BACKGROUND: Lung involvement in COVID-19 can be quantified by chest CT scan with some triage and prognostication value. At least 7 CT-severity score (CTSS) systems have been proposed. PURPOSE: We evaluated triage and prognostication performance of seven different CTSSs for COVID-19. MATERIALS AND METHODS: COVID-19, PCR positive patients admitted from February 20th 2020 to July 22 were included into a retrospective study. Demographic data and clinical data indicating disease severity at presentation and in peak disease severity were recorded. CT images were reviewed and scored according to seven different scoring systems (CTSS1-CTSS7) by two radiologists. Interrater reliability was determined for each CTSS. Then clinical severity of the disease at presentation (for triage) and peak disease severity (for outcome) were compared with CTSSs separately. ROC curves for performance of each CTSS in diagnosing severe/critical disease on admission, severe/critical disease at peak disease severity and critical disease at peak severity were plotted. Areas under the curve (AUCs), best thresholds and corresponding sensitivities and specificities were calculated. RESULTS: 96 patients were included with mean age of 63.6 ± 17.4 years (range: 21-88, median: 67). 57 (59,4%) were men and 39 (40.6%) were women. All CTSSs showed good interrater reliability as calculated intraclass correlation coefficients (ICCs) were 0.764-0.837 for all of the CTSSs. Only three CTSSs showed acceptable AUCs (AUC =0.7) for triage of severe/critical patients. All CTSSs showed acceptable AUCs for prognostication (AUCs=0.76-0.79). Calculated AUCs were not significantly different for triage and for prediction of severe/critical disease but some difference was shown for prediction of critical disease. CONCLUSION: Men are probably affected more frequently than women by COVID19. CTSS performance in triage was much lower than earlier reports and only three CTSSs showed acceptable AUCs. CTSS performed better for prognostic purposes than for triage as all 7 CTSSs showed acceptable AUCs in both types of prognostic ROC curves. Our results are compatible with those of recent studies. There is not much difference among performance of different CTSSs.

Background Lung involvement in COVID-19 can be quantified by chest CT scan with some triage and prognostication value. Optimizing initial triage of patients could help decrease adverse health impacts of the disease through better clinical management. At least 6 CT severity score (CTSS) systems have been proposed. We aimed to evaluate triage and prognostication performance of seven different CTSSs, including one proposed by ourselves, in hospitalized COVID-19 patients diagnosed by positive polymerase chain reaction (PCR). Results After exclusion of 14 heart failure and significant preexisting pulmonary disease patients, 96 COVID-19, PCR-positive patients were included into our retrospective study, admitted from February 20, 2020, to July 22. Their mean age was 63.6 ± 17.4 years (range 21–88, median 67). Fifty-seven (59.4%) were men, and 39 (40.6%) were women. All CTSSs showed good interrater reliability as calculated intraclass correlation coefficients (ICCs) between two radiologists were 0.764–0.837. Those CTSSs with more numerous segmentations showed the best ICCs. As judged by area under curve (AUC) for each receiver operator characteristic (ROC) curve, only three CTSSs showed acceptable AUCs (AUC = 0.7) for triage of severe/critical patients. All CTSSs showed acceptable AUCs for prognostication (AUCs = 0.76–0.79). Calculated AUCs for different CTSSs were not significantly different for triage and for prediction of severe/critical disease, but some difference was shown for prediction of critical disease. Conclusions Men are probably affected more frequently than women by COVID-19. Quantification of lung disease in COVID-19 is a readily available and easy tool to be used in triage and prognostication, but we do not advocate its use in heart failure or chronic respiratory disease patients. The scoring systems with more numerous segmentations are recommended if any future imaging for comparison is contemplated. CTSS performance in triage was much lower than earlier reports, and only three CTSSs showed acceptable AUCs in this regard. CTSS performed better for prognostic purposes than for triage as all 7 CTSSs showed acceptable AUCs in both types of prognostic ROC curves. There is not much difference among performance of different CTSSs.

Background: Coronavirus disease 2019 (COVID-19) is associated with diffuse alveolar damage (DAD) and coagulopathy in severe ill patients. Objective: To better understand and disease management, we investigated postmortem needle biopsies of lung, liver, and kidney pathologic changes along with clinical course, hematologic and imaging findings in two COVID-19 decedents. Patients and method We examined pathology of two patients with confirmed positive SARS-CoV-2 test died from respiratory failure. Computed tomography (CT) of the chest, Clinical and laboratory findings were investigated. Postmortem needle biopsies of lung, liver, and kidney were performed with complete protection. Results: The patients died from acute respiratory distress syndrome (ARDS). One of the patients was 56-year old man without any predisposing factor and the other (83-year old man) had hypertension, diabetes mellitus and renal failure. The patients had lymphopenia, elevated C-Reactive Protein (CRP), ferritin and D-Dimer. Axial CT images show diffuse ground glass opacity with some crazy paving and consolidation. The main pathologic finding of lungs revealed DAD. Intravascular micro-thrombi were detected despite anticoagulant prophylaxis. Renal autopsy demonstrated acute tubulointerstitial nephritis (ATIN) with tubular epithelium attenuation. Liver biopsy was consisted of lobular and portal inflammation and steatosis Conclusion This study emphasis that diffuse alveolar damage and microvascular pulmonary thrombosis in SARS-CoV-2 patients caused by either direct viral cytopathic effect or host immune and inflammatory reaction. Due to severe hypoxemia in COVID-19 patients suffering ARDS, appropriate oxygen support and anticoagulation therapy with strict monitoring is recommended Histopathologic findings in COVID-19 Autopsies from IRAN: A comprehensive report of laboratory, chest Computed tomography (CT) and morphology findings

This article presents a case of portal vein thrombosis accompanied by a large uterine fibroma. A 37-year-old virgin woman presented with vaginal bleeding, abdominal mass, fever, dyspnea and lower limbs edema. In past medical history, she did not have any systemic diseases. She had menometrorrhagia from four years ago. She was admitted with diagnosis of a large uterine fibroma and was suspected of COVID 19 pneumonia or thrombophlebitis. The final diagnosis was a large uterine fibroma with chronic portal vein thrombosis. Although uterine fibromas are benign tumors, they may make serious life-threatening complications like thrombosis. The cause of thrombosis is the pressure effect of fibroma and/ or transfusion to treat anemia. Although there may be other unknown etiologies for thrombosis in these patients. We suggest that existence of a large uterine myomas should be known as a risk factor for thrombosis ( like IBS, Covid 19 and etc.) and be given a score in Caprini Score system, to start anticoagulation before and after any surgical intervention.