik varyasyonlar ve inkomplet fissür varlığı pnömoni pozitif grupta istatistiksel olarak daha yüksekti, aksesuar fissürlerde ise fark istatistiksel olarak anlamlı değildi. Ortalama trakeal alan ve sağ ana bronş açısı pnömoni pozitif grupta negatif hastalara göre istatistiksel olarak daha yüksekti. Hem zonal hem de total akciğer tutulumu açısından sağ akciğer sola göre daha fazla tutulmuştu. Ek hastalık varlığı değerlendirildiğinde 59 hastada (%35,75) ek hastalık olduğu görüldü. Pnömoni pozitif grupta eşlik eden hastalıklar arasında hipertansiyon, diyabet ve kardiyovasküler hastalık anlamlı derecede yüksekti. Regresyon modeli, hipertansiyonun RT-PCR pozitif vakalarda COVID-19 pnömonisinde 3,75 kat artışla ilişkili bulundu.
Sonuç: COVID-19 pnömonisi vakalarında diğer komorbiditelerden bağımsız olarak anatomik akciğer varyasyonları ve tamamlanmamış fissürler daha sık gözlendi. RT-PCR testi pozitif olan olgularda pnömoniye yatkınlığı belirlemede kullanılabilecek anatomik değişkenlerin mevcut olduğunu düşünüyoruz.

Keywords

SARS-COV-2, COVID-19, pnömoni, toraks, akciğer, anatomik varyasyon, çok dedektörlü bilgisayarlı tomografi, komorbidite

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Can lung anatomy predict the development of COVID-19 pneumonia in RT-PCR positive cases?

Abstract

Purpose: The objective of this study was to investigate the relationship between Coronavirus disease 2019 (COVID-19) pneumonia and anatomical characteristics, including tracheobronchial and fissure variations, right/left main bronchus angle, carina angle, and large airway diameter, in patients who tested positive for the virus via reverse transcription-polymerase chain reaction (RT-PCR) at the outset of the pandemic.
Materials and Methods: This cross-sectional study included 165 cases with positive RT-PCR tests who were admitted between March and June 2020 and subsequently scanned with thin-section unenhanced chest computed tomography (CT). They were divided into two groups according to the presence of pneumonia based on the chest CT images.
Results: In our study, a total of 165 cases were analyzed, pneumonia was found in 35 of 76 (46.05%) female patients and 51 of 89 (57.30%) male patients. COVID-19 pneumonia was observed in older age groups. Anatomical variations and the presence of incomplete fissures were statistically higher in the pneumonia-positive group, while the difference was not statistically significant for accessory fissures. Mean tracheal area and right main bronchus angle were statistically higher in the pneumonia-positive group compared to the negative patients. The right lung was more involved than the left in terms of both zonal and total lung involvement. When the presence of comorbidity was assessed, 59 patients (35.75%) were found to have comorbidity. Hypertension, diabetes mellitus and cardiovascular disease were significantly higher among comorbidities in the pneumonia-positive group. The regression model showed that hypertension was associated with a 3.75-fold increase in COVID-19 pneumonia in test positive cases.
Conclusion: Anatomical lung variations and incomplete fissures were observed more frequently in the COVID-19 pneumonia cases, independent of other comorbidities. We believe that there are anatomical variables that can be used to identify those predisposed to pneumonia in RT-PCR test positive cases.

Keywords

SARS-COV-2, COVID-19, pneumonia, thorax, lung, anatomic variation, multidetector computed tomography, comorbidity

Ethical Statement

Ethical approval was obtained from the Ethics Committee for Clinical Research of the Ministry of Health, University of Bozyaka Training and Research Hospital, subject number 2020-242.

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