Evaluation of COVID-19 Thorax Computed Tomography Findings in Hemodialysis Patients

Year 2020, Volume: 22 Issue: Special Issue, 23 - 28, 30.11.2020

Ömer Faruk Ateş , Erbil Arık Ogün Taydaş Hamad Dheir , Fatih Güneysu

https://doi.org/10.18678/dtfd.778854

Abstract

Aim: Coronavirus disease 2019 (COVID-19) is an unprecedented cause of pandemics affecting all segments of society. It is not known whether hemodialysis patients form a different patient group in terms of susceptibility to COVID-19 infection or severe disease. In this study, thorax computed tomography (CT) findings were evaluated in hemodialysis patients diagnosed with COVID-19 infection during the pandemic period.
Material and Methods: CT findings of 32 hemodialysis patients diagnosed with COVID-19 with real-time polymerase chain reaction or thorax CT examination were evaluated retrospectively. Radiological findings were classified as ground glass, consolidation, mixed type involvement (ground glass and consolidation), crazy paving appearance, interlobular septal thickening, nodule, halo-reverse halo finding, air bronchogram finding, subpleural curvilinear opacities and tree-in-bud views.
Results: A total of 32 patients were included in the study. Twenty-one (65.6%) of the patients were male and 11 (34.4%) were female. The mean age was 67.5±8.5 years. All patients had chronic kidney failure. Thorax CT examination revealed ground-glass opacities in 14 (43.8%) patients, consolidation in 3 (9.4%) patients, and mixed type involvement (ground-glass opacities and consolidation) in 15 (46.9%) patients. The accompanying CT findings were pleural effusion in 23 (71.9%) patients, subpleural curvilinear opacities in 13 (40.6%) patients, bronchial wall thickening in 11 (34.4%) patients, lymphadenopathy in 7 (21.9%) patients, bronchiectasis in 4 (12.5%) patients and pleural thickening in 4 (12.5%) patients.
Conclusion: When hemodialysis patients are infected with COVID-19 infection, they differ significantly from other COVID-19 patients in terms of symptoms, clinical course, and prognosis, as well as imaging findings.

Keywords

COVID-19, hemodialysis, pneumonia, computed tomography

Hemodiyaliz Hastalarında COVID-19 Toraks Bilgisayarlı Tomografi Bulgularının Değerlendirilmesi

Abstract

Amaç: Koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) toplumun her kesimini etkileyen benzeri görülmemiş bir pandemi sebebidir. Hemodiyaliz hastalarının, COVID-19 enfeksiyonuna ya da şiddetli hastalığa yatkınlık açısından farklı bir hasta grubunu oluşturup oluşturmadıkları bilinmemektedir. Bu çalışmada pandemi döneminde COVID-19 enfeksiyonu tanısı alan hemodiyaliz hastalarında toraks bilgisayarlı tomografi (BT) bulguları değerlendirilmiştir.
Gereç ve Yöntemler: Gerçek zamanlı polimeraz zincir reaksiyonu veya toraks BT incelemesi ile COVID-19 tanısı konulan 32 hemodiyaliz hastasının BT bulguları geriye dönük olarak değerlendirildi. Radyolojik bulgular; buzlu cam, konsolidasyon, karışık tip tutulum (buzlu cam ve konsolidasyon), kaldırım taşı görünümü, interlobüler septal kalınlaşma, nodül, halo-ters halo bulgusu, hava bronkogram bulgusu, subplevral kürvilineer opasiteler ve tomurcuklanmış ağaç görünümleri olarak sınıflandırıldı.
Bulgular: Çalışmaya toplam 32 hasta dahil edildi. Hastaların 21’i (%65,6) erkek, 11’i (%34,4) kadındı. Yaş ortalaması 67,5±8,5 yıl idi. Tüm hastalarda kronik böbrek yetmezliği mevcuttu. Toraks BT incelemesinde hastaların 14'ünde (%43,8) buzlu cam görünümü, 3'ünde (%9,4) konsolidasyon ve 15'inde (%46,9) karışık tip tutulum (buzlu cam görünümü ve konsolidasyon) görüldü. Eşlik eden BT bulguları 23 (%71,9) hastada plevral effüzyon, 13 (%40,6) hastada subplevral kürvilineer opasiteler, 11 (%34,4) hastada bronşiol duvar kalınlaşması, 7 (%21,9) hastada lenfadenopati, 4 (%12,5) hastada bronşektazi ve 4 (%12,5) hastada plevral kalınlaşma idi.
Sonuç: Hemodiyaliz hastaları COVID-19 enfeksiyonuna yakalandıklarında semptom, klinik seyir ve prognostik açıdan olduğu gibi görüntüleme bulguları açısından da diğer COVID-19 hastalarından önemli farklılıklar göstermektedir.

Keywords

COVID-19, hemodiyaliz, pnömoni, bilgisayarlı tomografi

References

• Goicoechea M, Sánchez Cámara LA, Macías N, Muñoz de Morales A, Rojas ÁG, Bascuñana A, et al. COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain. Kidney Int. 2020;98(1):27-34.
• Akçay Ş, Özlü T, Yılmaz A. Radiological approaches to COVID-19 pneumonia. Turk J Med Sci. 2020;50(SI-1):604-10.
• Xu YH, Dong JH, An WM, Lv XY, Yin XP, Zhang JZ, et al. Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-CoV-2. J Infect. 2020;80(4):394-400.
• Ma Y, Diao B, Lv X, Zhu J, Liang W, Liu L, et al. COVID-19 in hemodialysis (HD) patients: Report from one HD center in Wuhan, China. medRxiv. doi: 10.1101/2020.02.24.20027201.
• Hani C, Trieu NH, Saab I, Dangeard S, Bennani S, Chassagnon G, et al. COVID-19 pneumonia: A review of typical CT findings and differential diagnosis. Diagn Interv Imaging. 2020;101(5):263-8.
• Huang P, Liu T, Huang L, Liu H, Lei M, Xu W, et al. Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology. 2020;295(1):22-3.
• Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT Findings in coronavirus disease-19 (COVID-19): Relationship to duration of infection. Radiology. 2020;295(3):200463.
• Özdemi̇r M, Taydaş O, Öztürk MH. Thorax computed tomography findings in COVID-19 infection. J Biotechnol and Strategic Health Res. 2020;4(Special Issue):91-6.
• 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.
• 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;30(8):4381-9.
• Du X, Li H, Dong L, Li X, Tian M, Dong J. Clinical features of hemodialysis patients with COVID-19: a single-center retrospective study on 32 patients. Clin Exp Nephrol. 2020;24(9):829-35.
• Gong J, Dong H, Xia Q, Huang Z, Wang D, Zhao Y, et al. Correlation analysis between disease severity and inflammation-related parameters in patients with COVID-19 pneumonia. medRxiv. doi: 10.1101/2020.02.25.20025643
• Wang R, Liao C, He H, Hu C, Wei Z, Hong Z, et al. COVID-19 in hemodialysis patients: A report of 5 cases. Am J Kidney Dis. 2020;76(1):141-3.
• Wang R, He H, Liao C, Hu H, Hu C, Zhang J, et al. Clinical outcomes of hemodialysis patients infected with severe acute respiratory syndrome coronavirus 2 and impact of proactive chest computed tomography scans. Clin Kidney J. 2020;13(3):328-33.
• Ufuk F, Savaş R. Chest CT features of the novel coronavirus disease (COVID-19). Turk J Med Sci. 2020;50(4):664-78.
• Ates OF, Taydas O, Dheir H. Thorax magnetic resonance imaging findings in patients with coronavirus disease (COVID-19). Acad Radiol. 2020;27(10):1373-8.
• Xiong Y, Sun D, Liu Y, Fan Y, Zhao L, Li X, et al. Clinical and high-resolution CT features of the COVID-19 infection: Comparison of the initial and follow-up changes. Invest Radiol. 2020;55(6):332-9.
• Zhu T, Wang Y, Zhou S, Zhang N, Xia L. A comparative study of chest computed tomography features in young and older adults with coronavirus disease (COVID-19). J Thorac Imaging. 2020;35(4):W97-101.
• Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology. 2020;295(1):210-7.
• Li K, Fang Y, Li W, Pan C, Qin P, Zhong Y, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol. 2020;30(8):4407-16.
• Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20(4):425-34.
• Li K, Wu J, Wu F, Guo D, Chen L, Fang Z, et al. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia. Invest Radiol. 2020;55(6):327-31.
• Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020;30(6):3306-9.
• Wang J, Xu Z, Wang J, Feng R, An Y, Ao W, et al. CT characteristics of patients infected with 2019 novel coronavirus: association with clinical type. Clin Radiol. 2020;75(6):408-14.
• Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: A multicenter study. Am J Roentgenol. 2020;214(5):1072-7.