First report on clinical and radiological features of COVID-19 pneumonitis in a Caucasian population: Factors predicting fibrotic evolution

Maurizio Marvisi, Francesco Ferrozzi, Laura Balzarini, Chiara Mancini, Sara Ramponi, Mario Uccelli, Maurizio Marvisi, Francesco Ferrozzi, Laura Balzarini, Chiara Mancini, Sara Ramponi, Mario Uccelli

Abstract

Background: At the end of February, the Lombardy region (Northern Italy) was involved in the pandemic spread of the new COVID-19. We here summarize the clinical and radiological characteristics of 90 confirmed cases and analyze their role in predicting the evolution of fibrosis.

Methods: We retrospectively analyzed the clinical and radiological data of 90 patients with COVID-19 pneumonitis. All subjects underwent an HRCT study on the day of admission and eight weeks later, and were treated with lopinavir + ritonavir (Kaletra) 400/100 mg two times a day or darunavir + ritonavir two times a day, and Hydroxychloroquine 200 mg two times a day. Pulmonary fibrosis was defined according to the Fleischner Society glossary of terms for thoracic imaging.

Results: Twenty-three patients developed pulmonary fibrosis (25.5%): 15 were males, whose mean age was 75 ± 15. The majority were active smokers (60.8%) and had comorbidities (78.2%), above all, hypertension (47.8%), and diabetes (34.7%). Interestingly, in our series of cases, the "reversed halo sign" is frequent (63%) and seems to be a typical COVID-19 pneumonitis pattern. The patients showing fibrosis had a higher grade of systemic inflammation (ESR and PCR) and appeared to have bone marrow inhibition with a significant reduction in platelets, leukocytes, and hemoglobin.

Conclusions: To conclude, our data showed that the reversed halo sign associated with a ground-glass pattern may be a typical HRCT pattern of COVID-19 pneumonitis. The evolution to pulmonary fibrosis is frequent in older males and patients with comorbidities and bone marrow involvement.

Keywords: Covid-19; Pneumonitis; Pulmonary fibrosis; Reversed halo sign.

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
“Reversed halo sign." Peripheral and bilateral consolidations. In the right lung, a peripheral “reversed halo sign.".
Figure 2
Figure 2
Fibrotic evolution. Honey combing and interstitial thickening in a patient who developed pulmonary fibrosis.

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Source: PubMed

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