Diagnosis of disappearing lung syndrome as a complication of non-hospital pneumonia of viral etiology (COVID-19)

Y. Feshchenko, М. Lynnyk, М. Gumeniuk, I. Kalabukha, V. Іgnatieva, G. Gumeniuk, O. Tarasenko, V. Ivaschenko, M. Palivoda
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引用次数: 1

Abstract

BACKGROUND. Particularly dangerous coronavirus disease (COVID-19) continues to be one of the urgent problems of mankind. Researchers around the world have noted that in the third wave of the COVID-19 pandemic, the disease became more aggressive. Physicians more often began to pay attention to the occurrence of progressive lung degradation, in particular bullous-emphysematous changes in the lungs, and in those patients who did not have a history of chronic lung disease. Due to the fact that in the acute phase of coronavirus infectious computed tomography (CT) of the chest according to the national protocol is not required, the timing of this complication remains unknown. OBJECTIVE. To study the timing of the onset of disappearing lung syndrome as one of the complications of communityacquired pneumonia of viral etiology (COVID-19) and to demonstrate on clinical observations according to CT. MATERIALS AND METHODS. A group of patients referred for treatment to the SI “National institute of phthisiology and pulmonology named after F.G. Yanovsky of the NAMS of Ukraine”. Among the examined according to CT of the chest identified 21 patients (15 men and 6 women aged 24 to 67 years) with radiological signs of disappearing lung syndrome. Nine of them (7 men and 2 women aged 24 to 54 years) were treated at the institute during the acute period of the disease. Another 12 (8 men and 4 women aged 27 to 67 years) were referred to the institute from other medical institutions, where they were treated for community-acquired pneumonia of viral etiology (COVID-19) 3-4 months ago. RESULTS AND DISCUSSION. CT analysis of the chest in 21 patients with disappearing lung syndrome showed that 9 (42,9 %) of them were diagnosed with bullous-emphysematous changes in the acute period of the disease – from 1 to 2 months, and in 12 (57,1 %) – in the postpartum period, in the period from 3 to 4 months. At the same time, patients had difficulty breathing, coughing, no significant improvement in general condition after previous inpatient treatment. Three of 12 patients noted deterioration of the general condition. CONCLUSIONS. In severe patients with community-acquired pneumonia of viral etiology (COVID-19), a progressive pulmonary degradation syndrome with the formation of bullous-emphysematous changes can occur both in the acute period of the disease and develop or progress in the postpartum period (after 3-4 months after inpatient treatment). CT of the chest should be performed in all patients after inpatient treatment and elimination of acute respiratory distress syndrome, which will allow timely diagnosis of changes in lung architecture and complications of the disease.
非医院病毒性肺炎(COVID-19)并发症肺消失综合征的诊断
背景。特别危险的冠状病毒病(COVID-19)仍然是人类面临的紧迫问题之一。世界各地的研究人员都注意到,在第三波COVID-19大流行中,这种疾病变得更具侵略性。医生开始更多地关注进行性肺退化的发生,特别是肺部的大疱性肺气肿变化,以及那些没有慢性肺部疾病史的患者。由于在冠状病毒感染的急性期不需要根据国家方案进行胸部CT扫描,因此该并发症的发生时间尚不清楚。目标。目的探讨社区获得性病毒性肺炎(COVID-19)并发症之一肺消失综合征的发病时间,并根据CT进行临床观察。材料和方法。一组患者转介到SI“以乌克兰NAMS的F.G. Yanovsky命名的国家细菌学和肺病学研究所”进行治疗。胸部CT检查发现21例患者(男15例,女6例,年龄24 ~ 67岁)有肺综合征消失的影像学征象。其中9人(7男2女,年龄24至54岁)在疾病急性期在研究所接受治疗。另有12例(男8例,女4例,年龄27 ~ 67岁)3 ~ 4个月前因社区获得性病毒性肺炎(COVID-19)就诊的其他医疗机构转介至本所。结果和讨论。21例肺消失综合征患者胸部CT分析显示,其中9例(42.9%)在疾病急性期(1 ~ 2个月)诊断为大疱性肺气肿改变,12例(57.1%)在产后(3 ~ 4个月)诊断为大疱性肺气肿改变。同时患者出现呼吸困难、咳嗽,既往住院治疗后一般情况无明显改善。12名患者中有3名指出一般情况恶化。结论。在社区获得性病毒性肺炎(COVID-19)重症患者中,进行性肺退化综合征伴大疱性肺气肿改变的形成可在疾病急性期发生,也可在产后(住院治疗后3-4个月)发生或进展。所有患者在住院治疗并消除急性呼吸窘迫综合征后,均应进行胸部CT检查,及时诊断肺结构改变及疾病并发症。
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